Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 66 Care of Patients with Problems of the Thyroid and Parathyroid Glands

2 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Hyperthyroidism  Thyrotoxicosis  Graves’ disease: goiter, exophthalmos, pretibial myxedema  Assessment  History  Physical assessment  Clinical manifestations  Psychosocial assessment

3 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Exophthalmos

4 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Goiter

5 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Laboratory Tests  T 3, T 4, T 3 RU, TSH, TSH-RAb  Thyroid scan  Ultrasonography  ECG

6 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Nonsurgical Management  Monitoring  Reducing stimulation  Promoting comfort  Drug therapy (antithyroid drugs, iodine preparations, lithium, beta-adrenergic blocking drugs)

7 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Surgical Management  Total or subtotal thyroidectomy  Postoperative complications:  Hemorrhage  Respiratory distress  Hypocalcemia and tetany  Laryngeal nerve damage  Thyroid storm or thyroid crisis  Eye and vision problems of Graves’ disease

8 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Postoperative Monitoring  Hoarseness or stridor  Suture line pressure  Hypocalcemia and tetany  Thyroid storm

9 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Hypothyroidism  Causes  Differentiating: aging vs. hypothyroidism  Decreased metabolism from low thyroid hormone levels  Myxedema  Myxedema coma

10 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Myxedema

11 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Hypothyroidism Assessment  History  Physical assessment  Clinical manifestations  Psychosocial assessment  Laboratory assessment

12 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Thyroiditis  Inflammation of thyroid gland  Three types—acute; subacute (granulomatous); chronic (Hashimoto’s disease—most common type)  Thyroiditis vs. hyperthyroidism, hypothyroidism  Nonsurgical management, drug therapy  Surgical management

13 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Thyroid Cancer  Four types:  Papillary  Follicular  Medullary  Anaplastic  Collaborative management  Surgery

14 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Hyperparathyroidism  Parathyroid glands—calcium and phosphate balance  Hypercalcemia and hypophosphatemia  Nonsurgical vs. surgical management

15 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Hypoparathyroidism  Decreased function of parathyroid gland  Iatrogenic  Idiopathic  Hypomagnesemia  Interventions—correcting hypocalcemia, vitamin D deficiency, hypomagnesemia

16 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 2 What is a priority intervention for an older female patient with a history of hyperparathyroidism? A. Encourage small frequent meals. B. Implement fall precautions. C. Provide pain medications as prescribed. D. Encourage oral fluid hydration.

17 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 3 A postoperative plan of care for a patient after a total thyroidectomy should include which intervention? A. Avoiding extending the patient’s neck B. Administering oxygen via nasal cannula as needed C. Assessing the patient’s voice once per shift D. Encouraging the patient to be out of bed in a chair