Concepts of Care for Patients with Endocrine, Thyroid, and Parathyroid Gland Problems

general functions of the endocrine system

• Growth and development stimulation during childhood and adolescence

• Coordination of male and female reproductive systems

• Maintenance of optimal internal environment (homeostasis)

• Emergency responses to adaptive and corrective demands

pituitary gland key fx

• ”Master Gland” or Hypophysis

• Size of pea located in the Sella turcica under hypothalamus at base of brain above the sphenoid bone.

• Consist of two parts: Anterior & Posterior

what are the two parts of the pituitary gland

• Anterior Pituitary - Controls growth, appetite, metabolism, temperature, sexual development

• Posterior Pituitary - Releases vasopressin (ADH) to help the body hold water and keep fluids balanced; it is essential for maintaining normal BP and hydration

what is hypopituitarism 

• Deficiency of one or more hormones from the pituitary gland -> it can disrupt normal regulation if it is too low

common causes of hypopituitarism

• Pituitary tumor (most common) - compress and damage surrounding tissue

• Tumor or damage to the hypothalamus

• Head trauma, brain surgery, or radiation

• Severe shock or hypotension → ↓ blood flow → ↓ hormones

• Malnutrition or rapid fat loss

• Infection (HIV/AIDS)

• Idiopathic (unknown cause)

what are the most life-threatening hormone losses with hypopituitarism

• ↓ ACTH (adrenocortical tropic hormone) → ↓ adrenal hormones → risk for shock

• ↓ TSH (thyroid stimulating hormone) → ↓ thyroid hormones → slowed metabolism, ↓ vital signs, lethargy

nursing focus for hypopituitarism 

• Recognize early signs of adrenal or thyroid failure

• Monitor vital signs, mental status, and stress response

• Provide education and emotional support

assessment findings of hypopituitarism

Hormone Deficiencies → Target Organ Changes

• Gonadotropin (LH (luteinizing hormone) & FSH (follicle stimulating hormone)) Deficiency

  • Men: ↓ facial/body hair, ↓ libido, impotence

  • Women: amenorrhea, ↓ libido, painful intercourse, infertility

  • Both: Dry skin, breast atrophy, ↓ axillary & pubic hair

• Neurologic Symptoms (Tumor Effects)

  • Vision changes (especially peripheral)

  • Headache, double vision, limited eye movement

diagnotic findings for hypopituitarism

• Measure pituitary hormones or their target gland effects

• Osmolality (concentration) tests for blood/urine - high concentration = high osmolality 

• Imaging (CT/MRI) - tumors, pressure against pituitary gland

• Angiogram: rules out aneurysm or vascular cause

lifelong management of hypopituitarism 

• Requires lifelong hormone replacement therapy (HRT) to maintain normal body function

• Continue HRT during hospital admissions

• Patients may be seen in any care setting (acute, outpatient, community)

• Must NOT be interrupted

goal of tx for hypopituitarism

Replace deficient hormones to restore normal cellular function, prevent life-threatening complications

what is hyperpituitiarism

Over secretion of one or more pituitary hormones

causes of hyperpituitiarism

• Pituitary tumors (most common cause) - adenoma (benign pituitary tumor)

• Tissue hyperplasia – overgrowth of pituitary cells

• Hypothalamic overstimulation → excessive releasing hormones → pituitary overproduction

what might you see as pituitary tumors grow with hyperpituitiarms

• Headache

• Vision changes (esp. peripheral vision loss)

• ↑ Intracranial pressure (ICP) → nausea, vomiting, altered LOC

assessment findings of hyperpituitiarism - excess growth hormone

• Acromegaly - rare condition acquired as an adult after growth plates have closed

  • Occurs slowly 

  • Bones can’t lengthen, but the width can increase - Enlarged bone features → enlarged hands, feet, facial features, jaw

  • Tongue enlarged (soft tissue growth), Deep voice (hypertrophy of vocal cords)

