Lecture 5B (Thyroid Gland) PowerPoint
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Transcript of Lecture 5B (Thyroid Gland) PowerPoint
Thyroid part 2
Hypothyroidism
Hypothyroidism
Definition• THPathophysiology• Primary hypothyroidism
– Thyroid fails to produce enough TH
• Secondary Hypothyroidism– stimulation Thyroid
(pituitary or hypothalmus)
Hypothyroidism
Etiology• Primary
– Congenital– I deficiency– Auto-immune– Thyroidectomy
• Secondary– Pituitary /
hypothalamus
Hypothyroidism
S&S• Think ______
– Slow
HypothyroidismS&S
Neurology• Slow mentation• Slurred speechAffect• Lethargy• depression
HypothyroidismS&S
Cardiovascular• BradycardiaGastro-intestinal• Constipation• Weight gain• Appetite loss
HypothyroidismS&S
Muscular-skeletal• Clumsy slow
movements• Fatigue• Cold intolerance• Dull facial expression
HypothyroidismS&S
Skin• Dry, pale• Hair dry • Thick lips• Puffy eyes
Hypothyroidism
Cretinism• Rare in the US• Congenital condition d/t
TH physical & mental retardation
• 18yr old
Hypothyroidism
Hashimoto’s thyroiditis• Most common adult
hypothyroidism• Auto-immune• Female > male• Age:
– 30-50
HypothyroidismDiagnostic Tests
Primary Hypothyroidism
Secondary Hypothyroidism
T3/T4
TSH
• By definition hypothyroidism means what?– T3/T4–
HypothyroidismDiagnostic Tests
• By definition primary hypothyroidism means what? (where is the problem – what is causing the problem?)– Thyroid
• T3/T4
• In primary hypothyroidism, is the pituitary gland working correctly?– Yes
HypothyroidismDiagnostic Tests
Primary Hypothyroidism
Secondary Hypothyroidism
T3/T4
TSH
• If the pituitary gland is working correctly and there is an T3/T4 level, what will the Pituitary gland do with the TSH level?
HypothyroidismDiagnostic Tests
Primary Hypothyroidism
Secondary Hypothyroidism
T3/T4
TSH
• By definition hypothyroidism means what?– T3/T4–
HypothyroidismDiagnostic Tests
• By definition secondary hypothyroidism means what? (where is the problem – what is causing the problem?)– Pituitary gland
• TSH • T3/T4
HypothyroidismDiagnostic Tests
Primary Hypothyroidism
Secondary Hypothyroidism
T3/T4
TSH
By definition secondary hyporthyroidism means what? (where is the problem – what is causing the problem?)– Pituitary gland TSH T3/T4
HypothyroidismMedical Treatment
Rx / life time• Thyroid (Armour thyroid)
– Natural form• Levothyroxine sodium /
Levothroid, Synthroid– Synthetic
• Time of dose– AM
• Monitor __________system – C/V
• Gradually meds – takes 2 wks to know full
affect
• Blood level monitoring– Annually
• Know S&S and report
HypothyroidismMedical Treatment
Diet• Fiber
– • Protein
– • Fluids
– • Calories
– • Avoid food in I (interferes
with meds)
• Avoid food in I– Kelp– Shellfish– Iodized salt– Cabbage– Turnips– Pears– Peaches
HypothyroidismNursing management
• Rest– Space
• Skin– Protect
• Diet– Adjust
Severe Hypothyroid State
Myxedema• Definition
– Advanced hypothyroidism
• Etiology– Iodine deficiency– Atrophy of thyroid– Surgery– Destruction of thyroid
by I 131
Hypothyroidism SevereMyxedema
Characteristics• Growing puffiness &
sogginess of the skin• Dry, waxy edema (non-
pitting)• Abnormal deposits of
mucin in the skin• Distinctive facial
changes
Hypothyroidism Severe
Myxedema Coma• Met. Rate drops so low
life threatened• Temperature
– < 95 F• Blood pressure
– • Glucose
– • Mental function
–
Hypothyroidism Severe
Myxedema Coma
• Death d/t…–Respiratory
Failure
Goiters
Definition• Enlarged thyroidPathophysiology
Review!
• What hormone causes the thyroid to grow?– TSH
• What hormonal change causes goiters?– TSH
Goiters
Definition• Enlarged thyroidPathophysiology• TSH levels goitersEtiology• TH levels• Iodine• PG
Goiters
• Endemic goiter– Caused by
environmental factors • iodine
Goiters
• Are goiters assoc. with
a. Hyperthyroidisma. YES!
b. Hypothyroidisma. YES!
c. Euthyroid statea. YES!
• All of the above
Goiters
Goitrogens• Suppress thyroid
function– Broccoli– Cauliflower– Cabbage– Turnips– Sulfonamide– Lithium– Salicylates
Goiters
S&S • Enlarged thyroidComplications• May interfere with
– Respiration– Swallowing
Goiters
Nursing Management• Diet
– Limit goitrogens• Assess
– Breathing• Stridor
– Swallowing• Palpate????
– NO!
Cancer of the Thyroid gland
Etiology• Rare• F>M• Thyroid hyperplasia• Radiation• Iodine deficiency
Cancer of the Thyroid gland
• #1 S&S– Nodule on thyroid – Hard– Painless
Cancer of the Thyroid gland
S&S• Difficulty swallowing or
breathing• Changes in voice• Lab values
– Normal TH levels
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
Cancer of the Thyroid gland
Medical Management• Thyroidectomy
– Partial– Total
• Chemotherapy
Cancer of the Thyroid gland
Nursing Management- thyroidectomy
• Pre-op– Euthyroid state– Verify meds taken
Cancer of the Thyroid gland
Nursing Management- thyroidectomy
• Post-op– Vital Signs– BP & Pulse =
• Shock d/t hemorrhaging
– Pulse fever BP =• Thyrotoxic crisis
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
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)
TetanyTetanus
Thyroidectomy Complications
• Thyrotoxic crisis– D/t manipulation of
thyroid during surgery
– release large amount of TH
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 – Calcium in blood