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MS 2 > THYROID HORMONES > Flashcards

THYROID HORMONES Flashcards

1
Q

Thyroid Hormone is regulated by

A

Thyroid-Stimulating Hormone

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2
Q

Thyroid Hormone is synthesized and secreted by

A

Thyroid Gland

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3
Q

The essential amino acids of thyroid gland

A

Thyrosine

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4
Q

The 3 Thyroid Hormones

A

Thyroxine (t4)
Tri-iodothyronine (T3)
Thyrocalcitonin

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5
Q

Whats the behind reason on why the thyroid hormone is produced?

A

Thyroid Hormone is produced because of the combination of iodide and thyrosine

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6
Q

Functions of T3 and T4

A

Basal Metabolic Rate
Blood Sugar
Breakdown of Lipids
Brain Maturation
Bone Growth
B-adrenergic effects
Balls and Baby Bumps

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7
Q

Everything is high, fast, and dry

A

Hyperfunction

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8
Q

Everything is low, wet, and slow

A

Hypofunction

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9
Q

It stores calcium in the bones

A

Thyrocalcitonin

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10
Q

Results from suboptimal levels of thyroid hormones

A

Hypothyroidism

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11
Q

In hypothyroidism, it commonly affects

A

Women than men

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12
Q

The 3 types of Hypothyroidism

A

Primary Hypothyroidism
Secondary Hypothyroidism
Cretinism

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13
Q

It is a type of Hypothyroidism that is hypofunction of the thyroid gland

A

Primary Hypothyroidism

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14
Q

It is a type of Hypothyroidism that dysfunction originates from the pituitary gland

A

Secondary Hypothyroidism

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15
Q

Hypothyroidism in children

A

Cretinism

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16
Q

What are the causes of Primary Hypothyroidism?

A

-Hashimoto’s thyroiditis (most common cause)
-Atrophy (common in elderly)
-Thyroidectomy
-Iodine Therapy
- Drugs: Lithium, Anti-Thyroids

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17
Q

Comparisons of Laboratory Findings In Primary vs. Secondary Hypothyroidism

A

Primary Hypothyroidism
-Elevated TSH
-Decreased free T4
-Elevated cholesterol, triglycerides, and LDL
-Hashimoto (+) Thyroid peroxidase antibodies

Secondary Hypothyroidism
- Decreased TSH
-Decreased free T4
-Elevated cholesterol, triglycerides and LDL

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18
Q

Clinical Manifestations of Hypothyroidism

A
  • Hypothermia
  • Cold Intolerance
  • Weight Gain
  • Fatigue
  • Bradycardia
  • Thickened skin
  • Hoarseness of voice
  • Myxedema (Subcutaneous)
  • Hyperlipidemia
  • Decreased Perspiration
  • Dry Skin
  • Constipation

Other Manifestations
* depression
* somnolence
* abnormal menses
* infertility

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19
Q

Decreased metabolic rate can also decreased glandular secretion in skin and Decreased GI motility . What manifestations that decreased GI motility?

A

Constipation

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20
Q

Medical Management of Hypothyrodism

A

Thyroid Replacement Therapy

Levothyroxine (Synthroid)
-Synthetic form of T4
- Treatment of Choice

Liothyronine (Cytomel)
- Synthetic form of T3
- Used as second line treatment
-Given more frequent
- Has better GI absorption than T4 but has a short duration of action

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21
Q

Nursing Responsibilities of Hypothyroidism

A

-Administer on an empty stomach (30 mins to 1 hour) before breakfast with a full glass of water
-Avoid eating strawberry, peaches, cabbage, grapefruit juice while while on thyroid replacement
-Facilitate dose titration (to prevent hyperthyroidism)
- Thyroid replacement is safe for pregnant or lactating mothers. Dose is higher in these situations
- WOF: chest pain as drug may precipitate angina. Discontinue if noted.

