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61 Cards in this Set

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Your thyroid gland has an important role in your body's metabolism
Thyroid disease is relatively rare
People with hyperthyroidism often feel as if "their motor is always running."
In hypothyroidism, your thyroid gland produces sufficient thyroid hormnone and your metabolic rate falls.
Thyroid disease develops rapidly with a sudden onset of symptoms
Delayed diagnosis of thyroid disease is unimportant for long-term health
Thyroid disease can be diagnosed with a blood test
Thyroid screening is not recommended, and just increases medical costs.
A goiter means that you have an overactive thyroid.
A thyroid nodule usually is not cancerous
Thyroid Physiology
*Thyroid releases 2 hormones
Thyroid Physiology
*Complex negative feedback system
Health Promotion/Maintenance Thryroid
*Normal thyroid function=Euthyroid
*Stimulation of energy use
*Stimulation of the heart
*Necessary for normal growth and development
Thyroid Disorders - Goiter
*Enlargement of thyroid unrelated to inflamm. or neoplasm
Thyroid Disorders - Hypothyroidism
*Deficiency of thyroid hormone (T3&T4)
Thyroid Disorders - Hyperthyroidism
*Excessive thyroid hormone production (T3&T4)
-Iodine needs to be available for the thyroid to make T3&T4
*Simple nontoxic goiter - hyperplasia of the thyroid gland in response to inability of gland to secrete enough hormone to meet metabolic needs
*Nodular - multiple nodules usually women > 40
*Toxic Nodular Goiter - associated with signs of hyperthyroidism
Hyperthyroidism (Thyrotoxicosis)
*Sustained increased synthesis and release of thyroid hormones by the thyroid gland - thyrotoxicosis
*2 Major Causes
-Graves' Disease Most Common
*Usually occurs in womrn 4-10 times more often than men, 30-50 years old
-Toxic nodular goiter (Plummer's Disease), same S&S except no exophthalmos, result of adenoma
-impaired venous damage exophthalmos can be permanent
*Severe hyperthyroidism (Thyroid Storm = Thyroid Crisis)
Hyperthyroidism - Other causes (Graves' Disease is most common)
*Over-treatment of hypothyroidism
*Thyroid Cancer
*Pituitary or hypothalamus disease
*Post-partum thyroiditis
Graves' Disease (Most Common)
*Autoimmune of unknown etiology
*Hyperthyroidism & hyperplasia caused by antibodies
*Antibodies called thyroid stimulating antibodies (TSAbs)- act like TSH
*Increased hormone cause
-increased metabolism (measure HR)
-increased sensitivity (to stress) to stimulation by ANS (symptom)
Clinical Manifestations
-Hand tremors at rest
-Increased appetite with weight loss
-May only have apathy, anorexia, and confusion
Clinical Manifestations
*Later (Untreated symptoms)
-Chaotic emotional state, fine muscle and tongue tremors
-Loose stools, diarrhea, increased BS
-Increased T,P,R,BP, increased CO, atrial dysrrhythmias
-Change in menstrual cycle, decreased libido in men
-Hard, nonpitting (orange peel like), pretibial and ankle edema
*Thyroid Storm or Crisis - acute, rare, severe hypermetabolic state
Thyroid Storm = Thyroid Crisis
*Causes=infection, surgery (develops post-operatively), trauma with preexisting hyperthyroidism
*S&S = tachycardia, heart failure, arrhythmias, hyperthermia, restlessness, agitation, N/V, coma (many effects, refer to Lewis)
*Hyperthermia - metabolism is increases
*Effects every organ in the body
Diagnosis of Hyperthyroidism (Primary)
*Lab - increased T3, T4, FT4, low TSH
*EKG - tachycardia, a-fib or change in P&T waves (heart is overworking)
*RAIU - increased radioactive iodine update (test that evaluates function of thyroid gland)
Thyroid/Parathyroid Studies:T4
Measures total serum level of T4. Useful in evaluating thyroid function and monitoring thyroid therapy. Normal values are 5-12ug/dl
Thyroid/Parathyroid Studies:T3
Measures serum levels of T3. It is helpful in diagnosing hyperthyroidism if T4 levels are normal. Normal values are 65-195 ng/dl
Nursing Responsibility: Same as for T4
Thyroid/Parathyroid Studies:T3 resin uptake (T3RU)
This study indirectly measures binding capacity of thyroid-binding globulin. Normal values are 25-35% (0.25-0.35).
Nursing Responsibility: Same as for T4
Thyroid/Parathyroid Studies:Free T4
Measures active component of total T4. Normal values are 1.0-3.5 ng/dl
Nursing Responsibility: Same as for T4
Thyroid/Parathyroid Studies:Free T3
Measures active component of total T3. Normal values are 0.26-0.65 ng/dl
Nursing Responsibility: Same as for T4
Thyroid/Parathyroid Studies: Thyroid 131I uptake (radioactive iodine uptake
Provides direct measure of thyroid activity. Useful for evaluation of functional activity of solitary thyroid nodules. Small tracer dose of 131I is given orally or intravenously. Serum uptake measurements are drawn at 2 to 4 and at 24 hours. Normal serum values for 2-4 hours are 3-10%; for 24 hours, they are 5-30%. Values are affected by drugs, seafood, certain radiographic contrast media, and antiseptics containing iodine.
