Disorders of the Thyroid and Parathyroid ACC, RNSG 1247 Created by Lydia Seese, RN.
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Transcript of Disorders of the Thyroid and Parathyroid ACC, RNSG 1247 Created by Lydia Seese, RN.
Thyroid Enlargement/Goiter
Maybe caused by: Increased TSH stimulationGrowth-stimulating immunoglobulins &
other growth factorsGoitrogensIodine-deficiency areas (endemic goiter)
Thyroid nodules
Mostly benignMalignant nodules: usually hard &
painlessDiagnostics: US, US-guided FNA,
thyroid scan Treatment: unilateral to total
thyroidectomy
Thyroiditis
Subacute and acute thyroiditis: Subacute - viral (as in subacute granulomtous thyroiditis)
Acute fungal or bacterial
Chronic autoimmune thyroiditis
Silent painless thyroiditis
Hashimoto’s thyroiditis
Chronic autoimmune diseaseMost common cause of hypothyroidism in
US
Diagnostics: T3 T4 usually low, TSH high, (+) for antithyroid antibodies
HYPERTHYROIDISM
Graves’ DiseaseToxic nodular goitersThyroiditis (hyper) – usually caused by virus
as in viral subacute granulomatous thyroiditis
Thyrotoxic crisis (thyroid storm)
Graves Disease
Autoimmune, unknown etiologyAntibodies attach to the TSH receptors
and stimulate the thyroid to release T3 & T4
May lead to destruction of thyroid tissue , thus hypothyroidism
Toxic Nodular Goiters
Release thyroid hormones independent of TSH stimulation
Maybe single or multinodular
Diagnostics for Hyper/Hypothyroid Dysfunction
1. History and PE
2. Most reliable blood tests are: TSH Free T4
Diagnostics Continued
T3, T4Radioactive iodine uptake (RAIU ) TRH stimulation testECGUSThyroid scanAntibody assay
Hyperthyroidism: Manifestations
S/sx of increased metabolism & stimulation of SNS
Goiter Opthalmopathy; exophthalmus in
Graves’
Thyroid storm
Rare but dangerous Systemic symptoms: examples
HyperthermiaTachycardia, esp. atrial arrhythmiasAgitation or delirium
Drug Therapy: Antithyroid drugs
Preferred Tx for pregnant women Methimazole - tapazole PTU - prophylthiouracil Improvement begins 1-2 weeks Good results in 4-8 weeks Remission in 6-15 mos. in < 50% of casesPatient concern: noncompliance
Drug Therapy: B adrenergic blockers
Symptomatic relief of thyrotoxicosisPropranolol - InderalAtenolol - Tenormin
Drug Therapy: Iodine
Maximal effect in 1-2 weeks Saturated solution of potassium iodine
(SSKI) Lugol’s solution
Radioactive Iodine Therapy
Preferred for most nonpregnant women Damages thyroid hormone Effect in 2-3 mos.
Pre/Post operative Care
CDB, turning, ambulate w/in hrs post opROM of neckAirway and incision site monitoringSemi fowlers to prevent tension on suture
linesVS monitoring including tetanyPain managementFluids if tolerated, soft diet day after
Post operative & home care
Remaining thyroid tissue is allowed to regenerate post-op
Reduced caloric intake, adequate iodineRegular exerciseAvoid temperature extremesRegular follow up to monitor for
hypothyroidism
HYPOTHYROIDISM
Primary – RT destruction of thyroid tissue or defective hormone synthesis
Secondary – RT pituitary disease
Hypothyroidism: Manifestations
Slowing of body process which develops over months to years
Exs: fatigue, cold intolerance, weight gain, systemic symptoms
Myxedema
Myxedema Coma
Rare but life threateningSevere metabolic disorders, hypothermia,
cardiovascular collapse, comaFactors: infection, trauma, failure to take
thyroid replacements
Hypothyroidism: Collaborative care
Goal – euthyroid stateLow calorie dietThyroid hormoneNatural hormones
Hypothyroidism: Acute Intervention
IV thyroid hormone Hypertonic saline solution Close assessment VS monitoring
Thyroid malignancies
Occur more often in people who have undergone radiation of the head, neck or chest.
Symptoms of thyroid cancer include hoarseness, dysphagia
Disorders of the parathyroid glands
Hyperparathyroidism (hypercalcemia)Hypoparathyroidism (hypocalcemia)Tumors
Hyperparathyroid
Major S/Sx: depression, fatigue, loss of appetite, constipation, osteoporosis, fractures, kidney stones
DX: bone x-rays, Ca & PTH levelsTX: decrease high serum levels, surgical
removal of parathyroid
Common Medications used in Hyperparathyroidism
PhosphorusBiphosphatesEstrogen or progestinOral phosphateDiureticsCalcimimetic agents
Signs that indicate calcium levels are abnormal
Trousseau’s sign: temporarily occlude arterial blood flow (with BP cuff inflated) above the normal systolic pressure. A + Trousseau”s sign occurs when the hand and fingers contract from ischemia
Chvostek’s sign: tap on the facial nerve just below the temple. Sign is + when nose, eye, lip & facial muscles twitch
HypoparathyroidismResults from abnormally low levels of
PTH low Ca level Symptoms: painful spasms of face, hands,
arms, and feet; seizuresTX: IV Calcium; CalMag & vit D;
Rebreathing
Parathyroid Tumors
Grow inside the gland itselfMay cause levels of PTH leading to
hyper states.Most are benign adenomas;
malignancies are very rare
Nursing Diagnosis for thyroid/parathyroid patients
Imbalanced nutrition: _______ r/t hypermetabolic or hypometabolic state
Disturbed body image: r/t changes in appearance AEB exopthalmus (myxedema), skin changes, facial edema, presence of goiter
Risk for constipation r/t slowed metabolic states and decreased activity tolerance
Risk for fluid/electrolyte imbalance r/t changes in production of thyroid hormones 2° hypothyroidism
Nursing Diagnosis, cont.
Electrolyte imbalance r/t decreased/increased levels of calcium AEB….
Knowledge deficit: dietary, r/t decreased parathyroid function AEB calcium serum levels of_____, facial twitching, muscle cramps, …..
R/F impaired cardiac outputR/F Imbalanced body temperatureRF acute pain RT effects of renal stone