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Thyroid & Prathyroid
Adult II EXAM III
| Question | Answer |
|---|---|
| What do three things do the Thyroid and Parathyroid hormones affect? | Metabolism, Electrolyte balance, Excitable membrane activity |
| Definition: "Hyperthyroidism" | excessive secretion of thyroid hormone |
| What body systems are stimulated by excessive thyroid hormones? | most of them |
| What are the two general results of excessive hormones stimulation of the body systems? | Hypermetabolism; Increased SNS activity |
| How many of the primary presenting problems of hyperthyroid patients are due to changes in metabolism? | Most of them are due to Hypermetabolism |
| What is the most common cause of Hyperthyroidism? | Grave's Disease |
| What kind of disorder is Grave's Disease? | autoimmune |
| Definition: "autoimmune disease" | disease caused by antibodies produced against substances naturally present in the body |
| What do antibodies attack in Grave's Disease? | Thyroid hormone receptors on thyroid gland cells |
| What is the PHYSICAL result of antibody attack in Grave's Disease? | Enlargement and proliferation of thyroid gland cells; resulting in a goiter |
| What is the HORMONAL result of Thyroid gland cell proliferation in Grave's Disease? | Hyperproduction of Thyroid Hormone d/t multiplication of Thyroid Hormone producing cells |
| What three key features characterize Grave's Disease? | Exophthalmus, Goiter, Pretibial Myxedema |
| Definition: "Exophthalmus" | abnormal protrusion of eyeballs |
| Definition: "Goiter" | swelling of the neck resulting from enlargement of the thyroid gland |
| Definition: "Pretibial Myxedema" (as defined by PPT) | dry, waxy swelling in the anterior lower legs |
| Definition: "exogenous" | caused by an agent or organism outside the body |
| What is the cause of exogenous hyperthyroidism? | excessive thyroid replacement hormone medication use |
| What is the name for hyperthyroidism d/t excessive thyroid replacement hormone medication use? | exogenous hyperthyroidism |
| What is a third cause of hyperthyroidism besides Grave's Disease or exogenous hyperthyroidism? | nodules on the thyroid |
| What is the general description of Hyperthyroidism symptoms? | everything is elevated and sped up |
| What are three cardiopulmonary symptoms of Hyperthyroidism? | Palpitations, Chest pain, Dyspnea |
| What are four neurological symptoms of Hyperthyroidism? | Increased sweating/heat intolerance; Vision changes/light sensitivity; Insomnia; Irritability |
| What is the pathophysiology of Exophthalmus? | edema and fatty tissue behind the eyes make them bulge out; gives the impression of a startled look |
| What may be heard upon auscultation of an enlarged thyroid in hyperthyroidism? | Bruits |
| What are changes in Heart rate, rhythm, and pressure associated with hyperthyroidism? | Increased Systolic BP, Tachycardia, Dysrhythmias |
| What labs are used to diagnose Hyperthyroidism (hint what hormones are effected)? | T3, T4, TSH |
| Definition: "TSH" | Thyroid Stimulating Hormone; hormone from posterior pituitary that stimulates the thyroid gland to produce T3 and T4 |
| Definition: "T3" | triiodothyronine |
| Definition: "T4" | thyroxine; synthetic thyroxine is given to patients with hypothyroidism |
| What hormone levels characterize Grave's Disease? | elevated T3 and T4 (because there is a proliferation of hormone producing cells); low TSH (because there is already too much thyroid hormone; this would stimulate more) |
| What must be taken orally before a Thyroid scan may be performed? | radioactive iodine |
| What is measured for diagnostic analysis in a Thyroid scan? | amount of radioactive iodine uptake |
| What would be the result of a Thyroid scan in Hyperthyroidism? | increased radioactive iodine uptake |
| What are the two goals of medical management of Hyperthyroidism? | Decrease effects of excess thyroid hormone on Cardiac System; Reduce secretion of thyroid hormone |
