JBorrero 3/09

Regulates rate of metabolism/caloric requirements

Stimulates consumption of O2 by the tissues Influences rate of growth Affects metabolism of protein, CHO and lipids Stimulates myocardium to increase force and

rate of contraction Affects resistance to infection Affects brain and nervous system function Some influence an sex organ development

1. T3- triiodothyronine2. T4- thyroxine Both synthesis and

release is regulated by TSH in the pituitary gland through a negative feedback mechanism

3. Calcitonin- made by thyroid, but not controlled by TSH

Iodine is an essential element in the production of thyroid hormone

T3 80-200ng/dL

T4 5-12mg/dL

1. Primary- Decreased thyroid hormone production, most common

2. Causes: Hashimoto’s thyroiditis Result of thyroid surgery Radioactive iodine treatment of

hyperthyroidism Overtreatment of hyperthyroidism Iodine deficiency

2. Secondary- Originates from anterior pituitary gland not producing TSH

3. Myxedema Coma- rare, serious complication

SUBJECTIVE: Weakness, fatigue, lethargy Headaches Slowed memory, psychotic behavior Loss of interest in sexual activity Menstrual disturbances Depression

Neurological CV Pulmonary Metabolic GI

Integumentary Psychological Reproductive Goiter

TSH T4 and T3 RAIU- Radioactive Iodine Uptake Test

1. Administer thyroid hormone therapy as ordered.

levothyroxine (Synthroid) Monitor for SE: tremors, HA, insomnia, palpitations, tachycardia

2. Monitor pulmonary function3. Monitor Cardiac function4. Monitor metabolism5. Monitor for infection or trauma6. Provide warmth and prevent heat loss7. Health Teaching

1. Diet teaching2. Review signs of Hypo/Hyper thyroidism3. Lifelong medication therapy- desired and

side effects4. Medication adjustments and interactions5. Stress management techniques6. Exercise program

Coma, respiratory failure, hypotension, hyponatremia, hypothermia, hypoglycemia

Emergency care: ABC

Clinical syndrome caused by excessive circulating thyroid hormones

AKA Thyrotoxicosis , Graves’ Disease Graves’ disease, the most frequent

cause. Signs: goiter, exophthalmos, pretibial

edema Thyroid scan Ultrasonography Electrocardiography

Graves’ Disease is most common cause Possible autoimmune repsonse Occurs in 3rd or 4th decade Affects women > men Emotional trauma, infection, increased

stress Overdose of meds to tx hypothyroidism Use of certain weight loss products

Nervousness, mood swings, irritability, hyperactivity, decreased attention span

Insomnia, interrupted sleep Increased appetite, weight loss Palpitations, widened pulse pressure,

increased SBP Heat intolerance, increased perspiration Dyspnea Weakness, exercise intolerance Vision changes, exophthalmos, staring gaze Goiter Bruits over thyroid gland Irregular menses

T3 & T4: elevated TSH- decreased RAI Uptake Test- High uptake with

hyperthyroidism Thyroid Scan EKG

Provide symptomatic treatment. Treatment of hyperthyroidism does

not correct eye and vision problems of Graves’ disease.

Elevate the head of bed at night. Instill artificial tears. Treat photophobia with dark

glasses/patches Give steroid therapy. Provide diuretics.

GOAL- Decrease thyroid tissue without destruction of gland. EUTHROID STATE

1. Antithyroid Drugs- methimazole (Tapazole) or propylthiouracil ( Propicil, PTU)

2. Iodine Preparations – Lugol’s solution3. Radioactive Iodine 1314. Beta blockers- propanolol (Inderal)5. Possible partial/ subtotal

thyroidectomy

Minimize energy expenditure Stress reduction techniques Diet: High caloric, high protein Avoid stimulants: coffee, tea, chocolate,

colas, tobacco Medications as ordered. Teach SE and

desired effects. Provide eye protection S&S Thyroid Storm Possible Preop

S&S1. Tachycardia >1 30/min2. Hyperpyrexia Up to 1063. Exaggerated symptoms of Hypertension

