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Module 4 > UNIT 4-Thyroid Disorders > Flashcards

UNIT 4-Thyroid Disorders Flashcards

1
Q

How does the thyroid hormone feedback loop work?

A
  1. Ant. Pituitary stimulates thyroid hormone production & release
  2. If blood levels of TH low then hypothalamus releases TRH
  3. TRH causes ant. pituitary to release TSH
  4. TSH stimulate thyroid to release TH
  5. High TH levels inhibit secretion of TRH & TSH
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2
Q

What allergies are important for thyroid scans?

A

Shellfish and iodine

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3
Q

What labs would we want to monitor with thyroid disorders?

A
  1. Serum TSH
  2. Free t4
  3. Serum T3, T4
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4
Q

What radiology exams might we see ordered for thyroid disorders?

A
  1. Ultrasound
  2. Thyroid scan
  3. RAI uptake
  4. Needle Biopsy
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5
Q

What is a Goiter?

A

Abnormal enlargement of thyroid gland

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6
Q

A goiter can occur with?

A
  1. Hyperthyroidism
  2. Hypothyroidism
  3. Euthyroidism
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7
Q

True or false: A goiter can tell us exactly what is wrong with the patient?

A

False- Just because a patient has a goiter doesn’t mean we know what is wrong

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8
Q

When looking at a thyroid panel for HYPOthyroidism what might our TSH, T4 and T3 look like?

A

TSH- High
T4- Low
T3- Low or normal

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9
Q

When looking at a thyroid panel for HYPERthyroidism what might our TSH, T4 and T3 look like?

A

TSH- Low
T4- High or normal
T3 - High or normal

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10
Q

What is a normal TSH level?

A

2-10 mU/mL

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11
Q

What is a normal T4 level?

A

4-12 mcg/dL

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12
Q

What is anormal T3 level?

A

70-205 ng/dL

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13
Q

Excess thyroid hormone results in:

A
  1. Increase BMR, CV, GI & Neuromuscular function
  2. Affects metabolism of fats, carbs & Proteins
  3. Wt Loss and heat intolerance

Everything is excited

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14
Q

What are causes of HYPERthyroidism?

A
  1. Autoimmune RXN (Grave’s disease)
  2. Excess dose of thyroid replacement
  3. Thyroiditis
  4. Tumor
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15
Q

Will your BMR, T, P, R & BP be increased or decreased with hyperthyroidism?

A
  1. increased/elevated
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16
Q

On assessment how might your hyperthyroidism patient present?

A
  1. Nervous tremor
  2. Wt. loss, hunger (even after eating)
  3. N/V/D
  4. Weakness, fatigue
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17
Q

Graves’ disease patient may present with? SKIP

A
  1. Goiter, exophthalmos, or raised red rashed
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18
Q

What are s/s of Hyperthryoidism?

A
  1. Intolerance to heat
  2. Fine straight hair
  3. Bulging eyes
  4. Facial flushing
  5. Enlarged thyroid
  6. Tachycardia
  7. increased systolic BP
  8. breast enlargement
  9. Weight loss
  10. Finger clubbing
  11. Tremors
  12. Increased diarrhea
  13. Menstrual changes (amenorrhea)
  14. Localized edema
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19
Q

How is hyperthyroidism managed?

A
  1. Lifelong antithyroid meds
  2. Ablative radioactive I-131
  3. Thyroidectomy (Partial or total)
    • May require thyroid replacement meds post-op
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20
Q

What problems may we need to assess with patients with hyperthyroidism?

A
  1. Knowledge deficit
  2. Insufficient nutrition
    • Avoid spicy foods because it stimulates the GI tract– same with caffeine and fiber
  3. Altered sleep patterns
  4. Altered body imagine
    • Exophthalmos or goiters
  5. May have decreased cardiac output or endurance
  6. May have vision changes
    • altered shape of eye
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21
Q

Nursing problems with hyperthyroidism varies how?

A

Severitity of conditions

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22
Q

What should we educate & evaluate our hyperthyroidism patient about?

A

Education
1. Medication
- Avoid decongestants and diet pills because it contains stimulants
2. Monitor weight & nutrition
3. Balance activity & rest
- avoid overexertion and manage energy to prevent fatigue
4. Lifestyle & self imagine change prn
5. Eye care PRN (exophthalmos)
- regular eye exams, teach patient to use saline eye drops. They are at an increased risk for light sensitivity or sun damage. Elevate HOB at night

Evaluation
1. Verbalize/demonstrate understanding
2. Follow up with HCP & Lab work..

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23
Q

What are two examples of hyperthyroid medications?

