Thyroid & Parathyroid Agents Flashcards
What are the actions of the Thyroid gland?
- Produces two thyroid hormones using iodine found in the diet:
- Tetraiodothyronine or levothyroxine (T4)
-Triiodothyronine or liothyronine (T3)
Removes iodine from the blood, concentrates it, and prepares it for attachment to tyrosine, an amino acid.
Which are the two Thyroid Hormones produced?
Tetraiodothyronine (T4 - ‘tetra means 4) ) & Triiodothyronine (T3 - ‘Tri’ means 3)
What is another name for Tetraiodothyronine ( T4)
Levothyroxine - synthetic
What is another name for Triiodothyronine ( T3)
Liothyronine
Apart from Thyroid Hormone, what other hormone does the Thyroid produce?
Calcitonin
What are the function of Thyroid Hormones (TH) in our body ?
- Regulate the rate of metabolism
- Affect heat production and body temperature
- Affect oxygen consumption, cardiac output, and blood volume
- Affect enzyme system activity
- Affect metabolism of carbohydrates, fats, and proteins
- Regulate growth and development
What are the two types of Thyroid Dysfunction?
Hypothyroidism (underactive) & Hyperthyroidism (overactive)
Which one is the most common in patients. Hypothyroidism or Hyperthyroidism?
Hypothyroidism.
Explain Hyperthyroidism.
Excessive amounts of thyroid hormones are produced and released into the circulation
* Cause : Graves’ disease - most common cause.
What are the signs and symptoms of hyperthyroidism?
Increased body temperature, tachycardia, thin skin, palpitations, hypertension, flushing, intolerance to heat, amenorrhea (absence of menstrual cycle), weight loss, and goiter (swelling in the neck that occurs when the thyroid gland enlarges due to THS stimulation)
What is the cause of Hypothyroidism?
Causes:
Absence of the thyroid gland either born without it or removed surgically.
Lack of sufficient iodine in the diet to produce the needed level of thyroid hormone
Lack of sufficient functioning of thyroid tissue due to tumor or autoimmune disorders (Hashimoto most common)
Lack of TSH (Thyroid Stimulating Hormone) due to pituitary disease
Lack of TRH (Thyroid Releasing Hormone) related to a tumor or disorder of the hypothalamus
What are the signs and symptoms of Hypothyroidism?
Can be varied and vague, such as obesity and fatigue, weight gain, eyelid edema, feeling cold, hair loss.
What are some lifespan considerations that we need to take into account when giving Thyroid and Parathyroid agents to children?
Hypothyroidism: we will use Levothyroxine
Higher doses - due to higher metabolism.
Monitor thyroid labs
Monitor growth and development
Hyperthyroidism : Methimazole
Don’t use: Propylthiouracil (PTU) or Radioactive agents
Hypercalcemia usually only seen in children with cancer and we can use Bisphosphonates to treat.
Monitor calcium levels closely when using.
What are some lifespan considerations that we need to take into account when giving Thyroid and Parathyroid agents to adults?
Hypothyroidism:
Thyroid replacement therapy is lifelong (Educate)
Levothyroxine is the drug of choice incl pregnancy and lactation.
Hyperthyroidism:
Side effects worse with methimazole such as bone marrow depression, GI and CNS effect.
Sodium iodide can affect fertility.
Pregnancy: Propylthiouracil (PTU) due to less drug passes through the placenta.
Do not use in lactation
Hypercalcemia:
Taken for Osteoporosis
Monitor calcium levels
Pregnancy: Do not use bisphosphonate
What specific condition can happen to the infant if mom is taking Hyperthyroidism agents during pregnancy or lactation ?
Creatininsm
What are some lifespan considerations that we need to take into account when giving Thyroid and Parathyroid agents to older adults?
Hypothyroidism :
Levothyroxine drug of choice.
Screen regularly
Start low, go slow
- Hyperthyroidism :
Sodium iodide usually drug of choice due to less adverse effects.
Monitor for hypothyroidism
Hypercalcemia:
Dietary deficiencies: Calcium and vit D supplements
Osteoporosis: Bisphosphonates can help move calcium back to bone.
Renal impairment
Monitor calcium levels
What are the drug classes that we need to remember for Thyroid Hormones?
- Levothyroxine
- Liothyronine
- Liotrix
- Thyroid Desiccated
Which Thyroid Hormone Agent is made out of dried animal Thyroid tissue, in particular Pig ?
Thyroid Desiccated
How does the Thyroid Hormones work on the body?
