Thyroid medications Flashcards
Euthroid
normal thyroid function
high TSH means?
hypothyroidism
low TSH means?
hyperthyroidism
metabolism is super slow, patient is cold, hair loss, edema, blank look on their face, weight gain, skin is going to be dry coarse and scaly, everything is in slow motion, gi system is slowed – constipation, tachycardia, they may even have low temperature, severe (low level of consciousness), menstrual disturbances (will stop) or will not be regular, may have a GOITER –enlarged thyroid gland
hypothyroidism
- enlargement of thyroid gland resulting from too much TSH due to too little thyroid hormones in circulation
Goiter-
Long duration of untreated hypothyroidism
Most severe form of hypothyroidism
Considered a life-threatening complication
Not common, but tends to be seen more frequently in patients over 50 years and in women
Increased incidence in the winter months likely secondary to the extremes in temperature
Loss of brain function or death can occur
hypothermia possible
will have very little hair on body on arms, legs, will have very little or no hair and is very brittle, may be missing the outside third of their eyebrows
Myxedema Coma/Crisis
Hypothermia
Severe mental changes and ultimately, deep coma
Significant swelling (edema) all over the body
Sparse, dry hair, and loss of the outer1/3 of the eyebrows
Difficulty breathing
Pleural effusion and pericardial effusion
Bradycardia, impaired pumping of heart
GI tract does not function well = paralytic ileus
S/S Myxedema Coma
What medication is used for hypothyroidism?
levothyroxine
Hyperthyroid
Recent MI
Adrenal insufficiency (adrenal glands don’t release cortisol)
contraindications for thyroid hormones
Adverse effects:
Often due to overdose (hyperthyroid)- cardiac dysrhythmias (tachycardia, palpitations)
Tremors, anxiety, weight loss
May enhance anticoagulants (warfarin) (monitor closely)
adverse effects of thyroid hormones (levothyroxine)
Half life long enough for once daily dosing
Should be given in the am 30-60 minutes before a meal- The same time every day
Mimics T4 (thyroxine)
Not a cure- will have to remain on drug
Dosed in mcg
25–200 mcg/day (any order over 200 mcg/day should be questioned)
Pregnancy safe
May take 3 weeks or more to change sx
Monitor thyroid panel
levothyroxine
Obtain baseline and monitor through treatment:
Vital signs, weight, height
Monitor T3, T4, and TSH lab levels
Assess for signs of cardiac excitability… such as? -Rapid heart beat, palpitations,
Nurses notes for both hypo and hyperthyroidism
Too much thyroid hormone
hyperthyroidism
increased metabolic rate, temperature, and pulse, restlessness, anxiety, emotional instability
s/s of hyperthyroidism
sudden onset of hyperthyroid symptoms with emphasis on cardiovascular and CNS symptom
– sudden onset of hyperthyroid symptoms with elevated pulse and blood pressure
thyroid storm
can occur bc they’re taking medications or because their body is making too many thyroid hormones. their metabolic rate is high, losing weight, really thin, may have muscle wasting, also may not have normal periods, fine straight hair, eyes may be bulging, flushing, sweating, hot all the time
hyperthyroidism
What is this condition, and disease or disorder is it associated with?
exophthalmos – bc of hyperthyroidism, is because they’ve had a long period of elevated thyroid hormones
causes:
Thyroid Crisis (Thyroid Storm)
Untreated HYPERthyroidism
Undertreated HYPERthyroidism
Infection associated with HYPERthyroidism
“Once symptoms are recognized, treatment should begin immediately and should not be delayed by waiting for the return of lab results.” (Dulak, 2005)
causes of uncontrolled hyperthyroidism
Symptoms:
Common symptoms of hyperthyroidism– Sudden, severe, extreme
Cardinal S/S
High fever, tachycardia, afib, heart failure, neurological symptoms, and GI symptoms
Lab Levels:
Low TSH
High T3 and T4
thyroid crisis
Eliminate excess thyroid hormone
Minimize symptoms and long term consequences
Must be very individualized
Treat the cause or the symptoms of the disease
goals for treating hyperthyroidism
Surgery –actually take out part of the thyroid
Antithyroid medication
PTU, Methimazole
Radioactive Iodine (RAI)
Iodide 131
treatment for hyperthyroidism
Impede the formation of thyroid hormones
Lower thyroid levels
Lower/normalize metabolic rate
May be used in preparation for thyroidectomy or radioactive iodine therapy
Risk of agranulocytosis (monitor CBC/instruct on s/s infection)
May alter response to warfarin or digoxin
Monitor of signs of worsening hyperthyroidism or development of hypothyroidism
Administer at the same time of day in relation to meals (meals may affect absorption)
methimazole (antithyroid med, used to treat hyperthyroidism)
PO med
Administer at the same time each day in relation to meals- may need to take with meals to prevent stomach upset
May be used in preparation for thyroidectomy or radioactive iodine therapy in hyperthyroidism
May cause agranulocytosis. Agranulocytosis is the most serious complication of antithyroid drug therapy (Monitor CBC)
Teach to monitor/report s/s of infection.
Monitor for continued/worsening signs of hyperthyroid
Monitor for development of hypothyroid
Granulocytes are type of WBC that fights infection. Can cause deficiency of these cells.
PTU or propylthiouracil, antithyroid med, used to treat hyperthyroidism
Action: Antithyroid
Destroys thyroid producing cells
Dosage dependentIndications:
Hyperthyroidism and thyroid cancer
Thyroid function studies
radioactive iodine
Radiation Sickness
Hematemesis, epistaxis, intense nausea, vomiting
Bone Marrow Depression
Monitor CBC, WBC, platelets
Hypothyroidism
after they destroy the thyroid they are going to have hypothyroidism which means they will need to be put on appropriate medication
adverse/side effects of radioactive iodine
Encourage fluid intake (2-3 L/day)
Encourage frequent voiding
Instruct clients to dispose of body wastes properly - THIS IS RADIOACTIVE!
Instruct clients to avoid coughing and expectoration – Also radioactive!
nursing notes for radioactive iodine
Use private toilet facilities, if possible, and flush twice after each use.
Bathe daily and wash hands frequently.
Avoid cough (cover cough/sneeze)
Drink a normal amount of fluids.
Use disposable eating utensils or wash your utensils separately from others.
Sleep alone and avoid prolonged intimate contact for three or four days.
Launder your linens, towels, and clothes daily at home, separately.
Do not prepare food for others that requires prolonged handling with bare hands.
If you are breastfeeding, you must stop several days before to ensure that milk production has also stopped.
You should avoid becoming pregnant from six months to one year after treatment.
care/instrucations/nursing notes for after administration of radioactive iodine
