[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Nursing care in hypo- and hyperthyroidism, and the warning signs of a thyroid storm or myxoedema coma # Nursing care in hypo- and hyperthyroidism, and the warning signs of a thyroid storm or myxoedema coma - Safe practice The nurse watches heart rate, temperature and mental status, gives thyroid medicines correctly and knows the signs of the two thyroid emergencies. Updated Nov 13, 2026 ## Key points - Levothyroxine: once a day, on an empty stomach, with water, 30–60 minutes before breakfast and at the same time each day. - Separate levothyroxine by at least 4 hours from iron, calcium, antacids and fibre supplements: they block its absorption. - Signs of too much thyroid hormone (fast heart rate, palpitations, chest pain, tremor, sweating): hold the dose and tell the doctor if they are cardiac. - Antithyroid drugs: fever or sore throat is reported at once (agranulocytosis); loss of appetite, itching or right upper abdominal pain can mean liver injury. - Thyroid storm: fever, very fast heart rate, agitation, confusion, diarrhoea. Myxoedema coma: low temperature, slow breathing, low blood pressure, drowsiness. - Myxoedema coma can be triggered by infection, cold, opioids or stopping the thyroid medicine. ## What it is In hypothyroidism everything slows down: tiredness, feeling cold, constipation, weight gain, slow heart rate. In hyperthyroidism everything speeds up: fast heart rate, heat intolerance, sweating, tremor, weight loss, diarrhoea. Nursing care centres on vital signs, giving the medicines correctly, watching for over- or under-treatment and teaching. Each disorder has a rare, life-threatening extreme. Thyroid storm is a sudden worsening of uncontrolled hyperthyroidism with fever, a very fast heart rate and agitation or confusion; it is often triggered by infection, trauma or a heart attack. Myxoedema coma is severe hypothyroidism with low temperature, slow breathing, low blood pressure, low glucose and reduced consciousness. Both are emergencies treated in intensive care. ## What it requires - Levothyroxine treatment is usually lifelong and is not stopped when the person feels better. - Older adults and people with heart disease start with a low dose because of the risk of angina and arrhythmia. - Levothyroxine can change glucose control in diabetes and the effect of oral anticoagulants: glucose and INR are watched when it starts or changes. - TSH and thyroid hormones are checked to judge the effect of treatment. ## How it is applied (and why) - Measure heart rate, rhythm, blood pressure and temperature every shift: they show over- or under-treatment. - Give levothyroxine on an empty stomach with water, before breakfast, away from iron, calcium and antacids. - Before each dose ask about palpitations, chest pain, tremor and heat intolerance: hold and report if they are cardiac. - With antithyroid drugs, weigh the patient 2–3 times a week: weight shows the response to treatment. - With antithyroid drugs, ask about fever, sore throat, yellow skin, itching and bruising: they are serious adverse effects. - In hypothyroidism, report drowsiness and review sedatives and opioids with the doctor: opioids can trigger myxoedema coma. - Watch for the triggers of a crisis (infection, surgery, trauma, a stopped medicine) and report them early. - Teach that treatment is lifelong, how to take the tablet, the signs of too much or too little hormone and the follow-up tests. ## In nursing practice - Graves disease may bring bulging eyes; report irritated eyes, double vision or loss of vision (risk of corneal ulcer). - After radioactive iodine or surgery many people develop hypothyroidism and need replacement for life. - Thyroid storm can cause arrhythmias, heart failure and pulmonary oedema that develop rapidly. - In myxoedema coma, care in intensive care may include oxygen, ventilation and IV fluids. ## Common mistakes - Giving levothyroxine with breakfast or with the iron and calcium tablets. - Missing a fever or sore throat in a patient on an antithyroid drug. - Treating new confusion with sedation in a patient with hypothyroidism without first reporting it. - Thinking that a thyroid storm is only anxiety: fever with a very fast heart rate in hyperthyroidism is an emergency. ## Test yourself Think of the answer, then tap the question to see it. ## How is levothyroxine taken? Once a day on an empty stomach with water, 30–60 minutes before breakfast, at the same time each day, and at least 4 hours apart from iron, calcium and antacids. ## A patient on an antithyroid drug reports fever and a sore throat. Why is this urgent? It can be agranulocytosis, a dangerous fall in white cells that usually appears in the first months. It is reported at once. ## What are the signs of a thyroid storm? Fever, a very fast pounding heart rate, agitation or confusion, sweating, tremor and diarrhoea in a person with uncontrolled hyperthyroidism. It is an emergency. ## What can trigger myxoedema coma? Infection or illness, cold exposure, some medicines such as opioids, and taking the thyroid medicine irregularly or not at all. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/nursing-care-in-hypo-and-hyperthyroidism-and-the-warning-signs-of-a-thyroid-stor/) ## Elsewhere in DurgiPedia - [Actions of thyroid hormones](https://durgical.com/en/physiology/actions-of-thyroid-hormones/) - [Hyperthyroidism and hypothyroidism: the signs](https://durgical.com/en/clinical-exam/hyperthyroidism-and-hypothyroidism-the-signs/) ## Connections ## Related 2 - [Vital signs in nursing: when, how often and how to record them](https://durgical.com/en/nursing/vital-signs-in-nursing-when-how-often-and-how-to-record-them/) - [After thyroid or parathyroid surgery: airway, bleeding, voice and the signs of low calcium](https://durgical.com/en/nursing/after-thyroid-or-parathyroid-surgery-airway-bleeding-voice-and-the-signs-of-low/) ## Related conditions 4 - [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/) - [Graves disease (hyperthyroidism)](https://durgical.com/en/conditions/graves-disease/) - [Thyroid storm](https://durgical.com/en/conditions/thyroid-storm/) - [Myxoedema coma](https://durgical.com/en/conditions/myxoedema-coma/) ## In Pharmacology 3 - [Levothyroxine](https://durgical.com/en/pharmacology/levothyroxine/) - [Methimazole](https://durgical.com/en/pharmacology/methimazole/) - [Propylthiouracil](https://durgical.com/en/pharmacology/propylthiouracil/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Pharmacology, 9.5: Thyroid Medications](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Pharmacology_(OpenRN)/09%3A_Endocrine/9.05%3A_Thyroid_Medications) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2023); [Thyroid storm](https://medlineplus.gov/ency/article/000400.htm) (MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine, 2026); [Hypothyroidism](https://medlineplus.gov/ency/article/000353.htm) (MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine, 2026); [Hyperthyroidism](https://medlineplus.gov/ency/article/000356.htm) (MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/nursing-care-in-hypo-and-hyperthyroidism-and-the-warning-signs-of-a-thyroid-stor/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/nursing-care-in-hypo-and-hyperthyroidism-and-the-warning-signs-of-a-thyroid-stor/