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Nursing 232- Exam 2 > Endocrine - Thyroid > Flashcards

Endocrine - Thyroid Flashcards

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1
Q

Normal TSH levels? What does Low Vs High TSH indicate in primary disorder.

A
  • Normal TSH - 0.5-5
  • HIGH TSH level could signify LOW production of TH from thyroid gland (Hypothyroid)
  • LOW TSH level could signify HIGH production of TH from thyroid gland (Hyperthyroid)
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2
Q

What type of hormone is TSH? Where does it come from? What does it stimulate?

A
  • Tropic Hormone
  • Comes from anterior pituitary
  • Stimulates Thyroid gland
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3
Q

Normal range for T3 Levels? What is this useful in diagnosing?

A

80 to 200 ng/dL (More potent than T4)

*Useful in diagnosing thyrotoxicosis (hyperthyroidism)

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4
Q

Hyperthyroidism is excess ____ in blood. This leads to _____.

A
  • Excess thyroid hormone

* Hypermetabolic state

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5
Q

Most common cause of Hyperthyroidism? What type of diseases is this? Which antibody mediates this? What may be present with this disorder?

A
  • Graves disease
  • Autoimmune
  • IgG antibody - activate TSH surface receptors producing excess thyroid hormone
  • Goiter may be present
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6
Q

2nd most common cause of hyperthyroidism? Who does this occur in? What does it involve?

A
  • Toxic adenoma
  • Common in elderly
  • Single nodule on thyroid gland
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7
Q

How do thyroid hormones travel? What is the normal range for this?

A
  • Protein bound iodine (PBI)

* 4-8

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8
Q

What does T4 control? What does it influence? Why is it important to test for this in newborns?

A
  • Metabolic rate of all cells
  • Influences tissue development (essential for physical, mental and sexual development)
  • Tested to avoid irreversible mental retardation seen in cretinism
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9
Q

Besides T3 and T4 what other hormone does it produce? What does this do?

A
  • Calcitonin
  • DECREASES blood calcium by INCREASING calcium deposits in bone and decreasing bone breakdown (osteoclasts)

(Memory trick - calciTON-IN. Places a bunch of CALCIUM IN the bone)

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10
Q

For signs and symptoms of hyperthyroidism everything will be ____ and _____.

A

HIGH AND HOT

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11
Q

S+S of hyperthyroidism - Affect/Mood/sleep - 4things

A
  • Restless/Excitability
  • Nervousness
  • Mood swings
  • Insomnia
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12
Q

S+S of hyperthyroidism - GI - Stools? Appetite? Weight? 3 things

A
  • Diarrhea/Multiple daily stools
  • Increased appetite/eating (polyphagia)
  • Weight loss despite heavy appetite
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13
Q

S+S of hyperthyroidism - Vitals -Heart? BP? TEMP? RESPIRATORY?

A
  • Heart - tachy, palpitations, dysrythmias (afib)
  • BP - increased
  • Temp - Increased
  • Resp- SOB at rest
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14
Q

S+S of hyperthyroidism - Physical appearance - Skin? hair? nails?

A
  • Moist/Flushed skin w/velvety texture
  • Hair is soft and fine
  • Nails - Fragile/Onycholysis
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15
Q

S+S of hyperthyroidism - Reproductive - Menstrual cycle? Fertility? Libido?

A
  • Menstrual irregularities
  • Impaired fertility
  • Altered libido
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16
Q

In hyperthyroidism, clients usually are intolerant to what? How will this present?

A
  • Heat intolerance

* Excessive sweating

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17
Q

What is another name for thyroid eye disease seen in what type of thyroid disorder? How does this present? What drug is used to treat this disorder?

A
  • Exopthalmia
  • Seen in Hyperthyroidism
  • Large Bulging eyes
  • Tepezza
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18
Q

Two antithyroid medications are _____ and ____. What do they do? What is a major toxic effect?

A
  • Propylthiouracil (PTU) and Methimazole (tapazole)
  • Block thyroid hormone
  • Agranulocytosis
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19
Q

Potassium iodide (SSKI) is an _______ medication that does what? Used when? What is another name for this?