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22
Q

Is a rare life-threatening condition presenting as a decompensated state of severe hypothyroidism

A

Myxedema Coma

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23
Q

Common among undiagnosed hypothyroidisms

A

Myxedema Coma

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24
Q

What triggers myxedema coma?

A

-Systemic illness
-Opioids
-Exposure to cold
- Bleeding

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25
Q

Essential Concept of Myxedema Coma

A

-Hypothyroid patients maintains a homeostasis through chronic neurovascular compensatory mechanisms

      -Chronic vasoconstriction
      -Diastolic hypertension (Narrowed PP)
       -Diminised blood volume
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26
Q

Clinical Manifestations of Myxedema Coma

A

-Decreasing mental status (initial sign)
- Hypothermia (best indicator of prognosis)
- Hypoventilation
- Bradycardia
-Hypotension
- Hypoglycemia

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27
Q

Medical Management of Myxedema Coma

A

Priority: Airway Management
-Mechanical Ventilation (initially)
-Respiratory support with non-invasive oxygen therapy

Thyroid Replacement
Intravenous T4 and T3 during acute stages, then shifted to ORAL form once able to take medications by mouth

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28
Q

Medical Emergency

A

Myxedema Coma

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29
Q

Supportive Measures for Myxedema Coma

A

-Passive rewarming using ordinary blankets and a warm room
- Monitor core temperature via the rectal route
- Treat associated infection using broad-spectrum antibiotics, as ordered

For hyponatremia:
-Saline Infusion
-Free water restriction

For hypoglycemia
-D50 Water

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30
Q

Is a set of disorders that involve excess synthesis and secretion of thyroid hormones by the thyroid gland, which leads to the hypermetabolic condition of thyrotoxicosis

A

Hyperthyroidism

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31
Q

Is a condition characterized by increased thyroid hormone levels with or without increased thyroid hormone synthesis

A

Thyrotoxicosis

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32
Q

Hyperthyroidism and Thyrotoxicosis are both characterized

A

both characterized by hyperfunction of thyroid hormones leading to hypermetabolism

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33
Q

3 forms of Hyperthyroidism

A

-Grave’s Disease
- Toxic Nodular Goiter
-Toxic Adenoma

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34
Q

An organ-specific autoimmune disorder characterized by circulating thyroid-stimulating antibodies which act as TSH receptor agonist in the thyroid gland

A

Grave’s Disease

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35
Q

-A form of goiter characterized by thyroid hormone-releasing nodules
- Commonly affects the elderly

A

Toxic Nodular Goiter

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36
Q

Presence of a hyperfunctioning follicular thyroid adenoma

A

Toxic adenoma

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37
Q

Causes of Thyrotoxicosis

A

-Excessive intake of Thyroid Hormone
- Subacute Thyroiditis

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38
Q

Causes of Thyrotoxicosis

-Overdosing
- Incorrect Dosage Prescription

A

Excessive Intake of Thyroid Hormone

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39
Q

Causes of Thyrotoxicosis

A self-limited thyroid condition associated with a triphasic clinical course of hyperthyroidism, hypothyroidism, and return to normal thyroid function

A

Subacute Thyroiditis

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40
Q

Clinical Manifestations of Hyperthyroidism and Thyrotoxicosis (REVERSIBLE MANIFESTATIONS)

A

Increased B receptor responsiveness to catecholamines

-Nervousness (most common presenting symptom)
- Tachycardia
- Hypertension
- Fine Tremors
- Diaphoresis

Increased glycogenolysis
- Hyperglycemia

Increased metabolic rate
-Heat intolerance
- Increased appetite
- Weight loss

Hypocalcemia
- Diarrhea
- Pllable nails
-Fine, silky hair

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41
Q

Clinical Manifestations of Hyperthyroidism and Thyrotoxicosis

A

-Ophthalmopathy
-Exophthalmos
-Dalyrimple’s sign (thyroid stare)

