Medical Surgical Thyroid #13

Question

The nurse is providing instructions to a client with a new diagnosis of Graves’ Disease who will also receive the prescription methimazole. What instruction will the nurse provide? Select all that apply.

Answers

  1. Take solu-cortef with methimazole daily to reduce adverse effects.
    • Rationale:

      This answer is not correct because steroids, such as solu-cortef should not be taken with methimazole. Steroids add an additional risk of infection associated with agranulocytosis.

  2. Take methimazole at the same time each day.
    • Rationale:

      This answer is correct because the client should be taught to take methimazole at the same time every day. Methimazole works best with a consistent medication level in the blood.

  3. Follow-up with the clinic for a complete blood count in 4 weeks.
    • Rationale:

      This answer is correct because periodic complete blood count tests should be performed to assess for risks associated with taking methimazole, agranulocytosis. The client should be taught to monitor for infection symptoms, such as reporting sore throat and fever.

  4. Follow-up with the clinic for laboratory blood test for T3.
    • Rationale:

      This answer is correct because thyroid studies, including T3 levels, should be checked monthly during initial therapy and every 2-3 months afterwards. The client should be taught the signs and symptoms of hypothyroidism, in case the thyroid hormone is decreased too much.

  5. Report fever, chills, or any other symptoms of illness to the physician.
    • Rationale:

      This answer is correct since agranulocytosis is a potential risk with methimazole. Agranulocytosis is a life-threatening immune response. Advising the client to report sore throat, fever, chills, or any other symptoms that could indicate an infection is indicated.

Overview

Methimazole decreases thyroid hormone in clients with hyperthyroidism. The client should be taught how to take the medication and the follow-up required.

Explanation

Learning Outcomes

Methimazole is an antithyroid medication used to decrease thyroid hormone levels in a person with excessive thyroid production, such as in hyperthyroidism or Graves disease. The client should be taught to take methimazole at the same time every day since the medication works best with a consistent medication level in the blood. Periodic complete blood count tests should be performed to assess for risks associated with taking methimazole, agranulocytosis. It should not be taken with steroids due to the increased risk for infection related to agranulocytosis risks. Thyroid studies, including T3 levels, should be checked monthly during initial therapy and every 2-3 months afterwards.

Test Taking Tip

Teach the client the signs and symptoms of when treatment has produced excessive action, such as when a client is taking antithyroid medication for excessive thyroid hormone, the client is at risk for too low of a level of thyroid hormone. It is treating excessive thyroid hormones, but the treatment could go too far and produce a hypo-state, or hypothyroidism symptoms.

Video Rationale