Hyper/Hypo Thyroid Flashcards
Hyperthyroidism
•Hyperthyroidism is a continuous excessive release of thyroid hormones
*women 20 to 40
Most common form of hyperthyroidism
Graves’ disease #1
Thyrotoxicosis
Graves’ disease
Autoimmune disease
•Diffuse thyroid enlargement
•Excess thyroid hormone secretion
•Eventual thyroid tissue destruction
Signs of hyperthyroidism
Related to effect of thyroid hormone excess
- Increased metabolism
Can hear a bruit over the thyroid
* Goiter
Exophthalmos (sign of hyperthyroidism and Graves’ disease)
Out pouch of the eyes
Need eye drops bc they can’t really close eyes
May need qauze w/ tape over eyes to sleep
Signs of hyperthyroidism
“Everything increased”
Bounding, rapid pulse Tachypnea Increased appetite, thirst 🥤 Weight loss (sudden) Diarrhea 💩 Thin, brittle nails💅🏼 Hair loss 💇🏼♀️ Acropachy: digital clubbing and swelling of fingers Diaphoresis 😓 Lack of ability to concentrate Lability of mood Insomnia 🥱 Nervousness, fine tremors Menstrual irregularities Eyelid retraction Intolerance to heat 🥵
Acute Thyrotoxicosis
Thyrotoxic crisis (thyroid storm)
What is it and signs ?
Excessive amount of thyroid hormones
* life threatening 😵
*** Increased agitation and confusion than they were already having
Severe tachycardia and possible heart failure
Diagnostic Studies for HYPERTHYROIDISM
- TSH
- Free thyroxine (free T4)
- Total T3 and T4
Hyperthyroidism Treatments
1) antithyroid
- tapazole, iodine, propranolol
2) radioactive iodine therapy (RAI)
3) surgery
Tapazole
“Methimazole”
Prevents production of thyroid hormone
- can’t stop medication (leads back to hyperthyroidism)
not pregnancy safe 🚫🤰🏽
monitor for HYPO (too much if med)
Iodine (SSKI)
What does it do?
How to take it ?
🔽 Vascularity (less bleeding) making surgery safer
Prevents T3 and T4 production
Mix with water and drink w/ straw to avoid teeth staining
Propranolol
Symptomatic relief (🔽HR)
Decreases tachycardia, nervousness, irritability, tremors
Given with antithyroid meds
Radioactive Iodine Therapy (RAI)
- Treatment of choice for most nonpregnant adults (preg test)
- RAI destroys thyroid tissue thus limiting thyroid hormone secretion
- Max effect may not be seen up to 3 months
- Therefore, pts are treated with antithyroid drugs and Propranolol during first 3 months of RAI
Patient teaching for RAI
Oral care for Parotiditis 🪥 Watch for HYPO Flush toilet 3 times bc it effects urine Avoid kids/preg women Stay 3 feet from people
Surgical therapy indication for HYPERTHYROIDISM
Why would they need surgery instead of medications?
- Large goiter causing tracheal compression
- Unresponsive to antithyroid therapy
- Thyroid cancer
- Not a candidate for RAI
Hyperthyroidism Nutritional Therapy
What foods do they need to increase?
What foods to avoid ?
🔼 cal (bc losing weight from that increased state)
🔼 protein
⬆️ carb
🚫 highly seasoned / high fiber foods or caffeine (bc body already In increased state)
Thyroidectomy Pre-op
What to give before surgery?
- Give medications to achieve euthyroid state
* Give iodine to decrease bleeding
Patient teaching for post-op:
Comfort and talking ?
- Comfort and safety measures: Head support with pillows and neck ROM (avoid flexion) to minimize suture line stress
- Talking may be difficult immediately post-op 🙊
Monitor for what complications post op throidectomy
1) Hemorrhage
- look/feel for 🩸 on back of neck
2) Laryngeal nerve damage
3) Laryngeal stridor
- harsh vibration could be something in airway
4) Hypocalcemia - bc parathyroid glands removed also
Maintain patent airway post op
- Oxygen, suction equipment, tracheostomy tray in patient’s room
- Monitor for stridor
- IV calcium readily available to treat tetany
Post op care
Assess for tracheal compression
Semi fowlers
Support head with pillows
Avoid tension on suture line (no neck flexion)
Diet after surgery for hyperthyroidism
🔽 calories
Monitor fiber intake
Regular exercise
Discharge teaching for partial thyroidectomy
Get blood drawn to monitor levels
Hypothyroidism
Deficiency in thyroid hormones
General slowing of metabolic rate
* women
Hypothyroidism can be caused by what 3 things
Iodine deficiency
Hashimoto’s thyroiditis: Atrophy of the gland
Thyroidectomy
Signs of HYPOTHYROIDISM
characterized by SLOWING of body processes
Tired /lethargic 🥱 impaired memory 🤔 low initiative weight gain Dyspnea Bradycardia Personality and mood changes Impaired memory, slowed speech, somnolence Constipation 💩 Cold skin 🥶 Dry, sparse, coarse hair 🌵 Puffy face
Myxedema (thyroid desert)
What is it ?
What are the signs ? (Face)
What can it lead too?
severe hypothyroidism
**facial puffiness🐡, facial and periorbital edema, and mask-like affect 🎭
•Can lead to myxedema coma and death if left untreated.
Myxedema coma
What is it Characterized by?
What is it treated with?
- medical emergency 🚨
Characterized by:
•Impaired consciousness
•Subnormal temp, hypotension hypoventilation
•Cardiovascular collapse
•Treated with IV thyroid hormone
General diagnostics comparison
Hyperthyroidism
•Decreased TSH
•Increased T3&4
- Hypothyroidism
- Increased TSH
- Decreased T3&4
Hypothyroidism diet
Low calorie, increased fiber “roughage”
Levothyroxine (Synthroid)
Drug of choice for HYPO (synthetic T3&4) Life long Monitor for signs of HYPER Every morning, empty stomach Pregnancy safe 🤰🏽
Myxedema coma acute care
What to monitor?
What to give ?
- Mechanical respiratory support
- Cardiac monitoring
- IV thyroid hormone replacement
- Monitoring of core temp 🤒
Patient teaching for hypothyroidism therapy
• life long therapy •Avoid stoping meds - relapse occur •Side effects of medication •Signs and symptoms of hypothyroidism and hyperthyroidism • Comfortable, warm environment • Avoid sedatives •Measures to minimize constipation
