Endocrine Focus: Thyroid and Parathyroid
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| Hyperthyroidism | Set of disorders characterized by abnormally increased synthesis and secretion of thyroid hormones.
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| Drug therapy for hyperthyroidism | thionamides & iodides
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| Most common types of hyperthyroidism | Graves' disease (toxic diffuse goiter) and multinodular goiter (toxic nodular goiter)
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| s/s hyperthyroidism | increased metabolic rate, weight loss, nervousness, irritable behavior, sleep disturbances, hair loss, fatigue, poor tolerance of heat, diaphorasis, swelling of the neck, warm and moist skin, and opthalmopathy including exohthalamos
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| complications of hyperthyroidism | thyrotoxicosis (thyroid storm/crisis)
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| dx of hyperthyroidism | elevated serum T3 is the most common finding. T4 measurments may be norm or elevated. TSH is low so that it cannot be located in the blood
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| pt teaching:hyperthyroidism | condition needs long-term care. Report excess fatigue and depression (may indicate hypothyroidism caused by antithyroid drug)
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| hypothyroidism | characterized by physical and mental retardation (cretinism) and myxedema
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| risk factors for hypothyroidism | can be caused by atrophy of thyroid gland p years c Graves' disease or thyrioditis, dietary iodine deficiency, high intake of goitrogens,and defects in thyroid hormone synthesis.
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| goitrogenic foods and drugs | soybeans, turnips, rutabagas, propylthiouracil, methimazole, and iodine
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| s/s; hypothyroidism | weight gain, lethargy, forgetfulness, irritability, HA, constipation, menstural disorders, numbness and tingling in arms and legs, and intolerance to cold, bradycardia, and dyspnea, thick skin, coarse hair, nonpitting generalized edema, myxedema,
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| dx: hypothyroidism | Free T4 is low. TRH stimulation test may be ordered
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| goiter | enlargment of the thyroid gland due to simple goiter, thyroid nodules, or thyroiditis
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| simple goiter | thyroid enlargement c norm thyroid hormone production
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| Chvostek's sign | test which reveals spasm of the facial muscle when the face is tapped over the facial nerve
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| Trousseau's sign | a carpopedal spasm that occurs when a blood pressure cuff is inflated above the patients' SBP and left in place for 2-3 minutes
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| hyperparathyroidism | secretion of excess PTH; most often caused by an adenoma, vitamin D deficiencies, malabsoption, CRF, and elevated serum phosphate
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| s/s: hyperparathyroidism | weakness, lethargy, depression, anorexia, and constipation, mental and personality changes, cardiac dysrhythmias, weight loss, and urinary calculi
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| complications of hyperparathyroidism | Chronic renal failure (CRF), urinary calculi, fx, brittle bones
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| dx of hyperparathyroidism | elevated serum calcium, decreased serum phosphate, elevated PTH, and elevated 24-hour urine calcium.
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| medical tx of hyperparathyroidism | calcitonin(Calcimar), gallium nitrate(Ganite), biphosphonates (etidronate, pamidronate) and plicamycin (Mithracin) inhibit release of calcium from bones. furosemide (Lasix) is given to promote relase of calcium from urine
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| pt teaching: hyperparathyroidism | Take drugs as prescirbed; eat a balanced diet; increase fluid intaked to the amount recommended; report bloody urine or pain in the kidney area or groin
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| hypoparathyroidism | an uncommon condition, most often due to accidental removal of or damaged to parathyroid glands during surgery and is a deficiency of PTH
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| complications; hypoparathyroidism | hypocalcemia, which can lead to convulsions and respiratory obstruction due to spasms of the larynx. Laryngospasms can be fatal
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| s/s: hypoparathyroidism | hypocalcemia (painful muscle cramps, fatigue and weakness, tingling and twitching to the face and hands, mental and emotional changes, dry skin and urinary frequency). In severe cases, dyspnea, convulsions and cardiac dysrhythmias
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| dx; hypoparathyroidism | low serum Ca+, elevated serum phosphate, low urine calcium, low serum magnesium, Chvostek's sign, and Trousseau's sign
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| tx; hypoparathyroidism | IV calcium salts, IV fluids, oral calcium salts, vitamin D supplements
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| parathromone | secreted by the parathyroid gland and maintains serum calcium levels
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| thyrocalcitonin | secreted by the thyroid gland and maintains serum calcium levels
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| thyroxine (T4), triiodothyronine (T3), and calcitonin | hormones produced by the thyroid gland: affects metabolic rate, growth, and development,and serum calcium regulation