Nursing Responsibility: Instruct patient to discontinue thyroid medication and start T3 (Cytomel) 2-3 times/day for 4 weeks. Tell patient to report for further testing in 10-14 days. Collect 24-hour urine specimen.
Thyroid/Parathyroid Studies: Thyroid-stimulating hormone (TSH)
This test measures level of TSH, which is markedly elevated in primary hypothyroidism. Normal values are 0.3-5.4 uU/ml.
Nursing Responsibility: Inform patient that fasting is not necessary. Inform patient that blood sample will be drawn. Observe venipuncture site for bleeding or hematoma formation.
Thyroid/Parathyroid Studies: Calcitonin
High calcitonin level with normal serum calcium level is associated with medullary thyroid carcinoma.
Nursing Responsibility: Ensure that patient has fasted. Inform patient that blood sample will be drawn. Observe venipuncture site for bleeding or hematoma formation.
Radiologic Studies: Thyroid scan
Used to evaluate nodules of the thyroid. Tracer dose of technetium is given intravenously. Scanner passes over thyroid and makes graphic record of radiation emitted. Normal thyroid scan reveals homogenous pattern with symmetric lobes.
Nursing Responsibility: Determine whether other tests requiring iodine preparation (IV pyelogram, saturated solution of potassium iodine, or barium enema) have been done within 30 days (can invalidate test). Explain procedure to patient.
Parathyroid Studies Serum Studies: Parathyroid hormone (PTH)
Measures PTH level in serum. Normal range depends on assay used (check with laboratory). This study must be interpreted in terms of concomitantly drawn serum calcium level.
Nursing Responsibility: Fasting specimen preferred. Inform patient that blood sample will be drawn. Sample must be kept on ice. Observe venipuncture site for bleeding or hematoma formation.
Parathyroid Studies Serum Studies: Total serum calcium
Measures total serum calcium to help detect bone and parathyroid disorders. Hypercalcemia can indicate primary hyperparathyroidism, and hypocalcemia can indicate hypoparathyroidism.
Nursing Responsibility: Fasting specimen preferred. Inform patient that blood sample will be drawn. Observe venipuncture site for bleeding or hematoma formation. Ensure that prolonged tourniquet application does not cause falsely elevated values. Adjust total calcium for albumin levels. Using following formula: Total serum calcium (mg/dl) - Albumin (g/dl) + 4.0 = Adjusted total serum calcium.
Parathyroid Studies Serum Studies: Phosphorus
Measures inorganic phosphorus. Hyperphosphatemia indicates primary hypoparathyroidism or secondary causes (e.g., renal failure); hypophosphatemia indicates hyperparathyroidism. Phosphorus and calcium levels are inversely related.
Nursing Responsibility: Needs for fasting varies with lab. Determine fasting requirement. Inform patient that blood sample will be drawn. Observe venipuncture site for bleeding or hematoma formation.
The nurse is assessing for endocrine dysfunction. Which manifestations are most common?
a. Goiter and alopecia
b. Exophthalmus and tremors
c. Fatigue and depression
d. Polyuria and polyphagia
Answer: c. Fatigue and depression
Treatment options
*First treat symptoms
*Anti-thyroid drugs
*Radioactive Iodine or brachytherapy (radiation preferred for adults in U.S.)
*Adjunctive medications
Treatment: Hyperthyroidism (suppress secretion of TH)
*Treat S&S
-tachycardia, arrhythmias
*Reduce circulating thyroid hormone with meds
*Anti-thyroid drugs for 6 months to 2 years
-Propylthiouracil (PTU)
-Saturated solution of Potassium Iodide (SSKI)
-Methimazole (Tapazole)
disadvantage=noncompliance & recurrence. Use for young Graves, pre-op, pre-radiation See handout
**Treatment of choice**
Radioactive Iodine (131I)
*Rx of chooice for nonpregnant adults
*Causes destruction of Thyroid tissue
*Maximal effect=2-3 months --
*high incidence of post rx hypothyroidism
-See Lehne may require 2nd dose in 6-8 weeks, simple & noninvasive
BRACHYTHERAPY - inpatient, higher dose, outpatient=precautions (Time, Distance, Shielding)
**Treatment of choice**
Radioactive Iodine (131I)
-Teach pts to go home on precautions
-Flush toilet 2x etc.
*Surgical removal of Thyroid Tissue
--Used when
*In combination with radiation
*Unresponsive to anti-thyroid medication
*Not a candidate for RAI (pregnant woman or child)
*Large goiter w/compression of trachea
--Most rapid decrease in T3 and T4
Thyroid Surgery
*Pre-op Teaching
-Assess for respiratory obstruction, edema (q 2hrs. for 24 hrs.)
