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M6 13-005

Exam 13: Thyroid Disorders

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 106F. 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