Hypothyroidism nursing: assessment, interventions, and NCLEX review

Hypothyroidism is a clinical condition in which the thyroid gland produces insufficient thyroid hormone to meet the body’s metabolic demands. It affects approximately 5% of Americans over age 12 and is one of the most commonly tested endocrine disorders on the NCLEX. Because thyroid hormones regulate the metabolic rate of virtually every organ system, deficiency produces a characteristic pattern of slowed function that nurses must recognize early — bradycardia, hypothermia, weight gain, fatigue, constipation, and cognitive slowing. This reference covers the complete pathophysiology, clinical presentation by body system, diagnostic interpretation, priority nursing assessments, interventions, levothyroxine pharmacology, myxedema coma emergency management, and six NCLEX-style questions with full rationales.

Use this page alongside the nursing lab values cheat sheet for TSH and T4 interpretation, the electrolyte imbalances reference for hyponatremia management, the diabetes mellitus nursing reference for related endocrine content, and the heart failure nursing reference for cardiovascular overlap in severe hypothyroidism.

What is hypothyroidism?

Hypothyroidism is a condition where the thyroid gland fails to produce adequate amounts of triiodothyronine (T3) and thyroxine (T4) to sustain normal metabolism. Because thyroid hormones influence the basal metabolic rate of every cell in the body, deficiency produces a global deceleration — the heart beats more slowly, the gut moves more slowly, the brain processes more slowly, and heat production drops. The result is a patient who is cold, tired, constipated, gaining weight, and thinking sluggishly.

For nursing students, the clinical picture of hypothyroidism can be remembered as “everything slows down.” This contrasts directly with hyperthyroidism, where everything speeds up. That contrast is heavily tested on NCLEX and is worth committing to memory.

Pathophysiology of hypothyroidism

The thyroid gland produces two primary hormones: T4 (thyroxine) and T3 (triiodothyronine). T3 is the biologically active form and is approximately four times more potent than T4. About 80% of circulating T3 is produced by peripheral conversion of T4 in the liver and kidneys, with only 20% secreted directly by the thyroid.

The hypothalamic-pituitary-thyroid axis

Thyroid hormone production is regulated by a negative feedback loop involving three levels:

1. Hypothalamus releases thyrotropin-releasing hormone (TRH)
2. Anterior pituitary responds to TRH by releasing thyroid-stimulating hormone (TSH)
3. Thyroid gland responds to TSH by producing T3 and T4

When circulating T3 and T4 levels are adequate, they feed back to suppress TRH and TSH release. When T3 and T4 fall below the set point, TRH and TSH increase to stimulate the thyroid to produce more hormone.

In primary hypothyroidism (the most common form), the thyroid gland itself is damaged or dysfunctional. It cannot respond to TSH stimulation. The result: T3 and T4 drop, and TSH rises as the pituitary attempts to compensate. This is why elevated TSH with low free T4 is the classic lab pattern of primary hypothyroidism.

Consequences of thyroid hormone deficiency

Thyroid hormones regulate oxygen consumption and heat production in every tissue. When levels fall:

• Metabolic rate drops — decreased thermogenesis, weight gain despite unchanged caloric intake
• Cardiac output decreases — bradycardia, decreased contractility, pericardial effusion in severe cases
• GI motility slows — constipation, possible ileus
• Neurological function declines — slowed cognition, depression, delayed reflexes
• Mucopolysaccharide accumulation — non-pitting edema (myxedema) in skin and tissues due to glycosaminoglycan deposition
• Cholesterol metabolism impaired — elevated LDL and total cholesterol (hypothyroidism is a reversible cause of hyperlipidemia)

Causes and classification of hypothyroidism

Hypothyroidism is classified by the anatomic level of dysfunction. Understanding the classification helps interpret lab results and guides treatment.