42
Q

Most frequent extrathyroidal involvement in Grave’s Disease

A

Ophthalmopathy

43
Q

Protrusion of eyeballs resulting from fluid accumulation at the fat pads behind the eyelids

A

Exophthalmos

44
Q

Bright-eyed stare and infrequent blinking

A

Dalyrimple’s sign (Thyroid stare)

45
Q

Nursing Care for Hyperthyroidism and Thyrotoxicosis

A
  • Artificial tears to prevent excessive dryness
  • Tinted and well- fitting eyeglasses at all times
46
Q

Laboratory and Diagnostic Tests for Hyperthyroidism and Thyrotoxicosis

A

TSH Level
Radioactive Iodine Uptake (Thyroid Scan)
Thyroid Hormone (T3 and T4) Level

47
Q

Laboratory and Diagnostic Tests for Hyperthyroidism and Thyrotoxicosis

The most reliable method of assessing thyroid function and SUPPRESED in hyperthyroidism

A

TSH Level

48
Q

What is the normal level of TSH level?

A

0.4-4.0 mlU/L

49
Q

Laboratory and Diagnostic Tests for Hyperthyroidism and Thyrotoxicosis

Done if etiology of thyroid hormone elevation remains unclear after physical exam and standard laboratory test

A

Radioactive Iodine Uptake (Thyroid Scan)

50
Q

Laboratory and Diagnostic Tests for Hyperthyroidism and Thyrotoxicosis

Uses Iodine-123 as an isotope

A

Radioactive Iodine Uptake (Thyroid Scan)

51
Q

Laboratory and Diagnostic Tests for Hyperthyroidism and Thyrotoxicosis

Elevated in hyperthyroidism and thyrotoxicosis

A

Thyroid Hormone (T3 and T4) Level

52
Q

Nursing Responsibilities of the Radioactive Iodine Therapy

A

Before the procedure:
-Assess for allergies to iodine or shellfish
- NPO for 8-12 hours
- Determine LMP in women. Facilitate pregnancy test if necessary
-Explain that test does not pose any radioactive hazard

After the Procedure:
- Isolate patient x 24 hours
- Institute safety precautions (DTS)
- No pregnant caregivers allowed
- Encouraged increased oral fluid intake
- Flush the toilet twice after using

53
Q

What is DTS?

A

D-Distance
T- Time (30 mins)
S- Sheild (Lead Apron)

54
Q

Medical Management of Hyperthyroidism and Thyrotoxicosis

A

Radioactive Iodine Therapy
-Most common treatment for Grave’s Disease
- Effects are less rapid than antithyroid medications for thyroidectomy
-Isotope: Iodine 131
Contraindications: Pregnancy and lactation
- Pre-treatment with Methimazole is CONTROVERSIAL

Special Nursing Considerations:
-Check female patients for pregnancy prior to treatment
- Institute radiosafety precautions

Anti-Thyroid Medications

Methimazole (Tapazole)
-First line drug for hyperthyroidism
- Has longer duration of action
-Contraindications:
-First trimester pregnancy
-Thyroid Storm

Propylthiouracil (PTU)
-Drug of choice for severe thyrotoxicosis
- May be given to pregnant women in the first trimester of pregnancy

Adjunct Medications for Symptomatic Relief
-Beta-Blockers
- DOC: Metoprolol (Neobloc), Propranolol (Inderal)
-Decreases HR, systolic blood pressure, and anxiety

55
Q

Enough to kill tissues that is very hyperactive

A

Iodine 131

56
Q

Anti-Thyroid Mechanism of action

A

Prevents formation of thyroid hormones by blocking iodine utilization

57
Q

Adverse Effect of Anti-Thyroid Medications

A

Agranulocytosis

WOF: fever and sore throat

58
Q

Nursing Responsibilities of Anti-Thyroid Medications

A

-Instruct to take medication early in the morning on an empty stomach 30 minutes before eating to avoid decrease in absorption
-Advise patient that it may take weeks until symptom relief occurs

59
Q

Surgical Removal of the Thyroid Gland

A

Thyroidectomy

60
Q

Removal of about 5/6 of the thyroid gland

A

Subtotal Thyroidectomy

61
Q

The remaining portion can still produce and secret thyroid hormones

A

Subtotal Thyroidectomy

62
Q

Removal of both lobes and isthmus

A

Total Thyroidectomy

63
Q

What’s the indication of Thyroidectomy?

