A patient taking levothyroxine complains of palpitations, insomnia, and nervousness. These symptoms are most… - AIIMS M.Sc. Nsg Entrance exam-2026

AIIMS M.Sc. Nsg Entrance exam-2026

Pharmacology

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Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism (an underactive thyroid).
The symptoms presented—palpitations, insomnia, and nervousness—are classic signs of hyperthyroidism (an overactive thyroid state).
This clinical picture occurs when the dose of levothyroxine is too high, leading to an iatrogenic (medication-induced) state of hyperthyroidism, also known as over-replacement.
The goal of therapy is to achieve a euthyroid (normal) state; these symptoms indicate the therapeutic dose has been exceeded, causing toxicity.

Option A: While these are adverse effects, they are not considered 'expected' or acceptable at a therapeutic dose. They are specific signs of toxicity due to an excessive dose.
Option B: Under-replacement would cause symptoms of hypothyroidism, which are opposite to those presented. Symptoms would include fatigue, weight gain, cold intolerance, and bradycardia.
Option C: An allergic reaction to levothyroxine is rare and manifests differently, typically with a rash, hives (urticaria), itching, or angioedema.

Visual 1: Table: Comparison of Hypothyroidism (Under-replacement) vs. Hyperthyroidism (Over-replacement) - A side-by-side list of the opposing signs and symptoms for each condition to help differentiate them.
Visual 2: Flowchart: Thyroid Hormone Feedback Loop - A diagram showing how TSH from the pituitary gland stimulates the thyroid and how high levels of thyroid hormone (from over-replacement) suppress TSH.

Clinical Relevance

Nursing practice connection: Use the key finding related to Adverse effects of levothyroxine therapy to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate patients to immediately report signs of over-replacement (palpitations, anxiety, weight loss, insomnia) or under-replacement (fatigue, weight gain, cold intolerance).
Monitoring Thyroid-Stimulating Hormone (TSH) levels is crucial. In over-replacement, the TSH level will be suppressed (low), as the body tries to reduce thyroid stimulation.
Patient teaching should emphasize taking levothyroxine on an empty stomach, 30-60 minutes before breakfast, for consistent absorption and to prevent insomnia by taking it in the morning.

How to Approach the Question

First, identify the drug mentioned: Levothyroxine. Recall that it is a thyroid hormone replacement for hypothyroidism.
Next, analyze the patient's symptoms: palpitations, insomnia, and nervousness. Recognize these as signs of a hypermetabolic or 'sped up' state.
Connect the drug's function to the symptoms. If a patient takes too much of a hormone replacement, they will develop symptoms of hormone excess. In this case, excess thyroid hormone causes hyperthyroidism.
Evaluate the options. 'Over-replacement' directly describes a state of excess hormone from medication, which aligns perfectly with the symptoms of hyperthyroidism.
Rule out other options: 'Under-replacement' would cause opposite symptoms. 'Allergic reaction' has a different symptom profile. 'Expected adverse effects' is too general; these effects specifically point to an incorrect, excessive dose.

Concept Tested & Keywords

Concept Tested: Adverse effects of levothyroxine therapy
Stem keywords: levothyroxine, palpitations, insomnia, nervousness
Lead-in keywords: most likely caused by
Clinical cues: The combination of palpitations, insomnia, and nervousness points towards a hypermetabolic state.
Negative lead-in flag: false

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