Endocrinology

Question 1

What hormones are secreted by the thyroid gland?

Answer 1

Follicular cells secrete T3 & T4

Parafollicular cells secrete thyrocalcitonin

Question 2

What are the functions of thyrocalcitonin?

Answer 2

maintain calcium deposits in bone
decreases intestinal absorption of CA++
decreases Ca++ & PO4- reabsorption in kidneys

Question 3

How are levels of thyroid hormone regulated?

Answer 3

negative feedback loop

levels of T3 and T4 in blood are monitored by pituitary gland and hypothalamus (they release TSH and TRH respectively)

Question 4

3 examples of hyperthyroidism

Answer 4

Grave’s Disease
Nodular Thyroid Disease
Toxic Nodular Goiter

Question 5

What is most common cause of hyperthyroidism?

Answer 5

Grave’s Disease

75% of cases

Question 6

What cause Grave’s disease

Answer 6

autoimmune

Question 7

What is nodular thyroid disease?

Answer 7

multiple/singular autonomously functioning nodules, can be benign of malignant, usually develop in 6th or 7th decade of life

Question 8

What is toxic nodular goiter?

Answer 8

usually benign; caused by over-medication of exogenous hormone

Question 9

Why should the thyroid gland not be over palpated?

Answer 9

thyroid gland is highly vascular and palpation can increase the release of thyroid hormone

Question 10

What are clinical signs of hyperthyroidism?

Answer 10

fatigue
goiter, hypertrophy of thyroid gland
tremors
irritability
heat intolerance; flushed moist skin
increased appetite
oily hair and skin
diarrhea
increased heart rate and palpitations
exopthalmos (eyes bulge)--impaired venous drainage-edema; deposition of excess tissue pushes eyes forward

Question 11

diagnosing hyperthyroidism

Answer 11

Decreased TSH levels
Increase in free T4 levels
Radioactive Iodine Uptake Test

Question 12

What must you consider when treating a geriatric hyperthyroid patient?

Answer 12

other medications may need to be adjusted due to increased metabolism
you must watch medications when treating thyroid conditions due to changes in metabolism

Question 13

Pharmacotherapy for Hyperthyroidism

Answer 13

PTU (propylthiouracil)
Tapazole (methimazole)
take 4-8 weeks

Large doses of iodine for 1-2 weeks–decrease vascularity and size of gland

Question 14

Irradiation–RAI (radioactive iodine)

Answer 14

treatment for hyperthyroidism
effect not evident for 2-3 months
hypothyroidism is common complication

Question 15

Nursing care for hyperthyroidism

Answer 15

monitor cardiac function (beta-blockers to calm heart)
low fiber diet with increased caloric intake
protect eyes and keep them moist (may need to tape them at night)
cool, quiet environment

Question 16

Nursing interventions for surgery for hyperthyroidism

Answer 16

Pre-treat with anti-thyroid medications–get patient to euthyroid state
Post-operative–observe for thyrotoxic crisis (cutting into thyroid can send a rush of thyroid hormone into circulation due to the thyroid’s high vascularity)
respiratory management–trachea is there
observe for signs and symptoms of hypocalcemia (parathyroid may have been taken too)
head alignment
bleeding at site (check behind neck)
damage to laryngeal nerve % parathyroid gland
avoid goitrogens–thyroid inhibiting substances (drugs and foods–gluten, soy, cruciferous vegetables)

Question 17

causes of thyrotoxic crisis

Answer 17

precipitated by stress (infection, trauma, surgery) in partially controlled or untreated patients

Question 18

signs and symptoms of thyrotoxic crisis

Answer 18

temperature of 102-106
heart rate > 130
nausea, vomiting, diarrhea
delirium–coma

Question 19

treatment of thyrotoxic crisis

Answer 19

anti-thyroid hormone
manage by lowering temperature and supporting high metabolic demand
do not give aspirin

Question 20

Why should a patient in thyrotoxic crisis not be given aspirin?

Answer 20

aspiring displaces thyroid hormone from protein binding sites (watch combination drugs)

Question 21

hypothyroidism

Answer 21

slowly progressing autoimmune disease
it can be treatment related or from goitrogens (thyroid inhibitors–drugs and foods that contain thyroid inhibiting substances)

Question 22

primary hypothyroidism

Answer 22

hypothyroidism related to thyroid dysfunction

Question 23

secondary hypothyroidism

Answer 23

hypothyroidism related to pituitary or hypothalamic dysfunction

Question 24

myxedema coma

Answer 24

severe hypothyroidism

accumulation of hydrophilic mucopolysaccharides in the dermis; atherosclerosis (no angina due to decreased metabolic demand)

Question 25

diagnosis of hypothyroidism

Answer 25

Increased TSH (problem with thyroid) Decreased TSH problem in anterior pituitary or hypothalamus decrease T4 mush find origin of problem--inject TRH; if there is increased TSH, the problem is in the hypothalamus; if there is no change, the problem is with the anterior pituitary assess serum ferritin levels--iron is required to make thyroid hormone