A

-Pregnant women who are allergic to antithyroid medications
- Large goiters
- Patients who are unable to take anti-thyroids

64
Q

Subtotal Thyroidectomy Iodine Compounds

A

Iodine Compounds
-Lugol’s solution, saturated solution of potassium iodide (SSKI)
-Administer with milk or fruit juice to increase palatability
-Administer using a straw to prevent staining of teeth

65
Q

Post-Operative Care of Subtotal Thyroidectomy

A

-Position: semi-fowler’s with head, neck and shoulders erect (support with a pillow)
- Monitor surgical site for bleeding and edema
-Check for dressing and back of neck
- WOF: respiratory distress
-Prepare at bedside:
-Tracheostomy set, oxygen, and suction equipment

66
Q

Respiratory distress manifestation

A

Grasping for air, cyanosis

67
Q

If someone is having a respiratory distress, what is the EMERGENCY INTERVENTION to do?

A

Perform Tracheotomy or Stab PT Windpipe

68
Q

Tracheostomy set, oxygen, and suction equipment among these three which is the most important?

A

Tracheostomy set

69
Q

A form of severe, life-threatening hyperthyroidism

A

Thyroid Storm

70
Q

What causes thyroid storm?

A

-Stress
-Infection

71
Q

Clinical Manifestations of Thyroid Storm

A

-Hyperpyrexia (T>38.5C)
- Extreme tachycardia (HR > 130 bpm)
-Exaggerated symptoms of hyperthyroidism
-Altered mental status (delirium, psychosis, coma)

72
Q

Management of Thyroid Storm

A

-Propylthiouracil (PTU), as ordered
-Ice packs, paracetamol (to lower temperature)
-Supplemental oxygen (provide for increased oxygen demands)
- IV fluids with dextrose (D5LR or PNSS)- Hypertonic solutions

73
Q

Secreted by the Parathyroid Gland

A

Parathyroid Hormone

74
Q

Increases serum calcium level, but decreases phosphorus level

A

Parathyroid Hormone

75
Q

Vitamin D enhances the effects of the hormone

A

Parathyroid Hormone

76
Q

Regulates PTH effects by depositing serum calcium into the bones, thus reducing its serum level

A

Calcitonin counter

77
Q

Is characterized by overproduction of PTH causing hypercalcemia

A

Hyperparathyroidism

78
Q

Types of Hyperparathyroidism

A

-Primary Hyperparathyroidism
-Secondary Hyperparathyroidism

79
Q

-Parathyroid adenoma (most common)
- Long-term lithium therapy

A

Primary Hyperparathyroidism

80
Q

-A compensatory response to conditions that induce hypocalcemia
- CKD, Vitamin D deficiency

A

Secondary Hyperparathyroidism

81
Q

Basic Concept of Hyperparathyroidism

A

-PTH decalcifies the bone, making it fragile and prone to fractures
- The kidneys will try to excrete excess calcium via the urine. However, this causes precipitation which forms kidney stones

82
Q

How to prevent precipitation?

A

To prevent precipitation is to increase oral fluid intake

83
Q

What delays sodium into the cell?