-Assess for laryngeal nerve damage
-Assess for hemorrhage (check behind neck)
-Assess for signs of hypocalcemia r/t removal or damage to parathyroids
-Semi-fowlers postion, avoid flexion of the neck
Thyroid Surgery: Adjunctive therapies
-propranolol, verapamil, corticosteroids, and nonradioactive iodine (Lugol's solution, SSKI)
High metabolic rate burning calories
See handout
Nursing Process
**See Care Plan**
-Intolerance to heat
-Fine-straight hair
-Bulging eyes
-Facial flushing
-Enlarged thyroid
-Increased systolic B/P
-Breast enlargement
-Weight loss
-Muscle wasting
-Localized edema
-Menstrual changes (Amenorrhea)
-Increased diarrhea
-Finger clubbing
The nurse's best response when asked about Grave's disease is:
a. It is thought to be genetic and cause is unknown
b. It is associated with Iodine deficiency and a decrease in hormone
c. Antibodies develop and destroy thyroid tissue causing a decrease in hormone
d. Antibodies form in genetically susceptible people and stimulate overproduction of hormone
Correct Answer:
d. Antibodies form in genetically susceptable people and stimulate overproduction of hormone
*Primary - resulting from destruction of thyroid tissue or defective hormone syn.
*Secondary r/t pituitary disease w/ decreased TSH secretion or hypothalamic problems w/ decreased TRH secretion
*Tertiary - hypothalamus fails to produce TRH
*Infancy=cretinism 1 in 3700 births in US
-Usually maternal iodine deprivation or thyroid abnormality
*Adults most common medical disorder in US - affects 8% women & 2% men over 50
-called hypothyroidism or severe=myxedema
-More frequent in females, usually over 50 but any age/sex
*Adults (in US where iodine is adequate)
-Hashimotos Thyroiditis - auto immune destroys thyroid gland
-Graves Disease - auto immune destroys thyroid gland
-Surgical removal of thyroid or pituitary/Radiation damage
-Nutritional/Medicinal goitrogens (food or meds that contain thyroid inhibiting substances)
-Treatment for hyperthyroidism (131I)
Iodine deficiency most common world-wide
*Decreased levels of thyroid hormone lead to slowing metabolic rate involving all body processes
*Decreased O2 consumption and metabolism (decreased HR and temperature)
Clinical Manifestations: Hypothyroidism
*Cardiovascular - bradycardia, weakened contractility, cardimyopathy, CAD
*Cerebral - diminished blood flow=mental sluggishness, memory loss, lethargy, change in mood, etc.
*GI - decreased motility, achlorhydria (no HCL), constipatiion
*Reproductive - infertility
Clinical Manifestations: Hypothyroidism
*Impaired wound healing (slow metabolism)
*Sensitivity to cold
*Weight gain
*dry, waxy non-pitting edema
*Dry skin and hair (cellular metabolism
Mild disease may be asymptomatic
If left untreated cerebral hypoxia and decreased metabolism may lead to stupor - Myxedema Coma
Myxedema Coma (severe hypothyroidism)
*Precipitated by infection, drugs, cold or trauma
*Rare medical emergency
Support life functions (airway,breathing,circulation), IV thyroid hormone
Signs and Symptoms of Hypothyroidism
-Dry hair/thin
-Brittle/dry skin
-Increased susceptibility to infection
-Increased sensitivity to CNS depressants
-Decreased tendon reflex response
-Weight gain, Obese
-Forgetful, lethargic
-Decreased sweat
-Fatigue, apathy
-Puffy, edematous
Diagnosis: Hypothyroidism
*Symptoms (mimic normal aging signs)
*Serum TSH - determines cause (high=defect in thyroid, low=defect in pituitary or hypothalamus then inject TRH if TSH increase suggest Hypothalamus
*T3, T4, T3RU = low, sometimes normal in elderly
*Decreased RAIU (Know all about RAIU for exam)
Medical Management: Hypothyroidism
*Lifelong Thyroid Hormone Replacement
-Levothyroxine (Synthroid, Levothroid)-synthetic preparation identical to the natural occurring hormone T4-Drug of choice
-Liothyroonine (Cytomel, Triostat) - synthetic preparation identical to the natural occurring hormone-T3-acts quicker, shorter duration and much more expensive (Myxedema Coma) see client instructions
Preoperative instructions for a client undergoing a subtotal thyroidectomy include:
a. Support of the head when turning
b. Avoid coughing post-op
c. Immobilize head and neck for incision healing
d. Tingling of lips and fingers is expected
a. Support of the head when turning
Signs and Symptoms of Hypothyroidism
-Intolerance to cold
-Receding hairline
-Facial and Eyelid Edema
-Dull-Blank Expression
-Extreme fatigue
-Thick tongue-slow speech
-Brittle nails and hair
-Menstrual disturbances
-Muscle aches and weakness
-Dry skin (coarse and scaly)
-Hair loss
Late Clinical Manifestations: Hypothyroidism
-Subnormal temp
-Weight gain
-Decreased LOC
-Thickened skin
-Cardiac complications