Hyperthyroidism & HYPOTHYROIDISM Flashcards
What is the most common type of hyperthyroidism
The autoimmune disease called Graves’ disease
What are signs and symptoms of hyperthyroidism
Hyper metabolism( ^ appetite with weight loss)
Heat intolerance ( ^ sweating is the hallmark sign)
Widening pulse pressure
Systolic HTN
tachycardia ( 90-160), atrial fibrillation, dysrhythmias, palpitations
Angina, CHF ( decompensation leads to HF)
Increased peristalsis ( diarrhea), hyperactive bowel sounds
Nervousness, restlessness, insomnia
Fine tremors ( hyperreflexia)
Mood swings, decrease in concentration
Hair loss, smooth, warm skin, facial flushing
Amenorrhea
Libido increase then decreases as condition progresses
Graves’ disease is most common in who
Females ages 20-40
What are signs and symptoms of Graves’ disease
Signs of hyperthyroidism AND enlarged thyroid gland ( goiter)
Proprosis ( forward displacement of eyes causing blurred vision, diplopia, lacrimation, and photophobia.)
Exophthalmos
Changes in menstration
What is exophthalmos
Forward protrusion of the eyes causing corneal dryness, irritation, ulceration ; it is a classic sign of Graves’ disease
The eyelids won’t close, give artificial tears to control dryness along with cool moist compresses, wear tinted glasses or eye shields to protect the eyes.
Elevate the bed 45 degrees to keep pressure off optic nerve.
What is toxic multinodular goiter
Nodules in thyroid tissue that secrete excessive thyroid hormone.
Is usually appears in woman 60-70 yrs of age, who had a goiter for a number of years
What is thyroid crisis
AKA thyroid storm or thyroidtoxicosis
It is a medical emergency, has a high mortality rate
Occurs with untreated hyperthyroidism
What can bring about thyroid crisis
Digoxin toxicity
Increase in stress
Extreme state of hyperthyroidism ( rare now)
Occurs with untreated hyperthyroidism or hyperthyroid person with stressors such as infection, trauma, manipulation of thyroid during surgery.
Why is thyroid crisis dangerous
It is a life threatening condition with excess metabolic symptoms such as temp of 102-106, HTN, tachycardia, and agitation advancing to seizures, psychosis, delirium.
What is treatment of thyroid crisis
Reducing thyroid secretion
Stabilizing cardiovascular system
Managing respiratory distress
What are diagnostic tests for hyperthyroidism
Serum thyroid antibodies ( TA)..... Antibodies in Graves' disease TSH test ( from pituitary) T3 & T4 RAI uptake test Thyroid suppression test
In diagnosing hyperthyroidism what will the clients TSH levels look like
They will be suppressed with primary hyperthyroidism
In diagnosing hyperthyroidism, what will the clients T3 &and ; T4 look like
They will be elevated
What is the RAI uptake test
Oral or intravenous dose of radioactive iodine 131 is given, then a thyroid scan after 24 hours, the size and shape of the gland is revealed. Uptake is increased with Graves’ disease.
What is thyroid suppression test
RAI and T4 are measured then remeasured after client takes thyroid hormone
( no suppression is noted with hyperthyroid
What is hyperthyroidism
Excessive delivery of thyroid hormone to peripheral tissues
It can be caused by excessive intake of medications ( exogenous) or neoplasms ( toxic multinodular goiter)
What are medications for hyperthyroidism
Antithyroid medications that block the synthesis of thyroid hormones such as; propylthiouracil (PTU) &; methimazole ( tapazole) more toxic than PTU
BETA BLOCKERS that controls symptoms such as tachycardia, tremor etc such as Propanolol ( Inderal) & atenolol ( temormin) for those with cardiac or asthma problems.
