Endocrine Disorders Part 2: Flashcards
Homeostatis is maintained through ____ feedback control mechanism
Negative
Controls function for the rest of the Endocrine system.
Sends releasing hormones to the Anterior Pituitary
Directly connected with the posterior Pituitary: Makes & stores Vasopressin (ADH) & oxytocin
Name organ…
Hypothalamus
Vasopressin (ADH) & Oxytocin are made in the hypothalamus but stored here ..
Posterior Pituitary
Anterior Pituitary Hormones
- Corticosteroids & adrenocortical
- Ovulation, progesterone, testosterone
- Estrogen, spermogenesis, follicle maturation
- Promotes growth through lipolysis, protein anabolism, insulin antagonism
Adrenocorticotropic hormone
1. Corticosteroids & adrenocortical
Luteinizing hormone
2. Ovulation, progesterone, testosterone
Follicle-Stimulating hormone
3. Estrogen, spermogenesis, follicle maturation
Growth hormone
4. Promotes growth through lipolysis, protein anabolism, insulin antagonism
Posterior Pituitary secretes these 2 hormones…
Vasopressin (ADH) Promotes water reabsorption
Oxytocin: Uterine contractions and breast milk ejection (let down)
Male & Female reproductive endocrine glands …. aka
Gonads
Adrenal Cortex makes up 90% of the adrenal glands.
It releases Mineralcorticoid steroids (control fluid & electrolyte balance)
&
Glucocorticoid: Essential for life.
Name the hormone it release and function….
Name the 2 hormones…
Aldosterone: Promotes sodium & water reabsorption
Renin: RAAS
Glucocorticoid = Cortisol
Stress response
Metabolism of all foods
Emotional stability
Immune
Sodium and Water balance
Adrenal medulla releases Catecholamines.
Name (2) and their effects…
Epinephrine 85%
Norepinephrine 15%
____ controls metabolism by secreting Thyroxine T4 (80%) & Triiodothyronine T3 (20%)
Regulates calcium & phosphorus balance by secreting …..
Thyroid gland
Thyrocalcitonin TCT (calcitonin)
Parathyroid gland is 4 small glands located on back of thyroid gland.
Parathyroid hormone
Regulates Calcium & phosphorus metabolism
Acts on bones, kidneys, and GI tract how…..
Bone: increase release of Calcium & phosphorus from bone into ECF. (BONE REABSORPTION)
Decrease Bone Formation
Increase Bone Breakdown
Kidney
Activates vit D
Increase reabsorption of Calcium & Mag
Increase Excretion Phosphorus, bicarbonate, sodium
GI
Activated vit D Enhances absorption of calcium & phosphorus
OVERALL INCREASED Vit D
Decreased ADH production with aging will produce (Concentrated/ Dilute) urine…
Dilute.
ADH concentrates urine and keep you from peeing it out. ADH increases fluid levels in the body
Deficiency in ___ (2) can cause Endocrine Disorders.
Protein & Iodine
Hirsutism is….
This occurs due to an excess of androgens (male hormones) or increased sensitivity of hair follicles to these hormones
Causes…(3)
Causes from medications…
When women grow facial, chest, and abdomen hair.
Polycystic Ovary Syndrome (PCOS) – The most common cause, leading to excess androgen production.
Cushing’s Syndrome – High cortisol levels can increase androgen levels.
Congenital Adrenal Hyperplasia (CAH) – A genetic disorder affecting adrenal hormone production.
Meds that cause hirsutism
Steroids, androgens, and some medications (e.g., danazol, minoxidil) can trigger excessive hair growth.
To confirm hyperthyroidism gently palpation of the thyroid can confirm….
False.
Dont palpate.
Causes thyroid storm
Lab diagnostics
Blood
Place _____ on ice
Dont use ______ due to Contamination
Catecholamines on ice
No double / triple lumens Contaminación
Endocrine Lab
Urine
This type of collection….
24 hr.
Is it still clean catch?
_____ measure level of specific hormone in blood or body fluid.
Assays
Very sensitive, can detect minute quantities
Endocrine assessment
Provocative test….
Vs
Suppression test….
Provocative test: Test UnderActive gland by stimulating it & compare measurements before & after.
