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NURS 2514 > Week 11 - Thyroid Disorders > Flashcards

Week 11 - Thyroid Disorders Flashcards

1
Q

where is the thyroid gland located

A
  • wraps the anterior of the trachea just below the thyroid cartilage
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2
Q

what produces thyroid hormone or thyroxin

A
  • cells arranged in circular patterns called follicles
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3
Q

what is thyroxin formed by

A
  • 4 iodine atoms attached to 2 linked tyrosine amino acids
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4
Q

what hormone is released from the thyroid gland? how is it released?

A

T4 (tetraiodothyronine & thyroxin)

- released mostly inactive

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5
Q

what is T4 converted to? where does it occur?

A
  • its active form = T3 (triiodothyronine)

- in the liver, kidneys, and other peripheral tissues

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6
Q

what happens to T3 once T4 is converted

A
  • enters most cells and binds to an intracellular receptor similar to steroid hormones
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7
Q

the thyroid gland in the only tissue in the body that uses ______; what is it used for

A
  • uses iodine

- used for synthesis of thyroid hormones

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8
Q

describe the negative feedback loop that plays a role in thyroid regulation

A
  • the hypothalamus releases thyrotropin releasing hormone (TRH)
  • TRH acts on the anterior pituitary to release thyroid stimulating hormone (TSH)/thryotropin
  • TSH travels to the thyroid hormone to increase the production & secretion of thyroxin
  • elevated lvls of thyroid hormone act in a negative feedback loop to inhibit TRH and TSH secretion
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9
Q

besides increasing the production & secretion of thyroxin, what else does TSH do

A
  • acts as a growth factor to thyroid tissue
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10
Q

what is euthyroid

A
  • state of having normal thyroid function
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11
Q

what are 2 hyper disorders of the thyroid gland

A
  • hyperthyroidism

- thyroid storm

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12
Q

what are 2 hypo disorders of the thyroid gland

A
  • hypothyroidism

- myxedema coma

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13
Q

what 3 things does the thyroid gland produce?

A
  • T4
  • T3
  • calcitonin
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14
Q

what is the main fnxn of the thyroid gland

A
  • production, storage, and release of T4 and T3
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15
Q

what is a goiter

A
  • an abnormal enlargement of the thyroid gland
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16
Q

what is a nodule

A
  • localized & palpable deformity of the thyroid gland which can be benign or malignant
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17
Q

what usually causes a goiter

A
  • increased secretion of TSH or activation of the TSH receptor in the thyroid gland
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18
Q

do goiters occur in hypo or hyperthyroidism

A
  • can occur in both
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19
Q

what are 2 types of goiters

A
  1. endemic

2. toxic

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20
Q

what is an endemic goiter

A
  • goiter that occurs due to deficiency of iodine in the diet
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21
Q

how does iodine deficiency cause an endemic goiter

A
  • causes a decreased production of thyroxin, leading to hypothyroidism
  • hypothyroidism causes a compensatory & prolonged increase in TSH secretion leading to excess growth of the thyroid gland
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22
Q

what is a toxic goiter

A
  • a goiter that continues to grow in the absence of TSH stimulation & hypersecrete thyroid hormone
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23
Q

what is a toxic goiter the result of

A
  • dysplastic transformation of the thyroid cells that do not respond to TSH
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24
Q

what are goitrogens

A
  • substances that can cause goiters by interfering w iodine uptake in the thyroid gland
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25
Q

list 4 drugs that are goitrogens

A
  • iodine in large doses
  • salicyclates
  • sulphonamides
  • lithium

(see notes for more)

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26
Q

thyroid nodules can be…. (3)

A
  • benign
  • malignant
  • functional
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27
Q

what is a functional nodule

A
  • nodule causes by elevated TSH
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28
Q

what is a concern with enlargement if the thyroid gland or thyroid nodules

A
  • can cause tracheal compression if they become too large
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29
Q

what type of pt is thyroid cancer often founnd in

A
  • an euthyroid pt
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30
Q

what are 2 risk factors for thyroid cancer

A
  • exposure to ionizing radiation

- thyroiditis

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31
Q

what symptoms may occur during thyroid cancer (3)

A
  • presence of painless, palpable nodules in an enlarged thyroid gland
  • symptoms of hypo & hyper thyroidism
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32
Q

what are 2 categories of treatment for thyroid cancer

A
  • surgical removal

- radiation therapy

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33
Q

describe surgical removal for thyroid cancer

A

may range from:

