1. JBorrero 3/09

2.  Regulates rate of metabolism/caloric requirements  Stimulates consumption of O2 by the tissues  Influences rate of growth  Affects metabolism of protein, CHO and lipids  Stimulates myocardium to increase force and rate of contraction  Affects resistance to infection  Affects brain and nervous system function  Some influence an sex organ development

3. 1. T3- triiodothyronine 2. T4- thyroxine Both synthesis and release is regulated by TSH in the pituitary gland through a negative feedback mechanism 3. Calcitonin- made by thyroid, but not controlled by TSH Iodine is an essential element in the production of thyroid hormone T380- 200ng/dL T45-12mg/dL

4. 1. Primary- Decreased thyroid hormone production, most common 2. Causes:  Hashimoto’s thyroiditis  Result of thyroid surgery  Radioactive iodine treatment of hyperthyroidism  Overtreatment of hyperthyroidism  Iodine deficiency

5.  2. Secondary- Originates from anterior pituitary gland not producing TSH  3. Myxedema Coma- rare, serious complication

6. SUBJECTIVE:  Weakness, fatigue, lethargy  Headaches  Slowed memory, psychotic behavior  Loss of interest in sexual activity  Menstrual disturbances  Depression

7.  Neurological  CV  Pulmonary  Metabolic  GI  Integumentary  Psychological  Reproductive  Goiter

8.  TSH  T4 and T3  RAIU- Radioactive Iodine Uptake Test

9. 1. Administer thyroid hormone therapy as ordered. levothyroxine (Synthroid) Monitor for SE: tremors, HA, insomnia, palpitations, tachycardia 2. Monitor pulmonary function 3. Monitor Cardiac function 4. Monitor metabolism 5. Monitor for infection or trauma 6. Provide warmth and prevent heat loss 7. Health Teaching

10. 1. Diet teaching 2. Review signs of Hypo/Hyper thyroidism 3. Lifelong medication therapy- desired and side effects 4. Medication adjustments and interactions 5. Stress management techniques 6. Exercise program

11.  Coma, respiratory failure, hypotension, hyponatremia, hypothermia, hypoglycemia  Emergency care: ABC

12.  Clinical syndrome caused by excessive circulating thyroid hormones  AKA Thyrotoxicosis, Graves’ Disease  Graves’ disease, the most frequent cause. Signs: goiter, exophthalmos, pretibial edema  Thyroid scan  Ultrasonography  Electrocardiography

13.  Graves’ Disease is most common cause  Possible autoimmune repsonse  Occurs in 3 rd or 4 th decade  Affects women > men  Emotional trauma, infection, increased stress  Overdose of meds to tx hypothyroidism  Use of certain weight loss products

14.  Nervousness, mood swings, irritability, hyperactivity, decreased attention span  Insomnia, interrupted sleep  Increased appetite, weight loss  Palpitations, widened pulse pressure, increased SBP  Heat intolerance, increased perspiration  Dyspnea  Weakness, exercise intolerance  Vision changes, exophthalmos, staring gaze  Goiter  Bruits over thyroid gland  Irregular menses

15.  T3 & T4: elevated  TSH- decreased  RAI Uptake Test- High uptake with hyperthyroidism  Thyroid Scan  EKG

16.  Provide symptomatic treatment.  Treatment of hyperthyroidism does not correct eye and vision problems of Graves’ disease.  Elevate the head of bed at night.  Instill artificial tears.  Treat photophobia with dark glasses/patches  Give steroid therapy.  Provide diuretics.

17. GOAL- Decrease thyroid tissue without destruction of gland. EUTHROID STATE 1. Antithyroid Drugs- methimazole (Tapazole) or propylthiouracil ( Propicil, PTU) 2. Iodine Preparations – Lugol’s solution 3. Radioactive Iodine 131 4. Beta blockers- propanolol (Inderal) 5. Possible partial/ subtotal thyroidectomy

18.  Minimize energy expenditure  Stress reduction techniques  Diet: High caloric, high protein  Avoid stimulants: coffee, tea, chocolate, colas, tobacco  Medications as ordered. Teach SE and desired effects.  Provide eye protection  S&S Thyroid Storm  Possible Preop