A
  1. Methimazole
  2. Propylthiouracil (PTU)
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24
Q

What is the MOA for Methimazole or propylthiouracil (PTU)

A

Inhibits thyroid hormone synthesis

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25
Q

What are adverse effects of Methimazole or Propylthiouracil (PTU)

A
  1. Agranulocytosis,
    • condition where the body has a low level of granulocytes, a type of white blood cell. This can weaken the immune system, making it harder for the body to fight off infections
  2. Hypothyroidism
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26
Q

What are some contraindication of methimazole or propylthiouracil?

A
  1. Allergy to thioamides
  2. impaired liver function
  3. pregnancy
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27
Q

Nursing care for PTU includes?

A
  1. Monitor for signs of hypothyroidism
  2. Monitor for signs of hyperthyroidism
  3. Monitor thyroid & LFT, PT, INR, CBC
  4. Assess vital signs and weight
  5. TAKE WITH FOOD
  6. Do not STOP abruptly
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28
Q

What do we teach patients who take PTU?

A
  1. Report fever, sore throat, unusual bleeding
  2. Take medication at the same time of day with meals or snack - space doses
  3. Signs of hypo- and hyper- thyroid
  4. Do not stop abruptly
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29
Q

Warning for patients taking methimazole for hyperthyroidism

A
  1. Peripheral neuropathy
  2. Fever, rash, pruritis
  3. GI upset
  4. Dizziness
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30
Q

MOA of Radioactive Iodine (I-131) hyperthyroid treatment

A

Destroys thyroid cells at high doses

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31
Q

What are adverse effects of Radioactive Iodine (I-131)?

A
  1. Radiation sickness
  2. Bone marrow suppression
  3. Hypothyroid
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32
Q

Radioactive Iodine is contraindicated for what patients?

A
  1. Pregnancy & Young children
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33
Q

What is the dosage of a radioactive Iodine (I-131) for hyperthyroid treatment?

A

4-10 mCI orally

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34
Q

True or False: We can expect hypothyroidism after a Radioactive Iodine I-131 tx?

A

True

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35
Q

What should we teach a patient in regards to radioactive Iodine I-131 tx?

A
  1. Monitor CBC
  2. Use private toilet facilities/flush twice after use
  3. Bathe daily & frequent handwashing
  4. Use disposable eating utensils
  5. Sleep alone & avoid prolonged intimate contact for 3-4 days
  6. Launder linens, towels, clothes daily & separately
  7. Avoid coughing & expectoration
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36
Q

What is the MOA of strong iodine solution- nonradioactive?

A
  1. Reduces iodine uptake, inhibits thyroid hormone production, & blocks release of T3 & T4
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37
Q

What are the adverse effects of strong iodine solution-nonradioactive hyperthyroidism treatment?

A
  1. Iodism
    • Metallic taste in mouth
    • Irritation in mouth
    • Sore teeth/gum
    • Swelling in upper throat possible
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38
Q

What is the dose of strong iodine solution-nonradioactive hyperthyroidism treatment?

A
  1. 2-6 drops 3x a day for 10 days
39
Q

As the nurse what should we monitor for in a patient receiving strong iodine solution nonradioactive hyperthyroidism txs?

A
  1. Signs of iodism
    -metallic taste in mouth
    • irritation in mouth
    • sore teeth/gum
    • Swelling in upper throat possible.
  2. Vital signs, weight, I & O
40
Q

What should we teach patients on a strong iodine solution-nonradioactive hyperthyroidism tx?

A
  1. Dilute medication in juice to help with taste
  2. Avoid foods high in iodine
  3. Take medication same time each day
  4. Increase fluid intake
41
Q

What are the common causes of hyperthyroidism in younger and older adults?

A

Younger Adult
1. Graves disease in > 90% of cases

Older Adult
1. Graves’ disease or toxic nodular goiter

42
Q

What are common symptoms of hyperthyroidism in younger adults vs. older adults.

A

Younger adult
1. Nervousness, irritability, weight loss, heat intolerance, warm moist skin

Older adult
1. Anorexia, weight loss, apathy, lassitude, depression, confusion

43
Q

How common is goiter in comparison to younger and older adults with hyperthyroidism?

A

Younger
1. Present in 90% of cases

Older
1. Present in about 50% of cases

44
Q

Ophthalmopathy in patients with hyperthyroidism in younger vs. older adults

A

Younger
1. exophthalmos present in 20-40% of cases

Older
1. Exophthalmos less common

45
Q

Cardiac features in patients with hyperthyroidism in younger vs. older adults?

