Final Exam: Disorders of the Thyroid Gland (Unit 11) Flashcards
The Thyroid produces what 3 hormones ?
- Thyroxine (T4)
- Triiodothyrone (T3)
- Calcitonin
90% of hormone secreted by the Thyroid is what ?
Thyroxine (T4)
Which Thyroid hormone is more potent, T3 or T4 ?
T3
The Thyroid gland works in what type of feedback loop ?
Negative
When circulating levels of thyroid hormone are low, _______ (_________ _______________ __________) is released by the hypothalamus ?
TRH (Thyrotropin releasing hormone)
When TRH is released by the hypothalamus, it causes what ?
causes TSH (thyroid stimulating hormone) to be released by the anterior pituitary gland)
TSH stimulates the production and release of what ?
T3 and T4 in the thyroid
Where is TSH produced ?
Anterior pituitary gland
Thyroid cells are stimulated to grow, which may result in what ?
Overactive (hyperthyroidism) or Underactive (hypothyroidism) thyroid
The most common cause of Thyroid issues worldwide is what ?
Lack of iodine in the diet
In the US what is the most common cause of thyroid issues ?
Over or under production of thyroid hormones or nodules that develop
What is a Goiter ?
Enlargement of the Thyroid
_____ & ____ levels are measured to determine whether a goiter is associated with hyperthyroidism, hypothyroidism, or normal thyroid function ?
TSH & T4
Thyroid __________ are measured to assess for thyroiditis (inflammation of the thyroid) ?
Antibodies
What is the Tx for Goiters to prevent further enlargement ?
Tx with thyroid hormones
What is the Tx for large Goiters ?
Surgery
What is Levothyroxine ?
Synthetic thyroid hormone
Thyroid nodules may be _______ (95%) or __________ ?
Benign (95%) or Malignant
Most thyroid cancers are what ?
Treatable
What is a Sign of Thyroid Cancer ?
Presences of painless, palpable nodule(s) in an enlarged thyroid gland
Thyroid cancer can metastasize to what ?
cervical nodes, and obstruct trachea
What are s/s of an enlarged thyroid gland ?
- Changes in voice (increased Hoarseness)
- Difficulty swallowing
What is the best diagnostic test to test for Malignant Thyroid cancer ?
Ultrasound-guided fine-needle aspiration
What is the Tx for Thyroid nodules and cancer ?
- Radiation
- Partial or total thyroidectomy
What Is Thyroiditis ?
Inflammation of the thyroid gland
Acute thyroiditis is due to what type of infections ?
Bacterial or Fungal infections
Subacute granulomatous thyroiditis is thought to be cause by what type of infection ?
Viral infection
What is another name for Chronic autoimmune thyroiditis ?
Hashimoto’s thyroiditis
What is Hashimoto’s thyroiditis ?
Thyroid tissue is replaced by lymphocytes and fibrous (scar) tissue
Recovery from thyroiditis (viral, bacterial, fungal) usually occurs when ?
within weeks to months
Acute thyroiditis caused by bacteria can be treated how ?
with Antibiotics
How can subacute thyroiditis (viral) be treated ?
NSAIDS
Myxedema coma falls under what type thyroid dysfunction ?
Hypothyroidism
Thyroid storm falls under what thyroid dysfunction ?
Hyperthyroidism
________________: A sustained increase in synthesis and release of thyroid hormones by the thyroid gland ?
Hyperthyroidism
Hyperthyroidism occurs most frequently in who ?
Women
highest frequency in 20 to 40 year olds
What is the most common form of Hyperthyroidism ?
Grave’s disease
What are other causes of Hyperthyroidism ?
- Thyroiditis
- Toxic nodular goiter
- Exogenous iodine excess
- pituitary tumors
- Thyroid cancer
What is another name for Thyrotoxicosis ?
Thyroid storm
What does Thyrotoxicosis (AKA: thyroid storm) result from ?
excess circulating levels of T3, T4, or both
_______________ and ________________ occur together in Grave’s disease ?
Hyperthyroidism and thyrotoxicosis
Grave’s disease is characterized by what ?
- Diffuse thyroid enlargement
- Excessive thyroid hormone secretion
Grave’s disease accounts for ____% of cases of hyperthyroidism ?
75%
Graves disease may progress to what ?
Destruction of thyroid tissue, causing hypothyroidism
What is the patho/etiology of Graves disease ?
Overproduction of T3 and T4
What are the clinical manifestations of Graves’ disease/Hyperthyroidism ?
- Increased metabolism
- Increased tissue sensitivity to stimulation by sympathetic nervous system
- Abnormal eye appearance or function
- Exophthalmos
What is Exophthalmos ?
Protrusion of eyeballs from the orbits
Cardiovascular manifestations such as…
- Bruit over thyroid gland
- Systolic hypertension
- increased cardiac output
- Dysrhythmias
are seen with what type of Thyroid dysfunction ?
Graves’ disease (Hyperthyroidism)
GI manifestations such as…
- increased appetite
- thirst
- weight loss
- diarrhea
- Hepatosplenomegaly
are seen with what type of Thyroid dysfunction ?
