thyroid and parathyroid disorders

Question 1

Age-Related Changes in Thyroid Function

Answer 1

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

Question 2

Health history

Answer 2

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

Question 3

Physical examination

Answer 3

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

Question 4

Diagnostic tests and procedures

Answer 4

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

Question 5

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

Answer 5

Hyperthyroidism

Question 6

Causes of Hyperthyroidism

Answer 6

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

Question 7

Classic sign of hyperthyroidism

Answer 7

is heat intolerance

Question 8

hyperthyroidism Can result from

Answer 8

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

Question 9

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

Answer 9

Graves’ disease

Question 10

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

Answer 10

Multinodular Goiter

Question 11

s/s of hyperthyroidsm

Answer 11

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

Question 12

Complications hyper

Answer 12

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

Question 13

Medical Diagnosis

hyper

Answer 13

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

Question 14

Medical Treatment hyper

Answer 14

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

Question 15

Care of the Nonsurgical Patient assess. hyper

Answer 15

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

Question 16

interventions for Care of the Nonsurgical Patient

Answer 16

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

Question 17

Care of the Patient Having a Thyroidectomy

Assessment: preoperative

Answer 17

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

Question 18

Care of the Patient Having a Thyroidectomy

Assessment: postoperative

Answer 18

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

Question 19

Care of the Patient Having a Thyroidectomy

Interventions for

Answer 19

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

Question 20

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

Answer 20

Hypothyroidism

Question 21

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

Answer 21

Cretinism

Question 22

Facial edema from severe, long-term hypothyroidism

Answer 22

Myxedema

Question 23

primary hypo

Answer 23

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

Question 24

secondary hypo

Answer 24

Pituitary or hypothalamic disorders

Thyroidectomy

Question 25

s/s of hypo

Answer 25

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

Question 26

medical diagnosis of hypo

Answer 26

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

Question 27

medical treatment of hypo

Answer 27

Hormone replacement therapy

Levothyroxine (Synthroid) or liothyronine (Cytomel

Question 28

assess. of hypo

Answer 28

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

Question 29

interventions for hypo

Answer 29

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

Question 30

Thyroid enlargement with normal hormone production

Answer 30

Simple Goiter

Question 31

cause of simple goiter

Answer 31

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

Question 32

treatment of simple goiter

Answer 32

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

Question 33

Thyroid Cancer

Answer 33

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

Question 34

health hx of parathyroid gland

Answer 34

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

Question 35

physical examinations of parathyroid gland

Answer 35

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

Question 36

Spasm of facial muscle when facial nerve tapped

Answer 36

Chvostek’s sign

Question 37

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

Answer 37

Trousseau’s sign

Question 38

Hypercalcemia occurs when

Answer 38

• • 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)

Question 39

Hypercalcemia S/S

Answer 39

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