thyroid disorders Flashcards
what are the disorders of the thyroid gland
hyperthroidism
thyroid englargement (goiter)
hypothyroidism
thyroiditis
what is thyroiditis
inflammation of the thyroid gland from stress on body can resolve on its own and could cause hypothyroidism
what is hyperthyroidism
is a clinical syndrom in which there is sustained increase in synthesis and release of thyroid hormones by the thyroid gland
what is the percent it occurs in men and women
.2% in men
2% in women
what is thyrotoxicosis
physiological effects of hyper metabolism that results from excess levels of T4, T3 and free T4
what is the highest frequency in which hyperthyroidism usually occurs
20-40 years of age
what is the most common form of hyperthyroidism
graves diseases 80%
what are other causes of hyperthyroidism
toxic nodular goiter thyroiditis exogenous iodine excess pitituary tumor thyroid cancer
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
what will the levels be like in hyperthyroidism
TSH will be low
T3, T4, and Free T4 will be high
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)
Graves disease accounts for ______% of cases of hyperthyroidism
75-80
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
what can happen with progress of graves disease
destruction of thyroid leading to hypothyroidism
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
Ophthalmopathy occurs in ___% of patients with graves disease
20-40
what is a complication of hyperthyroidism
thryotoxic crisis (thyroid storm)
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
