Levothyroxine Therapy Nursing Implications Quiz

Levothyroxine Therapy: Nursing Implications and Patient Teaching

• Excessive thyroid hormones can lead to cardiovascular problems, particularly in elderly patients and those with pre-existing heart disease
• Contraindications to levothyroxine include hypersensitivity, thyrotoxicosis, and acute myocardial infarction related to hypothyroidism
• Caution is warranted in Addison's disease, as thyroid hormones increase tissue demands for adrenocortical hormones
• Dosage of levothyroxine should be individualized based on factors such as age, severity of hypothyroidism, and clinical response
• Initial dosage is small, with gradual increases at 2-week intervals until symptoms are relieved and normal serum TSH levels are reestablished
• Thyroid replacement therapy for hypothyroidism is lifelong, requiring frequent medical supervision and annual check-ups
• Patients should take levothyroxine in the morning on an empty stomach, and not change brands of medication
• The nurse assesses for therapeutic effects such as increased energy, improved sleep, and reversal of skin and hair coarseness
• Adverse effects of levothyroxine include tachycardia, cardiac dysrhythmias, chest pain, edema, and signs of heart failure
• Patient teaching includes the importance of lifelong levothyroxine therapy, periodic thyroid function tests, and consistent timing of medication
• Patients should avoid switching drug brands, and consult a healthcare provider before taking over-the-counter drugs that stimulate the heart or cause nervousness
• Patients should take levothyroxine every morning on an empty stomach, avoid certain drug interactions, and report adverse effects to the prescriber

Levothyroxine: Key Points for Clinical Use

• Discontinuation of thyroid hormone administration is necessary if angina or arrhythmias occur, and cautious resumption at lower dosage is advised with close monitoring by the primary provider and nurse.
• Oral thyroid hormones interact with warfarin, adrenergic agents, insulin, oral hypoglycemic medications, and estrogen, requiring dosage adjustments and caution.
• Absorption of levothyroxine varies after oral administration, with 48% to 79% absorption, which can be increased by taking the drug on an empty stomach.
• Levothyroxine, a synthetic preparation of thyroxine, is the standard of care for long-term treatment of hypothyroidism and can be administered orally and parenterally.
• Levothyroxine increases the metabolic rate in the body's tissues, oxygen consumption, respiratory rate, heart rate, and metabolism of fats, carbohydrates, and proteins.
• Health care providers use levothyroxine for replacement therapy in hypothyroidism, treatment and prevention of euthyroid goiters, management of thyroid cancer, and prevention of goitrogenesis, hypothyroidism, and thyrotoxicosis during pregnancy.
• The FDA has issued a BLACK BOX WARNING cautioning against using thyroid hormones for obesity or weight loss due to serious complications in euthyroid individuals.
• Levothyroxine increases the workload of the heart and may cause serious adverse effects in older adults, especially those with cardiovascular disease, requiring cautious treatment and monitoring.
• Hepatic metabolism of levothyroxine in patients with hypothyroidism is slow, necessitating assessment of drug reactions in patients with hepatic impairment.
• Management of patients in thyroid storm or thyrotoxic crisis requires increased or more frequent dosing of levothyroxine due to the hypermetabolic state.
• Adverse effects of levothyroxine include signs and symptoms of hyperthyroidism, tachycardia, cardiac dysrhythmias, angina pectoris, myocardial infarction, heart failure, nervousness, hyperactivity, insomnia, diarrhea, abdominal cramps, nausea, vomiting, weight loss, fever, and heat intolerance.
• Most adverse reactions stem from excessive doses, and signs and symptoms produced are the same as those occurring with hyperthyroidism.