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Thyroid & Prathyroid


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