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NUR 326 > Hypothyroidism and Hyperthyroidism > Flashcards

Hypothyroidism and Hyperthyroidism Flashcards

1
Q

Thyroid Dysfunction Scale

A
  • Comatose state: temp goes up, over 105
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2
Q

Thyroid System and Hormones

A
  • Hypothalamus and pituitary gland are getting feedback from the blood and body
  • Thyroid secretes based on the messages being given to them
  • If the thyroid hormone is super high, TSH level is low because the hypothalamus and pituitary are thinking they are producing too much
  • If thyroid is super low, hypothalamus is releasing more TRH to make more
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3
Q

Disorders of the Thyroid

A
  • Disorders of the thyroid is one of the most common endocrine issues alongside diabetes
  • Goiter: enlarged thyroid from hyper but can sometimes be due to hypo
  • Nodules (both benign and malignant): can see or feel little tumors
  • Hyperthyroidism and Hypothyroidism
  • Thyrotoxicosis: over extreme hyperthyroidism
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4
Q

Etiology of Thyroid Disorders

A
  • A sustained increase in synthesis and release of thyroid hormones by thyroid gland - most common form is Graves disease
  • Graves disease is a kind of hyperthyroidism and is an autoimmune disorder

Other causes:
- Toxic nodular goiter: enlarged and stimulating thyroid to overproduce and overgrow
- Thyroiditis: inflammation
- Excess iodine intake: need iodine to make the hormone
- Pituitary tumors: regulate the amount
- Thyroid cancer

  • Occurs more often in women
  • Highest frequency between ages 20-40
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5
Q

Graves Disease

A
  • Autoimmune disease
  • Diffuse thyroid enlargement
  • Excessive thyroid hormone secretion
  • Accounts for 80% of hyperthyroidism cases
  • Precipitating factors interact with genetic factors
  • Women 5 times more likely than men
  • People with Grave’s Disease often have other autoimmune disorders (RA, Addison’s, systemic lupus erythematosus (SLE))
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6
Q

Clinical Manifestations of HYPERthyroidism

A
  • Protruding eyes causing them to be swollen
  • Edema around the orbitals giving them a wide eyed look
  • Thyroid eye disease
  • Think of Tigger from Winnie the Pooh, HR is accelerating, BP is increasing, is gonna be sweaty from jumping around
  • Tachycardia
  • Hyperthermia
  • Tremor
  • Irritability, hyper
  • Increased appetite, burning calories all day while moving around
  • Losing weight, increased metabolism
  • Abnormal protrusion of the eyes
  • Insomnia, can’t relax
  • Lack of concentration
  • Heat intolerance
  • Hair falling out
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7
Q

Assessing for Acute Thyrotoxicosis

A

Also called Thyrotoxic Crisis or Thyroid Storm
- Excessive amounts hormones released
- Life-threatening emergency
- Death rare when treatment started early
- Results from stressors
- Thyroidectomy patients at risk

Clinical Manifestations:
- Severe tachycardia, heart failure
- Shock
- Hyperthermia (up to 106° F [41.1° C])
- Agitation
- Seizures
- Abdominal pain, vomiting, diarrhea
- Delirium, coma

Results from stressors in patient with hyperthyroidism:
- Infection
- Trauma
- Surgery
- Thyroidectomy

  • Client who was in hospital because they had part of thyroid removed (thyroidectomy), try to leave some in so client can still produce some of the hormone, surgery hyper stimulates the thyroid so we need to watch for s/sx of this
  • Would happen within first day after surgery
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8
Q

Diagnostic Studies

A
  • The primary laboratory findings used to confirm the diagnosis of hyperthyroidism are low or undetectable TSH levels (<0.4 mU/L) and increased free thyroxine (free T4) levels. Total T3 and T4 levels also may be assessed, but they are not as definitive. Total T3 and T4 determine both free and bound (to protein) hormone levels. The free hormone is the only biologically active form of these hormones. (Lewis)
  • The RAIU test can distinguish Graves’ disease from other forms of thyroiditis. The patient with Graves’ disease shows a diffuse, homogeneous uptake of 35% to 95%, while the patient with thyroiditis shows an uptake of less than 2%. The person with a nodular goiter has an uptake in the high normal range. (Lewis)
  • Hyperthyroid = low TSH but high T3 and T4
  • RAIU = see how much thyroid hormone is there
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9
Q

