Module 13 Thyroids ¶thyroids Flashcards
TYPES OF THYROID
DYSFUNCTION
Hypothyroidism: Underactivity
Hyperthyroidism: Overactivity
ACTIONS OF THE THYROID
GLAND
Removes iodine from the blood,
concentrates it, and prepares it
for attachment to tyrosine, an
amino acid
THYROID
DYSFUNCTION Definition
Signs and Symptoms
Definition
• Excessive amounts of thyroid hormones are
produced and released into the circulation
Cause
• Graves’ disease
Signs and Symptoms
• Increased body temperature, tachycardia,
thin skin, palpitations, hypertension,
flushing, intolerance to heat, amenorrhea,
weight loss, and goiter
FUNCTIONS OF THYROID
HORMONES
Regulate the rate of
metabolism
Affect heat production and
body temperature
Affect oxygen consumption,
cardiac output, and blood
volume
Affect enzyme system activity
Affect metabolism of
carbohydrates, fats, and
proteins
Regulate growth and
development
THYROID
DYSFUNCTION Causes:
•Absence of the thyroid gland
•Lack of sufficient iodine in the diet to produce the
needed level of thyroid hormone
•Lack of sufficient functioning thyroid tissue due to
tumor or autoimmune disorders
•Lack of TRH related to a tumor or disorder of the
hypothalamus
•Lack of TSH due to pituitary disease
Signs & symptoms- can be varied and vague, such
as obesity and fatigue (see table 37.1 for all)
USE OF THYROID AND
PARATHYROID
AGENTS ACROSS THE
LIFESPAN: CHILDREN
Hypothyroidism
Levothyroxine
Higher doses
Monitor thyroid labs
Monitor growth and development
Hyperthyroidism
Methimazole
Don’t use:
Propylthiouracil
Radioactive agents
Hypercalcemia
• Rare
• Bisphosphonates
• Monitor calcium levels
USE OF THYROID AND PARATHYROID
AGENTS ACROSS THE LIFESPAN
adult and older adults
hypothyroidism
- Lifelong
- Monitor thyroid labs
- Pregnancy and lactation: levothyroxine
older adults screen regularly
start slow go slow
levothyroxine
monitor response thyroid level cardiac effect
Hyperthyroidism
- Side effects worse with methimazole
- Sodium iodide can affect fertility
- Pregnancy: Propylthiouracil
- Do not use in lactation
older adult
sodium iodide
Monitor for hypothyroidismm
Hypercalcemia
- Osteoporosis
- Monitor calcium levels
- Calcium and vit D supplements
- Pregnancy: Do not use bisphosphonates
for older adult dietary deficiencies
calcium and vitamin D supplement
for older adult
osteoporosis
Bisphosphonate
Renal impairment
monitor calcium level
THYROID HORMONES
Actions
indications
action
- Increases cellular metabolism
indication.
- Hypothyroidism
- Myxedema coma
- Pituitary TSH suppression in the treatment of euthyroid goiters
- Management of thyroid cancer;
- Thyrotoxicosis in conjunction with other therapy
THYROID HORMONES
Drug list
Levothyroxine
Liothyronine
Liotrix
Thyroid Desiccated
THYROID HORMONES
Contraindications
Caution
Adverse Effects: None*
Drug-Drug Interactions
Contra;
contra- Known allergy
Acute MI
Thyrotoxicosis*
Adverse Effects: None*
Skin reactions
Symptoms of hyperthyroidism
Cardiac stimulation
CNS effects
Drug-drug
Oral anticoagulants
Digoxin
Theophylline
THYROID HORMONES: THE NURSING PROCESS
Assess
ment Hx:
cautions/contraindicatio
ns, family history
• Physical
• Assess skin;
orientation and affect;
vitals & ECG
• Monitor appropriate labs
Nursing Diagnosis
• Decreased cardiac
output
• Imbalanced nutrition:
less than body
requirements
• Ineffective tissue
perfusion
• Deficient knowledge
Implementation
• Administration:
• single daily dose before breakfast each
day
• administer with a full glass of water
• do not administer other drugs at the same
time
• Monitor response carefully when beginning
therapy
• especially cardiac response
• Arrange for periodic blood tests
• Patient teaching
Evaluation
• Response to the drug and adverse effects
• Effectiveness of the teaching plan
• Effectiveness of comfort and safety
measures
• Compliance with medication regimen
ANTITHYROID AGENTS
- Thiomides
- Sodium iodide I131
- Strong iodine solution & potassium iodide
Action and indications for each
ANTITHYROID AGENTS
Thiomides
• Action:
- prevent formation of thyroid hormone within the thyroid cells
Indication: hyperthyroidism, radiation
Sodium iodide I131
- Action: enters thyroid cells and destroys them by giving off radiation
- Indication: hyperthyroidism, radiation emergencies
Sodium iodide I131
• Action: enters thyroid cells and destroys them
by giving off radiation
• Indication: hyperthyroidism, radiation
Strong iodine solution & potassium
iodide
• Action: high doses saturate the thyroid cells
preventing thyroid hormone formation
• Indication: hyperthyroidism, radiation
emergencies, suppression of thyroid gland
before surgery, acute thyrotoxicosis
ANTITHYROID AGENTS
Contraindications
caution
adverse effects
drug-drug intractions
Contraindications
Known allergy
Caution
- PTU: Liver impairment
Adverse Effects
- All: hypothyroidism
- Methimazole: bone marrow suppression
- PTU: severe liver toxicity
- Iodine Solutions: Iodism
Drug-Drug Interactions
- Oral anticoagulants
- Theophylline
- Beta-blockers
- Digoxin
ANTITHYROID AGENTS: THE
NURSING PROCESS
• History
• Allergy, liver impairment
• Physical
• Assess skin; orientation
and affect; vitals & ECG
• Monitor a• Decreased cardiac output
• Imbalanced nutrition: more
than body requirements
• Risk for injury
• Deficient knowledge
Nursing
Diagnos
es
Implementation
• Administration
• Administer propylthiouracil three times a day
around the clock
• Give iodine solution through a straw; tablets
can be crushed.
