Chapter 18 (Thyroid Emergencies)

Question 1

Thyroid Gland

Answer 1

• butterfly shaped organ
• anterior to trachea
• 2-2.5 cm wide to 3.5 cm length
• produced thyroid hormones that determine:
  1. metabolic rate
  2. growth rate
  3. other body mechanisms

Question 2

Thyroxine

Answer 2

1. stimulates gastrointestinal activity
2. stimulates heart activity
3. increases body temp
4. increases respiration
5. increases cellular metabolism

Question 3

What is hypothyroidism?

Answer 3

not enough thyroid hormone produced

Question 4

Hypothyroidism in the youth?

Answer 4

• cold intolerance
• weight gain
• dry skin
• constipation
• mental slowing
• physical slowing

Question 5

Hypothyroidism in the elderly

Answer 5

same as the youth. more difficult to determine as these are symptoms are similar to other chronic diseases.

Question 6

what is thyrotoxicosis?

Answer 6

too much thyroid hormone produced.

Question 7

what is graves’ disease?

Answer 7

enlarged thyroid gland

• origin unknown
• hereditary
• autoimmune suspected

Question 8

What is nodular goiter?

Answer 8

enlarged thyroid gland with multiple nodules.
inflammed:
2% of women
0.2% men

Question 9

what are the signs and symptoms of hyperthyroidism?

Answer 9

• weight loss
• nervousness
• insomnia
• bulging eyes
• tremors
• sweating
• rapid heart rate
• diarrhea

Question 10

what is hypothyroid?

Answer 10

synthetic thyroid hormone

• need to take for life
• usually levothyroxine
• dosage based upon weight, age, and cardiac status

Question 11

what re the three methods of treatment of hyperthyroidism?

Answer 11

1. surgery (last resort)
2. antithyroid medications
3. ablation therapy

Question 12

Ablation therapy

Answer 12

• radioactive iodine to disable thyroid gland

- patient will be hypothyroid so need synthetic hormone replacement

Question 13

treatment of surgery of hyperthyroidism

Answer 13

removal of thyroid gland

• last resort
• complications: hemorrhage, hypoparathyroidism, vocal chord paralysis

Question 14

(treatment) antithyroid medications

Answer 14

• methimazole or propylthiouracil
• relapses usually occur so usually temporary treatment
• side effects: agranulocytosis and hepatitis

Question 15

what are the thyroid emergencies?

Answer 15

• myxedema coma

- thyroid storm

Question 16

what is myxedema coma?

Answer 16

• occurs when body unable to compensate for thyroid hormone deficiency due to some precipitating event
• usually patent not comatose- misnomers
• more common in males and individuals over 70.
• often occurs in winter months (hypothermia)

Question 17

what are the signs and symptoms of myxedema coma?

Answer 17

• deterioration of mental state- confusion, apathy, depression, psychosis
• hypothermia (<95 F)
• hair loss
• facial conditions

Question 18

signs and symptoms of myxedema coma?

Answer 18

• cool, dry skin with non-pitting edema
• bradycardia
• elevated BP early then lowered BP later
• seizures possible

Question 19

treatment of myxedema coma

Answer 19

• normalize patient’s temp and respiration
• contact EMS immediately
• IV levothyroxine needed

Question 20

treatment of myxedema coma

Answer 20

• mortality rate 30-60%
• position patient supinely
• maintain airway and circulation
• administer O2 4-6L/min
• monitor vital signs

Question 21

Thyroid storm

Answer 21

• life threatening
• 10-50% fatal
• exacerbation of hyperthyroid state

Question 22

what are the signs and symptoms of thyroid storm?

Answer 22

• exaggeration of hyperthyroid symptoms
• fever
• diaphoresis
• CNS- restlessness, confusion, anxiety, psychosis

Question 23

signs and symptoms of thyroid storm

Answer 23

• GI symptoms- nausea, vomiting, diarrhea, juandice
• increase systolic BP
• widened pulse pressure
• Arrhythmias

Question 24

treatment of thyroid storm

Answer 24

hyperthyroid treatment of medication, ablation therapy, or surgery will follow once the patient is stabilized