Suppression test: High hormones, Suppression drugs given.
Failure of Suppression of hormone production indicates Hyperfunctiin
Diagnostics
_____ are used when hormone levels too low to measure.
Genetic DNA/RNA
Skull xray
Assess for erosion of sella turcica.
Why…
MRI w/ contrast or CT . WHY…
Hosuses Pituitary
Most sensitive image of pituitary
Thyroid, parathyroid, ovaries & testies are imaged using…
US
Adrenal glands, ovaries, pancreas use this imaging device…
CT
Diagnostic
Used to indicate composition of thyroid noddles…
Needle biopsy
Endocrine problems can be slow/insidious or abrupt/ life threatening….
True
Excess hormone production is a normal finding with age…
False
Decreased is norm
Hypopituitarism
Causes
Lowered Growth hormone - increase risk osteoporosis
Lowered Gonadotropin
Anterior Pituitary Deficiency- Decreased vital hormones from thyroid & adrenal glands
Thyroid Stimulating Hormone - causes Weight gain, cold intolerance, alopecia, hirsutism, low cognition, lethargy
Adrenocorticotropic hormone Deficiency - lower cortisol , hypoglycemia, hyponatremia, hypotension
Which is most dangerous…
Anterior Pituitary Deficiency
Can be either primary or secondary
Tumors
Malnutrition / rapid fat loss
Head trauma
Meningitis, Malaria, Fungal
Radiation/ Surgery
Late HIV stage
Sheehan syndrome (Postpartum hemorrhage)
Causes of…
Hypopituitarism
Hypopituitarism Interventions
Gonadotropin deficiency
Men: androgens (testosterone)
SE….(4)
Women: Hormone replacement therapy (HRT)
SE:….(2)
Men: Bald, acne, gynecomastia, enlarged prostate
Women: HTN, Blood clots
Hypopituitarism
ACTH Adrenocorticotropic hormone
Maybe prescribed….
Hydrocortisone or prednisone. Depending on cause/symptoms/labs
Compress brain tissues & cause neuro / endo changes
Most common in cell that produce PRL, GH, ACTH
Prolactin adenoma most common
Excessive PRL inhibits Gonadotropin- SE Galactorrhea, Amenorrhea, infertility
Pathophysiology for…
Hyperpituitarism
GH over production in hyperpituitarism can lead to acromegaly…… define
Giantism
Enlarged face, hands, feet, liver, lungs
Hyperglycemia
Hyperpituitarism
ACTH excess overstimulating of adrenal Cortex.
Causes excess Glucocorticoid, Mineralcorticoid & androgens
Leads to this syndrome…
Cushings - hypercortisolism may result
Causes
Multiple endocrine neoplasia
Inactive suppressor gene:MEN1
Autosomal Dominate
Benign tumor of pituitary, parathyroid, or pancreas
Increased production of GH = Acromegaly
Ask parents about tumors of pituitary, pancreas, parathyroid
Hyperpituitarism
Acromegaly drug therapy
Bromocriptine mesylate
Lanreotide
Octreotide
Pegvisomant
Safety Alert for Bromocriptine….
Can cause cardiac Dysrhthmias, coronary artery spasm, CSF leakage.
Hyperpituitarism
Non-surgical management
Does not immediately reduce pituitary hormone excess
Takes months to years
Doesn’t manage acromegaly
Gamma knife Radiation
Hypophysectomy is surgical management for hyperpituitarism.
Name conditions it can treat…
Most common post op problems….
Cushing’s disease, acromegaly, or hormone-secreting disorders
Diabetes Insipidus (DI) – Due to lack of antidiuretic hormone (ADH)
CSF Leak – Can lead to meningitis
Hormone Deficiencies – May require lifelong hormone replacement therapy (HRT)
Electrolyte Imbalances – Sodium and water balance must be monitored
Hyperpituitarism removes the Pituitary Gland to treat conditions such as Cushing’s disease, acromegaly, or hormone-secreting disorders.
Name pre-op teaching…(2)
Post op…
Monitor…
Monitor for this condition….
Post-nasal drip / excessive swallow may = ……
Headache, fever, rigid neck =…..
Types of medications 4 Life Brother….