Primary hypothyroidism (95% of cases)

Hashimoto thyroiditis is the most common cause of hypothyroidism in iodine-sufficient countries including the United States. It is an autoimmune disorder in which the immune system produces antibodies (anti-thyroid peroxidase and anti-thyroglobulin) that gradually destroy thyroid tissue. It is 5–10 times more common in women and often presents between ages 30 and 50. Patients may have a painless goiter initially, but the gland atrophies over time as tissue is destroyed.

Iodine deficiency remains the most common cause of hypothyroidism worldwide, though it is rare in the United States due to iodized salt. Iodine is an essential component of T3 and T4 — without sufficient iodine, the thyroid cannot synthesize hormone regardless of TSH stimulation.

Iatrogenic causes include thyroidectomy (partial or total), radioactive iodine (I-131) therapy for hyperthyroidism or thyroid cancer, and external beam radiation to the neck.

Medications that can cause hypothyroidism include:

• Amiodarone — contains 37% iodine by weight; can cause either hypothyroidism or hyperthyroidism
• Lithium — inhibits thyroid hormone synthesis and release; up to 20% of long-term lithium users develop hypothyroidism
• Interferon-alpha — triggers autoimmune thyroiditis
• Tyrosine kinase inhibitors — used in cancer therapy

Secondary and tertiary hypothyroidism

These forms are far less common and result from insufficient TSH production (secondary) or insufficient TRH production (tertiary). The critical lab distinction: in secondary and tertiary hypothyroidism, TSH is low or inappropriately normal despite low T4. This is the opposite of primary hypothyroidism, where TSH is elevated. NCLEX questions about central hypothyroidism often test whether students can distinguish these patterns.

Clinical manifestations of hypothyroidism

Signs and symptoms of hypothyroidism reflect the global metabolic slowdown. They develop gradually over weeks to months, which is why hypothyroidism is often missed in early stages. The following table organizes manifestations by body system — a format commonly used in NCLEX questions.

The clinical pearl: lateral eyebrow thinning

Loss of the outer third of the eyebrow (Queen Anne sign) is a classic finding in hypothyroidism and is frequently tested on NCLEX. While not present in all patients, it is considered a hallmark sign when observed during the head-to-toe assessment. For more on structured assessment technique, see the head-to-toe assessment guide.

Priority nursing assessment for hypothyroidism

The nurse assessing a patient with suspected or confirmed hypothyroidism should prioritize the following:

Vital signs

Expect the following pattern in hypothyroidism:

• Heart rate: Bradycardia (often 50–60 bpm; can drop below 50 in severe disease)
• Blood pressure: Hypotension or narrowed pulse pressure
• Temperature: Hypothermia or subnormal temperature (below 97°F / 36.1°C)
• Respiratory rate: May be decreased in severe hypothyroidism
• Weight: Gradual increase — track serial weights at the same time daily

See the vital signs by age reference for normal ranges across the lifespan.

Mental status

Assess orientation, alertness, and speech patterns. Hypothyroid patients may demonstrate:

• Slowed speech and processing
• Difficulty concentrating
• Memory impairment
• Depression or flat affect
• In severe cases, somnolence progressing toward myxedema coma

Focused physical assessment

• Neck: Palpate for goiter (thyroid enlargement); a smooth, non-tender goiter suggests Hashimoto
• Skin: Assess for dryness, non-pitting edema (myxedema), yellowish discoloration, cool extremities
• Face: Periorbital edema, puffy facial appearance, thinning of lateral eyebrows
• Reflexes: Delayed relaxation phase of deep tendon reflexes (a classic exam finding)
• Bowel sounds: Hypoactive, consistent with decreased GI motility

Priority assessment questions

When taking a nursing history, ask about:

• Cold intolerance (“Do you find yourself cold when others are comfortable?”)
• Fatigue pattern (“When did the fatigue begin? Is it worse than your baseline?”)
• Bowel habits (“Have you noticed increased constipation?”)
• Medication history (lithium, amiodarone, recent thyroid surgery or I-131 treatment)
• Menstrual changes in women of reproductive age
• Family history of thyroid disease or autoimmune conditions

Diagnostic findings in hypothyroidism

Laboratory testing confirms the diagnosis and determines the type of hypothyroidism. The most important test is the serum TSH level — it is the single most sensitive screening test for primary hypothyroidism.

