1. Evaluating Outcomes for Clients with Thyroid and Parathyroid Problems

2. The thyroid gland contains spherical follicles (50–500 μmin diameter).
Follicle cells synthesize the two iodine-containing thyroid hormones thyroxine (T4, tetraiodothyronine) and triiodothyronine (T3).

5. PARATHYROID GLAND Location: Usually paired.
Very small (less than 5 mm).
Called parathyroid glands because of their position on posterior margins outer surface of thyroid gland.
More superior of each pair usually near middle of margin of lobe.
More inferior of each pair usually at inferior apex of lobe.
Function:
PARATHYROID HORMONE (PTH) – raises the level of calcium in the blood, decreases levels of blood phosphate. Partially antagonistic to calcitonin of thyroid gland.

10. Thyroid hormone activation of target cells

11. Hyperthyroidism Thyrotoxicosis
Graves’ disease, the most frequent causes: goiter, exophthalmos, pretibial myxedema
Laboratory assessment
Thyroid scan
Ultrasonography
Electrocardiography

14. Drug Therapy Radioactive iodine therapy; not used in pregnant women
Additional drug therapy may be needed.
Implement radiation precautions.
Monitor regularly for changes in thyroid function.
S&P

15. Surgical Management
Surgery possible in absence of good response to drug therapy.
Postoperative care for:
Hemorrhage
Respiratory distress
Hypocalcemia and tetany
Laryngeal nerve damage
Thyroid storm or thyroid crisis

16. Infiltrative Opthalmopathy
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.
S&P

17. Hypothyroidism
Decreased metabolism from low levels of thyroid hormones
Myxedema coma a rare, serious complication
Mostly a result of thyroid surgery and radioactive iodine treatment of hyperthyroidism
Clinical manifestations
S&P

20. Decreased Cardiac Output
Interventions:
Monitor circulatory status.
Monitor for signs of inadequate tissue oxygenation.
Monitor for changes in mental status.
Monitor fluid status and heart rate.
Administer oxygen or mechanical ventilation, as appropriate.

21. Ineffective Breathing Pattern
Interventions:
Observe and record rate and depth of respirations.
Auscultate the lungs.
Assess for respiratory distress.
Assess the client receiving sedation for respiratory adequacy.

22. Disturbed Thought Processes
Interventions:
Assess lethargy, drowsiness, memory deficit, poor attention span, and difficulty communicating.
These problems should decrease with thyroid hormone treatment.
Provide a safe environment.
Provide family teaching.
S&P

23. Myxedema Coma
Coma, respiratory failure, hypotension, hyponatremia, hypothermia, hypoglycemia
Emergency care

24. Thyroiditis Inflammation of the thyroid gland
Three types of thyroiditis: acute, subacute (granulomatous), and chronic (Hashimoto’s disease)—the most common type
Dysphagia and painless enlargement of the gland
Nonsurgical management, drug therapy
Surgical management

25. Thyroid Cancer Papillary, follicular, medullary, and anaplastic
Collaborative management
Surgery treatment of choice: thyroidectomy
Suppressive doses of thyroid hormone for 3 months after surgery
Study performed after drugs are withdrawn
S&P

27. Hyperparathyroidism Parathyroid glands: calcium and phosphate balance
Hypercalcemia and hypophosphatemia
Nonsurgical management:
Diuretic and fluid therapy
Drug therapy: phosphates, calcitonin, calcium chelators
S&P

28. Surgical Management Parathyroidectomy preoperative care:
Client stabilized; calcium levels normalized
Studies: bleeding and clotting times, CBC
Teaching: coughing, deep-breathing exercises, neck support
Operative procedures
(Continued)
S&P

29. Surgical Management (Continued)
Postoperative care includes:
Observe for respiratory distress.
Keep emergency equipment at bedside.
Hypocalcemic crisis can occur.
Recurrent laryngeal nerve damage can occur.

30. Hypoparathyroidism Decreased function of the parathyroid gland
Iatrogenic hypoparathyroidism
Idiopathic hypoparathyroidism
Hypomagnesemia
Interventions: correcting hypocalcemia, vitamin D deficiency, and hypomagnesemia

31. If a manifestation is caused by hyperthyroidism, indicate “HYPER”
If a manifestation is caused by hyperthyroidism, indicate “HYPER”. If a manifestation is caused by hypothyroidism, indicate “HYPO.”
Decreased body temperature
Palpitations
Apathy
Diaphoresis
Thinning of scalp hair
Thick, brittle nails
Constipation
Tremors
Heat intolerance
Weight gain
Tachycardia
Insomnia
Dry, coarse, brittle hair
Decreased activity tolerance

32. HYPO = Hypothyroidism HYPER = Hyperthyroidism
Tremors: HYPER
Heat intolerance: HYPER
Weight gain: HYPO
Tachycardia: HYPER
Insomnia: HYPER
Dry, coarse, brittle hair: HYPO
Decreased activity tolerance: HYPO
Decreased body temperature: HYPO
Palpitations: HYPER
Apathy: HYPO
Diaphoresis: HYPER
Thinning of scalp hair: HYPER
Thick, brittle nails: HYPO
Constipation: HYPO