Thyroid part 2

1
Thyroid part 2

• Hypothyroidism

2
Hypothyroidism

• Definition
• i TH
• Pathophysiology
• Primary hypothyroidism
• Thyroid fails to produce enough TH
• Secondary Hypothyroidism
• i stimulation ? Thyroid (pituitary or
  hypothalmus)

3
Hypothyroidism

• Etiology
• Primary
• Congenital
• I deficiency
• Auto-immune
• Thyroidectomy
• Secondary
• Pituitary / hypothalamus

4
Hypothyroidism

• SS
• Think ______
• Slow

5
HypothyroidismSS

• Neurology
• Slow mentation
• Slurred speech
• Affect
• Lethargy
• depression

6
HypothyroidismSS

• Cardiovascular
• Bradycardia
• Gastro-intestinal
• Constipation
• Weight gain
• Appetite loss

7
HypothyroidismSS

• Muscular-skeletal
• Clumsy slow movements
• Fatigue
• Cold intolerance
• Dull facial expression

8
HypothyroidismSS

• Skin
• Dry, pale
• Hair dry
• Thick lips
• Puffy eyes

9
Hypothyroidism

• Cretinism
• Rare in the US
• Congenital condition d/t i TH ? physical mental
  retardation

• 18yr old

10
Hypothyroidism

• Hashimotos thyroiditis
• Most common adult hypothyroidism
• Auto-immune
• Female gt male
• Age
• 30-50

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HypothyroidismDiagnostic Tests

• By definition hypothyroidism means what?
• T3/T4
• i

12
HypothyroidismDiagnostic Tests

• By definition primary hypothyroidism means what?
  (where is the problem what is causing the
  problem?)
• Thyroid ?
• i T3/T4
• In primary hypothyroidism, is the pituitary gland
  working correctly?
• Yes

13
HypothyroidismDiagnostic Tests

• If the pituitary gland is working correctly and
  there is an i T3/T4 level, what will the
  Pituitary gland do with the TSH level?

14
HypothyroidismDiagnostic Tests

• By definition hypothyroidism means what?
• T3/T4
• i

15
HypothyroidismDiagnostic Tests

• By definition secondary hypothyroidism means
  what? (where is the problem what is causing the
  problem?)
• Pituitary gland?
• i TSH ?
• i T3/T4

16
HypothyroidismDiagnostic Tests

• By definition secondary hyporthyroidism means
  what? (where is the problem what is causing the
  problem?)
• Pituitary gland? i TSH ? i T3/T4

17
HypothyroidismMedical Treatment

• Rx / life time
• Thyroid (Armour thyroid)
• Natural form
• Levothyroxine sodium / Levothroid, Synthroid
• Synthetic
• Time of dose
• AM
• Monitor __________system
• C/V
• Gradually h meds
• takes 2 wks to know full affect

• Blood level monitoring
• Annually
• Know SS and report

18
HypothyroidismMedical Treatment

• Diet
• Fiber
• h
• Protein
• h
• Fluids
• h
• Calories
• i
• Avoid food h in I (interferes with meds)

19

• Avoid food h in I
• Kelp
• Shellfish
• Iodized salt
• Cabbage
• Turnips
• Pears
• Peaches

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HypothyroidismNursing management

• Rest
• Space
• Skin
• Protect
• Diet
• Adjust

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Severe Hypothyroid State

• Myxedema
• Definition
• Advanced hypothyroidism
• Etiology
• Iodine deficiency
• Atrophy of thyroid
• Surgery
• Destruction of thyroid by I 131

22
Hypothyroidism SevereMyxedema

• Characteristics
• Growing puffiness sogginess of the skin
• Dry, waxy edema (non-pitting)
• Abnormal deposits of mucin in the skin
• Distinctive facial changes

23
Hypothyroidism Severe

• Myxedema Coma
• Met. Rate drops so low ? life threatened
• Temperature
• lt 95 F
• Blood pressure
• i
• Glucose
• i
• Mental function
• i

24
Hypothyroidism Severe

• Myxedema Coma
• Death d/t
• Respiratory Failure

25
Goiters

• Definition
• Enlarged thyroid
• Pathophysiology

26
Review!

• What hormone causes the thyroid to grow?
• TSH
• What hormonal change causes goiters?
• h TSH

27
Goiters

• Definition
• Enlarged thyroid
• Pathophysiology
• h TSH levels ? goiters
• Etiology
• i TH levels
• i Iodine
• PG

28
Goiters

• Endemic goiter
• Caused by environmental factors
• i iodine

29
Goiters

• Are goiters assoc. with
• Hyperthyroidism
• YES!
• Hypothyroidism
• YES!
• Euthyroid state
• YES!
• All of the above

30
Goiters

• Goitrogens
• Suppress thyroid function
• Broccoli
• Cauliflower
• Cabbage
• Turnips
• Sulfonamide
• Lithium
• Salicylates

31
Goiters

• SS
• Enlarged thyroid
• Complications
• May interfere with
• Respiration
• Swallowing

32
Goiters

• Nursing Management
• Diet
• Limit goitrogens
• Assess
• Breathing
• Stridor
• Swallowing
• Palpate????
• NO!

33
Cancer of the Thyroid gland

• Etiology
• Rare
• FgtM
• Thyroid hyperplasia
• Radiation
• Iodine deficiency

34
Cancer of the Thyroid gland

• 1 SS
• Nodule on thyroid
• Hard
• Painless

35
Cancer of the Thyroid gland

• SS
• Difficulty swallowing or breathing
• Changes in voice
• Lab values
• Normal TH levels

36
Cancer of the Thyroid gland

• Diagnostic Tests
• Thyroid scan
• Shows cold spot
• Area that did not take up radioactive material
• Indicates malignancy
• Biopsy
• Confirms diagnosis

37
Cancer of the Thyroid gland

• Medical Management
• Thyroidectomy
• Partial
• Total
• Chemotherapy

38
Cancer of the Thyroid gland

• Nursing Management- thyroidectomy
• Pre-op
• Euthyroid state
• Verify meds taken

39
Cancer of the Thyroid gland

• Nursing Management- thyroidectomy
• Post-op
• Vital Signs
• i BP h Pulse
• Shock d/t hemorrhaging
• h Pulse h fever h BP
• Thyrotoxic crisis

40
Cancer of the Thyroid gland

• Nursing Management- thyroidectomy
• Post-op
• Check hemohaggin
• back of neck for pooling blood
• Check for SS of dyspnea or resp distress
• Check speech
• Semi-fowlers position

41
Cancer of the Thyroid gland

• Nursing Management- thyroidectomy
• Post-op
• Activity
• Support neck
• Monitor for Tetany
• Continuous tonic spasm
• Tracheostomy set at bed side
• Resp. obstruction
• Diet Changes (esp. if hyperthyroidism)

• Tetany
• Tetanus

42
Thyroidectomy Complications

• Thyrotoxic crisis
• D/t manipulation of thyroid during surgery ?
• release large amount of TH

43
ThyroidectomyComplications

• Tetany
• D/T low Ca levels
• Characterized by
• Fingers perioral area tingling
• Muscle spasm
• Twitching
• Cardiac Dysrhythmias

• Etiology
• D/t removal of parathyroid gland
• Treatment
• IV Calcium gluconate
• Breath into a paper bag ?
• mild acidosis ?
• h Calcium in blood