Increases the metabolic rate of body tissues which increases oxygen consumption, respirations, heart rate, rate of fat, protein and carbohydrate metabolism. - ultimately affecting our growth and maturation.
Increases cellular metabolism in all areas of our body.
What are the indications for Thyroid Hormones?
- Hypothyroidism
- Myxedema coma
- Pituitary TSH suppression in the treatment of euthyroid goiters
- Management of thyroid cancer;
- Thyrotoxicosis in conjunction with other therapy
What is Myxedema coma?
Severe hypothyroidism that leads to decreased mental status, hypothermia and other symptoms r/t the functioning and slowing of other organs, It is a medical emergency and there is a high mortality rate associated with it.
What is the difference between Hypothyroidism and Myxedema coma?
With Hyperthyroidism our organisms are still working whereas with Myxedema coma they are starting to not work.
What is Thyrotoxicosis?
A Hyperthyroidism where we see signs and symptoms. We would treat this with hyperthyroid medication to try to stop the negative feedback loop that is increasing the thyroid hormone levels. Decreasing the release of TSH should therefore reduce the TH levels.
To treat Thyrotoxicosis would we give them thyroid hormone alone?
No, that would end up making the Hyperthyroidism worse
What is an absolute contraindication of Thyroid Hormones?
Allergy
What are some relative contraindication of Thyroid Hormones?
Acute MI - however if they have hypothyroidism that is complicating their heart, then we would give medication.
Thyrotoxicosis - however, this is sometimes treated by using the negative feedback loop with anti-hyperthyroid medications in conjunction with other medications.
What are some known cautions to consider in relations to Thyroid Hormones?
Hypoadrenal conditions such as Addison’s Disease because the body cannot handle the drug effect.
What are some known adverse reactions to Thyroid Hormones?
NONE - Very very rare.
- Skin reactions - usually only in the beginning.
- Symptoms of hyperthyroidism
- Cardiac stimulation
- CNS effect
Are there any DDI’s to Thyroid Hormones, and if so, what are they?
- Oral anticoagulants - increased risk of bleeding
- Digoxin - Decreased Digoxin level.
- Theophylline - Decreased clearance of Theophylline.
Before giving a patient TH, what do we need to assess?
- History : cautions/contraindications (heart attack. Hypoadrenal state/Addison’s , family history
- Physical : Baseline status - Assess skin; CNS; vitals & ECG
- Monitor appropriate labs - Thyroid function test.
What nursing diagnosis should we be prepared for before giving TH’s?
- Decreased Cardiac Output r/t cardiac effect.
- Malnutrition risk: less than body requirements r/t changes in metabolism
- Altered tissue perfusion r/t Thyroid activity
- Knowledge deficit
What implementations should we be prepared for when we’ve give a patient TH’s?
- Administration: single daily dose 30-60 minutes before breakfast each day to keep blood levels consistent.
- Administer with a full glass of water.
- Do not administer other drugs at the same time
- Monitor response carefully when beginning therapy, especially cardiac response - may take 6 weeks to work.
- Monitor for cardiac response to detect any adverse cardiac effects.
- Arrange for periodic blood tests of Thyroid functioning
- Patient teaching
What are the Antithyroid Agents that we need to know?
- Thiomides : Propylthiouracil (PTU) & Methimazole
- Iodine Solutions : Strong iodine solution, Potassium iodide & Sodium iodide I131 and I123
What are the agents that we need to know for Thiomides?
Propylthiouracil (PTU)
Methimazole
What are the agents that we need to know for iodine solutions?
Strong iodine solution
Potassium iodide
Sodium iodide I131 and I123 (radioactive)
How does Thiomides work?
Prevents the formation of Thyroid Hormone within the Thyroid cells which lowers the serum levels.
Why would you give patients Thiomides ?
For Hyperthyroidism
Why would you give patients Iodine Solutions ?
- Indication for low dose: diagnosis/evaluate thyroid function
- Indication for high dose: hyperthyroidism, radiation emergencies
Which Iodine Solutions are most commonly used?
Strong Iodine Solution and Potassium Iodine.
Which Iodine Solutions are usually reserved for radiation emergencies, for women who cannot become pregnant because the detrimental effect of radiation on the fetus or for older adults not candidates for surgery ?
Sodium Iodine I 131 & I 123
How does Iodine Solutions work on the body?
Enters thyroid cells and destroys them by giving off radiation
In low doses, what can Iodine Solutions be used for?
Diagnose or evaluate thyroid function.
In high doses, what can Iodine Solutions be used as?
