Thyroid and Parathyroid Hormone Functions and Disorders

T3

Potent thyroid hormone increasing metabolism.

T4

Weak thyroid hormone maintaining steady metabolism.

TSH

Thyrotropin from pituitary regulating thyroid hormones.

Calcitonin

Lowers blood calcium by depositing in bones.

Serum Free T4

Measures unbound thyroxine

Serum T3 & T4

Measures bound and free thyroid hormone levels.

T3 Resin Uptake Test

Indirect measurement for thyroid hormone levels for
patients that have received Iodine for testing or treatment

Hashimoto Disease

Autoimmune thyroiditis attacking the thyroid gland.

Myxedema

Severe skin swelling with waxy consistency (hypo)

Hypothyroidism

Condition of decreased thyroid hormone production.

Synthetic Levothyroxine

Daily dosage 75-150 mcg for hypothyroidism.

Thyroid Storm

Life-threatening acute complication of hyperthyroidism.

Graves Disease

Autoimmune disorder causing excessive thyroid hormone.

Hyperthyroidism

Excessive thyroid hormone production increasing metabolism.

Dexamethasone

Medication suppressing thyroid hormone release.

Hyperparathyroidism

Overproduction of parathyroid hormone elevating calcium.

Tetany

Muscle spasms due to low calcium levels.

Trousseau Sign

Carpopedal spasm from blood flow occlusion.

Chvostek Sign

Facial twitching from nerve stimulation.

Hypoparathyroidism

Insufficient parathyroid hormone causing low calcium.

Addison's Disease

Adrenal insufficiency leading to various symptoms.

Addisonian Crisis

Severe adrenal insufficiency requiring immediate treatment.

ACTH

Hormone levels increased in primary Addison's.

Renal Calculi

Kidney stones due to calcium imbalance.

Medical Management

Includes hydration therapy and surgical interventions.

Weight Gain

Common symptom of hypothyroidism.

Cold Intolerance

Increased sensitivity to cold in hypothyroidism.

Bradycardia

Slow heart rate associated with hypothyroidism.

How to check pancreas function

amylase and lipase levels

Radiologic study of abdomen’

subjective pain history

What does thyroid regulate

basal metabolic rate, tissue thermogenesis, cholesterol level/resistance

what stimulates release of TSH

low t3 and T4

When is calcitonin released

When ca is high, reducing plasma levels

symptoms of hypothyroidism

lethargy, slow mentation, weight gain, constipation, cold intolerance, slowing of body systems

Levothroxine

hypothyroidism, must be taken on empty stomach, no food for at least an hour after

symptoms of hyperthyroidism

increased metabolic rate, goiter, anxiety, nervousness, tremor, irritability, tachycardia, weight loss, elevated systolic BP, cardiac dysrhythmias, skin flushed, warm, soft, and moist

What does serum free T4 tell you

metabolic status

Why is it important to assess for iodine allergy

iodine is used for a lot of diagnostic studies

what is normal range for serum free T4

0.7 - 2.0 ng/dL

Normal T4 levels

5.4 - 11.5 ug/dL

Normal T3 levels

260-480 pg/dL

Causes of hypothyroidism

Autoimmune disease
Atrophy due to Aging
Infiltrative Disease: Amyloidosis, Scleroderma,
Lymphoma
Iodine deficiencies or excess
Medications (Lithium)
Radioactive Iodine
Therapy or surgery for hyperthyroidism
Radiation

Pt has angina taking Levothyroxine (Synthroid)

stop immediately

Prevention of Cardiac Dysfunction with hypo

Decrease Serum Cholesterol, Monitor and treat atherosclerosis and CAD

hyperthyroidism nursing care

maintain adequate CO, improve nutrition, maintain normal body temp

Nursing care for thyroid cancer

Post-op:
- Monitor for bleeding
- Monitor Airway and breathing
- Vitals
- Pain control
- Fluids
- Keep patient to whispers and limited talking

hyperparathyroidism

Characterized by bone decalcification and formation of Renal
Calculi (Kidney Stones)

what does parathyroid do?

Parathormone regulates calcium and phosphorus balance
- Increased parathormone elevates blood calcium by increasing
calcium absorption from the kidney, intestine, and bone
- Parathormone lowers phosphorus level

Symptoms of hyperparathyroidism

No symptoms possible
- Apathy
- Fatigue
- Muscle weakness
- Nausea
- Vomiting
- Constipation
- Hypertension
- Cardiac Arrhythmias
- High Calcium Blood levels (monitor for Hypercalcemic
Crisis – Serum Calcium > 13 mg/dL)

what is hypercalcemic crisis

serum calcium greater than 13 mg/dl

Hypoparathyroidism

Vitamin D deficiency, Decreased intestinal absorption of calcium, Decreased reabsorption of calcium from bone and through renal
tubules

Manifestations of Hypoparathyroidism

tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchospasm, Laryngeal spasm, Carpopedal spasm, anxiety, irritability, depression, delirium, ECG changes

Testing hypocalcemia

Trousseau sign and Chvostek sign

Treatment of hypoparathyroidism

The goal is to increase serum Ca+ to 9 – 10 mg/dL
- Possible combination treatment of Calcium,
Magnesium, and Calcitriol
- Thiazide Diuretic ( help decrease urinary calcium
excretion)
- Treatment for Bone loss

Manifestations of Addison’s Disease

Muscle weakness
- Anorexia
- GI symptoms
- Fatigue
- Dark pigmentation of skin and mucosa
- Hypotension
- Low blood glucose
- Low serum sodium
- High serum potassium
- Apathy
- Emotional lability
- Confusion

ACTH in Addison’s

high

Nursing Management of Addison’s

Health History collection
- Assess for fluid imbalance
- Assess patient level of stress
- Monitor BP and HR
- Do Orthostatic BP’s
- Assess skin often for any change in color
- Restore fluid balance
- Improve activity as tolerated