Question 26

clinical manifestations of hypothyroidism

Answer 26

varies--look at the individual--could range from no symptoms to systemic manifestations onset is insidious--month to years severity of symptoms depends on degree of deficient Long term hypothyroidism effects can include neurologic, cardiovascular (atherosclerosis), GI, reproductive and hematologic (anemia) ``` fatigue, lethargy, impaired memory expressionless face; apathy slow speech; husky voice dry hair and skin; alopecia (hair loss), brittle nails intolerance to cold achlorhydria (low HCl in stomach); constipation edema, weight gain decreased libido enlargement of hands and feet menstrual disturbances ```

Question 27

clinical manifestations of myxedema coma

Answer 27

lethargic confusion progressing to unresponsiveness decreased temperature, blood pressure and respirations

Question 28

causes of myxedema coma

Answer 28

cold, trauma, infection, drugs, stress

Question 29

management of hypothyroidism

Answer 29

``` life-time drug replacement therapy Synthroid (T4 only; must be able to convert to T3) Liotrix T3 & T4 at 1:4 ratio Liothyrinine T3 Armour thyroid ```

Question 30

nursing concerns for hypothyroidism

Answer 30

``` altered health maintenance knowledge deficit regarding medications activity intolerance altered body temperature alterations in bowel elimination: constipation ```

Question 31

acute thyroiditis

Answer 31

bacterial infection causing extreme pain, enlarged thyroid, dysphagia

Question 32

acute thyroiditis treatment

Answer 32

antibiotics, surgical drain may give aspirin if there are no signs of hyperthyroidism NSAIDS and steroids if no response to other drugs within 50 hours

Question 33

sub-acute thyroiditis

Answer 33

thyroiditis that is usually preceded by viral infection | symptoms include fever, malaise, and firm and painful thyroid gland

Question 34

sub-acute thyroiditis treatment

Answer 34

can only treat the symptoms

Question 35

silent painless thyroiditis

Answer 35

form of lymphocytic thyroiditis with variable onset that occurs post-partum and resolves in 3-12 months may progress to Hashimoto's

Question 36

Hashimoto's thyroiditis (chronic)

Answer 36

autoimmune condition where thyroid gland is replaced with lymphocytes and fibrous tissue gradual enlargement of gland and decrease in T3 and T4 there is a feeling of pressure, fever, but no pain AB present if left untreated may progress to hypothyroidism

Question 37

control of parathyroid glands

Answer 37

responds to serum Ca++ levels; a decrease in Ca++ and Magnesium triggers an increase in PTH release; an increase in active Vitamin D causes decrease in PTH

Question 38

function of parathyroid hormone

Answer 38

increase of CA++ absorption from kidneys, intestine and bone increase bone resorption--breaking down bone stimulates renal conversion of vitamin D to active form stimulates renal absorption of Ca++ and decrease absorption of phosphorus

Question 39

hyperparathyroidism

Answer 39

over-secretion of PTH--hypercalcemia

Question 40

primary hyperparathyroidism

Answer 40

tumor in gland; benign adenoma

Question 41

secondary hyperparathyroidism

Answer 41

response to hypocalcemia--Vitamin D deficiency, chronic renal failure, malabsorption, hyperphosphatemia

Question 42

tertiary hyperparathyroidism

Answer 42

autonomous secretion of PTH--hyperplasia (increase in number of cells) of gland with loss of negative feedback from circulating Ca++ levels

Question 43

diagnoses of hyperparathyroidism

Answer 43

increase in PTH Serum Ca++ levels > 10 mg; phosphorus < 3 mg Increased urinary Ca++ Increased uric acid Increased creatinine Increase amylase (if pancreastitis) increased alkaline phosphatase (if bone disease)

Question 44

clinical manifestations of hyperparathyroidism

Answer 44

``` reflective of hypercalcemia and hypophosphatemia weakness loss of appetite constipation increased need for sleep emotional disorders; shortened attention span osteoporosis; fractures kidney stones ```

Question 45

medical management of hyperparathyroidism

Answer 45

for mild symptoms--increase fluids and give phosphate for tumors--partial or complete gland removal--auto-transplantation of parathyroid tissue into forearm or sternocleidomastoid muscle pharmacology anti-hypercalcemic agent--Pilcamycid which prevents RNA synthesis in osteoclasts calcium-mimetic agents--Sensipar which increase sensitivity of Ca++ receptors on parathyroid glands

Question 46

nursing management of hyperparathyroidism

Answer 46

increase mobility to increase bone density observe for signs and symptoms of tetany post-op due to low levels of calcium observe for tingling around mouth and hands observe for Chvostek's & Trousseau's Signs have IV Calcium gluconate available teach signs and symptoms of hypocalcemia verses hypercalcemia may need to take Ca++ supplements for life in auto-transplantation fails or is not done