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 S&S • Think ______ • Slow

5. HypothyroidismS&S Neurology • Slow mentation • Slurred speech Affect • Lethargy • depression

6. HypothyroidismS&S Cardiovascular • Bradycardia Gastro-intestinal • Constipation • Weight gain • Appetite loss

7. HypothyroidismS&S Muscular-skeletal • Clumsy slow movements • Fatigue • Cold intolerance • Dull facial expression

8. HypothyroidismS&S 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 Hashimoto’s thyroiditis • Most common adult hypothyroidism • Auto-immune • Female > male • Age: • 30-50

11. By definition hypothyroidism means what? T3/T4 i HypothyroidismDiagnostic Tests

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. 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? HypothyroidismDiagnostic Tests

14. By definition hypothyroidism means what? T3/T4 i HypothyroidismDiagnostic Tests

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. By definition secondary hyporthyroidism means what? (where is the problem – what is causing the problem?) Pituitary gland i TSH  i T3/T4 HypothyroidismDiagnostic Tests

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 S&S 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

20. HypothyroidismNursing management • Rest • Space • Skin • Protect • Diet • Adjust

21. 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 • < 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 S&S • 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 • F>M • Thyroid hyperplasia • Radiation • Iodine deficiency

34. Cancer of the Thyroid gland • #1 S&S • Nodule on thyroid • Hard • Painless

35. Cancer of the Thyroid gland S&S • 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 S&S 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