What is used to treat hyperthyroidism
Radioactive iodine therapy
The process includes iodine being taken up by the thyroid I which it concentrates in the thyroid gland and destroys cells, thus less hormone is produced
How is radioactive iodine therapy administered
Orally
Results occur in 6-8 weeks
DO NOT GIVE TO PREGNANT WOMAN
The client is often HYPOTHYROID after treatment
What is surgery for hyperthyroidism
Subtotal thyroidectomy: only part of the thyroid is removed
Total thyroidectomy to treat cancer of thyroid( client will need lifelong thyroid replacement).
What must be done prior to surgery for hyperthyroidism
Get client into a euthyroid state
Give potassium iodine prior to surgery to decrease size and vascular its of thyroid
What are post op concerns for surgery for hyperthyroidism
Airway: maintain airway; oxygen, suction, have tracheostomy set available.
Hemmorage: check neck dressing including posteriorly: it can compress the trachea.
Hypocalcemia: parathyroid glands may be removed or damaged, resulting in low calcium
For hypocalcemia what should be on hand
Calcium chloride or calcium gluconate
What is hypothyroidism
The thyroid gland produces insufficient amounts of thyroid hormone
What is myxedema
It is related to hyperthyroidism
It the the characteristic accumulation of non pitting edema in connective tissues throughout the body, water retention in mucoprotien deposits in interstitial spaces
More common in females ages 30-60.
What is the pathophysiology of hypothyroidism
Primary is more common There is a defect in the thyroid gland Congenital defects Post treatment of hyperthyroidism is a cause Iodine deficiency is a cause
The thyroid gland produces what hormones
Thyroxine T4
Triiodothyronine T3
Calcitonin
When serum T3 and T4 levels drop what occurs
TSH is released by the anterior pituitary, this stimulates the thyroid gland to secrete more hormones until normal levels are obtained
What does T3 and T4 affect
All body systems by regulating overall body metabolism, energy production, fluid and electrolyte balance, and controlling tissue use of fats, proteins, and carbohydrates
What does calcitonin do
It inhibits mobilization of calcium from bone and reduces blood calcium levels
Is TSH elevated or decreased in hyperthyroidism
Decreased
Radioiodine uptake
Clarifies the size and function of the gland
It is administered 24 hr prior to the test, then measured. And elevated uptake indicates hyperthyroidism
What are nursing considerations of radioiodine
Confirm the client is not pregnant
Recent use of contrast media and clients use of oral contraceptives may cause falsely elevated serum thyroid hormone levels.
Severe illness, malnutrition, and the use of aspirin, corticosteroids, phenytoin sodium may cause a false decrease in serum thyroid levels.
Inform provider if and iodine contrast was taken within 4 weeks of test.
What is client education regarding radioiodine
Advise to avoid foods high in iodine for one week prior to test
Suggest client uses noniodized salt, avoid fish, shellfish, and meds that contain iodine: reduce milk intake, avoid canned fruits and vegetables
Name 2 drugs that belong to the drug class thionamides
Methimazole ( tapazole)
Propylthiouracil (PTU)
What is the therapeutic effect of thionamides
Inhibits the production of thyroid hormone
What are thionamides used to treat
Graves’ disease
As an adjunct to radioactive iodine therapy
To decrease hormone levels in preparation for surgery
To treat thyrotoxicosis
What are manifestations of hypothyroidism
Intolerance to cold, edema, bradycardia, increase in weight, or depression
What are nursing considerations for administering thionamides
Monitor CBC for leukopenia or thrombocytopenia
Monitor for indications of hepatotoxicity
What is client education regarding thionamides
Take med with meals
Take in divided doses at regular intervals
Remind thionamides are typically take for 1-2 yrs
Advise to report fever, sore throat, or bruising
Report signs of jaundice
Name iodine solutions
Lugols solution
Saturated solution of potassium iodine ( SSKI)
They inhibit release of thyroid hormone
What are nursing considerations of iodine solutions such as lugol and SSKI
Short term use only
Administer 1 hr AFTER anti thyroid meds
Contraindicated in pregnancy
Mix with juice or milk to mask bad taste, use a straw to avoid staining teeth.
