Pituitary + Thyroid Gland Disorders

What is the Role of the Endocrine System?

It orchestrates transportation of chemicals across cell membranes, regulates growth / development / metabolism / fluid and electrolyte balance / acid and base balance

What part of the CNS responds to ALL external and internal stimuli?

Hypothalamus

Examples of Endocrine Glands

Pituitary, Thyroid, Parathyroid, Adrenal, Pancreatic Islets, Ovaries, Testes

Pituitary Gland

The MASTER gland that regulates endocrine hormones and secretes them into the bloodstream; CONTROLS EVERYTHING!!!

Endocrine Disorder Causes

Brain injuries, tumors, infection, genetics

Adrenocorticotropic Hormone (ACTH)

Anterior pituitary hormone that stimulates the production and release of cortisol from adrenal glands

Antidiuretic Hormone (ADH) aka Vasopressin

Posterior pituitary hormone that controls excretion of water via the kidney and is stimulated by blood osmolality or decreases in BP

Thyroid Stimulating Hormone (TSH)

Anterior pituitary hormone that stimulates thyroid gland to produce thyroid hormones

Function of Hormones

Travel to target via blood stream, alter function of target tissue, change membrane permeability, negative feedback control once target tissue is reached

The _________ gland is made up of Anterior and Posterior Lobes

Pituitary

2 Pituitary Gland Disorders

Diabetes Inspidus and Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

What is Diabetes Inspidus?

Condition characterized by hypoactive ADH secretion that reduces the kidneys ability to recollect H2O and concentrate urine, resulting in excessive urination, dehydration, thirst, and electrolyte loss

Diabetes Inspidus would make the blood ___________ and urine ___________

Concentrated, Diluted

Symptoms of Diabetes Inspidus

Urine output over 250 mL/hour, diluted urine, excessive water drinking, craving cold water, polydipsia, polyuria

How do you Assess for Dehydration?

Monitor I&O’s/DW’s, assessing skin and mucous membranes

How do you Assess for Cardiac Output?

Monitor vital signs and change in LOC (watch for hypotension)

Diabetes Inspidus Treatment

Replacing ADH via Desmopressin, ensure adequate fluid replacement, identify and correct the cause

Signs that Diabetes Inspidus is Improving

More concentrated urine and less polydipsia/polyuria

What is Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

A condition characterized by hyperactive ADH secretion that increase H2O reabsorption in the kidneys, leading to dilutional hyponatremia and water intoxication from renal excretion of Na

SIADH would make the blood ___________ and urine ___________

Diluted, Concentrated

Symptoms of SIADH

Concentrated urine, oliguria, weight gain w/o edema, headache, weakness, seizures, tachycardia, bounding pulse, HTN, lung crackles, taut skin, intake > output

What Problems arise from SIADH?

Fluid volume overload, safety risk, impaired cardiac output and gas exchange, pain, skin breakdown

SIADH Treatment

Promoting water excretion and increase in serum Na levels via ADH inhibitors / loop diuretics / and Demeclocycline, and replacing fluid and electrolyte imbalances w/ hypertonic solutions

What makes SIADH more concerning than Diabetes Inspidus?

Because of the fluctuation of Na levels which can lead to serious neuro complications

What is the Thyroid Gland?

The largest endocrine gland located in the lower neck anterior to the trachea; relies on IODINE to function properly

What foods are high in Iodine?

Seafood, iodized salt, Idaho potatoes

The levels of T3 and T4 in the blood controls the release of ______

TSH

2 Functions of the Thyroid Gland

Controlling cellular and metabolic activity AND affecting every organ system / tissue function

2 Thyroid Gland Disorders

Hypothyroidism (Hashimoto’s) and Hyperthyroidism (Grave’s Disease)

Symptoms of Hypothyroidism

Bradycardia, peripheral edema, weight gain, constipation, fatigue, cold intolerance (diminished perspiration), mimics aging process

Emergent Complication of Hypothyroidism

Myxedema Coma

Symptoms of Myxedema Coma

Respiratory failure, hypotension, hypothermia, bradycardia, dysrhythmia

What problems arise from Hypothryoidism?

Impaired cardiac output, nutrition alteration, safety risk, knowledge deficit, altered body image

Treatment for Hypothyroidism

Replacing thyroid hormone via Levothyroxine

Hyperthyroidism is being in a constant state of ____________

Hypermetabolism

Symptoms of Hyperthyroidism

Tachycardia, weight loss, exophthalmos (bulging eyes), anxiety, heat intolerance, tremors, goiter

What is a Goiter?

An enlarged thyroid gland due to an iodine deficiency

Treatment for Hyperthyroidism

Medications, Radioactive iodine therapy, surgery

What Medications are given for Hyperthyroidism?

Thionamides and Beta Blockers

Precautions for Patients on Radioactive Iodine Therapy

No using same toilet as others for 2 weeks, sit down when peeing to stop splashing, flush toilet three times after using, take laxative 2-3 times post treatment to rid body of radioactive stool, wear washable clothing, use disposable utensils, don’t share toothbrush

What Problems arise from Hyperthyroidism?

Impaired cardiac output, impaired nutrition, impaired thermoregulation, safety risk, knowledge deficit

Emergent Complication of Hyperthyroidism

Thyroid Storm

Symptoms of Thyroid Storm

Tachydysrhythmias, hyperthermia, HTN, delirium

Pre-Op Thyroidectomy Interventions

Pre-admission testing (PAT) and patient education

Post-Op Thyroidectomy Interventions

Assess airway for inflammation or bleeding, preventing hypocalcemia / impaired airway / hypothyroidism / incision infection, educate about symptoms of complications and lifelong thyroid replacement w/ meds

Patient Education for ALL Endocrine Disorders

Educate about follow up care, recognizing S/S, emergency care, medications, and wearing medic alert bracelets