Endocrine - Thyroid Flashcards
Normal TSH levels? What does Low Vs High TSH indicate in primary disorder.
- 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)
What type of hormone is TSH? Where does it come from? What does it stimulate?
- Tropic Hormone
- Comes from anterior pituitary
- Stimulates Thyroid gland
Normal range for T3 Levels? What is this useful in diagnosing?
80 to 200 ng/dL (More potent than T4)
*Useful in diagnosing thyrotoxicosis (hyperthyroidism)
Hyperthyroidism is excess ____ in blood. This leads to _____.
- Excess thyroid hormone
* Hypermetabolic state
Most common cause of Hyperthyroidism? What type of diseases is this? Which antibody mediates this? What may be present with this disorder?
- Graves disease
- Autoimmune
- IgG antibody - activate TSH surface receptors producing excess thyroid hormone
- Goiter may be present
2nd most common cause of hyperthyroidism? Who does this occur in? What does it involve?
- Toxic adenoma
- Common in elderly
- Single nodule on thyroid gland
How do thyroid hormones travel? What is the normal range for this?
- Protein bound iodine (PBI)
* 4-8
What does T4 control? What does it influence? Why is it important to test for this in newborns?
- Metabolic rate of all cells
- Influences tissue development (essential for physical, mental and sexual development)
- Tested to avoid irreversible mental retardation seen in cretinism
Besides T3 and T4 what other hormone does it produce? What does this do?
- 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)
For signs and symptoms of hyperthyroidism everything will be ____ and _____.
HIGH AND HOT
S+S of hyperthyroidism - Affect/Mood/sleep - 4things
- Restless/Excitability
- Nervousness
- Mood swings
- Insomnia
S+S of hyperthyroidism - GI - Stools? Appetite? Weight? 3 things
- Diarrhea/Multiple daily stools
- Increased appetite/eating (polyphagia)
- Weight loss despite heavy appetite
S+S of hyperthyroidism - Vitals -Heart? BP? TEMP? RESPIRATORY?
- Heart - tachy, palpitations, dysrythmias (afib)
- BP - increased
- Temp - Increased
- Resp- SOB at rest
S+S of hyperthyroidism - Physical appearance - Skin? hair? nails?
- Moist/Flushed skin w/velvety texture
- Hair is soft and fine
- Nails - Fragile/Onycholysis
S+S of hyperthyroidism - Reproductive - Menstrual cycle? Fertility? Libido?
- Menstrual irregularities
- Impaired fertility
- Altered libido
In hyperthyroidism, clients usually are intolerant to what? How will this present?
- Heat intolerance
* Excessive sweating
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?
- Exopthalmia
- Seen in Hyperthyroidism
- Large Bulging eyes
- Tepezza
Two antithyroid medications are _____ and ____. What do they do? What is a major toxic effect?
- Propylthiouracil (PTU) and Methimazole (tapazole)
- Block thyroid hormone
- Agranulocytosis
Potassium iodide (SSKI) is an _______ medication that does what? Used when? What is another name for this?
- Antithyroid
- Reduces vascularity of thyroid gland
- used preop to prevent hemorrhage
- LUGOLS
What medication can be used to decrease/alleviate sympathetic activity in hyperthyroidism?
*Betablockers - propranolol
An atomic cocktail that destroys thyroid cells? Who should this not be used in? What should be avoided for ___ months after treatment?
- Radioactive Iodine (I-131)
- Not to be used in pregnant women and caution in those under 20.
- Avoid pregnancy for 3 months post tx.
3 signs and symptoms of agranulocytosis seen w/antithyroid medications?
- Fever
- Soar throat
- Rash
What is the primary laboratory screening method for thyroid disorders? Normal Range?
- Serum TSH
* 0.9-1.7
What does serum free T4 measure?
Unbound T4
What is done in a radioactive iodine uptake test? how is this measured?
- client given tracer dose of iodine
* Measured by amount of gamma rays released
What type of diet should be provided for a client with hyperthyroidism? What should be avoided?
- High calorie, protein and carbs w/vitamin and supplemental feedings, low fiber.
- Avoid stimulants like caffeine and spicy foods
How can complications of exopthalmia be prevented?
- Artificial Tears
- Dark glasses
- Eyepatches
Thyroid storm is uncontrolled and potentially _____ hyperthyroidism caused by ____and ____ release of _____into the blood stream
- LIFE THREATENING
- Sudden and Excessive
- Thyroid hormone
Three drugs to treat thyroid storm?
