Hyperthyroidism & Thyroid Storm Flashcards
What 3 hormones does the thyroid gland produce?
Thyroxine (T4)
Triiodothyronine (T3)
Thyrocalcitonin (calcitonin)
What regulates the secretions of the T3 & T4 hormones?
Anterior pituitary gland through the negative feedback mechanism.
What is the negative feedback mechanism?
When T3 & T4 levels get low the negative feedback mechanism is activated releasing TSH to stimulate the thyroid glad to secrete more hormones until normal levels are reached then it stops secreting TSH to stop the production of hormones to prevent an imbalance from occurring
What happens when T3 & T4 levels decrease?
The anterior pituitary gland releases the thyroid-stimulating hormone (TSH) - this stimulates the thyroid to secrete more hormones until normal levels are reached
What affects does T3 & T4 have on the body systems?
Regulates body metabolism, energy production, and fluid and electrolyte balance
Controls tissue use of fats, proteins, and carbs
What does the body use calcitonin for?
Prevents calcium from leaving the bones and reduces blood calcium levels
What is hyperthyroidism?
Disorder caused by an excessive amt of thyroid hormone circulating in the blood stream causing the body to be in a state of hypermetabolism.
What causes hyperthyroidism?
Autoimmune antibodies mimic TSH causing a hyper-secretion of thyroid hormones.
Grave’s disease is the most common cause.
What is Grave’s disease?
Auto immune disease that causes overactivity of the thyroid gland
Labs to monitor
Serum TSH (decreased if disease present)
Free thyroxine index (FTI) and T3 - will be elevated if present
Thyrotropin-releasing hormone (TRH) stimulation: failure of expected rise in TSH
Causes of False elevated levels
Recent use of contrast median and oral contraceptives
Cause for false decreases in thyroid levels
Severe illness, malnutrition, use of aspirin, corticosteroid, and phenytoin sodium
S/S of hyperthyroidism
Heat intolerance, exophthalmos, palpitations, wt. loss, excessive sweating, insomnia, HTN
Nursing Interventions for hyperthyroidism
Administer antithyroid medication: (METHIMAZOLE - Tapazole)
Admin beta blocker to begin stabilization process
Admin iodine-containing meds to prevent the release of stored thyroid hormones
Monitor nutritional status, INOs, LOC and VS
Maintain a calm environment
What is the stabilization process?
Stabilization process should begin ASAP: beta blockers are given to help decrease the risk of cardiac effects, such as tachycardia and atrial fibrillation
What beta blocker should be used as part of the stabilization process with a patient with a history of asthma and why?
Metoprolol (Lopressor) bc it is a cardioselective and will not have any effects on the respiratory tract.
What is a thyroid storm?
Also known as thyrotoxic crisis: results from a sudden surge of a large amt of thyroid hormones into the blood stream, causing an even greater increase in the body’s metabolism
MEDICAL EMERGENCY with high mortality
Precipitating factors for a thyroid storm
Infection, trauma, emotional stress, and subtotal thyroidectomy
S/S of a thyroid storm
Hyperthermia, hypertension, delirium, vomiting, abdominal pain, tachydysrhytmias
Nursing Intervention for Thyroid Storm
Maintain airway, continuous telemetry monitoring for dysrhythmias, Tylenol for fever, cool sponge baths or ice packs, administer medications as ordered, admin IV fluids, monitor INOs and BG (admin insulin as ordered PRN), O2 PRN
S/S of thyroid storm in an older adult are…
Subtle and even absent
Older adults with hyperthyroidism normally presents with?
Heart Failure and Atrial Fibrillation
What 3 types of medications need to be administered for treatment of hyperthyroidism?
A beta blocker (metoprolol), a antithyroid (Methimazole) and an Iodine-containing medication.
What does an Iodine-containing medication do, when used to treat hyperthyroidism?
Prevents the release of stored thyroid hormones
What does Metroprolol help treat, when used for treatment of hyperthyroidism?
Treats sympathetic nervous systems symptoms: Heart palpitations and tachy.
What is Methimazole used for?
To block thyroid hormones from being released.
What dietary changes should be made for a patient with hyperthyroidism?
Increased Calories and Increased Protein
What patient/family education should be done regarding behavior changes in a patient with hyperthyroidism?
Behavior should return to normal with antithyroid treatment
