1. Thyroid and Parathyroid Glands NUR 111

2. Functions of the Thyroid Pg. 1450 Metabolic rate Regulate protein, carbs and fat metabolism Increase RBC production Inc bone formation, decrease bone resorption of Ca+

3. Regulation of Metabolism Hormones T3 & T4 increase BMR Secretion controlled by hypothalamic- pituitary-thyroid gland axis TRH » TSH » T3 & T4 (neg feedback) Protein and Iodine very important for T3 & T4 production

4. Calcium and Phosphorus Balance Calcitonin (thyrocalcitonin, or TCT) Reduces bone resorption, lowers serum Ca+ Low serum Ca+ suppress TCT: Elevated serum Ca+ trigger TCT

5. Causes of Hyperthyroidism Pg. 1482 Graves’ disease (Autoimmune) Toxic multinodular goiter Thyroid adenoma (benign tumor) Pituitary hyperthyroidism Excessive use of thyroid hormone

7. Goiter and Exophthalmos in Graves' Disease

8. Hyperthyroidism More common in women Lab assessment p.1485:  T3, T4  TSH (Graves’) Thyroid Scan (RAIU) = increased

9. Nursing Diagnosis Depends on condition of client Possible Dx. Include Imbalanced nutrition: > body requirements Fatigue Anxiety If large goiter present: what is priority???

10. Interventions Nonsurgical : monitor V/S, rest, cool environment Medications: PTU (propylthiouracil), SSKI, beta blockers Radioactive Iodine Therapy Remember eye care

11. Interventions Surgical: total or subtotal thyroidectomy Preop = antithyroid meds, SSKI Postop = very important Monitor for Bleeding, respiratory distress, tetany, weak voice, thyroid storm (p.1487)

12. Causes of Hypothyroidism Pg. 1489 Removal or destruction of thyroid Autoimmune (Hashimoto’s Disease) Iodine deficiency Medications (ex.Lithium)

14. Hypothyroidism More common in women Lab assessment:  T 3, T 4  TSH Monitor for depression

15. Nursing Diagnosis Decreased cardiac output Ineffective breathing pattern Altered thought process Constipation

16. Interventions Levothyroxine sodium (Synthroid) Avoid sedatives & narcotics Monitor vital signs Monitor for S&S of hyperthyroidism Family teaching re: mental status

17. Myxedema Coma Hypothyroid Crisis Hypothyroid Crisis --> rare but seriousEtiology: acute illness/ trauma * rapid withdrawal of thyroid meds. * rapid withdrawal of thyroid meds. use of sedatives / narcotics surgery exposure to cold

18. Myxedema Coma  temp / BP  Na+  blood glucose Lactic acidosis Coma

19. Collaborative Nursing Care IVF Airway IV: Synthroid Glucose Warming blanket

20. Thyroiditis n Acute – Bacterial l Pain l  Temp. l Malaise l Dysphagia – TX l Antibiotics n Subacute – Viral l  Temp. l Chills l Pain in jaw and/or ear – TX l ASA and steroids

21. Thyroid Cancer Painless nodule in thyroid Treatment : RAI Surgery

22. Parathyroid Glands: 4 in number can be removed w/ thyroid during surgery Parathyroid secretes: Parathyroid hormone (PTH)

23. REMEMBER : Thyroid -> Calcitonin -> decreases serum calcium PTH - increases serum calcium

24. Major Role: Regulate blood levels of calcium and phosphate PTH acts on: GI tract Kidney Bones If serum CA    PTH secretion PTH - activates Vit. D --Increase calcium absorption from g.i. tract Parathyroid Glands:

25. Remember:Thyroid also secretes Calcitonin Calcitonin helps--> keep Ca in bones maintain balance of Ca and Phosphorus Calcium -- 8.8 - 10.5 Phosphorus - 3 - 4.5

26. Hyperparathyroidism Pathophysiology  Ph os  PTH secretion =  Ca +  Ph os increased reabsorption of calcium by kidneys = increased excretion of Phosphate increased excretion of Phosphate Causes Causes tumors tumors hyperplasia of parathyroid gland hyperplasia of parathyroid gland

27. Data Collection :  PTH renal calculi nephrocalcinosis bone decalcification  serum Ca GI: anorexia, N&V, epigastric pain, constipation, M/S: fatigue & lethargy [serum Ca] > 12 mg/dl =  mental status

28. Complications: Renal Failure Fractures Collapse of vertebra

29. Collaborative Management : focuses to decrease serum calcium Diuretic & Fluid Therapy Lasix /0.9% Na Cl Drug therapy Phosphates Calcitonin -miacalin spray  Skel. Release  Renal clearance Calcium Chelators - binds with Ca. -< dec. Levels of free calcium Parathyroidectomy

30. Nursing Interventions : Diuretic & Fluid Rx: Monitor: cardiac function I & O renal status serum Ca Calcium Chelator Rx: Monitor: LFT, BUN & Creatinine, CBC

31. Post - op care Parathyroidectomy Same as thyroidectomy *** Tetany Monitor for *** Tetany spasm convulsions continuous spasm of hands / feet ---> convulsions calcium levels Calcium supplements ( Tums, Oscal ) Maintain airway

32. Pathophysiology Hypoparathyroidism   PTH Etiology (rare) thyroid / parathyroid surgery thyroid / parathyroid surgery Hypomagnesemia Hypomagnesemia Idiopathic Idiopathic

33. Data Collection Hypoparathyroidism Tetany Check Check : Chvostek’sChvostek’s Trousseau’sTrousseau’s tinglingtingling severe muscle crampingsevere muscle cramping irritabilityirritability

34. Collaborative management of care IV calcium gluconate Oscal Vitamin D High Calcium diet Magnesium IM or IV