THYROID DISORDERS Flashcards
what is hyperthyroidism?
-hyperactivity of the thyroid gland
- a form of thyrotoxicosis and both usually occur together.
what is thyrotoxicosis
inappropriately high tissue thyroid levels of t4, t3, or both
what is grave’s disease?
-an autoimmune disease of unknown etiology
-marked by diffuse thyroid enlargement and excessive thyroid hormone secretion
marked by diffuse thyroid enlargement and excessive thyroid hormone secretion
Grave’s Disease
most common type of hyperthyroidism
Grave’s disease
grave’s disease more common in what gender?
more common in women aging 20 to 40 years
etiology of hyperthyroidism
-insufficient iodine supply
- infections
- smoking
- stressful life events
-abnormally high antibodies
abnormally high antibodies cause
creating false signals to the TSH receptors, increasing T3 & T4 release
clinical manifestations of hyperthyroidism
-palpable thyroid gland (goiter)
- bruits heard on the thyroid gland due to increased blood supply
-exopthalmos
-excessive sweating
- heat intolerance
- tachycardia
- tremors
What is the complication of hyperthyroidism?
Thyrotoxic crisis
What is thyrotoxic crisis?
-aka as thyroid storm
- an intensification of all hyperthyroid manifestations
- a rare yet-life threatening condition
Thyrotoxic crisis can happen to:
happens to patients with pre-existing hyperthyroidism, severe tachycardia, heart failure, shock, seizures, delirium
Diagnosis of hyperthyroidism
-Thyroid stimulating hormone test
- T4 test
- Radioactive Iodine Uptake Test
The purpose of thyroid-stimulating hormone test
-decreased TSH levels in positive patient
- an early warning system
T4 test role
-the main form of thyroid hormone
- more accurate when checked with TSH
Radioactive Iodine Uptake Test role
differentiate grave’s disease from other forms of thyroiditis
What are the antithyroid medications?
- thionamides
- iodine
- beta-adrenergic blockers
- propanolol (inderal)
- atenolol
the first-line antithyroid medication
thionamides
mechanism of action of thionamides
inhibit the synthesis of thyroid hormones
this drug is continued for 6 months to 2 years
thionamides
examples of thionamide drug
- propylthiouracil
- carbimazole
- methimazole
iodine drug role in hyperthyroidism
-used with other antithyroid medications for thyroidectomy
iodine mechanism of action
rapidly inhibits synthesis of T3 and T4 and blocks the release of these hormones
through the use of iodine the surgery makes it much safer, why?
decreases the vascularity of the thyroid gland which makes surgery safer
Iodine example drug
-lugol’s solution
- potassium iodide (KI)
- tablets
- saturated solution of potassium iodide (SSKI)
Role of beta-adrenergic blockers in antithyroid medications
used for symptomatic relief of thyrotoxicosis
role of propanolol in antithyroid medications
administered with other antithyroid agents and rapidly provides symptomatic relief
role of atenolol in antithyroid medications
preferred for use in hyperthyroid patients with asthma or heart disease
What is radioactive iodine therapy?
damages or destroys thyroid tissue, thus limiting thyroid hormone secretion
radioactive iodine therapy can cause
causes dryness and irritation of the mouth and throat
best for nonpregnant adults
radioactive iodine therapy
interventions to prevent dryness and irritation of the mouth and throat when using a radioactive iodine therapy
-take sips of water or ice chips or baking soda solution (10 ml of baking soda in 250 ml water)
surgical therapy for hyperthyroidism
thyroidectomy
preferred surgical procedure
subtotal thyroidectomy
removal of a significant portion (90%) of the thyroid gland
subtotal thyroidectomy
what is subtotal thyroidectomy?
-preferred surgical procedure
- removal of a significant portion (90%) of the thyroid gland
minimally invasive procedure with less scarring, less pain, and a faster return to normal activity
Endoscopic thyroidectomy
what is endoscopic thyroidectomy?
minimally invasive procedure with less scarring, less pain, and a faster return to normal activity
nutritional therapy for hyperthyroidism
-increased metabolic rate means more nutritional deficits
- high calorie diet (4,000 to 5,000 kcal/day) may be ordered
- avoid seasoning as it stimulate the already hyperactive GI tract
- coffee must be substituted to avoid restlessness and sleep disturbances
nursing management for hyperthyroidism patient who have exophthalmos
for exophthalmos, apply artificial tears to soothe and moisten conjunctival membranes
symptoms of iodine toxicity
-swelling of buccal mucosa
- excessive salivation
- nausea and vomiting
- skin reactions
what is laryngeal stridor?
harsh, vibratory sound due to edema of the laryngeal nerve
harsh, vibratory sound due to edema of the laryngeal nerve
laryngeal stridor
what is hypothyroidism?
aka underactive thyroid (unable to produce enough of the thyroid hormones)
what does overt primary hypothyroidism mean?
characterized biochemically by high serum levels of TSH and insufficient free circulating thyroid t4 hormone
what does subclinical hypothyroidism means?
characterized by a high serum TSH and a normal serum level of free circulating t4 hormone
dubbed as the “stove” of the body
thyroid gland
“Puts the body “on fire”
thyroid gland
the role of thyroid gland
-increases basal metabolic rate
-releases thyroid hormones
What is thyroxine (t4)?
-main hormone
-the most abundant
what is triiodothyronine (t3)?
the most active
Etiology of Hypothyroidism
- Primary Hypothyroidism
- Secondary Hypothyroidism
- Tertiary Hypothyroidism
What is primary hypothyroidism?
problems stem from the thyroid gland itself
What is secondary hypothyroidism?
problems with the anterior pituitary gland
What is tertiary hypothyroidism?
problem with hypothalamus
what’s the common cause of hypothyroidism?
iodine deficiency
what is iodine?
a mineral found in food which helps make thyroid hormone
what is the atrophy of thyroid gland?
-due to hashimoto’s thyroiditis and grave’s disease (destroys thyroid gland)
Radioactive Iodine Therapy (for Hypothyroidism)
-can occur anytime from one month after the treatment
- most common within the first 12 months after treatment
clinical manifestations of hypothyroidism
-insidious and non-specific slowing of body processes
- symptoms may be unnoticed
-fatigued and lethargic
-impaired memory
-slowed speech
diagnostic studies of hypothyroidism
- history and physical examination
- serum T3 and serum t4 levels (if ordered)
- Serum TSH and free t4 levels
- TRH stimulation test
- Thyroid peroxidase antibodies
levothyroxine
- drug of choice for hypothyroidism
- dose is increased at 4 to 6 weeks intervals
-lifelong therapy is required
what’s the drug of choice of hypothyroidism
Levothyroxine
Nursing management for hypothyroidism
-Monitor pulse rate greater than 100 beats/minute on irregular heartbeat must be reported
- watch out for chest pain, weight loss, nervousness, tremors or insomnia
- Serum TSH levels must be checked 4 to 6 weeks after changing levothyroxine preparation.
