Nurs 3366 - Disorders of ADH and TSH

What are the Hormones released by the Pituitary gland?

• antidiuretic hormone (ADH)

• thyroid-stimulating hormone (TSH)

• adrenocorticotropic hormone (ACTH)

What are the two diseases that arise from ADH problems?

• diabetes insipidus (DI) [undersecretion]

• syndrome of inappropriate antidiuretic hormone (SIADH) [oversecretion]

What is the function of ADH?

ADH “tells” kidneys to “hang onto” water by decreasing urine output

What is Diabetes Insipidus?

under secretion of ADH (antidiuretic hormone)

• to diabetes means to pass too much urine; insipidus means flavorless urine

What are the S&S of Diabetes Insipidus?

• polyuria - void a lot of dilute urine, extreme thirst

• with loss of water —> serum osmolality INCREASES —> causing water to shift from T to B

• S&S of dehydration - poor skin turgor & dry mucous membranes

What are the S&S of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

oversecretion of ADH

• high levels of ADH cause retention of water —> decreasing urination (oliguria)

• water gain will cause a DECREASE in the serum osmolality —> water will shift from B to T —> causing edema

What are the hormones released by the Thyroid stimulating hormone?

• thyroxine (T4) and triiodothyronine (T3) - regulate many metabolic activities of body

• calcitonin - increases calcium movement from blood into bone

What is Hyperthyroidism?

a state of excess T3 & T4 secreted by the thyroid

• most common cause is autoimmune disease called Graves’ disease, in which autoantibodies mimic TSH by fitting into TSH receptors on the thyroid & causing it to over-secrete T3 & T4

What are the S&S of Hyperthyroidism?

• state of metabolism overdrive—pt is often nervous, irritable,

• CV – tachycardia

• GI - increased appetite but pt stays very thin & fatigued from hypermetabolism

• exophthalmos—tissue build-up behind eyes

• goiter - enlarged thyroid gland from hyperplasia and hypertrophy

How do you diagnose Hyperthyroidism?

lab— T4 will be higher than normal range and TSH will be lower than normal due to a negative feedback loop

What is the extreme version of Hyperthyroidism?

thyrotoxic crisis (AKA thyroid storm)

• severe tachycardia, heart failure, shock

• extreme restlessness & agitation; delirium; seizures; coma

• diaphoresis, hyperthermia (103-105 F)

What chemical compound is the production of T3 and T4 dependent on?

iodide

• in iodized salt

What is the treatment for Hyperthyroidism?

• antithyroid meds that inhibit synthesis of thyroid hormones

• surgery-- thyroidectomy (usually ~ 90 % removed)

What is Hypothyroidism?

low thyroid hormone secretion

• one of most common causes is Hashimoto’s thyroiditis—autoimmune disease in which autoantibodies directly destroy tissue —> scarring, nonfunctional tissue

What are the S&S of Hypothyroidism?

• psych/CNS—confusion, slow speech & thinking

• circulatory—anemia, bradycardia

• GI—decreased appetite, constipation

• face takes on a bloated appearance called myxedema - fluid trapped under dermis of skin

• goiter from thyroid tissue trying to compensate for undersecretion

How do you diagnose Hypothyroidism?

lab - T4 will be lower than normal range and TSH will be higher than normal

What is the Extreme state of Hypothyroidism?

myxedema coma or crisis

• manifested by progression of hypothyroid sluggishness & drowsiness into gradual or sudden impaired consciousness

What is the treatment of Hypothyroidism?

synthetic thyroid hormone -- levothyroxine (Synthroid)