  • unilateral total lobectomy with removal of the isthmus
  • to total thyroidectomy w bilateral lobectomy
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34
Q

when is radiation used for thyroid cancer

A
  • either as the primary treatment

- or as palliative treatment for pts w metastatic thyroid cancer

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35
Q

what parts of the body does T3 and T4 effect

A
  • all body tissues

- plays a major role in our energy and BMR

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36
Q

what parts of the body does calcitonin effect

A
  • bone tissue
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37
Q

what is hypothyroidism

A
  • insufficient thyroid hormone
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38
Q

what are 2 types of hypothyroidism

A
  1. cretinism = congenital hypothyroidism

2. myxedema = adult or late onset hypothyroidism

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39
Q

describe the growth & development of a fetus w congenital hypothyroidism; why does this happen

A
  • development if often normal

- bc T3 can cross the placental barrier from the maternal blood supply

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40
Q

what is required after birth for a newborn w congenital hypothyroidism

A
  • supplementation for normal CNS development & bone growth
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41
Q

what causes myxedema (late or adult onset hypothyroidism)

A
  • autoimmune destruction of the thyroid cells called Hashimoto’s thyroiditis
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42
Q

what does hashimoto’s thyroiditis cause (2)

A
  • destruction of the thyroid cells causes a decrease in thyroxin secretion & a compensatory increase in TSH leading to goiter formation
  • myxedema
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43
Q

what is myxedema

A
  • accumulation of polysaccharides & water in CT of the skin
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44
Q

what is a 3rd cause of hypothyroidism

A
  • drug induced

ex. anesthetics, amiodarone, lithium

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45
Q

what type of symptoms do we see during hypothyroidism

A
  • symptoms related to slowed metabolism
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46
Q

what CNS symptoms are present during hypothyroidism (7)

A
  • slowed mentation
  • fatigue
  • lethargy
  • slowed speech
  • depression
  • memory loss
  • possible paranoia or psychosis
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47
Q

what effect does hypothyroidism have on reflexes

A
  • causes delayed reflexes
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48
Q

what MSK symptoms are present during hypothyroidism (6)

A
  • muscle fatigue
  • decreased strength
  • decreased endurance
  • decreased exercise tolerance
  • muscle cramps
  • stiffness
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49
Q

what causes the MSK symptoms of hypothyroidism (2)

A
  • decreased amt of mitochondria causes the muscle fatigue

- elevated blood creatine kinase causes muscle cramps & stiffness

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50
Q

what CVS symptoms are present during hypothyroidism (5)

A
  • bradycardia
  • heartblock
  • decreased CO
  • cardiac dilation
  • elevated LDL
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51
Q

what causes the CVS symptoms of hypothyroidism

A
  • decreased production of myosin
  • decreased alpha adrenergic receptors in the heart
  • decreased LDL receptors in the liver
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52
Q

what impact does hypothyroidism have on the hematopoietic system (3)

A
  • decreased erythropoiesis
  • impaired absorption of vitamin B12

leading to anemia

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53
Q

what effect does hypothyroidism have on temp regulation (2)

A
  • cold intolerance

- hypothermia

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54
Q

what resp symptoms are present during hypothyroidism

A
  • decreased RR

- sleep apnea if left untreated

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55
Q

why does hypothyroidism cause decreased RR

A
  • due to decreased CO2 production
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56
Q

what renal symptoms are present during hypothyroidism (2)

A
  • decreased GFR = water retention
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57
Q

what causes the renal symptoms of hypothyroidism

A
  • reduced renal blood flow
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58
Q

what GI symptoms are present during hypothyroidism

A
  • constipation
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59
Q

what effect does hypothyroidism have on metabolism and how is it manifested (2)

A

delayed metabolism =

  • weight gain despite loss of appetite
  • myxedema = facial swelling, round cheeks
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60
Q

how does hypothyroidism impact the immune system

A
  • causes susceptibility to infection
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61
Q

in severe cases, hypothyroidism can cause

A
  • carotenemia = yellow pigmentation of the skin
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62
Q

what is one potential life-threatening complication of hypothyroidism

A
  • myxedema coma
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63
Q

what is myxedema coma

A
  • life-threatening coma caused by chronic untreated hypothyroidism
64
Q

what is myxedema coma characterized by (4)

A
  • hypothermia
  • HF
  • hypoventilation
  • lactic acidosis
65
Q

what can trigger a myxedema coma (2)

A
  • cold exposure

- concurrent illness

66
Q

in what cases does hypothyroidism not cause the “slow” symptoms (2)

