49 - Thyroid + Parathyroid Flashcards
goiter
enlarged thyroid gland
goiter is caused by
- hyperthyroid
- hypothyroid
- lack of iodine
- nodules
- goitrenogens
if goiter enlargens rapidly…
it may compress trachea or laryngeal nerves
-changes voice + affects breahting
most common cause of hyperthyroid
Grave’s disease
possible causes of hyperthyroid
- toxic nodular goiter
- thyroiditis
- excess iodine
- pituitary tumors
- thyroid cancer
subclinical hyperthyroidism
TSH< 0.4
T4/T3 is norm range
over hyperthryoidism
low TSH
high T3/T4
Graves’ Disease
autoimmune> antibodies TSI binds w TSH receptors
- thyroid enlargement
- secretes TSI which is unregulated hormone that causes a nonstop secretion of T3/T4
Grave’s Diseases causes
- low iodine
- smoking
- infection
- stressful life events
- genetic factors
auscultating the hyperthyroid thyroid gland may reveal…
bruits
-increased blood supply
exophtalmus
- hyperthyroid
- protrusion of eyes
- incr fat deposits + fluids
acropachy
clubbing of digits
-advanced hyperthyroid
manifestations of hyperthyroid
- palpitations
- tremors
- wt loss
- restless
acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm
- life threatening but rarely death if treated early
- usually results fr stressors (infection, trauma, surgery like thyroidectomy)
acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm
manifestations
- severe tachycardia
- HF
- shock
- hyperthermia (106f+)
- delirium
- seizure
- ab pain
- vomit
- diarrhea
- coma
diagnostics for hyperthyroid
low TSH + high T3/T4
free vs bound
bound means attached to protein
free is active form
radioactive iodine uptake [RAIU] test
distinguish bw Grave’s + other thyroiditis
Graves: 35-95% uptake
others: less than 2% uptake
drug therapy for hyperthyroid
- antithyroid: PTU + methimazole
- iodine
- beta blockes
- none cure it tho*
first line anti thyroid drugs
propylthiouracil + methimazole
-inhibit thyroid synth
which antithyroid med for pregnancy
propylthiouracil
propylthiouracil indication
- first line for THYROTOXICOSIS
- FASTer resuls than others
- 1st trimester
- a/e w methimazole
- need rapid reduction
- need to be euthyroid for surgery
propylthiouracil action
blocks conversion of T4 to T3
**must be taken 3x a day
iodine action
large doses inhibits synth of T3 + T4
- blocks release into circulation
- decreases vascularity of thyroid»> makes surgery safer + easier
iodine teaching
- mix w water/juice
- AFTER meals
- sip w straw
iodine toxicity
- swelling of buccal mucosa
- excess salivation
- n/v
- skin rxn
*STOP + notify HCP
radioactive iodine [RAI]
- tx of choice for nonpregnant
- damages + destroys thyroid tissue
- takes 3 months for effects
radiation thyroiditis + parotitis teaching
- frequent sips of water
- ice chips
- salt + baking soda gargle
- antacid, diphenhydramine, lidocaine for swish + spit
RAI home teaching
- pricate toiler
- flush 2-3x
- separate laundry
- dont prep food for others
- stay away fr pregnant + kids
preferred surgery for hyperthyroid
subtotal thyroidectory
-remvoes 90% of thyroid
nutrition for hyperthyroid
high cal diet (4k-5k cals)
- 6 full meals
- snacks high in protein, cabs, minerals, vitamins
- protein intake 1-2g/kg
- *avoid high fiber
- *avoid high seasoned
- *avoid caffeine
is exercise good for hyperthyroid?
yes assist w exercise involving LARGE muscle groups
- release of nervous tension + restlessness
- tremors interfere w sml muscles
exophthalmos teaching
- artificial tears
- restrict salt
- elevate head
- take them shut for sleep
- exercise intraocular muscles several times w ROM
postop care
- support head manually while turning to minimize stress on suture
- monitor O2
- keep suction + tracheostomy nearby
- monitor signs of hypo-Ca (if parathyroid was removed)
complications
- hypothyroid
- thyrotoxicosis
- laryngeal nerve damage> vocal cord paralysis> spastic airway
- hypo-Ca> tetany
- excess swelling in neck, hemorrhage, or hematoma can make resp difficult
- laryngeal stridor (harsh vibratory sound)
do you give thyroid hormone after a thyroidectomy?
avoided bc exogenous hormones inhibits pituitary production of TSH
-delays the restoration of normal gland function + tissue regeneration
discharge
- reduce caloric intake
- adequate iodine intake (seafood or iodized salt)
- avoid high temperatures bc inhibit thyroid regeneration
acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm interventions
- VS Q30 min
- continuous O2 + ECG monitoring
- assess for manifestations of HF or pulmo edema (extra hrt sound, adventitious lung sound)
- lower temp, acetaminophen
drugs: beta blockers, antithyroid, iodine, glucocorticoids
subclinical hypothyroid
TSH>4.5
T4 levels are normal
overt hypothyroid
high TSH
low T3/T4
nonthyroidal illness ysndrom NTIS
low TSH
low T3/T4
primary vs secondary hypothyroidism
P: destruction of thyroid tissue or defective hormone synth
S: pituitary disease w decr TSHm or hypothalamic dysfunction w low TRH
most common causes of hypothyroid
- hashimoto
- low iodine
Hashimoto’s thyroiditis
autoimmune
-atrophy of thyroid gland
cretinism
hypothyroid in infancy
hypothyroid manifestations
- decr cardiac contractility
- decr CO
- high cholesterol
- low exercise tolerance/SOB
- accumulation of mucopolysaccharides> atherosclerosis
myxedema
severe long standing hypothyroid
- from accumulation of mucopolysaccharides in dermis + tissues
- puffy face + periorbital edema
accumulation of mucopolysaccharides in hypothyroid causes…
- atherosclerosis
- myxedema
myxedema coma
- medical emergency
- cardiovasc collapse fr hypoventilation, hypo-Na, hypoglycemia, lactic acidosis
myxedema coma
caused by..
- illness
- infection
- drugs (esp opioids, tranquilizers, barbs)
- exposure to cold
- trauma
serum TSH helps determine…
cause of hypothyroidism
- high> defect in thyroid
- low> defect in pituitary/hypothalamus
drug therapy for hypothyroid
LEVOthyroxine
levothyroxine teaching
- low dose to avoid incr in resting HR + BP
- monitor w CVD
- monitor HR or pulse greater than 100
- report chest pain, wt loss, nervous, tremor, insomnia
- 1-3 wks to take effect
- lifelong
- take in AM before food
thyroid therapies given via…
IV bc severe gastric hypomotility prevents absorption
hypothyroid teaching
- take levo in morning before meals
- dont switch brands
- warm place
- use soap sparingly, always use lotion
- avoid sedatives
- incr activity
- incr fiber
- stool softeners
- avoid enema> vagus nerve stimulation
parathyroid hormone
regulates calcium + phosphate levels (inversely)
-by bone reabsorption of Ca + renal absorption of Ca, + activation of vitamin D
hyper PTH
- high Ca> renal calculi, osteoporosis, decr muscle tone
- low Ph
hypo PTH
- low Ca> muscle cramps, low CO, ab cramps
- high Ph