  • Vision changes, Headache - from adenoma pressing

  • Hyperglycemia (insulin hormone is inactive)

assessment findings of hyperpituitiarism - excess ACTH

Overstimulates adrenal glands -> Cushing Syndrome

assessment findings of hyperpituitiarism - excess prolactin

• Sexual dysfunction (infertility, production of breast milk in both men/women)

nonsurgical management of hyperpituitiarism

• Dopamine agonists: Inhibits release of GH and PRL

• Somatostatin analogs- inhibits growth hormone (somatotropin) production

• Targeted Radiation Therapy – Gamma Knife (targets specific area that is causing hypersecretion by radiation -> used when medications do not work and surgery isn’t an option)

surgical management of hyperpituitiarism

Hypophysectomy

• Most common treatment for hyperpituitarism

• Removes the tumor and/or pituitary gland to reduce hormone overproduction

• There are different techniques to remove the tumor depending on the size and location of it

how is hypophysectomy completed

• Usually performed by minimally invasive endoscopic nasal approach or transsphenoidal (through sphenoid sinus)

• A bone or fat graft is used to seal the surgical opening and prevent CSF leakage

• Transsphenoidal approach – nasal pack and mustache dressing may be used

neuro and surgical monitoring post hyppphysectomy

• Monitor neuro status q hour(vision, LOC, strength)

• Watch for complications (DI (low secretion of ADH), CSF leak, Infection (meningitis: nuchal rigidity (stiff neck), h/a, fever), ↑ ICP)

• Keep HOB elevated - for increased ICP

• Report postnasal drip or increased swallowing - leaking CSF

• Check nasal drainage for glucose or halo sign

• Persistent severe headache may indicate CSF in sinuses

• CSF leaks typically heal on their own with bedrest and fluid hydration

activity precautions post hypophysectomy

• Do NOT cough, sneeze, blow nose, or bend forward

• Avoid straining during bowel movements → increases ICP

• Use stool softeners, fluids, and high-fiber diet

• To pick up objects, bend at the knees, not the waist

respiratory and oral care post hypophysectomy 

• Encourage deep breathing hourly (no coughing)

• Rinse mouth frequently; apply lubricant to lips

• No toothbrushing for ~2 weeks to protect surgical incision; use mouth rinse & flossing

• Decreased sense of smell may last 3-4 months

hormone replacement post hypophysectomy

• If pituitary gland removed → lifelong hormone replacement

• Thyroid hormones, glucocorticoids, gonadal hormones (support sexual function and reproduction) 

• Vasopressin may be needed for fluid balance and prevention of dehydration

• Teach self-management - Do not skip doses, f/u w/ HCP

• Report any return of hyperpituitarism symptoms immediately

function of antidiuretic hormone (ADH)

Helps kidneys balance water in body; when it is released, it travels to the kidneys to signal to hold onto fluid -> stops kidneys from excreting urine -> does this when BP is low; it lowers the body’s osmolality -> increases blood volume -> increases BP. If this doesn’t correct it in a timely manner, your brain stimulates your thirst receptors 

problems of ADH

• Diabetes Insipidus (DI) - hormone deficiency

• Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - hormone excess

patio of diabetes insipid (DI)

• Decreased Antidiuretic hormone (ADH) →

• Decreased water reabsorption in renal tubules →

• Decreased intravascular fluid volume →

• Increased serum osmolality (excessive concentrated blood; hypernatremia) and Excessive dilute urine output

causes of DI

• Hypothalamus gland doesn’t make enough ADH

• Pituitary gland that doesn’t release enough ADH into the blood.

