Pharmacologic Highlights

Treatment consists of replacing the deficient hormone with synthetic thyroid hormone; low doses are initially used, and the dose is increased every 1 to 2 months based on the clinical response and serial laboratory measurements that show normalization of thyroid-stimulating hormone (TSH) levels in primary hypothyroidism. The patient begins to experience clinical benefits in 3 to 5 days, which level off after approximately 4 to 6 weeks. After the dose is stabilized, patients can be monitored with laboratory measurement of TSH annually.

Medication or

Drug Class Dosage Description Rationale

Levothyroxine 1.5-2.5 mcg/kg PO daily; Synthetic thyroid hormone Returns the patient to the sodium use lowest dose possible replacement euthyroid (normal) state because over-replacement of thyroid can cause bone loss or cardiovascular complications

Independent

Monitor the patient carefully for cardiac complications (chest pain, shortness of breath, palpitations, rapid pulse); check vital signs frequently; and monitor the patient's intake and output. Monitor the patient's weight at least twice a week.

The patient with myxedema is generally weak and therefore progressively immobile. Hypothyroidism exposes the patient to the risk of skin breakdown. One goal is to increase the patient's mobility while accommodating her or his extreme weakness with frequent rest periods. Provide meticulous skin care.

Another patient concern is the intolerance to cold. Caution the patient against using electric blankets or other electric heating devices because the combination of vasodilation, decreased sensation, and decreased alertness may result in unrecognized burns. Use of layered clothing and extra bedclothes is helpful to increase comfort. Patients tolerate warm liquids better than cold. Decreased mental acuity, significant weakness, and slower reflexes make the individual at risk for many injuries.

Patients may have difficulty interacting with significant others who have not understood or accepted the changes in their loved one. As their condition improves, patients and families may feel guilty that they did not notice the changes until they were severe. The return to the euthyroid state takes some time. Patients need frequent reassurance that the treatment is appropriate. Patient learning may be difficult for the hypometabolic patient; you can facilitate understanding that most of the physical manifestations are abnormal and reversible.

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