| What extrapersonal conditions may increase symptoms of Hyperthyroidism? | noise and stress |
| What four nursing interventions should be implemented to limit extrapersonal conditions that would = Hyperthyroidism symptom increase? | Keep environment quiet; Close the door; Limit visitors; Avoid nonessential care and treatment |
| What should be done to palliate Hyperthyroid patients' temperature intolerance? | Reduce room temperature; Keep ice water and clean cool linens available |
| Three medications used to treat Hyperthyroidism | PTU; Lithium; Radioactive iodine |
| Definition: "PTU" | Propyl-Thio-Uracil (propylthiouracil) |
| How does PTU treat Hyperthyroidism? | prevents conversion of T4 to T3 (which is the most potent of the two) |
| What is the Adverse Effect of PTU? | HIGH incidence of Liver damage |
| How does Lithium treat Hyperthyroidism? | inhibits thyroid hormone release |
| What Adverse Effect could Lithium cause; what should be checked to prevent or diagnose this Adverse Effect? | Hypothyroidism (d/t excessive thyroid hormone release inhibition); blood levels of Thyroid Hormones should be measured |
| How does Radioactive Iodine treat Hyperthyroidism; what is its administration route? | destroys some of the hyperactive thyroid tissue; administered orally |
| Definition: "thyroidectomy" | surgical removal of Thyroid tissue |
| How much Thyroid Tissue is removed to treat Hyperthyroidism? | sometimes all (total thyroidectomy), but not explicitly, sometimes subtotal thyroidectomy |
| When is surgery indicated in Hyperthyroidism patients? | when patients don't respond well to Antithyroid drugs or Radioactive iodine therapy |
| What is the result of Thyroid Tissue removal? | removal of Hormone producing Thyroid cells = decreased Thyroid Hormone (T3 and T4) production |
| Hyperthyroid patients are treated BEFORE surgery to alter what two things related to their condition? | 1. Thyroid Hormone levels 2. size and vascularity of Thyroid |
| How should Thyroid Hormone levels be BEFORE Thyroid Surgery in Hyperthyroidism? | AS NORMAL AS POSSIBLE |
| What medication is given to affect the size and vascularity of the Thyroid in Hyperthyroidism? | Iodine |
| How should Thyroid size and vascularity be altered BEFORE Thyroid surgery in Hyperthyroidism? | size and vascularity should be reduced |
| Why do we want to alter the size and vascularity of the Thyroid in Hyperthyroidism BEFORE surgery? | reduced size and vascularity reduces the risk of Bleeding and Thyroid Storm |
| Definition: "Thyroid Storm" | rapid worsening of Hyperthyroid condition with uncontrolled BP, HR, and high fever associated with untreated or undertreated Hyperthyroidism |
| What should be monitored closely following Thyroidectomy? | Vital Signs, Bleeding or Respiratory distress d/t tracheal compression, PAIN (medicate for pain!) |
| What should be avoided when positioning a patient following Thyroidectomy? | Distention of the Neck |
| What can be done to help ease respirations and thin any secretions following Thyroidectomy? | give Humidified Air (also assist patient with Deep Breathing) |
| What would be heard in acute obstruction of an airway? | Stridor |
| Definition: "Stridor" | harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx |
| What three symptoms and electrolyte imbalance may occur following Thyroidectomy? | Tetany, Tingling, and Muscle Twitching D/T Hypocalcemia |
| Where would Tingling occur following a Thyroidectomy and what would it occur as a symptom of? | fingers/toes, mouth; occurs as a symptom of Hypocalcemia |
| Definition: "Tetany" | condition marked by intermittent Muscular Spasms D/T malfunction of parathyroid glands and consequent Ca deficiency (Hypocalcemia) |
| What voice change is common following Thyroidectomy? | hoarseness |
| Is the voice change following Thyroidectomy permanent? | usually temporary |
| What should be done concerning the voice change following a Thyroidectomy and why (what is a possible underlying problem)? | Voice should be assessed; Laryngeal Nerve damage is possible |