What are preprocedures for a thyroidectomy
Explain purpose of procedure
Tell them their will be an incision in the neck, a dressing and a possible drain.
Tell them a sore throat from intubation and anesthesia may be experienced
They are usually prescribed PTU or methimazole for 4-6 weeks prior to surgery
The client should receive iodine for 10-14 days before surgery, this reduces the gland size and prevents bleeding
Propranolol may be given to block Adrenergic effects
What are post procedure tasks for a thyroidectomy
Keep client in high fowlers
Avoid neck extension
Check site and back of neck for bleeding, be aware that respiratory distress can occur because of compression of the trachea due to hemorrhage or edema
What are complications of a thyroidectomy
Hypocalcemia and tetany can occur if parathyroid gland are damaged or removed indications are tingling of toes or around mouth, and muscle twitching. Check for positive Chvosteks and trousseau signs. Ensure calcium gluconate or calcium chloride are available
What is calcium gluconate and calcium chloride
A calcium supplement used for emergency treatment of hypocalcemia due to damaged of the parathyroid glands
What are findings of thyroid crisis
Hyperthermia, hypertension, delirium, vomiting, abdominal pain, hyperglycemia and tachydysrhythmias
Additional findings include chest pain, dyspnea, and palpitations
What is a expected lab finding of Graves’ disease
Decrease thyroid stimulating hormone
What are clinical manifestations of hyperthyroidism
Heat intolerance
Palpitations
Weight loss
What is recommended teaching for propranolol ( Inderal)
Take pulse before each dose
What should the nurse have on hand in PACU for a patient who is post thyroidectomy
Suction equipment
Humidified air
Tracheostomy tray
O2 delivery equipment
A client is newly diagnosed with Graves’ disease and is prescribed methimazole ( tapazole). What should be included in the plan of care
Monitor CBC because it can cause leukopenia, and thrombocytopenia
Monitor T3 because this med decreased thyroid hormone production
Take at the same time every day
Hypothyroidism is classified how
By age of onset
Cretinism
Is a state of severe hypothyroidism found in infants
When infants do not produce normal amounts of thyroid hormones, CNS development and skeletal maturation may be altered resulting in retardation of cognitive development, physical growth or both
What are the 3 classes of hypothyroidism
Cretinism
Juvenile hypothyroidism
Adult hypothyroidism
What are risk factor for hypothyroidism
Woman ages 30-60
Lithium
Amidarome
Inadequate intake of iodine
What are expected lab findings of hypothyroidism
T3, TSH, T4 levels will be decreased
Thyroid antibodies will be increased
Serum cholesterol will be increased
CBC will show anemia ( low HCT levels)
What are meds for hypothyroidism
Levothyroxine ( synthroid)
it increases the effects of warfarin and can increase the need for insulin and digoxin
What are meds that decrease the absorption of levothyroxine
Cimetidine ( Tagamet)
Lansoprazole ( prevacid)
Colestipol ( Cholestid)
What interfere with absorption of synthroid
Fiber supplements
Calcium
Iron
Antacids
When should synthroid be administered
1-2 hr before breakfast
Myxedema coma
Is a life threatening condition that occurs when Hypothyroidism is untreated or when a stressor occurs such as trauma, infection, HF, stroke or surgery.
Clients taking synthroid and suddenly stop are also at risk.
What are clinical manifestations of myxedema coma
Severely depressed respirations ( hypoxia, hypercapnia)
Decrease CO
lethargy, stupor, coma, hypothermia, bradycardia, hypotension, hyponatremia, cerebral hypoxia.
What is the expected range for T3
70-205
What is the expected range for T4
4-12
For a client experiencing myxedema coma what should the nurse anticipate to do
Observe cardiac monitor for inverted T wave
Observe for evidence of UTI
initiate IV fluids using 0.9% NaCl
Expect a prescription for synthroid IV bolus
