Endocrine - Thyroid Disorders Flashcards
Hypothyroidism
aka myxedema coma
-low T3 + T4
“everything down except weight”
wt gain, slow metab, low energy, low temp, etc
more common than hyperthyroid
Hyperthyroidism
aka thyroid storm
“everything up except weight”
wt loss, high metab, high energy, high temp, INSOMNIA, incr hrt rt, HTN, seizures, dysrhythmias, tremors
-exophthalmos, grave’s disease
harder to treat than hypothyroid
euthyroid
normally functioning thyroid
common problem with medicating hypothyroid meds?
underdosage - hypo
overdosage - hyper
-takes a while to achieve homeostasis
treatment for
hypo vs hyperthyroidism
hypo - hormone replacement
hyper - hormone antagonist
- ——— destruction of thyroid
- ——— surgery to remove
levothyroxine
levo has 4 letters > T4
levothyroxine
MOA
hormone replacement
levothyroxine
CI
- following an MI
- caution w angina
- CAD
- Tx of obesity
levothyroxine
indication
- lab values
- may have goiter
*levothyroxine
A/E
HYPERhyroid s/s
INSOMNIA, incr HR, HTN, seizures, dysrhythmias, tremors, nervous, wt loss, diaphoresis, headache, irritability
levothyroxine
Interactions
- incr anticoag effect (warfarin)
- incr insulin req
*levothyroxine
admin
PO pill
**30-60 mins in AM b4 breakfast
(first thing in AM to prevent insomnia)
- can crush mix w water
- don’t take w Soy Isoflavones
*levothyroxine
RN/teaching
- full effect/PEAK takes 4-8wks
- DO NOT stop abruptly
- HOLD if HR>110
- dose gradually incr
treatment options for hyperthyroid
1 medical therapy
2 surgical therapy
surgical therapy for hyperthyroidism
- unresponsive to drug therapy
- large goiters/tumor causing tracheal compression
- malignancy
- emergency
medical therapy options for hyperthyroidism
1 thionamides (anti thyroid drugs)
2 I-131 (radioactive iodine therapy)
3 B-adrenergic blockers (adjunt meds)
4 Lugol’s Soln (iodine)
treatment of choice in NON-PREGNANT adults w hyperthyroidism
Radioactive I-131 “Iodotope”
- postTx, usually hypo - will need lifelong replacement
- requires radiation precautions
Radioactive I-131
“Iodotope”
MOA
-uptaken by thyroid cells>
damages/destroys thyroid tissue
*Radioactive I-131
“Iodotope”
CI
- category X
- no young children
- no breastfeeding
- shellfish/sulfite allergy
Radioactive I-131
“Iodotope”
indication
- thyroid cancer
- med non-responders
Radioactive I-131
“Iodotope”
A/E
- sore throat
- bone marrow depression (pancytopenia)
- radiation sickness (hematemesis, epistaxis,, N/V)
- HYPO
- dysgeusia
Radioactive I-131
“Iodotope”
interactions
w lugol’s soln + iodine soln
*Radioactive I-131
“Iodotope”
admin
- client secretion will be radioactive until Iodine decays
- TDS (time, distance, shielding)
- drink LOTS of water after admin
*Radioactive I-131
“Iodotope”
RN/teaching
- 6 ft distance
- isolate/limit contact to 30 min/day
- don’t prep food, share utensils
- incr fluid intake
- careful disposal
methimazole, PTU
class: thionamides
methimazole, PTU
MOA
- blocks synth of thryoid hormones
- -blocks T3 fr converting to T4
methimazole, PTU
CI
- lactation/breastfeeding
- other Iodine products
*methimazole, PTU
Indication
- Euthyroid state before/after surgery
- before surgery, PTU given + B blocker
- usually given when levo was unsuccessful
*methimazole, PTU
A/E
HYPO s/s
-drowsy, deprssn, wt gain, edema, bradycrda, cold intolerance, low BP, pancytopenia/agranulocytosis
PTU is hepatoxic
methimazole, PTU
interactions
anticoag
methimazole, PTU
admin
w/meals
-consistent time each day
methimazole, PTU
RN/teaching
- monitor wt
- careful w female
- full effect/peak 3-12 wks
- avoid consumption of shellfish + high iodine food
*when administrating methimazole or PTU, always monitor for ____
Brady, sore throat, fever
Lugol’s Soln
MOA
inhibits synt of T3 + T4
—-for short term treatment only
Lugol’s Soln
RN/teaching
can stain teeth
- sip w straw
- PC meals (prevent GI upset)
- assess moral mucosa for irritation