| What is a possible SERIOUS reaction of Thyroid Hormone production as a result of Thyroidectomy itself? | Thyroid Hormone production could increase EXCESSIVELY |
| What is it called when this change in Thyroid Hormone production occurs d/t Thyroidectomy, what are its S/S, and HOW SERIOUS is it? | Thyroid Storm/Crisis; Fever, Tachycardia, Severe HTN (basically hyper-action of everything that was wrong in Hyperthyroidism); CAN LEAD TO DEATH |
| What should be reported following Thyroidectomy to make sure any incidence of Thyroid Storm/Crisis is caught early? | ANY Elevation in temperature should be reported |
| What two things should be done in case of Thyroid Storm? | 1. MAINTAIN Patent Airway and Adequate Ventilation!!!! 2. Administer Antithyroid drugs (because this is major hyperthyroid reaction) |
| How do patients with HYPOThyroidism present an why? | with manifestations of DECREASED Metabolism D/T Low levels of Thyroid Hormones |
| Definition: "Primary Hypothyroidism" | decreased hormone production by the Thyroid gland (because of the Thyroid gland itself, not D/T Pituitary) |
| What Hormone levels characterize Primary Hypothyroidism? | 1. HIGH TSH (because there are NOT enough Thyroid Hormones) 2. Low T3 and T4 (because hypoactive Thyroid) |
| What characterizes HR and BP in Hypothyroidism? | slow HR, low BP |
| What psychological/neurological symptoms characterize Hypothyroidism? | Cold intolerance; Depression/withdrawal |
| What is the hematological result of slowed metabolism/function in Hypothyroidism? (remember, bones are creating stuff too, and this is affected by Hypothyroidism) | Anemia |
| What type of edema characterizes Hypothyroidism? | Myxedema |
| Definition: "Myxedema" | generalized mucousy edema (not just water) |
| What are oral/audible symptoms of Myxedema? | thickening of the tongue; voice is husky D/T edema in larynx |
| What is Hypothyroidism usually caused by? | HYPER-Thyroidism Treatment |
| What is a dietary cause of Hypothyroidism and where is it more common? | lack of dietary iodine; common in geographical areas where there is little iodine in the soil |
| Dysfunction of what gland causes Secondary Hypothyroidism and why (how would presenting Hormone levels differ for this instance)? | Pituitary problems/dysfunction; because TSH is produced by the pituitary, problems would = decreased TSH, therefore decreased Thyroid stimulation to produce T3 and T4; (T3, T4, AND TSH would be low) |
| What drugs could cause Hypothyroidism (hint, two are used to tx Hyperthyroidism)? | Lithium, PTU (Propyl-Thio-Uracil), and AMIODARONE |
| Definition: "Amiodarone" | anti-arrhythmic drug; Tx life-threatening heart rhythm problems (arrhythmias) in patients who have already taken other antiarrhythmic medicines |
| What gender and age group is Hypothyroidism most common in? | women 30-60 years old |
| With what does likelihood of Hypothyroidism increase, and with what other condition is Hypothyroidism associated? | Likeliness increases with AGE; associated with Diabetes |
| How does progression of symptoms occur in Hypothyroidism (timeframe); how should you ask patients about their condition? | Progression may occur GRADUALLY (not even slowly, GRADUALLY); ask known or suspected Hypothyroid patients to compare their current condition to a "YEAR AGO" |
| What should you ask Hypothyroid patients to compare their condition/symptoms to? | to their condition/symptoms a YEAR AGO |
| What assessments would be associated with Hypothyroidism? | Decreased activity level, libido; INCREASED weakness, sleep, muscle aches, cold intolerance, constipation, impotence, infertility (everything is tired, worn out, and not working great) |
| What would you expect to find on Physical assessment of Hyperthyroid patient? | Facial edema; Blank expression; Weight gain; Lethargy/depression; Thick tongue (myxedema); LOW Body Temp; SLOW movement, speech, HR, RR |
