Endocrine Disorders (Hypo- & Hyper-thyroidism) - Complex

Thyroid

What organ is responsible for cellular metabolism, thermogenesis, serum cholesterol levels, and vascular resistance?

Iodine

What mineral is required to produce the thyroid hormones T3 and T4?

Thyrotropin releasing hormone

What hormone is released by the hypothalamus to stimulate the pituitary gland?

Thyroid stimulating hormone

What hormone is released by the anterior pituitary gland that controls the release of thyroid hormone?

T3

Which thyroid hormone is more potent and rapid-acting? T3 or T4?
- This hormone binds to TH receptors more strongly and it’s more easily absorbed by cells.

Inspection, auscultation, palpation

What is the order of assessment for the thyroid gland?

Primary

This tier results in an issue with the thyroid gland itself and results in altered thyroid related serum levels (TSH, T3, T4). Some conditions that result are Hashimoto’s or iodine deficiencies.

Secondary

This tier results in an issue with the pituitary gland to stimulate TSH, such as a pituitary tumor.

Tertiary

This tier results in the failure of the hypothalamus to produce thyroid releasing hormone to stimulate the pituitary to make TSH.

Hypothyroidism

The inadequate circulation of thyroid hormones causing a decreased basal metabolic rate is what condition?

Hypothyroidism

This condition results in the signs/symptoms of:
- Infants: feeding problems, poor growth, poor weight gain, yellowing of the skin and whites of eyes (jaundice), constipation, poor muscle tone, dry skin, hoarse crying, enlarged tongue, a soft swelling bulge near belly button (umbilical hernia)
- Children & Teens: poor growth that leads to short stature, delayed development of permanent teeth, delayed puberty, poor mental development.
- Overall: cold intolerance, hoarse voice, muscle weakness

Hypothyroidism

What condition uses this medication management?
- Hormone replacement therapy with Levothyroxine - given in AM, 1 hr before breakfast/meds.

Levothyroxine

What medication can increase the effect of Warfarin, thus increasing the need for digoxin and insulin?

Levothyroxine

These medications decrease the absorption of what medication?
- Cimetidine, Lansoprazole, Sucralfate, Colestipol

Levothyroxine

These medications can accelerate the metabolism of which medication?
- Phenytoin, Carbamazepine, Rifampin, Sertraline, Phenobarbital

Levothyroxine

Geriatric considerations for this medication are: cautious use w/ hx of coronary heart disease & observe for angina and dysrhythmia

Hypothyroidism

What condition uses these nursing interventions?
- Monitor cardiovascular changes (HR, BP, EKG) & respiratory status
- Monitor weight
- Monitor mental status/safety
- Antiembolism stockings and elevation
- Encourage low calorie, high-bulk diet
- Encourage activity, cathartics, stool softeners
- Extra clothing and blankets to maintain temp
- Cautious use with medications due to decreased metabolism

Myxedema coma

What happens with a severe form of hypothyroidism?
- Life-threatening condition
- Hypothermia, bradycardia, hypotension
- Respiratory failure (hypercapnia & hypoxemic): underlying infection (pneumonia) or fluid accumulation (pleural effusion, ascites)
- Hyponatremia and hypoglycemia

Hyperthyroidism

What condition is the result of excessive output of hormones, thus increasing basal metabolic rates.

Hyperthyroidism

What condition has these signs/symptoms?
- sweating
- changes in menstrual cycles
- increased sensitivity to heat
- sleep problems
Older adults:
- irregular heartbeat
- weight loss
- depression
- feeling weak or tired during ordinary activities

Radioactive iodine therapy/ablation

What treatment is done for an overactive thyroid to destroy some of the hormone producing cells?
Considerations for this treatment?
- contraindicated in pregnant women
- monitor for manifestations of hypothyroidism
- 4-6 weeks for effects to be evident
- stay away from pregnant women, infants and small children
- limit exposure to others

Methimazole (MMI)

Which antithyroid medication is the drug of choice for non-pregnant people that requires daily dosing. This med also results in a quicker recovery to normal thyroid function.
Side effects: Teratogenic (in first trimester)

Propylthiouracil (PTU)

Which antithyroid medication is the drug of choice for pregnant patients that requires TID dosing.
Side effects: Hepatotoxic, neutropenia

Antithyroid

This education is used for which type of medications?
- Take medication in AM on an empty stomach 30 mins before eating (MMI)
- Take in divided doses at regular intervals (PTU)
- Report fever, sore throat, bruising immediately
- Report signs of jaundice
- Cautious use in pregnant or lactating women and children

Hyperthyroidism

These nursing interventions are done for which condition?
- Keep the patient comfortable: cool, quiet environment, calm
- Obtain daily weights
- Monitor EKG, heart rate, blood pressure
- Educate about medications & treatment
- Monitor for thyroid storm
- Encourage diet (high protein, small frequent meals)

Thyroidectomy

What procedure are these pre-op measures used for?
- Antithyroid meds 4-6 weeks prior; beta blockers as needed
- High protein, high carbohydrate diet
- Avoid caffeine and other stimulants
- Explain that hoarseness, and sore throat are expected
- Teach coughing and deep breathing exercises while supporting neck
*not first line treatment.

Thyroidectomy

This type of post-op management is for what procedure?
- semi-fowlers
- monitor respirations
- assist with deep breathing
- oral and tracheal suction as needed
- monitor for potential bleeding and hematoma formation
- assess pain and provide pain relief measures
- assess voice every 2 hrs., but discourage talking
- potential hypocalcemia related to injury or removal of parathyroid glands

Beta blockers

What class of medications help to counteract the effects of hyperthyroidism without altering levels. Its primary mechanism is to treat SNS effects of tachycardia and palpitations.
*Hold & contact provider if pulse is <60.

Lugol’s solution

This solution is a nonradioactive elemental iodine and potassium iodide diluted with water. It inhibits the release of thyroid hormone.
Education:
- short-term use only before surgery.
- administer 1-hr after antithyroid medications
- contraindicated in pregnancy and breastfeeding
- solution; mix with juice and use a straw
- notify provider for sore throat, fever, mouth ulcers

Thyroid storm

A sudden & excessive amount of thyroid hormone results in this.
This can also be precipitated by an event that increases metabolism.
Findings include:
- hyperthermia/hyperpyrexia
- tachydysrhythmias (>130 BPM)
- hypertension (primarily systolic)
- exaggerated symptoms of hyperthyroidism
- GI: weight loss, diarrhea, abd pain
- Card: edema, CP, dyspnea, palpitations
- Neuro: delirium, tremors, confusion, seizures

Thyroid storm

These nursing considerations are for which condition?
- maintain airway
- cardiac monitoring
- oxygen as needed
- strict I&O
- NO salicylates
- acetaminophen, cool sponge baths, ice packs, cooling blankets
- IVF + dextrose to provide hydration & replace glycogen stores
- Antithyroid medications followed by sodium iodide
- beta blockers as needed (propanalol)
- hydrocortisone PRN