Subclinical versus overt hypothyroidism

• Subclinical hypothyroidism: TSH elevated (typically 4.5–10 mIU/L), free T4 normal. Patient may be asymptomatic or have mild symptoms. Treatment is debated — most guidelines recommend treating if TSH exceeds 10 mIU/L or if symptoms are present.
• Overt hypothyroidism: TSH elevated, free T4 decreased. Patient is typically symptomatic and requires levothyroxine replacement.

For a broader overview of lab value interpretation in nursing, see the nursing lab values cheat sheet.

Nursing interventions for hypothyroidism

Nursing care for the hypothyroid patient centers on medication management, safety, symptom relief, and monitoring for complications. The following interventions are organized by priority.

Medication administration

• Administer levothyroxine as prescribed (see Medications section below for detailed pharmacology)
• Verify the patient takes the medication on an empty stomach, 30–60 minutes before the first meal
• Ensure separation from calcium supplements, iron supplements, and antacids by at least 4 hours
• Monitor for signs of over-replacement: tachycardia, anxiety, insomnia, tremors, heat intolerance, weight loss

Safety and fall prevention

Hypothyroid patients are at increased fall risk due to:

• Muscle weakness and fatigue
• Slowed reflexes and delayed reaction time
• Altered mental status (confusion, somnolence)
• Possible peripheral neuropathy

Nursing actions: fall risk assessment on admission, non-slip footwear, call light within reach, bed in low position, assistance with ambulation. For more on patient safety assessment, refer to the Glasgow Coma Scale reference for neurological monitoring techniques.

Temperature management

• Monitor core temperature every 4 hours (or more frequently in severe hypothyroidism)
• Provide extra blankets and warm environment — hypothyroid patients cannot generate adequate body heat
• Avoid rapid external rewarming (especially in myxedema coma — can trigger vasodilation and cardiovascular collapse)
• Room temperature should be comfortable but not overheated for staff; patient comfort takes priority

Constipation management

• Encourage high-fiber diet (25–30 g/day) and adequate fluid intake (at least 2 L/day unless fluid restricted)
• Promote physical activity as tolerated — even gentle walking stimulates peristalsis
• Administer stool softeners (docusate) as ordered
• Monitor bowel pattern daily — report absence of bowel movement for more than 3 days
• Auscultate bowel sounds each shift — hypoactive or absent sounds may indicate ileus

Cardiovascular monitoring

• Monitor heart rate and rhythm — report bradycardia below 60 bpm or new arrhythmias
• Assess for signs of heart failure — peripheral edema, jugular venous distension, dyspnea, crackles
• Monitor cholesterol levels — hypothyroidism is a reversible cause of hyperlipidemia
• In patients with coexisting coronary artery disease, levothyroxine must be started at low doses and titrated slowly to avoid precipitating angina or myocardial infarction

Skin and tissue integrity

• Apply moisturizer to dry skin; avoid harsh soaps
• Assess for non-pitting edema (myxedema) — note location and progression
• Protect skin from injury — healing is delayed in hypothyroid patients
• For wound assessment principles, see the wound assessment reference

Psychosocial support

• Assess for depression — hypothyroidism is a known cause of reversible depression
• Reassure the patient that cognitive slowing and mood changes often improve with thyroid replacement
• Involve social work or psychiatry if depressive symptoms are severe or suicidal ideation is present
• Educate family members that personality and energy changes are part of the disease process

Medications: levothyroxine (Synthroid)

Levothyroxine sodium (brand names: Synthroid, Levoxyl, Tirosint) is the standard treatment for hypothyroidism. It is synthetic T4 that the body converts to active T3 in peripheral tissues. It is one of the most commonly prescribed medications in the United States and is a high-yield pharmacology topic on the NCLEX.

