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Hypothyroidism and Hyperthyroidism
Terms in this set (52)
This condition results from insufficient circulating thyroid hormone
What hormones are secreted by the thyroid
What are the functions of the thyroid hormones?
T3 and T4
Hypothalamus release TRH; TSH is secreted from the anterior pituitary gland
Every cell in the body depends upon thyroid hormones for regulation of their metabolism.
Primary: Related to destruction of thyroid tissue itself or defective hormone synthesis
Secondary: Related to pituitary disease with ↓ TSH secretion or hypothalamic dysfunction
There wil be LOW T3 and T4; High TSH b/c the pituitary continues to secrete
Causation of Thyroid dysfunction
Define the causes of primary hypothyrpoidism?
Define the causes of secondary hypothyroidism?
Will the TSH be high or low in hypothyroidism? Why?
The function of the thyroid gland is to take iodine, found in many foods, and convert it into thyroid hormones: thyroxine (T4) and triiodothyronine (T3
T3 and T4 are then released into the blood stream and are transported throughout the body where they control _______________ (conversion of oxygen and calories to energy
Thyroid Stimulating Hormone (TSH)which stimulates the thyroid gland to produce more hormones. Under the influence of TSH, the thyroid will manufacture and secrete T3 and T4 thereby raising their blood levels.
The pituitary gland itself is regulated by another gland, known as the hypothalamus. The hypothalamus is part of the brain and produces TSH Releasing Hormone (TRH) which tells the pituitary gland to stimulate the thyroid gland
T3 and T4 are made up of iodine
Hypothyroidism May be transient, related to thyroiditis, or result from abrupt discontinuing thyroid hormone therapy
Hypothyroidism could occur due to iodine deficiency. Why?
In places where iodine intake is adequate, the primary cause is __________ of the thyroid gland.
Hyperthyroid is treated with radioactive iodine...this could cause destruction to thyroid
Hypothyroidism could also develop because of treatment for hyperthyroidism. How?
All infants are screened at birth for ↓ thyroid function.
This is a condition characterized by physical deformity and learning disabilities that is caused by thyroid deficiency during fetal or neonatal life
This should be detected early in order to prevent mental and growth retardation. What intervention should be done due to this fact?
S/s of hypothyroidism
-Vary depending on the severity of thyroid fxn, duration and age of onset
-Systemic effects characterized by __________ of body processes
-S/S could Range from no symptoms to classic symptoms and physical changes easily detected on examination
Onset of symptoms may occur over months to years. Unless occurs after thyroidectomy, thyroid ablation, treatment with antithyroid drugs
s/s of hypothyroidism inclds:
-fatigued and lethargic, and experiences personality and mental changes.
-sleeps for long periods of time
Note that these s/s are all decreased...
It's hard to memorize all the s/s..just think back on the physiology
-Impaired memory, sowed speech
-Muscle aches and pains
Those with severe long-standing hypothyroidism may display _______________.
This is the accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues, causing puffiness, periorbital edema, masklike effect
Dull, puffy skin; coarse, sparse hair; periorbital edema; and prominent tongue
What are the Common Features of Myxedema?
Cmplctns of Hypothyroidism
-This complication is characterized by lethargy progressing gradually or suddenly to impairment of consciousness or coma
High TSH: Hypothyroidism
Low TSH: Hyperthyroidism
decreased TSH levels and elevated free thyroxine (free T4) levels.
What lab tests are used for diagnosing hypothyroidism?
Which lab test determines the type of thyroidism?
The two primary laboratory findings used to confirm the diagnosis of hyperthyroidism are ?
The pituitary gland and hypothalamus both control the thyroid. When thyroid hormone levels drop too low, the hypothalamus secretes Thyroid Releasing Hormone (TRH), which alerts the pituitary to produce thyroid stimulating hormone (TSH). The thyroid responds to this chain of events by producing more hormones.
The TRH stimulation test is a diagnostic test that is used to determine where the problem of the thyroid is coming from S23
↑ in TSH after TRH injection suggests ________________ dysfunction.No change after TRH injection suggests ______________ dysfunction.
Cells are not able to use energy, so weight gain will become a problem due to the decreased metabolic state
Cell hyper excitability. Increase in metabolic state
-Restoration of euthyroid state
-Low-Calorie diet. Why?
-For someone with hyperthyroidism. They'll have a high calorie diet. Why?
They will be on these drugs for the rest of their life, so compliance may be an issue
What is important to teach the patient when they need to take thyroid drugs?
Any chest pain experienced by a patient starting thyroid replacement should be reported immediately, and an electrocardiogram (ECG) and serum cardiac enzyme tests must be performed.
-Family history of thyroid disease
-History of neck radiation
-Women over 50 postpartum are at high risk
There is no consensus for thyroid function. People who are at high risk are recommended to get screened for thyroid function.
Who are the high risk population?
Most patients with hypothyroidism do not require acute nursing care unless there's _______________. This is an emergence case
-Mechanical respiratory support
-IV thyroid hormone replacement
-If hyponatremic, hypertonic saline may be administered.
-Monitor core temperature.
-Administer thyroid hormone replacement therapy and all other medications IV because paralytic ileus may be present in the patient with myxedema coma.
What are the acute interventions for a patient who has myxedema?
Ambulatory and home care
-Patient and family must understand replacement therapy and that it is _____________.
-Individuals who need to take Valium or anything that suppress the CNS is ____________________ if they have a hypothyroidism state...they can easily progress into myxedema coma
-Emphasize need for warm environment.