To treat Hyperthyroidism and radiation emergencies.
Why would you give patients Strong iodine solution & potassium iodide ?
hyperthyroidism, radiation emergencies, suppression of thyroid gland before surgery, acute thyrotoxicosis.
How does Strong iodine solution & potassium iodide work on the body ?
High doses saturate the thyroid cells preventing thyroid hormone formation.
What is an absolute contraindication with giving a patient Antithyroid agents?
Allergy
What conditions should we be cautious of when giving patient Antithyroid agents?
Propylthiouracil (PTU ) : Liver impairment
What are some known adverse reactions that patients may experience when taking Antithyroid Agents?
- All: hypothyroidism
- Methimazole: bone marrow suppression
- PTU: severe liver toxicity
- Iodine Solutions: Iodism
Are there any DDI’s with Antithyroid agents, and if so, what are they?
- Oral anticoagulants
- Theophylline
- Beta-blockers
- Digoxin
Why is it so important to ensure that we do scheduled check ups when patients are taking Antithyroid hormones in relation to other medications?
Hyperthyroidism can often lead to Hypothyroidism and this can severely effect how other drugs are metabolized in the body.
What should we be assessing prior to giving Antithyroid agents?
- History : Allergy, liver impairment
- Physical Assess : skin; CNS; vitals & ECG
- Labs: thyroid function, CBC, liver function, pregnancy (PTU)
What nursing diagnoses can be anticipated and made prior to giving Antithyroid agents?
THESE ARE R/T DRUG REGIMEN AND NOT HYPERTHYROIDISM ITSELF.
- Decreased Cardiac output due to medication regimen on cardiac effect.
- Malnutrition risk: more than body requirements r/t changes in metabolism
- Injury risk/Infection and bleeding risk r/t bone marrow suppression.
- Knowledge deficit
What implementations should we do when giving patients Antithyroid medications?
Administration :
Administer PTU 3 times a day around the clock to ensure consistent therapeutic levels in the blood.
Iodine Solution can cause staining of teeth, If tablets needs to be crushed and dissolved in water make sure patient is drinking this through a straw to avoid staining.
Arrange for periodic blood tests r/t bone marrow suppression.
Assess patients for Iodism (Iodine Toxicity)
Provide through patient teaching.
What are the S&S of Iodism / Iodine Toxicity?
Sore mouth, Sore gums, Burning mouth, Excessive Watering of Mouth, Metallic Taste, HA & Confusion.
What are the two types of Parathyroid Dysfunction?
Hypoparathyroidism & Hyperparathyroidism
With Hypoparathyroidism, what is there an absence of?
Parathormone / Parathyroid Hormone.
What is the most common cause of Hypoparathyroidism?
Accidental removal of the parathyroid gland during Thyroid surgery.
What is there an excessive amount of with Hyperparathyroidism?
Parathormone.
What is the most common cause of Hyperparathyroidism?
parathyroid tumor or certain genetic disorders
Explain Hypoparathyroidism.
- The absence of parathormone
- Most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery
Explain Hyperparathyroidism.
- The excessive production of parathormone
- Can occur as a result of parathyroid tumor or certain genetic disorders
Explain how calcium in controlled in the body.
Calcium is absorbed from the intestines, movements of calcium in and out of the bones and the kidney’s ability to reclaim and excrete calcium in the urine..
If calcium levels fall, the Parathyroid will release parathormone into blood which signals osteoclasts to release calcium from the bone surfaces and for the kidneys to reclaim more calcium and to stimulate the synthesis of the active form of vitamin D.
What 3 hormones are involved in calcium regulation?
Parathormone (comes from Parathyroid gland)
Calcitonin (comes from cells in the Thyroid gland)
Calcitriol (active form of Vitamin D)
What are the Antihypocalcemic Agents that we need to know?
- Teriparatide
- Parathyroid hormone
- Calcitriol (Vitamin D )
What are the actions of Antihypocalcemic Agents?
- Stimulation of osteoclasts to release calcium from the bone and into blood stream. Serum levels increase.
- Increased intestinal absorption of calcium
- Increased calcium resorption from the kidneys - keeps more calcium in body. If kidneys urinate out phosphorous more calcium is retained.
- Stimulation of cells in the kidney to produce calcitriol (active form of Vitamin D that is needed to absorb calcium)
- Teriparatide: stimulates new bone formation
Does Antihypocalcemic agents raise or lower calcium levels in the blood?
Raise the levels.
Calcium has an inverse relationship with ___________________ ?