- Antithyroid
- Beta blockers
- Corticosteroids (Blocks thyroid hormone conversion
What can cause Thyroid storm? Give 4 examples.
- Hypermetabolic states such as infection, surgery, DKA
- Surgery on unprepared hyperthyroid client
- Untreated hyperthyroidism
- Stress/Preclampsia in pregnancy
Patho of thyroid storm:
Excess ___ and ___result in overproduction of ______ with _____ and _____ activity, which leads rapidly to decompensation of multiple systems including: __, ___, ___& ___
- Excess T3 and T4
- Overproduction of Epinephrine
- Hyperadrenergic and Hypermetabolic
- Decompensation of CV, HEPATIC, RENAL, NERVOUS
What are early signs of thyroid storm?
*Apprehension, restlessness, delirium/confusion
Assessment findings in thyroid storm (3 things)? What do these lead to?
- Extremely high fever
- Tachy/high BP/CHF
- Respiratory distress (increased RR)
*Leads to coma and death
What is given preop thyroidectomy?
Lugols and antithyroid medication
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?
- RESPIRATORY DISTRESS/stridor
- Secondary to tracheal edema
- O2, SUCTION, TRACHEOSTOMY KIT
- Semi-fowlers
What does extreme hoarsness signify postop thyroidectomy?
Laryngeal nerve damage
If tetany, twitching, glottis spasms occur, what could this signify? What should be on hand in case?
- Hypocalcemia from accidental parathyroid removal
* Calcium gluconate
3 conditions hypothyroidism is often associated with?
- High cholesterol/triglycerides
- Anemia
- Folate deficiency
Hypothyroidism is more prevalent in ____ and _____.
- Women
* Downs syndrome
4 common causes of hypothyroidism?
- Hoshimotos - Autoimmune
- Pituitary tumor
- Congenital
- Low iodine diet
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___
- 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
For signs and symptoms of hyporthyroidism everything will be ____ and _____.
*LOW AND SLOW
S+S of hyp0thyroidism - Affect/Mood/sleep - 4things
- Slowed mental process (impairment)
- Lethargy
- Fatigue
- Clumsy
What medication should be avoided with hyperthyroidism?
*ASPRIN
What medications should be avoided with hypothyroidism (3 types)
- Narcotics
- Sedatives
- Anesthetics
(Increased sensitivity in hypothyroidism)
S+S of hypothyroidism - GI - Stools? Appetite? Weight? 3 things
- Constipation
- Anorexia (late finding)
- Weight gain without change in intake
S+S of hypothyroidism - Vitals -Heart? BP? TEMP? RESPIRATORY?
- All vital signs are decreased
* Cold intolerance
S+S of hypothyroidism - Physical appearance - Skin? hair? nails? Eyes?
- Dry,Doughy, Cool skin
- Thinning and sparse hair all over
- Brittle nails
- Periorbital edema
S+S of hypothyroidism - Reproductive - Menstrual cycle? Fertility? Libido?
- Menstrual irregularities
- Impaired fertility
- Decreased libido
Medication treatment for myxedema/hypothyroidism. When should this be taken? Some teaching?
- 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
enlargement of the thyroid gland related to abnormal iodine supply or metabolism? What makes this non-toxic?
*Non-toxic goiter
*TSH level is normal, but gland reaction is increased
*cause of euthyroidic goiter
is NOT hyper or hypothyroidism, inflammation or neoplasm.
TOXIC goiter is where low levels of thyroid hormone stimulate increased ________, causing compensatory increase in ____ ___and
excess ______production.
- Increased secretion of TSH
- Compensatory increase in thyroid size.
- Excess thyroid hormone production (Hyperthyroidism)
(Note:Hyperthyroidism makes it toxic)
Endemic vs Sporadic non toxic goiter?
Endemic is caused by lack of iodine and Sporadic is caused by drugs/goitregenic foods.
What assessment finding would be a priority for a non-toxic goiter?
Respiratory distress & stridor – displacement / pressure on trachea.
What is the goal of treatment for goiters? List 5 treatment interventions?
- 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
Myxedema is perciptated by?
Physiologic stress (infection, trauma, cold)
Signs and symptoms leading to Mixedema coma for CARDIAC (2 things), RESP (2 things), TEMP (1 thing).
- 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)
How is a myxedema emergency treated? Mortality rate?
- IV levothyroxine and hydrocortisone
* 50% mortality rate even with aggressive treatment
Clients should report S/S of hypo/hyper thyroidism secondary to what?
*Over/Under medicating
