Thyroid Diseases Flashcards

Question

Nutritional Therapy

Answer 1

High-calorie diet (4000 to 5000 cal/day) 6 full meals/day with snacks in between Protein intake: 1 to 2 g/kg ideal body weight Increased carbohydrate intake Avoid highly seasoned foods, high-fiber foods, caffeine Dietitian referral

Answer 2

Deficiency of thyroid hormone causing general slowing in metabolic rate More common in patients with female natal sex than those with male natal sex Subclinical TSH greater than 4.5 mIU/L T4 levels normal Affects up to 10% of those with natal female sex over 60 Non-thyroidal illness syndrome (NTIS) Critically ill patients Low T3, T4, & TSH levels

Answer 3

History & physical examination TSH & free T4 TSH increases with primary hypothyroidism TSH decreases with secondary hypothyroidism Thyroid antibodies (Autoimmune origin) High cholesterol High triglycerides High creatine kinase (CK) Low RBCs (anemia)

Answer 4

Primary; Caused by destruction of thyroid tissue or defective hormone synthesis Secondary: Pituitary disease (decreased TSH) Hypothalamic dysfunction or (decreased TSH) Iodine deficiency Atrophy of thyroid gland Hashimoto's thyroiditis Graves' disease Treatment for hyperthyroidism Drugs Cretinism; physical deformity & learning disabilities caused by congenital thyroid deficiency

Answer 5

Acute infection and/or inflammation Manifestations Silent & painless Sub-acute Acute Granulomatous (Bacterial or viral) Chronic autoimmune (Hashimoto’s) Most common cause of hypothyroid goiter Management NSAID’s Corticosteroids (Prednisone) Antibiotics Surgical drainage Patient teaching; Importance of adherence to plan

Answer 6

Systemic effects characterized by slowing of body processes Manifestations variable Slow onset Tired, lethargic, impaired memory, low initiative, weight gain

Answer 7

CV problems may be significant in patients with history of cardiovascular disease Decreased cardiac contractility and output Increased serum cholesterol & triglycerides Anemia

Answer 8

Low exercise tolerance SOB on exertion

Answer 9

Decreased appetite Nausea, vomiting Weight gain Constipation Distended abdomen Enlarged, scaly tongue Celiac disease

Answer 10

Dry, thick, inelastic, cold skin Thick, brittle nails Dry, sparse, coarse hair Poor turgor of mucosa Generalized interstitial edema Puffy face Decreased sweating Pallor Increased susceptibility to infection Increased sensitivity to opioids, barbiturates, anesthesia Intolerance to cold Decreased hearing Sleepiness Goiter

Answer 11

Fatigue, weakness Muscular aches & pains Slow movements Arthralgia

Answer 12

Fatigue, lethargy Personality, mood changes Impaired memory, slowed speech, decreased initiative, somnolence

Answer 13

Prolonged menstrual periods or amenorrhea Decreased libido, infertility

Answer 14

Dull, puffy skin Coarse, sparse hair Periorbital edema Prominent tongue Interprofessional Care Treatment goal; Restore euthyroid state as safely & rapidly as possible Hormone therapy Low-calorie diet Relief / control of symptoms Maintain euthyroid state Maintain positive self-image Adhere with lifelong thyroid therapy

Answer 15

Precipitated by infection, drugs, cold, trauma Characterized by: Impaired consciousness Subnormal temperature Hypotension Hypoventilation CV collapse Treated with IV thyroid hormone

Answer 16

Written instructions important Need for lifelong therapy & regular follow-up care Avoid abruptly stopping drugs Side effects of medication Signs & symptoms of hypothyroidism and hyperthyroidism Comfortable, warm environment Measures to prevent skin breakdown Do not switch brands Medication interactions Avoid sedatives or use lowest dose possible Measures to minimize constipation Relapses occur if treatment is interrupted

Answer 17

Low dose; Increased in 4 – 6 week intervals PRN based on TSH levels Lifelong therapy Monitor for tachycardia, especially: During initiation of therapy In the elderly Teach - Notify Provider for: Chest pain Weight loss Nervousness Tremors Insomnia

Answer 18

Thyroid CA Papillary (70-80%) Follicular (10-15%) Common in elderly Medullary (5-10%) Hereditary Anaplastic (<5%) Most aggressive Primary sign: Painless, palpable nodule(s)