• Arrange for periodic blood tests
• Assess patients receiving iodine solution for
any sign of iodism
• Provide thorough patient teaching
Evaluation
• Patient response to drug and adverse effects
• Effectiveness of the teaching plan
• Effectiveness of comfort and safety measures
• Compliance to the regimen
Thiomides
drug list
Iodine Solutions drug list
Thiomides
• Propylthiouracil
(PTU)
• methimazole
- *iodine**
- *solution**
Strong iodine solution
Potassium iodide
Sodium iodide I131
ANTITHYROID AGENTS: THE NURSING PROCESS
- History
- Allergy, liver impairment
- Physical
- Assess skin; orientation and affect; vitals & ECG
- Monitor appropriate labs
- Decreased cardiac output
- Imbalanced nutrition: more than body requirements
- Risk for injury
- Deficient knowledge
implementation
- Administration
- Administer propylthiouracil three times a day around the clock
- Give iodine solution through a straw; tablets can be crushed.
- Arrange for periodic blood tests
- Assess patients receiving iodine solution for any sign of iodism
- Provide thorough patient teaching
evaluation
- Patient response to drug and adverse effects
- Effectiveness of the teaching plan
- Effectiveness of comfort and safety measures
- Compliance to the regimen
PARATHYROID DYSFUNCTION
Hypoparathyroidism
Hyperparathyroidism
Hypoparathyroidism
The absence of parathormone
Most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery
Hyperparathyroidism
The excessive production of parathormone
Can occur as a result of parathyroid tumor or certain genetic disorders
ANTIHYPOCALCEMIC AGENTS
Actions
ACTIONS
- Stimulation of osteoclasts to release calcium from the bone
- Increased intestinal absorption of calcium
- Increased calcium resorption from the kidneys
- Stimulation of cells in the kidney to produce calcitriol
- *Indications**
- Management of hypocalcemia in patients undergoing chronic renal dialysis
- Treatment of hypoparathyroidism
ANTIHYPOCALCEMIC AGENTS
Drugs list
Teriparatide
Calcitriol (Vitamin D)
Parathyroid hormone
ANTIHYPOCALCEMIC AGENTS
Contraindications
Adverse Effects
Drug-Drug Interactions
Contra; Allergy, vitamin D toxicity
adverse effect; GI effect and CNS effects
drug -drug
Magnesium containing antacids
Digoxin toxicity with hypercalcemia
ANTIHYPOCALCEMIC AGENTS: THE NURSING PROCESS
Assessment
History
Allergy; hypercalcemia; vitamin
toxicity; renal stone
Physical
Assess skin; orientation and affect
Labs: serum calcium,
magnesium, and alkaline
phosphate levels, LFTs
Xrays of bones as appropriate
Nursing Diagnosis
Acute pain
Imbalanced nutrition: less than body
requirements
Deficient knowledge
Implementation
Monitor serum calcium levels
Provide supportive measures
Arrange for a nutritiona
consultation
Provide thorough patient teaching
Evaluation
Response to the drug
Adverse effects
Effectiveness of the teaching plan
Effectiveness of comfort and safety
measure
Compliance with medication
regimen
ANTIHYPERCALCEMIC AGENTS
Bisphosphonates
- These drugs act on the serum levels of calcium and not directly on the parathyroid gland or PTH
- Inhibits bone resorption
ANTIHYPERCALCEMIC AGENTS
Calcitonins
- Hormones secreted by the thyroid gland to balance the effects of PTH
- Inhibits bone resorption
ANTIHYPERCALCEMIC AGENTS drug list
for Bisphosphonates and Calcitonins
Bisphosphonates
- Etidronate
- Ibandronate
- Pamidronate
- Risedronate
- Alendronate
Calcitonins
- Calcitonin salmon
ANTIHYPERCALCEMIC AGENTS
Indications:
Osteoporosis
Paget’s disease
Bisphosphonates-
hypercalcemia in cancer
Calcitonins-
Emergency treatment of hypercalcemia
ANTIHYPERCALCEMIC AGENTS. page 28
