thyroid disorders Flashcards by Chyanne Caniglia

what are the disorders of the thyroid gland

hyperthroidism
thyroid englargement (goiter)
hypothyroidism

thyroiditis

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what is thyroiditis

inflammation of the thyroid gland from stress on body can resolve on its own and could cause hypothyroidism

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what is hyperthyroidism

is a clinical syndrom in which there is sustained increase in synthesis and release of thyroid hormones by the thyroid gland

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what is the percent it occurs in men and women

.2% in men

2% in women

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what is thyrotoxicosis

physiological effects of hyper metabolism that results from excess levels of T4, T3 and free T4

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what is the highest frequency in which hyperthyroidism usually occurs

20-40 years of age

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what is the most common form of hyperthyroidism

graves diseases 80%

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what are other causes of hyperthyroidism

toxic nodular goiter
thyroiditis
exogenous iodine excess
pitituary tumor
thyroid cancer

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what are the normal levels of TSH, T4, Free T4 and T3`

TSH 0.4-4.9 mU/L
T3 80-180 ng/dL
T4 5-13.5 mcg/dL
Free T4 0.7-2 ng/dL

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what will the levels be like in hyperthyroidism

TSH will be low

T3, T4, and Free T4 will be high

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what is graves disease

autoimmune disorder of unknown etiology

thyroid englargment
excess thyroid hormone production
precipitating factors and genetic factors (infections, stressful life event, smoking)

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Graves disease accounts for ______% of cases of hyperthyroidism

75-80

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what happens in graves disease with the hormone levels

patient develops antibodies to the TSH receptor
antibodies attach to receptors and stimulate thyroid to release T3, T4 or both
hormones causes clinical manifestation

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what can happen with progress of graves disease

destruction of thyroid leading to hypothyroidism

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what are clinical manifestation of hyperthyroidism

-direct effect of hormones on increasing metabolism
-increased tissues sensitivity to stimulations by the sympathetic nervous system
-goiter
-ophthalmopathy (exophthalmos) - protruding eyeballss
due to the impaired drainage from the orbit, which causes increased fat deposits and fluid in the retroorbital tissues

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Ophthalmopathy occurs in ___% of patients with graves disease

20-40

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what is a complication of hyperthyroidism

thryotoxic crisis (thyroid storm)

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what is thyrotoxic crisis

life threatening emergency through to result from stressors such as infection, trauma or surgery

what are manifestations of thyrotoxic crisis

severe tachycardia
heart failure
shock
hyperthermia
seizures
delirium
coma

what is the treatment of thyrotoxic crisis

immediate to prevent death
aimed at reducing thyroid hormone levels, managing respiratory distress, fever reduction, fluid replacement and elimination or management of stressors

what are diagnostic studies of hyperthyroidism

decreased TSH levels
elevated FT4, T4 T3
radioactive iodine uptake (RAIU) helps determine if graves disease of other process is going on

what is the goal of hyperthyroidism

block adverse effects of excessive thyroid hormone, suppress over secretion of thyroid hormones and prevent complications

what inter professional care of hyperthyroidism

antithyroid meds
radioactive iodine therapy
subtotal thyroidectomy - about 90% of thyroid is removed

what are antithyroid drugs

inhibit the synthesis of thyroid hormones takes several weeks

prophylthiouracil (PTU)
methimazole (tapzaole))

what are drug therapy options

antithyroid drugs iodine- rapidly inhibits synthesis of T3, T4 and blocks release into circulation saturated solution of potassium and lug solution B-adrenergic blockers- provides symptomatic relief inderal

what is radioactive iodine therapy

treatment of choice for most nonpregnant adults destroys thyroid tissue 2-3 months for effects high incidence of post treatment hypothyroidism

when doing radioactive iodine therapy what shouldn't you be around

pregnant, young children, older adults of immnocomprised because for 7-10 days your body is still releasing the radioactivity

what should be taken prior to surgery

antithyroid drugs iodine B-adrengeric drugs: propanolo (inderal)

what is a subtotal thyroidectomy

removal of 90% of thyroid gland

what are indications that you could do a subtotal thyroidectomy

unresponsive to therapy very large goiter possible malignancy

what is an advantage of subtotal thryoiectomy over RAI

rapid reduction of T3, and T4 levels

what are nursing implementation of exophthalmos

artifical tear salt restriciton elevate head of bd administer corticosteroids

what are nursing implementation of thyroid surgery

prepare room with O2 suction and tracheotomy tray\ monitor repsirations observe for tetany

what are post op complications with hyperthyroidism

``` hypothyroidism damage to, or inadvertent removal of parathyroid gland hermorrhage thyrotoxic crisis infection ```

what is hypothyroidism

results from insufficient circulating thyroid hormone

what is primary hypothyroidism

related to destruction of thyroid tissue or defective hormone synthesis

what is secondary hypothyroidism

releated to pitutuaty disease with decreased TSH secretion of hypothalamic dysfunction with decreased thyropin releasing hormone secretion

what is the most common cause of hypothyroirism worldwide

iodine deficiency

what are clinical manifestation of hypothyroidism

- insidious and nonspecific slowing of body processes - impaired memory, slowed speech, depressed, fatigues, lethargic - decrease CO and cardiac contractitility - low excercise tolerance and SOB on exertion - anemia - coronary atherosclerosis - constipation - cold intolerance - dry, course skin, brittle nails - muscle weakness, and swelling - weigh gain - myxedem

what is myxedema

accumulation of hydrophilic mucopolysaccharides in dermis and other tissues causing characteristic facies of hypothyroidism

what are complications of hypothyroidism

mental sluggishness, drowsiness pay progress to impairment of consciousness and coma myxedema coma

what is myxedema coma

emergency due to infection, drugs, exposure to cold and trauma - subnormal temperature - hypotension - hypoventiliation treatment: IV thyroid hormone replacment

what are the diagnositic studies of hypothyroidism

High TSH, low T3, T4 and FT4

what is the goal of hypothyroidism

resture euthyroid state with hormone replacement therapy -low calorie diet levothyroxine (synthroid) -- same time before meal on empty stomach DO NOT give iron pill with 4 hours of levothryoxine