Thyroid Disorders (Exam 3) Flashcards
Continuum of Thyroid Dysfunction
Euthyroid State
Hyperthyroidism — Thyroid Storm
Hypothyroidism – Myxedema Coma
Thyroid Storm is interchangable with
Acute thyrotoxicosis
Thyrotoxic Crisis
Thyroid Review
Thyroid gland is control by secretion of TSH by Pituitary gland
TSH stimulates release of T4 (thyroxine) (inactive)
T4 is converted into T3 (triiodothyronine) Active
T3 Activates and energises all cells of the body
TSH is the shut off valve
Goiter
Enlarged thyroid gland
Goiter can be a result of
Overactive or underactive thyroid
Hyperthyroidism disorder
Graves Disease (75%) (Autoimmune)
Toxic multo-nodular goiter
Hyperthyroidism Hormones (Graves)
Increase T3 & T4
Decrease TSH
Hypothyroidism
Hashimoto’s thyroiditis
Hypothyroidism Hormones (hashimotos)
Decrease T3 and T4
Increase TSH
Goiter Can be caused by
Thyroiditis
Benign thyroid Nodules
Malignancy
Iodine deficiency
Toxic Goiter
Goiter with HYPERthyroidism
Non-toxic Goiter
Goiter with normal thyroid levels
(autoimmune problem)
Iodine Deficiency
Iodine is needed for synthesis of thyroid hormones
ONLY thyroid can uptake iodine
Deficiency occurs in parts of the world where it is insufficient in the diet
HORMONES CAN NOT BE SYNTHESIZED
Iodine Containing Foods
Yogurt
Milk
Eggs
Iodized Salt
Hyperthyroidism: Clinical S/S
-Metabolism
-Increase HR - murmurs - dysrhythmias - angina - palps
-Increase RR - DOE
-Weight loss
-Increase peristalsis
-Diarrhea
-Memory lapses
-Short attention span
-Hair loss (alopecia)
-Palmar erythema (red palms)
-Fine silky hair
-Diaphoresis
-Warm - moist skin
-VITILIGO
-BRUIT over gland
-Goiter
-EXOPHTHALMOS (Bulging Eyes)
Thyrotoxicosis
Excess thyroid hormone in body
Acute Thyrotoxicosis - Thyrotoxic Crisis - Thyroid Storm
Acute and severe (rare) (death rare when treat early)
Results from stressors in patient with pre-existing hyperthyroidism
Patient having thyroidectomy are at risk (manipulation of hyperactive thyroid)
Management of Hyperthyroidism: Durgy Therapy
Anti-thyroid Medication
-methimazole
Iodine therapy
-SSKI and Lugol’s solution
Beta Blocker
Hyperthyroidism: Antithyroid Medicaiton
Methimazole
-Improvement seen 1-2 weeks after start
-Results take 4-8 weeks
Hyperthyroidism: Iodine Therapy
SSKI and Lugol’s Solution
Used to prepare the patient for a thyroidectomy
Give rapidly in large dose: Inhibits T3 and T4 and decreases vascularity of thyroid gland.
Makes surgery easier and safer
Hyperthyroidism: Beta-blockers
Use for symptomatic relief of thyrotoxicosis
Hyperthyroidism: Treatment of choice
Radioactive Iodine Therapy 131
T/F: 60% of people with hashimoto’s disease received Radioactive Iodine Therapy 131?
False
People with graves disease get this therapy because the hyperactive thyroid uptakes the radioactive iodine
Radioactive Iodine Therapy 131 is for
Non pregnant adults
Radioactive Iodine Treatment 131
Taken po in solution or capsule without need for hospitalization
Radioiodine is rapidly incorporated into thyroid and its beta emission result in extensive local tissue damage
Patient who undergo radioactive thyroid treatment will have to be on
Thyroid replacement for the rest of life their life because it has killed off their thyroid
How does it take before RIT 131 to take effect?
6-18 weeks
How long is patient radioactive after radioactive iodine therapy?
Radioactivity is gone within a few days
Radioactive Iodine Therapy 131: Precautions
Minimize direct contact for 2-3 days
Double flush toilet
Separately launder clothes / towels
Subtotal Thyroidectomy
Removal of large portion of the thyroid gland (90%)
Hypothyroidism will occur if too much taken
Subtotal Thyroidectomy: Indications
For those who are not responsive to anti-thyroid therapy
Those with very large goiters
Possibility of malignancy
Endoscopic thyroidectomy is
less invasive and is used for small nodules
Subtotal Thyroidectomy: Postop
RISKY (around neck procedure)
Assess patient for signs of hemorrhage
Assess patient for tracheal compression
What to watch for post subtotal thyroidectomy
Irregular breathing
Neck swelling
Frequent swallowing
Choking
Blood on dressing
Sensation of fullness at incsion site
SERUM CALCIUM LEVELS
Is hoarseness an expected finding after subtotal thyroidectomy?
Yes for 3-4 days
What position should patient be in post subtotal thyroidectomy
Semi-fowlers with head on pillow
Avoid flexion or any tension on suture lines
Serum Calcium Concerns w/ Thyroid Removal
Tetany secondary to (accidental) hypoparathyroidism
AMB… tingling in toes, fingers, around mouth, muscle twitching, apprehension
Trousseau’s / Chvostek’s
Hypothyroid: Clinical S/S
SLOW Metabolism
-Weight gain
-Depression
-Fatigue
-Slow mentation
-Slow speech
-Somnolence
-Low exercise tolerance
-DOE
-Anemia
-Constipation
-Cold intolerance
-Hair loss
-Dry skin
-Goiter
-Difficulty swallowing
-MYXEDEMA
Myxedema
Term used to refer to changes seen in skin with prolong hypothyroidism
Swelling is hard / non pitting
Can be reversed with thyroid hormones
Myxedema Coma
Severe hypothyroidism with very low thyroid hormones levels
Medical Emergency
IV thyroid hormones and steroids given
What causes Myxedema Coma?
-HF
-Stroke
-Infections
-Not taking thyroid medication
-Certain drugs
Medical Management: Hypothyroidism
Levothyroxine (Thyroid hormone replacement)
Monitor thyroid hormones levels and adjust as prn
T3 / T4 = low w/ hypothyroid
TSH: High when defect is in thyroid
TSH: Low when it is in pituitary or hypothalamus
Nutrition to promote weight loss
