Thyroid And Parathyroid Stuff

Front 1

_________ refers to thyroid hormone production within normal limits

Back 1

Euthyroid

Front 2

Which one is more potent, T3 or T4?

Back 2

T3

Front 3

What hormones are released from the thyroid?

Back 3

T3
T4
Calcitonin

Front 4

What is secreted in response to high levels of CA++ and increases deposition of calcium into the bone?

Back 4

Calcitonin

Front 5

What are the normal levels of TSH?

Back 5

0.4-6.5

Front 6

What are the normal levels of FT4?

Back 6

0.9-1.7

Front 7

What are the normal levels of T3

Back 7

70-220

Front 8

What are the normal levels of T4

Back 8

4.5-11.5

Front 9

This lab test is used if you suspect an autoimmune disease?

Back 9

Antithyroid antibody titers

Front 10

This lab test is used to determine the amount of thyroid hormone bound to TGB and # of available binding sites?

Back 10

T3 resin uptake

Front 11

What type of lab values would you find in a pt with hyperthyroidism?

Back 11

- ↓ TSH
- ↑ T3
- ↑ T4
- ↑ FT4

Front 12

What type of lab values would you find in a pt with hypothyroidism?

Back 12

- ↑ TSH
- ↓ T3
- ↓ T4
- ↓ FT4

Front 13

iodine injected, checking for enlarged thyroid (hot areas = more uptake of iodine, cold areas = less uptake of iodine)

Back 13

Thyroid scan

Front 14

-local anesthetic, done for mass or nodule to determine if benign or malignant
- 1st test that is done when masses are found

Back 14

Needle biopsy

Front 15

neck is slightly flexed and ask the patient to swallow

Back 15

Thyroid exam

Front 16

If you have a pt with primary thyroid dysfunction, where does the dysfunction take place?

Back 16

Thyroid

Front 17

If you have a pt with secondary thyroid dysfunction, where does the dysfunction take place?

Back 17

Pituitary

Front 18

If you have a pt with tertiary thyroid dysfunction, where does the dysfunction take place?

Back 18

Hypothalamus

Front 19

- 2nd most prevalent endocrine disorder

Back 19

hyperthyroidism

Front 20

- excessive output of thyroid hormones
- caused by excessive stimulation of the thyroid gland to secrete thyroid hormone

Back 20

hyperthyroidism

Front 21

What is the most common type of hyperthyroidism?

Back 21

Grave's disease

Front 22

What type of disease process is Graves Disease?

Back 22

autoimmune

Front 23

Do we know how you get grave's disease?

Back 23

no, unknown etiology

Front 24

In grave's disease, is the thyroid enlarged?

Back 24

yes

Front 25

In Grave's disease, there are antibodies to the ____ receptors?

Back 25

TSH

Front 26

Graves can lead to ______, which can lead to thyroid storm.

Back 26

thyrotoxicosis

Front 27

What are the treatment options for Graves disease (hyperthyroidism)?

Back 27

1. Radioactive iodine therapy
2. Anti-thyroid medications
- PTU
- Methimazole (Tapazole)
3. Thyroidectomy

Front 28

Explain Radioactive iodine therapy and how it works.

Back 28

- usually one takes 1 PO dose of RAI to destroy overactive cells
- effects aren't seen for a few wks
- watch pt for thyroid storm (propranolol: control symptoms)

Front 29

- Excessive output of thyroid hormones, T3 and T4 produced excessively
- Caused by excessive stimulation of the thyroid gland to secrete thyroid hormone

Back 29

hyperthyroidism

Front 30

S/S of hyperthyroidism

Back 30

hair loss, anxiety, insomnia, restlessness, irritability, bulging eyes, goiter, rapid pulse, palpitations, muscle weakness in upper arms and legs, diarrhea, hand tremors, warm moist palms, increased sweating, temperature intolerance, weight loss, osteoporosis

Front 31

What is the mechanism of action for anti-thyroid medications?

Back 31

it blocks the conversion of T3 and T4

Front 32

What are the names of the antithyroid medications?

Back 32

PTU
Methimazole (Tapazole)

Front 33

What is the major S.E. with anti-thyroid medications?

Back 33

agranulocytosis - decreased WBC count -> infection

Front 34

When a thyroidectomy is performed, the surgeon must be very careful. Why?

Back 34

Because the surgeon doesn't want to cut out the parathyroid glands or the laryngeal nerve.

