Hyper/Hypo Thyroidism Flashcards
Hyperthyroidism
- A sustained increase in synthesis and release of thyroid hormones by thyroid gland
Hyperthyroidism occurs more often in men or women?
women
-
Highest frequency in Hyperthyroidism is found in what age group?
20- to 40-year-olds
Common symptoms of Hyperthyroidism in a younger adult?
nervousness, irritability, weight loss, heat intolerance, warm/moist skin
Common symptoms of Hyperthyroidism in an older adult?
anorexia, weight loss, apathy, lassitude, depression, confusion
medical term for lack of energy?
Lassitude
Lassitude
medical term for lack of energy?
Cardiac symptoms of Hyperthyroidism in a younger adult?
tachycardia, palpitations, no HF
Cardiac symptoms of Hyperthyroidism in an older adult?
- angina
- dysrhythmia (esp. A-Fib RVr)
- HF
Most common cause of Hyperthyroidism?
Graves’ disease-autoimmune
Causes of Hyperthyroidism?
- Graves’ disease-autoimmune
- Thyroiditis
- Toxic nodular goiter
- Exogenous iodine excess
- Pituitary tumors
- Thyroid cancer
Clinical syndrome of hypermetabolism resulting from increased circulating levels of T3, T4, or both
Thyrotoxicosis
Thyrotoxicosis
Physiologic effects/clinical syndrome of hypermetabolism resulting from increased circulating levels of T3, T4, or both
- heat intolerance
- weight loss
- palpitations
- weakness/fatigue
What two conditions occurring together is known as Grave’s disease?
Hyperthyroidism and Thyrotoxicosis
Causes of Grave’s disease?
- Insufficient iodine supply
- Infection
- Stressful life events interacting with genetic factors
- Cigarette smoking
General Signs and Symptoms Of Hyperthyroidism?
- Weight loss-despite increased appetite
- Nervousness-inability to concentrate
- rapid pulse
- heat intolerance
- ↑ Sensitivity to stimulant drugs
- Elevated basal temperature
- Goiter
- Ophthalmopathy
Protrusion of eyeballs from the orbits
Exophthalmos
Exophthalmos
Protrusion of eyeballs from the orbits
Cardiovascular System Signs and Symptoms/Complications of Hyperthryoidism?
- Bruit over thyroid gland
- Systolic hypertension
- ↑ Cardiac output
- Dysrhythmias
- Cardiac hypertrophy
- Atrial fibrillation
GI System Signs and Symptoms/Complications of Hyperthryoidism?
- ↑ Appetite, thirst
- Weight loss
- Diarrhea
- Splenomegaly
- Hepatomegaly
Integumentary System Signs and Symptoms/Complications of Hyperthryoidism?
- Warm, smooth, moist skin
- Thin, brittle nails
- Hair loss
- Clubbing of fingers
- Diaphoresis
- Vitiligo
Musculoskeletal System Signs and Symptoms/Complications of Hyperthryoidism?
- Fatigue
- Muscle weakness
- Proximal muscle wasting
- Dependent edema
- Osteoporosis
Swelling and clubbing of the fingers associated with Grave’s disease?
Acropachy
Acropachy
Swelling and clubbing of the fingers associated with Grave’s disease
Nervous System Signs and Symptoms/Complications of Hyperthryoidism?
- Fine tremors
- Insomnia
- Lability of mood, delirium
- Hyperreflexia of tendon reflexes
- Inability to concentrate
Reproductive System Signs and Symptoms/Complications of Hyperthryoidism?
- Menstrual irregularities
- Amenorrhea
- Decreased libido
- Impotence
- Gynecomastia in men
- Decreased fertility
Diagnostics for Hyperthyroidism?
- Physical Assessment
- Decreased TSH levels (<0.4mIU/L)
- Elevated Thyroxine (free T4)
- Radioactive iodine uptake test
- Graves 35-95% uptake
- Thyroiditis less than 2%
Causes of Thyrotoxic crisis or Thyroid Storm?
infection, trauma, or surgery with preexisting hyperthyroidism
S/S of Thyrotoxic crisis-thyroid storm?
tachycardia, HF, shock, hyperthermia (up to 106F), restlessness, n/v
Treatmentof Thyrotoxic crisis-thyroid storm?
decrease thyroid hormone, control fever, fluid replacement, decrease/eliminate stressors
Tx of Hyperthyroidism?
Antithyroid drugs Iodine Radioactive Iodine Therapy B-Adrenergic Blocker Surgical therapy Nutritional Therapy
Antithyroid drugs-inhibit the synthesis of thyroid hormone
Methimazole
Methimazole
Antithyroid drugs-inhibit the synthesis of thyroid hormone
Why is Iodine given to pts as treatment for hyperthyroidism?