A
  • Antithyroid
  • Reduces vascularity of thyroid gland
  • used preop to prevent hemorrhage
  • LUGOLS
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20
Q

What medication can be used to decrease/alleviate sympathetic activity in hyperthyroidism?

A

*Betablockers - propranolol

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21
Q

An atomic cocktail that destroys thyroid cells? Who should this not be used in? What should be avoided for ___ months after treatment?

A
  • Radioactive Iodine (I-131)
  • Not to be used in pregnant women and caution in those under 20.
  • Avoid pregnancy for 3 months post tx.
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22
Q

3 signs and symptoms of agranulocytosis seen w/antithyroid medications?

A
  • Fever
  • Soar throat
  • Rash
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23
Q

What is the primary laboratory screening method for thyroid disorders? Normal Range?

A
  • Serum TSH

* 0.9-1.7

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24
Q

What does serum free T4 measure?

A

Unbound T4

25
Q

What is done in a radioactive iodine uptake test? how is this measured?

A
  • client given tracer dose of iodine

* Measured by amount of gamma rays released

26
Q

What type of diet should be provided for a client with hyperthyroidism? What should be avoided?

A
  • High calorie, protein and carbs w/vitamin and supplemental feedings, low fiber.
  • Avoid stimulants like caffeine and spicy foods
27
Q

How can complications of exopthalmia be prevented?

A
  • Artificial Tears
  • Dark glasses
  • Eyepatches
28
Q

Thyroid storm is uncontrolled and potentially _____ hyperthyroidism caused by ____and ____ release of _____into the blood stream

A
  • LIFE THREATENING
  • Sudden and Excessive
  • Thyroid hormone
29
Q

Three drugs to treat thyroid storm?

A
  • Antithyroid
  • Beta blockers
  • Corticosteroids (Blocks thyroid hormone conversion
30
Q

What can cause Thyroid storm? Give 4 examples.

A
  • Hypermetabolic states such as infection, surgery, DKA
  • Surgery on unprepared hyperthyroid client
  • Untreated hyperthyroidism
  • Stress/Preclampsia in pregnancy
31
Q

Patho of thyroid storm:
Excess ___ and ___result in overproduction of ______ with _____ and _____ activity, which leads rapidly to decompensation of multiple systems including: __, ___, ___& ___

A
  • Excess T3 and T4
  • Overproduction of Epinephrine
  • Hyperadrenergic and Hypermetabolic
  • Decompensation of CV, HEPATIC, RENAL, NERVOUS
32
Q

What are early signs of thyroid storm?

A

*Apprehension, restlessness, delirium/confusion

33
Q

Assessment findings in thyroid storm (3 things)? What do these lead to?

A
  • Extremely high fever
  • Tachy/high BP/CHF
  • Respiratory distress (increased RR)

*Leads to coma and death

34
Q

What is given preop thyroidectomy?

A

Lugols and antithyroid medication

35
Q

Post op thyroidectomy, what is it very important to observe for? What is this secondary to? What should be kept close by for this reason? post op positioning?

A
  • RESPIRATORY DISTRESS/stridor
  • Secondary to tracheal edema
  • O2, SUCTION, TRACHEOSTOMY KIT
  • Semi-fowlers
36
Q

What does extreme hoarsness signify postop thyroidectomy?

A

Laryngeal nerve damage

37
Q

If tetany, twitching, glottis spasms occur, what could this signify? What should be on hand in case?

A
  • Hypocalcemia from accidental parathyroid removal

* Calcium gluconate

38
Q

3 conditions hypothyroidism is often associated with?

A
  • High cholesterol/triglycerides
  • Anemia
  • Folate deficiency
39
Q

Hypothyroidism is more prevalent in ____ and _____.

A
  • Women

* Downs syndrome

40
Q

4 common causes of hypothyroidism?

A
  • Hoshimotos - Autoimmune
  • Pituitary tumor
  • Congenital
  • Low iodine diet
41
Q

Classification of hypothyroidism based on what?

