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JBorrero 3/09
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Regulates rate of metabolism/caloric requirements
Stimulates consumption of O2 by the tissues
Influences rate of growth
Affects metabolism of protein, CHO and lipids
Stimulates myocardium to increase force and rate
of contraction
Affects resistance to infection
Affects brain and nervous system function
Some influence an sex organ development
1. T3- triiodothyronine
2. T4- thyroxine
Both synthesis and release
is regulated by TSH in the
pituitary gland through a
negative feedback
mechanism
3.
Calcitonin- made by
thyroid, but not controlled
by TSH
Iodine is an essential element in
the production of thyroid
hormone
T3
80200ng/dL
T4
5-12mg/dL
1.
2.
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Primary- Decreased thyroid hormone
production, most common
Causes:
Hashimoto’s thyroiditis
Result of thyroid surgery
Radioactive iodine treatment of
hyperthyroidism
Overtreatment of hyperthyroidism
Iodine deficiency
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2. Secondary- Originates from anterior
pituitary gland not producing TSH
3. Myxedema Coma- rare, serious complication
SUBJECTIVE:
 Weakness, fatigue, lethargy
 Headaches
 Slowed memory, psychotic behavior
 Loss of interest in sexual activity
 Menstrual disturbances
 Depression
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Neurological
CV
Pulmonary
Metabolic
GI
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Integumentary
Psychological
Reproductive
Goiter
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TSH
T4 and T3
RAIU- Radioactive Iodine Uptake Test
1. Administer thyroid hormone therapy as
ordered.
levothyroxine (Synthroid) Monitor for SE:
tremors, HA, insomnia, palpitations,
tachycardia
2. Monitor pulmonary function
3. Monitor Cardiac function
4. Monitor metabolism
5. Monitor for infection or trauma
6. Provide warmth and prevent heat loss
7. Health Teaching
1.
2.
3.
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5.
6.
Diet teaching
Review signs of Hypo/Hyper thyroidism
Lifelong medication therapy- desired and side
effects
Medication adjustments and interactions
Stress management techniques
Exercise program
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Coma, respiratory failure, hypotension,
hyponatremia, hypothermia, hypoglycemia
Emergency care: ABC
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Clinical syndrome caused by excessive circulating
thyroid hormones
AKA Thyrotoxicosis , Graves’ Disease
Graves’ disease, the most frequent cause.
Signs: goiter, exophthalmos, pretibial edema
Thyroid scan
Ultrasonography
Electrocardiography
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Graves’ Disease is most common cause
Possible autoimmune repsonse
Occurs in 3rd or 4th decade
Affects women > men
Emotional trauma, infection, increased stress
Overdose of meds to tx hypothyroidism
Use of certain weight loss products
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Nervousness, mood swings, irritability,
hyperactivity, decreased attention span
Insomnia, interrupted sleep
Increased appetite, weight loss
Palpitations, widened pulse pressure, increased SBP
Heat intolerance, increased perspiration
Dyspnea
Weakness, exercise intolerance
Vision changes, exophthalmos, staring gaze
Goiter
Bruits over thyroid gland
Irregular menses
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T3 & T4: elevated
TSH- decreased
RAI Uptake Test- High uptake with
hyperthyroidism
Thyroid Scan
EKG
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Provide symptomatic treatment.
Treatment of hyperthyroidism does not
correct eye and vision problems of Graves’
disease.
Elevate the head of bed at night.
Instill artificial tears.
Treat photophobia with dark glasses/patches
Give steroid therapy.
Provide diuretics.
GOAL- Decrease thyroid tissue without destruction
of gland. EUTHROID STATE
1.
Antithyroid Drugs- methimazole (Tapazole) or
propylthiouracil ( Propicil, PTU)
2.
Iodine Preparations – Lugol’s solution
3.
Radioactive Iodine 131
4.
Beta blockers- propanolol (Inderal)
5.
Possible partial/ subtotal thyroidectomy
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Minimize energy expenditure
Stress reduction techniques
Diet: High caloric, high protein
Avoid stimulants: coffee, tea, chocolate, colas,
tobacco
Medications as ordered. Teach SE and desired
effects.