Phosphorous
What are the Indications for giving Antihypocalcemic Agents?
Low calcium in blood
* Management of hypocalcemia in patients undergoing chronic renal dialysis
* Treatment of hypoparathyroidism
* Teriparatide: treatment of osteoporosis
What are 2 absolute contraindications to giving a patient Antihypocalcemic Agents?
- Allergy
- Vitamin D toxicity
What is a relative absolute contraindication to giving a patient Antihypocalcemic Agents?
Hypercalcemia
What existing condition should we be cautious of when giving patients Antihypocalcemic Agents?
History of renal stones because increased calcium can increase this.
What are some known adverse reactions to Antihypocalcemic Agents?
GI effects
Metallic Taste
Nausea
Vomiting
Constipation
CNS effects - weakness, headache, somnolence, irritability
Are there any DDI’s with Antihypocalcemic Agents?
Yes,
* Magnesium containing antacids - can lead to increase in increase of magnesium
* Digoxin toxicity with hypercalcemia - can lead to Dig toxicity.
What assessments should be done prior to giving patients Antihypocalcemic Agents?
- History : Allergy; hypercalcemia; vitamin toxicity (esp Vit. D); renal stones
- Physical : Assess skin, CNS, GI
- Labs: serum calcium, magnesium, and alkaline phosphate levels, Liver Function tests.
- X-rays of bones as appropriate for the bones.
What nursing diagnoses should be anticipated prior to giving patients Antihypocalcemic Agents?
- Impaired comfort/Acute pain r/t GI or CNS effect.
- Malnutrition risk: less than body requirements r/t GI effect.
- Knowledge deficit
What nursing implementations should we be prepared to do after administering Antihypocalcemic Agents?
- Monitor serum calcium levels
- Provide comfort and safety measures
- Arrange for a nutritional consultation
- Provide thorough patient teaching
What are the Antihypercalcemic Agents that we need to know?
- Bisphosphonates “-dronate”
Etidronate, Ibandronate, Pamidronate, Risedronate, Alendronate - Calcitonins
Calcitonin salmon
What are the drugs for Bisphosphonates?
Have “dronate” in the name
Etidronate,
Ibandronate,
Pamidronate,
Risedronate,
Alendronate
What drug to we need to know for Calcitonins?
Calcitonin salmon
Why would we give Bisphosphonates to a patient?
For osteoporosis,
Paget’s disease,
Emergency treatment of hypercalcemia
How does Bisphosphonates work on the body?
- Act directly on the serum levels of calcium. They do not work through the Parathyroid or PTH.
- Inhibits bone resorption, by doing this it helps lower serum levels of calcium without inhibiting normal bone formation and mineralization.
Why would we give Calcitonins to a patient?
osteoporosis, Paget’s disease, emergency treatment of hypercalcemia
How does Calcitonins work on the body?
- Inhibits bone resorption which lowers serum calcium levels in children and patients with Paget’s disease. It increases the excretion of phosphate, calcium and sodium from the kidney.
- Hormones secreted by the thyroid gland to balance the effects of PTH
What does both classes of drugs work on ?
Bone resorption
What is Bone resportion?
When bone is broken down and absorbed by the body.
Osteoclasts responsible for the breakdown of bone minerals which releases calcium and phosphorous into bloodstream - These drugs prevent this from happening.
Why would we give patients Bisphosphonates?
Osteoporosis
Paget’s disease
Hypercalcemia
Cancer
What are some conditions that absolutely contraindicates the use of Bisphosphonates in patients?
Allergy,
Hypocalcemia
Renal disfunction - excreted in kidneys
Gi disease - can be exacerbated.
What has long term use (over 5 yrs.) of Bisphosphonates been associated with?
Bone issues including fractures
What are some conditions that absolutely contraindicates the use of Calcitonins in patients?
Allergy to fish (Calcitonin Salmon)
What are some conditions that relatively contraindicates the use of Bisphosphonates in patients?
Renal dysfunction,
GI disease,
Prolonged use
What are some conditions that relatively contraindicates the use of Calcitonins in patients?
Pregnancy,
renal dysfunction,
pernicious anemia
All excarcebated.
What are some known adverse reactions to Bisphosphonates in patients?
- GI: abd. pain, nausea, and diarrhea/constipation
- HA
- Esophageal erosion
- Bone pain with Paget’s disease
What are some known adverse reactions to Calcitonins in patients?
Flushing of face & hands, skin rash, nausea and vomiting, urinary frequency, local inflammation at injection site
most improve over time
What are some DDI’s with Bisphosphonates ?