Graves’ disease (hyperthyroidism)
Integumentary manifestations such as…
- Warm, smooth, moist skin
- Thin, brittle nails
- Hair loss
- Clubbing of fingers
Are seen in what type of Thyroid dysfunction ?
Graves’ disease (Hyperthyroidism)
Musculoskeletal clinical manifestations such as…
- Fatigue
- Muscle weakness
- Proximal muscle wasting
- Dependent edema
Are seen in what type of Thyroid dysfunction ?
Graves’ disease (Hyperthyroidism)
Nervous system manifestation such as…
- Fine tremors
- Insomnia
- Ability of mood
- Delirium
- Hyperreflexia of tendon reflexes
- Inability to concentrate
Are clinical manifestation of what ?
Graves’ disease (Hyperthyroidism)
Reproductive manifestations such as….
- Menstrual irregularities
- Amenorrhea
- Decreased libido
- Impotence
- Decreased fertility
Are clinical manifestations of what ?
Graves’ disease (Hyperglycemia)
General clinical manifestations such as…
- intolerance to heat
- increased sensitivity to stimulant drugs
- Elevated basal temperatures
Are clinical manifestations seen with what ?
Graves’ disease (Hyperthyroidism)
What laboratory values are used to confirm Hyperthyroidism ?
- Decreased TSH
- Elevated T3 & T4 levels
What are the Tx goals of Hyperthyroidism ?
- Block adverse effects of thyroid hormones
- Stop hormone oversecretion
What are 3 primary Tx options for Hyperthyroidism ?
- Anithyroid medications
- Radioactive iodine therapy (RAI)
- Subtotal thyroidectomy
In general, what is the treatment of choice for Hyperthyroidism ?
Radioactive iodine therapy
True or False: Hyperthyroidism is not considered curative ?
True
How does Iodine work to treat Hyperthyroidism ?
Large doses rapidly inhibit the synthesis of T3 and T4 and block their release into circulation
True or False: long term iodine therapy in not effective in treating Hyperthyroidism ?
True
How do Antithyroid drugs work to treat Hyperthyroidism ?
Inhibit the synthesis of Thyroid hormone
How does Iodine work in the body to treat Hyperthyroidism ?
Large doses rapidly inhibit the synthesis of T3 & T4 and block their release into circulation
(maximal effect seen within 1-2 weeks)
What are First-line examples of Antithyroid drugs ?
- Propylthiouracil (PTU)
- Methimazole (Tapazole)
What is the treatment of choice for Hyperthyroidism in non pregnant adults ?
Radioactive iodine therapy (RAI)
How does RAI work ?
Damages or destroys thyroid tissue
There is a High incidence of what after Radioactive iodine when used to treat Hyperthyroidism ?
Post-treatment Hypothyroidism
Pt’s who undergo Radioactive iodine therapy (RAI) for hyperthyroidism, need lifelong what ?
Lifelong thyroid hormone replacement
Why do pt’s who undergo Radioactive Iodine therapy need lifelong thyroid hormone replacement ?
B/c RAI therapy damages or destroys thyroid tissue
Of the 2 thyroid disorders (Hypo & Hyper), which one is easier to treat ?
Hypothyroidism
Pt’s with acute thyrotoxicosis or pt’s undergoing thyroidectomy require what type of care ?
Hospitalization and acute care
What is a Thyrotoxic crisis (aka Thyroid storm) ?
Acute, rare condition, where all Hyperthyroid manifestations are heightened
True or False: A Thyrotoxic crisis (aka thyroid storm) is a Life-threatening emergency ?
True
What are Manifestations of a thyrotoxic crisis (aka thyroid storm) ?
- Tachycardia
- Heart failure
- Shock
- Hyperthermia
- Restlessness
- Agitation
- Seizures
- Nausea
- Vomiting
- Diarrhea
- Delirium
- Coma
What is the Tx goal for a Thyrotoxic crisis (aka thyroid storm) ?
Decrease thyroid hormone levels and clinical manifestations with drug therapy
Acute Thyrotoxicosis requires what ?
Agressive treatment
what do we want to administer in acute thyrotoxicosis ?
administer medications to block thyroid hormone production
Why do we want to administer IV fluids in pt’s suffering from Acute Thyrotoxicosis ?
B/c of dehydration from increased metabolism
True or False: in pt’s suffering from Acute Thyrotoxicosis, we want to change linens frequently if diaphoretic ?
True
With Acute Thyrotoxicosis, we want to apply what to relieve eye discomfort ?
artificial tears
True or False: with Acute Thyrotoxicosis, we want to elevate the HOB ?
True
True or False: In pt’s with Acute Thyrotoxicosis, we want to restrict salt for edema ?
True
What type of diet is usually ordered for pt’s with Hyperthyroidism ?
High-calorie diet
(usually need 4,000 - 5,000 cal/day)
- To compensate for the increased metabolism
When talking about Nutrition therapy for Hyperthyroidism, pt’s should Avoid what ?
