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NUR 146 Lecture > NUR 146 - Week 4 - Thyroid & Parathyroid > Flashcards

NUR 146 - Week 4 - Thyroid & Parathyroid Flashcards

1
Q

What hormones does the thyroid produce?

A

Thyroid Hormones: ​
- T3 (Triiodothyronine)​
- T4 (Thyroxine)​

Calcitonin

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2
Q

Which trace mineral does the Thyroid Gland need?

A

Iodine

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3
Q

Describe the hypothalamus-pituitary-thyroid axis

A
  • Hypothalamus releases Thyroid releasing hormone (TRH)
  • TRH stimulates anterior pituitary gland
  • Anterior pituitary gland releases Thyroid stimulating hormone (TSH)
  • TSH stimulates thyroid to release thyroid hormone (T3 & T4)
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4
Q

T4 - Thyroxine

Function?
How is it transported?
Strong/Weak?

A

Primary function:
- Regulation of metabolism & energy production
Secondary function:
- Growth & development
- Reproduction

Transported via protein; weaker bond to protein = more readily available

Weaker

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5
Q

T3 - Troopdpthyronine

Add more here later

A

Stronger and more active–but shorter acting than T4 and there are smaller amounts

Released during severe stress and high demand for energy

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6
Q

Calcitonin

When is it secreted?
Function?
Complications of excess?

A

Secreted in response to elevated calcium
Antagonist to Parathyroid Hormone

Function:
- Reduces plasma levels of calcium; activates osteoblast = builds new bone tissue
- “pushes calcium into bones”

Excess can lead to:
- Hypocalcemia; “too much calcium being taken from serum into bones”
- Increased bone density

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7
Q

Assessing the thyroid gland

A
  • Stand behind patient to palpate Thyroid gland
  • Shouldn’t feel anything, only if enlarged
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8
Q

Diagnostic tests for Thyroid gland

A

TSH: “If TSH is high, that means it’s ‘yelling’ at the Thyroid gland”
Free T4:
T3 and T4 (total):
Thyroid antibodies: Not good patient shouldn’t have them; body attacking the thyroid
Radioactive iodine uptake: radioactive iodine gets injected into thyroid; if iodine “lights up” then it’s overactive OR if it doesn’t “light up” may be hypoactive
Fine needle biopsy: Small
Thyroid scan:
Serum thyroglobulin: to detect presence of thyroid cancer

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9
Q

Nursing implications for diagnostic testing

A

Patient cooperation
Iodine/Shellfish allergy:
Hx of iodine containing meds:

Foods:
- Kelp, seaweed = high in iodine; may give false positive

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10
Q

Disorders

Hypothyroidism

What is it?
s/s
Causes

A

Suboptimal levels of T3 & T4
- More common w/ women & the elderly

s/s:
- Decreased metabolic rate
- Decreased oxygen consumption by body tissue
- Hypersensitivity to “sleepy meds”: narcotics, anesthetics, barbiturates

Clinical manifestations:
- Fatigue/lethagy
- Weight gain
- Cold intolerance / hypothermia
- Bradycardia
- High cholesterol

Causes:
- Hashimoto’s thyroiditis:
- Treatment of hyperthyroidism
- Thyroidectomy (if pt had thyroid cancer)
- Meds (Lithium)

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11
Q

Levels of dysfunction for hypothyroidism

A

Primary hypothyroidism: Problem is in the thyroid itself
Secondary hypothyroidism: Problem is in Anterior Pituitary (TSH)
Tertiary hypothyroidism: Problem is in the hypothalamus (TRH)

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12
Q

Hypothyroidism:
Management

Pharmacologic
Prevention of med complication
What to avoid

A

Pharmacologic:
- Synthetic levothyroxine (synthetic T4)

Prevention of cardiac dysfunction (Bradycardia, high cholesterol)
Adjust sedative hypnotic agents

Prevention of medication compliactions:
- Lithium, warfarin

Avoid goitrogen (inhibit production of thyroxine):
- Soybean
- Spinach
- Strawberry
- Peanuts

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13
Q

Levothyroxine Sodium (Synthroid):
Use?
Contraindication
Instruction?
Pt education?

A

Indicated for treatment of hypothyroidism

Contraindications:
- Unstable angina
- Thyrotoxicosis
- Untreated adrenal gland disorders
- Avoid grapefruit juice

Instruction:
Take on an empty stomach in morning; or at least 30 minutes before eating

Pt education:
- Report tachycardia, angina, irritability

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14
Q

Myxedema
What is it?
Clinical manifestations?

