1. A patient is diagnosed with Hashimoto’s thyroiditis and is unsure of what the disease entails. She would like the RN to describe the disease for her. Which would NOT be an accurate statement to tell the patient?
a. It is an autoimmune disorder
b. It is more likely to affect middle-aged women
c. It usually does not cause neck pain
d. It is the most common cause of hyperthyroidism
2. After providing more information about Hashimoto’s thyroiditis, you decide to employ the teach-back method for your patient and have her repeat what she has learned to make sure she fully understands. Which statement made by the patient would let you know that more patient education is needed?
a. “I will have to take levothyroxine as treatment.”
b. “My ultrasound may show that my thyroid is enlarged and heterogeneous.”
c. “I do not have goiter.”
d. “I will need to have my TSH, T3, and FT4 labs checked regularly.”
3. Very rarely, Hashimoto’s thyroiditis can cause thyroid pain/tenderness and can have a patient presentation similar to subacute thyroiditis. What signs/symptoms can one expect to see in both disease processes?
a. Fever
b. Malaise
c. Elevated erythrocyte sedimentation rate (ESR)
d. All of the above
4. The nurse knows that high calcium levels in the blood can be lowered by _____ hormone which is released by the ____ gland.
a. Calcitonin; parathyroid
b. Calcitonin; thyroid
c. TSH; anterior pituitary
d. TRH; anterior pituitary
5. A patient with painful Hashimoto’s thyroiditis undergoes a total thyroidectomy but continues to have pain months after the procedure. What should be the healthcare provider’s next step in their plan of care?
a. Prescribe pain medication
b. Rule out the presence of thyroid remnants
c. Order glucocorticoid treatments
d. Perform exploratory surgery
Question 1 Correct answer – D Rationale: Hashimoto’s thyroiditis is an autoimmune disorder that usually manifests as nontender, diffuse goiter. It is more likely to affect middle-aged women. It is the most common cause of hypothyroidism; Grave’s disease is the most common cause of hyperthyroidism.
Question 2 Correct answer – C Rationale: Nearly all patients with Hashimoto’s thyroiditis have a previous history of goiter which could have been present for any number of months or years. An ultrasound will usually demonstrate diffusely enlarged and heterogeneous parenchyma. One of the most common treatments for the disease is levothyroxine and it is taken orally. Patients must have their thyroid labs checked regularly to ensure that they are receiving the correct dosage and that there are no major fluctuations.
Question 3 Correct answer – D Rationale: It can be difficult to differentiate painful Hashimoto’s thyroiditis and subacute thyroiditis because they share many of the same symptoms. These symptoms include thyroid pain and tenderness, fever, general malaise, and an elevated erythrocyte sedimentation rate (ESR).
Question 4 Correct answer – B Rationale: Calcitonin is the hormone that regulates high levels of serum calcium in the bloodstream. It is released by the thyroid gland. When calcium levels are decreased, the parathyroid releases parathyroid hormone. TRH (thyrotropin-releasing hormone) would not be correct because it stimulates the secretion of TSH. TSH (thyroid-stimulating hormone) promotes the growth of thyroid gland and stimulates it to produce more thyroid hormones.
Question 5 Correct answer – B Rationale: With Hashimoto’s thyroiditis, the thyroid parenchyma can become very fibrosed and complete removal of the gland can be difficult. Pain can still be present if remnants of the thyroid remain. Pain medication will only mask the underlying issue and glucocorticoid treatments are meant to be used before a total thyroidectomy is considered. Exploratory surgery would not be an appropriate option as it is overly invasive. If thyroid remnants are present, radioiodine ablation would be a better option.
References
McCance, K. L., & Heuther, S. E. (2015). Pathophysiology: The biological basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby.
Seo, H. M., Kim, M., Bae, J., Kim, J. H., Lee, J. W., Lee, S. A., … Lee, D. H. (2012). A case of painful Hashimoto thyroiditis that mimicked subacute thyroiditis. Chonnam medical journal, 48(1), 69–72. doi:10.4068/cmj.2012.48.1.69