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34 Cards in this Set
- Front
- Back
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What three hormones, that are essential for proper regulation of metabolism, are secreted by the thyroid gland?
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1. Thyroxine (T4)
2. Triiodothyronine (T3) 3. Calcitonin |
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Where is the location of the thyroid gland?
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Located near the parathyroid gland, which is responsible for maintaining adequate levels of calcium in the extracellular fluid (Monitor Ca+ levels w/ parathyroid glands)
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Thyroxine (T4)
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- Major form of hormone
- Longer half-life |
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Triiodothyronine (T3)
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- More potent than T4
- Some of T4 converts to T3 |
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Actions of the Thyroid Gland hormones
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Affectmost body cells
Basalmetabolic rate, protein synthesis, bone growth, neural maturation, sensitivityto catecholamines,metabolism of protein, fat, carbs, vitamin metabolism… |
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How does Iodine affect thyroid hormones?
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- Iodine is used to produce thyroid hormone
-Amount needed varies by age, pregnancy, and breastfeeding -Sources: Fish, seaweed, shrimp, and other seafood, Dairy products, Grain products, Soy and Tofu, Iodized Salt |
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What is hypothyroidism?
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- Primary:abnormality in the thyroid gland itself
- Secondary:results when the pituitary gland isdysfunctional and does not secrete TSH - Tertiary:results when the hypothalamusgland does not secrete thyrotropin-releasinghormone, which stimulates the release of TSH |
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What is Cretinism?
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- Hyposecretion of thyroid hormone during youth
- Low metabolic rate, retarded growth and sexual development, possible mental retardation |
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What is Myxedema? |
-Hyposecretion of thyroid hormone during adulthood - Decreased metabolic rate, loss of mental and physical stamina, weight gain, loss of hair, firm edema, yellow dullness of the skin |
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What is a Goiter?
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- Enlargementof the thyroid gland
- Resultsfrom overstimulationby elevated levels of TSH - TSHis elevated because there is little or nothyroid hormone in circulation |
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Common symptoms of Hypothyroidism
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- Thickenedskin
- Hairloss - Constipation - Lethargy - Anorexia - ColdIntolerance (hypo=cold, hyper=hot) - Weightgain
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Thyroid drugs (Hypo)
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- levothyroxine (Synthroid, Levoxyl) (life time)
-Syntheticthyroid hormone T4 - liothyronine (Cytomel) -Syntheticthyroid hormone T3 |
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Thyroid drugs (Hypo)
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- liotrix (Thyrolar)
-Synthetic thyroid hormone T3 and T4 combined - thyroid, desiccated (Armour Thyroid, Westhroid) -Desiccated (dried) animal thyroid gland |
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How do Thyroid preparations work?
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- Thyroidpreparations are given to replace whatthe thyroid gland cannot produce to achieve normal thyroid levels (euthyroid: back to working)
- Thyroiddrugs work the same way as endogenous thyroid hormones |
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Apatient has been taking levothyroxine for 6 months. After this month’slaboratory work, the nurse practitioner tells the nurse that the patient is “euthyroid.” Whatdoes that term mean?
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The patient thyroid hormone levels are within normal limits.
*euthyroid = normal |
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When do you know to use Hypothyroid drugs?
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- Totreat all three forms of hypothyroidism
- Levothyroxineis the preferred drug because its hormonal content is standardized; therefore,its effect is predictable |
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When do you know to use Hypothyroid drugs?
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- Dosed in micrograms: common med error is to write “milligrams”- QUESTION ALL ORDERS OVER 200 MICROGRAMS! (will be on exam)
- Also used for thyroid replacement in patients whose thyroid glands have been surgically removed or destroyed by radioactive iodine in the treatment of thyroid cancer or hyperthyroidism |
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Adverse effects of Hypothyroid drugs
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- Cardiacdysrhythmiais the most significant adverseeffect
- Mayalso cause:Tachycardia,palpitations, angina, hypertension, insomnia, tremors, headache, anxiety,nausea, diarrhea, menstrual irregularities, weight loss, sweating, heatintolerance, fever, others |
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A patient who is taking a thyroid replacement medication tells the nurse that she is starting to experience cold intolerance, depression, constipation, and dry skin. The nurse anticipates that these manifestations are caused by |
inadequate doses of the medication *return of sx |
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What does the nurse need to do with a pt taking hypo-drugs?