• Damage to the hypothalamus or pituitary gland r/t trauma, tumor or during surgery or radiation (neurogenic DI)

• Decreased renal response to ADH (nephrogenic DI) - d/t CKD, AKI, specific medications (lithium)

reveiwing hx for DI

Brain surgery, trauma, medication use, inadequate fluid intake; regardless of cause, s/s always the same

assessment findings of DI

Dry Inside

• Diurese - Polyuria (Excessive dilute urination) - >2L/day

• Dilute urine with low specific gravity (<1.005) with ↓ osmolality

• Drinking a lot - Polydipsia (Excessive thirst)

• Dehydrated - Fluid volume deficit

• Decreased BP - Due to fluid loss

• High and dry serum labs - High osmolality (highly concentrated blood) & Hypernatremia

DI interventions

• Desmopressin (DDAVP) - ONLY if it is neurogenic cause

• Prevention or management of dehydration and electrolyte imbalance

  • Encourage the client to drink fluids equal to the amount of urinary output

  • Measure & record intake and output, and urine specific gravity

  • Monitor vital signs & record: monitor fluid volume deficit and poor tissue perfusion 

• Measure and record weight daily - At least 2.2 lbs in a day

Desmopressin key fx

• Synthetic vasopressin (synthetic ADH) - Makes body hold onto water

• Route: intranasal, po, (IV route 10x stronger)

• Dose depends on how well they respond to medication

pt teaching for permanent DI

• Should not be deprived of fluid over 4 hours

• Lifelong drug replacement is necessary

• Call 911 for S/S water toxicity (can cause hyponatremia): persistent H/A, acute confusion, N/V  

• Polyuria and polydipsia are signals for the need for another drug dose

• Measure & record daily weights to estimate dehydration

• Side effects of nasal sprays - can erode nasal cavity

• Teaching how to self-inject the drug if discharge using parenteral dose

• Chronic DI: wear a medical alert bracelet or necklace at all times

patho of syndrome of inappropriate antidiuretic hormone (SIADH)

• Increased Antidiuretic hormone (ADH) despite normal or ↑ plasma volume →

• Increased water reabsorption in renal tubules - holding onto a lot of fluid →

• Retention of free water in blood →

• Concentrated urine, Dilutional hyponatremia, ↓ serum osmolality (not concentrated), ↑ urine osmolality (highly concentrated)

causes of SIADH

Anything that is causing swelling or pressure against the pituitary gland

• Malignancies - Small cell lung cancer

• Pulmonary Disorders - Pneumonia

• CNS Disorders - Inflammatory conditions: Encephalitis, Meningitis, TBI, increased ICP, brain tumors &/or removal

• Medications 

assessment findings of SIADH

Soaked Inside

• Stops Urination - Decreased urinary output (oliguria possible-<400 ml/24 hours)

• Sticky and thick urine - ↑Urine specific gravity (>1.025)

• Pulmonary congestion - Low sats, crackles

• Low and Liquidity Labs - Hyponatremia (Na+ <115mEq/L) & Serum Osmolality is low

what s/s might you see with hyponatremia in SIADH

• CNS changes r/t osmotic shift of water into brain cells causing cerebral edema

• Lethargy, headaches, irritability, ↓DTR, disorientation, Change in LOC

• Progresses to ↓responsiveness, seizures, coma

SIADH interventions 

• Stop all fluids - Fluid restriction 

• Give Salt - Correct Hyponatremia

• Drug therapy with vasopressin receptor antagonists (vaptans) & diuretics 

• Hypertonic saline (3% NS) - highly concentrated bag of saline

• Monitor for fluid volume overload in response to treatment

• Place PT in seizure precautions with therapy

fluid restriction in SIADH key fx

• Restricted to as little as 500-1000mL/24 hours

• Strict I&O, daily weights to assess degree of restriction needed

• Oral care to distract from restriction

how to correct hyponatremia in SIADH

• Raise serum sodium no more than 12 mEq in 24 hours.