Other meds given at the same time - can affect absorption (wait at lest 30 in between)
Aspirin - Can increase GI ulcer risk.
What are some DDI’s with Calcitonins ?
None
What should we be assessing for prior to giving patients Antihypercalcemic Agents?
- History : Assess for conditions that are cautions and contraindications
- Physical : Assess GI, skin, urinary system
- Labs: calcium, phosphorus, vitamin D, magnesium levels, renal function
What nursing diagnoses should be anticipated prior to giving patients Antihypercalcemic Agents?
- Impaired comfort/Acute pain r/t GI or Skin effect.
- Malnutrition: less than body requirements r/t GI effect.
- Knowledge deficit
What nursing implementations should we be prepared to do after administering Antihypercalcemic Agents?
- Bisphosphonates: administer on an empty stomach with a full glass of water 30-60 minutes before other food or medication. Remain upright for 30 minutes after administration can cause esophageal erosion.
- Ensure adequate hydration due to excretion through kidneys
- If taken for Postmenopausal osteoporosis the arrange for concomitant vitamin D, calcium supplements, and hormone replacement therapy.
- Calcitonin: Rotate injection sites and monitor for inflammation
- Monitor serum calcium regularly
- Arrange for periodic blood tests of renal function
- Provide comfort measures
- Provide thorough patient teaching
What does the Thyroid gland use iodine for?
The thyroid gland uses iodine to produce the thyroid hormones that regulate body metabolism.
What other gland is the Thyroid gland under the control of?
The pituitary gland. (located at the base of our brain)
What hormone does the pituitary gland produce when thyroid hormone levels drop too low?
THS - Thyroid Stimulating Hormone.
When THS stimulates the thyroid gland to produce more of what?
T3 & T4 - thyroid hormones to increase thyroid hormone levels.
When there is enough thyroid hormone circulating in our blood it stimulates the pituitary gland to do what?
Reduces the release of TSH.
Which gland stimulates the pituitary gland?
The hypothalamus.
What hormone does the hypothalamus produce?
THS releasing hormone (TRH) (Thyroid Stimulating Releasing Hormone)
What is the most common disease that causes hypothyroidism?
Hashimoto’s
What is the most common disease that causes hyperthyroidism?
Grave’s
The client is diagnosed with hypothyroidism. Which signs/symptoms should the nurse expect the client to exhibit?
A decrease in thyroid hormone causes decreased metabolism, which leads to fatigue and hair loss.
Which medicine do we use for kids with hypothyroidism?
Levothyroxine
Does kids need higher or lower doses of medication than adults?
Higher due to higher metabolism.
What drug would we use with children suffering from hyperthyroidism?
Methimazole
Why would we not use PTU medicines for children?
It can cause severe liver disorders.
What is the most common reason for hypercalcemia in children?
Cancer.
What medication would we use for children suffering from hypercalcemia?
Bisphosphonates
Is treatment for hypothyroidism short term or lifelong?
Lifelong.
What medication for hypothyroidism would we use for pregnant and lactating women?
Levothyroxine
What medication may affect fertility?
Sodium iodine
What is the risk to the infant with the use of PTU drugs?
Creatinism
Where in the body is the thyroid located?
In the neck. It wraps around the trachea.
Which two hormones does the thyroid produce?
Thyroid hormone & calcitonin.
In what way does the Thyroid use iodine?
The thyroid gland uses iodine to produce the thyroid hormones that regulate body metabolism. Control of the thyroid gland involves an intricate balance among TRH, TSH, and circulating levels of thyroid hormone.
The client is diagnosed with hypothyroidism. Which signs/symptoms should the nurse expect the client to exhibit?
A decrease in thyroid hormone causes decreased metabolism, which leads to fatigue and hair loss
After a year of taking hyperthyroid medication what should we monitor our patients for?
Hypothyroidism.
The client diagnosed with hypothyroidism is prescribed the thyroid hormone levothyroxine. Which assessment data indicate the medication has been effective?
The clients temperature is within normal limits.
Which Antithyroid agent is particularly hard on the Liver?
Propylthiouracil (PTU)
Which Antithyroid agent could cause bone marrow suppression and therefore should be monitored via CBC labs?
Methimazole
Which Antihypocalcemic agent stimulate new bone formation?
Teriparatide
Why does patients need to remain upright for 30 minutes after taking Bisphosphonates?
Because reflux could erode the esophagus
Is calcitonin given PO or via injection?
Injection.