A
  • if caused by
    1. thyroidectomy
    2. antithyroid
  • sx will be insidious for months to years
67
Q

how is hypothyroidism diagnosed (5)

A
  • history
  • physical exam
  • blood test
  • TPO antibodies
  • others
68
Q

what type of blood tests would we order for hypothyroidism

A
  • T3
  • T4
  • TSH
69
Q

what would be expected for blood works findings for hypothyroidism due to a problem w the thyroid

A
  • low T4
  • low T3
  • high TSH (trying to compensate)
70
Q

what blood work findings would be expected for hypothyroidism due to a problem w the hypothalamus

A
  • low T4
  • low T3
  • low TSH
71
Q

what are 4 other findings that may occur w hypothyroidism

A
  • elevated cholestrol
  • elevated triglycerides
  • anemia
  • increased creatine kinase
72
Q

what med is given for hypothyroidism

A
  • levothyroxone (synthroid)
73
Q

what is levothyroxone

A
  • synthetic T4
74
Q

what is the MOA of levothyroxone

A
  • replaces what the thyroid gland cannot produce to achieve normal thyroid levels
    = works the same way as normal T4
75
Q

what are 3 indications for levothyroxone

A
  • primary hypothyroidism
  • myxedema coma
  • simple goiter
76
Q

what reduces levothyroxone absorption

A
  • food

- drugs

77
Q

what implication does levothyroxone absorption being reduced by food have

A
  • should be taken on an empty stomach in the morning ~30-60 min before breakfast
78
Q

what 6 drugs reduce the absorption of levothyroxone

A
  • H2 receptor blockers
  • proton pump inhibitors
  • antacids
  • sucralfate
  • aluminum containing antacids
  • calcium supplements (tums)
79
Q

describe the half life, plateau, and dosing of levothyroxone

A
  • half life = 7 days
  • once-a-day dosing & may have to be adjusted
  • takes ~1 month to reach plateau
80
Q

what does levothyroxone enhance the effect of

A

warfarin

= dosing may have to be adjusted

81
Q

what can acute overdose of levothyroxone cause

A
  • thyrotoxicosis (hyperthyroidism) = may have to be adjusted
82
Q

what can chronic overdose of levothyroxine cause (2)

A
  • accelerated bone loss
  • increased risk of afib
    (especially w older adults)
83
Q

what is the goal in treatment of hypothyroidism

A
  • restore a euthyroid state
84
Q

what is treatment for hypothyroidism

A
  • levothyroxine

- low calorie diet to promote weight loss

85
Q

how long does a pt have to be on levothyroxine

A
  • forever
86
Q

what should we assess for during treatment of hypothyroidism

A
  • ongoing symptoms
  • worsening symptoms
  • symptoms of hyperthyroidism
87
Q

what is hyperthyroidism

A
  • excessive amt of thyroid hormone
88
Q

what is hyperthyroidism often caused by (5)

A
  • autoimmune mechanisms
  • thyroid cell transformation
  • endemic goiters & hypothyroidism treated w iodine supplements
  • pituitary adenoma
  • hypothalamic disease
89
Q

what is an example of how autoimmune mechanisms cause can hyperthyroidism? describe what happens

A

grave’s diseases

  • an antibody that is formed binds to & activates the TSH receptor on cells
  • the antibody mimics the effect of TSH resulting in hyperthyroidism
90
Q

describe plasma TSH lvls in hyperthyroidism

A
  • very low due to the negative feedback mechanism
91
Q

overtime, hyperthyroidism causes by autoimmune mechanisms can lead to

A
  • autoimmune destruction of the thyroid & hypothyroidism
92
Q

grave’s disease & hasimoto’s thyroiditis are often associated w other autoimmune diseases like… (5)

A
  • type 1 DM
  • pernicuous anemia
  • lupus
  • RA
  • myesthenia gravis
93
Q

what are 2 examples of how thyroid cell transformation can cause hyperthyroidism

A
  1. endemic goiter

2. follicular adenoma (thyroid cancer)

94
Q

what causes an endemic goiter & follicular adenoma and explain how this can cause hyperthyroidism

A
  • both caused by transformed cells that do not respond to TSH & hypersecrete TSH
95
Q

describe how an endemic goiter & hypothyroidism treated w iodine supplement can cause hyperthyroidism

A
  • when iodine supplements are given to a pt w an endemic goiter or hypothyroidism, T4 synthesis is greatly increased = temporary hyperthyroidism
96
Q

how does pituitary adenoma (cancerous growth) and hypothalamic disease cause hyperthyroidism