Avoid:
- caffeine
- highly seasoned foods
- high fiber foods
(to not add to SNS effects on CV and GI system)
What are indications that Surgery should be done as therapy for Hyperthyroidism ?
- Unresponsive to drug therapy
- Large goiters causing tracheal compression
- Possible malignancy
- Individuals who are not a good candidate for RAI therapy
What MUST be at the bedside of pt’s who just had Thyroid surgery ?
- Oxygen
- Suction equipment
- Tracheostomy tray
(B/c they just had neck surgery & edema may cause airway obstruction and need for emergent trach)
True or False: You should support the head while turning in bed ?
True !
Don’t want to stress the sutures in the neck
True or False: Its who just had Thyroid surgery, may have speaking difficulty for a short time after surgery ?
True
What should we assess for postoperatively in pt’s who just had Thyroid surgery ?
Assess for tracheal compression & signs of hemorrhage
What are signs of Tracheal compression ?
- Irregular breathing
- Neck swelling
- Frequent swallowing
- Choking
Frequent swallowing after Thyroid surgery is a sign of what ?
Hemorrhaging (swallowing the blood)
What position should pt’s be in after Thyroid surgery ?
Semi-Fowler’s position
- support head with pillows
- Avoid flexion of neck
What is Laryngeal stridor ?
Harsh vibratory sound that can occur during inspiration or expiration, due to edema on the larynx
What mineral should you think of when you hear Parathyroid gland ?
CALCIUM & phosphorus
Post-op from Thyroid surgery, what should you check for signs of ?
Hypocalcaemia
What are signs of Hypocalcaemia ?
- Numbness and tingling around the mouth
- tetany
- Trousseau’s sign
- Chvostek’s sign
What does Trousseau’s sign present as ?
Carpal spasms induced by inflating a blood pressure cuff on the arm.
(pressure on upper arm induces twitching)
What does Chvostek’s sign present as ?
Contraction of the facial muscle in response to a tap on the facial nerve in front of the ear
Surgery on the Thyroid gland can inadvertently harm what ?
Harm the Parathyroid gland
Some hoarseness is expected for ___ to ___ days after Thyroid surgery ?
3 to 4
What is important discharge teaching for pt’s who just had Thyroid surgery ?
They will require Lifelong thyroid replacement
b/c they just removed the thyroid gland, so they can no longer make thyroid hormones
Pt’s with Hypothyroidism have what type of metabolism ?
SLOWER metabolic rate
What does Hypothyroidism result from ?
Insufficient circulating thyroid hormone
What is the most common cause of Hypothyroidism worldwide ?
Iodine deficiency
and most prevalent in iodine deficient areas
In places where iodine intake is adequate (USA), what is the primary cause ?
atrophy of the thyroid gland
Hypothyroidism may develop b/c of treatment for what ?
Hyperthyroidism
What 2 drugs can produce hypothyroidism ?
- Amiodarone
- Lithium
Hypothyroidism can vary depending on what ?
- Severity
- Duration
- Age of onset
Systematic effects of Hypothyroidism are characterized by what ?
Slowing of body processes
Onset of symptoms for Hypothyroidism may occur when ? Unless it occurs after what ?
Over months to years
- Unless it occurs after: thyroidectomy, thyroid ablation, Tx w/ antithyroid drugs
How do symptoms present in pt’s with Hypothyroidism ?
Ranges from no symptoms to classic symptoms
physical changes easily detected on examination
What are some clinical manifestations of Hypothyroidism ?
- decreased cardiac output
- decreased cardiac contractility
- decreased motility (GI)
- constipation
- fatigued & Lethargic
- slowed speech
- personality and mood changes
- cold intolerance
- hair loss
- dry coarse skin
- thick, brittle nails
- hoarseness
- muscle weakness and swelling
- weight gain
Those with severe long-standing hypothyroidism may display what ?
Myxedema
What does Myxedema cause ?
- Puffiness
- Periorbital edema
- masklike effect
How does hypothyroidism present Lab value wise ?
- TSH (may be high or low depending on cause)
- T3 & T4 will be low
What kind of diet should individuals with Hypothyroidism be on and why ?
Low-calorie diet b/c of slow metabolism/weight gain
What is a drug that is used to treat Hypothyroidism ?
Levothyroxine (Synthroid)
- must take regularly
True or False: Myxedema coma is a medical emergency ?
True!
True or False: Most individuals do not require acute nursing cure for general Hypothyroidism ?
True
Managed on outpatient basis
Individuals with Myxedema coma require ______ nursing care ?
acute
What are complications of Myxedema ?
- Mental sluggishness
- Drowsiness
- Lethargy progressing gradually or suddenly to impairment of consciousness or coma
- Myxedema coma
What are common features of myxedema ?
- Dull, puffy skin
- Coarse sparse hair
- Periorbital edema
- Prominent tongue
True or False: Soap should be used sparingly in pt’s with Hypothyroidism ?
True
In pt’s with Hypothyroidism, we need to emphasize the need for a ________ environment ?
Warm
