thyroid and parathyroid glands and disorders Flashcards
describe thyroid gland hormones
thyroid hormone - T3 and T4 (T3 is 5x more potent than T4) and calcitonin
- synthesis if thyroid hormone, iodine is needed for TH
- controlled by TSH
- calcitonin is secreted in response to high plasma calcium levels, increases calcium deposits in the bone
function of thyroid hormone:
- accelerates cellular reaction in most body cells
- increases BMR and growth
- stimulates protein synthesis
- regulates energy metabolism
- exerts chronotropic and inotropic cardiac effects
- acts as insulin antagonist
what is a goiter
overgrowth of thyroid tissue, can be caused by hypo or hyper thyroidism
describe the assessment of the thyroid gland
- physical exam: hair, skin, nails, bowels, sleep patterns, energy
- inspection and palpation
describe diagnostic evaluation of the thyroid gland
thyroid tests
- serum TSH, T3, T4
- serum free T4
- T3 resin uptake test
- thyroid antibodies
- radioactive iodine uptake
- fine needl aspiration biopsy
- thyroid scan, radioscan
- serum thyroglobulin
what are some nursing implications for thyroid management
- assess for iodine allergies
- assess for meds that contain iodine (esp contrast)
- foods that contain iodine (salt, fish, kelp, seaweed)
- meds that are known to affect thyroid testing
what are some meds that are known to affect thyroid testing
- amiodarone (antiarrhythmic)
- aspirin
- simetadine (histamine blocker)
- glucocorticoids (can enlarge thyroid and cause respiratory issues)
describe hypothyroidism
- deficiency of thyroid hormone (TH)
- slowed body metabolism
- decreased heat production
- decreased oxygen consumption by the tissues
describe primary hypothyroidism
- autoimmune thyroiditis - hashimotos
- 95% of cases
describe secondary hypothyroidism
- overtreatment of hyperthyroidism
- thyroidectomy
- radioactive iodine
whats a gerontologic considerations for hypothyroidism
whatch for toxicities r/t metabolism changes
what are some clincial maniestations of hypothyroidism
- skin: dry, brittle
- pulmonary: thick secretions in lungs, decreased RR
- CV: decreased HR and decreased BP
- psychological: depressed, apathetic
- GI: constipation (increase fiber and fluid intake)
- MSK: aches and weakness
- neurologic: slow and sluggish
- metabolic: bad. increased weight and drug toxicity
describe myxedema
- elevated serum cholesterol
- rare life-threatening condition
- undiagnosed/undertreated hypothyroidism patients - stressors
symptoms:
depression, diminished cognitive status, lethargy, and somnolence
hat are some complications of myxedema
- major complication = coma (40% mortality rate)
other complications: - hyponatremia
- hypercalcemia 2’ adrenal insufficiency
- hypoglycemia
- water toxicity
- hypoventilation
- hypotension and bradycardia
- hypothermia
these symptoms, along with CV collapse and shock, require aggressive and intensive supportive therapy and hemodynamic therapy if the patient is to survive
describe medical management of hypothyroidism
- pharmacologic therapy - levothyroxine (take first thing in the mroning on an empty tummy)
- prevention of cariac dysfunction (tele/EKG)
- prevention of medication interactions
describe preventing med interactions with drugs for hypothyroidism
- increase effects of warfarin
- CV effects of adrenergic agents
- diabetic meds may need adjusted
- caution when taking estrogen
- absorption may be effects by calcium, iron, mag, or zinc
- may need lower dose narcotics
describe nursing management of hypothyroidism
- administer thyroid hormones (dont switch back and forth between brands)
- provide stimulation
- monitor response to increased activity
- monitor heat and cold intolerance
- monitor neurologic status
- monitor VS
- explain life long therapy
- interventions for myxedema: recognize and treat as soon as possible and assess compliance
describe hyperthyroidism
excess of thyroid hormone
what are the most common forms of hyperthyroidism
- toxic multinodular goiter
- toxic adenoma
- thyroiditis
- graves disease (toxic, diffuse goiter)
describe graves disease
- three hallmarks: goiter, exophthalmos, and hyperthyroidism
- women more than men
- autoimmune disorder
what are some clinical manifestations of hyperthyroidism
- skin: thin oily hair
- pulmonary: increased RR
- CV: increased HR and BP
- psychological: irritible, anxious, easily agitated, restless
- GI: increased appetite, diarrhea
- MSK: muscle wasting, premature osteoporosis
- neurologic: nervous, tremors, heat intolerance
- metabolic: everything is sped up
what are some complications of hyperthyroidism
- exopthalmos: use eye drops, tape em up at night, keep HOB elevated, corneal abrasion risk, surgical decompression
- heart disease: beta blockers, prevent stress on heart
- thyroid storm: monitor closely, can be fate; sx include t>38.5C, hr>130, increased BP, delirium and psychosis
whats included in the medical management of hyperthyroidism
- antithyroid meds: PTU (blocks synthesis of TH)
- SSKI: decrease size and vascularity of thyroid b4 OR
- radioactive iodine: give test dose, can initially cuase thyroid storm; contraindicated in pregnancy, dont conceive for 6mo after using
- thyroidectomy: cause hypothyroidism
what are some nursing interventions for hyperthyroidism
- maintaining CO: monitor VS, EKG, and tele
- maintain high calorie, high protein diet (4k-5k cal)
- assist with coping
- weigh daily
- monitor appetite
- body temp regulation
- monitor sx of complications
describe goiter
- enlargement of the thyroid gland
- may occur from hypothyroidism or hyperthyroidism
- can be benign or malignant
types:
- endemic (iodine deficient): most common
- nodular
