absent levels of natural thyroid
hormone and suppress the
Thyroid
Dysfunction
 Thyroid dysfunction involves
either under activity
(hypothyroidism)
overactivity (hyperthyroidism).
This can affect any age group.
 Hypothyroidism is a lack of
sufficient levels of thyroid
hormones to maintain a
normal metabolism. This is the
most common type of thyroid
dysfunction and is common
among older women and men.
Symptoms include obesity
and fatigue.
 Cretinism is a condition in
children who are born without a
thyroid gland or who have a
nonfunctioning gland. This can
lead to poor growth and
development as well as mental
retardation.
 Hyperthyroidism occurs when
excessive amounts of thyroid
hormones are produced and
released into
circulation. Graves’ disease is
the most common cause of
hyperthyroidism.
Thy
roid
Hormones
 Thyroid hormones are made
available to replace the low or
overproduction of TSH by the
pituitary.
 These can contain both natural
and synthetic thyroid hormone.
or The following are drug-drug
interactions involved in the use of
thyroid hormones:
 Cholestyramine. Decreased
absorption of thyroid hormones
(take two hours apart)
 Anticoagulants. Increased bleedi
ng
 Digitalis glycosides. Decreased
effectiveness of digitalis
glycosides.   
Contraindications and
Cautions
The following are
contraindications and cautions for
the use of thyroid hormones:
 Allergy to any component of
the drug. To prevent
hypersensitivity reactions.
 Acute thyrotoxicosis (unless used
in conjunction with antithyroid
drugs). Can be exacerbated by
the drugs
 Myocardial infarction. Can be
exacerbated by the drugs
 Lactation. Drug enters breast
milk and can suppress infant’s
thyroid production
 Addison disease. Body will not
be able to deal with drug
effects.
 Pregnancy. Potential adverse
effects on the fetus
 Liothyronine and liorix have
greater incidence of cardiac
side effects

Nursing
Considerations
The important nursing
considerations when administering
thyroid hormones:
 Nursing Assessment
 history taking, and
examination:
 Assess for contraindications or
cautions (e.g. history of allergy,
pregnancy, Addison disease,
etc.) to avoid adverse effects.
 Assess skin lesions; orientation
and affect; blood pressure,
pulse, peripheral perfusion, and
vessel evaluation; respiration
and adventitious breath sounds;
thyroid function test to
determine baseline status before
beginning therapy and for any
potential adverse effects.
Nursing Diagnoses
Here are some of the nursing
diagnoses that can be formulated in
the use of this drug for therapy:
 Decreased cardiac output related
to CV effects
 Imbalanced nutrition: less than
body requirements related to
changes in metabolism
 Ineffective tissue
perfusion related to thyroid
activity
 Implementation with
Rationale
These are vital nursing interventions
done in patients who are taking
thyroid hormones:
 Administer a single daily dose
before breakfast each day to
ensure consistent therapeutic
levels.
 Administer with a full glass of
water to prevent difficulty of
swallowing and esophageal
atresia.
 Monitor cardiac response to
detect cardiac adverse effects.
 Arrange for periodic blood
tests of thyroid function to
monitor the effectiveness of the
therapy.
 Provide comfort measures
(temperature control, rest as
needed, safety precautions) to
help patient cope with drug
effects.
 Provide patient education
about drug effects and warning
signs to report to enhance
patient knowledge and to
promote compliance.
Evaluation
Here are aspects of care that should
be evaluated to determine
effectiveness of drug therapy:
 Monitor patient response to
therapy (return of metabolism to
normal, prevention of goiter).
 Monitor for adverse effects
(tachycardia, hypertension, anxi
ety, skin rash).
 Evaluate patient understanding
on drug therapy by asking
patient to name the drug, its
indication, and adverse effects to
watch for.
 Monitor patient compliance to
drug therapy.
Antithyr
oid Agents
 Antithyroid agents are drugs
used to block the production of
thyroid hormone and treat
hyperthyroidism.
Therapeut
ic Action
The desired and beneficial action of
antithyroid agents:
 Thioamides lower thyroid
hormones by preventing the
formation of thyroid hormone in
the thyroid cells. They also
partially inhibit the conversion
of T4 to T3 at cellular level.
Thioamides
include propylthiouracil
(PTU) and methimazole.
 Iodine solutions in high doses
block thyroid function. They
cause the cells to become
oversaturated with iodine and
stop producing hormones.

Indi
cations
Antithyroid agents are indicated for
the following medical conditions:
 Treatment of hyperthyroidism
 Thyroid blocking in a radiation
emergency
Adverse Effects
Use of antithyroid agents may result
to these adverse effects:
 Thioamides: drowsiness,
lethargy, bradycardia, nausea,
skin rash
 PTU: nausea, vomiting, GI
complaints, severe liver toxicity
 Methimazole: bone marrow
suppression
 Iodine solution: hypothyroidism; alkaline phosphate levels; and
metallic taste and burning radiographs of bones as
sensation in the mouth, sore appropriate, to determine
teeth and gums, diarrhea; baseline status before beginning
staining of teeth, skin rash, and therapy and for any potential
development of goiter. I131 is adverse effects.
only for patients over 30 years
old because of adverse effects Nursing Diagnoses
associated with radioactivity.
Here are some of the nursing
diagnoses that can be formulated in
the use of this drug for therapy:

Interactions  Imbalanced nutrition: more than

The following are drug-drug body requirements related to
interactions involved in the use of metabolic changes
antithyroid agents:  Risk for injury related to bone
marrow suppression
 Thioamides: increased bleeding 
with oral anticoagulants and
PTU(propyl thio uracil)
 Iodine solutions: changes in the
metabolism and level of
anticoagulants,
theophylline, digoxin, metoprolo
l, and propranolol
Nursing Considerations
Here are important nursing
considerations when administering
antithyroid agents:  Nursing implimentations
 Nursing Assessment These are vital nursing interventions
done in patients who are taking
 history taking, and antithyroid agents:
examination:
 Administer PTU three times a
 Assess for contraindications or day, around the clock to ensure
cautions (e.g. history of allergy, consistent therapeutic levels.
renal stone, pregnancy, etc.) to  Give iodine solution through a
avoid adverse effects. straw to decrease staining of
 Assess skin lesions; orientation teeth; tables can be crushed.
and affect; liver evaluation;
serum calcium, magnesium, and
 Provide comfort measures to
help patient cope with drug
effects.
 Provide patient education
about drug effects and warning
signs to report to enhance
patient knowledge and to
promote compliance.

Evaluation
Here are aspects of care that should
be evaluated to determine
effectiveness of drug therapy:

 Monitor patient response to

therapy (lowering of thyroid
hormone levels).
 Monitor for adverse effects
(bradycardia, anxiety, blood
dyscrasias).
 Evaluate patient
understanding on drug
therapy by asking patient to
name the drug, its indication,
and adverse effects to watch for.
 Monitor patient compliance to
drug therapy.