Endocrine – Thyroid gland

1. Endocrine – Thyroid gland Part 1

2. Description: Thyroid • Butterfly shaped • Two lobes connected by an isthmus • Straddles the trachea • Largest endocrine gland

3. Function: Thyroid • Produce thyroid hormones (TH) • Vital for growth & metabolism • Iodine storage • Essential for T3/T4 syntheses

4. Hormones

5. Thyroid Hormones

6. Hormone Loop • i Metabolic rate  • Detected by hypothalamus  • Stimulates anterior pituitary  • Secretes TSH  • Blood stream  target organ  thyroid • Stimulate Thyroid to secrete T3/T4  • Blood stream  target organs  adrenal medulla  • Secretes Epinephrine & Norepinephrine  • hMetabolic rate

7. United States Auto-immune Thyroid Disorders • World-wide • Iodine deficiency

8. Hyperthyroidism Definition • h T3/T4 in blood Pathophysiology • Primary hyperthyroidism • Problem with thyroid gland  h T3/T4 • Secondary hyperthyroidism • Problem with pituitary gland  h T3/T4 • Pituitary  h TSH  h T3/T4 • h TSH  thyroid growth  goiter

9. Hyperthyroidism Etiology • Auto-immune • AKA: • Grave’s disease • F vs M? • F > M • Age • 20-40 yrs

10. HyperthyroidismS&S Neurological • Heat intolerance • Diaphoresis • h sympathetic nervous response

11. HyperthyroidismS&S Affect • Nervous • Emotional lability • Irritable • I Concentration • Mood swings •  manic/psychotic

12. HyperthyroidismS&S Cardiovascular • Tachycardia • Palpitations

13. HyperthyroidismS&S Gastrointestinal • Appetite • h • Weight • i • BM • h • Diarrhea

14. HyperthyroidismS&S Muscle-skeletal • Tremors • Restlessness • Muscle • weakness

15. HyperthyroidismS&S Skin • Temperature • Warm • Smooth • Hair • Fine, soft • Gray • h Loss

16. HyperthyroidismS&S Exophthalmos • Bulging of the eye • Stare

17. HyperthyroidismS&S Goiter • Enlarged thyroid • TSH levels • h

18. HyperthyroidismS&S Oncholysis • Distal nail separates from the nail bed • Nail fragile

19. HyperthyroidismS&S Gynecomastia • Abnormal enlargement breasts • male

20. HyperthyroidismS&S Elderly • Heart failure • Fatigue • Apathy • Depression

21. Hormone Review • i T3/T4  • Pituitary  • h TSH  • Thyroid  • h T3/T4 ___________________ • h T3/T4  • Pituitary  • i TSH  • Thyroid  • i T3/T4

22. By definition hyperthyroidism means what? T3/T4 h HyperthyroidismDiagnostic Tests

23. HyperthyroidismDiagnostic Tests • By definition primary hyperthyroidism means what? (where is the problem – what is causing the problem?) • Thyroid  • h T3/T4 • In primary hyperthyroidism, is the pituitary gland working correctly? • Yes

24. If the pituitary gland is working correctly and there is an h T3/T4 level, what will the Pituitary gland do with the TSH level? HyperthyroidismDiagnostic Tests

25. By definition hyperthyroidism means what? T3/T4 h HyperthyroidismDiagnostic Tests

26. HyperthyroidismDiagnostic Tests • By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?) • Pituitary gland • h TSH  • h T3/T4

27. By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?) Pituitary gland h TSH  h T3/T4 HyperthyroidismDiagnostic Tests

28. Question? Mrs. Goiter has a thyroid panel done and shows an elevated T3/T4 and an elevated TSH? Which of the following diagnosis apply? • Primary hyperthyroidism • Secondary hyperthyroidism • Primary hypothyroidism • Secondary hypothyroidism

29. Question? Mrs. Canta Geta Up has a thyroid panel done and shows an elevated T3/T4 and an decreased TSH? Which of the following diagnosis apply? • Primary hyperthyroidism • Secondary hyperthyroidism • Primary hypothyroidism • Secondary hypothyroidism

30. HyperthyroidismMedical Treatment Meds first • Goal • i T3/T4 levels • Meds alone sometimes work - if not  • Surgery

31. HyperthyroidismMedical Treatment Anti-thyroid therapy • Propylthioracil / PTU • Methimazole / Tapazole • Action • Inhibits synthesis of T3/T4

32. HyperthyroidismMedical Treatment Propranolol hydrochloride / Inderal • Beta-blocker • i sympathetic nervous system • No smoking

33. HyperthyroidismMedical Treatment • Meds alone not  • Surgery • If Ca Thyroid  • Surgery • Euthyroid state before surgery! • How? • Anti-thyroid meds

34. HyperthyroidismMedical Treatment • Iodine before surgery • Potassium iodine saturated solution (SSKI) • i vascularity of the thyroid • i risk of post-op bleeding

35. HyperthyroidismMedical Treatment Radioactive Iodine • I131 • Used instead of radiation tx • Stop anti-thyroid meds x 7 days • Single dose • S&S i in @ 3wks  full effect in 3 months

36. HyperthyroidismMedical Treatment Radioactive Iodine • Safety • No PG nurses • Watch body fluids • Avoid kids x 7 days

37. HyperthyroidismMedical Treatment Diet (When hyperthyroid) • Calories • h • 4,000-5,000 cal/day • Fluids • h • Na • i • Fiber • i • Caffeine • i

38. HyperthyroidismNursing Management Assessment • Vital signs • Lung sounds • Anxiety level • Weight • Bowel function • NEVER palpate goiter  • Release TH

39. HyperthyroidismNursing Management Nrs. Dx • Risk for injury • Hyperthermia • Diarrhea • Alt. Nutrition • Sleep pattern disturbance • Anxiety

40. HyperthyroidismNursing Management • Exophthalmos • Lubricate eyes • Tape closed • Dark glasses • i Na diet • HOB h

41. HyperthyroidismSevere Thyrotoxicosis • AKA: Thyroid Storm • Definition • Sever hyperthyroid state • Etiology • Stress • Post thyroid surgery • Undiagnosed

42. Hyperthyroidism SevereThyrotoxicosis S&S • h TH  h adrenergic activity  h epinephrine • Pulse • h • Temperature • h • BP • h • Depression • Activity • Restlessness • Delirium • SOB • Coma

43. Hyperthyroidism SevereThyrotoxicosis • Death • <2hr • Cardiac Failure

44. Hyperthyroidism SevereThyrotoxicosis Treatment • Fever • Tylenol/ acetaminophen • Not aspirin • For h pulse & h BP • Propranolol / Inderal • Beta-adrenergic blocker • If SOB • O2 • HOB h