Thyroid part 2 Hypothyroidism

Hypothyroidism Definition i TH Pathophysiology Primary hypothyroidism Thyroid fails to produce enough TH Secondary Hypothyroidism i stimulation  Thyroid (pituitary or hypothalmus)

Hypothyroidism Etiology Primary Secondary Congenital I deficiency Auto-immune Thyroidectomy Secondary Pituitary / hypothalamus

Hypothyroidism S&S Think ______ Slow

Hypothyroidism S&S Neurology Slow mentation Slurred speech Affect Lethargy depression

Hypothyroidism S&S Cardiovascular Bradycardia Gastro-intestinal Constipation Weight gain Appetite loss

Hypothyroidism S&S Muscular-skeletal Clumsy slow movements Fatigue Cold intolerance Dull facial expression

Hypothyroidism S&S Skin Dry, pale Hair dry Thick lips Puffy eyes

Hypothyroidism Cretinism Rare in the US Congenital condition d/t i TH  physical & mental retardation 18yr old

Hypothyroidism Hashimoto’s thyroiditis Most common adult hypothyroidism Auto-immune Female > male Age: 30-50

Hypothyroidism Diagnostic Tests By definition hypothyroidism means what? T3/T4 i Primary Hypothyroidism Secondary Hypothyroidism T3/T4 i TSH

Hypothyroidism Diagnostic Tests By definition primary hypothyroidism means what? (where is the problem – what is causing the problem?) Thyroid  i T3/T4 In primary hypothyroidism, is the pituitary gland working correctly? Yes

Hypothyroidism Diagnostic Tests If the pituitary gland is working correctly and there is an i T3/T4 level, what will the Pituitary gland do with the TSH level? Primary Hypothyroidism Secondary Hypothyroidism T3/T4 i TSH h

Hypothyroidism Diagnostic Tests By definition hypothyroidism means what? T3/T4 i Primary Hypothyroidism Secondary Hypothyroidism T3/T4 i TSH h

Hypothyroidism Diagnostic Tests By definition secondary hypothyroidism means what? (where is the problem – what is causing the problem?) Pituitary gland i TSH  i T3/T4

Hypothyroidism Diagnostic Tests By definition secondary hyporthyroidism means what? (where is the problem – what is causing the problem?) Pituitary gland i TSH  i T3/T4 Primary Hypothyroidism Secondary Hypothyroidism T3/T4 i TSH h

Hypothyroidism Medical Treatment Rx / life time Thyroid (Armour thyroid) Natural form Levothyroxine sodium / Levothroid, Synthroid Synthetic Time of dose AM Monitor __________system C/V Gradually h meds takes 2 wks to know full affect Blood level monitoring Annually Know S&S and report

Hypothyroidism Medical Treatment Diet Fiber h Protein Fluids Calories i Avoid food h in I (interferes with meds)

Avoid food h in I Kelp Shellfish Iodized salt Cabbage Turnips Pears Peaches

Hypothyroidism Nursing 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 Severe Myxedema 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 i Glucose Mental function

Hypothyroidism Severe Myxedema Coma Death d/t… Respiratory Failure

Goiters Definition Enlarged thyroid Pathophysiology

Review! What hormone causes the thyroid to grow? TSH What hormonal change causes goiters? h TSH

Goiters Definition Enlarged thyroid Pathophysiology h TSH levels  goiters Etiology i TH levels i Iodine PG

Goiters Endemic goiter Caused by environmental factors i iodine

Goiters Are goiters assoc. with All of the above Hyperthyroidism YES! Hypothyroidism Euthyroid state All of the above

Goiters Goitrogens Suppress thyroid function Broccoli Cauliflower Cabbage Turnips Sulfonamide Lithium Salicylates

Goiters S&S Enlarged thyroid Complications May interfere with Respiration Swallowing

Goiters Nursing Management Diet Assess Palpate???? Limit goitrogens 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 i BP & h Pulse = Shock d/t hemorrhaging h Pulse h fever h 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) Tetany Tetanus

Thyroidectomy Complications Thyrotoxic crisis D/t manipulation of thyroid during surgery  release large amount of TH

Thyroidectomy Complications 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  h Calcium in blood