Front 35

What are some post-op nursing interventions and things you need to watch out for?

Back 35

- prop head up
- pooling of blood in the back of the neck
- watch for hematoma (airway)
- have a trach set available
- watch for tetany

Front 36

What is the inflammatory process of the thyroid?

Back 36

thryroiditis

Front 37

What are the three classifications of thyroiditis?

Back 37

1. acute
2. subacute
3. chronic

Front 38

What is acute thyroiditis?

Back 38

- very rare
- swelling, heat, tenderness
- infectious disease process
- Tx: antibiotics and fluid replacement

Front 39

What is the Tx for acute thyroiditis?

Back 39

antibiotics and fluid replacement

Front 40

Is thyroiditis associated hyper or hypo thyroidism?

Back 40

hyperthyroidism

Front 41

 Redness, warmth, tenderness, difficulty swallowing/speaking, c/o sore throat
 Caused by infectious process

Back 41

acute thyroiditis

Front 42

What are the two different kinds of subacute thyroiditis's?

Back 42

Granulomatous thyroiditis

Silent Thyroiditis

Front 43

What is Granulomatous thyroiditis?

Back 43

-Painful swelling for 1-2 months and then it disappears spontaneously

-Follows respiratory infection

Front 44

What is Silent thyroiditis?

Back 44

o Post-partum
o Autoimmune

Front 45

What is the Tx for subacute thyroiditis?

Back 45

NSAIDs (not aspirin)
Beta blockers
Corticosteroids

synthroid (if hypothyroidism occurs)

Front 46

Why are supplemental thyroid hormones used cautiously in the elderly?

Back 46

1. they get confused about medication directions
2. polypharmacy
3. Drug interactions

Front 47

What are the drugs that might cause an interaction with thyroid supplement hormones?

Back 47

o Amiodarone
o Salicylates
o Sulfonimides
o Lithium
o Phenylbutazone
o Birth control
o Testosterone
o Antiseizure medications
o Caution with heart disease

Front 48

What are some s/s of thyroid storm?

Back 48

- Exaggerated by symptoms of thyrotoxicosis
- Very sensitive to temperature
- Hyperpyrexia
- Extreme tachycardia >140
- Altered mental status (delirium, psychosis, somnolence, coma)

Front 49

What is thyroid storm precipitated by?

Back 49

stress, tooth extraction, injury, coming off of hyperthyroid medications abruptly, pregnancy

Front 50

Is thyroid storm life threatening? What is another name for thyroid storm?

Back 50

Yes, thyrotoxic crisis and thyrotoxicosis

Front 51

What are some common ND that you could use for hyperthyroidism?

Back 51

Activity intolerance
Imbalanced Nutrition
Ineffective Coping
Anxiety
Low Self Esteem
Altered Body Temp

Front 52

What is Inadequate output of thyroid hormone?

Back 52

hypothyroidism

Front 53

What is the most common type of hypothyroid dysfunction?

Back 53

primary

Front 54

What are some s/s of hypothyroidism?

Back 54

tired, puffy eyes, forgetfulness/slower thinking, swelling (goiter), moodiness/irritability, hoarseness/deepening of voice, depression, inability to concentrate, thinning hair/hair loss, loss of body hair, dry patchy skin, weight gain, cold intolerance, family history of thyroid disease or diabetes, persistent dry or sore throat, difficulty swallowing, slower heartbeat, menstrual irregularities/heavy period, infertility, constipation, muscle weakness/cramps

Front 55

What are some s/s of severe hypothyroidism?

Back 55

- Decreased left ventricular function, Increased Cholesterol, CAD
- Hypothermic
- Sensitive to opiates, narcotics, anesthetics
- Lethargy
- AMS progressing to MYEXDEMA COMA and DEATH

Front 56

What is the most common type of hypothyroidism?

Back 56

Hashimoto's disease

Front 57

- Autoimmune etiology
- May initially present with hyperthyroidism and ultimately become hypothyroid

Back 57

Hashimoto's disease (chronic thyroiditis)

Front 58

Besides Hashimoto's disease, what are some other causes of hypothyroidism?

Back 58

- Radioiodine RX
- Antithyroid medication
- Thyroid surgery
- Head and neck radiation
- Age related atrophy
o Anyone over the age of 60 needs to have their labs drawn yearly
- Medications
- Infiltrative thyroid diseases (amyloidosis, scleroderma)
- Iodine deficiency and excess

Front 59

What is the Tx for hypothyroidism?