A

Younger
1. Tachycardia and palpitations but without heart failure

Older
1. Angina, dysrhythmia (especially atrial fibrillation with rapid ventricular response), heart failure may occur

46
Q

Why is thyrotoxic crisis?

A

Extreme hyperthyroidism

47
Q

What causes thyrotoxic crisis “Thyroid storm”?

A
  1. Severe infection
    • can trigger a release of excess thyroid hormones into the bloodstream.
  2. Manipulation of thyroid gland
48
Q

What would we expect to see upon assessment of a patient in thyrotoxic crisis?

A
  1. Temp > 101.3 F
  2. increase HR, systolic HTN
  3. Agitation, confusion, seizure
  4. Exaggerated s/s of hyperthyroidism
49
Q

What is the dx testing for thyrotoxic crisis?

A
  1. Same as hyperthyroidism. May need additional cardiac testing
50
Q

How do we treat thyroid crisis?

A
  1. Stabilize CV function
    • beta blockers
  2. Oxygen
  3. Replace fluids & Electrolytes
  4. Anti-thyroid medication
    • propylthiouracil, corticosteroids, lithium or iodinated contrast
  5. Calm environment
51
Q

True or False: Avoid aspirin during a thyroid crisis event?

A

True- can worsen

52
Q

What is thyroiditis?

A
  1. Inflammation of thyroid
53
Q

What are the 3 types of thyroiditis?

A

acute, subacute, chronic

54
Q

What causes acute thyroiditis?

A

Infection– bacteria, fungal, parasites

55
Q

What are the symptoms of acute thyroiditis?

A
  1. pain
  2. swelling
  3. dysphagia
  4. Dysphonia
    • difficulty or abnormality in producing voice
  5. S/S of hyperthyroidism
56
Q

What is the treatment for acute thyroditis?

A
  1. Antibiotics
  2. Fluid replacement
57
Q

Does function return after acute thyroiditis?

A

Yes, returns after treatment

58
Q

What causes subacute thyroiditis?

A
  1. Granulomatous- Viral
59
Q

What are the s/s of subacute thyroiditis?

A
  1. Low fever
  2. Fatigue
  3. Swelling
  4. Pain (Varies)
60
Q

What are the two phases of subacute s/s of thyroiditis?

A
  1. Phase 1- Hyperthyroid s/s (1-3months)
  2. Phase 2- Hypothryroid s/s (9-12 mo.)
61
Q

How is subacute thyroiditis treated?

A
  1. NSAIDS
  2. Beta Blockers
  3. Steroid’s
62
Q

When does function of the thyroid return after subacute thyroiditis?

A

Normal function after 12-18 months

63
Q

True or false: Subacute thyroiditis does not exhibit both hypo and hyper thyroid s/s

A

False- it can

64
Q

Chronic thyroiditis aka Hashimoto’s disease is caused by what?

A

Chronic lymphocytic - autoimmune

65
Q

What are the symptoms of Chronic thyroiditis (Hashimoto’s disease)?

A
  1. Painless
  2. hypothyroid s/s
66
Q

What is the treatment for chronic thyroiditis (Hashimoto’s disease) ?

A

Thyroid replacement

67
Q

When does function return after chronic thyroiditis (Hashimoto’s disease)?

A

Never– thyroid is too damaged and destroyed

68
Q

What type of thyroiditis is the biggest cause of hypothyroidism?

A
  1. Hashimoto’s disease aka chronic thyroiditis
69
Q

What is the treatment of choice for thyroid cancer or goiters that cause issues with the airway?

A
  1. Thyroidectomy
70
Q

When treating thyroid cancer the surgery may include which approch?

A
  1. Modified or radical neck dissection
  2. Radioactive iodine to minimize size and reduce metastasis
71
Q

What should our pre-op teaching for thyroidectomy include?

A
  1. Nutrition
    • the bigger the surgery the more important nutrition becomes
    • pain with swallowing may occur– eat foods as tolerated. Recommended soft foods for the 1st 24 hours
  2. Avoid caffeine & stimulants
  3. Tests & procedures
72
Q

What post-op teaching should be included for thyroidectomy?

A
  1. Head and neck support
    • support with pillows
  2. Incision & airway
    • # 1 priority is airway and then assess for bleeding
  3. Thyroid hormone
    • depending on how much thyroid is left will depend on the need for thyroid hormone postop
73
Q

Using the acronym BOW TIE what is our post op care for thyroidectomy?

A

B- bleeding
O- Open airway
W- Whisper
T- Trache set
- Dr. may order for bedside.
I- Incision
- avoid hyperextension of neck
E- Emergency

74
Q

Hypothyroidism leads to

A
  1. Insufficient T3 & T4 leading to a decreased BMR and decreased heat production
75
Q

What causes Hypothyroidism?

