thyroid

Question 1

Hypothyroidism

Answer 1

Deficiency in thyroid hormone T3 and T4
Decreases metabolic rate
LOW AND SLOW

Question 2

Primary hypothyroidism vs secondary hypothryroidism

Answer 2

Primary- problem is within the thyroid gland itself

Secondary- problem with pit. or hypothalamus

Question 3

Hypothyroidism is Often associated with what other lab values?

Answer 3

High cholesterol
High triglycerides
Anemia
Decreased folate

Question 4

who is affected?

Answer 4

Women > men

commonly dx 40-50 year olds

Question 5

Which medications can cause hypothyroidism?

Answer 5

lithium

Iodine compounds

Question 6

Why is iodine important in hypothyroidism

Answer 6

It is required to synthesize TH

Question 7

Hashimoto

Answer 7

low and slow
Autoimmune disorder that attacks the thyroid itself causing thyroid to be unable to produce thyroid hormones…can lead to goiter

Question 8

s/s of hypothyroidism

Answer 8

Low energy= fatigue, muscle weakness, clumsy, lethargy
Low metabolism= weight gain, water gain= eye edema
Low libido, menstrual cycle changes
Low mood= depression, confusion, slow mental processes
Alopecia, thinning hair
Dry, rough skin; brittle nails
LOW body temp= cold
Low BP and RR…. c/o…

Question 9

Myxedema ..

Answer 9

Decompensated state of extreme hypothyroidism
Very low BP, hypotension
Very low body temp, hypothermia, 75>
Very low respirations, hypoventilation 10>

fatigue –> weakness –> stupor –> coma –> death

Question 10

Myxedema treatment

Answer 10

IV levothyroxine & hydrocortisone

• endotracheal tube @ bedside!!

Question 11

Hypothyroidism dx

Answer 11

clinical s/s
TSH levels
Primary=  low TH, high TSH
secondary= low TH, low TSH
increased cholesterol

Question 12

Hypothyroidism Tx

Answer 12

Levothyroxine (synthetic thyroid) Synthroid
Gives T4 to body to be converted to T3
c/o hypermetabolic state= s/s hyperthyroidism c/o thyroid storm

Question 13

L
E
V
O

Answer 13

Life long treatment! low and slow onset, will take time to get to therapeutic levels
Early AM, empty stomach! Same time everyday and do not dbl dose
Very hyper! report s/s of hyperthyroidism c/o thyroid storm
OK w/ baby- okay during preganancy

Question 14

Causes of myxedema

Answer 14

Thyroidectomy
abrupt stopping of levothyroxine
stressors such as trauma, infection, surgery, stress
cold

Question 15

Hyperthyroidism

Answer 15

Excessive levels of thyroid hormone in the blood which leads to a hypermetabolic state
Think excessive, HYPER, HIGH

Question 16

Different causes of hyperthyroidism

Answer 16

Graves disease- most common
Toxic adenoma- 2nd most common
subacute thyroiditis- virus
Pit or Hypothalamus tumor
Thyrotoxicosis facitia- ingestion of excessive thyroid hormone

Question 17

Graves disease

Answer 17

Most common hyperthyroidism cause
autoimmune disease
IgG activate surface receptors on thyroid cells which leads to excess TH production (T4 & T3)
The IgG acts as the pituitary gland however there is no increased release of TSH

Question 18

Toxic Adenoma

Answer 18

2nd most common

Nodule which increased thyroid production leading to hyperthyroidism and increases thyroid size (goiter)

Question 19

s/s of hyperthyroidism

Answer 19

Remember HIGH!
High metabolism= weight loss w/ increased appetite
High HR, palpations possible w AFIB
High BP c/o HTN crisis
High GI motility- diarrhea
High temp- heat intolerance, hot and sweaty, flushed with salmon skin color
High irritability, extreme NERVOUSNESS
High eyeball size- grape eyes, exophthalmos

Question 20

Thyroid storm (thyroid toxicosis)

Answer 20

Uncontrolled and potentially life threatening hyperthyroidism cause by sudden and excessive release of thyroid into blood stream

Question 21

S/S thyroid storm

Answer 21

Apprehension, restlessness, confusion (first signs)
^^^^ BP
^^^^ Temp 106<
^^^^ HR
leads to..
CNF > resp distress > delirium > Coma > Death

Question 22

Causes thyroid storm

Answer 22

Stress- such as trauma, DKA, stress
Surgery on unprepared hyperthyroid person
Untreated thyrotoxicosis

Question 23

Treatment of thyroid crisis

Answer 23

Anti thyroid drugs- get rid of excess thyroid hormone
Beta blockers- help cardiac situation, lower BP/HR
Corticosteroids - block thyroid

Question 24

Treatment for hyperthyroidism

Answer 24

Antithyroid drugs
Beta blockers
radioactive iodide
Thyroidectomy

Question 25

Anti thyroid medications

Answer 25

Stops thyroid from making too much TH

• Propylthiouracil (PTU) (puts thyroid underground) OK w/ BABY
• Methimazole (tapazole) Teratogenic- report fever/sore throat- c/o infection while on medication (agranulocytosis, LOW wbc) GIVE PO
• Potassium Iodide (SSKI) Stains teeth- give w. straw and juice, Shrinks thyroid, Keep 1 hour apart from other meds, NO w/ seafood allergy

Betablockers- propranolol- Lowers BP and HR dt/ hypermetabolic state

Radioactive Iodide- Extremely toxic! DESTROYS thyroid
Need negative preg test, remove jewelry and dentures NO PPL post op, no same restrooms, laundry or utensils

Question 26

Thyroidectomy

Answer 26

Removal of the thyroid gland
Partial- d/t hyperthyroidism
Complete- d/t cancer

Question 27

Thyroidectomy post op care

Answer 27

A-Airway- observe for respiratory distress such as laryngeal stridor or hoarseness secondary to tracheal edema
B- breathing- assess for noisy breathing, keep TRACH KIT AT BEDSIDE, 02, suction
C- circulation- assess wound for bleeding and hemorrhage- bleeding around back of neck, support sutures by having client place hands on posterior neck when moving
C- c/o LOW calcium
-+ Chvosek- cheeky smile w numbness

Question 28

Thyroidectomy post op care

Answer 28

A-Airway- observe for respiratory distress such as laryngeal stridor or hoarseness secondary to tracheal edema
B- breathing- assess for noisy breathing, keep TRACH KIT AT BEDSIDE, 02, suction
C- circulation- assess wound for bleeding and hemorrhage- bleeding around back of neck, support sutures by having client place hands on posterior neck when moving
C- c/o LOW calcium
+ Chvostek- cheeky smile w numbness
+ Trousseau - hand jerk w BP cuff

Question 29

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

Answer 29

Thyroid crisis
Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness.

Question 30

The nurse is aware that the best time of day for the total large corticosteroid dose is between

Answer 30

The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland.