endocrine – thyroid gland part 1. description: thyroid butterfly shaped two lobes connected by an...
TRANSCRIPT
Endocrine – Thyroid gland
Part 1
Description: Thyroid
• Butterfly shaped• Two lobes connected
by an isthmus• Straddles the trachea• Largest endocrine
gland
Function: Thyroid
1. Produce thyroid hormones (TH) Vital for growth &
metabolism
2. Iodine storage Essential for T3/T4
syntheses
Hormones
Hormone Function Stimulated by
T3/T4 metabolic rate
protein synthesis
energy production
Most important hormone in day today regulation of metabolic rate
metabolic rate
T3/T4 TSH
Thyroid Hormones
Hormones Function Stimulated by
T3/T4 metabolism metabolism
Calcitonin blood calcium concentration
the reabsorption of Ca and Ph from bones to blood
Calcitonin “tones” down serum Ca levels
blood Ca levels
Hormone Loop• Metabolic rate • Detected by hypothalamus • Stimulates anterior pituitary • Secretes TSH • Blood stream target organ thyroid• Stimulate Thyroid to secrete T3/T4 • Blood stream target organs adrenal medulla • Secretes Epinephrine & Norepinephrine • Metabolic rate
Thyroid Disorders
• World-wide– Iodine deficiency
• United States– Auto-immune
Hyperthyroidism
Definition• T3/T4 in bloodPathophysiology• Primary hyperthyroidism
– Problem with thyroid gland T3/T4
• Secondary hyperthyroidism– Problem with pituitary gland T3/T4– Pituitary TSH T3/T4 – TSH thyroid growth goiter
Hyperthyroidism
Etiology• Auto-immune• AKA:
– Grave’s disease• F vs M?
– F > M• Age
– 20-40 yrs
HyperthyroidismS&S
Neurological• Heat intolerance• Diaphoresis• sympathetic nervous
response
HyperthyroidismS&S
Affect• Nervous• Emotional lability• Irritable• I Concentration• Mood swings• manic/psychotic
HyperthyroidismS&S
Cardiovascular• Tachycardia• Palpitations
HyperthyroidismS&S
Gastrointestinal• Appetite
– • Weight
– • BM
– – Diarrhea
HyperthyroidismS&S
Muscle-skeletal• Tremors• Restlessness• Muscle
– weakness
HyperthyroidismS&S
Skin• Temperature
– Warm• Smooth• Hair
– Fine, soft– Gray– Loss
HyperthyroidismS&S
Exophthalmos• Bulging of the eye• Stare
HyperthyroidismS&S
Goiter• Enlarged thyroid• TSH levels
–
HyperthyroidismS&S
Oncholysis• Distal nail separates
from the nail bed• Nail fragile
HyperthyroidismS&S
Gynecomastia• Abnormal enlargement
breasts• male
HyperthyroidismS&S
Elderly• Heart failure• Fatigue• Apathy• Depression
Hormone Review
• T3/T4 • Pituitary • TSH • Thyroid • T3/T4___________________ • T3/T4 • Pituitary • TSH • Thyroid • T3/T4
HyperthyroidismDiagnostic Tests
Primary Hyperthyroidism
Secondary Hyperthyroidism
T3/T4
TSH
• By definition hyperthyroidism means what?– T3/T4–
HyperthyroidismDiagnostic Tests
• By definition primary hyperthyroidism means what? (where is the problem – what is causing the problem?)– Thyroid
• T3/T4
• In primary hyperthyroidism, is the pituitary gland working correctly?– Yes
HyperthyroidismDiagnostic Tests
Primary Hyperthyroidism
Secondary Hyperthyroidism
T3/T4
TSH
• If the pituitary gland is working correctly and there is an T3/T4 level, what will the Pituitary gland do with the TSH level?
HyperthyroidismDiagnostic Tests
Primary Hyperthyroidism
Secondary Hyperthyroidism
T3/T4
TSH
• By definition hyperthyroidism means what?– T3/T4–
HyperthyroidismDiagnostic Tests
• By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?)– Pituitary gland
• TSH • T3/T4
HyperthyroidismDiagnostic Tests
Primary Hyperthyroidism
Secondary Hyperthyroidism
T3/T4
TSH
By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?)– Pituitary gland TSH T3/T4
Question?
Mrs. Goiter has a thyroid panel done and shows an elevated T3/T4 and an elevated TSH? Which of the following diagnosis apply?
A. Primary hyperthyroidismB. Secondary hyperthyroidismC. Primary hypothyroidismD. Secondary hypothyroidism
Question?
Mrs. Canta Geta Up has a thyroid panel done and shows an elevated T3/T4 and an decreased TSH? Which of the following diagnosis apply?
A. Primary hyperthyroidismB. Secondary hyperthyroidismC. Primary hypothyroidismD. Secondary hypothyroidism
HyperthyroidismMedical Treatment
Meds first• Goal
– T3/T4 levels• Meds alone sometimes
work - if not – Surgery
HyperthyroidismMedical Treatment
Anti-thyroid therapy• Propylthioracil / PTU• Methimazole /
Tapazole– Action
• Inhibits synthesis of T3/T4
HyperthyroidismMedical Treatment
Propranolol hydrochloride / Inderal
• Beta-blocker• sympathetic nervous system• No smoking
HyperthyroidismMedical Treatment
• Meds alone not – Surgery
• If Ca Thyroid – Surgery
• Euthyroid state before surgery!– How?
• Anti-thyroid meds
HyperthyroidismMedical Treatment
• Iodine before surgery– Potassium iodine
saturated solution (SSKI)
– vascularity of the thyroid
– risk of post-op bleeding
HyperthyroidismMedical Treatment
Radioactive Iodine• I131
• Used instead of radiation tx
• Stop anti-thyroid meds x 7 days
• Single dose• S&S in @ 3wks full
effect in 3 months
HyperthyroidismMedical Treatment
Radioactive Iodine• Safety
– No PG nurses– Watch body fluids– Avoid kids x 7 days
HyperthyroidismMedical Treatment
Diet (When hyperthyroid)
• Calories– – 4,000-5,000 cal/day
• Fluids–
• Na–
• Fiber–
• Caffeine–
HyperthyroidismNursing Management
Assessment• Vital signs• Lung sounds• Anxiety level• Weight• Bowel function• NEVER palpate goiter
– Release TH
HyperthyroidismNursing Management
Nrs. Dx• Risk for injury• Hyperthermia• Diarrhea• Alt. Nutrition• Sleep pattern
disturbance• Anxiety
HyperthyroidismNursing Management
• Exophthalmos– Lubricate eyes– Tape closed – Dark glasses– Na diet– HOB
HyperthyroidismSevere
Thyrotoxicosis• AKA: Thyroid Storm• Definition
– Sever hyperthyroid state
• Etiology– Stress– Post thyroid surgery– Undiagnosed
Hyperthyroidism SevereThyrotoxicosis
S&S• TH adrenergic activity
epinephrine• Pulse
– • Temperature
– • BP
–
• Depression• Activity
– Restlessness• Delirium• SOB• Coma
Hyperthyroidism SevereThyrotoxicosis
• Death– <2hr– Cardiac Failure
Hyperthyroidism SevereThyrotoxicosis
Treatment• Fever
– Tylenol/ acetaminophen – Not aspirin
• For pulse & BP– Propranolol / Inderal– Beta-adrenergic blocker
• If SOB– O2– HOB