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Download Disorders of the Thyroid and Parathyroid
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Disorders of the Thyroid and Parathyroid ACC, RNSG 1247 Created by Lydia Seese, RN Thyroid Enlargement/Goiter Maybe caused by: Increased TSH stimulation Growth-stimulating immunoglobulins & other growth factors Goitrogens Iodine-deficiency areas (endemic goiter) Thyroid nodules Mostly benign Malignant nodules: usually hard & painless Diagnostics: US, US-guided FNA, thyroid scan Treatment: unilateral to total thyroidectomy Thyroiditis Subacute and acute thyroiditis: Subacute - viral (as in subacute granulomtous thyroiditis) Acute fungal or bacterial Chronic autoimmune thyroiditis Silent painless thyroiditis Hashimoto’s thyroiditis Chronic autoimmune disease Most common cause of hypothyroidism in US Diagnostics: T3 T4 usually low, TSH high, (+) for antithyroid antibodies HYPERTHYROIDISM Graves’ Disease Toxic nodular goiters Thyroiditis (hyper) – usually caused by virus as in viral subacute granulomatous thyroiditis Thyrotoxic crisis (thyroid storm) Graves Disease Autoimmune, unknown etiology Antibodies attach to the TSH receptors and stimulate the thyroid to release T3 & T4 May lead to destruction of thyroid tissue , thus hypothyroidism Toxic Nodular Goiters Release thyroid hormones independent of TSH stimulation Maybe single or multinodular Diagnostics for Hyper/Hypothyroid Dysfunction 1. 2. History and PE Most reliable blood tests are: TSH Free T4 Diagnostics Continued T3, T4 Radioactive iodine uptake (RAIU ) TRH stimulation test ECG US Thyroid scan Antibody assay Hyperthyroidism: Manifestations S/sx of increased metabolism & stimulation of SNS Goiter Opthalmopathy; exophthalmus in Graves’ Exopthalmus Thyroid storm Rare but dangerous Systemic symptoms: examples Hyperthermia Tachycardia, esp. atrial arrhythmias Agitation or delirium Hyperthyroidism: Collaborative Care Medications/Drugs Radioactive Iodine Nutritional Surgical Drug Therapy: Antithyroid drugs Preferred Tx for pregnant women Methimazole - tapazole PTU - prophylthiouracil Improvement begins 1-2 weeks Good results in 4-8 weeks Remission in 6-15 mos. in < 50% of cases Patient concern: noncompliance Drug Therapy: B adrenergic blockers Symptomatic relief of thyrotoxicosis Propranolol - Inderal Atenolol - Tenormin Drug Therapy: Iodine Maximal effect in 1-2 weeks Saturated solution of potassium iodine (SSKI) Lugol’s solution Radioactive Iodine Therapy Preferred for most nonpregnant women Damages thyroid hormone Effect in 2-3 mos. Acute Intervention Support ABC’s Rest, minimal stimulation Eye care Pre/Post operative Care CDB, turning, ambulate w/in hrs post op ROM of neck Airway and incision site monitoring Semi fowlers to prevent tension on suture lines VS monitoring including tetany Pain management Fluids if tolerated, soft diet day after Post operative & home care Remaining thyroid tissue is allowed to regenerate post-op Reduced caloric intake, adequate iodine Regular exercise Avoid temperature extremes Regular follow up to monitor for hypothyroidism HYPOTHYROIDISM Primary – RT destruction of thyroid tissue or defective hormone synthesis Secondary – RT pituitary disease Hypothyroidism: Manifestations Slowing of body process which develops over months to years Exs: fatigue, cold intolerance, weight gain, systemic symptoms Myxedema Myxedema Coma Rare but life threatening Severe metabolic disorders, hypothermia, cardiovascular collapse, coma Factors: infection, trauma, failure to take thyroid replacements Hypothyroidism: Collaborative care Goal – euthyroid state Low calorie diet Thyroid hormone Natural hormones Hypothyroidism: Acute Intervention IV thyroid hormone Hypertonic saline solution Close assessment VS monitoring Thyroid malignancies Occur more often in people who have undergone radiation of the head, neck or chest. Symptoms of thyroid cancer include hoarseness, dysphagia Most Common Types of Thyroid Cancer Papillary thyroid cancer Follicular thyroid cancer The parathyroid glands Disorders of the parathyroid glands Hyperparathyroidism (hypercalcemia) Hypoparathyroidism (hypocalcemia) Tumors Hyperparathyroidism Primary Secondary Tertiary Hyperparathyroid Major S/Sx: depression, fatigue, loss of appetite, constipation, osteoporosis, fractures, kidney stones DX: bone x-rays, Ca & PTH levels TX: decrease high serum levels, surgical removal of parathyroid Hyperparathyroidism: Nonsurgical Treatment Close follow up Active lifestyle. Dietary measures Drugs Common Medications used in Hyperparathyroidism Phosphorus Biphosphates Estrogen or progestin Oral phosphate Diuretics Calcimimetic agents Signs that indicate calcium levels are abnormal Trousseau’s sign: temporarily occlude arterial blood flow (with BP cuff inflated) above the normal systolic pressure. A + Trousseau”s sign occurs when the hand and fingers contract from ischemia Chvostek’s sign: tap on the facial nerve just below the temple. Sign is + when nose, eye, lip & facial muscles twitch Hypoparathyroidism Results from abnormally low levels of PTH low Ca level Symptoms: painful spasms of face, hands, arms, and feet; seizures TX: IV Calcium; CalMag & vit D; Rebreathing Parathyroid Tumors Grow inside the gland itself May cause levels of PTH leading to hyper states. Most are benign adenomas; malignancies are very rare Nursing Diagnosis for thyroid/parathyroid patients Imbalanced nutrition: _______ r/t hypermetabolic or hypometabolic state Disturbed body image: r/t changes in appearance AEB exopthalmus (myxedema), skin changes, facial edema, presence of goiter Risk for constipation r/t slowed metabolic states and decreased activity tolerance Risk for fluid/electrolyte imbalance r/t changes in production of thyroid hormones 2° hypothyroidism Nursing Diagnosis, cont. Electrolyte imbalance r/t decreased/increased levels of calcium AEB…. Knowledge deficit: dietary, r/t decreased parathyroid function AEB calcium serum levels of_____, facial twitching, muscle cramps, ….. R/F impaired cardiac output R/F Imbalanced body temperature RF acute pain RT effects of renal stone