Nasal packing
No sneezing, coughing, blowing nose, bending forward
Monitor: Neurological & vision
Monitor for Diabetes Insipidus
Post-nasal drip = CSF leak
HA, Fever, rigid neck = Meningitis
Replacement Hormone & gluco8
Post-hypophysectomy
Monitor neuro statis how often….
Fluid balance
Nasal drip pad
Hourly for 24 hrs then Q4
Post-Hypophysectomy
Education
Deep breathing
Prevent constipation/ No straining
No cough, sneeze, blow nose
No brush teeth, how long… (Only Floss & mouthwash)
No bend at waist
2 weeks
Large volume of water loss caused by Vasopressin/ ADH deficiency or lack of kidneys to respond to it…
Diabetes Insipidus
Diabetes Insipidus
Describe
Urine output
Urine specific gravity
Dehydration/ Overload
Hypotension/ Hypertension
Plasma osmolality
Electrolyte levels
Thirst
Urine output VERY HIGH
Urine specific gravity LOW
Dehydration
Hypotension
Plasma osmolality INCREASED
Electrolyte levels Sodium INCREASED
Thirst INCREASED
4 - 30 L urine daily
Dilute with low specific gravity & osmolality
Name disease
DI
Posterior Pituitary Disorder
DI
Symptoms related to dehydration.
Causes
Surgery
Head trauma
Drugs….
Poor skin turgor & cracked mucous membranes
Drug Lithium
Desmopressin is used for…
Describe…..
Route…
DI
A synthetic version of Vasopressin ADH
PO, Maybe given intranasal
IM / IV for severe dehydration
- IV formation is 10x stronger than oral
Interventions for DI
I&O & urine specific gravity
Daily weight
Education….
Fluid intake…
Report daily weight gain of….
Monitor SS of Water Intoxicación (4)
Fluid intake match output
Report 1 lb weight gain
Intoxicación = HA, Confusion, NV
Medic Alert bracelet
Improvement of DI
Urine output (Increased/ Decreased)
Urine Specific Gravity (Increased/Decreased)
Output Decreased
Urine Specific Gravity Increased
Sticky thick urine
Low sodium
Increased BP
Seizures
Associated with SIADH or DI
SIADH
Soaked Inside
Schwartz-Bartter Syndrome
Over secretion of ADH Vasopressin
Even when plasma osmolality is low / norm
Water retention
Dilutional hyponatremia
SIADH
Causes
Malignant tumor
Pulmonary disorder
CNS disorder
Drugs
SS
NV
Anorexia
Weight gain
Neuro
Lethargy
HA
Angry
Disorientation
Seizures
Coma
VS
Bounding Pulse
Hypothermia
Post pituitary disorder
SIADH
Interventions for SIADH
Fluid restriction 500 - 1000 ml
IO / Daily Weight
2 meds
Tolvaptan: PO Lowers fluid level without lowering Na level
Conavaptan: IV - Central Venous lowers fluid level without lowering Na level
Tolvaptan:
SIADH
PO Lowers fluid level without lowering Na level
In hospital setting only - Monitor for Na Increase
Conavaptan….
IV - Central Venous lowers fluid level without lowering Na level
Hospital setting only - Monitor for Hypernatremia
Which IV fluid maybe given for SIADH….
3% sodium chloride
SIADH
Safety
Type of precautions….
Neuro status checks….
Seizure precautions/ padded siderails, quiet environment
Neuro checks 2 - 4 hrs - if stable
Q1H if status change
Adrenal Cortex 90% of gland
Mineralcorticoid…..
Aldosterone…..
Renin….
Mineralcorticoid Control Fluid & Electrolyte Imbalance
Aldosterone Promotes sodium & water reabsorption
Renin RAAS
Adrenal Gland Hypo function
This problem….
Addison disease
Addison disease is a Adrenal glands hypofunction - caused by
Autoimmune
TB
HIV
Cancer
Sepsis
ADRENALRCTOMY
Drugs
Addison causes loss of Aldosterone & Cortisol action
Decreased Cortisol
BS…
Gastric Acid….
GFR….
BUN….
Weight….