Nursing Diagnosis for HYPERthyroidism

A
  • Impaired comfort
  • Imbalanced nutrition: less than body requirements
  • Knowledge Deficit
  • Disturbed Sleep
  • Weight loss, not eating enough to keep up with metabolic
  • Insomnia because they are so wound up
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10
Q

Goals for the Client - HYPER

A
  • Relief of symptoms
  • No serious complications related to disease or treatment
  • Understand and Cooperate with therapeutic plan

Nursing Goals:
- Block adverse effects of thyroid hormones
- Suppress hormone oversecretion
- Prevent complications

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11
Q

Collaborative Care - HYPER

A

Three primary treatment options:
1. Antithyroid medications – work best for mild hyperthyroidism
- Too high of dosing can lead to hypothyroid issues
- Block formation of thyroid hormone by thyroid gland
- Propylthiouracil (PTU)
- Methimazole (Tapazole)

  1. Radioactive iodine therapy (RAI)
    - use iodine to take radioactive activity to take the thyroid gland; higher dose may need to stay away from other people
  2. Surgery
    - Thyroidectomy- usually subtotal to remove a large portion (up to 50-90%) of the thyroid
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12
Q

Nursing Interventions for Acute Thyrotoxicosis

A
  • Necessitates aggressive treatment
  • Give medications that block thyroid hormone production
  • Monitor for dysrhythmias
  • Ensure adequate oxygenation
  • Fluid and electrolyte replacement
  • Report it and provider will order hormone blocking medication
  • On monitors for tachycardia
  • May be diaphoretic and losing fluid
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13
Q

Nutritional Therapy - HYPER

A
  • High-calorie diet (4000 to 5000 cal/day)
    • Six full meals/day with snacks in between
    • Protein intake: 1 to 2 g/kg ideal body weight
    • Increased carbohydrate intake
  • Avoid highly seasoned and high-fiber foods, caffeine
  • Dietitian referral
  • High calorie until we get the thyroid blocking medication in the system
  • Bowels are hyperactive as well, think everything is increased, going to have diarrhea, high fiber would hurt them because it will make them go even more, highly seasoned foods can be irritating, caffeine is a stimulant and they are already hyped up enough
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14
Q

Evaluating Outcomes - HYPER

A
  • Were symptoms relieved?
  • No serious complications related to disease or treatment?
  • Does the client understand and is the client cooperating with therapeutic plan?
  • Successful in blocking adverse effects of thyroid hormones ?
  • Was hormone over-secretion suppressed?
  • Always checking blood levels
  • Start slow because we can put them into hypothyroid and overkill the treatment
  • Make sure client knows what to and not eat
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15
Q

Define hypothyroidism

A
  • Deficiency of thyroid hormone
  • Slow metabolic rate
  • More common in women than in men
  • Incidence increases with age, especially in those greater than 60
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16
Q

Clinical Manifestations - HYPOthyroidism

A
  • Too low of thyroid
  • Eeyore is hunched over, flat affect, seems depressed
  • Everything is slowed down
  • Will be constipated
  • Low BP
  • Cold/dry skin
  • Depression
  • Brittle hair
  • Decreased sweating
  • Fatigue
  • Expressionless face
  • Weight gain
  • Decreased cardiac contractility and output
  • Cold intolerance
  • Systemic effects characterized by slowing of body processes: decreased metabolism
  • Slow onset unless precipitated by ablation, surgical removal or overtreatment with hyperthyroid medications
    • Common initial complaints: fatigue, weight gain
17
Q

Primary vs. Secondary Hypothyroidism

A
  • Primary hypothyroidism
    • Problem with thyroid gland
    • Caused by destruction of thyroid tissue (atrophy) or defective hormone synthesis (Increased TSH and decreased T3, T4
  • Secondary hypothyroidism
    • Problem with pituitary or hypothalamus
    • Caused by pituitary or hypothalamic dysfunction (_ TSH or TRH)
  • Primary = thyroid
  • Secondary = pituitary or hypothalamus
18
Q

Etiology of Hypothyroidism

A
  • Iodine deficiency: Usually not a problem in developing countries because we supplement our salt since a lot of it is iodized
  • Atrophy of the gland: autoimmune disease or aging
  • Treatment for hyperthyroidism: Overtreated for hyperthyroidism can cause client to go into hypothyroidism
  • Other drugs: Other medications they are taking could interfere with production
  • Cretinism (infancy-congenital deficiency of thyroid hormone): Babies that are born with the inability
19
Q