Mechanism of action

Levothyroxine replaces the deficient endogenous thyroid hormone. After oral administration, it is absorbed in the small intestine. The body then converts T4 to T3 as needed, mimicking normal physiology. Full therapeutic effect takes 4–6 weeks, which is why TSH is rechecked 6–8 weeks after starting or adjusting the dose.

Dosing considerations

• Typical starting dose (adults): 1.6 mcg/kg/day (usually 50–100 mcg/day for most adults)
• Elderly patients and patients with cardiac disease: Start low — 12.5–25 mcg/day — and increase by 12.5–25 mcg every 4–6 weeks. Rapid replacement in these patients can precipitate angina, arrhythmia, or myocardial infarction
• Goal: Normalize TSH to within the reference range (0.4–4.0 mIU/L)
• Monitoring: Recheck TSH 6–8 weeks after any dose change; once stable, monitor TSH annually

Administration rules (NCLEX high-yield)

• Take on an empty stomach with a full glass of water
• Wait 30–60 minutes before eating (food decreases absorption by up to 40%)
• Take at the same time each day — morning dosing is standard
• Separate by at least 4 hours from: calcium supplements, iron supplements, antacids (aluminum/magnesium hydroxide), sucralfate, bile acid sequestrants (cholestyramine)
• Do not crush enteric-coated formulations
• Brand consistency: The FDA considers levothyroxine a narrow therapeutic index drug — some guidelines recommend keeping patients on the same brand or formulation to avoid fluctuations

Signs of over-replacement (too much medication)

Over-replacement essentially produces iatrogenic hyperthyroidism. Watch for:

• Tachycardia, palpitations
• Anxiety, nervousness, insomnia
• Tremor
• Heat intolerance, diaphoresis
• Weight loss
• Diarrhea

If these develop, hold the dose and notify the provider. The TSH will be suppressed (low) if the patient is over-replaced.

Signs of under-replacement (insufficient dose)

The original hypothyroid symptoms persist or worsen:

• Continued fatigue, cold intolerance, constipation
• Weight gain or inability to lose weight
• Depression, cognitive slowing
• TSH remains elevated above the reference range

Drug interactions

For a broader pharmacology overview, see the drug classifications nursing reference.

Key interactions with levothyroxine:

• Warfarin: Levothyroxine increases warfarin effect — monitor INR closely when starting or adjusting thyroid replacement
• Insulin and oral hypoglycemics: Thyroid hormone increases hepatic glucose production — patients with diabetes may need dose adjustments (see the diabetes mellitus reference for insulin management)
• Digoxin: Hypothyroidism increases sensitivity to digoxin; as thyroid function normalizes, digoxin dose may need to increase
• SSRIs/SNRIs: Concurrent use can increase risk of serotonin-related effects; monitor closely

Myxedema coma

Myxedema coma (also called myxedema crisis) is the most severe, life-threatening form of hypothyroidism. Despite the name, patients may present without frank coma — the term refers to the decompensated hypothyroid state with multiorgan failure. Mortality ranges from 20% to 50% even with aggressive treatment, making early recognition and rapid intervention essential.

Triggers

Myxedema coma rarely develops spontaneously. It is typically precipitated by a physiologic stressor in a patient with undiagnosed or undertreated hypothyroidism:

• Infection (most common trigger — especially pneumonia and UTI)
• Cold exposure
• Surgery or trauma
• Medications (sedatives, opioids, anesthetics, lithium, amiodarone)
• Stroke or myocardial infarction
• Medication non-adherence (abrupt discontinuation of levothyroxine)

Clinical presentation

The hallmarks of myxedema coma are:

• Hypothermia — often severe, body temperature may drop below 90°F (32.2°C); standard thermometers may not register
• Altered consciousness — ranges from lethargy and confusion to unresponsive coma
• Bradycardia — heart rate often below 50 bpm
• Hypotension — decreased cardiac output and peripheral vasoconstriction failure
• Hypoventilation — respiratory depression with CO2 retention; may require mechanical ventilation
• Hyponatremia — from impaired free water excretion
• Hypoglycemia — from decreased gluconeogenesis
• Non-pitting edema — generalized myxedema of face, hands, extremities