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- Cautioususe advisedfor those with cardiac disease, hypertension, and pregnant women
- Drugtherapy for hypothyroidism is usually lifelong. Medicationcannotbe stopped even if the patient is “feeling better” |
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What does the nurse need to do with a pt taking hypo-drugs?
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- During pregnancy, treatment for hypothyroidism should continue
- Fetal growth may be retarded if maternal hypothyroidism is untreated during pregnancy -Adjust dosage every 4 weeks to keep TSH at the lower end of the normal range |
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What does the nurse need to do with a pt taking hypo-drugs?
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- Teachpatient to take thyroid drugs once dailyin the morningto decrease the likelihood of insomnia if taken later in the day
-Teachpatient to take the medications at the same time every day and notto switch brands without primary care provider approval (inactive ingredients are different) |
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What does the nurse need to do with a pt taking hypo-drugs?
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- Teachpatients to report any unusual symptoms, chestpain,or heart palpitations
- Teachpatients that therapeutic effects may take severalweeks tooccur |
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Which information will the nurse include when teaching a patient about thyroid replacement therapy?
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"Take the medication on an empty stomach"
*Thyroid replacement drugs are best taken 1/2 to 1 hr before breakfast on an empty stomach to enhance absorption orally |
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What do nurses need to do with a pt taking hypo-drugs?
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- Teachpatients the importance of alerting health care providers of thyroid medicationuse
- May enhanceactivity ofanticoagulants - Diabeticpatients may need increased dosages ofhypoglycemic meds - May decreaseserum digoxin levels |
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What is hyperthyroidism?
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Causedby several diseases:
- Graves’disease - Multinodulardisease - Plummer’sdisease (rare) *Alsocalled toxic nodular disease - Thyroidstorm (induced by stress or infection) *Severeand potentially life-threatening |
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Effects of Hyperthyroidism
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- Affects multiple body systems, resulting in an overall increase in metabolism
-Diarrhea, Flushing, Increased appetite, Muscle weakness, Sleep disorders, Altered menstrual flow, Fatigue, PalpitationsNervousness, Heat intolerance, Irritability |
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Treatment of Hyperthyroidism
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- Radioactive iodine (I131) works by destroying the thyroid gland
- Contact with other people, food, utensils, travel must be limited after treatment - Sit to urinate and flush 2-3 times - Surgery to remove all or part of the thyroid gland - Lifelong thyroid hormone replacement will be needed |
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Treatment of hyperthyroidism
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- Antithyroid drugs: thioamide derivatives
- methimazole (Tapazole) - Propylthiouracil (PTU) - Mechanism of action is to slow the formation of thyroid hormone |
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Treatment of Hyperthyroidism
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- Usedto treat hyperthyroidism and to preventthe surge inthyroid hormones that occurs after surgical treatment or during radioactiveiodine treatment for hyperthyroidism
- Maycause live and bone marrow toxicity |
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What does the nurse need to do with a pt taking hyper-treatment/drugs?
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- Antithyroid medications
- Better tolerated when given with food - Give at the same time each day to maintain consistent blood levels - Never stop these medications abruptly - Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt) |
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Which would be the best menus choice for a patient who is taking an antithyroid medication?
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Pasta with marinara sauce
*Pt should avoid foods high in iodine |
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What does the nurse need to do with a pt taking hyper-treatment/drugs?
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- Monitorfor therapeutic response
- Thyroiddrugs: decreased symptoms of hypothyroidism, improvedenergy levels,improved mental and physical stamina - Antithyroiddrugs: no evidence of hyperthyroid |
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What does the nurse need to do with a pt taking hyper-treatment/drugs?
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- Monitor for adverse effects
- Thyroid drugs: cardiac dysrhythmia - Antithyroid drugs: leukopenia (manifested as fever, sore throat, lesions) |