A

Result of severe hypothyroidism; “Hypothyroidism with significant symptoms”
- Life threatening if untreated; may result in myxedema coma

Clinical manifestations:
- Hypotension
- Bradycardia
- Hypoventilation
- Swelling of skin and underlying tissues
- Waxy appearance of skin
- Hypothermia

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15
Q

Goals for Management of Myxedema

A

Restore normal metabolic state
- Temp >96 F
- HR >60 bpm
- RR 8-16bpm
- BP >90/60

Improved mentation
Normalized urine output

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16
Q

Patient education for Myxedema patient on med treatment

A

Importance of medication compliance

Signs of replacement overdose:
- “Don’t seesaw back in the other direction”
- Chest pain
- HR >100 bpm
- SOB
- Tachycardia
- Insomnia

Importance of proper nutrition
Avoid exposure to infection–body can’t respond as well

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17
Q

Myxedema coma:
Causes?
Risk factors?

A

Severe state of (untreated) myxedema, life threatening

Causes:
- Undiagnosed hypothyroidism
- Infection
- Sedative medications
- Medication non-compliance
- Cold exposure

Risk factors:
- Osteoarthritis
- Cardiac disease
- Hypothermia
- Infection, sepsis

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18
Q

Management of myxedema coma

A

T3 IV until stabilized
T4 intravenous, until able to take orally

Glucocorticoids
Laboratory studies
- Free T4, TSH, Cortisol, ABG

Monitor for signs of Acute Coronary Syndrome (ACS)
Provide extra layer of clothing (avoid use of external warming blanket)

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19
Q

Hyperthyroidism

What is it?
s/s or clinical manifestations
Causes:

A

Results from excessive synthesis of thyroid hormone

Clinical Manifestations:
- Insomnia
- Tachycardia, palpitations, hypertension
- Heat intolerance, sweating
- Exophthalmos (bulging of the eyes)
- Increased appetite
-

Causes:
- Graves disease
- Toxic multinodular goiter
- Toxic adenoma
- Thyroiditis
- Medications to treat HYPOthyroidism

20
Q

Clinical manifestations of Hyperthyroidism

A
  • Tachycardia, hypertension, palpitations
  • Weight loss, diarrhea
  • Sweating, heat intolerance
  • Tremors, nervousness
  • ## Warm, soft skin
21
Q

Graves disease

What is it
Causes

A

Most common cause of hyperthyroidism; leads to excess production of thyroid hormones
Women are affected 8:1

Results in increased overall metabolic state

Causes:
- Autoimmune condition
- Viral trigger
- Genetics
- Stress

22
Q

Things to assess for hyperthyroidism
“Physical” attributes:
Vitals
Labs

A

Enlarged thyroid gland (goiter)
Increased vascularity of thyroid

Vitals:
- Tachycardia, tachypnea
- Hypertension
- Hyperthermia

Labs:
- Decreased TSH
- Elevated T3, free T4
- Increased radioactive (iodine) uptake
- Presence of thyroid stimulating immunoglobulins

23
Q

Management of Hyperthyroidism:

Radioactive Iodine

What does it do?
Pt teacing?
Contraindications
Post-Op meds?
May lead to?

A

Kills off thyroid tissue
All body fluids are radioactive after treatment

Contraindications:
Pregnancy, breastfeeding
Age <30

  • Patient will require hormone replacement (levothyroxine), initiated weeks after radioactive treatment

May cause thyroid storm:
- Result of acute release of TH
- Beta blockers can prevent this

24
Q

Antithyroid medications

A

Propylthiouracil (PTU):
- Blocks thyroid hormone synthesis
- Can potentiate anticoagulants
- Many drug interactions