| What Hormone levels characterize Secondary Hypothyroidism (Hypothyroidism D/T Pituitary problems; what does the Pituitary produce)? | T3 and T4 are low D/T LOW TSH Summary: low T3, T4, TSH |
| How does Hypothyroidism affect OXYGEN, Metabolism, Cardiac function, Cognitive function? | OXYGENATION, metabolism, cardiac, and cognitive function are DECREASED/IMPAIRED |
| What symptoms are related to Metabolism in Hypothyroidism? | Decreased energy, Weight gain, Fatigue, Muscle weakness (possibly more D/T oxygenation) |
| What symptoms are related to Cardiac function in Hypothyroidism? | Decreased HR and Myocardial metabolism = HYPOTENSION (note, NO metabolism in the body is going to be anything but DECREASED in Hypothyroidism) |
| What causes altered Cognitive function in Hypothyroidism? | Impaired BRAIN metabolism; EDEMA |
| What are three Oxygenation treatment goals for Hypothyroid patients? | 1. Maintain O2 sat at 90% or more 2. No cyanosis 3. Maintain cognitive orientation |
| What type of medication should be used with caution in Hypothyroid patients? | sedatives or pain medications |
| Why should some medications be used with caution in Hypothyroid patients (considering O2)? | doses of sedatives or pain medications SHOULD BE REDUCED to reduce the risk of respiratory effect |
| What are three interventions to meet Oxygenation treatment goals for Hypothyroid patients? | 1. Monitor respirations 2. Monitor O2 sat (apply O2 if indicated) 3. Monitor breath sounds (listen for sounds of pleural effusion) |
| What are three goals for Hypotension in Hypothyroidism? | 1. Maintain HR above 60 2. Keep BP within normal limits 3. No dysrhythmias, no peripheral edema |
| How long-term is the supplementation for Hypothyroidism? | Thyroid supplementation is life-long |
| What do Hypothyroid patients need periodically to monitor Thyroid Hormone status? | periodic blood tests |
| How should Hypothyroid patients approach taking other meds? | don't take other medications unless prescribed by Dr. |
| What can Hypothyroid patients do to avoid constipation? | eat a well balanced High Fiber diet |
| When should Hypothyroid patients take Thyroid Hormone medication? | on an empty stomach |
| What are two indicators that Hypothyroid patients need an adjustment of their Thyroid Hormone medication? | sleep patterns (increased lethargy indicates low hormone levels); constipation (increased constipation indicates low hormone levels) |
| What kind of patients require LOWER doses of Thyroid medication? | Older patients |
| Definition: "Myxedema Coma" | organ failure D/Tfurther reduction of cellular metabolism D/T decreased COutput and organ perfusion D/T heart muscle atrophy and loss of firmness (DUE TO UNTREATED HYPOTHYROIDISM) |
| How serious is Myxedema Coma? | LIFE THREATENING emergency - it is RARE however |
| What are causees of Myxedema Coma? | Acute illness; Chemotherapy; Discontinuation of Thyroid replacement therapy; Use of sedatives or opioids in Hypothyroid patients = Coma, Respiratory FAILURE, Hypotension, Hyponatrema, Hypothermia, Hypoglycemia |
| Tx for Myxedema Coma? | MAINTAIN PATENT AIRWAY; provide fluids (increase BP); levothyroxine (currently in some level of blood stasis); steroids (speed things up); warm patient (hypothermia); turn every 2 hours; aspiration precautions; MONITOR temperature, BP, mental status |
| What are the three types of Thyroiditis? | Acute , Subacute, and Chronic |
| What is Acute Thyroiditis? | bacterial infection; treated with antibiotics |
| What is Subacute Thyroiditis? | viral infection secondary to cold or upper respiratory infection (URI); PAINFUL |
| What is thyroiditis? | MOST COMMON type of Thyroiditis; "Hashimoto's Disease" |
| Definition: "Hashimoto's Disease" | Autoimmune disorder usually triggered by an INFECTION that leads to Thyroid tissue destruction; characterized by low T3 and T4 and high TSH |
| How many different types of Thyroid Cancer are there? | four |
