Hypothyroidism (Myxedema) — NCLEX Cheat Sheet
↑ TSH, ↓ T3/T4 → hypometabolicAlso known as: underactive thyroid · low thyroid · slow thyroid · myxedema · Hashimoto's
Use this quick-reference guide to spot, treat, and prevent Hypothyroidism (Myxedema) on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
🩺 Signs
- Wt gain, fatigue, cold intolerance
- Bradycardia, constipation, dry skin
- Periorbital edema, hair loss
🧪 Labs
- ↑ TSH, ↓ free T4
- ↑ cholesterol common
🧪 Meds
- Levothyroxine AM, empty stomach
- Lifelong, same time daily
- Don't stop abruptly
🚩 Report
- Myxedema coma: hypothermia, ↓ LOC
- Chest pain (overdose effect)
📚 Hypothyroidism (Myxedema) — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Key points
Understand these first- Signs include bradycardia, hypotension, cold intolerance, fatigue, lethargy, and weight gain despite poor appetite.
- Skin is dry and coarse, hair is thin and brittle, and there is generalized nonpitting edema (myxedema), especially facial puffiness.
- Constipation, slowed speech and movement, depression, and impaired memory are common.
- TSH is elevated while free T4 is low in primary hypothyroidism.
- Hypercholesterolemia develops from slowed metabolism, increasing cardiovascular risk.
- Menstrual irregularities and decreased libido may occur.
Nursing priorities
What to do, in order- Administer levothyroxine in the morning on an empty stomach, starting low and titrating slowly, especially in older adults.
- Provide warmth, monitor for cardiac changes, and prevent constipation with fluids and fiber.
- Monitor for signs of overmedication (tachycardia, weight loss, nervousness) and undermedication (continued fatigue, weight gain).
- Institute fall and skin precautions and pace activities to accommodate fatigue.
- Monitor closely for myxedema coma in severely affected or stressed patients.
Red flags — report now
Escalate immediately- Report decreased level of consciousness, hypothermia, hypotension, hypoventilation, and bradycardia, which signal myxedema coma.
- Report chest pain or new dysrhythmias after starting or increasing levothyroxine, especially in patients with cardiac disease.
- Avoid sedatives and opioids, which can precipitate myxedema coma in these patients.
Labs & values
Numbers to know- TSH: elevated (normal 0.4-4.0 mIU/L)
- Free T4: low (normal 0.8-1.8 ng/dL)
- Cholesterol: often elevated
Patient teaching
What patients must know- Take levothyroxine for life, at the same time each day on an empty stomach, and do not stop it even when feeling well.
- Separate levothyroxine from antacids, calcium, and iron by several hours, as they reduce absorption.
- Report palpitations, chest pain, insomnia, or weight changes, which may indicate a dose adjustment is needed.
❓ Hypothyroidism (Myxedema): NCLEX FAQs
What are the priority nursing interventions for Hypothyroidism (Myxedema)?
Administer levothyroxine in the morning on an empty stomach, starting low and titrating slowly, especially in older adults. Provide warmth, monitor for cardiac changes, and prevent constipation with fluids and fiber. Monitor for signs of overmedication (tachycardia, weight loss, nervousness) and undermedication (continued fatigue, weight gain). Institute fall and skin precautions and pace activities to accommodate fatigue.
What are the warning signs of Hypothyroidism (Myxedema) a nurse must report?
Report decreased level of consciousness, hypothermia, hypotension, hypoventilation, and bradycardia, which signal myxedema coma. Report chest pain or new dysrhythmias after starting or increasing levothyroxine, especially in patients with cardiac disease. Avoid sedatives and opioids, which can precipitate myxedema coma in these patients.
What do I need to know about Hypothyroidism (Myxedema) for the NCLEX?
Signs include bradycardia, hypotension, cold intolerance, fatigue, lethargy, and weight gain despite poor appetite. Skin is dry and coarse, hair is thin and brittle, and there is generalized nonpitting edema (myxedema), especially facial puffiness. Constipation, slowed speech and movement, depression, and impaired memory are common. TSH is elevated while free T4 is low in primary hypothyroidism.
What patient teaching is important for Hypothyroidism (Myxedema)?
Take levothyroxine for life, at the same time each day on an empty stomach, and do not stop it even when feeling well. Separate levothyroxine from antacids, calcium, and iron by several hours, as they reduce absorption. Report palpitations, chest pain, insomnia, or weight changes, which may indicate a dose adjustment is needed.
Quick Tip
Signs include bradycardia, hypotension, cold intolerance, fatigue, lethargy, and weight gain despite poor appetite.
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