1. Endocrine – Thyroid gland Part 1

2. Description: Thyroid Butterfly shaped Two lobes connected by an isthmus Straddles the trachea Largest endocrine gland

3. Function: Thyroid 1.Produce thyroid hormones (TH)  Vital for growth & metabolism 2.Iodine storage  Essential for T3/T4 syntheses

4. Hormones HormoneFunction Stimulated by T3/T4  metabolic rate  protein synthesis  energy production Most important hormone in day today regulation of metabolic rate  metabolic rate  T3/T4  TSH

5. Thyroid Hormones HormonesFunctionStimulated by T3/T4  metabolism  metabolism Calcitonin  blood calcium concentration  the reabsorption of Ca and Ph from bones to blood Calcitonin “tones” down serum Ca levels  blood Ca levels

6. Hormone Loop  Metabolic rate  Detected by hypothalamus  Stimulates anterior pituitary  Secretes TSH  Blood stream  target organ  thyroid Stimulate Thyroid to secrete T3/T4  Blood stream  target organs  adrenal medulla  Secretes Epinephrine & Norepinephrine   Metabolic rate

7. Thyroid Disorders World-wide – Iodine deficiency United States – Auto-immune

8. Hyperthyroidism Definition  T3/T4 in blood Pathophysiology Primary hyperthyroidism – Problem with thyroid gland   T3/T4 Secondary hyperthyroidism – Problem with pituitary gland   T3/T4 – Pituitary   TSH   T3/T4 –  TSH  thyroid growth  goiter

9. Hyperthyroidism Etiology Auto-immune AKA: – Grave’s disease F vs M? – F > M Age – 20-40 yrs

10. Hyperthyroidism S&S Neurological Heat intolerance Diaphoresis  sympathetic nervous response

11. Hyperthyroidism S&S Affect Nervous Emotional lability Irritable I Concentration Mood swings  manic/psychotic

12. Hyperthyroidism S&S Cardiovascular Tachycardia Palpitations

13. Hyperthyroidism S&S Gastrointestinal Appetite –– Weight –– BM –– – Diarrhea

14. Hyperthyroidism S&S Muscle-skeletal Tremors Restlessness Muscle – weakness

15. Hyperthyroidism S&S Skin Temperature – Warm Smooth Hair – Fine, soft – Gray –  Loss

16. Hyperthyroidism S&S Exophthalmos Bulging of the eye Stare

17. Hyperthyroidism S&S Goiter Enlarged thyroid TSH levels ––

18. Hyperthyroidism S&S Oncholysis Distal nail separates from the nail bed Nail fragile

19. Hyperthyroidism S&S Gynecomastia Abnormal enlargement breasts male

20. Hyperthyroidism S&S Elderly Heart failure Fatigue Apathy Depression

21. Hormone Review  T3/T4  Pituitary   TSH  Thyroid   T3/T4 ___________________  T3/T4  Pituitary   TSH  Thyroid   T3/T4

22. Hyperthyroidism Diagnostic Tests Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4  TSH By definition hyperthyroidism means what? – T3/T4 ––

23. Hyperthyroidism Diagnostic Tests By definition primary hyperthyroidism means what? (where is the problem – what is causing the problem?) – Thyroid   T3/T4 In primary hyperthyroidism, is the pituitary gland working correctly? – Yes

24. Hyperthyroidism Diagnostic Tests Primary Hyperthyroidism Secondary Hyperthyroidism 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?

25. Hyperthyroidism Diagnostic Tests Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4  TSH  By definition hyperthyroidism means what? – T3/T4 ––

26. Hyperthyroidism Diagnostic Tests By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?) – Pituitary gland   TSH   T3/T4

27. Hyperthyroidism Diagnostic Tests Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4  TSH  By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?) – Pituitary gland   TSH   T3/T4

28. Question? Mrs. Goiter has a thyroid panel done and shows an elevated T3/T4 and an elevated TSH? Which of the following diagnosis apply? A.Primary hyperthyroidism B.Secondary hyperthyroidism C.Primary hypothyroidism D.Secondary hypothyroidism

29. Question? Mrs. Canta Geta Up has a thyroid panel done and shows an elevated T3/T4 and an decreased TSH? Which of the following diagnosis apply? A.Primary hyperthyroidism B.Secondary hyperthyroidism C.Primary hypothyroidism D.Secondary hypothyroidism

30. Hyperthyroidism Medical Treatment Meds first Goal –  T3/T4 levels Meds alone sometimes work - if not  – Surgery

31. Hyperthyroidism Medical Treatment Anti-thyroid therapy Propylthioracil / PTU Methimazole / Tapazole – Action Inhibits synthesis of T3/T4

32. Hyperthyroidism Medical Treatment Propranolol hydrochloride / Inderal Beta-blocker  sympathetic nervous system No smoking

33. Hyperthyroidism Medical Treatment Meds alone not  – Surgery If Ca Thyroid  – Surgery Euthyroid state before surgery! – How? Anti-thyroid meds

34. Hyperthyroidism Medical Treatment Iodine before surgery – Potassium iodine saturated solution (SSKI) –  vascularity of the thyroid –  risk of post-op bleeding

35. Hyperthyroidism Medical Treatment Radioactive Iodine I 131 Used instead of radiation tx Stop anti-thyroid meds x 7 days Single dose S&S  in @ 3wks  full effect in 3 months

36. Hyperthyroidism Medical Treatment Radioactive Iodine Safety – No PG nurses – Watch body fluids – Avoid kids x 7 days

37. Hyperthyroidism Medical Treatment Diet ( When hyperthyroid) Calories –– – 4,000-5,000 cal/day Fluids –– Na –– Fiber –– Caffeine ––

38. Hyperthyroidism Nursing Management Assessment Vital signs Lung sounds Anxiety level Weight Bowel function NEVER palpate goiter  – Release TH

39. Hyperthyroidism Nursing Management Nrs. Dx Risk for injury Hyperthermia Diarrhea Alt. Nutrition Sleep pattern disturbance Anxiety

40. Hyperthyroidism Nursing Management Exophthalmos – Lubricate eyes – Tape closed – Dark glasses –  Na diet – HOB 

41. Hyperthyroidism Severe Thyrotoxicosis AKA: Thyroid Storm Definition – Sever hyperthyroid state Etiology – Stress – Post thyroid surgery – Undiagnosed

42. Hyperthyroidism Severe Thyrotoxicosis S&S  TH   adrenergic activity   epinephrine Pulse –– Temperature –– BP –– Depression Activity – Restlessness Delirium SOB Coma

43. Hyperthyroidism Severe Thyrotoxicosis Death – <2hr – Cardiac Failure

44. Hyperthyroidism Severe Thyrotoxicosis Treatment Fever – Tylenol/ acetaminophen – Not aspirin For  pulse &  BP – Propranolol / Inderal – Beta-adrenergic blocker If SOB – O2 – HOB 