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| nursing care p thyroidectomy | ineffective airway clearance, decreased cardiac output, disturbed body image, acute pain, and risk for infection
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| nursing care of hypothyroid patient | activity intolerance, imbalanced nutrition: > body requirements, hypothermia, constipation, risk for impaired skin integrity, decreased CO, disturbed thought process, disturbed body image, self-care deficits
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| nursing care of pt c hyperparathyroidism | activity intolerance, risk for injury, impaired urine elimination, constipation, disturbed thought process, and imbalanced nutrition
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| thyroid storm/ thyroid crisis | a crisis of uncontrolled hyperthyroidism caused by the release into the bloodstream of increased amounts of thyroid hormone.May occur spontaneously or be precipitated by infection, stress, or a thyroidectomy on a pt who isn't prepared well c antithyroids
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| s/s; thyroid storm/thyroid crisis | fever (may reach 106 degree F), tachycardia, acute respiratory distress, apprehension, restlessness, irritability, and prostration, pt can become delirious, lapse into a coma, and die of heart failure
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| drugs to treat hypothyroidism and thyroiditis. Increases metabolic rate | disiccated thyroid (thyroid USP), levothyroxine (Synthroid), liothyronine (Cytomel), liotrix (Euthroid)
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| thyroid-releasing hormone (TRH) stimulation test | test that measures the blood level of TSH p administration of TRH. Shows whether thyroid abnormalities are caused by a disorder of the thyroid gland itself or by altered production of stimulating hormones by the hypothalamus or the pituitary
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| radioactive iodine (RAI) uptake test | p radioactive iodine is taken PO, the amount of 131I taken up by thyroid is measured c a special instrument
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| 131I, 123I, 99mTc | radioactive isotopes that are useful for diagnositc purposes because they concentrate in the thyroid. The amount of iodine taken up by the thyroid is measured to assess the activity level of the gland
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| serum T3 and serum T4 measurements of free and total T4. | detects abnormal levels of thyroid hormones in the blood
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| elevated T3 | Graves' disease, toxic adenoma, and toxic nodular goiter
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| elevated T4 | hyperthyroidism, excesive thyroid hormone replacement.
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| low T3 and T4 | hypothyroidism
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| thyroid scan | 131I, 123I, or 99mTc is given orally and a scanner is used to detect pattern of uptake by the thyroid gland. Can differentiate benign and malignant nodules and detect other abnormalities
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| thyroid gland | located in lower portion of the anterior neck: plays a major role in regulating the body's rate of metabolisim and growth and development
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| parathyroid glands | small glands usually located on the back of the thyroid. Occasionally some are located in the mediastinum: secretes only one hormone, parathyroid hormone (PTH), which plays a critical role in regulating serum calcium levels
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| parathyroidectomy | surgery in which some or in extreme cases, all parathyroids are removed. best for the pt if most were left to prevent hypoparathyroidism. If pt is not a good candidate for surgery, medical tx is aimed @ lowering the serum calcium level.
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| parathyroidectomy:postoperative care | 2 potential complications:airway obstruction and hypocalcemia. Monitor and document the resp rate and effort and the pulse rate. Increasing pulse and resp rate suggests inadequate oxygenation. Notify MD of complications and keep a trach kit @ bedside
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| thyroidectomy | surgery where all or only part of the thyroid is removed.
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| thyroidectomy:preoperative care | assess pt's knowledge and what to expect. tell pt to expect dressing on the front of the neck and demonstrate how to avoid straining the neck incision by supporting head when rising. Ask pt to repeat information given and to demo deep breathing, etc.
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| thyriodectomy:postoperative care | if subtotal thyroidectomy is done, pt will not need replacement tx. giving thyroid hormone interferes c the regeneration of thyroid tissue. Immediately p surgery, assess and document resp, LOC, wound drainage, voice, and s/s of hypocalcemia.
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| thyroidectomy:complications | airway obstruction, recurrent laryngeal nerve damage, hemorrhage, tetany, and thyroid crisis/storm
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| thyroidectomy:pt teaching | if all of thyroid is removed, lifelong therapy is needed, scars usually heal so that they are barely noticeable, take drugs exactly as prescribed, nervousness and palpitations may be adverse effects of thyroid replacement drugs. notify MD if they occur
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Created by:
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