Thyroid Disorders Flashcards
What hormones are secreted by the thyroid?
- T4
- T3
- calcitonin
What is the thyroid gland palpated and inspected for? -4
- Swelling
- Asymmetry
- Tenderness
- Texture / Firmness
What does a tender thyroid mean?
thyroiditis
What does a soft textured thyroid mean?
grave’s disease
What does a firm thyroid mean?
hashimotos
TSH levels in hypo/hyperthyroidism
hypothyroidism=elevated
hyperthyroidism=decreased
T3, T4 levels in hypo/hyperthyroidism
hypo=decreased
hyper=increased
Iodine uptake levels in hypo/hyperthyroidism
hypo=decreased
hyper=increased
What is hypothyroidism?
deficient level of thyroid hormone
Who is more affected by hypothyroidism?
women are affect 5-8x more than men
occurs between 40-70 years old
Causes of hypothyroidism-6
- Autoimmune thyroiditis (Hashimoto disease) most common
- Antithyroid medications
- Occurs after thyroidectomy
- Dysfunction of thyroid gland
- Atrophy of thyroid gland due to aging
- Radiation to head and neck
If enlargement of the gland is felt, the nurse can auscultate for bruit. What does it mean if they hear bruit?
hyperthyroidism
Common symptoms of hypothyroidism-8
- Extreme fatigue
- Hair loss
- Brittle nails
- Dry skin
- Numbness / tingling of fingers
- Hoarse / husky voice
- Menstrual disturbances
- Decreased libido
Severe symptoms of hypothyroidism-8
- Low body temperature
- Bradycardia
- Weight gain, enlarged hands & feet
- Thickened skin
- Slowed speech
- Altered mentation
- Elevated cholesterol
- Constipation
Medical management hypothyroidism-2
Hormone replacement (levothyroxine)
Monitor for cardiac dysfunction
What is hypothyroidism associated with?-3
elevated cholesterol, atherosclerosis, coronary artery disease
Which medications interact with hypothyroidism replacement therapy?
antacids, digitalis, anticoags, sedatives
How do antacids interfere with thyroid replacement?
o Decrease in absorption of thyroid hormones
How does digitalis interfere with thyroid replacement?
o Thyroid hormones decrease the effects of digitalis glycosides
How do anticoags interfere with thyroid replacement?
o Should be decreased when beginning thyroid replacement because of the increased risk of bleeding
How do sedatives interfere with thyroid replacement?
o May produce profound somnolence lasting longer than anticipated
nursing mangement- hypothyroidism- 5
Monitor patients taking sedatives / analgesics
Maintain normal body temperature
Monitor for constipation
Monitor for signs of altered mental status
Educate patient on treatment regimen- lifelong hormone replacement
hypothyroidism nursing management-maintain normal body temp-4
- Provide extra layer of clothing or blanket
- Avoid use of external heat sources (heating blanket)
- Monitor body temp
- Protect from exposure to cold or drafts
hypothyroidism nursing management-constipation-4
- Encourage increased fluid
- Provide foods high in fiber
- Encourage mobility
- Encourage to use laxatives sparingly
hypothyroidism nursing management-educate patient on treatment-3
- Explain reason for thyroid hormone
- Describe desired effects
- Assist to develop schedule
potential complication of hypothyroidism
myxedema coma
How does myxedema coma happen
prolonged hypothyroidism (occurs most often in older women in the cooler months)
s/s myxedema coma-6
- Decreased mental status
- Hypothermia
- Hypoglycemia
- Precipitated by infection and use of sedatives / opioids
- Decreased function in multiple organs
- Progressive lethargy, stupor, and coma
causes of hyperthyroidism-5
- Graves disease
- Toxic goiter
- Toxic adenoma
- Thyroiditis
- Excessive ingestion of thyroid hormone
Most common cause of hyperthyroidism
grave’s disease
s/s graves disease
- Bulging eyes
* Thick red skin to shin & tops of feet
What is goiter?
abnormal enlargement of thyroid
What can cause goiter?
lack of dietary iodine
What can goiter affect?
swallowing/breathing
clinical manifestations of hyperthyroidism-13
Nervousness / anxiety Hyperexcitable, can’t sit still Emotional / irritable Tachycardia / palpitations Warm, flushed skin Hand tremors Bulging eyes Increased appetite Weight loss Weakness Finger clubbing Menstrual changes Changes in bowel function
Medical management hyperthyroidism-4
Antithyroid medications (thionamides)
Radioactive iodine
Thyroidectomy
Symptom management (beta blockers)
radioactive iodine- (tx for, contraindications)
- Most common form of treatment of Grave’s disease
* Contraindicated during pregnancy (Should not conceive for at least 6 months after treatment)
Who can receive a thyroidectomy?