A
  • can cause overproduction of TRH or TSH
97
Q

what are symptoms of hyperthyroidism r/t (3)

A
  • increased metabolism
  • sensitivity to stimulation from SNS
    = “fast” symptoms
98
Q

what CVS symptoms are present during hyperthyroidism (7)

A
  • increased CO
  • increased HR & contractility
  • widened pulse pressure
  • afib
  • supraventricular tachycardia
  • premature beats
  • cardiac hypertrophy
99
Q

what can the rapid & strong HR during hyperthyroidism lead to

A
  • exhaustion & HF
100
Q

what resp symptoms are present during hyperthyroidism (3)

A
  • tachypnea
  • dyspnea
  • resp failure
101
Q

what causes the resp symptoms of hyperthyroidism

A
  • tachypnea = d/t increased metabolic rate

- dyspnea & resp failure = d/t weakness & atrophy of resp muscles

102
Q

what CNS symptoms are present during hyperthyroidism (8)

A
  • rapid mentation
  • anxiety
  • nervousness
  • irritability
  • mania & psychosis
  • poor conc
  • insomnia
  • rapid thoughts/speech
103
Q

what effect does hyperthyroidism have on reflexes (2)

A
  • tremor

- hyperactive deep tendon reflex

104
Q

what MSK symptoms are present during hyperthyroidism (3)

A
  • muscle atrophy & wasting (weight loss)
  • weakness
  • bone reabsorption exceeds bone formation
105
Q

why does weight loss occur during hyperthyroidism? how does hyperthyroisism effect appetite

A
  • due to increased metabolic rate

- appetite increases

106
Q

why does muscle weakness occur during hyperthyroidism (3)

A
  • due to inreased protein catabolism

- changes in myosin

107
Q

what effect does bone reabsorption exceeding bone formation have during hyperthyroidism (3)

A
  • hypercalcemia
  • hypercalcuria
  • osteoporosis
108
Q

what effect does hyperthyroidism have on temp regulation (4)

A
  • heat intolerance
  • increased temp
  • increased heat dissipation
  • hot
109
Q

what digestive & metabolic symptoms are present during hyperthyroidism (6) how does it effect BG, lipids, etc.

A
  • rapid glucose absorption = BG rise (but often returns to normal)
  • glucosuria (temp)
  • LDL low
  • adipocyte lipolysis increases
  • FA rapidly metabolized
  • vitamin deficiencies common
110
Q

what impact does the rapid glucose absorption during hyperthyroidism have on DM pts

A
  • may have increased insulin requirements
111
Q

why is LDL low during hyperthyroidism

A
  • due to increased hepatic LDL receptors
112
Q

what GI symptoms are present during hyperthyroidism

A
  • diarrhea

- defacation

113
Q

what impact does hyperthyroidism have on menstrual cycles

A
  • can cause menstrual irregularities & inferility
114
Q

what does hyperthyroidism cause that relates to the eyes (2)

A
  • exophthalamus/proptosis = bulging, wide eyes

- pretibial myxedema (this doesn’t relate to the eyes lol idk why i put this here)

115
Q

why does exopthalamus occur during hyperthyroidism

A

due to:

  • increased sympathetic tone
  • orbital soft tissue becomes inflamed, edematous, and infiltrated w lymphocytes
116
Q

what is pretibial myxedema? what does this occur w

A
  • pretibial skin becomes thick & resembles an orange peel

- occurs w grave’s disease

117
Q

how is hyperthyroidism diagnoses (4)

A
  • history
  • physical exam
  • blood test
  • RAIU
118
Q

what can we get a blood test for during hyperthyroidism

A
  • T4
  • TSH
  • T3 if needed
119
Q

what blood test findings would be expected for hyperthyroidism d/t a problem w the thyroid

A
  • high T4
  • high T3
  • low TSH (due to negative feedback)
120
Q

what blood test findings would be expected for hyperthyroidism d/t a problem w the pituiatry or hypothalamus

A
  • low TSH
  • high T4
  • high T3
121
Q

what is a RAIU

A
  • radioactive iodine uptake test
122
Q

describe how an RAIU works

A
  • radioactive iodine is given in oral form, circulates thru the body & is taken up by the thyroid in different amts depend on the thyroid disease
123
Q

how is hyperthyroidism treated (4)

A
  • drug therapy
  • nutritional therapy
  • radioactive iodine therapy
  • surgical therapy
124
Q

what are types of drug therapy for hyperthyroidism (2)

A
  • beta blockers

- thionamides (antithyroids)

125
Q

what is a type of antithyroid used for hyperthyroidism

A
  • methimazole (tapazole)
126
Q

what is the MOA of methimazole

A
  • suppresses synthesis of thyroid hormone
127
Q

how long might it take to become euthyroid on methimazole? why?

