1. Care of Patients with Problems of the Thyroid and Parathyroid Glands
Chapter 66
Care of Patients with Problems of the Thyroid and Parathyroid Glands

2. Concept Map Body systems affected by the thyroid gland
Hypersecretion effects vs. hyposecretion effects

3. Hyperthyroidism Thyrotoxicosis
Graves’ disease: goiter, exophthalmos, pretibial myxedema
Assessment
History
Physical assessment
Clinical manifestations
Psychosocial assessment

4. Exophthalmos

5. Goiter

6. Laboratory Tests T3, T4, T3RU, TSH, TSH-RAb Thyroid scan
Ultrasonography
ECG

7. Nonsurgical Management
Monitoring
Reducing stimulation
Promoting comfort
Drug therapy (antithyroid drugs, iodine preparations, lithium, beta-adrenergic blocking drugs)

8. 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

9. Postoperative Monitoring
Hoarseness or stridor
Suture line pressure
Hypocalcemia and tetany
Thyroid storm

10. Hypothyroidism Causes Differentiating: aging vs. hypothyroidism
Decreased metabolism from low thyroid hormone levels
Myxedema
Myxedema coma

11. Myxedema

12. Hypothyroidism Assessment
History
Physical assessment
Clinical manifestations
Psychosocial assessment
Laboratory assessment

13. 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

14. Thyroid Cancer Four types: Collaborative management Surgery Papillary
Follicular
Medullary
Anaplastic
Collaborative management
Surgery

15. Hyperparathyroidism Parathyroid glands—calcium and phosphate balance
Hypercalcemia and hypophosphatemia
Nonsurgical vs. surgical management

16. Hypoparathyroidism Decreased function of parathyroid gland Iatrogenic
Idiopathic
Hypomagnesemia
Interventions—correcting hypocalcemia, vitamin D deficiency, hypomagnesemia

17. A 45-year-old woman who is seeing her health care provider states that she is tired all the time and has muscle aches and pains. Assessment reveals a heart rate of 56/min and a BP of 96/58. She has non-pitting edema of her face, especially around her eyes, and in her hands and feet. Her health history includes radioactive iodine (RAI) for hyperthyroidism. What diagnosis does the nurse expect for this patient?
Rule out hypothyroidism – most cases of hypothyroidism in the U.S. occur as a result of thyroid surgery and radioactive iodine treatment of hyperthyroidism.

18. (cont’d)
The provider orders laboratory work that includes thyroid function tests.
Which results does the nurse expect to see?
Increased T3 and T4 levels
Decreased TSH level
Decreased T3 and T4 levels
Normal T3 and T4 levels
ANS: C
Laboratory findings for hypothyroidism include decreased T3 and T4 levels, and increased TSH levels with primary hypothyroidism. With secondary hypothyroidism, the TSH level can be close to normal.

19. (cont’d)
Which statement by the patient indicates the need for additional teaching about her condition?
“When I go home I should check my heart rate and BP every day.”
“I will call my provider if I notice any change in level of consciousness.”
“I will be sure to include fiber in my diet and drink plenty of water.”
“When I am feeling better in a few months I will no longer need to take the Synthroid pills.”
ANS: D
The most important educational need for the patient with hypothyroidism is about hormone replacement therapy and its side effects. The need to take these drugs is life-long.

20. (cont’d) The patient is preparing to go home.
What important teaching points should the nurse include? (Select all that apply.)
“Report any difficulty with orientation to time, place, or person.”
“Note how many hours you sleep in a 24-hr period.”
“Be sure that you take your medication every day at the same time.”
“Your diet should be low-fiber, but with plenty of fluids.”
“Call the provider if you develop an unsteady gait or tremors in your hands.”
ANS: A, B, C, E
Patients should not take OTC drugs because thyroid hormone preparations interact with many drugs. The patient should always consult the provider before taking any OTC preparations. The diet should include fiber to prevent constipation. When the patient becomes constipated, the dose of replacement thyroid hormone may need to be increased. When the patient has difficulty getting to sleep and has more bowel movements than normal, the dose may need to be decreased.

21. Audience Response System Questions
Chapter 66
Audience Response System Questions 21

22. Question 1 What parameter should be critically evaluated when
providing care to a patient with Graves’ disease?
Irregular heart rate and rhythm
Elevated blood pressure
Elevated temperature
Change in respiratory rate
Answer: C
Rationale: Increases in temperature may indicate a rapid worsening of the patient’s condition and the onset of “thyroid storm.” Further evaluation of cardiovascular status is warranted.

23. Question 2
What is a priority intervention for an older female patient with a history of hyperparathyroidism?
Encourage small frequent meals.
Implement fall precautions.
Provide pain medications as prescribed.
Encourage oral fluid hydration.
Answer: B
Rationale: Manifestations of hyperparathyroidism may present as bone lesions, pathologic fractures, bone cysts, and osteoporosis. Preventing falls is a priority nursing intervention. Fluid hydration may be used to treat hypercalcemia. Small frequent meals can assist with nutritional need.

24. Question 3
A postoperative plan of care for a patient after a total thyroidectomy should include which intervention?
Avoiding extending the patient’s neck
Administering oxygen via nasal cannula as needed
Assessing the patient’s voice once per shift
Encouraging the patient to be out of bed in a chair
Answer: A
Rationale: The nurse should avoid extending the patient’s neck to decrease tension on the suture line. The air in the patient’s room should be humidified to promote easier respirations and thin respiratory secretions. The patient’s voice should be assessed for changes every 2 hours. Sandbags or pillows should be used to support the patient’s head or neck, and the patient should be placed in a semi-Fowler’s position.