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Chapter 66
Care of Patients with
Problems of the Thyroid
and Parathyroid Glands
Hyperthyroidism
• Thyrotoxicosis
• Graves’ disease is the most frequent
cause; usually has goiter, exophthalmos,
pretibial myxedema
• Assessment
• History
• Physical assessment
• Clinical manifestations
• Psychosocial assessment
Exophthalmos
Goiter
Laboratory Tests
•
•
•
•
T3, T4, T3RU, TSH, TSH-RAb
Thyroid scan
Ultrasonography
ECG
Nonsurgical Management
•
•
•
•
Monitoring
Reducing stimulation
Promoting comfort
Drug therapy—antithyroid drugs, iodine
preparations, lithium, beta-adrenergic
blocking drugs
Surgical Management
• Total thyroidectomy, subtotal
thyroidectomy
• Postoperative complications:
• Hemorrhage
• Respiratory distress
• Hypocalcemia and tetany
• Laryngeal nerve damage
• Thyroid storm or thyroid crisis
• Eye and vision problems of Graves’
disease
Hypothyroidism
• Decreased metabolism from low levels of
thyroid hormones
• Myxedema
• Myxedema coma
Myxedema
Hypothyroidism: Assessment
•
•
•
•
•
History
Physical assessment
Clinical manifestations
Psychosocial assessment
Laboratory assessment
Hypothyroidism: CommunityBased Care
• Home care management
• Health teaching
• Health care resources
Thyroiditis
• Inflammation of the thyroid gland
• Three types of thyroiditis—acute; subacute
(granulomatous); and chronic
(Hashimoto’s disease), the most common
type
• Nonsurgical management, drug therapy
• Surgical management
Thyroid Cancer
• Papillary, follicular, medullary, and
anaplastic
• Collaborative management
• Surgery
Hyperparathyroidism
• Parathyroid glands—calcium and
phosphate balance
• Hypercalcemia and hypophosphatemia
Hyperparathyroidism: Nonsurgical
Management
•
•
•
•
Diuretic and hydration therapies
Monitoring
Preventing injury
Drug therapy
Hyperparathyroidism: Surgical
Management
• Parathyroidectomy
Hyperparathyroidism: Surgical
Management (Cont’d)
• Postoperative care includes:
• Observe for respiratory distress.
• Keep emergency equipment at bedside.
• Hypocalcemic crisis can occur.
• Recurrent laryngeal nerve damage can
occur.
Hypoparathyroidism
• Decreased function of the parathyroid
gland
• Iatrogenic hypoparathyroidism
• Idiopathic hypoparathyroidism
• Hypomagnesemia
• Interventions—correcting hypocalcemia,
vitamin D deficiency, and
hypomagnesemia
Chapter 66
Care of Patients with Problems of the
Thyroid and Parathyroid Glands
NCLEX
TIME
Question 1
What is an appropriate expected outcome for
the 35-year-old female patient who is
undergoing treatment with radioactive
iodine therapy?
A. Complete cure of all symptoms of
hyperthyroidism within 2 weeks after
therapy
B. Discontinuation of drug therapy for
hyperthyroidism after completing therapy
C. Observation of required radiation
precautions
D. Regular monitoring for thyroid function
changes after therapy
Question 2
What parameter should be critically
evaluated when providing care to a
patient with Graves’ disease?
A.
B.
C.
D.
Irregular heart rate and rhythm
Elevated blood pressure
Elevated temperature
Change in respiratory rate
Question 3
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 fluid hydration by mouth.
Question 4
How many times more often than men are
women affected with hypothyroidism?
A.
B.
C.
D.
2 to 3 times more
4 to 5 times more
6 to 7 times more
7 to 10 times more
Question 5
When formulating the postoperative plan of
care for a patient who is scheduled to
have a thyroidectomy, the nurse should
plan to
A.
B.
C.
D.
Avoid extending the patient’s neck.
Avoid humidification of the air.
Assess the patient’s voice once per shift .
Avoid using pillows or sandbags to
support the patient’s head and neck.