Hypothyroidism /Hyperthyroidism Flashcards

1
Q

Thyroid Hormone release

A
1. Hypothalamus
releases
thyrotropinreleasing hormone
(TRH) to anterior
pituitary

2.Anterior pituitary
releases thyroidstimulating
hormone (TSH) to
thyroid gland

  1. Thyroid secretes
    thyroid hormones
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2
Q

Thyroid Hormones and what they do?

A

► T3 – Increases metabolic rate
► T4 – Increases cellular response to catecholamines
► Thyrocalcitonin – Decreases breakdown of bone and
decreases reabsorption of calcium in the intestines and
kidneys (↓Ca++)

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3
Q

Causes of Hypothyroidism

Thyroid Disorder

A

• Disorders of hypothalamus or
anterior pituitary
• Autoimmune disease
– Hashimoto’s thyroiditis

• Hyperthyroidism treatment
– Thyroidectomy, radioactive iodine therapy

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4
Q

Hypothyroidism prevalence

A

Women affected 7-10x more than men

Onset between age 30-60

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5
Q

Causes Hyperthyroidism

(Thyroid Disorder) and prevalence

A

• Autoimmune disease
̶ Graves’ disease

Women affected 10x more than men
Onset between age 20-40

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6
Q

Hypothyroidism clinical manifestations

A
• Sluggish mental & physical activity
• Weight gain
• Decreased GI motility
• Decreased appetite
• Cold sensitivity
• Bradycardia
• Coarse, dry (not fragile) skin
• Goiter
• Decreased fertility/menstrual
irregularities
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7
Q

Hyperthyroidism clinical manifestations

A
• Tachycardia, hypertension
• Nervousness, excitability
• Increased gastric activity
• Increased appetite
• Weight loss
• Heat intolerance
• Insomnia
• Decreased fertility/menstrual
irregularities
• Exophthalmos/goiter
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8
Q

Hypothyroid Diagnosis

A
  • Elevated TSH

* Decreased T3, T4

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9
Q

Hypothyroid Treatment and Safety (drug metabolism )

A

-Treatment
• Thyroid hormone replacement (levothyroxine)
► Safety – Drug metabolism
• Decreased metabolism of sedatives, hypnotics, or narcotics
• Decrease dose or frequency

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10
Q

Hypothyroidism Assessments

A
  • Vital signs
  • Weight
  • Bowel patterns
  • Calcium levels
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11
Q

Hypothyroidism Actions (Nursing Interventions)

A
  • Administer medication in AM (at the same time every day) ( In the morning to mimic normal circadian rhythm) (do not give w/ food.. 2 hrs before breakfast)
  • Be mindful of drug metabolism (i.e. narcotics and sedatives)
  • Warming blankets
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12
Q

Hypothyroidism Complication: Myxedema Coma

A

Profound decrease in cellular metabolism
– Hypoventilation → Hypoxia and CO2 retention
– Fluid and electrolyte imbalance
– Hypothermia
– Decreased cardiac function → Bradycardia and hypotension
– Hypoglycemia
– Hyponatremia

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13
Q

Hypothyroidism Complication: Myxedema Coma Treatment

A

Replace thyroid hormone, supportive care

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14
Q

Hyperthyroid Diagnosis

A

Decreased TSH, Increased T3, T4

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15
Q

Hyperthyroid Treatment

A

• Symptom management (fluid replacement, beta blockers)

• Medical
– Propylthiouracil (PTU), methimazole (Tapazole), lithium carbonate (Lithonate)

• Radioactive iodine (most commonly used)

Surgical
– Total or subtotal thyroidectomy

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16
Q

Thyroidectomy: Preoperative considerations

A
  • Antithyroid medications and/or beta-blockers
  • Potassium iodide
  • Vitamin D and calcium
17
Q

Thyroidectomy: Postoperative care

A
  • Pain control
  • Thyroid hormone supplementation
  • Calcium management
18
Q

Calcium Management in Thyroidectomy

A

► Hypocalcemia – Complication of thyroidectomy

• Parathyroid damage during surgery
– Surgical damage, devascularization

• Appears within 48 hours, resolves within a few months

► Calcium given pre-procedure

► Calcium levels checked routinely post procedure and Ca
replaced

• May need exogenous calcitrol for Ca absorption if PTH levels are also
low

► S/s hypocalcemia

19
Q

Hyperthyroid Assessment

A
  • Vital signs
  • Intake and output
  • Eyes and vision
  • Thyroid hormone levels
  • Seizures
  • Daily weight
20
Q

Hyperthyroid Interventions

A

• Administer medications as
ordered
• Implement cooling measures
• Administer eye lubricant

21
Q

Thyroid Storm clinical manifestations

A

Tachycardia, fever, systolic hypertension, abdominal pain, tremors, changes in level of consciousness

22
Q

Thyroid Storm Treatment

A

• Supportive care* – i.e. Airway, pulse rate and blood pressure
management
• Fluid resuscitation
• Glucocorticoids
• Anti-thyroid meds once the pt’s symptoms stabilize