• Reserved for patients with obstructive symptoms, pregnant women in second trimester, and for patients that need a rapid normalization of thyroid function
nursing management hyperthyroidism
- assess nutritional status
- monitor VS
- monitor for emotional changes/anxiety
- maintain normal body temp
nursing management hyperthyroidism-nutritional status
- Several, small meals
* Replace fluid lost through diarrhea
nursing management hyperthyroidism-monitor for emotional changes/anxiety-
- Stressful experiences should be minimized and a quiet, uncluttered environment should be maintained
- Balance periods of activity with rest
nursing management hyperthyroidism-maintain normal body temp
- Cool, comfortable temperature
* Cool baths and cold fluids
potential complications of hyperthyroidism
thyroid storm
s/s thyroid storm
- Fever > 101.3 F
- Tachycardia > 130 bpm
- Exaggerated symptoms of hyperthyroidism
- Altered mental status
what can cause a thyroid storm?-6
stress, infection, abrupt withdrawal of antithyroid meds, diabetic ketoacidosis, surgery, pregnancy
What does parathormone do?
regulates calcium and phosphate metabolism
Causes of hyperparathyroidism
- Enlargement of one or more parathyroid gland
* Any disease that causes low Ca levels, resulting in increased production of parathormone
What happens in hyperparathyroidism?
Increased calcium absorption from kidney, intestines, bones- raises serum Ca level
Results in bone decalcification and kidney stones
Results in decreased serum phosphate levels
clinical manifestations of hyperparathyroidism-12
Fatigue Muscle weakness Nausea Vomiting Constipation HTN Cardiac dysrhythmias Kidney stones Skeletal pain Pain with weight bearing Pathologic fractures Bone loss
Medical management hyperparathyroidism-4
Parathyroidectomy
Hydration therapy- prevention of renal calcium
Monitor dietary calcium
Encourage patient mobility
Medical management hyperparathyroidism-hydration therapy
- At least 2000 mL
* Thiazide diuretics are avoided
Medical management hyperparathyroidism-monitor dietary calcium
• Avoid diet with restricted or excessive amounts of calcium
Medical management hyperparathyroidism-encourage patient mobility
• Bed rest increases calcium excretion and the risk of renal calculi
potential complication of hyperparathyroidism
hypercalcemic crisis
hypercalcemic crisis
- Occurs with serum Ca levels > 13 mg/dL
- Can cause life threatening neurologic, cardiovascular, kidney symptoms
- Patient is given Calcitonin (Promotes renal excretion of excess Ca)
- Patient is hydrated with large volumes of IV fluids
hypoparathyroidism causes-4
- abnormal parathyroid development
- surgical removal of glands
- thyroidectomy
- vit D deficiency
What happens to calcium and phosphate levels in hypoparathyroidism
Results in increased serum phosphate levels & decreased serum calcium levels
clinical manifestations of hypoparathyroidism-8
Tetany- intermittent muscular spasms Muscle cramping Numbness / tingling Stiffness in hands and feet Dysphagia Photophobia Cardiac dysrhythmias Seizures
Assessment and dx hypoparathyroidism
Positive Chvostek or Trousseau sign indicate latent tetany
Labs (Serum calcium, Serum phosphate)
X-ray shows increased bone density
Medical management hypoparathyroidism
Increase serum calcium level to. 9-10 mg/dL
If tetany occurs –> IV calcium gluconate, Provide non-stimulating environment
Diet- high calcium, low phosphorus (Milk, milk products, and eggs are avoided due to high amounts of calcium)
Monitor for respiratory distress
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