Thyroid disorders

Question 1

Single Nodule S/S

Answer 1

adenomas and cancer

Firm, fixed, rubbery to hard nodes; may be accompanied by lymph node involvement and vocal cord palsy

Question 2

Multiple nodules S/S

Answer 2

Multinodular goiter, Hashimoto’s thyroiditis

 Firm nodes

Question 3

Diffuse goiter

Answer 3

Graves disease, Hashimoto’s thyroiditis, Thyroid lymphoma, Multinodular goiter
Irregular surface, bruit or thrill may be palpable

Question 4

Tenderness

Answer 4

Tenderness Subacute thyroiditis, Hashimoto’s thyroiditis, Hemorrhagic or infarcted adenoma, 10 Cancer (chronic tenderness)

Question 5

What laboratory studie differentiates between Hyper and hypothyroidism

Answer 5

TSH
Increased TSH = primary hypothyroidism
Decreased TSH = primary hyperthyroidism

Question 6

Medication or foods that may alter thyroid tests

Answer 6

kelp or seaweed
aspirine 
lithium
heparin
furosemide
diazepam
cimedtidine
amiodarone 
phenytoin
propranolol

Question 7

Sporadic Goiter is caused by?

Answer 7

enlargement developed by good and meds that decrease thyroxine (4)

Question 8

What are some foods and meds that decrease thyroxin (T4) and what does it cause?

Answer 8

Sporadic goiter
Foods: peaches, strawberries, radish, spinach, peas, cabbage, soybeans, peanuts
Meds: Iodine in large doses, lithium, propylthiouracil, methimazole, dopamine, glucocorticoids

Question 9

S/S of a simple goiter

Answer 9

Fullness in neck

May cause difficulty swallowing or breathing

Question 10

Dx findings of a simple goiter

Answer 10

Thyroid scan: enlarged gland
Increased uptake of 125I
High TSH, normla T3 and T$
Antibody test negative

Question 11

Toxic goiter cause

Answer 11

hyper and hypothyroidism

Question 12

S/S of acute thyroiditis

Answer 12

anterior neck pain and swelling
fever
dysphagia
dysphonia

Question 13

S/S of chronic lymphocytic thyroiditis

Answer 13

painless, pressure, fever

Question 14

S/S of thyroid cancer

Answer 14

Firm, irregular, fixed, painless mass below the adam’s apple.
Hoarseness or difficulty swallowing
trouble breathing
swollen lymph nodes in the neck.
Pain in the thought or neck, which may radiate to the ears.

Question 15

S/S of hypothyroidism

Answer 15

Fatigue, weakness
Intolerance to cold
dry skin and hair loss
weight gain
bradycardia
Constipation
Menstrual disturbances
Facial edema (myxedema)

Question 16

Meds for Hypothyroidism

Answer 16

Thyroid (thyroid extract)
Levothyroxine
Liothyronine

Question 17

NI for levothyroxine

Answer 17

Take PO 30min before breakfast or same time each day..
Interacts with the absorption of Ca, iron, Mg, Zn
Watch for drug interactions - protein bound meds, such as warfarin, aspirin.
Assess for tachydysrthmias and any chest pain - toxic overdose S/S of hyperthyroidism

Question 18

What is myxedema

Answer 18

Servere form of Hypothyroidism, occurs of hypothyroidism is untreated

Question 19

S/S of myxedema and Life threatening S/S

Answer 19

slowing of vital functions
slow speech, 
puffiness of face
dementia like symptoms 
slow HR
hypothermia 
hearing loss
pleural effusion 
increased shoe size 
Life‐threatening event characterized by hyponatremia, hypoglycemia, hypothermia, hypoventilation, hypotension, profound lethargy, stupor, somnolence progressing  into ventilatory and circulatory collapse and coma.

Question 20

Dx tests for hypothyroidism

Answer 20

increased TSH
decreased T3, T4
decreased RAI uptake

Question 21

S/S of Hyperthyroidism

Answer 21

Nervousness in elderly
Heat intolerance 
Tremor in hands
fine hair 
tachycardia 
weight loss
goiter
exophthalmos (protruding of the eyeballs) - grave's 
Diarrhea 
Muscle wasting
sweating (diaphoresis)

Question 22

Dx findings of hyperthyroidism

Answer 22

increased T3, T4 and 124I uptake

Decreased TSH

Question 23

Meds to treat hyperthyroidism

Answer 23

Propylthiouracil
Methimazole
Propranolol to control tachycardia
Potassium Iodine solution (Lugol’s and SSKI) - to protect thyroid before and after radiation

Question 24

NI and Side effects of hyperthyroidism meds (Thioamides)

Answer 24

Baseline LFT
Take on empty stomach
Thioamides can cause Agranulocytosis, and thrombocytopenia
Report S/S of infection immediately (sore throat), hepatotoxicity
Watch for rash, N/V, SLE

Question 25

S/S of acute thyrotoxicosis (thyroid storm)

Answer 25

high fever >101.3
Extreme tachycardia >130
Exaggerated symptoms of hyperthyroidism
Delirium, psychosis, somnolence, coma

Question 26

Foods high in iodine

Answer 26

Seafood, bread, milk, eggs, meat, spinach