Common Features of Myxedema

A
  • Swollen
  • Puffy
  • Tongue enlarged
20
Q

Nursing Assessment

A

Subjective
History
Hyperthyroidism treatment
Iodine-containing medications
Changes in appetite, weight
Activity level
Speech, memory, or skin changes
Objective
Physical examination
Cold intolerance
Constipation
Signs of depression
Decreased heart rate
Tenderness over thyroid gland
Edema
Tired
Gaining weight
I’ m not doing anything different

21
Q

Nursing Assessment

A

Asses for risk factors:
- Female
- White ethnicity
- Advancing age
- Type 1 diabetes
- Down syndrome
- Family history
- Goiter
- Previous hyperthyroidism
- Previous radiation treatment
- Overtreating somebody so we kill off too much of the hormone

22
Q

Diagnostic Studies

A

TSH and free T4
TSH _ with primary hypothyroidism
TSH _ with secondary hypothyroidism
_ freeT4
Thyroid antibodies: autoimmune
- Primary hypothyroid makes sense that the feedback is the thyroid is too low so they gotta speed it up, hypothalamus and pituitary are trying to do that but nothing happens as there is no increase in the thyroid hormone
- Secondary is when hypothalamus and pituitary cannot even process what is going on, there is something blocking it
- Checking for thyroid antibodies because if they are against the thyroid you have an autoimmune disease; body looks at it as a foreign object

23
Q

Nursing Diagnoses - HYPO

A

Imbalanced nutrition: more than body requirements
Constipation
Impaired memory
Fatigue
Eating too much, goes on a low calorie diet
Constipation uncomfy, peristalsis is slow, bloated
Teach them to eat high fiber, fluids, exercise, laxative, stool softener
Foggy brain with hypo, cant concentrate

24
Q

Client Goals - HYPO

A
  • Experience relief of symptoms
  • Maintain a euthyroid state by understanding and cooperating with therapeutic plan
  • Comply with lifelong thyroid replacement therapy: levothyroxine (Synthroid)
  • Maintain a positive self-image
25
Q

Nursing Interventions - HYPO

A
  • Restoration of euthyroid state as safely and rapidly as possible
  • Begin Low-calorie diet till stable
  • Start Hormone Therapy: start on a low dose, increase every few weeks
26
Q

Hormone Therapy

A

Levothyroxine (Synthroid)
- Start with low dose (recall dosage in micrograms)
- Monitor for chest pain, weight loss, nervousness, tremors, insomnia
- Increase dose in 4- to 6-week intervals as needed
- Lifelong therapy and hormone level monitoring
- Monitor for s/sx of hyper, we have given them too much

27
Q

Nursing Implementation

A
  • Skin care
  • Vital signs, weight, I & O, edema
  • Cardiovascular response to hormone
  • Assess for therapeutic effects
  • Energy level
  • Mental alertness
  • Most is outpatient therapy
  • Absorption is different based on the producer of the med, ask them to not change brands of the med as it may impact their blood levels (how fast or slow it is going in the blood)
28
Q

Nursing Implementation - Myxedema

A
  • Myxedema coma needs acute care
  • Mechanical respiratory support
  • Cardiac monitoring
  • IV thyroid hormone replacement
  • Monitoring of core temperature
  • Typically someone who has not had their case treated so by time they go in they are in a severe state
29
Q

Patient Education

A
  • Written instructions important
  • Need for lifelong therapy
  • Thyroid medicine in morning on empty stomach (Why?)
  • Side effects of medication
  • Signs and symptoms of hypothyroidism and hyperthyroidism
  • Regular follow-up care
  • Do not switch brands
  • Comfortable, warm environment
  • Measures to prevent skin breakdown
  • Emphasize need for warm environment
  • Medication may increase energy so give during the day
30
Q

Evaluation of Outcomes

A
  • Were symptoms relieved?
  • Is the client in a euthyroid state?
  • Is the client cooperating with therapeutic plan and understands this is lifelong thyroid replacement therapy?
  • Is client maintaining positive self-image?
  • Was low calorie diet and hormone therapy initiated?

NUR 326 (27 decks)

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