Decreased Aldosterone
Potassium…
Sodium…
Fluid volume…
Decreased Cortisol
BS: Lowered
Gastric Acid: Increased
GFR: Lowered
BUN: Increased
Weight: Lowered
Decreased Aldosterone
Increased Potassium: due to peeing it out
Sodium Lowered
Fluid volume Lowered
(Again due to peeing it out)
Assessment for….
Fatigue, muscle weakness?
Salt craving?
Anorexia, NV, Diarrhea, ab pain
Weigjt loss
Impotence
Radiation to abdomen/head
Drugs: Steroids, Anticoagulation, opiods, cancer drugs
Addison
Hypo Cortical from adrenal glands
Physical assessment
Increased/ Decreased pigmentation
Decreased body hair
Hypoglycemia: Sweaty, HA, Tachycardia, tremors
Fluid depletion: postural hypotension & dehydration
Hyperkalemia/ Hyponatremia
Addisons
Low cortisol from adrenal glands
ACTH test is mos5 definitive for diagnose Addison disease
ACTH given via IV plasma control drawn at 30 & 60 minutes
Primary insufficiency…
Secondary insufficiency….
Primary insufficiency: Cortisol response is absent or decreased
Secondary insufficiency: Cortisol response is increased
Interventions
Promote fluid balance
Monitor for fluid deficit
Prevent hypoglycemia
Cardiac monitor
VS Q1-4
Daily weight & IO
This condition…
Addison
Addison medications
Cortisone….
Hydrocortisone….
Prednisone…
Fludrocortisone….
Dose may need adjustment during illness
Excessive Drug therapy my cause Cushings Syndrome (Weight Gain, Round Face, Fluid Retention)
Take with meals
HTN, weight gain, edema, Na restrict maybe needed
Cortisone: Take with meals
Hydrocortisone: Excessive Drug therapy my cause Cushings Syndrome (Weight Gain, Round Face, Fluid Retention)
Prednison: Dose may need adjustment during illness
Fludrocortisone: Monitor HTN, weight gain, edema, Na restrict maybe needed
Acute adrenal insufficiency
Addisons / Deadly
Occurs due to Stress, Surgery, Infection
What is the body lacking to cause this issue…
Cortisol & Aldosterone
Addison crisis
Replace / Mange these issues…
Hormone:
IV bolus hydrocortisone/ Dexamethasone
Continuous IV hydrocortisone 8hrs
Hydrocortisone IM Q 12
H2 Blocker for ulcer prevent
Hyperkalemia
IV insulin
Kayexalate
Diuretics
Hypoglycemia
IV Glucose / Glucagon
Monitor BS hourly
Adrenal glands hyper functioning.
Excessive cortisol release
Cushings
Cushings
Excessive cortisol release from adrenal glands
Under / over weight…
(2) distinguishing features…
Muscle mass…
Skin…
Bones…
Immunity….
Androgens cause…
Troncal obesity
Moon face & Buffalo Hump
Decreased muscle
Thin skin
Reduced bone density
Lowered immunity
Androgens cause: Acne, Hirsutism, oligomenorrhea
Cushings disease
Cushing Syndrome is more common
Women > men
Most common Non-Drug cause…
Pituitary adenoma
Cushings
Skin….
Women issues…
Cardiac….
Musculoskeletal…
Glucose metabolism….
Immune….
Skin: bruise, thin, wounds, acne, striae
Women issues: hirsutism, clit hypertrophy, male pattern baldness
Cardiac: Hypervolemia, edema, Increased BP, Bounding pulse
Musculoskeletal: lower muscle mass / osteoporosis
Glucose metabolism Increased fasting glucose
Immune: lower lymphocytes & macrophages
Cushings disease
Psychosocial…..
Emotional instability
Irritated
Confused
Sleep difficulty
Fatigue
Lab assessment for Cushings
Blood, urine, saliva ____ levels
ACTH levels
Androgen levels
Dexamethasone ____ testing
24 hr urine test follows
_____ blood glucose
____ sodium levels
____ Calcium levels
____ lymphocytes count
Blood, urine, saliva Cortisol levels (Increased)
ACTH levels
Androgen levels
Dexamethasone Suppression
24 hr urine test follows
Increased blood glucose
Increased sodium levels
Decreased Calcium levels
Decreased lymphocytes count
Cushings disease
Prevent (Dehydration/Overload)….
