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Thyroid part 2

Thyroid part 2. Hypothyroidism. Hypothyroidism. Definition i TH Pathophysiology Primary hypothyroidism Thyroid fails to produce enough TH Secondary Hypothyroidism i stimulation  Thyroid (pituitary or hypothalmus). Hypothyroidism. Etiology Primary Congenital I deficiency

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Thyroid part 2

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  1. Thyroid part 2 Hypothyroidism

  2. Hypothyroidism Definition • i TH Pathophysiology • Primary hypothyroidism • Thyroid fails to produce enough TH • Secondary Hypothyroidism • i stimulation  Thyroid (pituitary or hypothalmus)

  3. Hypothyroidism Etiology • Primary • Congenital • I deficiency • Auto-immune • Thyroidectomy • Secondary • Pituitary / hypothalamus

  4. Hypothyroidism S&S • Think ______ • Slow

  5. HypothyroidismS&S Neurology • Slow mentation • Slurred speech Affect • Lethargy • depression

  6. HypothyroidismS&S Cardiovascular • Bradycardia Gastro-intestinal • Constipation • Weight gain • Appetite loss

  7. HypothyroidismS&S Muscular-skeletal • Clumsy slow movements • Fatigue • Cold intolerance • Dull facial expression

  8. HypothyroidismS&S Skin • Dry, pale • Hair dry • Thick lips • Puffy eyes

  9. Hypothyroidism Cretinism • Rare in the US • Congenital condition d/t i TH  physical & mental retardation • 18yr old

  10. Hypothyroidism Hashimoto’s thyroiditis • Most common adult hypothyroidism • Auto-immune • Female > male • Age: • 30-50

  11. By definition hypothyroidism means what? T3/T4 i HypothyroidismDiagnostic Tests

  12. HypothyroidismDiagnostic Tests • By definition primary hypothyroidism means what? (where is the problem – what is causing the problem?) • Thyroid  • i T3/T4 • In primary hypothyroidism, is the pituitary gland working correctly? • Yes

  13. If the pituitary gland is working correctly and there is an i T3/T4 level, what will the Pituitary gland do with the TSH level? HypothyroidismDiagnostic Tests

  14. By definition hypothyroidism means what? T3/T4 i HypothyroidismDiagnostic Tests

  15. HypothyroidismDiagnostic Tests • By definition secondary hypothyroidism means what? (where is the problem – what is causing the problem?) • Pituitary gland • i TSH  • i T3/T4

  16. By definition secondary hyporthyroidism means what? (where is the problem – what is causing the problem?) Pituitary gland i TSH  i T3/T4 HypothyroidismDiagnostic Tests

  17. HypothyroidismMedical Treatment Rx / life time • Thyroid (Armour thyroid) • Natural form • Levothyroxine sodium / Levothroid, Synthroid • Synthetic • Time of dose • AM • Monitor __________system • C/V • Gradually h meds • takes 2 wks to know full affect • Blood level monitoring • Annually • Know S&S and report

  18. HypothyroidismMedical Treatment Diet • Fiber • h • Protein • h • Fluids • h • Calories • i • Avoid food h in I (interferes with meds)

  19. Avoid food h in I • Kelp • Shellfish • Iodized salt • Cabbage • Turnips • Pears • Peaches

  20. HypothyroidismNursing management • Rest • Space • Skin • Protect • Diet • Adjust

  21. Severe Hypothyroid State Myxedema • Definition • Advanced hypothyroidism • Etiology • Iodine deficiency • Atrophy of thyroid • Surgery • Destruction of thyroid by I 131

  22. Hypothyroidism SevereMyxedema Characteristics • Growing puffiness & sogginess of the skin • Dry, waxy edema (non-pitting) • Abnormal deposits of mucin in the skin • Distinctive facial changes

  23. Hypothyroidism Severe Myxedema Coma • Met. Rate drops so low  life threatened • Temperature • < 95 F • Blood pressure • i • Glucose • i • Mental function • i

  24. Hypothyroidism Severe Myxedema Coma • Death d/t… • Respiratory Failure

  25. Goiters Definition • Enlarged thyroid Pathophysiology

  26. Review! • What hormone causes the thyroid to grow? • TSH • What hormonal change causes goiters? • h TSH

  27. Goiters Definition • Enlarged thyroid Pathophysiology • h TSH levels  goiters Etiology • i TH levels • i Iodine • PG

  28. Goiters • Endemic goiter • Caused by environmental factors • i iodine

  29. Goiters • Are goiters assoc. with • Hyperthyroidism • YES! • Hypothyroidism • YES! • Euthyroid state • YES! • All of the above

  30. Goiters Goitrogens • Suppress thyroid function • Broccoli • Cauliflower • Cabbage • Turnips • Sulfonamide • Lithium • Salicylates

  31. Goiters S&S • Enlarged thyroid Complications • May interfere with • Respiration • Swallowing

  32. Goiters Nursing Management • Diet • Limit goitrogens • Assess • Breathing • Stridor • Swallowing • Palpate???? • NO!

  33. Cancer of the Thyroid gland Etiology • Rare • F>M • Thyroid hyperplasia • Radiation • Iodine deficiency

  34. Cancer of the Thyroid gland • #1 S&S • Nodule on thyroid • Hard • Painless

  35. Cancer of the Thyroid gland S&S • Difficulty swallowing or breathing • Changes in voice • Lab values • Normal TH levels

  36. Cancer of the Thyroid gland Diagnostic Tests • Thyroid scan • Shows “cold” spot • Area that did not take up radioactive material • Indicates malignancy • Biopsy • Confirms diagnosis

  37. Cancer of the Thyroid gland Medical Management • Thyroidectomy • Partial • Total • Chemotherapy

  38. Cancer of the Thyroid gland Nursing Management- thyroidectomy • Pre-op • Euthyroid state • Verify meds taken

  39. Cancer of the Thyroid gland Nursing Management- thyroidectomy • Post-op • Vital Signs • i BP & h Pulse = • Shock d/t hemorrhaging • h Pulse h fever h BP = • Thyrotoxic crisis

  40. Cancer of the Thyroid gland Nursing Management- thyroidectomy • Post-op • Check hemohaggin • back of neck for pooling blood • Check for S&S of dyspnea or resp distress • Check speech • Semi-fowlers position

  41. Cancer of the Thyroid gland Nursing Management- thyroidectomy • Post-op • Activity • Support neck • Monitor for Tetany • Continuous tonic spasm • Tracheostomy set at bed side • Resp. obstruction • Diet Changes (esp. if hyperthyroidism) Tetany Tetanus

  42. Thyroidectomy Complications • Thyrotoxic crisis • D/t manipulation of thyroid during surgery  • release large amount of TH

  43. ThyroidectomyComplications Tetany • D/T low Ca levels • Characterized by • Fingers & perioral area tingling • Muscle spasm • Twitching • Cardiac Dysrhythmias • Etiology • D/t removal of parathyroid gland • Treatment • IV Calcium gluconate • Breath into a paper bag  • mild acidosis  • h Calcium in blood

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