Thyroid part 2 Hypothyroidism. Definition TH Pathophysiology Primary hypothyroidism – Thyroid...

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–


• 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




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?




T3/T4

TSH

• By definition hypothyroidism means what?– T3/T4–


• By definition secondary hypothyroidism means what? (where is the problem – what is causing the problem?)– Pituitary gland

• TSH • T3/T4




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


• #1 S&S– Nodule on thyroid – Hard– Painless


S&S• Difficulty swallowing or

breathing• Changes in voice• Lab values

– Normal TH levels


Diagnostic Tests• Thyroid scan

– Shows “cold” spot• Area that did not take

up radioactive material

• Indicates malignancy

• Biopsy– Confirms diagnosis


Medical Management• Thyroidectomy

– Partial– Total

• Chemotherapy


Nursing Management- thyroidectomy

• Pre-op– Euthyroid state– Verify meds taken



• Post-op– Vital Signs– BP & Pulse =

• Shock d/t hemorrhaging

– Pulse fever BP =• Thyrotoxic crisis



• Post-op– Check hemohaggin

• back of neck for pooling blood

– Check for S&S of dyspnea or resp distress

– Check speech– Semi-fowlers position



• 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

Thyroid part 2 Hypothyroidism. Definition TH Pathophysiology Primary hypothyroidism – Thyroid...

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