Ch 49 disorders of thyroid Flashcards
how are T3 and T4 made
- hypothalamus makes TRH
- anterior pituitary makes TSH
- thyroid makes T3 and T4
term for normal thyroid
euthyroid
visible symptom of enlarged thyroid gland
goiter
treatment thyroiditis (3)
- drug therapy
- surgery
- lifelong hormone replacement
chronic autoimmune condition caused by destruction of thyroid tissue by antibodies, goiter present
hashimotos thyroiditis
what is the thyroid responsible for in the body
regulating cellular metabolism
most common form of hyperthyroidism
graves disease
syndrome: physiological effects of hypermetabolism resulting from excess thyroid
thyrotoxicosis
S+S hyperthyroidism (graves disease) (6)
- increased HR
- decreased weight
- diarrhea
- fine straight hair
- exophthalmos
- heat intolerance
S+S acute thyrotoxicosis (6)
- tachycardia
- heart failure
- hyperthermia
- seizures
- V/D
- coma
how to distinguish graves disease from other forms thyroiditis/hyperthyroidism
RAIU test
graves has higher uptake of blood by thyroid (35-95%) and thyroiditis has uptake of less than 2%
how are TSH and T4 levels affected by hypothyroidism
increased TSH
decreased T4
how are TSH and T4 levels affected by hyperthryoidism
decreased TSH
increased T4
antithyroid med that blocks conversion of T3 to T4; preferred during pregnancy
propylthiouracil (PTU)
antithyroid med that blocks production of T3 and T4; contraindicated during pregnancy; high doses needed for thyroid storm
methimazole
antithyroid med that reduces vascularity around thyroid before surgery, reducing risk of hemorrhage (*administer with straw because permanently stains teeth)
lugol’s solution (contains iodine)
antithyroid med that decreases heartrate and helps prevent palpitations
B blocker
nutrition recommendations for hyperthyroid pts (3)
- high calorie
- high protein
- reduce salt intake
when would radioactive iodine therapy be recommended for hyperthyroid pts
- treatment of choice for nonpregnant adults
- destroys thyroid tissue and limits thyroid hormone secretion
3 reasons someone with hyperthyroidism would have thyroidectomy surgery
- large goiter causing tracheal compression
- lack of response to antithyroid therapy
- thyroid cancer
2 priority postop nursing considerations for pt with thyroidectomy
- have suction and tracheotomy kit nearby
- monitor for hypocalcemia
2 possible complications postop thyroidectomy
- respiratory distress (laryngeal stridor or edema)
- hypocalcemia
treatment thyroid storm (thyrotoxicosis) (5)
- fluid replacement with isotonic saline infusion containing dextrose
- continuous O2 and ECG monitoring
- apply ice packs and cooling blankets
- monitor ABGs
- drugs (B blockers, antithyroid meds, iodine, glucocorticoids)
possible causes thyrotoxicosis (3)
- infection
- thyroidectomy
- trauma in pt with hyperthyroidism
most common form hypothyroidism
hashimotos thyroiditis
S+S hypothyroidism (9)
- anemia
- heart failure
- constipation
- cold intolerance
- weight gain
- slow speech
- bradycardia
- decreased LOC
- FATIGUE
important nursing considerations for med levothyroxine (4)
- narrow therapeutic index
- long half life
- take on empty stomach 1 hr before first meal
- IV push for severe hypothyroidism
S+S myxedema (4)
- dull puffy skin
- coarse sparse hair
- periorbital edema
- prominent tongue
progression of hypothyroidism to coma; medical emergency
myxedema coma
S+S myxedema coma (4)
- hypothermia
- hypotension
- hypoventilation
- can lead to cardiovascular collapse
possible causes myxedema coma (4)
- infection
- drugs (opioids, barbiturates)
- exposure to cold
- trauma
med for thyroid hormone replacement
levothyroxine
