NCLEX-RN cheat sheet · Endocrine
Thyroid, adrenal and pituitary
Slow or fast thyroid, thyroid surgery, Addison's or Cushing's, SIADH or DI
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The thyroid sets the body's pace: too little hormone slows everything, and too much speeds it up. The adrenal and pituitary glands control stress, salt and water, so their disorders can turn dangerous fast.
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At a glance
Hypothyroid or hyperthyroid: opposites
| Hypothyroid: slow | Hyperthyroid: fast | |
|---|---|---|
| Mood | Tired, slow, often depressed | Nervous, restless, shaky |
| Temperature | Cold intolerance | Heat intolerance; sweating |
| Heart | Slow; diastolic pressure may rise | Fast; often high blood pressure |
| Weight | Weight gain; constipation | Weight loss despite a big appetite; diarrhea |
| Skin and hair | Dry, pale, cool; coarse hair | Warm, moist; fine hair. Also bulging eyes (exophthalmos) |
| TSH | High in primary disease (central disease: check free T4) | Low in primary disease |
| Cause | Hashimoto's thyroiditis, where iodine is sufficient | Graves' disease |
| Emergency | Myxedema coma: hypothermia (the hallmark), a very slow heart rate, low blood pressure, falling consciousness | Thyroid storm: high fever, a racing heart, nervous system, gut and heart dysfunction. Can progress to low blood pressure |
Hypothyroidism: levothyroxine and care
- Levothyroxine: same time every day, on an empty stomach, apart from calcium, iron and soy. Don't switch brands.
- Older clients and those with heart disease start low and go up slowly; others may start at the full dose. Expect repeated TSH tests.
- Report signs of too much: a fast heart rate, chest pain, sweating, heat intolerance.
- Use sedatives and opioids cautiously: extra sedation and breathing depression.
Hyperthyroidism: drugs and care
- Methimazole and PTU: report fever or a sore throat at once (they can wipe out white cells). PTU can injure the liver: report itching, poor appetite, pain under the right ribs.
- Beta blockers, like propranolol, ease fast heart rate, tremor, anxiety.
- Radioactive iodine often leaves lifelong hypothyroidism. For a while after, keep distance from others; avoid anyone pregnant.
- Thyroid storm triggers: untreated disease, severe stress, stopping antithyroid drugs suddenly, handling the gland in surgery.
After a thyroidectomy
- Airway first: bleeding, swelling or low-calcium spasm can block it. Watch for stridor, neck swelling, low oxygen, trouble swallowing.
- Check the dressing behind the neck too. A neck hematoma is an emergency, escalated per protocol. Keep a tracheostomy tray nearby; neck neutral.
- Numbness, tingling, cramps, Chvostek's and Trousseau's signs: low calcium from parathyroid injury. Report it; expect calcium and vitamin D.
- Hoarseness can mean laryngeal nerve injury: rest the voice, watch for aspiration.
Parathyroid disorders
| Hypoparathyroidism | Hyperparathyroidism | |
|---|---|---|
| Calcium | Low; usually from neck surgery | High; primary is usually a tumor |
| Signs | Tingling, cramps, rhythm changes; tetany, seizures | Nausea, constipation, thirst, bone pain, kidney stones |
| Care | Calcium, vitamin D; high-calcium, low-phosphorus foods | Surgery cures primary disease. Meanwhile, fluids lower calcium; furosemide only if overloaded |
Pattern: Parathyroid hormone raises calcium and lowers phosphorus, so they often move opposite ways.
Addison's or Cushing's: mirror images
| Addison's: too little cortisol | Cushing's: too much cortisol | |
|---|---|---|
| Cause | Usually autoimmune, or from infections like TB. Suddenly stopping long-term steroids causes a different, central type | Most often steroid medicine, like prednisone |
| Pressure, glucose | Often low pressure; glucose can be low | Often high pressure; glucose high |
| Sodium, potassium | Often low sodium, high potassium | Can be high sodium, low potassium |
| Signs | Tired, weak, dizzy on standing; nausea, belly pain; salt craving; often weight loss and darker skin | Moon face, buffalo hump, purple stretch marks; weight gain on the trunk; thin skin that bruises; infections; thin bones |
| Treatment | Lifelong hydrocortisone and fludrocortisone. Never skip doses; when ill, the glucocorticoid goes up per the sick-day plan | Taper steroids; never stop them suddenly. Check glucose, blood pressure, potassium; protect the skin; prevent infection |
Not every case: Darker skin, low sodium and high potassium describe primary adrenal insufficiency, and may be absent.
