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AH2 Exam 3 > Thyroid Gland > Flashcards

Thyroid Gland Flashcards

1
Q

Thyroid

A
  • Primary Function
    > controls cellular metabolic activity throughout body
  • Influences every major organ system
  • Hormones:
    > Thyroxine (T4) & Triiodothyronine (T3); aka Thyroid hormone (TH)
    > Calcitonin
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2
Q

Thyroid Hormone

A
  • T3 & T4
  • Effect growth, maturation, & function of cells and tissues
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3
Q

Thyroiditis

A
  • Inflammation of the thyroid tissue, can result in fibrosis & lymphocytic infiltration(buildup of lymph tissue around thyroid)
  • 3 Types
    > acute: from an infection
    > subacute: granulomatous
    > chronic: Hashimoto’s disease (most common type)
  • Symptoms: neck pain, swelling, dysphagia
  • Try nonsurgical management 1st: drug therapy
    > Levothyroxine (Synthroid)
  • Surgical management
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4
Q

Hyperthyroidism (Thyrotoxicosis)

fast forward

A
  • Excessive output of thyroid hormones
  • Women 8x greater than men
  • Graves Disease most common type
    > caused by abnormal stimulation by immunoglobulins (autoimmune): immunoglobulins bond irregularly to thyroid tissue = excess secretion of T3 & T4
  • Other types
    > formation of nodules from iodine deficiency (toxic multinodular goiter)
    > viral infection of thyroid gland (thyroiditis)
    > excessive pituitary secretion of TSH (secondary hyperthyroidism)
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5
Q

Hyperthyroidism - CMs

A
  • Nervous/anxious
  • Apprehensive
  • Can’t sit still
  • Poor heat tolerance
    > heat flashes
  • High HR
    > 120-180 @ rest
  • Flushed
  • Skin moist
  • Tremors
  • Incrd appetite
  • Wt loss
  • Weakness
  • Amenorrhea
  • Exophthalmos: bulging eyes (permanent)
  • Thyroid enlargement
    > bruit over thyroid arteries
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6
Q

Hyperthyroidism - Labs & Diagnostics

A
  • Thyroid labs
    > TSH will be low, T3 & T4 will be elevated
  • Radioactive Iodine uptake
    > thyroid needs iodine to produce T3 & T4
    > measure rate of iodine uptake by thyroid
    > hyperthyroid will be high uptake
    > hypothyroid will be low uptake
  • Fine-Needle aspirate biopsy
    > tissue sample to detect cancer
  • Thyroid scan
    > radionuclide injeted in thyroid and test determines “hot” areas of incrd activity & “cold” areas of dcr activity (cancer)
    > entire body may be scanned to determine metastatic thyroid disease
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7
Q

Thyroid Storm

extreme fast forward

A
  • Emergency
  • Worsening of hyperthyroid S/S
  • Rare complication of hyperthyroidism
    > can be fatal
  • Develop HF, circulatory collapse, high fever
    > high risk for seizures
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8
Q

Thyroid Storm - Medical Management

A
  • Antithyroid meds
  • Plasmapheresis or dialysis to remove excessive T3 & T4
    > short term fix
  • Ablation or removal of gland
  • Cardiac monitoring dysrhythmias
  • Oxygen to treat dyspnea & (possible) HF
    > even if at 90% RA
  • Beta blockers to dcr sympathetic activity symps
  • Acetaminophen to reduce temp
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9
Q

Hyperthyroidism - Nursing Care

A
  • Monitor VS w/ special attention on temp & HR elevations
  • Provide calm & quiet envir’t to scr anxiety & irritability
  • Maintain a cool room & envir’t
  • Provide ete care (exophthalmos)
    > admin artificial tears to reduce dryness
    > elevate HOB at night
  • Corticosteriods to reduce inflammation
  • Collaborate w/ dietician
    > hypermetabolic state, caloric intake must be incrd to 4000-5000cals/day
    > encourage 6 meals/day
  • Teach pt & family
  • Need for antithyroid med
  • Encourage f/u w/ PCP
  • Provide info about online resources
  • Treat photophobia w/ dark glassess
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10
Q

Hyperthyroidism - Medical Management: Ablation/Removal

A
  • Radioactive Iodine Therapy (I 131)
    > most common treatment; remission w/ high dose 80%
  • Surgical removal of thyroid; relapse 19% at 18mnths
    > if I 131 not successful
  • Total thyroidectomy/Ablation will need lifelong thyroid hormone replacement
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11
Q