Emergency nursing management

Myxedema coma requires ICU-level care. Priority nursing actions include:

1. Airway and breathing — Assess airway patency; prepare for possible intubation and mechanical ventilation. Hypoventilation with CO2 retention is a primary cause of death
2. IV levothyroxine — Oral absorption is unreliable in myxedema coma due to decreased GI motility and possible ileus. IV loading dose is typically 200–400 mcg, followed by daily IV doses of 50–100 mcg until the patient can take oral medication
3. IV hydrocortisone — Administer stress-dose corticosteroids (100 mg IV hydrocortisone) before or with levothyroxine. Rationale: undiagnosed adrenal insufficiency may coexist (autoimmune polyendocrine syndrome), and giving thyroid hormone without cortisol replacement can precipitate adrenal crisis
4. Passive rewarming only — Use warm blankets. Do NOT use active external rewarming (heating blankets, warm baths) — rapid rewarming causes peripheral vasodilation, which worsens hypotension and can precipitate cardiovascular collapse
5. IV fluids — Cautious volume resuscitation with isotonic saline; avoid hypotonic fluids (worsens hyponatremia). Monitor for fluid overload given decreased cardiac function
6. Continuous cardiac monitoring — Monitor for bradyarrhythmias, QT prolongation, and hemodynamic instability
7. Blood glucose monitoring — Treat hypoglycemia with IV dextrose as needed
8. Vasopressors — May be required for refractory hypotension; note that vasopressors have reduced effectiveness in the hypothyroid state until thyroid hormone begins to take effect
9. Identify and treat the precipitating cause — Obtain blood cultures, chest X-ray, urinalysis; start empiric antibiotics if infection is suspected

NCLEX key point: myxedema coma

The most commonly tested concept: passive rewarming only. Active rewarming (heating blankets, forced warm air) is contraindicated because it causes vasodilation, drops blood pressure, and can trigger cardiac arrest in the profoundly hypothyroid patient. This is a frequently tested safety question.

Patient education for hypothyroidism

Patient education is a core nursing responsibility. Hypothyroidism requires lifelong management, and medication adherence directly determines outcomes.

Key teaching points

• Lifelong medication: Hypothyroidism is a chronic condition that requires daily levothyroxine for life. The thyroid will not recover function (in most cases of Hashimoto or post-surgical/ablation hypothyroidism)
• Do not skip doses: Missing doses causes thyroid hormone levels to drop and symptoms to return. If a dose is missed, take it as soon as remembered unless it is close to the next dose — do not double up
• Morning routine: Take levothyroxine first thing in the morning on an empty stomach with water. Wait 30–60 minutes before eating, drinking coffee, or taking other medications
• Separate from interfering substances: Calcium, iron, antacids, and soy products reduce absorption — wait at least 4 hours
• Monitor for over-replacement signs: Teach patients to report palpitations, anxiety, tremor, unexplained weight loss, or heat intolerance — these suggest the dose is too high
• Monitor for under-replacement signs: Report persistent fatigue, cold intolerance, constipation, or weight gain — the dose may need to be increased
• Follow-up lab work: TSH should be checked 6–8 weeks after any dose change and annually once stable
• Pregnancy: Women of childbearing age should know that levothyroxine requirements increase by 30–50% during pregnancy. TSH must be monitored each trimester, and the provider should be notified immediately upon discovering pregnancy
• Generic vs brand: Advise patients to stay consistent with one formulation. Switching between brands or generic versions can cause fluctuations in thyroid levels
• Medical alert identification: Patients with severe hypothyroidism or history of myxedema coma should wear medical alert identification