| How do the different types of Thyroid Cancer differentiate? | age group of the patient with cancer |
| Definition: "anaplasia" | loss of differentiation of cells and their orientation to each other, a characteristic of tumor cells |
| What is the treatment for Anaplastic cancer of the Thyroid? | Radiation |
| What kind of cancer are Papillary, Follicular, Medullary, and Aplastic cancer of the Thyroid? | malignant |
| What is the treatment for Papillary, Follicular, and Medullary carcinomas of the Thyroid? | TOTAL Thyroidectomy; dissection of lymph nodes if involved |
| What treatment must patients generally undergo following surgery to treat Thyroid cancer? | Thyroid Replacement therapy |
| Definition: "Parathyroid Glands" | 4 small glands on the back surface of the Thyroid |
| What do the Parathyroid Glands secrete? | Parathyroid Hormone (PTH) |
| What electrolytes do PTH regulate? | Calcium and Phosphoroous |
| What is the main storage site of Calcium? | Bone |
| What effect does PTH have on Calcium? | increases Bone release of Calcium into Blood from storage site, INCREASING serum Calcium |
| Definition: "Hyperparathyroidism" | Increased levels of PTH |
| What are the results of excessive PTH? | Hypercalcemia and Hypophosphatemia (remember Ca and P work inversely/opposite to each other) |
| What are the results of Hyperparathyroid (considering Hypercalcemia)? | 1. Fractures, Cysts, and Osteoporosis 2. Kidney stones, Calcium deposits in Kidney 3. Anorexia, N/V, Constipation (D/T Hypercalcemia) |
| How is Hyperparathyroidism treated? | Diuretics, Hydration, Calcitonin, Ster |
| How does Hyperpaprathyroidism cause decreased bone integrity (considering Hypercalcemia)? | Hypercalcemia D/T increased rate of bone release of Calcium = Bone DESTRUCTION |
| How does Hyperparathyroidism cause Calcium buildup in the Kidneys? | Hypercalcemia D/T overstimulated bone release of Calcium; excessive Calcium needs to be filtered through the kidneys, resulting in buildup |
| How is Hypercalcemia treated in Hyperparathyroidism? | Diuretics = increased Calcium excretion Hydration = to decrease Calcium concentration in body Calcitonin = to decrease bone breakdown and subsequent release of Calcium Steroids = to increase Calcium renal excretion |
| How do Steroids cause loss of bone integrity and increase risk of fractures? | Steroids increase renal excretion of Caclium = low blood Calcium = signal body that it needs more Calcium = bone breakdown to produce more Calcium (to excess = bone instability, at increased risk for fractures) |
| How does Calcium relate to Cardiac Function? | changes in Calcium levels cause Heart contraction in every Systole |
| What should be monitored and what should be prevented in patients with Hypercalcemia (in this case D/T Hyperparathyroidism)? | Monitor Cardiac function (excessive Calcium could cause Arrhythmia) Prevent injury/fracture D/T decreased bone density |
| Does surgical Parathyroidectomy as treatment for Hyperparathyroidism require removal of ALL FOUR gland necessarily? | no |
| If all four Parathyroids are removed in Parathyroidectomy (as treatment for Hyperparathryoidism), what will be required for the patient from surgery on? | Calcium and vitamin D replacement |
| Definition: "Hypoparathyroidism" | RARE decreased function of Parathyroid |
| What is the electrolytic result of Hypoparathyroidism? | Hypocalcemia |
| What are the three goals of treatment for Hypoparathyroidism? | 1. correct Hypocalcemia 2. Treat Vitamin D deficiency 3. if indicated, treat Hypomagnesemia |
| What electrolyte could cause impairment of Parathyroid Hormone (PTH) secretion? | low levels of Magnesium; Hypomagnesemia |
| How should Hypoparathyroid patients approach dietary management of their condition? | 1. eat foods high in Calcium 2. eat foods LOW in Phosphorous |
| What food (group) contains a high level of Phosphorous? | Dairy: Milk, processed cheese, or yogurt |
Created by:
HESTONA001
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