Thyroid Disorders (3/31)

• Thyroid makes t3 and t4

• Needs thyroxine and iodine

primary = gland itself

secondary= upper part

Goiter

• Enlargement of thyroid

• Symptoms may or may not be present

• May develop with

  • Too much TSH (secondary from anterior)

  • Iodine level ↘

  • Goitrogens

    • Foods that cause enlargement

Hypothyroidism

cauases

• Hashimotos thryoidits

  • Autoimmune

• Drugs

• Genetics

• Thryoditis

• congenital hypothyroidism

Symptoms and signs

• Think SLOWWWW

• Cold intolerance

• Weight gain

• Fatigue

• Cramps

• Memory deficits

• Hair loss

Systemic effect

• Hyperlipidemia

• Yellow skin ( ↗carotene)

• Anemia

• Decreased kidney function

• Pendred syndrome

• Myxedemia - adults

• Subclinical hypothyroidism

Diagnosis

• Primary- gland itself

  • High tsh

  • Low free t3

  • Low free t4

• Secondary- upper issue

  • LOW tsh

  • Low free t3 

  • Low free t4

• Ultrasound

• Antibodies for Hashimoto's thryoiditis

How do you differentiate between primary and secondary hypothyroidism?

Treatment

• Replacement hormone- levothryozine

• Surgery

• Myxedema coma

  • Serve conditions

>>Levothyroxine

• Actions:

  • T4 replacement for primary hypothyroidism

• Indications:

  • Hypothyroidism

  • Mexoedema

  • Goiter prevention

• Contraindications

  • CV diseases

  • adrenal insufficiency

• Caution

  • CV diseases 

  • HTN

  • Diabetes mellinus

  • eldery

• Adverse effects

  • Palpations 

  • Tachycardia

  • HTN

  • Anxiety

  • Heat intolerance

• Drug to drug

  • Calcium

  • Iron

  • Antiacids

  • Bleeding risks

• Assessment

  •  Apical pulse 60 sec

  • Function tests

  • Signs of overdose

  • Check weifght

• Teach

  •  3 wks to take effect

  • Empty stomach

  • Can cause nasuea

    • CALL THE DOCTOR

    • DO NOT STOP

Hyperthyroidism

• Elevated free t3 and t4

causes

• Graves Disease

• Most common cause

• Autoimmune stimulation of thyroid gland

• Thyroid stimulating antibodies

• Bind to thryopin receptors

• Gland enlargement

• Continual synthesis thyroid hormone

• Subacute throidtis

• Thyroid adenoma

• Excessive tsh

Signs and symptoms

• HYPER

• Heat sensititvity

• Weight loss

• Nervousness

• Insomnia

• A fib

• HR ↗

• Exophatlmos

  • Wide-eyed stare

Diagnosis

• Primary

  • Low tsh 

  • High t3

  • High t4

• Secondary

  • High tsh

  • High t3

  • High t4

• Antibodies for graves

• Ultrasound

• Radioactive iodine for scanning,

• Inodine uptake

Treatment

• Antithyroid hormone medication PTU

• Radioactive iodine treatment

• Surgery 

  • Gland removed > thyroid hormone for life

• medication: METHIMAZOLE

Methimazole

• Action

  • Antithyroid agent

  • Suppresses thyroid hormones 

• Indication

  • Graves Disease

  • Hyperthyroidism

  • pre-op

• Contraindication

  • Pregnancy

  • lataction

• Cautions

  • Bone infections 

  • URI

• Adverse effects

  • Agranulocytosis

    • Low wbc

  • Rash-—allergic

  • Fever

  • Joint pain

• Drug-to-drug interaction

  • Anticoagulants

• Assess

  • CBC for WBC count

  • Liver function tests

• Teach

  • Avoid sick others

  • Look for bleeding or brusing

  • Avoid iodine foods

    • salt

Thyrotoxic crisis (thrypid storm)

• Overwleming release of throuid hormones

• Surgery or trauma

• Stimulate metabolism

  • High fever

  • Tachycardia

  • Agitation

  • Psychosis

• Medical emergency!!

Thyroid Nodules

• Asymptomatic usually

• Hypothyroidism and hyperthyroidism

  • Single nodules

    • Malignancy

      • Male

      • Imobile nodule

      • <20 or >70

  • Multiple

    • Benign 

• Diagnosis

  • Ultrasound 

  • Needle biopsy

  • Tec scan (temperature)

calcium serum range is 9.5-11

Which assessment should the nurse expect to see in a client whose levothyroxine dose is sub-therapeutic

• Lethargy, bradycardia, pallor (SLOW still)

Should client stop Levo when nauseous?

• NOO

Enlarged gland test

• Dysphagia swallow test

Hyperparathyroidism >>> INCREASES blood calcisum

hypothyroidism  what is the priory?

• Depression

Foods with idone that people taking methimazole avoid

• Shrimp

• Lobster