Is skin breakdown a common problem….
Overload
Monitor Q2H for Bounding pulse, JVD, Crackles, edema, low output
Skin breakdown is common. Turn Q2
Cushings
Interventions involving fluid and sodium…
May require restrictions of both
Cushings
I&O / Daily Weight
Best indicator of fluid overload…
Daily weight
Cushing disease
Pre op (3)
Post op (2)
Pre
Correct fluid & electrolyte
Cardiac monitor
GLUCOCORTICOID B4 SURGERY
POST
ICU Monitoring
ASSESS Q15min for shock
Difference in medication for bilateral & unilateral adrenalectomy….
Bilateral: Lifelong Glucocorticoid & Mineralcorticoid replacement therapy
Unilateral: HRT up to 2 years
Glucocorticoid & Mineralcorticoid
Take when…
Weight self daily
When to increase dose…
Medical bracelet
2 divided doses with Meal / Snacks
Increase dosage for Increased stess
Cushing client must remain on Glucocorticoid therapy for another health problem. Which will the client use to prevent harm
A. Urge client to salt their food
B. Testing urine for glucose
C. Use non-adhesive methods to secure IV access
D. Ensure med is given on empty stomach
C. Use non-adhesive methods to secure IV access
Increased secretion of Aldosterone with Mineralcorticoid excess…
Primary hyperaldosteronism …..
Secondary hyperaldostroneism….
Primary hyperaldosteronism:
Conn Syndrome.
Excessive secretion from 1 or both adrenal glands
Secondary hyperaldostroneism….
Caused by high levels of angiotensin II
Hyperaldosteronism
Na….
K…..
This acid balance….
Risks ….
Hypo/hypertension
Increased Na
Decreased K
Metabolic Alkalosis
Risk: strokes, MI, Renal Damage
HTN
Hyperaldosteronism
Renin levels….
Urine specific gravity…. Why?
Hypokalemia
Hypernatremia
Metabolic alkalosis
Low renin in Primary Conns
High renin in 2ndary. High renin is the cause the of hyperaldosteronism. RAAS
Low specific gravity
Hyperaldosteronism
Excess Sodium Retention & Water Loss:
Aldosterone increases sodium reabsorption in the kidneys, pulling water back into the bloodstream.
This leads to expanded blood volume and increased blood pressure.
The kidney compensates by excreting more water, leading to diluted urine with lower specific gravity.
Interventions for Hyperaldosteronism….
Caution…
Removal 1 or both adrenal glands
Correct K prior
Temp or permanent Glucocorticoid hormone maybe needed
Pheochromocytoma
Small vascular tumor of adrenal medulla
Causes….
SS…
Irregular secretion of epinephrine & norepinephrine
Increased BP, Palpation, HA, Sweaty
Pheochromocytoma
Causes HTN, Palpation, HA, Sweaty
Diagnosis….
Urine: Catecholamines & metanephrine
Thyroid function decreases with age.
Describe how they respond to HRT…
More sensitive to HRT
Start low and increase slowly
Hypothyroidism is gradual come on.
Describe substances missing in the diet that relates to this disorder….
Iodine & tyrosine
Why does a goiter happen with hypothyroidism…
Low metabolism cause hypothalamus & anterior pituitary to make TSH. TSH binds to thyroid, causing enlargement, and a goiter
Hypothyroidism
Reduced cellular thyroid regulation causes glycosaminoglycans (GAG)
Mucopolysaccharides.
Water/ mucus build up in tissues =….
Myxedema
Severe hypothyroidism
swelling of the skin and tissues due to excessive mucopolysaccharide.
Can progress to myxedema coma, a life-threatening condition
Source of primary and secondary hypothyroidism….
Primary: Thyroid cannot produce needed amount of hormones
Secondary: Thyroid gland not stimulated by pituitary
Low hormones due to Low TSH
Non-pitting edema everywhere
Eyes,hands, feet, between shoulders
Tongue thickens
Larynx = Husky voice
Function decline
Problem….
