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Hypothyroidism and Hyperthyroidism
Terms in this set (52)
What is precocious puberty?
Early release of estrogen or testosterone
Early sexual characteristics
When does puberty normally occur?
When does precocious puberty occur?
What are causes of precocious puberty?
What is central precocious puberty?
Hypothalamus and pituitary
Excess of gonadotropin releasing hormone
Causes secondary sexual characteristics to develop
LH and FSH makes these children capable of reproducing
Some causes of peripheral precocious puberty:
What are signs and symptoms of precocious puberty?
growth plate closure
organs become sensitive
What causes an increased risk of PP?
What would you assess for PP?
Health history and family history
How tall is mom at this age? How tall was dad at this age? Does anyone in your family have any endocrine disorder?
Presenting signs and symptoms: abrupt: tumor/cremes gradual: chronic
Ask about behavioral changes
In depth labs: estrogen, testosterone, infection?
How do we treat PP?
What secretes TSH?
Pituitary secretes thyroid stimulating hormone
What secretes T3 and T4?
The thyroid gland based on pituitary secretion of TSH
What does the thyroid effect?
GI and Muscles
What is hyperthyroidism
Caused by excessive delivery of thyroid hormone
Too much thyroid hormone leads to increased metabolism, carb lipid and protein metabolism
What are signs and symptoms of hyperthyroidism
Malnourishment and hungry all the time
Tachycardia due to fight or flight
Hair loss all over
What are causes of hyperthyroid?
Graves disease autoimmune disease because of the excess production of TSH it is sent to the thyroid causing a goiter (swollen thyroid) Not producing anymore T3 or T4
Found in women 20-40 same symptoms as hyperthyroidism- weight loss, tremors with exphothalmos, proptosis
How do you manage proptosis?
Is is caused by inflammatory by products built up behind the eye.
Sleep with eye patches and eye creams due to risk for abrasions
Can't close their eyes
Signs and symptoms of Graves disease:
Palpitations: A fib - TSH is the first test they do for new onset
Hyperthyroid: Too much or too little T3 or T4?
Normal T3 and T4
Hyperthyroid: Too much or too little TSH?
Too much TSH
What are other causes of hyperthyroidism?
Toxic multi-nodular goiter- the thyroid gland has tons of nodules that develop on it. Usually causes excessive thyroid hormone. Typically seen in women. does not happen overnight
Thyroiditis inflammation of thyroid gland, viral and acute. If it does not resolve then the function of the gland can be destroyed and it goes into hypothyroidism.
How do we diagnose a thyroid disorder?
Check TSH and T3 and T4 levels
MRI, X-ray, Ultrasounds to tell us size of thyroid gland
What medications that we use to treat hyperthyroidism?
Iodine for acute periods as they suppress the production of thyroid hormone. Iodine decreases vascular of thyroid. Given pre-surgery.INCREASES anticoagulant. They are at risk for bleeding
PTU- antithyroid drugs does not affect hormones that are already made. We have to deplete supply so takes a couple weeks. TAKE AT SAME TIME EACH DAY! Monitor s/s of hypothyroidism
Radioactive iodine- NEVER give to someone who is pregnant. Damages or destroys thyroid cells. no results for 6-8 weeks. CAN CAUSE A-Fib
What do you need to know about thyroid surgery?
This is a last resort when thyroid is compromising swallowing or breathing
Airway is the most important assessment- tracheostomy kit at bedside if you hear stridor prepare to intubate
Watch for dysphagia after surgery- at aspiration risk
Position in semi-fowlers support neck with pillow to support incision.
MONITOR CALCIUM LEVELS CLOSE- parathyroid glands could get irritated with surgery leading to hypercalcemia: tetany is a sign
Calcium glyconate or chloride for emergency administration
Monitor vocal quality of laryngeal nerve don't overwork
What is thyroid storm?
Complication of pre-existing hyperthyroidism that is out of control
Need to catch it fast as this is deadly
What are signs and symptoms of a thyroid storm?
High blood pressure
Nausea and vomiting
At risk for Myocardium infarct
What are thyroid storm labs?
