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Endocrine – Thyroid gland

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					Endocrine – Thyroid gland

          Part 1
        Description: Thyroid
• Butterfly shaped
• Two lobes connected
  by an isthmus
• Straddles the trachea
• Largest endocrine
  gland
          Function: Thyroid
1. Produce thyroid
   hormones (TH)
    Vital for growth &
     metabolism
2. Iodine storage
    Essential for T3/T4
     syntheses
                   Hormones
Hormone Function                Stimulated by

T3/T4    h metabolic rate       i metabolic
         h protein synthesis    rate
         h energy production    iT3/T4
         Most important         h TSH
         hormone in day today
         regulation of
         metabolic rate
            Thyroid Hormones
Hormones   Function                Stimulated by
T3/T4      h metabolism            i metabolism
Calcitonin i blood calcium         h blood Ca
           concentration           levels
           i the reabsorption of
           Ca and Ph from
           bones to blood
           Calcitonin “tones”
           down serum Ca
           levels
                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 
•   h Metabolic rate
            Thyroid Disorders
• World-wide            • United States
  – Iodine deficiency     – Auto-immune
              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
            Hyperthyroidism
Etiology
• Auto-immune
• AKA:
  – Grave’s disease
• F vs M?
  – F>M
• Age
  – 20-40 yrs
            Hyperthyroidism
                 S&S

Neurological
• Heat intolerance
• Diaphoresis
• h sympathetic nervous
  response
              Hyperthyroidism
                   S&S

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

Cardiovascular
• Tachycardia
• Palpitations
               Hyperthyroidism
                    S&S

Gastrointestinal
• Appetite
  –h
• Weight
  –i
• BM
  –h
  – Diarrhea
             Hyperthyroidism
                  S&S

Muscle-skeletal
• Tremors
• Restlessness
• Muscle
  – weakness
                 Hyperthyroidism
                      S&S

Skin
• Temperature
  – Warm
• Smooth
• Hair
  – Fine, soft
  – Gray
  – h Loss
             Hyperthyroidism
                  S&S

Exophthalmos
• Bulging of the eye
• Stare
             Hyperthyroidism
                  S&S

Goiter
• Enlarged thyroid
• TSH levels
   –h
              Hyperthyroidism
                   S&S

Oncholysis
• Distal nail separates
  from the nail bed
• Nail fragile
            Hyperthyroidism
                 S&S

Gynecomastia
• Abnormal enlargement
  breasts
• male
                Hyperthyroidism
                     S&S

Elderly
•   Heart failure
•   Fatigue
•   Apathy
•   Depression
            Hormone Review
• i T3/T4 
• Pituitary 
• h TSH 
• Thyroid 
• h T3/T4
___________________
• h T3/T4 
• Pituitary 
• i TSH 
• Thyroid 
• i T3/T4
                 Hyperthyroidism
                 Diagnostic Tests
• By definition hyperthyroidism means what?
  – T3/T4
  –h


             Primary           Secondary
             Hyperthyroidism   Hyperthyroidism
  T3/T4      h
  TSH
                  Hyperthyroidism
                  Diagnostic 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
                   Hyperthyroidism
                   Diagnostic Tests
• 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?


              Primary             Secondary
              Hyperthyroidism     Hyperthyroidism
   T3/T4      h
   TSH        i
                 Hyperthyroidism
                 Diagnostic Tests
• By definition hyperthyroidism means what?
  – T3/T4
  –h


             Primary           Secondary
             Hyperthyroidism   Hyperthyroidism
  T3/T4      h                 h
  TSH        i
                  Hyperthyroidism
                  Diagnostic Tests
• By definition secondary hyperthyroidism means
  what? (where is the problem – what is causing the
  problem?)
   – Pituitary gland
      • h TSH 
      • h T3/T4
                 Hyperthyroidism
                 Diagnostic Tests

        By definition secondary hyperthyroidism means
          what? (where is the problem – what is causing
          the problem?)
           – Pituitary gland h TSH  h T3/T4
            Primary               Secondary
            Hyperthyroidism       Hyperthyroidism
T3/T4       h                     h
TSH         i                     h
                Question?
Mrs. Goiter has a thyroid panel done and shows
   an elevated T3/T4 and an elevated TSH?
   Which of the following diagnosis apply?
A. Primary hyperthyroidism
B. Secondary hyperthyroidism
C. Primary hypothyroidism
D. Secondary hypothyroidism
                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?
A. Primary hyperthyroidism
B. Secondary hyperthyroidism
C. Primary hypothyroidism
D. Secondary hypothyroidism
                Hyperthyroidism
               Medical Treatment

Meds first
• Goal
   – i T3/T4 levels
• Meds alone
  sometimes work - if
  not 
   – Surgery
               Hyperthyroidism
              Medical Treatment

Anti-thyroid therapy
• Propylthioracil / PTU
• Methimazole /
  Tapazole
   – Action
      • Inhibits synthesis of
        T3/T4
            Hyperthyroidism
           Medical Treatment

Propranolol hydrochloride /
  Inderal
• Beta-blocker
• i sympathetic nervous system
• No smoking
                Hyperthyroidism
               Medical Treatment

• Meds alone not 
   – Surgery
• If Ca Thyroid 
   – Surgery
• Euthyroid state before
  surgery!
   – How?
      • Anti-thyroid meds
              Hyperthyroidism
             Medical Treatment

• Iodine before surgery
   – Potassium iodine
     saturated solution
     (SSKI)
   – i vascularity of the
     thyroid
   – i risk of post-op
     bleeding
             Hyperthyroidism
            Medical 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
              Hyperthyroidism
             Medical Treatment

Radioactive Iodine
• Safety
   – No PG nurses
   – Watch body fluids
   – Avoid kids x 7 days
              Hyperthyroidism
             Medical Treatment
Diet (When hyperthyroid)
• Calories
   –h
   – 4,000-5,000 cal/day
• Fluids
   –h
• Na
   –i
• Fiber
   –i
• Caffeine
   –i
            Hyperthyroidism
          Nursing Management
Assessment
• Vital signs
• Lung sounds
• Anxiety level
• Weight
• Bowel function
• NEVER palpate goiter
  
  – Release TH
             Hyperthyroidism
           Nursing Management

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

• Exophthalmos
  –   Lubricate eyes
  –   Tape closed
  –   Dark glasses
  –   i Na diet
  –   HOB h
              Hyperthyroidism
                  Severe

Thyrotoxicosis
• AKA: Thyroid Storm
• Definition
   – Sever hyperthyroid
     state
• Etiology
   – Stress
   – Post thyroid surgery
   – Undiagnosed
              Hyperthyroidism Severe
                  Thyrotoxicosis
S&S                          • Depression
• h TH  h adrenergic        • Activity
  activity  h epinephrine      – Restlessness
• Pulse                      • Delirium
   – h                       • SOB
• Temperature                • Coma
   – h
• BP
   – h
          Hyperthyroidism Severe
              Thyrotoxicosis

• Death
  – <2hr
  – Cardiac Failure
            Hyperthyroidism Severe
                Thyrotoxicosis
Treatment
• Fever
   – Tylenol/ acetaminophen
   – Not aspirin
• For h pulse & h BP
   – Propranolol / Inderal
   – Beta-adrenergic blocker
• If SOB
   – O2
   – HOB h

				
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posted:7/30/2012
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