Thyroid Dysfunction (405)

Question 1

goiter

Answer 1

enlarged thyroid gland caused by thyroiditis, benign thyroid nodules, malignancy, iodine deficiency

Question 2

hyperthyroidism

Answer 2

inc T3&T4, dec TSH
most of the time caused by graves disease

Question 3

hypothyroidism

Answer 3

dec T3&T4, inc TSH
hashimoto’s

Question 4

toxic goiter

Answer 4

refers to goirt w/ hyperthyroidism

Question 5

non toxic goiter

Answer 5

refers to goiter w/ normal thyroid levels

Question 6

iodine can be found in what foods

Answer 6

yogurt, milk, eggs and iodized salt

Question 7

hyperthyroidism S/s

Answer 7

-inc HR, murmurs, dysrhyth, palpitations, angina
-inc RR & DOE
-inc appetite & thirst
-weight loss
-inc peristalsis & diarrhea
-memory lapses / short attention span

Question 8

hyperthyroidism physical sx

Answer 8

-warm, moist, smooth skin
-hair loss
-palmar erythema
-fine silky hair
-diaphoresis
-vitiligo
-exophthalmos
-bruit over thyroid gland

Question 9

drug therapy for hyperthyroidism

Answer 9

-anti thyroid (tapazol)
-iodine therapy (SSKI & Lugols)
-beta blockers
-radioactive iodine therapy

Question 10

acute thyrotoxicosis / crisis/ storm

Answer 10

-results from stressor (infection, trauma, surgery)
-pt having a thyroidectomy are at risk d/t manipulation of the hyperactive thyroid
-S/s: severe hyperthyroid sx

Question 11

SSKI

Answer 11

-used to prepare pt for thyroidectomy
-inhibits synthesis of T3&4 and dec the vascularity of the thyroid gland

Question 12

radioactive iodine therapy

Answer 12

-used for med mgt of hyperthyroidism
-treatment of choice for non pregnant adults
-take it PO (do not need to be admitted)
-radio iodine is rapidly incorporated into the thyroid & its beta emissions result in extensive local tissue damage (delayed response tho)
-give anti thyroid drugs & beta blockers for sx mgt
pt secretions will be radioactive for a few days & if thyroid is destroyed they need to supplement for life

Question 13

radioactive iodine therapy precautions

Answer 13

minimize direct contact for 2-3 days, double flush toilet, separately launder clothes and use seperate towels

Question 14

subtotal thyroidectomy

Answer 14

-removal of large portion (90%) of the thyroid gland
-hypo will occur if too much is taken
-indicated for those not responsive to anti thyroid therapy, large goiters or possibility of malignancy

Question 15

less invasive surgical mgt of hyperthyroidism

Answer 15

endoscopic thyroidectomy

Question 16

post op interventions for subtotal thyroidectomy

Answer 16

-assess for hemorrhage or tracheal compression
-hoarseness will be expected for 3-4 days post surgery
-semi fowlers w/ head on pillow, avoid flexion or any tension on suture line
-monitor vitals & Ca levels

Question 17

serum calcium concerns w/ thyroid removal

Answer 17

-tetany secondary to (accidental) hypoparathyroidism
-S/s: tingling in toes/fingers/around mouth muscular twitching & apprehension
-monitor for trousseau’s & chvostek’s sign

Question 18

hypothyroidism S/s

Answer 18

wt gain, depression, fatigue, slow mentation, slow speech, somnolence, low exercise tolerance,
DOE, anemia, constipation, cold intol, hair loss, dry skin, goiter, difficulty swallowing & myxedema

Question 19

myxedema

Answer 19

changes seen in the skin and tissue d/t prolonged hypothyroidism -> swelling is hard & non pitting
can be reserved w/ thyroid replacement

Question 20

myxedema coma

Answer 20

-severe hypothyroidism w/ very low thyroid hormone levels
-a medical emergency
-IV thyroid hormones & steroids given
-mental status changes / unresponsive

Question 21

myxedema coma causes

Answer 21

HF, stroke, infections, not taking thyroid meds

Question 22

med mgt of hypothyroidism

Answer 22

-thyroid hormone replacement (levothyroxine)
-monitor TH levels & adjust dosage prn
-nutrition for wt loss

Question 23

T3&T4 w/ hypothyroidism

Answer 23

low

Question 24

TSH w/ hypothyroidism

Answer 24

high when defect is the thyroid
low when iti is in the pituitary or hypothalamus