SIADH or diabetes insipidus: the water disorders
| SIADH: too much ADH | DI: too little ADH, or ignored | |
|---|---|---|
| Urine | Inappropriately concentrated, not always scant | Huge, dilute urine every hour, with intense thirst |
| Sodium | Low (hypotonic, euvolemic): nausea, headache, confusion, falls; severe: seizures | Rises if the client can't drink enough; confusion follows |
| Causes | Brain injury, lung disease, cancers, some drugs | Often pituitary surgery or head injury. Lithium: the kidney type |
| Treatment | Severe symptoms: hypertonic saline right away, with serial sodium checks. Suitable chronic, non-emergency cases, after assessment: follow the ordered fluid limit, counting all fluids; seizure and fall precautions | Central type: desmopressin. On it, drinking more than the body needs can cause a dangerous sodium imbalance |
Both: Daily weights and intake and output track the water. Raise long-standing low sodium slowly, within limits: too fast can damage the brain.
Adrenal crisis: an emergency
- The need for cortisol outruns the supply. Triggers: infection, surgery, trauma, dehydration, stopping long-term steroids suddenly.
- Low blood pressure sliding into shock, confusion, vomiting, belly pain, low glucose. High potassium: monitor the heart.
- Hydrocortisone right away, by vein or muscle, with IV saline.
- Vomiting or can't keep medicine down: emergency injected hydrocortisone and urgent care, not just a higher oral dose.
Pheochromocytoma
- A rare, usually benign adrenal tumor releasing too much epinephrine and norepinephrine.
- Attacks, minutes to hours: headache, palpitations, sweating, high blood pressure.
- Surgery removes it, once medicines steady the blood pressure and pulse.
Priority and safety calls
- ★ After a thyroidectomy, the airway comes first. Check behind the neck for blood: a hematoma is an emergency, escalated per protocol.
- ★ Tingling around the mouth and fingers after thyroid surgery isn't expected: check Chvostek's and Trousseau's signs and report it.
- Fever or a sore throat on methimazole or PTU: report it at once.
- ★ Addison's, vomiting, can't keep hydrocortisone down, dizzy, low pressure: possible adrenal crisis. Expect IV or IM hydrocortisone and IV saline now. Holding the steroid is the trap.
- Long-term prednisone is tapered: stopping suddenly can bring on adrenal crisis.
- Extra fluids in SIADH is a trap. Fluid restriction is for chronic, non-emergency SIADH.
- Very thirsty, passing large amounts of pale urine every hour, after pituitary surgery: diabetes insipidus. Report it.
How the NCLEX tests it
- Low thyroid is cold and slow, with a high TSH if primary; high thyroid is hot and fast, with a low one.
- Levothyroxine on an empty stomach, apart from calcium and iron.
- Myxedema coma: cold and slow. Thyroid storm: fever and a racing heart.
- After thyroid surgery: airway, blood behind the neck, calcium, and the voice.
- Addison's: never skip replacement, follow the sick-day plan; crisis: injected hydrocortisone and saline.
- Cushing's: usually from steroids, which are tapered, never stopped suddenly.
- SIADH holds water and lowers sodium; DI loses water, and desmopressin treats the central type.
Practice it next
This sheet comes from Thyroid and parathyroid disorders and Adrenal and pituitary disorders in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- The hallmark of myxedema coma is ___.
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hypothermia - After a thyroidectomy, the first priority is the ___.
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airway - Fludrocortisone replaces ___.
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aldosterone - In Cushing's, a fat pad between the shoulders is a ___.
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buffalo hump - Central diabetes insipidus is treated with ___.
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desmopressin - Pheochromocytoma: attacks of headache, palpitations, ___ and high blood pressure.
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sweating
Sources
- Open RN, Nursing: Health Alterations, 7.6 Thyroid Disorders
- Open RN, Nursing: Health Alterations, 7.8 Parathyroid Disorders
- American Thyroid Association, Thyroid Function Tests
- NIDDK, Primary Hyperparathyroidism
- Open RN, Nursing: Health Alterations, 7.7 Adrenal Disorders
- Society for Endocrinology, emergency management of severe symptomatic hyponatremia in adults (PDF)
- Society for Endocrinology, adrenal insufficiency sick-day rules leaflet (PDF) (2025)
More endocrine cheat sheets
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.