Thyroid and parathyroid and meds

What is hyperthyroidism?

Sustained increased synthesis and release of thyroid hormones, especially T4 and T3.

What is the most common cause of hyperthyroidism?

Graves' disease, an autoimmune disorder causing diffuse thyroid enlargement and excess thyroid-hormone secretion.

What other causes of hyperthyroidism are listed?

Toxic nodular goiter, thyroiditis, excess iodine intake, pituitary tumors, and thyroid cancer.

Who is more commonly affected by hyperthyroidism?

Women, especially ages 20–40, in the lecture notes.

Why is TSH low in Graves' hyperthyroidism?

High thyroid hormone suppresses pituitary TSH production through negative feedback.

What eye finding is associated with Graves' disease?

Ophthalmopathy/exophthalmos: fat/fluid increase pushes the eyeballs outward; lid lag, stare, and eyelid retraction may occur.

What thyroid assessment finding can occur with hyperthyroidism?

Goiter on palpation and a bruit on thyroid auscultation.

What general metabolic symptoms occur in hyperthyroidism?

Heat intolerance, elevated basal temperature, sweating, weight loss despite increased appetite, thirst, diarrhea, and rapid speech.

What cardiovascular findings occur in hyperthyroidism?

Systolic hypertension, palpitations, tachycardia, increased cardiac output, murmurs, dysrhythmias, angina, and possible hypertrophy.

What respiratory/GI findings occur in hyperthyroidism?

Dyspnea with mild exertion/tachypnea; increased appetite, weight loss, diarrhea, and possible hepatosplenomegaly.

What musculoskeletal/skin findings occur in hyperthyroidism?

Fatigue, weakness, proximal muscle wasting, osteoporosis; warm smooth moist skin, brittle nails, fine hair/hair loss, diaphoresis, palmar erythema, clubbing, and vitiligo.

What reproductive findings occur in hyperthyroidism?

Menstrual irregularities/amenorrhea, decreased libido, infertility, impotence, and gynecomastia in men.

What tests diagnose/evaluate hyperthyroidism?

TSH, free T4, total T3/T4, thyrotropin-receptor antibodies, and radioactive iodine uptake (RAIU).

What does RAIU show in hyperthyroidism and what is its safety issue?

Elevated uptake supports hyperthyroidism/helps differentiate Graves; it is contraindicated in pregnancy and allergy history should be assessed.

What nutrition is recommended for hyperthyroidism?

High-calorie/high-protein diet with frequent meals/snacks; increased carbohydrates; avoid caffeine, highly seasoned, and high-fiber foods.

What are the three main hyperthyroidism treatments?

Antithyroid medication, radioactive iodine therapy, and surgery.

What are PTU and methimazole used for?

Treatment of hyperthyroidism; thioamides prevent thyroid-hormone formation and partly inhibit T4-to-T3 conversion.

What do high-dose iodine solutions do?

Block thyroid function.

What are beta blockers used for in hyperthyroidism?

Treat sympathetic symptoms such as palpitations, tachycardia, and heat intolerance.

What nursing interventions help a hyperthyroid client?

Alternate activity/rest, provide a calm cool environment, monitor weight/I&O/VS/ECG/nutrition, and manage diaphoresis with cool showers/linen changes.

Why should a 1°F temperature increase be reported in hyperthyroidism?

It may indicate impending thyroid storm.

What eye care is needed with exophthalmos?

Artificial tears, dark glasses, HOB elevation/salt restriction as ordered, and tape eyelids closed for sleep if needed.

What is thyroid storm?

Life-threatening acute thyrotoxicosis/hypermetabolic crisis caused by excessive thyroid hormone and increased SNS sensitivity.

What can precipitate thyroid storm?

Uncontrolled hyperthyroidism, infection, trauma, emotional stress, DKA, digitalis toxicity, surgery, or thyroid-gland manipulation.

What are thyroid-storm manifestations?

Severe tachycardia/heart failure, shock, hyperthermia, agitation, seizures, abdominal pain, vomiting/diarrhea, delirium, coma.

What are priority interventions for thyroid storm?

Maintain airway/oxygenation, continuous dysrhythmia monitoring, fluids/electrolytes, PTU or methimazole to reduce hormone production, and beta blockade such as propranolol.

Which antipyretic is preferred in thyroid storm and what should be avoided?

Acetaminophen may be used; avoid aspirin because it releases thyroxine from protein-binding sites.

What is hypothyroidism?

Inadequate circulating T3 and T4 causing generalized slowing of metabolism.

What causes primary versus secondary hypothyroidism?

Primary: thyroid tissue destruction/defective hormone synthesis. Secondary: pituitary/hypothalamic dysfunction causing low TSH or TRH.

What cardiovascular findings occur in hypothyroidism?

