Download Thyroid and Parathyroid Glands

Thyroid and Parathyroid Glands
NUR 111
Functions of the Thyroid
Pg. 1450
Metabolic rate
Regulate protein, carbs
and fat metabolism
Increase RBC
production
Inc bone formation,
decrease bone
resorption of Ca+
Regulation of Metabolism
Hormones T3 & T4 increase BMR
Secretion controlled by hypothalamicpituitary-thyroid gland axis
TRH » TSH » T3 & T4 (neg feedback)
Protein and Iodine very important for
T3 & T4 production
Calcium and Phosphorus Balance
Calcitonin (thyrocalcitonin, or TCT)
Reduces bone resorption, lowers serum
Ca+
Low serum Ca+ suppress TCT:
Elevated serum Ca+ trigger TCT
Causes of Hyperthyroidism
Pg. 1482
Graves’ disease (Autoimmune)
Toxic multinodular goiter
Thyroid adenoma (benign tumor)
Pituitary hyperthyroidism
Excessive use of thyroid hormone
Goiter and Exophthalmos in Graves'
Disease
Hyperthyroidism
More common in women
Lab assessment p.1485: T3, T4
 TSH (Graves’)
Thyroid Scan (RAIU) = increased
Nursing Diagnosis
Depends on condition of client 
Possible Dx. Include
 Imbalanced nutrition: > body
requirements
 Fatigue
 Anxiety
 If
large goiter present: what is priority???
Interventions
Nonsurgical: monitor V/S, rest, cool
environment
Medications: PTU (propylthiouracil),
SSKI, beta blockers
Radioactive Iodine Therapy
Remember eye care
Interventions
Surgical: total or subtotal
thyroidectomy
Preop = antithyroid meds, SSKI
Postop = very important
 Monitor
for Bleeding, respiratory
distress, tetany, weak voice, thyroid storm
(p.1487)
Causes of Hypothyroidism
Pg. 1489
Removal or destruction of thyroid
Autoimmune (Hashimoto’s Disease)
Iodine deficiency
Medications (ex.Lithium)
Hypothyroidism
More common in women
Lab assessment:  T3, T4
 TSH
Monitor for depression
Nursing Diagnosis
Decreased cardiac output
Ineffective breathing pattern
Altered thought process
Constipation
Interventions
Levothyroxine sodium (Synthroid)
Avoid sedatives & narcotics
Monitor vital signs
Monitor for S&S of
hyperthyroidism
Family teaching re: mental status
Myxedema Coma
Hypothyroid Crisis --> rare but serious
Etiology:
 acute illness/ trauma
 * rapid withdrawal of thyroid meds.
 use of sedatives / narcotics
 surgery
 exposure to cold
Myxedema Coma
 temp / BP
 Na+
 blood glucose
Lactic acidosis
Coma
Collaborative Nursing Care
IVF
Airway
IV:
 Synthroid
 Glucose
Warming blanket
Thyroiditis

Acute
–
–
Bacterial
 Pain
  Temp.
 Malaise
 Dysphagia
TX
 Antibiotics

Subacute
–
–
Viral
  Temp.
 Chills
 Pain in jaw
and/or ear
TX
 ASA and steroids
Thyroid Cancer
Painless nodule in thyroid
Treatment :
 RAI
 Surgery
Parathyroid Glands:
4 in number
can be removed w/
thyroid during
surgery
Parathyroid
secretes:
Parathyroid
hormone (PTH)
REMEMBER :
Thyroid -> Calcitonin ->
decreases serum calcium
PTH - increases serum
calcium
Parathyroid Glands:
Major Role:

Regulate blood levels of calcium and phosphate
PTH acts on:



GI tract
Kidney
Bones
If serum CA   PTH secretion
PTH - activates Vit. D --Increase calcium
absorption from g.i. tract
Remember:Thyroid also
secretes Calcitonin
Calcitonin helps-->
keep Ca in bones
maintain balance
of Ca and
Phosphorus
Calcium -- 8.8 - 10.5
Phosphorus - 3 - 4.5
Hyperparathyroidism
Pathophysiology
PTH secretion = Ca+  Phos

increased reabsorption of calcium by
kidneys =
increased excretion of Phosphate
Causes
 tumors
 hyperplasia
of parathyroid gland
Data Collection :
 PTH
renal calculi
 nephrocalcinosis
 bone decalcification

 serum Ca
GI: anorexia, N&V, epigastric pain, constipation,
 M/S: fatigue & lethargy
 [serum Ca] > 12 mg/dl =  mental status

Complications:
Renal Failure
Fractures
Collapse of
vertebra
Collaborative Management :
focuses to decrease serum calcium
Diuretic & Fluid Therapy
 Lasix /0.9% Na Cl
Drug therapy
 Phosphates
 Calcitonin -miacalin spray Skel. Release
Renal clearance
 Calcium Chelators - binds with Ca. -< dec.
Levels of free calcium
Parathyroidectomy
Nursing Interventions :
Diuretic & Fluid Rx:

Monitor:
cardiac function
I&O
 renal status
 serum Ca

Calcium Chelator Rx:

Monitor:

LFT, BUN & Creatinine, CBC
Post - op care
Parathyroidectomy
Same as thyroidectomy
Monitor for *** Tetany
 continuous spasm of hands / feet --->
convulsions
 calcium levels
 Calcium supplements ( Tums, Oscal )
 Maintain airway
Pathophysiology
Hypoparathyroidism
 PTH
Etiology (rare)
 thyroid /
parathyroid
surgery
 Hypomagnesemia
 Idiopathic
Data Collection
Hypoparathyroidism
Tetany
 Check
:
• Chvostek’s
• Trousseau’s
• tingling
• severe muscle cramping
• irritability
Collaborative management of
care
IV calcium
gluconate
Oscal
Vitamin D
High Calcium diet
Magnesium IM or
IV