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Chapter 66
Care of Patients with
Problems of the Thyroid and
Parathyroid Glands
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Hyperthyroidism
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Thyrotoxicosis
Graves’ disease: goiter, exophthalmos,
pretibial myxedema
Assessment
History
Physical assessment
Clinical manifestations
Psychosocial assessment
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Exophthalmos
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Goiter
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Laboratory Tests
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T3, T4, T3RU, TSH, TSH-RAb
Thyroid scan
Ultrasonography
ECG
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Nonsurgical Management
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Monitoring
Reducing stimulation
Promoting comfort
Drug therapy (antithyroid drugs, iodine
preparations, lithium, beta-adrenergic
blocking drugs)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Surgical Management
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Total or subtotal thyroidectomy
Postoperative complications:
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Hemorrhage
Respiratory distress
Hypocalcemia and tetany
Laryngeal nerve damage
Thyroid storm or thyroid crisis
Eye and vision problems of Graves’ disease
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Postoperative Monitoring
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Hoarseness or stridor
Suture line pressure
Hypocalcemia and tetany
Thyroid storm
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Hypothyroidism
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Causes
Differentiating: aging vs. hypothyroidism
Decreased metabolism from low thyroid
hormone levels
Myxedema
Myxedema coma
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Myxedema
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Hypothyroidism Assessment
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History
Physical assessment
Clinical manifestations
Psychosocial assessment
Laboratory assessment
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Thyroiditis
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Inflammation of thyroid gland
Three types—acute; subacute
(granulomatous); chronic (Hashimoto’s
disease—most common type)
Thyroiditis vs. hyperthyroidism,
hypothyroidism
Nonsurgical management, drug therapy
Surgical management
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Thyroid Cancer
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Four types:
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Papillary
Follicular
Medullary
Anaplastic
Collaborative management
Surgery
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Hyperparathyroidism
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Parathyroid glands—calcium and phosphate
balance
Hypercalcemia and hypophosphatemia
Nonsurgical vs. surgical management
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Hypoparathyroidism
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Decreased function of parathyroid gland
Iatrogenic
Idiopathic
Hypomagnesemia
Interventions—correcting hypocalcemia,
vitamin D deficiency, hypomagnesemia
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Question 2
What is a priority intervention for an older female patient
with a history of hyperparathyroidism?
A.
B.
C.
D.
Encourage small frequent meals.
Implement fall precautions.
Provide pain medications as prescribed.
Encourage oral fluid hydration.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Question 3
A postoperative plan of care for a patient after a total
thyroidectomy should include which intervention?
A.
B.
C.
D.
Avoiding extending the patient’s neck
Administering oxygen via nasal cannula as needed
Assessing the patient’s voice once per shift
Encouraging the patient to be out of bed in a chair
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