TOPIC 1 - hypo and hyperthyroidism Flashcards
excessive hyperthyroidism
thyrotoxicosis
excessive hypothyroidism
myxedema coma
primary hypothyroidism
destruction of thyroid tissue or defective hormone synthesis
secondary hypothyroidism
pituitary disease with decreased TSH or hypothalamic dysfunction with decreased TRH
most common cause of hypothyroidism
iodine deficiency
graves is related to
hyperthyroid
hashimotos is related to
hypothyroid
most common cause of primary hypothyroidism
atrophy of thyroid gland
hypothyroidism may develop after …
treatment for hyperthyroidism, RAI therapy, thyroidectomy
manifestations of hypothyroidism
systemic effects (slowing body process), fatigue, lethargy, personality and mood change, impaired memory, decreased initiative somnolence, depression, weight gain, slowed speech
cardio relationship to hypothyroidism
decreased cardiac contractility and decreased cardiac output - low exercise tolerance and shortness of breath
coronary atherosclerosis - increased cholesterol and triglyceride level
anemia
lab values of hypothyroidism
normal T4 and increased TSH
management of hypothyroidism
levothyroxine - monitor heart rate (report over 100 bpm), lifelong therapy and follow up care
nutritional therapy to promote weight loss
avoid ___ with hypothyroidism
sedatives - monitor LOC and RR
enemas - vagal stimulation = cardiac issues
hyperthyroidism causes
thyroiditis, excess iodine, pituitary tumor, thyroid cancer, toxic nodular goiter, graces disease
early signs of hyperthyroidism
weight loss, increased nervousness
manifestations of hyperthyroidism
hypertension, bounding pulse, angina, dysrhythmias, CHF, fatigue
dyspnea, increased RR
weight loss, increased appetite and thirst, increased peristalsis, increased bowel sounds
warm, moist skin, brittle nails, diaphoresis
difficulty sleeping, tremors, edema, osteoporosis, delirium, lack of concentration
menstrual abnormalities, gynecomastia, decreased fertility
intolerance to heat, elevated basal temp
teaching for hyperthyroidism
elevate HOB at night, eye drops, dark glasses for photophobia, steroid therapy for swelling, diuretics for edema
labs for hyperthyroidism
low TSH, elevated T4
antithyroid drugs
methimazole, propylthiouracil, iodine, propranolol, atenolol, metoprolol
nutritional therapy for hyperthyroidism
high calorie, high protein, frequent meals, avoid highly seasoned food and high fiber foods (GI effects), avoid caffeine (decrease restlessness)
what causes exophtalmos
increased fat deposits and fluid in the orbital tissues and ocular muscles
primary lab finding to confirm diagnosis of hyperthyroid
low TSH
the RAIU test can…
distinguish graves disease from other forms of thyroiditis
treatment options for hyperthyroid
antithyroid meds, radioactive iodine therapy, surgery
supportive therapy of hyperthryoidism
manage resp distress, reduce fever, replace fluids, eliminate stressors
propylthiouracil vs methimazole
propyliouracil achieves goal quicker, but is taken 3 times per day
methimazole is given in a single daily dose
what happens upon abrupt stops of meds
return to hyperthyroid state
the use of iodine with other antithyroid drugs
prepare patient for thyroidectomy or for treatment of thyroxicosis
is long term iodine therapy effective
no
signs of iodine toxicity
swelling of buccal mucosa and other mucous membranes, excess salivation, nausea and vomiting, skin reactions
beta blockers are used for what purpose related to hyperthyroidism
symptomatic relief to decrease tachycardia, nervousness, irritability, tremors
what is the preferred b blocker for hyperthyroidism
atenolol
after RAI treatment, what cautions should patients take to limit exposure to others
private toilet, flush 2-3 times, separate laundry, do not prepare food for others, avoid being close to pregnant women or children
(up to 7 days)
who are candidates for a thyroidectomy
patients with a large goiter causing tracheal compression, those with a lack of response to antithyroid therapy, people with thyroid cancer
postoperative complications of thyroidectomy
hypothyroid, damage to parathyroid, hypocalcemia, hemorrhage, injury to laryngeal nerve, thyrotoxicosis, infection
airway obstruction = emergency, keep O2 on hand
position for postoperative patients
semi fowlers and support the head with pillows
subclinical hypothyroidism occurs when
TSH is greater than 4.5 but the T4 levels are normal
drugs causing hypothyroidism
amiodarone (which contains iodine), lithium (which blocks hormone production)
there are significant cardiovascular problems in hypothyroid patients who also have ….
CVD
it is associated with decreased cardiac contractility and decreased cardiac output
what causes myxedema
results from accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues = puffy subcutaneous tissues, facial and periorbital edema, and a masklike affect
difference in thyroid defect and pituitary or hypothalamus defect
serum TSH is high when defect is in the thyroid
TSH is low when it is in the pituitary or hypothalamus
nutritional therapy of hypothyroidism
low calorie diet
drug of choice to treat hypothyroidism and implications of it
levothyroxine
lifelong therapy, do not stop abruptly or switch brands
begin with low doses and monitor for cardiovascular complications
may take up to 8 weeks before therapy is effective
take in the morning before food