-Caution patient to avoid sedatives or use lowest dose possible.
-Minimize constipation (avoid enemas b/c of vagal stimulation in cardiac patient
Orthopnea, dyspnea, rapid pulse, palpitations, nervousness, insomnia
Ambulatory and home care
-Teach patient to notify physician immediately if signs of overdose appear. What would those s/s be?
DM patients with hypothyroidism will need an ____________ in insulin requirements, so they should check their blood sugar frequently
Hypothyroidism is associated with decreased insulin sensitivity and glucose tolerance
Drug interactions includes:
Hyperthyroidism is a sustained increase in synthesis and release of thyroid hormones by thyroid gland
What is the causative factor for hyperrthyroidism for 75% of the time?
This is a physiologic effects/clinical syndrome of hypermetabolism resulting from increased circulating levels of T3, T4
An autoimmune disease of unknown origin to the thyroid causing thyroid enlargement and excessive thyroid hormone secretion
Hyperthyroidism and thyrotoxicosis occur together as Graves' disease.
What is Graves' disease?
Will there be high or low TSH level?
Precipitating factors of Graves' disease would include:
-Insufficient iodine supply
-Stressful life events interacting with genetic factors
Grave disease will lead to clinical manifestations of thyrotoxicosis and may progress to destruction of thyroid tissue, causing hypothyroidism
-↑ tissue sensitivity to stimulation by sympathetic nervous system
Exophthalmos: Protrusion of eyeballs from the orbits
What are the s.s of hyperthyroidism?
What is a classic s/s of Graves' disease? ...TQ
A patient with Graves' disease who has exophthalmos can lead to :
-Impaired ______________ from orbit
-Increased fat and edema in retroorbital tissue
In ophthalmopathy, the upper lids are usually retracted and elevated, with the sclera visible above the iris. When the eyelids do not close completely, the exposed corneal surfaces become dry and irritated....eye lubricants may be needed
The s/s of hyperthyoidism:
Think about the physiology...everything is excitable
-Bruit over tyroid due to incr. vascular supply
-Weight loss no matter food intake
-Increase stimulant to drugs
-This is an acute , rare condition, where all manifestations are heightened
-This is life-threatening emergency that requires hospitalization
S/S of Thyrotoxic crisis is:
↓ Thyroid hormone levels and clinical manifestations with drug therapy.
Therapy is Aimed at managing respiratory distress, fever reduction, fluid replacement, and management of stressors
What would treatment would be for thyrotoxic crisis?
Radioactive iodine uptake (RAIU)
This tool is indicated to differentiate Graves' disease from other forms of thyroiditis
-The patient swallows a radioisotope of iodine in the form of capsule or fluid, and the absorption (uptake) of this radiotracer by the thyroid is studied after 4-6 hours and after 24 hours. Low uptake suggests thyroiditis, high uptake of iodine suggests Graves' disease
Long term use can cause destruction of the thyroid and can result in hypothyroidism
Three primary treatment options
2.Radioactive iodine therapy (RAI)
What is a complication of this?
These genre of drugs are used to relieve the symptoms of hyperthyroidism:
These drugs Inhibit synthesis of thyroid hormone. Improvement in 1 to 2 weeks. Good results in 4 to 8 weeks. Therapy for 6 to 15 months
-noncompliance can occur with this drug
This drug is used with other antithyroid drugs in preparation for thyroidectomy or treatment of crisis
-will decre. vascularity to thyroid gland.
Causes Symptomatic relief of thyrotoxicosis resulting from β-adrenergic receptor stimulation
Radioactive iodine therapy (RAI)
This drug txtmnt of choice is for nonpregnant adults.
-Destruction of thyroid tissue can occur if long term
Delayed response is 2 to 3 months for onset, so give symptomatic relief drugs until onset occurs
Post thyroidectomy...worry about RESPIRATORY FUNCTION....they are at risk for RESPIRATORY COMPROMISE!!
Better to take out only part of the thyroid because it could regenerate...if not going to work, complete thyroid removal, lifelong drugs needed
Surgical therapy is indicated if the thyroid is unresponsive to drug therapy and causes airway obstruction.
What is a major concern post thyroid removal?
Is it better to remove some or all of the thyroid? Why?
Patients with hyperthyroidism will need a ________-calorie diet to treat hunger and prevent tissue breakdown
Have them avoid caffeine, highly seasoned foods, and high-fiber foods
Those with acute thyrotoxicosis or undergoing thyroidectomy require hospitalization and acute care.
-Requires aggressive treatment
-Administer medications to block thyroid hormone production.
-Administer IV fluids.
-Ensure adequate oxygenation.
-Calm, quiet room
-Light bed coverings b/c they are sweaty and have a high basal temp
-Change linens frequently if diaphoretic.
-Encourage and assist with exercise.
-Establish supportive relationship.
-Apply artificial tears to relieve eye discomfort.
-Elevate HOB and salt restriction for edema.
-Do eye exercises.
-Tape eyelids shut for sleep if they cannot close.
-Wear dark glasses to reduce glare and prevent environmental irritants.
Acute Thyrotoxicosis interventions includes:
Oxygen, suction equipment, and tracheostomy tray are available in room.
Respiratory compromise due to tracheal compression is a major concern post op
remember that the thyroid sits above the trachea
Before a patient goes into thyroid surgery, it is important to make sure that what equipment is set up for use? Why?
Post op Thyroid surgery interventions:
S56 - 57
Ambulatory and home care teaching...S58-59
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