  • Cretinism occurs at ____ and leads to ___ and ____.
  • Lymphocytic thyroiditis occurs from __ to ___.
  • Hypothyroidism is a mild degree of ____ occuring in ____ and ____.
  • Myxedema - ____hypothyroidism occurring in___
A
  • Time of life it occurs
  • Cretinism - Occurs at birth and leads to mental and physical retardation
  • Lymphocytic thyroiditis- 6 to adolescence
  • Hypothyroidism- mild degree of thyroid failure, occuring in adults and older children.
  • Myxedema - severe hypothyroidism in adults
42
Q

For signs and symptoms of hyporthyroidism everything will be ____ and _____.

A

*LOW AND SLOW

43
Q

S+S of hyp0thyroidism - Affect/Mood/sleep - 4things

A
  • Slowed mental process (impairment)
  • Lethargy
  • Fatigue
  • Clumsy
44
Q

What medication should be avoided with hyperthyroidism?

A

*ASPRIN

45
Q

What medications should be avoided with hypothyroidism (3 types)

A
  • Narcotics
  • Sedatives
  • Anesthetics

(Increased sensitivity in hypothyroidism)

46
Q

S+S of hypothyroidism - GI - Stools? Appetite? Weight? 3 things

A
  • Constipation
  • Anorexia (late finding)
  • Weight gain without change in intake
47
Q

S+S of hypothyroidism - Vitals -Heart? BP? TEMP? RESPIRATORY?

A
  • All vital signs are decreased

* Cold intolerance

48
Q

S+S of hypothyroidism - Physical appearance - Skin? hair? nails? Eyes?

A
  • Dry,Doughy, Cool skin
  • Thinning and sparse hair all over
  • Brittle nails
  • Periorbital edema
49
Q

S+S of hypothyroidism - Reproductive - Menstrual cycle? Fertility? Libido?

A
  • Menstrual irregularities
  • Impaired fertility
  • Decreased libido
50
Q

Medication treatment for myxedema/hypothyroidism. When should this be taken? Some teaching?

A
  • Levothyroxine (synthroid)
  • same time daily In the morning, one hour before meals
  • Med is for life, do not stop abruptly - moisturize skin - hydration - carry medic alert bracelet
51
Q

enlargement of the thyroid gland related to abnormal iodine supply or metabolism? What makes this non-toxic?

A

*Non-toxic goiter
*TSH level is normal, but gland reaction is increased
*cause of euthyroidic goiter
is NOT hyper or hypothyroidism, inflammation or neoplasm.

52
Q

TOXIC goiter is where low levels of thyroid hormone stimulate increased ________, causing compensatory increase in ____ ___and
excess ______production.

A
  • Increased secretion of TSH
  • Compensatory increase in thyroid size.
  • Excess thyroid hormone production (Hyperthyroidism)

(Note:Hyperthyroidism makes it toxic)

53
Q

Endemic vs Sporadic non toxic goiter?

A

Endemic is caused by lack of iodine and Sporadic is caused by drugs/goitregenic foods.

54
Q

What assessment finding would be a priority for a non-toxic goiter?

A

Respiratory distress & stridor – displacement / pressure on trachea.

55
Q

What is the goal of treatment for goiters? List 5 treatment interventions?

A
  • Goal is to reduce thyroid hyperplasia *
    1. Diet (Avoid giotregenic foods)
    2. Lugols
    3. Hormone replacement (gives thyroid a rest.)
    4. Radiation ablation
    5. Surgery
56
Q

Myxedema is perciptated by?

A

Physiologic stress (infection, trauma, cold)

57
Q

Signs and symptoms leading to Mixedema coma for CARDIAC (2 things), RESP (2 things), TEMP (1 thing).

A
  • CARDIAC - Bradycardia (Decreased C/O) and Hypotension
  • RESP - Hypoventilation/respiratory acidosis (increased CO2)
  • TEMP- Hypothermia as low as 75 degrees

(Fatigue - Weakness- Stupor - COMA- DEATH)

58
Q

How is a myxedema emergency treated? Mortality rate?

A
  • IV levothyroxine and hydrocortisone

* 50% mortality rate even with aggressive treatment

59
Q

Clients should report S/S of hypo/hyper thyroidism secondary to what?

A

*Over/Under medicating

Nursing 232- Exam 2 (11 decks)

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