  • If it is raised too quickly, then the myelin sheath around nerves in pons area will be destroyed and can cause brain and nerve damage

• Aim at maximum serum sodium of 125-130 mEq/L

vasopressin receptor antagonists and diuretics tx for SIADH key fx

• Meds below only given in hospital setting (ICU) – must monitor serum Na+ levels

• Tolvaptan (Samsca), conivaptan (Vaprisol)- promotes water excretion without sodium loss

• Loop diuretics with saline - helps pull fluid off PT with FO

how to administer hypertonic saline in SIADH

• Given in the presence of neurologic manifestations (Na+ <120mEq/L)

• Must be given SLOWLY and through central venous catheter

DI vs SIADH Chart

Diabetes Insipidus – Dry Inside	SIADH – Soaked Inside
ADH Deficiency	ADH Excess
High urinary output: output > intake	Low urinary output: output<intake
↓ urine specific gravity (<1.05)	↑ urine specific gravity (>1.025)
Low body water	Too much free water
Hypernatremia	Dilutional hyponatremia
S/S: Extremely dilute urine	S/S: Concentrated urine
Risk: Hypovolemic shock	Risk: Seizures
Treatment: DDAVP (ADH)	Treatment: Vaptans, Hypertonic saline (3%)

Hormones of the Adrenal Glands Chart

Hormones of the Adrenal Glands
Adrenal gland	Associated hormones	Chemical class	Effect
Adrenal cortex	Aldosterone	Steroid	Increases blood Na+ levels
Adrenal cortex	Cortisol, corticosterone, cortisone	Steroid	Increase blood glucose levels
Adrenal medulla	Epinephrine, norepinephrine	Amine	Stimulate fight-or-flight response

adrenal glands key fx

• Make life-sustaining hormones that control blood pressure, stress response, and energy use.

• Not primarily response for sex hormones, but it does produce androgens, which contribute to secondary sex characteristics (body hair & sexual development).

• Additionally, they produce chatecolines (adrenaline), which is rapidly introduced when we are in acute stress. This helps your body prepare for immediate physical reaction.

what life-threatening problem can occur with the adrenal glands

pheochromocytoma

• rare tumor of the adrenal medulla

• it produces epinephrine and norepinephrine

• it can be life threatening because if the epi and norepi are released from this tumor, then it can lead to hypertensive crisis, stroke, kidney disease, and seizures)

cortisol key fx

• The body’s stress hormone (fuel manager/stress responder).

• It keeps blood sugar elevated when we need energy. It breaks down fat and protein for fuel. It helps our blood vessels respond to adrenaline, so our BP stays up. It calms inflammation when we are sick or injured.

• When it is missing, the body can’t make enough energy or handle stress. Therefore, our blood sugar and BP drops, we have no energy, it can’t handle stress, and it can lead to shock. 

aldosterone key fx

• This regulates fluid and electrolytes. It is a thermostat for sodium, potassium, and fluid balance. It normally tells the kidneys to keep sodium and water to maintain BP, and to let go of extra potassium and acid.

• When it is missing, sodium and water are lost. Therefore, BP decreases, leads to dehydration, potassium and acid build up (hyperkalemic and metabolic acidosis).

what is adrenal insufficiency

• AKA Addison’s Disease

• Adrenal gland hypo function. No longer supplies normal levels of glucocorticoids, androgens, or mineralocorticoids

• Absent Steroids

causes of Addison’s Disease

• Autoimmune disease or infection

• Abrupt discontinuation of long term glucocorticoid therapy

• A problem with the hypothalamus or pituitary gland

assessment findings of Addison’s Disease

ADDSS

• Added Tan - Hyperpigmentation r/t chronic condition because the adrenal gland is damaged. It is a result of elevated melanocyte-stimulating hormone. 

• Added Potassium (>5) 

• Decrease weight, N/V/D, abdominal pain

• Decreased b/p, hair, glucose, energy - Decreased secondary sex characteristics & blood vessels relaxed

• Sodium loss (135 or less) - Can lead to seizures & decreased cognition

• Salt craving – craving salty foods because their sodium is low

Addison’s Disease Interventions

ADDDI

• Add steroids - “Sone” 

• Diet high in protein, carbs, and sodium - prevents hypoglycemia and hyponatremia

• Don’t “abruptly” STOP steroids – can lead to crisis

• Don’t believe this medication will cure you

• Indefinite lifelong hormone replacement

indefinite lifelong hormone replacement key fx for Addison’s disease

• Correct Aldosterone Deficiency

  • Dosage adjustments may be required in hot weather with excessive perspiration

  • Monitor aldosterone excess

• Correct Cortisol Deficiency

  • Oral cortisol is divided doses and taken with food.