Diet considerations

• No specific diet is required for hypothyroidism, but certain foods affect thyroid function and medication absorption:
• Goitrogens (cruciferous vegetables like broccoli, cabbage, kale, cauliflower) — in very large amounts, these can interfere with thyroid hormone synthesis. Cooking reduces goitrogenic activity. Normal dietary amounts are safe for most patients on replacement therapy
• Soy products — can decrease levothyroxine absorption; separate from medication by 4 hours
• High-fiber foods — encourage for constipation management, but very high fiber intake can decrease levothyroxine absorption; maintain consistent fiber intake rather than dramatic changes
• Iodine — patients on levothyroxine do not need iodine supplementation unless specifically directed by the provider

Hypothyroidism versus hyperthyroidism: comparison for NCLEX

This contrast is one of the most tested endocrine topics on the NCLEX. Memorize the opposing patterns.

Hypothyroidism in special populations

Pregnancy

Untreated hypothyroidism during pregnancy increases the risk of preeclampsia, placental abruption, low birth weight, preterm delivery, and impaired fetal neurodevelopment. TSH should be maintained below 2.5 mIU/L in the first trimester per American Thyroid Association guidelines. Levothyroxine dose requirements typically increase by 30–50% during pregnancy — patients should increase their dose by approximately 30% (often by taking two extra doses per week) as soon as pregnancy is confirmed and notify their provider for formal TSH testing.

Elderly patients

Hypothyroidism is common in older adults (up to 10% of women over 60) and often presents atypically. Fatigue and cognitive slowing may be attributed to aging rather than thyroid dysfunction. Levothyroxine must be started at low doses (12.5–25 mcg/day) and titrated slowly to avoid cardiac complications. Elderly patients are more sensitive to thyroid hormone replacement, and over-replacement increases the risk of atrial fibrillation and osteoporosis. For more on atrial fibrillation, see the atrial fibrillation nursing reference.

Pediatric patients

Congenital hypothyroidism (1 in 2,000–4,000 newborns) is screened via newborn heel stick in all 50 states. Untreated congenital hypothyroidism causes cretinism — irreversible intellectual disability and growth failure. Early levothyroxine replacement (within 2 weeks of birth) results in normal cognitive development.

NCLEX-style practice questions

Question 1: priority assessment

A patient with a history of Hashimoto thyroiditis is admitted with altered mental status, temperature of 94°F (34.4°C), heart rate of 48 bpm, and blood pressure of 82/54 mmHg. Which action should the nurse take first?

A. Administer oral levothyroxine B. Apply warm blankets and notify the provider C. Assess airway and breathing D. Obtain a stat TSH level

Answer: C

Rationale: This presentation is consistent with myxedema coma — a medical emergency. Using the ABCs (airway, breathing, circulation), the nurse’s first priority is assessing airway patency and breathing effectiveness. Hypoventilation and respiratory failure are primary causes of death in myxedema coma. Warm blankets (B) are appropriate but are a secondary intervention. Oral levothyroxine (A) is incorrect because GI absorption is unreliable in myxedema coma — IV administration is required. A TSH level (D) is important for diagnosis but does not take priority over stabilizing the patient.

Question 2: pharmacology

A patient newly started on levothyroxine 50 mcg daily asks the nurse about the best time to take the medication. Which response by the nurse is most appropriate?

A. “Take it with your breakfast to avoid stomach upset.” B. “Take it at bedtime with a glass of milk for better absorption.” C. “Take it in the morning on an empty stomach, at least 30 minutes before eating.” D. “Take it whenever is most convenient, as long as you take it daily.”

Answer: C

Rationale: Levothyroxine should be taken on an empty stomach, ideally 30–60 minutes before the first meal of the day. Food reduces absorption by up to 40%. Milk (B) contains calcium, which further impairs absorption. Taking it with breakfast (A) decreases bioavailability. While consistency is important (D), timing relative to food intake directly affects absorption and efficacy.

Question 3: select all that apply (SATA)

The nurse is caring for a patient with hypothyroidism. Which findings does the nurse expect? Select all that apply.