19. S&S 1. Tachycardia >1 30/min 2. Hyperpyrexia Up to 106 3. Exaggerated symptoms of Hypertension

20.  Goals: 1. Maintain airway 2. Prevent CV collapse 3. Reduce body temp 4. Reduce metabolic demands  Airway  EKG monitor  Acetominophen  Cool sponge baths  PTU  Propanalol  IVF  Insulin  Sodium iodide  Insulin  O2

21. Inflammation of the Thyroid Gland. Three types A. Acute B. Subacute C. Chronic (Hashimoto’s disease)

22. Classification: A. Benign- associated with thyrotoxicosis or glandular enlargement (goiter) B. Malignaat 1. Papillary, 2. Follicular 3. Medullary 4. Anaplastic.

23.  Thyroid hormone replacement for life  CXR and total body scan yearly x 3 years  Assess for signs of recurrence  Follow up with T4, T3, serum Ca and Phos

24.  Pre Op:  Antithyroid hormone and SSKI Iodine to reduce activity and decrease vascularity  Nutritional assessment  Expalnation of procedure and post op course  Teach support of neck incision to prevent strain

25.  Postoperative care:  Hemorrhage  Respiratory distress  AIRWAY, SUCTION AND TRACH SET AT BEDSIDE  Humidified O2  Semi-fowlers with pillows on either side of neck  Hypocalcemia and tetany  Laryngeal nerve damage

26.  Pain Management  Nutrition  Rest, relaxation, and avoidance of stress  Thyroid storm or thyroid crisis- uncontrolled hyperthyroidism triggered by stressors

27.  Parathyroid glands: calcium and phosphate balance  Hypercalcemia (Norm 9.0-10.5 mg/dL) and hypophosphatemia  Sign & Symptoms  Nonsurgical management:  Diuretic and fluid therapy  Drug therapy: phosphates, calcitonin, calcium chelators (Mithramycin)  Nutrition

28.  Parathyroidectomy preoperative care:  Client stabilized; calcium levels normalized  Studies: bleeding and clotting times, CBC  Teaching: coughing, deep-breathing exercises, neck support  Operative procedures- transverse incision in lower neck. All 4 glands are check for enlargement  Minimal Parathyroid Surgery http://www.parathyroid.com/MIRP-Surgery.htm )

29.  Postoperative care includes:  Observe for respiratory distress.  Keep emergency equipment at bedside.  Hypocalcemic crisis can occur.  Recurrent laryngeal nerve damage can occur.  Lifetime Ca and Vitamin D supplements

30.  Decreased function of the parathyroid gland  CAUSES:  Iatrogenic hypoparathyroidism  Idiopathic hypoparathyroidism  Hypomagnesemia (Norm 1.6-2.6 mg/dL)  INTERVENTIONS:  Correct hypocalcemia, vitamin D deficiency, and hypomagnesemia  Tx: Rocaltrol – Vitamin D compound  PO Calcium intake up to 2Gm /day

31. Following thyroid resection, the nurse frequently assesses the client's ability to speak. What is the nurse evaluating with this intervention? A. Changes in level of consciousness B. Recovery from anesthesia C. Injury to parathyroid gland D. Spasm or edema of the vocal cords

32. In reviewing laboratory results in the client with Hashimoto's thyroiditis, the nurse expects which of the following? A. Elevated thyroxine B. Elevated triiodothyronine C. Elevated thyroid-stimulating hormone D. Elevated plasma catecholamines

33.  The nurse correlates which clinical manifestations with the diagnosis of hyperthyroidism? A. Fatigue, weight gain, cold intolerance B. Decreased pulse rate, slurred speech, anorexia C. Abdominal pain, constipation, heat intolerance D. Nervousness, weight loss, tachycardia

34.  The nurse monitors for which of the following as indicative of effective treatment of hypothyroidism?  A. Decreased sweating  B. Weight gain  C. Decreasing heart rate  D. Increasing energy level

35.  The nurse recognizes that the client with Graves' disease is at risk for which of the following complications?  A. Corneal ulceration  B. Pitting edema  C. Hypotension  D. Urinary retention

36.  Which of the following statements by the client on thyroid replacement therapy indicates the need for further teaching? A. “I should take this every morning.” B. “If I continue to lose weight, I may need to have the dose increased.” C. “I should have more energy with this medication.” D. “If I gain weight and feel tired all the time, I may need the dose increased.”