Thyroid disorders Flashcards
Single Nodule S/S
adenomas and cancer
Firm, fixed, rubbery to hard nodes; may be accompanied by lymph node involvement and vocal cord palsy
Multiple nodules S/S
Multinodular goiter, Hashimoto’s thyroiditis
Firm nodes
Diffuse goiter
Graves disease, Hashimoto’s thyroiditis, Thyroid lymphoma, Multinodular goiter
Irregular surface, bruit or thrill may be palpable
Tenderness
Tenderness Subacute thyroiditis, Hashimoto’s thyroiditis, Hemorrhagic or infarcted adenoma, 10 Cancer (chronic tenderness)
What laboratory studie differentiates between Hyper and hypothyroidism
TSH
Increased TSH = primary hypothyroidism
Decreased TSH = primary hyperthyroidism
Medication or foods that may alter thyroid tests
kelp or seaweed aspirine lithium heparin furosemide diazepam cimedtidine amiodarone phenytoin propranolol
Sporadic Goiter is caused by?
enlargement developed by good and meds that decrease thyroxine (4)
What are some foods and meds that decrease thyroxin (T4) and what does it cause?
Sporadic goiter
Foods: peaches, strawberries, radish, spinach, peas, cabbage, soybeans, peanuts
Meds: Iodine in large doses, lithium, propylthiouracil, methimazole, dopamine, glucocorticoids
S/S of a simple goiter
Fullness in neck
May cause difficulty swallowing or breathing
Dx findings of a simple goiter
Thyroid scan: enlarged gland
Increased uptake of 125I
High TSH, normla T3 and T$
Antibody test negative
Toxic goiter cause
hyper and hypothyroidism
S/S of acute thyroiditis
anterior neck pain and swelling
fever
dysphagia
dysphonia
S/S of chronic lymphocytic thyroiditis
painless, pressure, fever
S/S of thyroid cancer
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.
S/S of hypothyroidism
Fatigue, weakness Intolerance to cold dry skin and hair loss weight gain bradycardia Constipation Menstrual disturbances Facial edema (myxedema)
Meds for Hypothyroidism
Thyroid (thyroid extract)
Levothyroxine
Liothyronine
NI for levothyroxine
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
What is myxedema
Servere form of Hypothyroidism, occurs of hypothyroidism is untreated
S/S of myxedema and Life threatening S/S
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.
Dx tests for hypothyroidism
increased TSH
decreased T3, T4
decreased RAI uptake
S/S of Hyperthyroidism
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)
Dx findings of hyperthyroidism
increased T3, T4 and 124I uptake
Decreased TSH
Meds to treat hyperthyroidism
Propylthiouracil
Methimazole
Propranolol to control tachycardia
Potassium Iodine solution (Lugol’s and SSKI) - to protect thyroid before and after radiation
NI and Side effects of hyperthyroidism meds (Thioamides)
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
S/S of acute thyrotoxicosis (thyroid storm)
high fever >101.3
Extreme tachycardia >130
Exaggerated symptoms of hyperthyroidism
Delirium, psychosis, somnolence, coma
Foods high in iodine
Seafood, bread, milk, eggs, meat, spinach
