Endocrine - Hyperthyroidism (Too much Energy/Grave's Disease)

Question 1

The Thyroid gland produces what 3 hormones?

Answer 1

T3, T4, Calcitonin

Question 2

_____________ decreases serum calcium levels by taking calcium out of the blood and pushing it back into the bone ?

Answer 2

Calcitonin

Question 3

What do you need to make hormones ?

Answer 3

Iodine

Question 4

Thyroid hormones give us _________ ?

Answer 4

Energy !

Question 5

A Hyperthyroid is also known as what ?

Answer 5

Graves Disease (Too much energy!)

Question 6

Signs & Symptoms of Hyperthyroidism (Graves Disease) ?

Answer 6

• Nervous
• Irritable
• Decreased attention span
• Increased appetite
• Decreased weight
• Sweaty/hot (b/c of increased energy and sweat production)
• Exophthalmos (bulging eyes)
• Fast GI
• Increased BP and HR
• Arrhythmias/palpitations
• Thyroid size increases

Question 7

Eye care for Grave’s eye disease ?

Answer 7

• Sunglasses
• apply cool compress for moisture
• lubricating eye drops
• Elevate HOB to reduce swelling
• Steroids and/or surgery may be needed

Question 8

Diagnosing Hyperthyroidism (Graves Disease)

• Would a T4 (thyroxine) level be increased or decreased ?

Answer 8

Increased

Question 9

Diagnosing Hyperthyroidism (Graves Disease)

Would TSH be increased or decreased ?

Answer 9

Decreased

Question 10

Are Thyroid scans used to diagnosis Hyperthyroidism (Graves Disease) ?

Answer 10

Yes

Question 11

How far in advance should Iodine containing medications be discontinued prior to a thyroid scan ?

Answer 11

1 week prior

Question 12

How long after a thyroid scan (Hyperthyroidism) must a pt. wait to restart medications (iodine containing?)

Answer 12

6 weeks

Question 13

What are treatments for Hyperthyroidism (Grave’s Disease) ?

Answer 13

• Anti-thyroids
• Iodine compounds
• Beta Blockers (supportive therapy)
• Radioactive iodine therapy
• Surgery

Question 14

What are 2 Anti-thyroid medications used for Hyperthyroidism (Grave’s Disease) ?

Answer 14

• Methimazole (Tapazole)

- Propylthiouracil (PTU)

Question 15

Which of the 2 anti-thyroid medication is the favorite and why ?

Answer 15

Methimazole

• Because its a single dose with less side effects :)

Question 16

What do Anti-thyroid medications do ?

Answer 16

Stop the thyroid from making thyroid hormones

Question 17

For a patient with Hyperthyroidism (Grave’s Disease), why are we giving Anti-thyroid medications ?

Answer 17

We want the patient to become euthyroid

eu = Normal

Question 18

ALL endocrine glands are very what ?

Answer 18

VERY VASCULAR !

Question 19

Why are Iodine Compounds given for Hyperthyroidism (Grave’s Disease) ?

Answer 19

Decrease the size and vascularity of the gland

Question 20

What is an example of an Iodine Compound?

Answer 20

Potassium Iodine

Question 21

How should Iodine compounds be given ? Why ?

Answer 21

• Given in milk or juice & use a straw

- To prevent staining the teeth

Question 22

Why are Beta Blockers (-lol) used as treatment modality for Hyperthyroidism (Grave’s Disease) ?

Answer 22

Supportive Therapy

Question 23

What Beta Blocker is used in the treatment of Hyperthyroidism (Grave’s Disease) ?

Answer 23

Propranolol (Inderal)

Question 24

What effects do Beta Blockers have in the treatment for Hyperthyroidism ?

Answer 24

• Decrease myocardial contractility
• Could decrease CO
• Decrease HR and BP (increased BP and HR = s/s)
• Decrease anxiety (increased anxiety =s/s)

Question 25

How does Radioactive Iodine therapy work for the treatment of Hyperthyroidism ?

Answer 25

Destroys Thyroid Cells (--> Hypothyroidism)

Question 26

What is the dosage Given for Radioactive Iodine Therapy ? Route ?

Answer 26

- 1 dose | - Given PO (liquid or tablet form)

Question 27

Radioactive precautions for radioactive iodine therapy state that individuals should... - Stay away from babies for how long ? - Dont kiss anyone for how long ?

Answer 27

- Stay away from babies for 1 week | - Dont kiss anyone for 1 week

Question 28

TESTING STRATEGY You should not give Beta Blockers to ________ or _________ ?

Answer 28

Asthmatics or diabetics

Question 29

What do you want to watch for in a person with Hyperthyroidism (Grave's Disease) receiving Radioactive iodine ?

Answer 29

Thyroid storm (thyrotoxicosis or thyrotoxic crisis) | Could be a rebound effect post-radioactive iodine

Question 30

What is a thyroid strom ?

Answer 30

Hyperthyroidism multiplied by 100

Question 31

What are 2 other names for a thyroid storm ?

Answer 31

- Thyrotoxicosis | - Thyrotoxic crisis

Question 32

What is a last resort (?) treatment modality for Hyperthyroidism (Grave's Disease ?

Answer 32

Surgery (Thyroidectomy --> Partial/complete)

Question 33

When does surgery become an option in a pt with Hyperthyroidism (Grave's Disease) ?

Answer 33

Done when a client has a - large goiter - thyroid cancer - did not respond to anti-thyroid therapy

Question 34

What is the post-op priority for a patient who underwent a thyroidectomy ? - A pt might report feelings of what ?

Answer 34

- Hemorrhage | - Might report feeling of pressure

Question 35

In a patient who just underwent a Thyroidectomy for Hyperthyroidism ( Grave's Disease), Where would you check for bleeding ?

Answer 35

At the incision site and behind the neck

Question 36

What must you assess for in a patient who underwent a thyroidectomy ?

Answer 36

Assess for recurrent laryngeal nerve damage by listening for hoarseness and weak voice

Question 37

Could recurrent laryngeal nerve damage lead to vocal cord paralysis ?

Answer 37

Yes

Question 38

When there is paralysis of both cords following a thyroidectomy, __________ obstruction will occur ? requiring an immediate _______ ?

Answer 38

Airway obstruction | Trach

Question 39

Following a Thyroidectomy for Hyperthyroidism (GRave's Disease), what should be at the bed side ?

Answer 39

Trach set

Question 40

Why should a trash set be at the bedside for a post-thyroidectomy patient ?

Answer 40

- Swelling - Recurrent laryngeal nerve damage (vocal cord paralysis) - Hypocalcemia

Question 41

Post- Thyroidectomy, what should you teach the patient ?

Answer 41

How to support the neck

Question 42

How should you position the HOB for a post-thyroidectomy patient ? and why ?

Answer 42

- HOB should be increased | - Why --> to decrease edema

Question 43

What nutrition needs does a thyroidectomy patient require pre & post- op ?

Answer 43

Increased calories