A

Hypercalcemia

84
Q

Delayed sodium influx means

A

Slower neuromuscular impulse transmission

85
Q

Hyperparathyroidism decreases:

A

-Decrease cognitive function (decreased mental status)
- GI function (constipation, nausea and vomiting)
-Decrease muscle activity (fatigue, muscle weakness)
- Decrease Myocardial depolarization (bradycardia, dysrhythmias, ECG changes)
- Decrease Osteoblastic Activity (pathologic fractures, bone pain, shortened height)

86
Q

Diagnostics for Hyperparathyroidism

A

-Serum Calcium Level
-Normal: 8.5 to 10.5 mg/dl
-Hyperparathyroidism: ELEVATED

-Intact PTH
-Normal: 14-72 pg/ml
-Hyperparathyroidism: ELEVATED

-Serum phosphorous level
-Normal: 2.5 - 4.5 mg/dl
-Hyperparathyroidism: Decreased

-Bone Mineral Density
-Score of 2.5 or less at any site or previous fragility fracture

87
Q

Medical and Surgical Management of Hyperparathyroidism

A

Hydration Therapy
-Increased fluid intake to 2,00 ml or more to prevent renal calculi
- PNSS IV- fluid of choice as sodium enhances excretion of calcium

Mobility
-Bones subjected to the normal stress of walking give up less calcium. Bed rest increases calcium excretion and the risk of renal calculi
-Ambulation prescribed

Parathyroidectomy
- Removal of one or more of the parathyroid glands
- Post-Operative Care:
Position: Semi-Fowler’s
-WOF respiratory distress, bleeding at post-operative site
-Prepare at bedside: tracheotomy set

88
Q

Occurs with extreme elevation of calcium levels greater than 13 mg/dl

A

Hypercalcemic Crisis

89
Q

What causes Hypercalcemic Crisis?

A

Dehydration

90
Q

Management of Hypercalcemic Crisis?

A

-Rapid dehydration with large volume of isotonic fluid
-Loop diuretic (e.g., Furosemide) if with edema
- Calcitonin-promotes renal excretion of calcium
- Corticosteroids- promotes calcium deposition in bone
-Dialysis

91
Q

Hyposecretion of Parathyroid Hormome

A

Hypoparathyroidism

92
Q

Causes of Hypoparathyroidism

A

-Subtotal Thyroidectomy (Most Common)
- Abnormal Parathyroid Development

93
Q

Very little calcium in the blood

A

Hypocalcemia

94
Q

Clinical Manifestations of Hypoparathyroidism

A

TETANY

95
Q

General muscle hypertonia, with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movement

A

Tetany

96
Q

TETANY

-Numbness, tingling, and cramps in the extremities
- Stiffness of hands and feet

A

Latent Tetany

97
Q

Overt Tetany

A

(+) trousseau’s sign: carpopedal spasm resulting from occlusion of the blood flow to the arm for 3 minutes
(+) Chvostek’s sign: sharp tapping over the facial nerve causes spasm or twitching of mouth, nose, eye
-Photophobia
- Dysrhythmias
- Laryngospasm, bronchospasm
-Seizure

98
Q

A contraction of the facial muscles elicited in response to light tap over the facial nerve in front of the ear

A

Chvostek sign

99
Q

A carpopedal spasm induced by inflating a blood pressure cuff above systolic blood pressure for 3 minutes

A

Trousseau sign

100
Q

Medical Management of Hypoparathyroidism

A

-Vitamin D3 (calciferol) ( to supplement calcium deficit)
- Hydrochlorothiazide (Hydrodiuril) (decreases urinary calcium excretion)
- Calcium gluconate very slow IVTT (if hypocalcemia is after thyroidectomy)
-Aluminum hydroxide gel (Amphojel) after meals to bind phosphate its excretion through GI tract

  • Place patient on seizure precaution
  • Have a tracheostomy set, oxygen, and suction available at bedside
    -Provide a high- calcium, low phosphorus diet
    -Broccoli, tomato, banana, kidney beans
    • Avoid cheese, milk and milk products, and egg yolk
      -Avoid spinach which contains oxalate that forms insoluble calcium substances

MS 2 (27 decks)

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