Myxedema
Hypothyroidism
Poorly treated hypothyroidism
Dangerous reduce cardiopulmonary/ neuro function
Decreased cardiac output & perfusion to the brain
Tissu3 / Organ failure
EXTREMELY HIGH MORTALITY RATE
Myxedema coma
Most common cause of hypothyroidism…
Describe patho…
Hashimoto Thyroiditis
Autoimmune
Infection/ inflammation if Thyroid gland causes autoantibodies to destroy Thyroid tissue.
Reducing Thyroid hormone
Hypo or hyperthyroidism
Sleepy
Weak
Anorexia
Paresthesia
Muscle ache
Constipation
Cold intolerance
Decreased libido
Impotent / Infertility
Drugs that may cause this problem
Lithium
Thiocyantes
Sodium/ potassium perchlorate
Cobalt
Amiodarone
Hypothyroidism
Coarse features
Edema eyes & face
Blamk expression
Thick tongue
Possible goiter
Weight gain
Slow
Slurred Speech
Hypothyroidism
Depression is a common reason to seek help with this illness
Tired
Apethetic
Withdrawn
Hypothyroidism
Hypothyroidism
Dramatic reduction in _____
Primary TSH levels….
Secondary TSH levels….
> 80 yrs what to do if T³ & T⁴ levels are low…
Reduced T³&T⁴
Primary TSH increased
Secondary TSH decreased/ nomral
Elderly Dont replace hormones unless they are symptomatic
Myxedema coma
Maintain airway
Replace fluids
_______ via IV as ordered
Type of steroid….
IV glucose
Hourly temp / blood pressure
Turn Q2H
Warm blankets
Levothyroxine sodium
Corticosteroids
Risk for myxedema….
SS….
Hypothyroidism + other problem
Acute illness
Chemo
Sirgery
Opiods
Discontinue thyroid replacement meds
Resp failure
Bradycardia
HYPO EVERYTHING
LOC Decreased
Hypothyroidism
Lifelong hormone replacement
Take meds when…
Medical alert bracelet
Periodic hormone/ blood test
Prevent constipation
4 hrs before / after a meal
Puffiness, lethargy, respiratory depression
Are SS of…
myxedema in severe hypothyroidism cases
Levothyroxine (Synthroid)
Liothyronine (Cytomel)
Litotricia (Thyrolar)
Thyroid desiccated (Armour Thyroid)
Drug doses…
________ (T4) = First-line treatment (stable, well-tolerated).
Once daily
________ (T3) = Used for resistant hypothyroidism or myxedema coma. Multiple Daily Doses
Levothyroxine (Synthroid)
50 - 200 mcg PO
Liothyronine (Cytomel)
25 - 100 mcg PO
Litotricia (Thyrolar)
60 - 120 mg PO
Thyroid desiccated (Armour Thyroid) 60 - 120 mg PO
Levothyroxine (T4) = First-line treatment (stable, well-tolerated).
Once daily
Liothyronine (T3) = Used for resistant hypothyroidism or myxedema coma. Multiple Daily Doses
Thyroid hormones for hypothyroidism
Levothyroxine
Liothyronine
Liotrix
Thyroid desiccated
Take 2 hrs apart from this medication….
Increases effects of….
Decrease effects of….
Take 2 hrs apart from cholestyramine
bile acid sequestrant primarily used for lowering cholesterol levels and treating bile acid-related conditions: Pruritus from liver disease and Diarrhea due to bile acid malabsorption.
Increases effects of oral anticoagulants
Decrease effects of digitales/ Digoxin - (Digoxin slows HR & Increases strength of contractions)
Can be temporary or permanent
Key Features
Intolerance to heat
Fine, straight hair
Flush facial
Enlarged thyroid
Tachycardia
Increased BP
Breast enlargement
Weight loss
Muscle waisting
Temors
Finger clubbing
Hyperthyroidism
Exophthalmos….
Bulging eyes seen with hyperthyroidism
Toxic diffuse goiter is seen in…
Cause…
Genetic considerations…
Graves disease - Hyperthyroidism
Autoimmune - stimulation of thyroid cells - increased thyroid hormone
Associated with immune disorders
DM
Vitiligo
RA
Identical twins
Usual 1st sign of hyperthyroidism….
Heat intolerance
Thyrotropin receptor TRABs will be measured with this condition…
Graves
Graves disease
A temp increase of 1° may indicate….
