exam 5 study guide: thyroid etc

what does the thyroid do?

produced hormones that regulate:

-metabolism

-cardiac function

-growth and development

metabolism-->

stimulates energy

cardiac function -->

stimulates the heart

growth and development -->

promotes maturation through infancy / childhood

what are the thyroid hormones?

thyroxine (T4) and triiodothyronine (T3)

hyperthyroidism is .............

excessive stimulation of thyroid

what is hyperthyroidism caused by?

thyroid stimulating immunoglobulins

types of hyperthyroidism....

1. graves disease (most common)

2. toxic nodular goiter (Plummers disease)

what are the treatments for hyperthyroidism ?

-surgical removal of thyroid tissue

-destruction of thyroid tissue

-beta blockers (propranolol)

-nonradioactive iodine tx

what are the S/S of hyperthyroidism?

everything is hot and dry

-warm moist skin

-tachycardia

-increased activity and nervousness

-palpitations

-tremors

-exophthalmos

-wt loss

What is exopthalmus indicative of?

Hyperthyroidism (Graves Disease)

-enlarged eyes

what is a thyroid storm?

-thyrotoxic crisis

happens with pt going through significant stress , surgery, illness

thyroid storm is not caused by ______________________________

rise in thyroid hormones

manifestations of thyroid storm / thyrotoxic crisis=

-hyperthermia

-severe tachycardia

-restlessness

-agitation

-tremors

-unconsciousness

-coma

-hypotension

what is tx of thyroid storm or thyrotoxic crisis?

Methimazole or PTU

Beta blockers

Lugal's Solution (iodine and

potassium iodide mixture)

Sedation

Cooling, IV fluids

hypothyroidism is caused by .....

malfunction of the thyroid

causes of hypothyroid =

Hashimoto's disease - Autoimmune thyroiditis

Insufficient iodine in diet

Surgical removal of thyroid

Insufficient secretion of TSH

treatment of hypothyroid =

Lifelong replacement of thyroid hormone

Levothyroxine (T4) or Liothyronine (T3)

clinical presentations of hypothyroidism :

-pale, puffy face

-cold, dry skin

-brittle hair

-hair loss

-low HR

-low body temp

-lethargic

-impaired mental status

-intolerance to cold

What is levothyroxine used for?

hypothyroidism

what instructions need to be given to a client on levothyroxine?

should be taken 30-60 mins before breakfast

*****on empty stomach

what to not take with levothyroxine :

-warfarin; can increase effects of warfarin

****will need to decrease warfarin while on levothyroxine

levothyroxine

adverse effects=

tachycardia

angina

tremors

levothyroxine is synthetic preparation of ___________

thyroxine T4

What assessment findings would cause you to hold the levothyroxine and call the doctor?

s/s of thyrotoxicosis- tachycardia, angina, nervousness, insomnia, hyperthermia, heat intolerance, sweating

When iodine availability is diminished, production of thyroid hormones ____________________.

decreases

This drop in hormones causes the pituitary to release more _______, which acts on the thyroid gland to increase in size

TSH

Levothyroxine enhances the effects of what medications?

warfarin

Beta blockers can control what type of symptom in patients with hyperthyroidism?

tachycardia

-beta blockers (propranolol) will supress tachycardia and S/S of graves disease

Levothyroxine is strongly lipid bound therefore has a long half life; what is the advantage to

this?

Hormone levels remain fairly steady, even with once-a-day dose, well suited for lifelong therapy. Bad news- takes 1 months for steady state

The thyroid hormone increases cardiac responsiveness to catecholamines such as dopamine, epinephrine, dobutamine which can lead to....

dysrhythmias

Hyperthyroidism: two major forms/causes, they are?

Graves disease (most common)

and

toxic nodular goiter (Plummer's disease)

What are the signs and symptoms seen with Grave's disease?

- HR rapid/strong/dysrhythmias/angina, nervousness, insomnia, rapid thought flow/speech rapid; skeletal muscles weak/atrophy, hot sweaty skin, appetite increased, weight loss, bulging eyes (exophthalmos)

What treatment options are there

for Grave's Disease?

Methimazole and PTU

Cause of Toxic Nodular Goiter (Plummer's Disease)=

result of thyroid adenoma (overgrowth)

Thyrotoxic Crisis (Thyroid Storm), what is it?

OD of levothyroxine

What causes Thyrotoxic Crisis?

Significant stress (surgery, illness, sepsis)

What characterizes Thyrotoxic Crisis?

profound hyperthermia, severe tachycardia, restlessness, agitation, tremor, unconsciousness, coma, hypotension, heart failure

Treatment of Thyroid Storm

for suppressing thyroid hormone release?

high doses of potassium iodide or strong iodine solution

Treatment of Thyroid Storm

to suppress thyroid hormone synthesis ?

methiamazole

Treatment of Thyroid Storm

to reduce HR?

beta blocker

-propranolol?

Advantages and disadvantages of Iodine-131 (131I)

advantages- low cost, patients are spared the risks, discomfort, and expense of thyroid surgery. Death is extremely rare; no tissue other than thyroid is injured.

Disadvantages- effect of treatment is delayed, taking several months to become maximal. Tx is associated with significant incidence of delayed hypothyroidism à results from excessive dosage and occurs in up to 90% of pts. within the first year.

what is lugol solution used for?

Nonradioactive Iodine (Lugol

Solution)

suppress thyroid function in preparation for thyroidectomy

Nonradioactive Iodine (Lugol

Solution): adverse effects =

Brass taste

Burning sensation in mouth/tongue

Soreness of teeth/gums

Frontal headache

Coryza

Salivation

Skin eruptions

Methimazole and pregnancy ?

not safe

PTU and pregancy?

can be used

Methimazole

Drug of choice for __________________

hyperthyroidism

Methimazole

what does it do?

suppress thyroid hormone synthesis

-it doesnt destroy existing stores of hormone but it prevents body from making more

-it slows down the thyroid enough to fall into normal levels

Methimazole

main adverse effect to worry about?

