thyroid and parathyroid disorders Flashcards by Diane M.

Age-Related Changes in Thyroid Function

Increased incidence of thyroid nodules
Serum levels of T4 remain approximately the same in a healthy older person, but levels of T3 often decline
Incidence of hypothyroidism increases with age, especially among women

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Health history

Changes in energy level, sleep patterns, personality, mental function, emotional state
Unexplained weight changes
In the review of systems, changes in menstrual cycles, sexual function, hydration, bowel elimination pattern, and tolerance of heat and cold

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Physical examination

Vital signs and height and weight
Facial expression and characteristics as well as mental alertness
Inspect/palpate skin for moisture, temperature, texture
Hair texture
Examine the eyes for exophthalmos (bulging)
Inspect the neck for enlargement typical of goiter. Observe the hands for tremor

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Diagnostic tests and procedures

Serum T3, free T4, T4, and TSH
Thyroid-releasing hormone (TRH) stimulation test 
Radioactive iodine (RAI) uptake test
Thyroid ultrasonography 
MRI or CT

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Abnormally increased synthesis & secretion of thyroid
hormones
Affects all body systems

Hyperthyroidism

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Causes of Hyperthyroidism

Autoimmune disease (Graves’ Disease most common)
Psychological, physiological stress (infection)
Thyroiditis (radiation induced)
Pituitary tumors
Thyroid adenomas
Genetic
Toxic Multinodular Goiter….Note: not all patients with a
goiter have hyperthyroidism

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Classic sign of hyperthyroidism

is heat intolerance

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hyperthyroidism Can result from

overactivity (Graves’ disease) or a change in thyroid gland (toxic nodular goiter)

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Most often develops in young women between 20 & 40, but can occur at any age
Most common type of hyperthyroidism
Autoimmune disorder
Antibodies activate TSH receptors, which in turn stimulate thyroid enlargement and hormone secretion

Graves’ disease

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Often in women (4 time more than men) in their 60s and 70s
Likely develop in people who have had goiter for a number of years
Caused by small thyroid nodules that secrete excess thyroid hormone
Increased hormone production is independent of TSH
Nodules can be benign or malignant
Symptoms are usually less severe

Multinodular Goiter

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s/s of hyperthyroidsm

Weight loss and nervousness with a mild form
In more severe cases
Restlessness, irritable behavior, anxiety, mood swings, sleep disturbances, personality changes,
Hair loss, and fatigue
Weight loss, even when the patient is eating well, is common; increased hunger
Poor tolerance of heat and excessive perspiration, flushed skin
Changes in menstrual and bowel patterns
Warm, moist, velvety skin; fine hand tremors; swelling of the neck; and ophthalmopathy including exophthalmos (more common with Graves)
Tearing, light sensitivity, decreased visual acuity, and swelling around orbit of the eye
Tachycardia, increased systolic blood pressure, palpitations sometimes atrial fibrillation
Dyspnea, tachypnea
Bruit over thyroid
Diarrhea

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Complications hyper

Thyrotoxicosis (aka Thyroid Storm)
Excessive stimulation caused by elevated thyroid hormone levels that produce dangerous tachycardia and hyperthermia
Potential for heart failure
Occurs when hyperthyroidism is untreated or poorly controlled or when the person is severely stressed (trauma, infection, diabetic ketoacidosis, pregnancy).
Do not vigorously palpate a goiter.
Rare with today’s meds, but can occur after surgery

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Medical Diagnosis

hyper

Decreased TSH and elevated serum T4
Measurement of thyroid-stimulating antibodies and results of a radioactive iodine uptake test to diagnose Graves’ disease
Thyroid scans

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Medical Treatment hyper

Drug therapy
Antithyroid drugs
Thionamides and iodides (blocks production)
Digoxin (for heart failure when it occurs)
Glucocorticoids (reduces immune & inflammatory response)
Iodine prep (decreases blood flow to the through the thyroid gland)
Sedatives (reduce anxiety)
Adrenergic blocking agents (relieves sweating, anxiety, and arrhythmias)

Radioactive iodine
Accumulates in the thyroid gland, where it causes destruction of thyroid tissue

Surgical treatment
Subtotal thyroidectomy

High protein, high carb, high calorie diet restricting stimulants

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Care of the Nonsurgical Patient assess. hyper

Activity tolerance
Heat tolerance
Bowel elimination pattern, appetite, weight changes, and food intake
Mental-emotional state, adaptation to the condition, and understanding of the treatment
Measure vital signs and height and weight
Skin texture and edema

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interventions for Care of the Nonsurgical Patient

Decreased Cardiac Output
Disturbed Sleep Pattern
Hyperthermia
Imbalanced Nutrition: Less Than Body Requirements
Risk for Injury
Disturbed Sensory Perception
Diarrhea