  • Monitor cortisol excess

complications of Addison’s disease

acute adrenal insufficiency - AKA addisonian crisis

Addisonian Crisis causes

severe infection, surgery, trauma, abrupt stop of steroids

addisonian crisis manifestations

• Same as for Addison’s Disease but more severe

• Severe hypotension (89/40 or less) 

• Rapid sodium decrease and rapid potassium increase

interventions for addisonian crisis

• Always carry an emergency kit with IM steroids

• Cortisol Hormone Replacement (priority**)

• Hyperkalemia management 

• Hypoglycemia management

  • Hourly glucose checks

  • Administer IV glucose or glucagon as prescribed

how to replace cortisol in addisonian crisis

• **Initial dose: IV bolus hydrocortisone 100-300 mg OR IV bolus dexamethasone 4 to 12 mg.

• **Follow with a continuous IV infusion (lower dose) x 8 hours

• *Volume Replacement: Rapid IV infusion of 0.9% NS or D₅NS 

• H₂ Histamine blocker for GI ulcer prevention

how to manage hyperkalemia in addisonian crisis

• Rapid acting: IV insulin (20-50 units), & IV D₅₀W (20-50 mg) in NS

• Slow: K⁺ binding resin (Kayexalate) PO or enema

• Loop/Thiazide diuretics

• Continuous cardiac monitor

• Restrict Dietary K+ 

what is hypercortisolism

• AKA Cushing’s disease

• Excess secretion of cortisol by adrenal glands

causes of Cushing’s disease

• Glucocorticoid therapy (most common)

• Problem with adrenal cortex,  Anterior pituitary gland or hypothalamus

• Malignant Small cell lung cancer

hx assessment of Cushing’s disease

• Other health problems that require glucocorticoid use

• Weight gain, increased appetite

physical assessment of cushings disease

CUSHH

• Cushion - Truncal obesity + Moon Face + Buffalo Hump

• Unusual Hair Growth - Hirsutism (hairy suit) r/t increased androgen excretion

• Skin is thin - Purple striae (stretch marks) r/t increased muscle mass breakdown

• High glucose, b/p, weight

• High risk for infections and fractures (lowers lymphocyte and WBC production; inhibits bone formation)

lab assessment of Cushing’s disease 

• Blood, salivary, and urine cortisol levels

• Dexamethasone suppression testing - measures cortisol secretion after giving synthetic cortisol -> did the cortisol suppress when it was supposed to

interventions for Cushing’s disease

• Restoring fluid balance

  • Nutrition: “no added salt diet”

  • Fluid restrictions: modified based on clinical findings and prescription

• Preventing infection - Hand hygiene, vaccines, avoid crowds

• Preventing injury - Avoid skin breakdown, falls/fractures, GI bleed

• Monitor patient response to drug therapy

  • Weight loss

  • Increased urine output

  • Serum sodium and potassium values

surgical management of Cushing’s disease

laparoscopic adrenalectomy

• Pre-op: high-calorie, high-protein diet in days prior to surgery

• Pre-op, intra-op & post-op: glucocorticoid given to prevent adrenal crisis r/t sudden drop in cortisol level

• Post-op Outcome goals: Hemodynamic Stability, Free of infection, free of injury, free of acute adrenal insufficiency

post-op laparoscopic adrenalectomy key fx

• Client goes to critical care unit post-op for monitoring of central venous pressure & pulmonary wedge pressure

• Assessing the patient every 15 minutes for shock (e.g., hypotension, a rapid and weak pulse, decreasing urine output) during the first 6 hours