Thyroid storm- Fatal
High-fever
Severe HTN
Graves Hyperthyroidism
Most important monitor
BP
Apical pulse
Rhythm
Temp Q4h
Palpitations
Dyspnea
Vertigo
Chest pain
You will be an RN with less than 16 weeks of school
Graves Hyperthyroidism
Comfort measures…
Reduce stimulation
Close doors
Limit visitors
Postpone non-essential care
Room not too hot
Artificial tears for dry eyes
When surgery for Graves….
When medication doesnt work
Methimazole (Tapazole)
Propylthiouracil (PTU)
When goiter causes trachea/esophageal compression
Thionamides
Methimazole (Tapazole)
Propylthiouracil (PTU)
Iodine solution
Drug therapy for…
Hyperthyroidism
Graves
Also
Name med.
Preferred for long-term therapy (except in the first trimester of pregnancy).
More potent than PTU and has a longer half-life (taken once daily).
Contraindicated in the first trimester of pregnancy (risk of fetal abnormalities).
Name med.
Used during the first trimester of pregnancy (lower teratogenic risk than methimazole).
Higher risk of liver toxicity – Monitor for jaundice, dark urine, right upper quadrant pain.
Requires multiple daily doses (shorter halflife)
Methimazole (Tapazole)
Propylthiouracil (PTU)
Methimazole (Tapazole)
Preferred for long-term therapy (except in the first trimester of pregnancy).
More potent than PTU and has a longer half-life (taken once daily).
Contraindicated in the first trimester of pregnancy (risk of fetal abnormalities).
⚡ Propylthiouracil (PTU)
Used during the first trimester of pregnancy (lower teratogenic risk than methimazole).
Higher risk of liver toxicity – Monitor for jaundice, dark urine, right upper quadrant pain.
Requires multiple daily doses (shorter
Pre op
Type of drug therapy…
Iodine preps to ….
Post op
Monitor vs….(How often)
Pain control
Semi folwers posistion- Support neck
Avoid neck extensions
Deep breathing exercises
Keep _____ available at bed side
for total / subtotal thyroidectomy
Pre
Thionamides
Methimazole (MMI) – Preferred due to fewer side effects and once-daily dosing.
Propylthiouracil (PTU) – Used in pregnancy (first trimester) and thyroid storm due to its additional inhibition of T4 to T3 conversion in peripheral tissues.
Iodine prep to reduce vascularity. Given 7 - 10 days before.
Post
VS q15min
Suction equipment bed side
Surgery complications for thyroid removal
Hemorrhage
Resp distress
Swelling, damage to larynx nerves, this complication from Hypocalcemia…..
Assess for this abnormal breathing condition….
Parathyroid injury = Hypocalcemia = ……. this problem
Biggest concern. Describe problema…
Tetany
Stridor
Tetany
Thyroid storm: Fever, tachycardia, systolic HTN. Death even with treatment
Tingling numbness= mild / mod
Severe cramps / spasm, seizures = severe
Mental status change. Irritable - Psychosis
Hypoparathyroidism or Hyperparathyroidism
Hypoparathyroidism
Due to low calcium
Chvostek vs Trousseau
carpal spasm triggered by inflating a blood pressure cuff above systolic pressure for 3–5 minutes.
Involuntary twitching of the facial muscles when tapping the facial nerve near the ear (over the cheekbone).
Trousseau (More Severe)
carpal spasm triggered by inflating a blood pressure cuff above systolic pressure for 3–5 minutes.
Chvostek
Involuntary twitching of the facial muscles when tapping the facial nerve near the ear (over the cheekbone).
