1. Thyroid part 2
Hypothyroidism

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

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

4. Hypothyroidism
S&S
Think ______
Slow

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

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

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

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

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

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

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

12. 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

13. 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

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

15. 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

16. 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

17. 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

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

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

20. Hypothyroidism Nursing management
Rest
Space
Skin
Protect
Diet
Adjust

21. Severe Hypothyroid State
Myxedema
Definition
Advanced hypothyroidism
Etiology
Iodine deficiency
Atrophy of thyroid
Surgery
Destruction of thyroid by I 131

22. 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

23. Hypothyroidism Severe
Myxedema Coma
Met. Rate drops so low  life threatened
Temperature
< 95 F
Blood pressure i
Glucose
Mental function

24. Hypothyroidism Severe
Myxedema Coma
Death d/t…
Respiratory Failure

25. Goiters
Definition
Enlarged thyroid
Pathophysiology

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

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

28. Goiters
Endemic goiter
Caused by environmental factors
i iodine

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

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

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

32. Goiters Nursing Management Diet Assess Palpate???? Limit goitrogens
Breathing
Stridor
Swallowing
Palpate????
NO!

33. Cancer of the Thyroid gland
Etiology
Rare
F>M
Thyroid hyperplasia
Radiation
Iodine deficiency

34. Cancer of the Thyroid gland
#1 S&S
Nodule on thyroid
Hard
Painless

35. Cancer of the Thyroid gland
S&S
Difficulty swallowing or breathing
Changes in voice
Lab values
Normal TH levels

36. 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

37. Cancer of the Thyroid gland
Medical Management
Thyroidectomy
Partial
Total
Chemotherapy

38. Cancer of the Thyroid gland
Nursing Management- thyroidectomy
Pre-op
Euthyroid state
Verify meds taken

39. 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

40. 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

41. 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

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

43. 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