T2: Thyroid Flashcards
medication for hypothyroid
levothyroxine (synthroid)
medications for hyperthyroid
methimazole (Tapazole) &
Propylthiouracil
thyrotoxicosis results from
increased circulating levels of T3, T4, or both (hyper metabolism)
graves disease
autoimmune disease of unknown etiology characterized by diffuse thyroid enlargement and excess thyroid hormone secretion (hyperthyroid)
precipitating factors for graves disease
insufficient iodine supply, cigarette smoking, infection, and stressful life events
Related to effect of thyroid hormone excess
↑ Metabolism
↑ Tissue sensitivity to stimulation by sympathetic nervous system
goiter
enlarged thyroid gland, auscultating the thyroid gland may reveal bruits, a reflection of increased blood supply.
exophthalmos is present in
hyperthyroidism
complications of exophthalmos
dry eyes, corneal abrasion , eyes might not close when sleeping
clinical manifestations of hyperthyroidism
-rapid pulse
-dyspnea on exertion, increased RR
-increased appetite, weight loss, diarrhea
-warm skin, thins skin and nails
-pretibial myxedema -insomnia
-personality changes
-amenorrhea
-intolerance to heat
acute thyrotoxicosis (thyroid storm/crisis)
an acute, severe, and rare condition that occurs when excessive amounts of thyroid hormones are released into the circulation MEDICAL EMERGENCY
what needs to be done with a patient in thyroid storm
take out the thyroid (thyroidectomy)
what needs to be monitored when taking out the thyroid
calcium levels because of the parathyroid (this can affect the heart)
manifestations of acute thyrotoxicosis
-Severe tachycardia, heart failure
-Shock
-Hyperthermia
-Agitation
-Seizures
-Abdominal pain, vomiting, diarrhea
-Delirium, coma
what are ehe two primary laboratory findings used to confirm the diagnosis of hyperthyroidism
*low or undetectable TSH levels (< 0.4 mIU/L) and elevated free thyroxine (free T4) levels.
The RAIU test is used to
differentiate Graves’ disease from other forms of thyroiditis.
-The patient with Graves’ disease will show a diffuse, homogeneous uptake of 35% to 95%, whereas the patient with thyroiditis will show an uptake of less than 2%.
what are the primary treatment options for hyperthyroidism
-Antithyroid medications
-Radioactive iodine therapy (RAI)
-Surgery
drug therapy for hyperthyroidsm
-Anti-thyroid drugs
-Iodine
-β-Adrenergic blockers
(not curative)
improvement of antithyroid drugs
-Improvement in 1 to 2 weeks
-Good results in 4 to 8 weeks
Potassium iodine (SSKI) and Lugol’s solution
Inhibit synthesis of T3 and T4 and block their release into circulation, Decreases vascularity of thyroid gland
Before thyroid surgery what is given
Iodine is used with other antithyroid drugs to prepare the patient for thyroidectomy
signs of iodine toxicity
swelling of the buccal mucosa and other mucous membranes, excessive salivation, nausea and vomiting, and skin reactions
indications for surgical therapy: thyroid
-Large goiter causing tracheal compression
-Unresponsive to anti-thyroid therapy
-Thyroid cancer
-Not a candidate for RAI
Subtotal thyroidectomy
Preferred surgical procedure
Involves removal of 90% of thyroid
how can we check calcium levels without a blood draw
trousseau and chvostek
Nursing Implementation: Acute Thyrotoxicosis-Thyroid storm
-thyroidectomy
-anti thyroid medications
-monitor for dysrhythmias
-fluid and electrolyte replacement (from vomit and diarrhea)
environment for hyperthyroidism/thyrotoxicosis
*Calm, quiet room
*Cool room
*Light bed coverings
ensure adequate rest
If exophthalmos present:
-Apply artificial tears to relieve eye discomfort
-Salt restriction and elevate head of bed
-Dark glasses
-Tape eyelids closed if needed for sleep
-ROM of intraocular muscles
Hypothyroidism/Myxedema Coma
-Deficiency of thyroid hormone
-Causes general slowing metabolic rate
Primary hypothyroidism is caused by
destruction of thyroid tissue or defective hormone synthesis.
Secondary hypothyroidism is caused by
pituitary disease with decreased TSH secretion or hypothalamic dysfunction with decreased thyrotropin-releasing hormone (TRH) secretion.
what is the most common cause of hypothyroidism
Iodine deficiency
hypothyroidism autoimmune
Hashimoto’s
cretinism
Hypothyroidism that develops in infancy, is caused by thyroid hormone deficiencies during fetal or early neonatal life.
Clinical Manifestations of hypothyroidism
slowing of body processes
fatigue, cold and dry skin, hoarseness, hair loss, constipation, and cold intolerance
since everything is slowed down in hypothyroidism we lose
end organ perfusion
myxedema coma is precipitated by
infection, drugs, cold, trauma
myxedema coma is characterized by
-Impaired consciousness
-Subnormal temperature, hypotension, hypoventilation
-Cardiovascular collapse-from hypoventilation, hyponatremia, hypoglycemia, and lactic acidosis
treatment for myxedema coma
IV levothyroxine (thyroid hormone)
Levothyroxine (Synthroid)
-Start with low dose
-Monitor for cardiovascular side effects (chest pain, dysrhythmias), weight loss, nervousness, tremors, insomnia
-Increase dose in 4- to 6-week intervals as needed
-Lifelong therapy
Myxedema coma necessitates acute care
-Mechanical respiratory support
-Cardiac monitoring
-IV thyroid hormone replacement
-Monitoring of CORE TEMP
