HYPERTHYROIDISM Flashcards
Hypersecretion of thyroid hormones
Hyperthyroidism
Hyperthyroidism is also called
Thyrotoxicosis
Incidence of hyperthyroidism
Female (<40)
Most common cause of hyperthyroidism
Grave’s disease
It enhances the action of epinephrine and norepinephrine, increasing sympathetic activity and central nervous system
Thyroid hormones
Results to increased membrane permeability which leads to increased neuromuscular irritability
Hypocalcemia
Factors of Grave’s Disease (ANE)
Autoimmunity
Neoplasms
Excessive Intake of Thyroid Meds
Basic Concepts (MBH)
a. Increased Metabolic Rate (⬆️T3)
b. Increased Body heat production (heat intolerance)
c. Hypocalcemia (⬆️Thyrocalcitonin)
Manifestations (due to increased metabolism - WIH)
a. Weight Loss
b. Increased Appetite
c. Heat intolerance
Manifestations (due to activation of CNS and SNS - DiPaH)
a. Diaphoresis
b. Palpitation
c. Hypertension
Manifestation (due to hypocalcemia - HyNDiR)
a. Hyperactive bowel sounds
b. Nervousness
c. Diarrhea
d. Restlessness
Protrusion of one or both eye
Exophthalmos
Abnormal vertical wideness of the palpebral fissure
Von Graefe’s
Forehead remains smooth when one looks up
Joffroy’s
Forward displacement of the eye; the bulging of one or both your eyes from their natural position
Proptosis
Signs of Proptosis (BLEPD)
a. Blurred Vision
b. Lacrimation
c. Eye pain
d. Photophobia
e. Diplopia
Inhibits thyroid hormone synthesis and release
Iodides
Given before subtotal thyroidectomy; DOC for thyroid storm
Lugol’s solution
Rationale for giving Lugol’s solution before subtotal thyroidectomy
Makes hyperplastic thyroid less vascular
Give 2 example of iodides
a. Lugol’s Solution
b. Saturated Solution Potassium Iodide (SSKI)
Nursing Responsibilities for giving Iodide (MADiP)
a. Monitor for increased bleeding tendencies if taking anticoagulants
b. Assess for hypersensitivity to iodine
c. Dilute iodine sources: cold water, fruit juice
d. Provide drinking straw: causes permanent teeth stain
Common side effects (iodism) - MARIVACS
a. Metallic or Brassy Taste Mouth
b. Allergic Reaction
c. Rashes
d. Increased Salivation
e. Vomiting
f. Abdominal Pain
g. Coryza
h. Sore Gums
Inhibit Thyroid Hormone production
Thioamides
______Can be taken in ______ dose
Methimazole - 1 daily
Methimazole can be taken during pregnancy. T/F
F (contraindicated to pregnancy)
______ Must be taken in _____ doses
Prophythiouracil - 3 daily
Thioamides - Monitor for side effects (agranulocytosis/neutropenia with leukopenia) - DiFeRSS
a. Diarrhea
b. Fever
c. Rashes
d. Sore Throat
e. Sore Gums
Thioamides - other side effects (PruPeHALM)
a. Pruritus
b. Periorbital Edema
c. Hypothyroidism
d. Anorexia
e. Loss of taste
f. Menstrual changes
When should you administer thioamides? Rationale?
Administer at same time each day with meals to prevent thyroid storm
If taking warfarin with thioamides: WOF?
Bleeding
If taking lithium with thioamides: WOF?
Hypothyroidism
How long does it take for the full effect of thioamides to happen?
12 weeks
Overall nursing responsibilities when taking antithyroid medications - MWAdAv
a. Monitor BP, PR, and Weight
b. Weight gain indicates effectiveness of meds
c. Administer with meals to prevent GI irritation
d. Avoid ASA and iodine containing medications to elevate free thyroid hormone levels
Function of beta blocker
To control hypertension and tachycardia
Function of glucocorticoids
It inhibits the action of thyroid hormones
5/6 of the gland is removed
Subtotal thyroidectomy
Rationale for subtotal thyroidectomy
Leaves enough of the gland in place to produce adequate amount of thyroid hormone
Treats cancer of the thyroid and the client requires lifelong hormone replacement
Total thyroidectomy
Before surgery, client should be in as nearly euthyroid state as possible, assess (ViEWHG)
a. Vital Sign
b. Electrolyte Levels
c. Weight
d. Hyperglycemia
e. Glucosuria
Perioperative Care (Thyroidectomy) - TTPA
a. Teach client to support neck when sitting up in bed, while moving about and while performing deep breathing and coughing techniques
b. Teach to expect hoarseness: mild
c. Place on ECG
d. Administer meds as prescribed to prevent thyroid storm: Lugol’s solution, Propanolol, glucocorticoids
Postoperative Care (PP)
a. Provide comfort measures. Administer Analgesic pain meds
b. Position in semi-fowlers after recover and support head and neck with pillows
Postoperative Care - Hemorrhage (AMA)
a. Assess dressing if present and the area under/back of the neck and shoulders
b. Monitor BP and pulse
c. Assess tightness of dressing if present
Postoperative Care - Respiratory Distress (AHA)
a. Assess RR, rhythm, depth, and effort
b. Have suction equipment, oxygen, and a tracheostomy set available for immediate use
c. Assist with Deep Breathing and Coughing Exercise
Postoperative Care - Laryngeal Nerve Damage (LAMS)
a. Limit talking and assess for level of hoarseness
b. Assess for ability to speak aloud every hour, noting quality and tone of voice
c. Mild hoarseness is normal
d. Severe hoarseness indicates laryngeal nerve damage and notify physician
Observe for other signs of recurrent laryngeal nerve damage (SHiRRD)
a. Stridor
b. High pitched voice
c. Respiratory obstruction
d. Restlessness
e. Dysphagia
Due to calcium deficiency
Tetany
When does tetany occurs?
1-7 days after surgery
DOC for tetany
Calcium gluconate
S/s of tetany (3PsMC)
a. Paresthesia
b. Positive Chvostek’s sign
c. Positive Trousseaus
d. Muscle Twitching
e. Convulsion, Seizure
Extreme state of hyperthyroidism
Thyroid Storm
Thyroid Storm Factors
a. People with untreated hyperthyroidism
b. People with hyperthyroidism that have experienced infection, trauma, untreated DKA
Thyroid Storm Manifestations
a. High fever/ hyperthermia
b. Tachycardia
c. Dysrhythmia
d. Hypertension
e. Nausea and vomiting
f. Diarrhea
g. Restlessness
h. Confusion
i. Agitation
j. Irritability
k. Tremors/seizures
l. Delirium and coma
Collaborative Management (Thyroid Storm) - MAMIMU
a. Maintain patent airway and adequate ventilation
b. Administer antithyroid medication as prescribed
c. Monitor VS, I and O, neurologic status, cardiovascular status every 1 hour
d. Implement measures to lower fever
e. Maintain quiet, calm, cool, private environment until crisis is over
f. Use cooling blanket
Patient teaching after thyroidectomy (SMHS)
a. Support neck with interlaced fingers when getting up from bed to prevent hyperextension of neck
b. Massage incision with cocoa butter lotion once healing occurs to minimize scarring
c. Have regular follow-up care
d. Start ROM exercises of the neck 3-4 days after discharge