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M6 13-005
Exam 13: Thyroid Disorders
| Term | Definition |
|---|---|
| Thyroid Gland | Butterfly shaped with one lobe lying on either side of the trachea. Lies just below the larynx. Lobes connected by isthmus. Very vascular. |
| Thyroid Function | Secretes hormones Regulate growth and development, metabolism, and activity of the nervous system. Controlled by release of TSH from the pituitary gland. |
| Hormones Secreted by Thyroid | Thyroxine(T4) and Triiodothyronine(T3) |
| Where is the Thyroid Gland located? | Just below the larynx on either side of the trachea. |
| What does the Thyroid gland regulate? | Metabolism, growth and development, and activity of the nervous system. |
| Hyperthyroidism | Also called Graves' disease, exophthalmic goiter, and thyrotoxicosis. Overproduction of the thyroid hormones. Results in exaggerated metabolic processes. Exact cause is unknown. |
| Hyperthyroidism: Clinical Manifestation | Vary from mild to severe. Anterior neck enlargement. Exophthalmos (bulging eyes). |
| Exophthalmos | Enlargement of the eyes (Bulging) |
| Hyperthyroidism: Subjective Data | ↓ ability to concentrate, presence of memory loss. Dysphagia or hoarse voice. Weight loss even with increased appetite. Complaint of nervousness, jittery, excitable. Insomnia. Emotionally labile, may overreact to stress. |
| Hyperthyroidism: Objective Data | Tachycardia, hypertension. Edema of anterior portion of neck. Exophthalmos. Elevated body temperature and intolerance to heat. Skin warm and flushed with profuse diaphoresis. Bruit auscultated over thyroid. Cessation of menses. |
| Hyperthyroidism: Dx | Increased serum T3 and T4 levels. Radioactive iodine uptake test (RAIU). Thyroid scan. |
| Hyperthyroidism: Medical Management | Administer drugs that block the production of thyroid hormones: --propylthiouracil: Propyl-Thoracil, PTU --methimazole – Tapazole Ablation Therapy: --Radioactive Iodine -131I or 125I Ablation Therapy. |
| Hyperthyroidism: Sx Management | Subtotal thyroidectomy: -5/6th of thyroid removed -Risk of excessive bleeding |
| Subtotal Thyroidectomy | Partial removal of thyroid. |
| Hyperthyroidism: Post-op care | Maintain semi-fowler’s position. Avoid hyperextension of head. Maintain suction and tracheotomy kit at bedside. Provide cool mist humidification. Check vital signs q 4 hours. Assess swallow reflexes before giving liquids. |
| Hyperthyroidism: Post-op Complications | Tetany: -From accidental removal of parathyroid gland -Lead to dysrhythmia, convulsions, death |
| Tetany: S&S | Numbness or tingling. Carpopedal spasm. Tachycardia, tachypnea, hypertension. Laryngeal spasm. Positive Chvostek’s Sign. Positive Trousseau’s Sign. |
| Tetany: Tx | IV Calcium Gluconate. Should always be available postoperatively. |
| Thyroid Storm (Rare) | Manipulation of thyroid. Over-release of thyroid hormone in the blood stream. Appears within 12 hours post-op. |
| Thyroid Storm: S&S | Exaggerated hyperthyroidism. Severe hypertension, tachycardia. Hyperthermia up to 106F. Cardiac dysrhythmias, heart failure. |
| Thyroid Storm: Tx | IV fluids. Sodium iodide and Corticosteroids. Antipyretics and oxygen as needed. |
| Hypothyroidism | Severe form in adults called myxedema. Congenital is called cretinism. Decreased hormone secretion. Primarily effects women 30-60 years of age. |
| Hypothyroidism: Causes | Hyposecretion of thyroid gland. Failure of anterior pituitary to secrete adequate TSH for proper stimulation. Side effect of surgical treatment of hyperthyroidism. |
| Hypothyroidism: Clinical Manifestations | Mild to severe depending on deficiency. Hypothermia/intolerance to cold. Weight gain. Development of atherosclerosis /CAD. |
| Hypothyroidism: Subjective Assessment | Impaired memory, slow thought processes. Depression or paranoia. Lethargy, forgetfulness, and irritability. Anorexia and constipation. ↓ libido and reproductive difficulty. Menstrual irregularities. Speech and hearing impairments. |
| Hypothyroidism: Objective Data | Bradycardia, hypotension and bradypnea. Facial features become enlarged, edematous. Voice low and hoarse. Exercise intolerance. Weakness, clumsiness, and ataxia. Ileus. |
| Hypothyroidism: Dx | Physical examination and history. Laboratory tests (TSH, T3, and T4 levels): -Identify whether hyposecretion is from anterior pituitary or thyroid |
| Hypothyroidism: Medical Management | Replacement therapy: Desiccated animal thyroid (Armour Thyroid). Thyroglobulin (Proloid). Levothyroxine sodium (Levothroid /Synthroid). Liothyronine sodium (Cytomel). |
| Hypothyroidism: Medical Management S/E | Palpitations, tachycardia, and nervousness. Headache and insomnia. Vomiting, diarrhea, and weight loss. Sweating and heat intolerance. |
| Hypothyroidism: Nursing Management | Symptomatic relief: -Keep room warm (70 - 74 F). -Avoid hypothermia. -Encourage high-fiber, low-calorie diet. -Do not stop medication without consulting physician. |
| Goiter | Develops when thyroid gland enlarges. Low circulating T3 level signals the pituitary gland. Attributed to inadequate dietary intake of iodine. |
| Goiter: Subjective Data | Dysphagia, hoarseness, or dyspnea |
| Goiter: Objective Assessment | Increase in goiter size. Voice changes. Adequacy of food and fluid intake. |
| Goiter: Medical Management | Oral Potassium iodine. Iodine rich foods. |
| Goiter: Surgical Management | Cosmetic removal of gland |
| Goiter: Nursing Management | Prevention of post-operative complications: -Thyroid storm, bleeding, and tetany. Dietary and medication regimen education. |
| What dietary information is important for the patient to know when he/she has a goiter? | The importance of taking in adequate dietary intake of iodine. |
| Thyroid Cancer | Rare malignancy. More frequent in females and Caucasians. Cancer that grows slowly, usually contained, and does not spread beyond adjacent lymph nodes. |
| Thyroid Cancer: Types | Papillary. Follicular. Anaplastic. |
| Thyroid Cancer: Clinical Manifestations | Presence of a firm, fixed, painless nodule, palpable on examination. Rarely, symptoms of hyperthyroidism. |
| Thyroid Cancer: Subjective Data | observation of Pt coping and support System |
| Thyroid Cancer: Objective data | Progression of tumor. Response to 131-i therapy. |
| Thyroid Cancer: Dx Tests | Thyroid Scan: -"Cold" scan. -"Hot" scan. Thyroid Function Tests (TFT). Needle biopsy. |
| Thyroid Cancer: Sx Management | Total Thyroidectomy. Radial neck dissection with metastasis. |
| Thyroid Cancer: medical Management | Radiation. Chemotherapy. Radioactive iodine treatment. |
| What is the risk involved in needle biopsy? | Possibility of “seeding” adjacent tissue with cancer cells causing metastasis. |
| What possible complications are associated with total thyroidectomy? | Thyroid storm, tetany, excess bleeding. |
Created by:
jtzuetrong
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