Answer 19

Thyroidectomy: Primary treatment w/ Lymph node dissection PRN Some patients may receive RAI External beam radiation: Palliative treatment in metastatic cases High-dose thyroid hormone therapy Chemotherapy for advanced disease

Answer 20

Treatment of choice for most non-pregnant adults; Damages, destroys thyroid tissue Delayed response up to 3 months; Anti-thyroid drugs & β-blocker before & during first 3-months Outpatient Radiation Precautions: Private toilet, double-flushing Separate laundry daily No food prep with bare hands Avoid pregnant women/children for 7-days after treatment 80% have post-treatment hypothyroidism Patient Teaching Oral care (Thyroiditis / Parotiditis) Water / ice chips Salt & soda gargle “Magic Mouthwash” (Antacid, Benadryl, Viscous Lidocaine) Radiation precautions Symptoms of hypothyroidism

Answer 21

Indications Large goiter causing tracheal compression Unresponsive to anti-thyroid therapy Thyroid cancer Not a candidate for RAI Rapid reduction in T3 & T4 levels Subtotal Thyroidectomy Preferred procedure Removal of up to 90% of thyroid Minimally invasive procedures possible Endoscopic Robotic surgery

Answer 22

Administration of medications to achieve euthyroid state Administration of iodine to decrease vascularity Patient teaching Comfort & safety measures Leg exercises, head support, neck ROM Routine postoperative care

Answer 23

Frequent vital signs Assess for signs of: Hemorrhage Tracheal compression Avoid flexion / tension on suture lines Semi-Fowler’s position Support head with pillow(s) Difficulty speaking? Voice hoarse? Smile symmetrical? Tongue midline? Monitor for 72-hours Chvostek's Trousseau’s Caloric adjustment? Complete thyroidectomy? Life long thyroid hormone replacement

Answer 24

Monitor for complications Hypothyroidism Hypocalcemia Hemorrhage Laryngeal nerve damage Thyrotoxicosis Infection Maintain patent airway Oxygen, suction equipment, tracheostomy tray in patient’s room Monitor for laryngeal stridor Assess frequently during first 24-hours for hemorrhage or tracheal compression Semi-Fowler’s position Support head with pillows to avoid tension on suture line Monitor vital signs Signs of hypocalcemia IV calcium readily available Ambulation Psychosocial support

Answer 25

Monitor hormone balance periodically Decrease caloric intake Adequate but not excessive iodine intake Regular exercise Avoid high environmental temperature Regular follow-up care Complete thyroidectomy Symptoms of hypothyroidism Need for lifelong thyroid hormone replacement

Answer 26

Parathyroid hormone (PTH) regulates Calcium & Phosphate levels HYPERcalcemia HYPOphosphatemia Decreased bone density Weakness Increased urinary calcium Calculi Stimulates biologically active Vitamin D, which increases Ca+ uptake and hypercalcemia

Answer 27

Primary (30-70 years of age) Increased secretion of PTH; Disorders of Ca+, phosphate, bone metabolism Benign tumors

Answer 28

Secondary; Compensatory to conditions that cause HYPOcalcemia Vitamin D deficiency Malabsorption CKD HYPERphosphatemia

Answer 29

Tertiary; Hyperplasia of parathyroid & loss of negative feedback from circulating Ca+ Kidney transplant s/p long term hemodialysis

Answer 30

Most effective treatment for Primary & Secondary Criteria Serum Ca+ > 12 HYPERcalciuria > 400 mg / day Decreased bone density Partial or complete Auto-transplantation of normal tissue If not, Ca+ supplements for life

Answer 31

Re-breathing in a paper bag or rebreather oxygen mask may partially relieve muscle cramps & mild tetany by decreasing serum pH SLOW IV administration: Calcium Chloride (CaCl) Venous irritation, inflammation Careful infusion, check IV patency Calcium Gluconate 500 mg – 2 Grams Rate not more than 200 mg/min ECG monitoring advised High serum Ca+ Hypotension Arrhythmias Cardiac arrest Oral Ca+ supplements Correct HYPOmagnesemia Vitamin D to enhance GI absorption of Ca+ Dark, green vegetables Soy products & tofu Spinach & Rhubarb (inhibit absorption of Ca+)