QuestionSBA
QuestionChoice
Effective treatment with levothyroxine would be indicated by a resolution of symptoms. The patient’s body temperature may well rise with successful treatment and as a result she may report feeling less cold, but monitoring temperature in of itself is generally not useful as a marker of benefit
34439
e
Temperature
QuestionChoice
The patient’s respiratory rate is unlikely to change significantly with successful treatment and is thus not a useful marker of benefit
34438
d
Respiratory rate
QuestionChoice
Effective treatment with levothyroxine would be indicated by a resolution of symptoms. A lower heart rate may be purely physiological in some patients and is not a useful marker of effective treatment with levothyroxine
34437
c
Heart rate
QuestionChoice
Effective treatment with levothyroxine would be indicated by a resolution of symptoms including an improvement in the patient’s energy levels
34435
a
Patient reports of energy levels
QuestionChoice
The patient’s blood pressure is unlikely to change significantly with successful treatment and is thus not a useful marker of benefit
34436
b
Blood pressure
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2830
Levothyroxine monitoring
Topic
92
General Practice
6898
Case Presentation: A 34-year-old woman attends her GP with symptoms of tiredness, menstrual irregularities and feeling cold all the time. **PMH** coeliac disease


**O/E**

HR 53, RR 10, BP 106/65, Temperature 35.7°C. Peripheries cool. Mild periorbital oedema. Smooth non-tender goitre on palpation.

Her GP makes a provisional diagnosis of Hashimoto’s thyroiditis. She books the patient for a blood test and prescribes levothyroxine sodium 100 micrograms PO OD.

Question: Select the most appropriate monitoring option to assess the beneficial effects of this treatment.
a