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Thyroid Dysfunction
Hyperthyroidism
| Question | Answer |
|---|---|
| Thyroid Hormone Process | hypothalamus - serotonin and dopamine needed to make TRH -stimulates pituitary gland - makes TSH ( mag, b12, zinc and protein needed for to make TSH) - TSH stimulates thyroid to release T3 and T4 which is then carried to liver - T4 converted to T3 |
| factors that inhibit T4 from getting converted to T3 | stress, starvation, beta-blockers and corticosteroids |
| roles of thyroid gland | body metabolism, regulation of body temperature and heart rate, growth and development, how fast food moves through the gut, stimulates SNS |
| hyperthyroidism | hyperactivity of thyroid hormones |
| causes and forms of hyperthyroidism | Graves disease, toxic nodular goiter, thyroiditis, excess iodine intake, pituitary tumor, thyroid cancer |
| thyrotoxicosis | physiologic effects of hypermetabolism which results from increased circulating levels of T3 or T4 or both, occurs with hyperthyroidism |
| Graves Disease | autoimmune disease --> antibodies produced then attack thyroid --> diffuse thyroid enlargement and excess thyroid hormone secretion |
| precipitating factors of Graves Disease | insufficient iodine, cigarette smoke, stressful life events, infection |
| goiter | thyroid gland enlarged bruits |
| exopthalmos | increased fat deposits and fluid eyeballs forced outward |
| cardiovascular system | systolic HTN, increased cardiac output bounding, rapid pulse; palpitations |
| respiratory system | dyspnea on exertion and increased respiratory rate |
| GI system | increased appetite, weight loss, increased thirst |
| integumentary system | hair loss, fine silky hair, diaphoresis clubbing of fingers and palmar erythema |
| musculoskeletal system | fatigue, weakness, osteoporosis |
| nervous system | nervousness, fine tremors, insomnia, exhaustion, labile mood |
| reproductive system | menstrual irregularities, decreased libido, amenorrhea, gynecomastia |
| thyrotoxic crisis or thyroid storm | excessive amount of hormones released- life threatening emergency which results from stressors |
| clinical manifestations of thyroid storm | high fever, hyperthermia, coma, delirium, rapid HR, agitation, high blood pressure |
| if thyroid storm is not treated ... | hypotension and shock |
| antithyroid drugs | propylthiouracil (PTU) methimazole (Tapazole) |
| PTU | first line of treatment for thyrotoxic crisis take 3 times a day puts thyroid underground |
| iodine | potassium iodine (SSKI) used with others to prepare for thyroidectomy |
| B-adrenergic blockers | propanalol (Inderal) atenolol (Tenormin) blocks SNS |
| iodine toxicity | swelling of lips/ mucosal membranes, skin irritation, nausea and vomiting |
| radioactive iodine therapy | damages / destroys thyroid tissue treated with anti-thyroid / propranalol until RAI effects are seen |
| considerations for RAI | NPO 2-4 hours before and 1-2 hours after gargle salt water if dry mouth occurs will experience hypothyroidism post-op so have to have life-long therapy |
| post-operative care for RAI | must use private toilet, flush 2-3 times after, separate laundry, do not cook / prepare food for others, stay away from pregnant women and children for 7 days |
| when is surgical therapy needed | those with a large goiter that is causing tracheal compression, or unresponsive to thyroid drugs, or has thyroid cancer |
| nutritional therapy | high calorie, high protein, high carb diet avoid highly seasoned and high fiber foods, avoid caffeine |
| pre-op care for thyroidectomy | administer medications to achieve euthyroidism administer iodine to decrease vascularity assess for signs of iodine toxicity teach - leg exercises, head support, neck and ROM |
| post op care for thyroidectomy | monitor for complications (hypocalcemia, hemorrhage, hypothyroidism, infection) maintain patent airway teach- regular exercise, decrease caloric intake, avoid high temperatures, s/s of thyroid failure |
| thyroid storm nursing management | administer PTU or beta-blockers to block thyroid hormone production monitor for dysrhythmias, ensure adequate oxygenation, fluid and electrolyte replacement, rest and a cool environment |
| exopthalamos nursing care | artificial tears, elevate HOB, wear dark glasses, light tape when sleeping watch for corneal pain and vision loss |
Created by:
ebrewer12
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