T3 and T4 low
Cardiac monitor: Atrial fibrillation and tachycardia
How do we treat thyroid storm?
Supportive: Prevent cardiovascular collapse with beta blockers
Increase fluids with cool fluids IV
Give PTU first and then wait an hour and give the Iodine
Give steroids to decrease hypermetabolic state
What is patient education for hyperthyroidism?
Avoid medications with iodine:
AVOID ASPIRIN at any time
Give PTU first and then wait an hour and give the Iodine
Take medication at the same time every day
Educate her to eat high calorie foods
Have them keep a chart of stool patterns
Teach her about eye care and how to put eye drops in and how to wear patches or mask
Set her on 45 degrees at night to keep eyes closed
How do you know someone is in thyroid storm?
decreased level of consciousness
What are post op surgery priorities for hyperthyroidism?
Airway and swallowing
Incision and voice
check calcium every 4 to hours have calcium replacement immediately available watch for tetany
What is hypothyroidism?
When the thyroid gland produces insufficient amount of thyroid hormone
Common in age 30-60
Not diagnosed quickly because thought to be part of aging
What is chronic untreated hypothyroidism?
Facial edema and swollen tongue
Fluid around vocal cords- hoarse voice
Weight gain and fluid retention
What are causes of primary hypothyroidism?
Treatment of hyperthroidism -antithyroid meds
Iodine deficiency can cause goiter
Amiodarone- long term use- automatically get thyroid checked
LITHIUM, DILATIN, INDERAL, INTERFERON
What causes secondary hypothyroidism?
Pituitary has a TSH deficiency
Body becomes resistant to the thyroid hormone
What is hashimotos?
Thyroid tissue is replaced with fibrous tissue leading to goiter developing
Has genetic link
What are signs and symptoms of hypothyroidism?
What do you need to know about hypothyroid medication levothyroxine?
Take on empty stomach in the morning 30 min before meal
Do not switch thyroid medication
Do not use iodized salt or over the counter drugs with iodine
It can potentiate Digoxin- take heart rate
Speeds up elimination of vitamin K so they can bleed out faster
What are signs and symptoms of decreased cardiac output?
Heart rate high
Blood pressure low
Risk for impaired skin integrity
What can cause myxedema coma?
Abrupt stop of thyroid medication
What are s/s of myxedema coma?
Puffy skin- pillsbury doughboy
TSH should be high
PLEURAL EFFUSIONS ARE VERY COMMON
How do treat myxedema coma?
Treat hypotension with fluids and vasopressors
If they are hypoglycemic treat hypoglycemia
May need to intubate them
Give IV THYROID REPLACEMENT
Where are parathyroid glands?
Next to the thyroid
Most people have 4 some people have 6
What is hyperparathyroidism?
Results from an increase in the secretion of parathyroid hormone or PTH
The parathyroid regulates calcium so if it is high so will the calcium
It affects kidney's and bones affects calcium in both of these
Calcium plays a role in skeletal muscle movement
What is hyperparathyroidism caused by?
Hyperplasia or adenoma of thyroid gland
Moans, Groans, Stones, and Bones
Hypercalcium- moans and groans, loss of energy
Stones- frequent kidney stone problems
How do we treat hyperparathyroidism?
Decrease calcium level: Drink up to two liters of fluid a day
AVOID THIAZIDE DIURETICS
AVOID VITAMINS A AND D AND ANTACIDS
MONITOR THYROID HORMONE TO MAKE SURE WE DO NOT CAUSE HYPERTHYROIDISM
What is hypoparathyroidism?
Abnormally low parathyriod hormone
Decrease calcium with increased phosphorus
Decreased threshold for electrical muscle signals
What are signs and symptoms of hypoparathyroidism?
tetany- continuous muscle spasms
How do we diagnose hypoparathyroidism?
Low calcium and high phosphorus WITHOUT renal failure
What is treatment for hypoparathyroidism?
Long term- supplemental calcium and dietary calcium
How do we rememeber signs and symptoms of hypoparathyroidism?
Chvosteks- touching persons face tapping
Trousseau's Blood pressure cuff
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