A. Tachycardia B. Constipation C. Cold intolerance D. Weight loss E. Fatigue F. Delayed deep tendon reflexes

Answer: B, C, E, F

Rationale: Hypothyroidism produces a hypometabolic state: constipation (B) from decreased GI motility, cold intolerance (C) from decreased thermogenesis, fatigue (E) from decreased metabolic rate, and delayed deep tendon reflexes (F) from slowed neuromuscular function. Tachycardia (A) is a sign of hyperthyroidism or levothyroxine over-replacement. Weight loss (D) is associated with hyperthyroidism — hypothyroid patients gain weight.

Question 4: medication safety

A patient taking levothyroxine also takes calcium carbonate 600 mg twice daily and ferrous sulfate 325 mg daily. Which instruction should the nurse include in the teaching plan?

A. “Discontinue the calcium and iron while taking levothyroxine.” B. “Take the calcium and iron at the same time as levothyroxine to simplify your schedule.” C. “Take levothyroxine at least 4 hours before or after taking calcium or iron.” D. “Take levothyroxine with orange juice to increase absorption.”

Answer: C

Rationale: Calcium and iron bind to levothyroxine in the GI tract and significantly reduce its absorption. The standard recommendation is to separate these medications by at least 4 hours. Patients do not need to discontinue calcium and iron (A) — they are often medically necessary. Taking them together (B) would reduce levothyroxine efficacy. Orange juice (D) does not improve absorption and the acidic environment is not a recommended strategy.

Question 5: priority nursing diagnosis

A 68-year-old patient with newly diagnosed hypothyroidism has a heart rate of 54 bpm, blood pressure of 100/62 mmHg, and reports feeling “exhausted all the time.” Which nursing diagnosis takes the highest priority?

A. Imbalanced nutrition: more than body requirements B. Activity intolerance related to decreased metabolic rate C. Decreased cardiac output related to bradycardia D. Constipation related to decreased GI motility

Answer: C

Rationale: Using Maslow’s hierarchy and the ABCs, decreased cardiac output is the highest priority because it represents a physiologic threat to tissue perfusion. A heart rate of 54 bpm with a blood pressure of 100/62 indicates compromised cardiac output that could deteriorate further. Activity intolerance (B), imbalanced nutrition (A), and constipation (D) are valid nursing diagnoses for hypothyroidism but are lower priority than cardiovascular compromise.

Question 6: myxedema coma management

The nurse is caring for a patient in myxedema coma. The provider orders IV levothyroxine and IV hydrocortisone. The patient’s temperature is 91°F (32.8°C). Which intervention is contraindicated?

A. Applying warm blankets for passive rewarming B. Using a forced-air warming device set to high C. Monitoring continuous cardiac telemetry D. Restricting hypotonic IV fluids

Answer: B

Rationale: Active external rewarming (forced-air warming devices, heating blankets, warm baths) is contraindicated in myxedema coma. Rapid rewarming causes peripheral vasodilation, which further drops blood pressure and can precipitate cardiovascular collapse or cardiac arrest. Passive rewarming with warm blankets (A) is the appropriate approach. Continuous cardiac monitoring (C) is essential. Restricting hypotonic fluids (D) is appropriate because these patients already have dilutional hyponatremia.

Related nursing references

Build your endocrine nursing knowledge with these companion references:

• Diabetes mellitus nursing reference — types, insulin, DKA vs HHS, oral medications, and NCLEX review
• DKA nursing reference — pathophysiology, emergency management, and the three pillars of treatment
• Electrolyte imbalances nursing reference — sodium, potassium, calcium, and magnesium with mnemonics
• Nursing lab values cheat sheet — complete reference ranges for clinical interpretation
• Heart failure nursing reference — HFrEF vs HFpEF, NYHA classification, and pharmacology
• Atrial fibrillation nursing reference — assessment, rate vs rhythm control, and anticoagulation
• Hypertension nursing reference — BP classification, antihypertensives, and crisis management
• Drug classifications nursing reference — pharmacology overview across major drug classes