A
  • 3-12 weeks

- bc it does mot destroy store of thyroid hormone

128
Q

what are indications for methimazole (3)

A
  • graves disease
  • adjunct to radiation therapy
  • prior to surgery
129
Q

what is the half life of methimazole? how does this effect dosing>

A
  • 6-13 hr = half life

= once/day dosing

130
Q

describe the side effects of methimazole

A
  • generally well tolerated

- may cause hypothyroidism

131
Q

who should methimazole be avoided in? why?

A
  • pregnancy women

- can cause neonatal hypothyroidism

132
Q

what is the most dangerous toxicity associated w methimazole

A
  • angranulosytosis = reduction in circulating granulocytes
133
Q

what are signs of agranulocytosis? what should we monitor for?

A
  • sore throat
  • fever

monitor for signs of infection & CBC

134
Q

is the agranulocytosis associated w methimazole reversible?

A
  • yes once med is stopped
135
Q

what beta blockers is often used for hyperthyroidism

A
  • propanolol
136
Q

what effect does propanolol have for someone w hyperthyroidism

A
  • provides symptom relief r/t high beta adrenergic stimulation from thyroid hormones
137
Q

when should propanolol not be used? why?

A
  • if a pt has COPD, asthma, or HF
138
Q

what BB should be used as replacement for propanolol if a pt has COPD, asthma, or HF

A
  • metaprolol, atenolol (bc they are selective)
139
Q

when is iodine used during hyperthyroidism

A
  • short term prior to surgery or in crisis
140
Q

what effect does iodine have on a pt w hyperthyroidism

A
  • rapidly inhibits T3 and T4 synthesis

- decreases vascularity of thyroid gland

141
Q

what is radioactive iodine used in

A
  • graves disease
142
Q

what is the effect of radioactive iodine

A
  • destroys thyroid tissue to suppress thyroid hormone production
143
Q

what is a common adverse effect of radioactive iodine

A
  • excessive destruction can cause hypothyroidism
144
Q

who cannot have radioactive iodine

A
  • pregnant women
145
Q

what is a type of surgical therapy for hyperthyroidism

A
  • subtotal thyroidectomy –> significant part of the thyroid gland
146
Q

what is included in nutritional therapy for hyperthyroidism (3)

A
  • high calorie for hunger & prevention of tissue breakdown
  • protein allowance
  • avoidance of certain foods
147
Q

what is the protein allowance for an individual w hyperthyroidism

A
  • 1-2 g/kg of ideal body weight
148
Q

what foods should someone w hyperthyroidism avoid (3)

A
  • caffeine
  • highly seasoned foods
  • high fibre foods

to decrease abdom pain

149
Q

what should you assess during ongoing treatment for hyperthyroidism (3)

A
  • ongoing symptoms
  • worsening symptoms & associated stressors
  • symptoms of hypothyroidism
150
Q

what is an emergency complication associated w hyperthyroidism

A
  • untreated hyperthyroidism can lead to a thyroid crisis or storm
151
Q

what typically precipitates a thyroid crisis or storm (3)

A
  • concurrent illness
  • trauma
  • surgery
152
Q

what are manifestations of a thyroid storm (8)

A

uncontrollable hyperthyroidism

  • tachycardia or tachyarrythmia
  • angina
  • symptoms of HF
  • fever
  • NV
  • diarrhea
  • restlessness
  • psychosis
153
Q

what should you assess during inspection of the thyroid gland (2)

A
  • size

- nodules

154
Q

what should you auscultate during assessment of the thyroid gland

A
  • any bruits? (may be heard during hyperthyroidism due to increased CO)
155
Q

what should you palpate for during assessment of the thyroid gland

A
  • tenderness
  • nodules
  • shape
156
Q

what should you assess during history aspect of thyroid assessment (9)

A
  • PMHx
  • FMx
  • any autoimmune disorders?
  • PSHx
  • Meds
  • allergies
  • immigration from an iodine deficient area?
  • reproductive & menstrual history
  • OPQRSTU & RoS of current symptoms
157
Q

what should you assess during the physical exam for thyroid assessmentq

A
  • vitals
  • general h2t
  • head, neck, eyes
  • integ
  • resp
  • cvs
  • abdom
  • thyroid gland

NURS 2514 (75 decks)

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