# A nurse is teaching a patient newly started on levothyroxine 50 mcg daily for hypothyroidism. Which patient statement indicates correct understanding?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374914&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: PPT

## Question

A nurse is teaching a patient newly started on levothyroxine 50 mcg daily for hypothyroidism. Which patient statement indicates correct understanding?

## Option

1. "I will take my levothyroxine with my morning calcium and multivitamin so I do not forget either one."
2. "I will take levothyroxine on an empty stomach in the morning, at least 30 to 60 minutes before breakfast and other medications, and separate it from calcium, iron, and antacids by at least 4 hours." **✔ Correct answer**
3. "I will take levothyroxine at bedtime with a snack to avoid stomach upset."
4. "If I start to feel jittery and lose weight, that means the medication is working at the right dose and I can stop my next blood test."

**Correct answer: 2**

## Explanation

Levothyroxine teaching: take on empty stomach 30-60 min before breakfast, separate from calcium/iron/antacids/PPI/sucralfate by at least 4 hours (these reduce absorption), and continue routine TSH monitoring. Symptoms of jitteriness/weight loss/palpitations suggest OVER-replacement (hyperthyroidism) and require dose reduction with continued monitoring.

## In-depth explanation

The take-with-morning-vitamins trap is the most-tested levothyroxine error: calcium, iron, magnesium, antacids, and PPIs all reduce absorption. Patients on chronic PPI need TSH rechecked because the proton-pump inhibition decreases levothyroxine absorption over time.

## Clinical scenario

A 52-year-old **started on levothyroxine 50 mcg daily for hypothyroidism**. The patient also takes calcium carbonate, iron, omeprazole, and a multivitamin. The nurse provides medication teaching.

## Key concepts

- **Levothyroxine** — Synthetic T4 for hypothyroidism; narrow therapeutic window; absorption affected by food and many medications.
- **Absorption interactions** — Calcium, iron, magnesium, antacids, sucralfate, PPI, soy, fiber — separate by at least 4 hours from levothyroxine.
- **TSH monitoring** — Recheck 6-8 weeks after initiation or dose change; jitteriness/palpitations suggest over-replacement and need dose reduction.

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