Thyroid Disorders

T3 and T4 regulate

energy metabolism, growth, and development

goiter

enlarged thyroid gland
#1 cause= lack of iodine
could have normal function, or hypo/hyperthyroid (check labs to determine)

goitrogen

toxin interferes with the function of the thyroid gland.
obtained through broccoli, strawberries, turnips or drugs such as salicylates or lithium

thyroid nodules

-benign or malignant
-need a biopsy to determine
-common >40 yrs
-can lead to compression on the trachea
-thyroid scan

thyroiditis

- inflammation of thyroid gland
- Hashimoto's disease: chronic autoimmune hypo (TSH is up; T4 is down)
- acute thyroiditis: bacterial or fungal
- subacute granulomatous: viral

Thyroiditis treatment

-antibiotic for bacterial
-thyroid replacement= hypothyroid
-beta blocker for hyperthyroid
-sub/acute= salicylates + anti-inflammatory or corticosteroids if not responsive

Hyperthyroidism

-most common in women 20-40 yrs
-most common from graves disease (an autoimmune disorder w periods of remission/exacerbation)
- goiters
- excessive thyroid hormone secretion

symptoms of hyperthyroidism

everything speeds up
-exophthalmos
-weight loss
-diarrhea
-dyspnea
-systolic hypertension
-systolic murmurs or arrhythmias
-increased pulse rate
-warm, moist skin
-thin brittle nails
-hair loss; fine silky hair
-diaphoresis
-clubbing
-angina

Thyroid Storm (Thyrotoxic Crisis)

- hyperthyroid symps increased
- life threatening emergency usually from a stressor
- severe tachycardia, HF, shock, hyperthermia, restlessness, seizures, delirum, increased GI symps
-give beta blockers

diagnostic studies for hyperthyroidism

-TSH down and T4 up = thyroid gland/primary hyperthyroidism
-TSH up and T4 up= pituitary gland/secondary

antithyroid meds

Propothiouracil (PTU) and Methimazole (Tapazole)
-first line PTU for pregnancy or before surgery
- 1-2 weeks to show improvement

Iodine

-SSKi or Lugols solution
- decreases vascularity of thyroid
- prep for surgery or thyroid storm
- effects in 1-2 weeks; not for long term use
- se: not common, sore mouth, skin reaction or GI

radioactive iodine therapy

- first line for nonpreg adults (must do preg test first)
- damages thyroid tissue to slow down secretion
- takes longer to work (up to 3 months)
- risk for hypothyroidism
- avoid children, flush multiple times, don’t prepare food with bare hands, separate laundry etc
-se: dry mouth and throat irritation

beta blockers

manage symptoms of hyperthyroidism

indications for surgery for hyperthyroidism

1. large goiter pressing on trachea
2. unresponsive to antithyroid therapy
3. thyroid cancer
4. can not receive RAI

subtotal thyroidectomy

removes 90% of the throid tissue (other 10% will function)
- for pts unresponsive to antithyroid or not candiate for RAI
-must be able to tolerate hypothyroidism while body readjusts
if cancer pt= remove whole thyroid

priority intervention for surgical intervention

airway

Nutrition for hyperthyroidism

high calorie, high protein, high carbs, frequent meals and snacks

caring for a acute thyrotoxicosis (thyroid storm)

1. monitor for cardiac arrhythmias, O2, hyperthermia, and increased resps
2. administer meds to handle symps
3. start an Iv and give fluids to replace from diarrhea/vomiting
4. cool, private room
5. may still have energy for tasks such as making ones bed, but have a loss of fine motor skills.
6. Elevate HOB for exophthalmos and no extra added salt to diet

Preop care for a pt undergoing thyroid surgery

1. PTU and iodine to achieve euthyroid state
2. teach to support head when moving
3. talking may be difficult postop

postop care for a pt after thyroid surgery

1. monitor for hypocalemia -> parathyroid may have accidentally been removed
2. monitor for hemorrhage -> airway concern
3. monitor for thyroid storm-> excess hormone release
- pt may get worse before they get better
4. have O2, suction and trach tray nearby after surgery
-stridor indicates not enough air going through
5. monitor for laryngeal nerve damage
6. hoarseness normal for 3-4 days postop
7. pain is usually controlled
-if 10, worried about a possible complication

early sign of hypocalcemia

numbness and tingling around the lips, toes and fingers

positioning postop thyroidectomy

semi fowlers with pillows for support
avoid neck flexion

other signs of hypocalcemia

1. Positive trousseau and Chvostek -> spasm=positive
2. tetany
3. difficulty speaking/hoarseness

home care postop thyroidectomy

1. adequate iodine and reduce high caloric intake (seafood and salt)
2. regular exercise
3. avoid high temps-> uncomfortable for these pts
4. follow ups for potential hypothyroidism/thyroid replacement drugs (once on, on for the rest of their lifespan)

Pts that have undergone a total thyroidectomy will need...

lifelong thyroid replacement

Hypothyroidism

A disorder caused by a thyroid gland that is slower and less productive than normal
-most common in women

primary hypothyroidism

destruction of thyroid tissue or defective hormone synthesis

es: removal of thyroid gland could cause this

- T4 down, TSH is up

secondary hypothyroidism

Caused by pituitary or hypothalamic dysfunction (

-T4 down, TSH down

number 1 symptom of hypothyroidism

weight gain

Causes of hypothyroidism

most common: iodine deficiency
-result of treatment of hyperthyroidism
- Hashimotos disease =most common in US
-drugs (lithium)

symptoms of hypothyroidism

-everything slows down
- lethargy, fatigue
-personality changes
-impaired memory
-anemia
-constipation
-cold intolerance
-hair loss/dry, coarse skin
-muscle weakness
-commonly confused w depression

Myxedema coma

-complication of hypothyroidism
-impaired consciousness
-low temp, hypotension, hypoventilation
-caused by infection, drugs (opiods), cold or trauma
-give IV thyroid hormone replacement to bring back up
-avoid sedatives and narcotics

related diagnostic tests

1. cholesterol up
2. triglycerides up
3. creatine kinase up
4. RBCs down (anemia)
-these support T4 and TSH readings

Levothyroxine (Synthroid)

-replacement therapy for hypothyroidism
-start as a low dose and increase if needed
-check cardiac function prior to and after administration (report >100)
-can decrease the effectiveness of digoxin or anticoagulants
-single dose before breakfast
-usually given IV push
-stool softeners/laxatives; no enemas
-do not switch brands
-lifelong treatment
-SE: hyperthyroid symps such as tachycardia, palpitations, diarrhea, vomiting, tremors