Exam 4 - Thyroid Flashcards
the thyroid gland is very ___
vascular
5 x’s the blood flow to the liver
Thyroid hormones
T3, T4, calcitonin
where is the parathyroid?
inside the thyroid gland
TSH comes from the ___ ___ ___
anterior pituitary gland
what controls the release of T3, T4
TSH
when is calcitonin released?
high plasma calcium levels
increases calcium deposit in bone
thyroid hormone production within normal limits
euthyroid
thyroid is controlled by what feedback system?
negative
low T3, T4 will cause an increase in
TSH
what is the issue with primary thyroid disorder
thyroid is the issue
no longer listening to the anterior pituitary gland
what is the issue with secondary thyroid disorder
anterior pituitary gland
no longer listening to the hypothalamus
what is the issue with central thyroid disorder
hypotalamus
childhood thyroid disoder
cretinism
neonatal hypothyroidism is tested when?
24-48 hours after birth
r/t low iodine, mental retardation
most common condition r/t hyperthyroidism
Grave’s disease
excess output of thyroid hormone
thyrotoxicosis
hyperthyroidism s/sx
nervousness rapid pulse heat intolerance tremors skin flushed, warm, soft and moist exophthalmos increased appetite weight loss elevated SBP cardiac dysrhythmias
thyrotoxicosis puts the body in which state?
hyper-metabolic state
most sever hyperthyroid disorder
thyroid storm
protruding or bulging eyes as a result of impaired venous drainage from the orbit
exophthalmos
exophthalmos is only seen in ___ disease
Grave’s
early stage of hyperthyroidism may only have which 2 s/sx
nervousness
weight loss
meds to tx hyperthyroidism
propylthiouracil (PTU) + methimazole
Na, K iodine solutions
dexamethasone
beta-blockers (propranolol
purpose of PTU + methimazole
Tapazole
inhibit/block synthesis of thyroid hormones
how long does it take to see improvement with PTU + methimazole
1-2 weeks but can take 4-8 weeks
side effects/labs of PTU + methimazole
agranulocytosis
**low WBC, neutrophil, eosinophil
thrombocytopenia
hepatoxicity
how often is PTU taken?
who can take it?
TID
pregnant women in their 1st trimester
how often is Tapazole taken
daily
propranolol is contraindicated in who?
asthma
severe heart disease
cause of thyroid storm
stressors such as infection, trauma, surgery
thyroid storm s/sx
severe tachycardia heart failure hyperthermia (up to 105.3) agitation seizures N/V/D delirium coma
pts who have a ___ are in danger of having a thyroid storm
thyroidectomy
hyperthyroidism TSH and T4 level will be ___
elevated
best indicator of hyperthyroidism
free thyroxine (T4)
hyperthyroidism treatment of choice for most nonpregnant adults
radioactive iodine therapy (RAI)
how does radioactive iodine therapy work?
damages, destorys thyroid tissue
how long until RAI is affective?
3 months
PTU, tapazole, and inderal taken until effective
PO RAI can cause what?
dryness
throat irritation
thyroiditis
*frequent sips of water, ice chips or magic mouth wash (Benadryl, lidocaine, mylanta - swish + spit)
RAI precautions
avoid pregnant women and children for at least 7 days
RAI education
use separate lavatory
*flush twice
wash clothes separately
how much of the thyroid is removed with a subtotal thyroidectomy?
90%
why is a subtotal thyroidectomy performed
prevent damage to parathyroid gland
why are parathyroid glands rarely removed?
prevent hypocalcemia
complications s/p subtotal thyroidectomy
hypothyroidism hypocalcemia hemorrhage injury to laryngeal nerve thyroid storm
hyperthyroidism nutrition therapy
high calorie (4000-5000/day) 6 meals (high protein, carb, vitamins, minerals)
avoid high fiber, highly seasoned foods, and beverages high in caffeine
hyperthyroidism protein intake should __-__ g/kg
1-2 g/kg of ideal body weight
after a thyroidectomy, will a high calorie diet still need to be implemented?