• Monitoring vital signs and other hemodynamic variables to detect hypervolemia/hypovolemia:

• Strict I & O, Daily weights & Serum electrolyte levels

care coordination and transition management for Cushing’s disease

• Home care management - Needs assistance r/t muscle weakness and fatigue

• Self-management education

  • Daily weight

  • For bilateral adrenalectomy: Adhere to lifelong HRT

  • Prevent infection r/t reduced immunity

• Health care resources

  • Home health

  • Medical alert bracelet

what is hyperaldosteronism

• Increased secretion of aldosterone “mineralocorticoid excess”.

what are the two types of hyperaldosteronism 

• Primary “Conn’s syndrome”: Adrenal adenoma, bilateral adrenal hyperplasia, Adrenal carcinoma

• Secondary (reduced blood flow to kidneys): Renal artery stenosis, Renal artery obstruction, CHF 

what does hyperaldosteronism result in

hypokalemia and elevated blood pressure

tx of hyperaldosteronism

• Potassium supplements

• Potassium sparing diuretics

• Adrenalectomy is most common treatment (removal of one or both adrenal glands)

  • High risk for Addisonian Crisis (if both adrenal glands are removed)

thyroid glands and hormones key fx

• Hypothalamus - Releases TRH (thyroid-tropin hormone). It sends the hormone to the pituitary gland to stimulate that release. It is released into the bloodstream and binds and activates to the thyroid to stimulate the production of T3 and T4, which are then released into the bloodstream. 

• Pituitary Gland - TSH

• T3, T4- They help regulate metabolism, body temperature, heart rate, and nervous system response. 

• Calcitonin - Released from the thyroid gland and helps regulate serum calcium when it needs to be lowered. 

what is hypothyroidism

• Thyroid cells fail to produce sufficient levels of thyroid hormones (multiple reasons)

• Cellular regulation decreased

causes of hypothyroidism

• Hashimoto thyroiditis (autoimmune disorder)

• Treatment of hyperthyroid state (thyroidectomy or radiation iodine treatment), radiation or trauma to neck

• Insufficient excretion of TSH from pituitary gland

hypothyroidism assessment findings 

LOW AND SLOW

• Hallmark sign is cold intolerance, decreased body temperature

• Weight gain

• decreased appetite

• cold intolerance, increased sensitivity to cold

• bradycardia

• constipation

• fatigue, depression, impaired memory, impaired concentration, mental fog

• hair loss, thin nails, dry skin

lab assessment of hypothyroidism

• Dramatic reduction of T₃ and T₄

• High TSH in primary; decreased or near normal in secondary

hypothyroidism management

• Levothyroxine (Synthyroid) or Liothyromine sodium (Cytomel)

  • Avoid changing brands

• Medication effectiveness: Improved metabolism 

  • Improve gas exchange

  • Sleep and bowel elimination patterns improve

pt teaching of hypothyroidism 

• Seek treatment for chest pain or chest tightness (911)

• Lifelong therapy -Take on empty stomach, same dose and same time every day

• Recognize/report symptoms of hypo/hyper thyroid state

• Too much medication can cause s/s of hyperthyroidism

what is hypothyroidism complication

myxedema coma

• Life threatening decreased metabolism

causes/triggers of myxedema coma 

• Causes: Untreated or undertreated hypothyroidism or a trigger

• Triggers: Acute illness, surgery (thyroidectomy), chemo around neck, sedatives, opioids, discontinued thyroid medication

manifestations of myxedema coma

• Non-pitting edema, hypothermia, puffy face and tongue, cardiovascular collapse, coma

