thyroid and parathyroid disorders Flashcards
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
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
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
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
Abnormally increased synthesis & secretion of thyroid
hormones
Affects all body systems
Hyperthyroidism
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
Classic sign of hyperthyroidism
is heat intolerance
hyperthyroidism Can result from
overactivity (Graves’ disease) or a change in thyroid gland (toxic nodular goiter)
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
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
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
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
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
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
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
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