Back 59

- Synthroid
- Generic- Levothyroxine
- Brand- Unithroid, Levoxyl, Synthroid, Levothroid

Front 60

- Can be accompanied by swelling in neck
- Can by symmetric, diffuse or nodular

Back 60

Thyroid tumors

Front 61

What are thyroid cancer diagnosis tests?

Back 61

- Needle Biopsy
- Ultrasound
- CT scan
- MRI
- Thyroid Scan
- Thyroid Suppression Tests

Front 62

Who is most likely to have thyroid cancer?

Back 62

Women

<20 and >40

Front 63

What is the treatment for thyroid cancer?

Back 63

- Total/near total thyroidectomy
- Radiation therapy
o Orally administered
o Externally

Front 64

________ are food or drugs that contain thyroid inhibiting substances and can cause goiters.

Back 64

- Goitrogens

Front 65

What 2 types of diseases do you see goiters?

Back 65

Grave's disease
Iodine deficient

Front 66

_________ ______ secrete parahormone which regulates Ca++ and phosphorus metabolism

Back 66

Parathyroid glands

Front 67

What types of labs would you see if your pt had hyperparathyroidism?

Back 67

- ↑ PTH, ↑ Ca ++, ↓ Phos

Front 68

What are kidney stones usually made of?

Back 68

Ca+

Front 69

What are some s/s of hyperparathyroidism?

Back 69

- Fatigue
- Apathy
- Muscle weakness
- Irritability
- Neurosis
- Psychosis
- N/V
- Constipation
- HTN
- Cardiac arrhythmias
- Skeletal pain, tenderness
- Renal calculi

Front 70

What are some lab and diagnostic tests that you would do for hyperparathyroidism?

Back 70

Serum Ca+
Parathormone RIA
x-ray
ultrasound
MRI
thallium scan
fine needle biopsy

Front 71

How do you treat hyperparathyroidism?

Back 71

- Parathyroidectomy
- Hydration therapy: dilute the serum (2000ml/day) cranberry juice
- Increase activity: weight bearing exercise
- Oral phosphates: drives Ca+ back into bone
- Regular diet: prune juice and stool softeners

Front 72

Why is hypercalcemic crisis so dangerous?

Back 72

It has life threatening neurologic, renal, and cardiovascular symptoms

Front 73

What is the Ca+ level in a hypercalcemic crisis?

Back 73

15 mg/dl

Front 74

What is the treatment for hypercalcemic crisis?

Back 74

- hydration
- diuretics
- phosphate therapy

Calcitonin and corticosteroids - emergency

dialysis - last resort (emergency)

Front 75

What would lab levels look like for hypoparathyroidism?

Back 75

↓ PTH
↓ Ca+
↑ Phos

Front 76

What is trousseau's sign?

Back 76

carpopedal spasm is produced when occluding blood supply to the arm for three minutes

Front 77

What is the most common cause for hypoparathyroidism?

Back 77

surgery

Front 78

What is the big sign that you need to be looking out for in hypoparathyroidism?

Back 78

tetany

Front 79

What are some s/s of latent tetany in hypoparathyroidism?

Back 79

numbness
tingling
cramps in ext.
stiffness in hands and feet
bronchospasms
laryngeal spasms
carpopedal spasms
dysphgia
photophobia
arrythmias
seizures

Front 80

- Latent tetany, numbness, tingling, cramps in ext. stiffness in hands and feet
- Tetany- bronchospasms, laryngeal spasms, carpopedal spasms, dysphgia, photophobia, arrythmias, seizures
- General symptoms may include anxiety irritability depression and delirium

Back 80

hypoparathyroidism

Front 81

How do you check for Chvostek’s sign?

Back 81

- tapping the side of the face over the facial nerve in front of the parotid gland anterior to the ear causes twitching or spasm of mouth, nose and eyes.

Front 82

What is the acute treatment for hypoparathyroidism?

Back 82

o IV Ca++ Gluconate
o Sedatives (Phenobarbital) – prevent seizures
o Parathormone IV for Acute Situations – high incidence of allergic reactions
o Respiratory Support

Front 83

What are the chronic treatments for hypoparathyroidism?

Back 83

- High Ca++ Low Phos diet
- Oral Ca++ salts
- Phos binders (amphogel, Gelusil)
- Vitamin D

No spinach and no milk!