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Med Surg 2 > 49 - Thyroid + Parathyroid > Flashcards

49 - Thyroid + Parathyroid Flashcards

1
Q

goiter

A

enlarged thyroid gland

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2
Q

goiter is caused by

A
  • hyperthyroid
  • hypothyroid
  • lack of iodine
  • nodules
  • goitrenogens
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3
Q

if goiter enlargens rapidly…

A

it may compress trachea or laryngeal nerves

-changes voice + affects breahting

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4
Q

most common cause of hyperthyroid

A

Grave’s disease

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5
Q

possible causes of hyperthyroid

A
  • toxic nodular goiter
  • thyroiditis
  • excess iodine
  • pituitary tumors
  • thyroid cancer
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6
Q

subclinical hyperthyroidism

A

TSH< 0.4

T4/T3 is norm range

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7
Q

over hyperthryoidism

A

low TSH

high T3/T4

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8
Q

Graves’ Disease

A

autoimmune> antibodies TSI binds w TSH receptors

  • thyroid enlargement
  • secretes TSI which is unregulated hormone that causes a nonstop secretion of T3/T4
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9
Q

Grave’s Diseases causes

A
  • low iodine
  • smoking
  • infection
  • stressful life events
  • genetic factors
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10
Q

auscultating the hyperthyroid thyroid gland may reveal…

A

bruits

-increased blood supply

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11
Q

exophtalmus

A
  • hyperthyroid
  • protrusion of eyes
  • incr fat deposits + fluids
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12
Q

acropachy

A

clubbing of digits

-advanced hyperthyroid

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13
Q

manifestations of hyperthyroid

A
  • palpitations
  • tremors
  • wt loss
  • restless
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14
Q

acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm

A
  • life threatening but rarely death if treated early

- usually results fr stressors (infection, trauma, surgery like thyroidectomy)

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15
Q

acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm

manifestations

A
  • severe tachycardia
  • HF
  • shock
  • hyperthermia (106f+)
  • delirium
  • seizure
  • ab pain
  • vomit
  • diarrhea
  • coma
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16
Q

diagnostics for hyperthyroid

A

low TSH + high T3/T4

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17
Q

free vs bound

A

bound means attached to protein

free is active form

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18
Q

radioactive iodine uptake [RAIU] test

A

distinguish bw Grave’s + other thyroiditis

Graves: 35-95% uptake
others: less than 2% uptake

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19
Q

drug therapy for hyperthyroid

A
  • antithyroid: PTU + methimazole
  • iodine
  • beta blockes
  • none cure it tho*
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20
Q

first line anti thyroid drugs

A

propylthiouracil + methimazole

-inhibit thyroid synth

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21
Q

which antithyroid med for pregnancy

A

propylthiouracil

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22
Q

propylthiouracil indication

A
  • first line for THYROTOXICOSIS
  • FASTer resuls than others
  • 1st trimester
  • a/e w methimazole
  • need rapid reduction
  • need to be euthyroid for surgery
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23
Q

propylthiouracil action

A

blocks conversion of T4 to T3

**must be taken 3x a day

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24
Q

iodine action

A

large doses inhibits synth of T3 + T4

  • blocks release into circulation
  • decreases vascularity of thyroid»> makes surgery safer + easier
25
Q

iodine teaching

A
  • mix w water/juice
  • AFTER meals
  • sip w straw
26
Q

iodine toxicity

A
  • swelling of buccal mucosa
  • excess salivation
  • n/v
  • skin rxn

*STOP + notify HCP

27
Q

radioactive iodine [RAI]

A
  • tx of choice for nonpregnant
  • damages + destroys thyroid tissue
  • takes 3 months for effects
28
Q

radiation thyroiditis + parotitis teaching

A
  • frequent sips of water
  • ice chips
  • salt + baking soda gargle
  • antacid, diphenhydramine, lidocaine for swish + spit
29
Q

RAI home teaching

A
  • pricate toiler
  • flush 2-3x
  • separate laundry
  • dont prep food for others
  • stay away fr pregnant + kids
30
Q

preferred surgery for hyperthyroid

A

subtotal thyroidectory

-remvoes 90% of thyroid

31
Q

nutrition for hyperthyroid

A

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
32
Q

is exercise good for hyperthyroid?

A

yes assist w exercise involving LARGE muscle groups

  • release of nervous tension + restlessness
  • tremors interfere w sml muscles
33
Q

exophthalmos teaching

A
  • artificial tears
  • restrict salt
  • elevate head
  • take them shut for sleep
  • exercise intraocular muscles several times w ROM
34
Q

postop care

A
  • 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)
35
Q

complications

A
  • 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)
36
Q

do you give thyroid hormone after a thyroidectomy?

A

avoided bc exogenous hormones inhibits pituitary production of TSH
-delays the restoration of normal gland function + tissue regeneration

37
Q

discharge

A
  • reduce caloric intake
  • adequate iodine intake (seafood or iodized salt)
  • avoid high temperatures bc inhibit thyroid regeneration
38
Q

acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm interventions

A
  • 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
39
Q

subclinical hypothyroid

A

TSH>4.5

T4 levels are normal

40
Q

overt hypothyroid

A

high TSH

low T3/T4

41
Q

nonthyroidal illness ysndrom NTIS

A

low TSH

low T3/T4

42
Q

primary vs secondary hypothyroidism

A

P: destruction of thyroid tissue or defective hormone synth
S: pituitary disease w decr TSHm or hypothalamic dysfunction w low TRH

43
Q

most common causes of hypothyroid

A
  • hashimoto

- low iodine

44
Q

Hashimoto’s thyroiditis

A

autoimmune

-atrophy of thyroid gland

45
Q

cretinism

A

hypothyroid in infancy

46
Q

hypothyroid manifestations

A
  • decr cardiac contractility
  • decr CO
  • high cholesterol
  • low exercise tolerance/SOB
  • accumulation of mucopolysaccharides> atherosclerosis
47
Q

myxedema

A

severe long standing hypothyroid

  • from accumulation of mucopolysaccharides in dermis + tissues
  • puffy face + periorbital edema
48
Q

accumulation of mucopolysaccharides in hypothyroid causes…

A
  • atherosclerosis

- myxedema

49
Q

myxedema coma

A
  • medical emergency

- cardiovasc collapse fr hypoventilation, hypo-Na, hypoglycemia, lactic acidosis

50
Q

myxedema coma

caused by..

A
  • illness
  • infection
  • drugs (esp opioids, tranquilizers, barbs)
  • exposure to cold
  • trauma
51
Q

serum TSH helps determine…

A

cause of hypothyroidism

  • high> defect in thyroid
  • low> defect in pituitary/hypothalamus
52
Q

drug therapy for hypothyroid

A

LEVOthyroxine

53
Q

levothyroxine teaching

A
  • 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
54
Q

thyroid therapies given via…

A

IV bc severe gastric hypomotility prevents absorption

55
Q

hypothyroid teaching

A
  • 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
56
Q

parathyroid hormone

A

regulates calcium + phosphate levels (inversely)

-by bone reabsorption of Ca + renal absorption of Ca, + activation of vitamin D

57
Q

hyper PTH

A
  • high Ca> renal calculi, osteoporosis, decr muscle tone

- low Ph

58
Q

hypo PTH

A
  • low Ca> muscle cramps, low CO, ab cramps

- high Ph

Med Surg 2 (13 decks)

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