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Disorders of the Thyroid and Parathyroid. ACC, RNSG 1247 Created by Lydia Seese, RN . Thyroid Enlargement/Goiter . Maybe caused by: Increased TSH stimulation Growth-stimulating immunoglobulins & other growth factors Goitrogens Iodine-deficiency areas (endemic goiter). Thyroid nodules.

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disorders of the thyroid and parathyroid

Disorders of the Thyroid and Parathyroid

ACC, RNSG 1247

Created by Lydia Seese, RN

thyroid enlargement goiter
Thyroid Enlargement/Goiter

Maybe caused by:

  • Increased TSH stimulation
  • Growth-stimulating immunoglobulins & other growth factors
  • Goitrogens
  • Iodine-deficiency areas (endemic goiter)
thyroid nodules
Thyroid nodules
  • Mostly benign
  • Malignant nodules: usually hard & painless
  • Diagnostics: US, US-guided FNA, thyroid scan
  • Treatment: unilateral to total thyroidectomy
thyroiditis
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
Hashimoto’s thyroiditis
  • Chronic autoimmune disease
  • Most common cause of hypothyroidism in US
  • Diagnostics: T3 T4 usually low, TSH high, (+) for antithyroid antibodies
hyperthyroidism
HYPERTHYROIDISM
  • Graves’ Disease
  • Toxic nodular goiters
  • Thyroiditis (hyper) – usually caused by virus as in viral subacute granulomatous thyroiditis
  • Thyrotoxic crisis (thyroid storm)
graves disease
Graves Disease
  • Autoimmune, unknown etiology
  • Antibodies 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
Toxic Nodular Goiters
  • Release thyroid hormones independent of TSH stimulation
  • Maybe single or multinodular
diagnostics for hyper hypothyroid dysfunction
Diagnostics for Hyper/Hypothyroid Dysfunction
  • History and PE
  • Most reliable blood tests are:
  • TSH
  • Free T4
diagnostics continued
Diagnostics Continued
  • T3, T4
  • Radioactive iodine uptake (RAIU )
  • TRH stimulation test
  • ECG
  • US
  • Thyroid scan
  • Antibody assay
hyperthyroidism manifestations
Hyperthyroidism: Manifestations
  • S/sx of increased metabolism & stimulation of SNS
  • Goiter
  • Opthalmopathy; exophthalmus in Graves’
thyroid storm
Thyroid storm
  • Rare but dangerous
  • Systemic symptoms: examples
    • Hyperthermia
    • Tachycardia, esp. atrial arrhythmias
    • Agitation or delirium
hyperthyroidism collaborative care
Hyperthyroidism: Collaborative Care
  • Medications/Drugs
  • Radioactive Iodine
  • Nutritional
  • Surgical
drug therapy antithyroid drugs
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 cases
  • Patient concern: noncompliance
drug therapy b adrenergic blockers
Drug Therapy: B adrenergic blockers
  • Symptomatic relief of thyrotoxicosis
  • Propranolol - Inderal
  • Atenolol - Tenormin
drug therapy iodine
Drug Therapy: Iodine
  • Maximal effect in 1-2 weeks
  • Saturated solution of potassium iodine (SSKI)
  • Lugol’s solution
radioactive iodine therapy
Radioactive Iodine Therapy
  • Preferred for most nonpregnant women
  • Damages thyroid hormone
  • Effect in 2-3 mos.
acute intervention
Acute Intervention
  • Support ABC’s
  • Rest, minimal stimulation
  • Eye care
pre post operative care
Pre/Post operative Care
  • CDB, turning, ambulate w/in hrs post op
  • ROM of neck
  • Airway and incision site monitoring
  • Semi fowlers to prevent tension on suture lines
  • VS monitoring including tetany
  • Pain management
  • Fluids if tolerated, soft diet day after
post operative home care
Post operative & home care
  • Remaining thyroid tissue is allowed to regenerate post-op
  • Reduced caloric intake, adequate iodine
  • Regular exercise
  • Avoid temperature extremes
  • Regular follow up to monitor for hypothyroidism
hypothyroidism
HYPOTHYROIDISM
  • Primary – RT destruction of thyroid tissue or defective hormone synthesis
  • Secondary – RT pituitary disease
hypothyroidism manifestations
Hypothyroidism: Manifestations
  • Slowing of body process which develops over months to years
  • Exs: fatigue, cold intolerance, weight gain, systemic symptoms
  • Myxedema
myxedema coma
Myxedema Coma
  • Rare but life threatening
  • Severe metabolic disorders, hypothermia, cardiovascular collapse, coma
  • Factors: infection, trauma, failure to take thyroid replacements
hypothyroidism collaborative care
Hypothyroidism: Collaborative care
  • Goal – euthyroid state
  • Low calorie diet
  • Thyroid hormone
  • Natural hormones
hypothyroidism acute intervention
Hypothyroidism: Acute Intervention
  • IV thyroid hormone
  • Hypertonic saline solution
  • Close assessment
  • VS monitoring
thyroid malignancies
Thyroid malignancies
  • Occur more often in people who have undergone radiation of the head, neck or chest.
  • Symptoms of thyroid cancer include hoarseness, dysphagia
most common types of thyroid cancer
Most Common Types of Thyroid Cancer
  • Papillary thyroid cancer
  • Follicular thyroid cancer
disorders of the parathyroid glands
Disorders of the parathyroid glands
  • Hyperparathyroidism (hypercalcemia)
  • Hypoparathyroidism (hypocalcemia)
  • Tumors
hyperparathyroidism
Hyperparathyroidism
  • Primary
  • Secondary
  • Tertiary
hyperparathyroid
Hyperparathyroid
  • Major S/Sx: depression, fatigue, loss of appetite, constipation, osteoporosis, fractures, kidney stones
  • DX: bone x-rays, Ca & PTH levels
  • TX: decrease high serum levels, surgical removal of parathyroid
hyperparathyroidism nonsurgical treatment
Hyperparathyroidism: Nonsurgical Treatment
  • Close follow up
  • Active lifestyle.
  • Dietary measures
  • Drugs
common medications used in hyperparathyroidism
Common Medications used in Hyperparathyroidism
  • Phosphorus
  • Biphosphates
  • Estrogen or progestin
  • Oral phosphate
  • Diuretics
  • Calcimimetic agents
signs that indicate calcium levels are abnormal
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
hypoparathyroidism
Hypoparathyroidism
  • Results from abnormally low levels of PTH low Ca level
  • Symptoms: painful spasms of face, hands, arms, and feet; seizures
  • TX: IV Calcium; CalMag & vit D; Rebreathing
parathyroid tumors
Parathyroid Tumors
  • Grow inside the gland itself
  • May cause  levels of PTH leading to hyper states.
  • Most are benign adenomas; malignancies are very rare
nursing diagnosis for thyroid parathyroid patients
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
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 output
  • R/F Imbalanced body temperature
  • RF acute pain RT effects of renal stone