• Bradycardia, hypotension, Alterations LOC, Hypotension

• Hyponatremia, hypoglycemia

• Elevated serum TSH & low T4

nursing interventions of myxedema coma

• Place tracheostomy/airway kit at bedside

• Place PT on cardiac monitor

• Monitor ABCs

tx of myxedema coma 

• Thyroid replacement hormone – lowest dose to start IV levothyroxine 100-500mcg

• Rapid Dose increase can result in hypertension, heart failure, myocardial infarction

what is hyperthyroidism

• AKA thyrotoxicosis

• Excessive thyroid hormone secretion from the thyroid gland

causes of hyperthyroidism

• Autoimmune disorder (Graves’ Disease) - Immune system forms antibodies that causes your thyroid to grow and produce excess of thyroid hormone

• Toxic multinodular goiter (multiple thyroid nodules)

• Excessive thyroid replacement hormones

hx assessment of hyperthyroidism 

• Weight loss, increased appetite

• Hallmark sign: Heat intolerance

• Vision changes (double or blurred vision, eye fatigue)

physical assessment of hyperthyroidism

• Exophthalmos (Graves Disease) - Due to inflammation and swollen eye tissue that forces eyes out (Educate on use of eye patch to close eye and rest)

• Goiter - Prevalent in Graves Disease; Do not palpate because it can stimulate the release of the hormones and cause thyroid storm

• Palpitations, Tachycardia

• Insomnia, Irritable, Tremors

lab assessment of hyperthyroidism

• High T₃ & T₄, Low TSH (can vary), elevated TRAbs (antibody that can be measured to diagnose Graves disease)

diagnostic assessments of hyperthyroidism 

• Thyroid scan

• Ultrasonography

• Electrocardiography (ECG) - Looks at HR to determine if there is any CV problems due to hypermetabolic state

interventions of hyperthyroidism

• Monitoring: temperature increase of one degree F° from baseline (cue that PT is possibly going into thyroid storm) -> immediately assess cardiac status and report

• Reducing stimulation - Encourage rest, limit visitors, postpone nonessential care

• Drug therapy

• RAI therapy

drug therapy of hyperthyroidism

• Methimazole – Watch out: can cause birth defects, avoid and report pregnancy

• Propylthiouracil (PTU)-increases risk for infection

RAI therapy key fx hyperthyroidism 

• Takes 6-8 weeks for symptom relief, destroys thyroid cells to a degree 

• Used Preoperatively - decreased vascularity and size of thyroid

complication of hyperthyroidism

thyroid storm

Hyperthyroidism Complication: Thyroid Storm

manifestations of thyroid storm

• Fever (>1º F), tachycardia, systolic hypertension, anxious, tremors, abdominal pain, N/V/D

• Worsening of condition: Agitation, confusion, seizures, coma, death

tx of thyroid storm 

• ICU for care & monitoring

  • Maintain airway, ventilation, cardiac monitoring***

  • Give antithyroid medications to achieve hemodynamic stabilization

  • Reduce fever (non-salicylate antipyretics), cooling blanket or ice packs

  • IV saline to correct dehydration: Maintain adequate hydration

surgical management for hyperthyroidism

partial or total thyroidectomy p

pre-op care for thyroidectomy

• Euthyroid state to ↓ decrease size, vascularity and risks

• Control B/P, dysrhythmias, & tachycardia prior to surgery

• Pt teaching – deep breathing, supporting posterior neck to reduce strain, hoarse voice is common (have to monitor severe changes -> indicate laryngeal complications)

post-op care for thyroidectomy 

• Place suction, oxygen and tracheostomy trays at BS

• Priority ABCs, monitor vital signs, ability to swallow saliva, O2 sats, deep breathe 

• Position - ↑HOB to semi-fowler’s, pillows to support head & neck, avoid neck extension 

• Pain control

complication of thyroidectomy

• Hemorrhage - monitor dressing & drainage, bleeding under skin

• Respiratory distress & impaired gas exchange - edema or spasms can cause stridor indicating resp. distress

• Laryngeal nerve damage - laryngeal spasms can impair airway

• Hypocalcemia and tetany - If parathyroid glands inadvertently removed or blood supply damaged. Numbness tingling around mouth, fingers or toes, and +Chvostek’s and +Trousseau’s signs