Med Surg Chapter 43

Question 1

Euthyroidism

Answer 1

normal gland function

Question 2

describe endemic goiter

Answer 2

caused by lack of nutritional iodine. commonly seen in adolescents and pregnant or nursing women due to the growth spurts

Question 3

describe sporadic goiter

Answer 3

can be found in any region. caused by genetics or ingestion of goitrogens

Question 4

how do goitrogens function and what are examples

Answer 4

they inhibit T4 production.
cabbage, soybeans, spinach;
glucocorticoids, dopamine, lithium

Question 5

primary hypothyroidism

Answer 5

low TH, high TSH. most common is primary auto-immune

Question 6

secondary hypothyroidism

Answer 6

low TH, low TSH. TSH is not performing properly

Question 7

Tertiary or Central hypothyroidism

Answer 7

low TH, low TSH. hypothalamus cannot produce thyroid releasing hormone

Question 8

low TH levels cause increases in what other levels and conditions

Answer 8

cause an increase in cholesterol and triglycerides and an increase in atherosclerosis, arteriosclerosis, and heart disease

Question 9

what are some s/sx of hypothyroidism

Answer 9

patient may complain of cold, lethargy, constipation, forgetfulness, depression, dry skin, and wt gain

Question 10

what is myxedema

Answer 10

dry, waxy swelling with abnormal deposits of mucin in the skin. edema is non-pitting and common in pretibial and facial areas

Question 11

what can lead up to a myxedema coma

Answer 11

infection, trauma, stress, or surgery

Question 12

why is levothyroxine sodium (synthroid) commonly used to treat hypothyroidism

Answer 12

synthroid is converted to both T3 and T4 in the body

Question 13

how long does it take for physical effects to decrease once tx is started with synthroid

Answer 13

about 3-12 weeks

Question 14

what should be monitored when giving T4 to the elderly and why

Answer 14

pulse rate should be monitored daily

ischemic heart disease as evidenced by angina may develop

Question 15

what population does hyperthyroidism generally affect

Answer 15

women 20-40 years old

Question 16

what is the most common form of hyperthyroidism

Answer 16

Grave’s disease

Question 17

Grave’s disease has what 3 general characteristics

Answer 17

goiter, exopthalmos, hyperthyroidism

Question 18

what problems can be caused by elevated TH related to sexual function

Answer 18

diminished libido, irregular periods, decreased fertility, delay in sexual development if before puberty

Question 19

what are common s/sx of hyperthyroidism

Answer 19

agitation, irritability, hand tremors at rest, increased appetite, wt loss, loose stools, heat intolerance, tachycardia

Question 20

what are the major c/o of Grave’s disease

Answer 20

heart disease, thyroid storm, exopthalmos

Question 21

define exopthalmos

Answer 21

protruding eyes in a fixed stare

condition usually does not regress with therapy

Question 22

what are some symptoms of exopthalmos

Answer 22

photophobia, gritty sensation in the eye, and lacrimation

Question 23

what are some interventions for pt with exopthalmos

Answer 23

have pt wear dark sunglasses, elevate head of bed, wear eyemask when sleeping or tape lids shut, decrease salt intake to help with edema

Question 24

how is thyroid storm or thyrotoxicosis diagnosed

Answer 24

only by s/sx. there is no clinical diagnosis. no labs to confirm

Question 25

what s/sx would a pt in thyroid storm have

Answer 25

high pulse rate of up to 200bpm, high fever up to 106, delirium, dehydration, extreme irritability

Question 26

antithyroid medications are recommended for what population

Answer 26

pregnant women and pt under 18 y/o

Question 27

Name 3 common antithyroid medications

Answer 27

iodine, methimazole (Tapazole), and propylthiouracil (most common)

Question 28

What toxic affect can occur due to the medication propylthiouracil

Answer 28

agranulocytosis

Question 29

describe the affect of propylthiouracil on Grave’s disease

Answer 29

it improves the condition within 4-8 weeks, but usually takes several months for symptoms to disapear

Question 30

How soon would you start a surgical patient on iodine therapy

Answer 30

10-14 days prior to surgery

Question 31

radioactive iodine is generally used for what population

Answer 31

middle aged and older adults

Question 32

what type of diet for hyperthyroid patient

Answer 32

high calorie (4000-5000), high protein

Question 33

describe s/sx for thyroid storm

Answer 33

anxiety, irritability, dyspnea, hyperreflexia, fever as high as 106, pulse as high as 200, systolic hypertension