A
  1. Treatment for hyperthyroidism
  2. Antibody destruction of thyroid
  3. Iodine deficiency
76
Q

What would you expect to see in a patient with hypothyroidisms assessment?

A
  1. Wt gain
  2. Dry skin, Hair
  3. constipation
  4. Lethargy & Fatigue
  5. Intolerance to cold
77
Q

What would you expect to see as far as lab values go for a patient with hypothyroidism?

A
  1. Increased TSH and lipids,
  2. Decreased T4, low/normal T3
  3. Decreased BMP, T,P, BP
78
Q

What are s/s of hypothyroidism?

A
  1. Hair loss
  2. Apathy
  3. Lethargy
  4. Dry skin (course/scaley)
  5. Muscle aches and weakness
  6. Constipation
  7. Intolerance to cold
  8. Receding hairline
  9. Facial and eyelid edema
  10. Thick tongue- slow speech
  11. Anorexia
  12. Brittle nails and hair
  13. Menstrual disturbances
79
Q

What are late clinical manifestations of hypothyroidism

A
  1. Subnormal temp
  2. Bradycardia
  3. Weight gain
  4. Decreased LOS
  5. Thickened skin
  6. Cardiac complications
80
Q

How is hypothyroidism managed?

A
  1. Thyroid replacement (T3 or T4)
81
Q

What are some nursing problems that a nurse should be aware of when taking care of a hypothyroid patient

A
  1. Knowledge deficit
  2. Decreased cardiac output & temperature
  3. Excess nutrition
    • wt gain
  4. Constipation
  5. Skin integrity
  6. Body image
82
Q

What is the MOA of Levothyroxine (hypothyroidism)

A
  1. Synthetic T4- produces various physiologic effects, including increasing metabolism
83
Q

What are adverse affects of levothyroxine (tx for hypothyroidism)

A

Thyrotoxicosis

84
Q

What are the contraindications for levothyroxine?

A
  1. Acute MI
    • Wouldn’t want to give because it may be stimulating if they have never had hypothyroid meds before
  2. CVD
  3. Thyrotoxicosis
85
Q

What is the nursing care for levothyroxine?

A
  1. Assess vital signs, BP, weight, history of; weight change, diet, energy level, mood, temperature response
  2. Monitor thyroid function test results & glucose levels
  3. Educate patient that labs will need to be done prior to starting medication regimen and then again in 30 mins because the meds can take that long to take effect and those results will tell us if drug is effective at dose
  4. Give dose in morning before breakfast
    • given on empty stomach and try to avoid other medication
  5. Teach symptoms of thyrotoxicosis
86
Q

What patient teaching do we need to give patients on levothyroxine?

A
  1. Take daily- lifelong therapy
  2. Immediately report any signs of chest pain, nervousness, tremors, sleeplessness, heat intolerance, & excessive sweating
  3. Do not discontinue medication suddenly.
87
Q

What symptoms might a patient exhibit if the dose of levothyroxine is too low?

A
  1. Bradycardia
  2. Lethargy
  3. Constipation
  4. Excessive fatigue
  5. Excessive sleeping
88
Q

What symptoms might a patient exhibit if the dose of levothyroxine is too high?

A
  1. Irritability
  2. Palpations
  3. Tachycardia
  4. Diarrhea
  5. Tremors
  6. Insomnia
89
Q

What education should we give to our hypothyroid patients?

A
  1. Medication
  2. Follow-up w/ HCP & labs
  3. Unplanned wt. loss/gain >5lbs
  4. Nutrition, fluids, & fiber intake
  5. Avoid sedatives
90
Q

What should the nurse be evaluating in a patient with hypothryoidism?

A
  1. medication administration
  2. Sleep & Elimination
  3. Follow-up w/ HCP & lab
  4. Vital signs
  5. Activities
  6. Weight
91
Q

What is Myxedema?

A

Severe hypothyroidism

92
Q

What are the causes of myxedema?

A
  1. Sudden d/c thyroid replacement
  2. Acute illness, trauma
93
Q

What should our assessment include in a patient who has myxedema?

A
  1. S/S of hypothyroidism
    • decreased bp, hr less than 50, decreased body temp, edema, spongy swelling in face/tongue
  2. Edema-non pitting
  3. Decreased T4, Na, glucose and increased TSH
  4. Possible CV collapse & coma
94
Q

How do we manage myxedema?

A
  1. Replace T4
  2. Treat precipitating factors
  3. Respiratory & CV factors
  4. Increase body temperature
  5. Maintain fluid, electrolytes & Acid-base

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