Goals:1. Maintain airway2. Prevent CV collapse3. Reduce body temp4. Reduce metabolic

demands

Airway EKG monitor Acetominophen Cool sponge baths PTU Propanalol IVF Insulin Sodium iodide Insulin O2

Inflammation of the Thyroid Gland.Three types A. Acute B. Subacute C. Chronic (Hashimoto’s disease)

Classification:A. Benign- associated with thyrotoxicosis or

glandular enlargement (goiter)

B. Malignaat 1. Papillary, 2. Follicular 3. Medullary 4. Anaplastic.

Thyroid hormone replacement for life CXR and total body scan yearly x 3 years Assess for signs of recurrence Follow up with T4, T3, serum Ca and Phos

Pre Op: Antithyroid hormone and SSKI Iodine to

reduce activity and decrease vascularity Nutritional assessment Expalnation of procedure and post op

course Teach support of neck incision to prevent

strain

Postoperative care: Hemorrhage Respiratory distress AIRWAY, SUCTION AND TRACH SET AT

BEDSIDE Humidified O2 Semi-fowlers with pillows on either side

of neck Hypocalcemia and tetany Laryngeal nerve damage

Pain Management Nutrition Rest, relaxation, and avoidance of stress Thyroid storm or thyroid crisis-

uncontrolled hyperthyroidism triggered by stressors

Parathyroid glands: calcium and phosphate balance

Hypercalcemia (Norm 9.0-10.5 mg/dL) and hypophosphatemia

Sign & Symptoms Nonsurgical management:

Diuretic and fluid therapy Drug therapy: phosphates, calcitonin,

calcium chelators (Mithramycin) Nutrition

Parathyroidectomy preoperative care: Client stabilized; calcium levels

normalized Studies: bleeding and clotting times, CBC Teaching: coughing, deep-breathing

exercises, neck support Operative procedures- transverse incision

in lower neck. All 4 glands are check for enlargement

Minimal Parathyroid Surgeryhttp://www.parathyroid.com/MIRP-

Surgery.htm)

Postoperative care includes: Observe for respiratory distress. Keep emergency equipment at bedside. Hypocalcemic crisis can occur. Recurrent laryngeal nerve damage can

occur. Lifetime Ca and Vitamin D supplements

Decreased function of the parathyroid gland

CAUSES: Iatrogenic hypoparathyroidism Idiopathic hypoparathyroidism Hypomagnesemia (Norm 1.6-2.6 mg/dL) INTERVENTIONS: Correct hypocalcemia, vitamin D

deficiency, and hypomagnesemia Tx: Rocaltrol – Vitamin D compound PO Calcium intake up to 2Gm /day

Following thyroid resection, the nurse frequently assesses the client's ability to speak. What is the nurse evaluating with this intervention?

A.Changes in level of consciousnessB.Recovery from anesthesiaC.Injury to parathyroid glandD.Spasm or edema of the vocal cords

In reviewing laboratory results in the client with Hashimoto's thyroiditis, the nurse expects which of the following?

A.Elevated thyroxineB.Elevated triiodothyronineC.Elevated thyroid-stimulating hormoneD.Elevated plasma catecholamines

The nurse correlates which clinical manifestations with the diagnosis of hyperthyroidism?

A.Fatigue, weight gain, cold intoleranceB.Decreased pulse rate, slurred speech,

anorexiaC.Abdominal pain, constipation, heat

intoleranceD.Nervousness, weight loss, tachycardia

The nurse monitors for which of the following as indicative of effective treatment of hypothyroidism?

A.Decreased sweating B.Weight gain C.Decreasing heart rate D.Increasing energy level

The nurse recognizes that the client with Graves' disease is at risk for which of the following complications?

A.Corneal ulceration B.Pitting edema C.Hypotension D.Urinary retention

Which of the following statements by the client on thyroid replacement therapy indicates the need for further teaching?

A.“I should take this every morning.”B.“If I continue to lose weight, I may need to

have the dose increased.”C.“I should have more energy with this

medication.”D.“If I gain weight and feel tired all the time,

I may need the dose increased.”