Hypothyroidism vs Hyperthyroidism
The NCLEX hands you a set of vitals and a symptom cluster — bradycardia with constipation or tachycardia with diarrhea — and expects you to pick the correct thyroid disorder in seconds. Reversing even one finding (like temperature intolerance) leads you to the wrong diagnosis and the wrong intervention.
Side-by-side comparison
- ↓ thyroid hormone — metabolism slows
- Hashimoto's, post-RAI/thyroidectomy
- ↑ thyroid hormone — metabolism accelerates
- Graves' autoimmune (TSI antibodies)
- Bradycardia, weight gain, cold intolerance
- Constipation, fatigue, depression
- Dry coarse skin, hair loss, periorbital edema
- ★Exophthalmos (bulging eyes) — Graves'
- Tachycardia/AFib, weight loss, heat intolerance
- Diarrhea, anxiety, tremor, insomnia
- ★↑ TSH (primary)
- ↓ T3, ↓ T4
- ★↓ TSH (suppressed)
- ↑ T3, ↑ T4
- Provide warmth; monitor for slowed vitals
- Prevent constipation; pace activity
- Cool, low-stimulation environment
- Cardiac monitoring (AFib); eye protection
- Levothyroxine daily, empty stomach
- Lifelong replacement
- Methimazole or PTU; beta-blocker for symptoms
- Radioactive iodine or thyroidectomy
- Same time daily, 30–60 min before food
- Lifelong; do not stop abruptly
- ★Report sore throat/fever — agranulocytosis
- RAI radiation precautions; protect eyes
- Myxedema coma: hypothermia, bradycardia, ↓ LOC
- Warm slowly; IV levothyroxine
- Thyroid storm: temp > 104°F, severe tachycardia
- Cooling, beta-blocker, PTU, iodine
- Myxedema coma; pericardial effusion
- AFib, heart failure, osteoporosis
Hypothyroidism
- ↓ thyroid hormone — metabolism slows
- Hashimoto's, post-RAI/thyroidectomy
Hyperthyroidism (Graves')
- ↑ thyroid hormone — metabolism accelerates
- Graves' autoimmune (TSI antibodies)
Hypothyroidism
- Bradycardia, weight gain, cold intolerance
- Constipation, fatigue, depression
- Dry coarse skin, hair loss, periorbital edema
Hyperthyroidism (Graves')
- ★Exophthalmos (bulging eyes) — Graves'
- Tachycardia/AFib, weight loss, heat intolerance
- Diarrhea, anxiety, tremor, insomnia
Hypothyroidism
- ★↑ TSH (primary)
- ↓ T3, ↓ T4
Hyperthyroidism (Graves')
- ★↓ TSH (suppressed)
- ↑ T3, ↑ T4
Hypothyroidism
- Provide warmth; monitor for slowed vitals
- Prevent constipation; pace activity
Hyperthyroidism (Graves')
- Cool, low-stimulation environment
- Cardiac monitoring (AFib); eye protection
Hypothyroidism
- Levothyroxine daily, empty stomach
- Lifelong replacement
Hyperthyroidism (Graves')
- Methimazole or PTU; beta-blocker for symptoms
- Radioactive iodine or thyroidectomy
Hypothyroidism
- Same time daily, 30–60 min before food
- Lifelong; do not stop abruptly
Hyperthyroidism (Graves')
- ★Report sore throat/fever — agranulocytosis
- RAI radiation precautions; protect eyes
Hypothyroidism
- Myxedema coma: hypothermia, bradycardia, ↓ LOC
- Warm slowly; IV levothyroxine
Hyperthyroidism (Graves')
- Thyroid storm: temp > 104°F, severe tachycardia
- Cooling, beta-blocker, PTU, iodine
Hypothyroidism
- Myxedema coma; pericardial effusion
Hyperthyroidism (Graves')
- AFib, heart failure, osteoporosis
★ marks the fact that sets a column apart.
Clinical Pearl
Hypo = cold, slow, heavy, constipated. Hyper = hot, fast, thin, diarrhea — opposites across every system.
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