Thyroid Gland Notes

Thyroid Gland

• Located in the anterior neck

• Consists of 2 lobes

• 1 gland

Thyroid Gland Hormones

1. T3 - Triiodothyronine

2. T4 - Tetraiodothyronine

3. Thyrocalcitonin

1. T3 - Triiodothyronine

2. T4 - Tetraiodothyronine

Metabolic Hormones

Thyrocalcitonin

• Calcium reabsorption

• ↓ Calcium

Simple Goiter

Enlarged thyroid gland due to ↓ thyroid hormone

Predisposing Factors of Simple Goiter

1. Goitrogenic Area - Far from sea areas; mountain area; Endemic

2. Goitrogenic Food - Progoitrin - ↓ Iodine; Sporadic

   • Ex: Strawberry, All nuts, Turnips, Cabbage, Radish

3. Goitrogenic Drugs - Lithium (Bipolar disorder), Acetylsalicylic Acid (ASA), Propylthiouracil (PTU)

Assessment of Simple Goiter

1. Irritability, Agitated

2. Enlargement of thyroid gland

Diagnostics of Simple Goiter

1. T3 - 80 to 180 mg/dl

   T4 - 0.8 to 1.8 mg/dl

2. ↑ TSH - 0.4 to 4.5 mIU/L

3. Thyroid Scan - To assess the enlargement of thyroid gland

Nursing Management of Simple Goiter

1. DOC: Levothyroxine (Synthroid)/Liothyronine

2. Best time to take the meds in the morning to prevent Insomnia

3. WOF: Tachycardia, Palpitation, Insomnia

4. Iodine-Rich Food

   a. Seaweed - 99%

   b. Crabs

   c. Shrimp

5. Administer Lugol’s Solution/SSKI - Use straw

   a. Prophylaxis - 2 to 3 drops

   b. Medication/Therapeutic - 5 to 6 drops

6. Iodized Salt

7. WOF: Iodism - Too much Iodine as evidenced by brassy-taste like

8. Surgery - Subtotal Thyroidectomy (1 lobe removed)

Hypothyroidism

• An endocrine that can be diagnosed through telephone call due to hoarseness of voice

• ↓ T3/T4

Cretinism

• An endocrine disorder that leads to mental retardation

• Hypothyroidism in Pediatric

Myxedema Coma

Hypothyroidism in Adult

Predisposing Factors of Hypothyroidism

1. Iatrogenic Cause - Due to surgery ff. Subtotal/Total Thyroidectomy

2. Atrophy of Thyroid Gland - Due to radiation therapy, tumor, inflammation

3. Iodine Insufficiency

4. Autoimmune (Hashimoto’s Disease/Chronic Lymphocytic Thyroiditis) - Destruction of own thyroid cell

Assessment of Hypothyroidism

Early Signs

1. Agitation

2. Cold Intolerance

3. Loss of Appetite

4. Constipation

5. Weight Gain - ↓ Metabolism

6. Weakness/Fatigability

Assessment of Hypothyroidism

Late Signs

1. Dry/Brittle Hair

2. ↓ Vital Signs

3. ↓ Libido

4. Lethargy

5. Menorrhagia (Excessive menstruation)

6. Pitting or Non-Pitting Edema

7. Hoarseness of Voice

Nursing Management of Hypothyroidism

1. WOF: Myxedema Coma - Severe type of _ as evidenced by:

   a. Hypovolemic Shock

   b. Hyponatremia

   c. Hypoglycemia

   d. Bradycardia

   e. Bradypnea

   f. Hypotension

2. Administer medications: Levothyroxine/Liothyronine

3. ↓ Calorie diet

4. Provide calm environment

5. Force fluid - 2 to 3 Liters

6. Avoid the ff: Stress, Infection, Cold Environment

   X No Anesthesia

7. WOF Complications:

   a. Atherosclerosis

   b. Angina Pectoris

   c. Myocardial Infarction

   d. Myxedema Coma

   e. Stroke

Hyperthyroidism

↑ T3/T4

Predisposing Factors of Hyperthyroidism

1. Excessive iodine

2. Hyperplasia of thyroid gland

3. Autoimmune

Signs and Symptoms of Hyperthyroidism

1. Weight Loss

2. Hyperphagia

3. Moist Skin

4. Amenorrhea - Absence of menstruation

5. Irritability

6. Exophthalmos - Drooling of eyeballs

Exophthalmos

Pathognomonic Sign of Hyperthyroidism

Nursing Management of Hyperthyroidism

1. Administer medications: PTU, Methimazole, Tapazole

   WOF: Agranulocytosis - ↑ Agranulocytes WBC

   a. Monocyte

   b. Lymphocyte

   • Complains sore throat

2. Calorie diet

3. Monitor VS accurately. WOF: Thyroid Storm

4. Meticulous skin care

5. Bilateral eye patch

6. Assist in Subtotal/Total Thyroidectomy

7. Hormonal Replacement

   a. Subtotal - 6 months

   b. Total - Lifetime

Signs and Symptoms of Thyroid Storm

1. Hyperthermia

2. Agitation

3. Tachycardia

Thyroidectomy Postoperative Complications

1. Hypocalcemia

2. Laryngeal Nerve Damage

3. Bleeding

Thyroidectomy Postoperative Complications

Hypocalcemia

• Due to accidental hit of parathyroid gland during operation

  NSG. MGMT.

• WOF: Chvostek’s Sign and Trousseau’s Sign] Tetany

• Monitor Ionized Calcium post subtotal/total thyroidectomy. N: 4.5 to 5.1 mg/dl

• In case of Hypocalcemia: Administer Calcium Gluconate - Slow IV push to prevent IV burn/Arrhythmia

Thyroidectomy Postoperative Complications

Laryngeal Nerve Damage

• Due to accidental hit of the laryngeal nerve during operation

  NSG. MGMT.

• WOF: Hoarseness ot the voice

• Prepare at bedside: Tracheostomy Set, Suction Set, ET Tube

Thyroidectomy Postoperative Complications

Bleeding

• Fullness of site of operation

  NSG. MGMT.

• Monitor VS/Signs and Symptoms of Hypovolemic Shock

• Monitor operation site such as dressing