Interventions for Hypoparathyroidism:
Correct levels
Calcium
Vit D
Magnesium
Increase consumption of milk, yogurt & cheese for Hypoparathyroidism…
Medic alert bracelet Yes
Calcium
Vit D
Magnesium
(ALL LOW & NEED SUPPLEMENTS)
No, they contain phosphorus in addition to calcium
Serum calcium 9 - 10.5
Phosphorus 3 - 4.5
Mag 1.3 - 2.1
PTH C-terminal 50 - 330
N-terminal 8 -24
Whole: 10 - 65
Vitamin D 25 - 80
Describe values with the following
Hypoparathyroidism
Hyperparathyroidism
Symptoms of each…
Hypoparathyroidism
Calcium <9 decreased
Phosphorus >4.5 increased
Magnesium <1.3 decreased
PTH <10 Decreased
Vitamin D <25 Decreased
Hyperparathyroidism
Calcium >10.5 increased-primary
Phosphorus <4.5 decreased
Magnesium >2.1 increased
PTH >65 Increase
Vitamin D Variable
Hyperparathyroidism- Hypercalcemia
Symptoms: kidney stones, osteoporosis, fatigue, muscle weakness.
Hypoparathyroidism- hypocalcium Symptoms: muscle cramps, tingling, tetany, seizures.
Normal value
Calcium
9 - 10.5
Normal value
Phosphorus
3 - 4.5
Normal value
Magnesium
1.3 - 2.1
Normal Values
PTH
10 - 65 Whole PTH
Normal value
Vitamin D
25 - 80ng/mL
Causes of Hyperparathyroidism
Related to increased calcium levels
Bine fractures
Weigjt loss
Arthritis
Stress
Radiation ti head/neck
Physical assessment findings associated with…
Kidney stones
Bone deformities
Waxy skin
NV, Ab pain, weight loss
Peptic ulcer disease (high gastrin level)
Fatigue
Hyperparathyroidism
Non - Surgery interventions for Hyperparathyroidism
Mild disease
Therapy to lower calcium levels….
More severe
Medication that reduces PTH production…
Oral phosphate when not responding to first named medication.
IV phosphate has this effect…
Calcitonin & Glucocorticoid.
Cardiac function & I&O Q_____
Diuretics & hydration
Cinacalcet lowers PTH production
IV phosphate Lowers Calcium levels
Q2H
After parathyroid removal for Hyperparathyroidism
Pt. is at risk for this type of electrolyte imbalance….
Describe this imbalance…
Hypocalcemia
C – Convulsions (seizures)
✅ A – Arrhythmias (prolonged QT, bradycardia)
✅ T – Tetany (muscle spasms, cramps)
✅ S – Spasms & Stridor (laryngospasms → airway risk!)
✅ Numb – Paresthesia (tingling in fingers, toes, lips)
Primary Hyperaldosteronism (AKA)….
Cause…..
Lab Findings:
Aldosterone….
Renin….
K……
PH Balance….
Symptoms:
Resistant hypertension (difficult to control with medication)
Muscle weakness or cramps
Fatigue
Frequent urination
Headaches
Conn’s Syndrome
Overproduction of aldosterone due to an adrenal tumor or adrenal hyperplasia (both glands enlarged).
High aldosterone
Low renin (due to negative feedback)
Hypokalemia (low potassium)
Metabolic alkalosis
Secondary Hyperaldosteronism
Cause: _________, often from conditions like:
Renal artery stenosis (narrowing of kidney arteries)
Congestive heart failure
Cirrhosis
Diuretics or excessive dehydration
Lab Findings:
Aldosterone…..
Renin…..
Excess aldosterone due to high renin levels
High aldosterone
High renin (due to kidney sensing low blood volume)
Low cortisol levels during an acute episode.
Elevated ACTH levels, since the pituitary gland is attempting to stimulate the adrenal glands.
Electrolyte imbalances, including high potassium, low sodium, and low blood glucose.
Low blood pressure and signs of dehydration.
Name disease….
Name interventions….(4)
Addison Primary adrenal insufficiency
Interventions
Intravenous (IV) hydrocortisone (a synthetic form of cortisol) is given immediately to replace the missing cortisol and reverse the crisis.
IV fluids (especially saline) to correct dehydration and electrolyte imbalances (e.g., correcting hyponatremia and hyperkalemia).
Electrolyte correction, including glucose to treat hypoglycemia and sodium to correct low levels.
Monitoring and supportive care, including managing any underlying infection (e.g., antibiotics if infection is suspected).
_____ acts as a counter-regulatory hormone to parathyroid hormone (PTH), which increases blood calcium levels.
Calcitonin
Calcitonin is produced by the C cells (also known as parafollicular cells) in the thyroid gland