Care of the Patient Having a Thyroidectomy

Assessment: preoperative

Identify and address learning needs
Teaching: primary preoperative nursing intervention
Goals: understanding of the usual preoperative and postoperative procedures and decreased anxie

Care of the Patient Having a Thyroidectomy

Assessment: postoperative

Assess and document respiratory status, level of consciousness, wound drainage or bleeding, voice quality, comfort, and neuromuscular irritability

Care of the Patient Having a Thyroidectomy

Interventions for

Ineffective Airway Clearance
Decreased Cardiac Output 
Disturbed Body Image
Acute Pain
Risk for Infection

Inadequate secretion of thyroid hormones
Women more commonly affected
Thyroid gland fails to produce sufficient thyroid hormone, decreasing overall metabolism
Severe cases cause “myxedema

Hypothyroidism

If not treated early, hypothyroidism during infancy causes permanent physical and mental retardation
In adults can be serious but usually reversible with treatment

Cretinism

Facial edema from severe, long-term hypothyroidism

Myxedema

primary hypo

Atrophy of the thyroid gland after years of Graves’ disease or thyroiditis
Treatment for hyperthyroidism
Dietary iodine deficiency
High intake of goitrogens
Defects in thyroid hormone synthesis

secondary hypo

Pituitary or hypothalamic disorders

Thyroidectomy

s/s of hypo

``` Swelling of the lips and eyelids Dry, thick skin Bruising Thin, coarse hair, alopecia Hoarseness Generalized nonpitting edema Facial edema May seem slow, depressed, or apathetic ```

medical diagnosis of hypo

Based on laboratory determination of free T4 and TSH Complications Myxedema coma

medical treatment of hypo

Hormone replacement therapy | Levothyroxine (Synthroid) or liothyronine (Cytomel

assess. of hypo

``` Fatigue Hypothermia Constipation Menstrual disorders Weight gain Anorexia Mental sluggishness Dry, flaky skin Thinning nails Cold intolerance Decreased diaphoresis Edema Thick tongue, swollen lips ```

interventions for hypo

``` Activity Intolerance Imbalanced Nutrition: More Than Body Requirements Hypothermia Constipation Risk for Impaired Skin Integrity Decreased Cardiac Output Disturbed Thought Processes Disturbed Body Image Self-Care Deficit ```

Thyroid enlargement with normal hormone production

Simple Goiter

cause of simple goiter

Iodine deficiency and long-term exposure to goitrogens The gland may enlarge to compensate for hypothyroidism Sometimes the enlarged gland produces excess hormones, making the patient hyperthyroid

treatment of simple goiter

If mild enlargement and normal hormones, no intervention Some patients need hormone replacement therapy Surgery indicated if pressure on the trachea or esophagus or if the condition is disfiguring

Thyroid Cancer

Uncommon Fatal in less than 1% of all cases Early stages: nodule that can be felt on thyroid If cancer spreads, enlarged lymph nodes felt in the neck Patient may not show dramatic changes in thyroid hormone levels Total thyroidectomy is the usual treatment If malignancy spreads beyond thyroid gland, more radical surgery may be indicated

health hx of parathyroid gland

Change in mental-emotional status, such as memory problems, irritability, or personality changes Musculoskeletal problems, including weakness, skeletal pain, backache, and muscle twitching or spasms Urinary frequency, polyuria, urinary calculi (stones), or constipation Head/neck radiation, renal calculi, chronic renal failure Medications, including calcium and vitamin D supplements

physical examinations of parathyroid gland

Heart rate and rhythm, blood pressure, respiratory effort, muscle strength, muscle twitching, and hair and skin texture

Spasm of facial muscle when facial nerve tapped

Chvostek’s sign

Carpopedal spasm when a blood pressure cuff is inflated above the patient’s systolic blood pressure and left in place for 2 to 3 minutes

Trousseau’s sign

Hypercalcemia occurs when

* * Excessive intake not usually a factor, except with excessive intake of Vit.D * * Lab values > 10.5 mg/dL (5.3 mEq/L) * * Excessive use of alkali compound (antacids) * * prolonged immobilization * * metastatic disease of bone * * metabolic acidosis (calcium ionizes in acid environment) * * Parathyroid disease (hyperparathyroidism)

Hypercalcemia S/S

Deep bone pain or flank pain ** Sedative effect: weakness, lethargy, decreases in reflexes, N/V, anorexia ** High blood levels can result in kidney stone (renal calculi) ** High blood levels can indicate a shift of calcium from bones resulting in osteoporosis ** Increased cardiac arrhythmias (PVC’s and heart block) ** High incidence of psychiatric disturbances (depression, apathy, and acute psychosis