Decreased contractility/output, bradycardia/dysrhythmias, increased cholesterol/triglycerides, anemia, low exercise tolerance, and dyspnea on exertion.

What neurologic symptoms occur in hypothyroidism?

Fatigue/lethargy, mood/personality changes, memory impairment, slowed speech, decreased initiative, and somnolence.

What GI symptoms occur in hypothyroidism?

Decreased appetite, nausea/vomiting, weight gain, constipation, distended abdomen, and enlarged scaly tongue.

What skin/musculoskeletal findings occur in hypothyroidism?

Dry thick cold inelastic skin, brittle nails, dry sparse coarse hair, puffy face/interstitial edema, pallor, decreased sweating, weakness, aches, slow movement, and arthralgia.

What reproductive findings occur in hypothyroidism?

Prolonged menses or amenorrhea, decreased libido, and infertility.

What lab pattern occurs in primary hypothyroidism?

Low T3/T4 with increased TSH; cholesterol is increased and radioisotope uptake is low.

What lab pattern occurs in secondary hypothyroidism?

Low T3/T4 with decreased TSH.

What ECG findings can occur in hypothyroidism?

Sinus bradycardia and dysrhythmias.

What nursing care is important in hypothyroidism?

Monitor cardiovascular/respiratory/mental status and weight; gradually increase activity with rest; low-calorie diet, fluids for constipation, skin/repositioning care, and warmth without heating devices.

Why should heating devices be used cautiously in hypothyroidism?

Reduced sensation/alertness and vasodilation increase burn risk.

What is levothyroxine?

Synthetic T4 and the common drug of choice for hypothyroidism because it has consistent potency and once-daily dosing.

How should levothyroxine be taken?

Once daily before breakfast, on an empty stomach, with a full glass of water; typically in the morning.

What medications can reduce levothyroxine absorption?

Cimetidine, lansoprazole, sucralfate, colestipol, and excessive grapefruit juice; giving after meals also decreases absorption.

What medications can accelerate levothyroxine metabolism?

Phenytoin, carbamazepine, and rifampin.

What medications may need adjustment with levothyroxine?

Warfarin effects can increase; insulin and digoxin requirements may change.

What signs suggest excessive levothyroxine dose?

Increased pulse/BP, chest pain, nervousness, tremors, and other hyperthyroidism manifestations.

How is levothyroxine started in older adults?

At a low dose and gradually increased to prevent toxicity.

Should levothyroxine continue during pregnancy?

Yes; hypothyroid clients generally continue replacement during pregnancy as directed.

What is myxedema coma?

Life-threatening severe hypothyroidism, often triggered by stress/illness or untreated disease.

What are myxedema-coma findings?

Respiratory failure, hypotension, hypothermia, bradycardia/dysrhythmia, hyponatremia, hypoglycemia, and coma.

What are priority interventions for myxedema coma?

Airway/ventilatory support, continuous ECG/ABG/mental-status/temperature monitoring, IV 0.9% saline, IV levothyroxine, I&O monitoring, glucose for hypoglycemia, and treatment of the cause.

What are other thyroid replacement products?

Desiccated thyroid (T3/T4), liothyronine (synthetic T3), and liotrix (T4/T3 combination).

What are key antithyroid-agent adverse effects?

Thioamides can cause thyroid suppression; iodine solutions can cause hypothyroidism.

What major cautions/assessments apply to antithyroid agents?

Assess allergy, pregnancy/lactation, liver dysfunction, pulmonary edema/TB, skin lesions, mental status, pulse/BP/ECG, respiratory status, and thyroid tests.

What is hypoparathyroidism?

Too little/absent parathormone, commonly after accidental parathyroid removal during thyroid surgery.

What is hyperparathyroidism?

Excess parathormone, often from parathyroid tumor or certain genetic disorders.

What do antihypocalcemic agents such as teriparatide/PTH do?

Increase calcium by promoting bone calcium release, intestinal absorption, renal calcium resorption, and calcitriol production.

What are indications for antihypocalcemic agents?

Hypoparathyroidism and hypocalcemia management in chronic renal dialysis.

What key risks apply to antihypocalcemic agents?

Hypercalcemia, vitamin toxicity, renal stones, GI/CNS effects; monitor calcium, magnesium, alkaline phosphatase, renal/liver status.

How do bisphosphonates and calcitonin lower calcium?

Bisphosphonates slow/block bone resorption; calcitonin inhibits bone resorption and increases renal excretion of calcium, phosphate, and sodium.

What are common bisphosphonate adverse effects and teaching?

Headache, nausea, diarrhea, and bone pain; ensure calcium/vitamin D intake and monitor renal function/electrolytes.

What adverse effects can calcitonin cause?

Facial/hand flushing, rash, nausea/vomiting, urinary frequency, and local injection-site inflammation.