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- triiodothyronine 2. 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

T3 T4

80200ng/dL 5-12mg/dL

Iodine is an essential element in the production of thyroid hormone

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Primary- Decreased thyroid hormone production, most common Causes: Hashimotos 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 function 3. Monitor Cardiac function 4. Monitor metabolism 5. Monitor for infection or trauma 6. Provide warmth and prevent heat loss 7. Health Teaching

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Diet teaching Review signs of Hypo/Hyper thyroidism Lifelong medication therapy- desired and side effects Medication adjustments and interactions Stress management techniques 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 Lugols solution 3. Radioactive Iodine 131 4. 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&S 1. Tachycardia >1 30/min 2. Hyperpyrexia Up to 106 3. Exaggerated symptoms of Hypertension

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Goals: Maintain airway Prevent CV collapse Reduce body temp 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 (Hashimotos 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 Surgery http://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 consciousness B.Recovery from anesthesia C.Injury to parathyroid gland D.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 thyroxine B.Elevated triiodothyronine C.Elevated thyroid-stimulating hormone D.Elevated plasma catecholamines

The nurse correlates which clinical manifestations with the diagnosis of hyperthyroidism? A.Fatigue, weight gain, cold intolerance B.Decreased pulse rate, slurred speech, anorexia C.Abdominal pain, constipation, heat intolerance D.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.