No, they will gain weight.
methods to relieve eye discomfort with hyperthyroidism
Na restriction elevate HOB use dark glasses tape shut at night turn eyes in complete ROM
severe exophthalmos treatment options
corticosteroids
radiation of retroorbital tissue
orbital decompression
corrective lid, muscle surgery
a temperature increase of __ degree should be reported
1
how often to assess after thyroidectomy
q2h for the first 24 hours
monitor for tracheal compression, irregular breathing, swelling, frequent swallowing, presence of blood
pt positioning after thyroidectomy
semi-fowlers
avoid neck flexion
how long to assess for tetany, Trousseau’s, and Chvostek’s after thyroidectomy?
72 hours
a complete thyroidectomy requires what for life?
lifelong thyroid hormone replacement
what can provide sufficient iodine intake?
seafood once weekly
iodized salt
what is encouraged regularly to stimulate the thyroid gland
exercise
what type of environment inhibits thyroid regeneration
high temperatures
what is a strong risk factor for Graves disease
smoking
hypothyroidism occurs from ___ levels of T3, T4 in the bloodstream
deficient
hypothyroidism causes
Hashimotos (autoimmune)
atrophy associated with agin
iodine deficiency
hyperthyroidism treatment
cause of secondary hypothyroidism
inadequate secretion of TSH
pituitary gland issue
does hypothyroidism have a fast or slow onset?
slow
s/sx of hypothyroidism
decreased HR anemia decreased appetite weight gain constipation dry, thick, cold skin thick nails dry, coarse hair puffy face SOB on exertion cold intolerance sleepiness
mis-Dx hypothyroidism is r/t
aging
meds that depress the CNS and should used with caution if a pt has hypothyroidism
opioids
barbituates
anesthesia
accumulation of mucopolysaccharides in the dermis and other tissue
myxedema
s/sx of myxedema coma
slow, gradual onset progressive drowsiness, lethargy below subnormal temperature* hypotension* hypoventilation*
causes of myxedema coma
infection
meds (CNS depressants)
exposure to cold
trauma
what metabolic state will a myxedema coma pt be in?
respiratory alkalosis
kidneys will retain bicarb
myxedema coma treatment
IV thyroid hormone - STAT
airway management - possible vent
temperature management - warmer
TSH, T3, T4 will be low or high with primary hypothyroidism
TSH - high
T3, T4 - low
issue is with the thyroid gland
TSH, T3, T4 will be low or high with secondary hypothyroidism
TSH - low
T3, T4 - low
issue is with the anterior pituitary gland
best time to administer Synthroid
first thing in AM; on an empty stomach
what to educate pts on when taking Synthroid
report chest pain immediatley
initial dose of Synthroid will be low or high
low
dose may be increased q4-6 weeks depending on labs
is Synthroid a short-term or life-long med?
life-long
side effects of synthroid
insomnia
hyperthyroidism s/sx
what to assess weekly if taking Synthroid
pulse
hypothyroidism pts activities should be ___ out with lots of ___ periods
spaced; rest
hypothyroidism nursing interventions
provide extra clothes, blankets protect from drafts increase fiber, fluids in diet low calorie diet administer stool softeners PRN avoid use of heating pads, electric blankets*
mental alertness should increase within ___ - ___ days after treatment
2-14 days
myxedema coma nursing interventions
cardiac monitoring mechanical ventilation monitor temp/warming needed monitor for MI report angina administer all meds IV **incase of paralytic ileus
how many parathyroid glands are on the thyroid gland
4; posterior thyroid gland
parathyroid gland regulates which 2 electrolytes via parathormone (PTH)
Ca; Ph
PTH increases __ by increasing absorption from they ___, ___, and ___.
Ca
kidney, intestines, bone
does PTH increase or decrease Ph
decreases
remember Ca + Ph have an inverse relationship
s/sx of hyperparathyroidism mimic those with
hypercalcemia
hyperparathyroidism treatment
surgical removal of parathyroid tissue
hydration therapy
hypercalcemic crisis treatment
IV bolus isotonic solution (NS)
calcitonin + corticosteriods