Provide eye protection
S&S Thyroid Storm
Possible Preop
S&S
1. Tachycardia >1 30/min
2. Hyperpyrexia Up to 106
3. Exaggerated symptoms of Hypertension
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Goals:
Maintain airway
Prevent CV collapse
Reduce body temp
Reduce metabolic
demands
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Airway
EKG monitor
Acetominophen
Cool sponge baths
PTU
Propanalol
IVF
Insulin
Sodium iodide
Insulin
O2
Inflammation of the Thyroid Gland.
Three types
A. Acute
B. Subacute
C. Chronic (Hashimoto’s disease)
Classification:
A. Benign- associated with thyrotoxicosis or
glandular enlargement (goiter)
B. Malignaat
1. Papillary,
2. Follicular
3. Medullary
4. Anaplastic.
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Thyroid hormone replacement for life
CXR and total body scan yearly x 3 years
Assess for signs of recurrence
Follow up with T4, T3, serum Ca and Phos
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Pre Op:
Antithyroid hormone and SSKI Iodine to
reduce activity and decrease vascularity
Nutritional assessment
Expalnation of procedure and post op course
Teach support of neck incision to prevent strain
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Postoperative care:
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Hemorrhage
Respiratory distress
AIRWAY, SUCTION AND TRACH SET AT
BEDSIDE
Humidified O2
Semi-fowlers with pillows on either side of neck
Hypocalcemia and tetany
Laryngeal nerve damage
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Pain Management
Nutrition
Rest, relaxation, and avoidance of stress
Thyroid storm or thyroid crisis- uncontrolled
hyperthyroidism triggered by stressors
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Parathyroid glands: calcium and phosphate
balance
Hypercalcemia (Norm 9.0-10.5 mg/dL) and
hypophosphatemia
Sign & Symptoms
Nonsurgical management:
Diuretic and fluid therapy
 Drug therapy: phosphates, calcitonin, calcium
chelators (Mithramycin)
 Nutrition
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Parathyroidectomy preoperative care:
 Client stabilized; calcium levels normalized
 Studies: bleeding and clotting times, CBC
 Teaching: coughing, deep-breathing exercises,
neck support
 Operative procedures- transverse incision in
lower neck. All 4 glands are check for
enlargement
 Minimal Parathyroid Surgery
http://www.parathyroid.com/MIRP-Surgery.htm
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Postoperative care includes:
Observe for respiratory distress.
 Keep emergency equipment at bedside.
 Hypocalcemic crisis can occur.
 Recurrent laryngeal nerve damage can occur.
 Lifetime Ca and Vitamin D supplements
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Decreased function of the parathyroid gland
CAUSES:
Iatrogenic hypoparathyroidism
Idiopathic hypoparathyroidism
Hypomagnesemia (Norm 1.6-2.6 mg/dL)
INTERVENTIONS:
Correct hypocalcemia, vitamin D deficiency, and
hypomagnesemia
Tx: Rocaltrol – Vitamin D compound
PO Calcium intake up to 2Gm /day
Following thyroid resection, the nurse frequently
assesses the client's ability to speak. What is the
nurse evaluating with this intervention?
A.Changes in level of consciousness
B.Recovery from anesthesia
C.Injury to parathyroid gland
D.Spasm or edema of the vocal cords
In reviewing laboratory results in the client with
Hashimoto's thyroiditis, the nurse expects
which of the following?
A.Elevated thyroxine
B.Elevated triiodothyronine
C.Elevated thyroid-stimulating hormone
D.Elevated plasma catecholamines
The nurse correlates which clinical
manifestations with the diagnosis of
hyperthyroidism?
A.Fatigue, weight gain, cold intolerance
B.Decreased pulse rate, slurred speech, anorexia
C.Abdominal pain, constipation, heat intolerance
D.Nervousness, weight loss, tachycardia
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The nurse monitors for which of the following
as indicative of effective treatment of
hypothyroidism?
A.Decreased sweating
B.Weight gain
C.Decreasing heart rate
D.Increasing energy level
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The nurse recognizes that the client with
Graves' disease is at risk for which of the
following complications?
A.Corneal ulceration
B.Pitting edema
C.Hypotension
D.Urinary retention
Which of the following statements by the client
on thyroid replacement therapy indicates the
need for further teaching?
A.“I should take this every morning.”
B.“If I continue to lose weight, I may need to have
the dose increased.”
C.“I should have more energy with this
medication.”
D.“If I gain weight and feel tired all the time, I
may need the dose increased.”
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