Agranulocytosis

Methimazole

Dangerous in ____________________ of

pregnancy and lactation

1st trimester

Methimazole

you take _______ dose a day

one

Propylthiouracil (PTU)

what is it used for?

Grave's Disease (2nd line tx)

Adjunct to radiation therapy

Preparation for thyroid surgery

Thyrotoxic crisis

Propylthiouracil (PTU)

full benifits may take ________________

6-12 months

Propylthiouracil (PTU)

can cause severe _____________ damage

liver

Propylthiouracil (PTU)

most serious adverse effect=

Agranulocytosis

Propylthiouracil (PTU)

you take ______________ doses a day

multiple

Drugs Related to Hypothalamic and

Pituitary Function

Drugs Related to Hypothalamic and

Pituitary Function

what does growth hormone do?

-promotes growth in body

-protein synthesis

-carb metabolism

Hormones of the anterior pituitary:

Growth hormone (GH)

Corticotropin

Thyrotropin

Follicle-stimulating hormone (FSH)

Luteinizing hormone (LH)

Prolactin

Hormones of the posterior pituitary:

Oxytocin

Antidiuretic hormone

Growth hormones helps regulate.....

helps regulate growth

childhood deficiency in growth hormone=

short stature

excess GH before puberty=

gigantism

excess GH in adulthood=

acromegaly

Tx for GH deficiency in pediatrics=

replacement therapy of GH

what monitoring is required for somatropin?

height and weight regularly

prep and adm. for somatropin

IM or subQ

Somatostatin: Used to treat _________________

acromegaly

Somatropin: tx should begin early and when must tx stop?

if tx fails to promote growth, GH should be discontinued and the dx of GH deficiency should be reevaluated.

what does ADH do?

Acts of the kidneys to cause reabsorption of water

deficiency in ADH produces what condition?

Hypothalamic diabetes insipidus, a condition in which large volumes of dilute urine are produced

Antidiuretic Hormone (ADH)

Also known as ________________

vasopressin

vasopressin

used for ?

Diabetes insipidus

Postoperative abdominal distention

and

nocturnal enuresis

vasopressin

adverese effects:

water intoxication

and

excessive vasoconstriction

vasopressin

how to know med is working?

by urine output

vasopressin

teach pt to monitor ____________

input and output daily

vasopressin

has risk for MI, Angina, and Gengreen due to what?

severe vasoconstriction

Drug of choice for ADH diabetes Insipidus:__________________ because it lacks the side effect

of vasoconstriction

desmopressin

What is diabetes insipidus?

-large amounts of dilute urine

-Not enough ADH, pituitary gland

s/s of diabetes insipidus=

dehydration,

dilute urine,

insatiable thirst,

electrolyte imbalance

teaching point for desmopressin (DDAV)

water intoxication

-teach pt to monitor IandO

Vasopressin is also used in

nocturnal enuresis

what is treatment for diabetes insipidus?

Desmopressin

Vasopressin

Drugs for Disorders of the Adrenal

Cortex

Drugs for Disorders of the Adrenal

Cortex

what are the three glucocorticoids?

Hydrocortisone

Prednisone

Dexamethasone

what are the uses for Hydrocortisone?

adrenal insufficiency

and

inflamatory disorders / conditions

-allergic reactions to inflammation

-cancer

what is the preferred Adison's disease ?

prednisone

what drug possess small amounts of miner corticoids ?

prednisone

what are the Preferred drugs for oral therapy of chronic adrenal insufficiency?

Prednisone and Dexamethasone

glucocorticoids:

end is -sone

things to keep in mind about them......

-they are for life long use

-they are small dose

when do you raise the level of glucocorticoids?

end is sone

when under stress, are sick, or having surgery

Vital Note: when glucocorticoids are used for replacement therapy; during times of

stress (ie, life event, surgery, infection, etc) patients MUST INCREASE THEIR

GLUCOCORTICOID DOSAGE. Not doing so could be fatal. Need to be able to identify

how much of an increase in dosage would be appropriate for a pt undergoing a stressful

event

Vital Note: when glucocorticoids are used for replacement therapy; during times of

stress (ie, life event, surgery, infection, etc) patients MUST INCREASE THEIR

GLUCOCORTICOID DOSAGE. Not doing so could be fatal. Need to be able to identify

how much of an increase in dosage would be appropriate for a pt undergoing a stressful

event

An important note; when glucocorticoids are employed for replacement therapy, doses are

much _____________than the doses used for non endocrine disorders (such as arthritis, COPD, etc)

smaller

what is cushings syndrome?

-Excess adrenal hormones.

-clinical presentation: obesity, hyperglycemia, glycosuria, hypertension

tx for circulating glucocorticoid if caused by pituitary adenoma?

surgical removal of adrenal gland, replacement therapy with mineralocorticoids for bilateral adrenalectomy, drugs as adjuncts to surgical treatment, Ketoconazole

What is ketoconazole?

-Antifungal

-blocks glucocorticoid synthesis (tx of Cushings)

-can cause liver dysfunction

how much of an increase in dosage would be appropriate for a pt. undergoing a stressful event

take 3 times the usual does for 3 days

what is Addison's disease?

insufficient secretion of adrenal hormones

Addison's disease is characterized by?

-thin stature

-wt loss

-faitgue

-dehydration

-renal shut down

tx for Addison's disease

hydrocortisone is drug of choice.

both glucocorticoids and mineralocorticoid, if additional mineralocorticoid is needed then add fludrocortisone