Inhibit synthesis of T3 and -T4, block release of hormones
Inhibit synthesis of T3 and T4, block release of hormones
Iodine
B-Adrenergic Blocker
- Tx for thyrotoxicosis
- Blocks SNS, decrease tachycardia, nervousness, irritability, tremors
- Tx for thyrotoxicosis
- Blocks SNS, decrease tachycardia, nervousness, irritability, tremors
B-Adrenergic Blocker
Nutritional Therapy for Hyperthyroidism?
- High calorie diet (4-5K cal/day)
- Six full meals
- High proteins, carbs, minerals, and vitamin
- Avoid caffeine
Preferred surgical procedure for Hyperthyroidism?
Subtotal thyroidectomy
Complications from surgical tx of Hyperthyroidism?
- Damage or removal of the parathyroid gland may cause:
- Hypoparathyroidism and hypocalcemia
- Hemorrhage
- Infection
- Laryngeal nerve damage
- Tracheal compression
Harsh vibratory sounds heard with respirations following surgical tx of hyperthyroidism?
Laryngeal stridor
Post-op Nursing Assessment/Interventions surgical tx of hyperthyroidism?
- Vitals Q 2 hours
- hemorrhage
- tracheal compression
- Frequent swallowing
- Sensation of fullness
at incision site - Blood on dressing
- Semi-fowlers position-support neck, avoid hyper extension
- assess for Laryngeal Stridor
- Hypocalcemia for 72 hours
- Treat pain
Signs of a tracheal compression following surgical tx of hyperthyroidism?
- Frequent swallowing
- A sensation of fullness at the incision site
- Blood on dressing
Post-op Nursing Teaching for surgical tx of hyperthyroidism?
- C&DB
- Leg exercises
- Support head manually while turning in bed
- ROM neck exercises
- Decrease caloric intake,
- Decrease exercise
- avoid high temps
- life long thyroid replacement
Discharge Teaching
Subtotal thyroidectomy?
- Monitor for signs of hypothyroidism
- Will not take a thyroid replacement
- Need some iodine – normal use of iodized salt
- Regular exercise
- Avoid extreme environmental temperatures
- Decrease calorie intake
- Regular follow-up care
Discharge Teaching Total thyroidectomy?
- Will be on a lifelong thyroid replacement
- Decrease calorie intake
- Regular follow-up care
most common cause
of Hypothyroidism world wide?
Iodine deficiency
Causes of Hypothyroidism
- Insufficient circulating thyroid hormone
- Primary-destruction of thyroid tissue or defective hormone replacement
- Secondary-pituitary disease
- treatment of hyperthyroidism
- Iodine deficiency
Secondary Hypothyroidism is cause by?
pituitary disease
risk factors of Hypothyroidism?
Female, white ethnicity, advancing age, type 1 diabetes, Down syndrome, family history, goiter, previous hyperthyroidism, previous radiation treatment
S/S of Hypothyroidism
- NO symptoms to classic symptoms
- Fatigue, muscle weakness, and edema
- Cold, dry skin
- Hair loss
- Constipation
- Cold intolerance
- Impaired memory and confusion
- Weight gain
- Lethargic, lacks initiative, Slow speech, personality changes
- Brittle nails
- Hoarseness
- Menorrhagia
Cardiovascular System Signs and Symptoms/Complications of Hypothyroidism?
- ↓ Cardiac contractility and output
- ↑ Serum cholesterol and triglycerides
- Anemia
Diagnostics of Hypothyroidism?
- TSH
- ↑if thyroid function is ↓
- ↓ if problems with pituitary gland or hypothalmus
- ↓ Thyroxine (free T4)
- ↑ Cholesterol & triglycerides
- ↓ RBCs
Treatment of Hypothyroidism?
- Levothyroxine (Synthroid)
- REPORT HR > 100 bpm or CP IMMEDIATELY
- Life long therapy – take in AM on empty stomach
Levothyroxine (Synthroid) side effects?
- weight loss
- nervousness
- tremors
- insomnia
Complications of Hypothyroidism?
- Mental sluggishness, drowsiness and lethargy progress gradually or suddenly to impairment of consciousness or coma
- Myxedema Coma
s/s of Myxedema Coma
- low temp
- hypotension
- hypoventilation
- puffiness
- periorbital edema
- mask-like effect
Treatment for Myxedema coma?
- Monitor cardiac function
- Monitor core body temperature
- Mechanical respiration support
- IV hormone replacement
Patient presents with diagnosis of hypothyroidism, low temp, hypotension, hypoventilation. What condition is expected?
Myedema coma
s/s of overdose of hypothyroidism treatment?
- orthopnea,l
- dyspnea
- rapid pulse
- palpitations,
- nervousness
- insomnia
