Hypothyroidism /Hyperthyroidism Flashcards
Thyroid Hormone release
1. Hypothalamus releases thyrotropinreleasing hormone (TRH) to anterior pituitary
2.Anterior pituitary
releases thyroidstimulating
hormone (TSH) to
thyroid gland
- Thyroid secretes
thyroid hormones
Thyroid Hormones and what they do?
► 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++)
Causes of Hypothyroidism
Thyroid Disorder
• Disorders of hypothalamus or
anterior pituitary
• Autoimmune disease
– Hashimoto’s thyroiditis
• Hyperthyroidism treatment
– Thyroidectomy, radioactive iodine therapy
Hypothyroidism prevalence
Women affected 7-10x more than men
Onset between age 30-60
Causes Hyperthyroidism
(Thyroid Disorder) and prevalence
• Autoimmune disease
̶ Graves’ disease
Women affected 10x more than men
Onset between age 20-40
Hypothyroidism clinical manifestations
• Sluggish mental & physical activity • Weight gain • Decreased GI motility • Decreased appetite • Cold sensitivity • Bradycardia • Coarse, dry (not fragile) skin • Goiter • Decreased fertility/menstrual irregularities
Hyperthyroidism clinical manifestations
• Tachycardia, hypertension • Nervousness, excitability • Increased gastric activity • Increased appetite • Weight loss • Heat intolerance • Insomnia • Decreased fertility/menstrual irregularities • Exophthalmos/goiter
Hypothyroid Diagnosis
- Elevated TSH
* Decreased T3, T4
Hypothyroid Treatment and Safety (drug metabolism )
-Treatment
• Thyroid hormone replacement (levothyroxine)
► Safety – Drug metabolism
• Decreased metabolism of sedatives, hypnotics, or narcotics
• Decrease dose or frequency
Hypothyroidism Assessments
- Vital signs
- Weight
- Bowel patterns
- Calcium levels
Hypothyroidism Actions (Nursing Interventions)
- 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
Hypothyroidism Complication: Myxedema Coma
Profound decrease in cellular metabolism
– Hypoventilation → Hypoxia and CO2 retention
– Fluid and electrolyte imbalance
– Hypothermia
– Decreased cardiac function → Bradycardia and hypotension
– Hypoglycemia
– Hyponatremia
Hypothyroidism Complication: Myxedema Coma Treatment
Replace thyroid hormone, supportive care
Hyperthyroid Diagnosis
Decreased TSH, Increased T3, T4
Hyperthyroid Treatment
• Symptom management (fluid replacement, beta blockers)
• Medical
– Propylthiouracil (PTU), methimazole (Tapazole), lithium carbonate (Lithonate)
• Radioactive iodine (most commonly used)
Surgical
– Total or subtotal thyroidectomy
Thyroidectomy: Preoperative considerations
- Antithyroid medications and/or beta-blockers
- Potassium iodide
- Vitamin D and calcium
Thyroidectomy: Postoperative care
- Pain control
- Thyroid hormone supplementation
- Calcium management
Calcium Management in Thyroidectomy
► 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
Hyperthyroid Assessment
- Vital signs
- Intake and output
- Eyes and vision
- Thyroid hormone levels
- Seizures
- Daily weight
Hyperthyroid Interventions
• Administer medications as
ordered
• Implement cooling measures
• Administer eye lubricant
Thyroid Storm clinical manifestations
Tachycardia, fever, systolic hypertension, abdominal pain, tremors, changes in level of consciousness
Thyroid Storm Treatment
• Supportive care* – i.e. Airway, pulse rate and blood pressure
management
• Fluid resuscitation
• Glucocorticoids
• Anti-thyroid meds once the pt’s symptoms stabilize
