ATI Unit 12 Hyperthyroidism Flashcards
what 3 hormones are produced by the thyroid gland
- T4 = thyroxine
- T3 = triiodothyronine
- thyrocalcitonin = calcitonin
*first two regulated by anterior pituitary through negative feedback (eg T3/T4 serum level decreased, anterior pituitary released TSH)
what do T3/T4 due
regulators of overall body functioning
- metabolism
- energy production
- fluid/electrolyte balance
- tissue use of fats/proteins/carbs
what does calcitonin do?
- inhibits mobilization of Ca+ from bone and reduces blood calcium levels
so if we have too many hormones from the thyroid what is that?
called hyperthyroidism
there’s too many thyroid hormones in our blood and their create extreme body processes, hypermetabolic states
what are the causes of hyperthyroidism?
`1) Grave’s disease (most common) = autoimmune antibodies results in hypersecretion
2) toxic nodular goiter = presence of thyroid nodules cause overproduction
3) exogenous drugs
what are the clinical manifestations of hyperthyroidism
can’t be vigilant with that hot body
- Group 1 = vigilant
- nervousness, irritable, hyperactive, no attention
- insomnia
- tremor, hyperkinesia, hyperreflexia
2) Group 2 = hot body
- frequent stools/diarrhea
- menstural irregularities
- warm/sweaty flushed skin
- weight change, hair loss, vision changes
- goiter
3) Group 3 - can’t be
- weakness, fatigue, exervise intolerance
- libido initially increased then decreases
what is a unique marker of Grave’s disease
exophthalmos = eyes bulging out
would hyperthyroidism display tachycardia or bradycardia?
tachycardia, elevated systolic, dysrhythmias
which test clarifies the size and funciton of the thyroid gland?
- radioiodine (123I) uptake and thyroid scan
- 123I admin PO 24hrs before test and then measured; elevated uptake = hyperthyroidism
- confirm client not preg before scan
- recent oral contraceptive may elevated levels
- avoid iodized salt, fish, shellfish, milk, canned fruits/veggies
nursing care for hyperthyroidism
- provide rests
- increase calories/protein
- eye protection/lubricant if exophthalmos of Grave’s disease
- don’t palpate thyroid gland
- airway due to goiter
Medications for hyperthyroidism
1) thionamide: inhibit thyroid hormone production
- methimazole (Tapazole)
- propylthiouracil (PTU)
these drugs are used to treat Graves’ disease along with radioactive iodine therapy, todecrease hormone levels in prep for surgery, and to treat thyrotoxicosis
monitor for
a. hypothyroidism manifestionsL intolerance ot cold, edema, bradycardia, increase in weight, depression
b. leukopenia or thrombocytopenia (brusing, sore throat, fever)
c. hepatotoxicity
Education
- typcially taken for 1-2 years
- jaundice (yellow skin/eyes, darkening of urine)
- guidelines for intake of iodine
2) propranolol (Inderal) (beta-adrenergic blocker, treats tachycardia, palpitations)
Monitor for….
- BP, HR, ECG
- hpoglycemia
Education
- if dizziness, sit on bedside
- bheck pulse before dose
3) Iodine solutions - Lugol's solution and saturated solutions of K+ iodine (SSKI) inhibit release of thyroid hormone Considerations - short-term use ONLY - admin 1 hr after antithyroid med - NO PREG
Education
- fever, sore throat, mouth ulcers
- med available as solution, mix with juice to mask taste, use straw to avoid staining teeth, take with food
what is 131I
radioactive iodine
- therapy used, taken up by thyroid an destroys hormone-producing cells
- no preg
- monitor for hypothyroidism
Education
6-8 weeks effect
- stay away from infants/small children for 2-4 days
radiation precaution
- no same toilet for 2 weeks, sit down to urinate/flush toilet three times
- take laxative 2-3 days after treatment to ride body of stool
- wear washable clothing
- avoid contamination from saliva, no shared toothbrush, use disposable food items
what is the surgical interventino for hyperthyroidism
Thyroidectomy
- usually prescribed thionamides before surgery (propylthiouracil/methimazole)
- recieve iodine 10-14 days before surgery (reduces gland’s size/bleeding)
- propranolol may be given
Post
- high Fowler’s, supoort head/neck pillows, avoid neck extension
- hemorrhage = compression of tachea, resp distress, or due to edema -> ensure trach supplies available, humidy air, cough , deep breath, suction
- laryngeal nerve damage = ask client to speek when awake an q2hrs
- if parathyroid damaged/removed = hypocalcemia/tetany possible -> tingling toes or around mouth, muscle twitches (positive Chvostek’s Trousseu’s signs), have calcium gluconate or chloride available
- hoarseness normal
- hypothyroidism manifestations
- if total thyroidectomy - replacement needed lifelong
Medications for thyroidectomy
1) calcium gluconate/chloride
- supplements if parathyroid damaged/gone
2) prednisone )Deltasone)
- corticosteroids reduce postop edema
- taper slowly to discontinue
3) furosemide (Lasix)
- reduces swelling
What are the five complications of post-thyroidectomy
- hemorrhage at incision site
- 50mL in first 24 hours of drainage expected
- support neck, no flexion/extension
- cough, deep breath - thyroid storm crisis: large amt of thyroid hormones in serum at once = great increase in metab, medical emergency high mortality rate
- manifestations: hyperthermia, hypertension, delirium, vomitting, ab pain, hyperglycemia, achydysrhythmias
- plus angina, dyspnea, palpitation
CAUTION: salicylate antipyretics contraindicated b/c release thyroxine
CAUTION: administer iodie 1 hr after PTU (propylthiouracil, that thionamide); if given before can make manifestations worse
- admin small doses of insulin
- O2 - airway obstruction
- keep trach near
- may report dressings feel tight - hypocalcemia/tetany
- talked aobut it earlier - nerve damage
- already earlier, hoarseness occurs, need to speek q2h
