1. Endocrine � Thyroid gland Part 1

2. Description: Thyroid Butterfly shaped Two lobes connected by an isthmus Straddles the trachea Largest endocrine gland

3. Function: Thyroid Produce thyroid hormones (TH) Vital for growth & metabolism Iodine storage Essential for T3/T4 syntheses

4. Hormones

5. Thyroid Hormones

6. Hormone Loop i Metabolic rate ? Detected by hypothalamus ? Stimulates anterior pituitary ? Secretes TSH ? Blood stream ? target organ ? thyroid Stimulate Thyroid to secrete T3/T4 ? Blood stream ? target organs ? adrenal medulla ? Secretes Epinephrine & Norepinephrine ? h Metabolic rate

7. Thyroid Disorders World-wide Iodine deficiency United States Auto-immune

8. Hyperthyroidism Definition h T3/T4 in blood Pathophysiology Primary hyperthyroidism Problem with thyroid gland ? h T3/T4 Secondary hyperthyroidism Problem with pituitary gland ? h T3/T4 Pituitary ? h TSH ? h T3/T4 h TSH ? thyroid growth ? goiter

9. Hyperthyroidism Etiology Auto-immune AKA: Grave�s disease F vs M? F > M Age 20-40 yrs

10. HyperthyroidismS&S Neurological Heat intolerance Diaphoresis h sympathetic nervous response

11. HyperthyroidismS&S Affect Nervous Emotional lability Irritable I Concentration Mood swings ? manic/psychotic

12. HyperthyroidismS&S Cardiovascular Tachycardia Palpitations

13. HyperthyroidismS&S Gastrointestinal Appetite h Weight i BM h Diarrhea

14. HyperthyroidismS&S Muscle-skeletal Tremors Restlessness Muscle weakness

15. HyperthyroidismS&S Skin Temperature Warm Smooth Hair Fine, soft Gray h Loss

16. HyperthyroidismS&S Exophthalmos Bulging of the eye Stare

17. HyperthyroidismS&S Goiter Enlarged thyroid TSH levels h

18. HyperthyroidismS&S Oncholysis Distal nail separates from the nail bed Nail fragile

19. HyperthyroidismS&S Gynecomastia Abnormal enlargement breasts male

20. HyperthyroidismS&S Elderly Heart failure Fatigue Apathy Depression

21. Hormone Review i T3/T4 ? Pituitary ? h TSH ? Thyroid ? h T3/T4 ___________________ h T3/T4 ? Pituitary ? i TSH ? Thyroid ? i T3/T4

22. HyperthyroidismDiagnostic Tests By definition hyperthyroidism means what? T3/T4 h

23. HyperthyroidismDiagnostic Tests By definition primary hyperthyroidism means what? (where is the problem � what is causing the problem?) Thyroid ? h T3/T4 In primary hyperthyroidism, is the pituitary gland working correctly? Yes

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

25. HyperthyroidismDiagnostic Tests By definition hyperthyroidism means what? T3/T4 h

26. HyperthyroidismDiagnostic Tests By definition secondary hyperthyroidism means what? (where is the problem � what is causing the problem?) Pituitary gland? h TSH ? h T3/T4

27. HyperthyroidismDiagnostic Tests By definition secondary hyperthyroidism means what? (where is the problem � what is causing the problem?) Pituitary gland? h TSH ? h T3/T4

28. Question? Mrs. Goiter has a thyroid panel done and shows an elevated T3/T4 and an elevated TSH? Which of the following diagnosis apply? Primary hyperthyroidism Secondary hyperthyroidism Primary hypothyroidism Secondary hypothyroidism

29. Question? Mrs. Canta Geta Up has a thyroid panel done and shows an elevated T3/T4 and an decreased TSH? Which of the following diagnosis apply? Primary hyperthyroidism Secondary hyperthyroidism Primary hypothyroidism Secondary hypothyroidism

30. HyperthyroidismMedical Treatment Meds first Goal i T3/T4 levels Meds alone sometimes work - if not ? Surgery

31. HyperthyroidismMedical Treatment Anti-thyroid therapy Propylthioracil / PTU Methimazole / Tapazole Action Inhibits synthesis of T3/T4

32. HyperthyroidismMedical Treatment Propranolol hydrochloride / Inderal Beta-blocker i sympathetic nervous system No smoking

33. HyperthyroidismMedical Treatment Meds alone not ? Surgery If Ca Thyroid ? Surgery Euthyroid state before surgery! How? Anti-thyroid meds

34. HyperthyroidismMedical Treatment Iodine before surgery Potassium iodine saturated solution (SSKI) i vascularity of the thyroid i risk of post-op bleeding

35. HyperthyroidismMedical Treatment Radioactive Iodine I131 Used instead of radiation tx Stop anti-thyroid meds x 7 days Single dose S&S i in @ 3wks ? full effect in 3 months

36. HyperthyroidismMedical Treatment Radioactive Iodine Safety No PG nurses Watch body fluids Avoid kids x 7 days

37. HyperthyroidismMedical Treatment Diet (When hyperthyroid) Calories h 4,000-5,000 cal/day Fluids h Na i Fiber i Caffeine i

38. HyperthyroidismNursing Management Assessment Vital signs Lung sounds Anxiety level Weight Bowel function NEVER palpate goiter ? Release TH

39. HyperthyroidismNursing Management Nrs. Dx Risk for injury Hyperthermia Diarrhea Alt. Nutrition Sleep pattern disturbance Anxiety

40. HyperthyroidismNursing Management Exophthalmos Lubricate eyes Tape closed Dark glasses i Na diet HOB h

41. HyperthyroidismSevere Thyrotoxicosis AKA: Thyroid Storm Definition Sever hyperthyroid state Etiology Stress Post thyroid surgery Undiagnosed

42. Hyperthyroidism SevereThyrotoxicosis S&S h TH ? h adrenergic activity ? h epinephrine Pulse h Temperature h BP h Depression Activity Restlessness Delirium SOB Coma

43. Hyperthyroidism SevereThyrotoxicosis Death <2hr Cardiac Failure

44. Hyperthyroidism SevereThyrotoxicosis Treatment Fever Tylenol/ acetaminophen Not aspirin For h pulse & h BP Propranolol / Inderal Beta-adrenergic blocker If SOB O2 HOB h