Radioactive Iodine Therapy

A
  • Ablative dose of I 131 administered
  • Causes acute release of thyroid hormone as it is destroyed
  • Observe for thyroid storm (thyrotoxic crisis)
    > 101.3+ fever, 130bpm+, effects on organs: abd paon, diarrhea, edema, chest pain, dyspnea, delirium, psychosis
  • Management
    > cooling blanket
    > Hydrocortisone (shock & adrenal insuf)
    > Methimazole (impede formation of thyroid hormone)
    > Iodine (dcr T4 output)
    > support cardiac, resp, renal systems
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12
Q

Precautions for I-131

A
  • Wear gloves & shoe covers
  • Wear dosimetry badge
  • Minimize time spent w/ pt
  • Remain at least 3 ft away when possible
  • Contaminated linens must be collected
  • Pt must remain in room at all times
  • Pt must use disposable utensils
  • No minors or pregnant vistors
  • Radiation Safety must release room
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13
Q

I-131 Nursing Post-Op

A
  • Observe for potential comps:
    > hemorrhage
    > resp distress: swelling around neck
    > hypocalcemia & tetany (parathyroid)
    > laryngeal nerve damage
    > thyroid storm or thyroid crisis
  • Admin hormone replace
    > Levethyroxine (Synthroid)
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14
Q

Hypothyroidism

slow motion

A
  • 95% primarly due to low lvls of thyroid hormones (T3&T4)
    > women 5x more than men
    > autoimmune (Hashimoto’s), thyroid removal surgery, iodine deficiency, tumors, drugs
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15
Q

Hypothyroidism - CMs

A
  • Early
    > fatigue, cold intolerance (subnormal temp), low HR, weight gain w/ poor appetite, constipation
  • TSH high, T3 & T4 low
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16
Q

Hypothyroidism - Medical Management

A

Levothyroxine (Synthroid)

17
Q

Compensatory Mechanisms: Enlarged Thyroid

A
  • Goiter
    > abnormal enlargement of thyroid
    > not common in US
  • Hypothyroid
    > hypothalamus signals release of more TSH binds to thyroid cells & causes thyroid to enlarge in attempt to trigger release of T3 & T4
  • Hyperthyroid
    > too much thyroid hormone released
18
Q

Compensatory Mechanisms: Enlarged Thyroid - Nursing Management

A
  • Modify activity
    > risk of immobility problems
  • Monitor physical status
    > VS & mental status; manis of meds & potential effects
  • Promote physical comfort
    > keep room warm, no heating pads, nutrition, incr fluids, ADLs
  • Enhance coping mechanisms
    > may have extremes of emotions; need supporrt & counseling
  • Promote home & community based care
    > teach: meds, keep appts for labs & PCP, self care
19
Q

Hypothyroid Complication - Myxedema Crisis

A
  • 60% mortality rate
  • Tissue & organ failure due to dcrd metabolism
  • Occurs w/ undiagnosed hypothyroidism or poorly treated hypothyroidism
20
Q

Hypothyroid Complication - Myxedema Crisis: CMs

A
  • Mucinous Edema
    > mucous & water form cellular (solid) edema, non-pitting, everywhere (eyes, hands, feet, btwn shoulder blades, tongue)
  • Hypothermia, incr lethargy, stupor (unresponsive), loss of consciousness, depressed resp drive, coma, cardiovascular collapse, shock & death
  • Very sensitive to sedating drugs
21
Q

Hypothyroid Complication - Myxedema Crisis: Nursing Interventions

A
  • Ineffective Breathing Pattern
    > observe & record rate and depth of respirs
    > auscultate lungs
    > assess for resp distress
    > assess pt receiving sedation for resp adequacy
  • Dcrd Cardiac Output
    > monitor circulatory status
    > signs of inadequate tissue oxygenation
    > changes in mental status
    > fluid status & HR (low)
    > admin oxygen or mechanical vent, as appropriate
22
Q

Thyroid Cancer

A
  • Papillary, Follicular, Medullary, & Anaplastic
  • Collaborative management
  • Surgery treatment of choice: thyroidectomy
    > suppressive doses of thyroid hormone for 3 mnths after surgery
    > study performed after drugs are withdrawn
    > genetic counseling

AH2 Exam 3 (12 decks)

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