Methimazole
- Blocks thyroid hormone hormone

Sodium iodide

25
Anti-thyroid medications: Methimazole (Tapazole) What does it do? Complications? Desired effect?
Mechanism: - Blocks thyroid hormone synthesis Complications: - Agranulocytosis: No white blood cells being formed - Thrombocytopenia: No platelets - Fever, rash, leukopenia Desired effects: - Think: correction of all s/s of hyperthyroidism
26
Iodine solution: What is it? How is it used? Indications to hold?
Sodium Iodide / Potassium Iodide Blocks release of thyroid hormone Used short term in tandem with radioactive therapy Instruction: - Dilute in juice/milk - Use via straw to prevent dental staining Indications to hold: - Vomiting - Diarrhea - Metallic taste
27
Untreated hyperthyroidism What can it lead to?
Thyrotoxicosis: - CHF + All symptoms related to hyperthyroidism Thyroid Storm
28
Thyroid Storm What is it? Cause? Clinical Manifestations?
Severe hyperthyroidism; high mortality if untreated Cause: - Usually stress Clinical manifestations: - Sudden onset - Hyperpyrexia, >101 - Extreme tachycardia, >130 bpm - Exaggerated symptoms of hyperthyroidism -
29
Management of Thyroid Storm
Help lower body temperature: - Ice packs - Cooling blanket Meds: - Propylthiouracil / Methimazole / Iodine - Hydrocortisone Humidified oxygen IV fluids
30
Thyroiditis
Inflammation and enlargement of thyroid gland (Can *result* in euthyroid, hypo- or hyperthyroidism, but not necessarily one or another) Subacute granulomatous thyroiditis: - Usually viral or post viral - Self limiting Suppurative Thyroiditis: - Bacterial etiology - Fever, neck tenderness, swelling, elevated WBC - Requires hospitalization, IV antibiotics (abx) & airway monitoring
31
Thyroid tumors: How are they classified?
Classification: - Benign vs. malignant - Presence or absence of thyrotoxicosis - Presence of absence of goiter Simple Goiter, "Iodine deficient goiter" Nodular goiter
32
Thyroid Cancer Risk factors Assessment/Diagnosis
Common in patients <50 y/o Common risk factors: Localized radiation exposure Assessment: - Palpable lesion - Fine needle biopsy = gold standard - Thyroid function test = NOT reliable -
33
Assessments for thyroid cancer
- Palpable firm lesion with cervical lymphadenopathy - Fine needle biopsy = gold standard - Thyroid function tests = Not reliable
34
Thyroidectomy
Removal of the thyroid - NOT first choice for hyperthyroidism - Usually for patients with thyroid cancer Subtotal thyroidectomy: Part of the thyroid is taken, patient gets to keep some
35
Thyroidectomy Pre-Op Care
Reduce stress; avoid caffeine/stimulants Sufficient dietary intake to support increased metabolic needs Educate patient on post-op neck supports
36
Thyroidectomy Post-Op Care
Airway-Breathing-Circulation Monitor Airway: - May require airway insertion - Keep trachea tray at bedside Monitor bleeding: - Vital signs: HR, BP - Hematoma - Dressing Pain management Semi-Fowler's: - Support head and neck Frequent voice assessment: - Discourage talking Monitor for hypocalcemia: - Less PTH = Less serum calcium
37
Parathyroid Glands
4 glands located on posterior aspect of thyroid gland Produces Parathyroid Hormone/Parathormone/PTH Excess calcium Responsible for regulation of phosphorous and calcium metabolism - Increased PTH = Increased calcium in blood - Increased PTH = Decreased phosphorous in blood Negative feedback system
38
Hyperparathyroidism: What is it? Clinical manifestations?
Overproduction of PTH; often asymptomatic Incidence: Women & Elderly Characterized by: - Decalcification of bone - Renal Calculi (Kidney stones) Clinical Manifestations: - Apathy - Fatigue - Muscle weakness; d/t excess calcium - Bone demineralization: Fractures. osteoporosis, kyphosis - N/V/C: (Nausea, vomiting, constipation) - Hypertension
39
Assessments for hyperparathyroidism
Bone changes if advanced Diagnostic findings: - Prolonged elevated serum calcium levels - Hypophosphatemia (low phosphorous) - Elevated PTH - Imaging - Fine needle biopsy Complications: Hypercalcemic crisis
40
Management of Hyperparathyroidism
Medical management: - Parathyroidectomy Nursing Care: - Encourage mobility - Encourage hydration >2L/day - Post-Op Care similar to thyroidectomy (airway monitoring) - Monitor calcium levels / signs of hypocalcemia
41
Hypercalcemic Crisis What is it? Complications?/What does it lead to? Management?
Extreme elevation of serum calcium levels, potentially life threatening; can have major effect on all muscles ( including cardiac muscles) May lead to: Cardiac arrhythmias Metabolic encephalopathy Renal dysfunction Management: - Rapid rehydration with large amount of isotonic saline - Goal = Urine Output 100-150 mL/hr - Administer: Calcitonin & Corticosteroids
42
MED Calitonin Calmon Function? Indication? Side effect?
Calcitonin receptor agonist Function: Prevents bone breakdown, increases bone density Indications: - Osteoporosis for postmenopausal women - Treatment of Paget's disease - Quick reduction of calcium levelse Side effects: - Nausea, abdominal pain, diarrhea, vomiting - Flushing, salty taste in mouth - Increased urination - Loss of appetite
43
Hypoparathyroidism Causes? Clinical manifestation? What can it lead to?
Low levels of PTH Causes: - Destruction of gland: Surgical removal, autoimmune condition Clinical manifestations: - Tetany: Muscle hypertonia, spasms, abnormal muscle contractions - Latent Tetany: Numbness, tingling, cramping, stiffness - Overt Tetany: Bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia, photophobia Leads to: - Hypocalcemia - Hyperphosphatemia
44
Assessment for tetany
Chvostek's sign: - Tap over facial nerve = twitching Trousseau's sign: - Occlude blood to arm for 3 mins = Carpopedal spasm
45
Who are the greatest at risk for Hypocalcemia?
Those with thyroidectomy No thyroid = No Parathyroid = Low
46
Management of hypoparathyroidism
Correct electrolyte abnormalities: - Administer calcium gluconate IV Pentobarbital = decrease neuromuscular irritability Dietary modifications: - High calcium, low phosphorous
47
Post-Op Thyroidectomy: Should you keep a trach tray?
Yes, in case airway patency is compromised

NUR 146 Lecture (21 decks)

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