Lecture 5A (thyroid gland) PowerPoint
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Lecture 5A (thyroid gland) PowerPoint Lecture 5A (thyroid gland) PowerPoint Presentation Transcript

  • Endocrine – Thyroid gland Part 1
  • Description: Thyroid
    • Butterfly shaped
    • Two lobes connected by an isthmus
    • Straddles the trachea
    • Largest endocrine gland
  • Function: Thyroid
    • Produce thyroid hormones (TH)
      • Vital for growth & metabolism
    • Iodine storage
      • Essential for T3/T4 syntheses
  • Hormones Hormone Function 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
  • Thyroid Hormones Hormones Function Stimulated 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
  • 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
  • Thyroid Disorders
    • World-wide
      • Iodine deficiency
    • United States
      • Auto-immune
  • 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
  • Hyperthyroidism
    • Etiology
    • Auto-immune
    • AKA:
      • Grave’s disease
    • F vs M?
      • F > M
    • Age
      • 20-40 yrs
  • Hyperthyroidism S&S
    • Neurological
    • Heat intolerance
    • Diaphoresis
    •  sympathetic nervous response
  • Hyperthyroidism S&S
    • Affect
    • Nervous
    • Emotional lability
    • Irritable
    • I Concentration
    • Mood swings
    •  manic/psychotic
  • Hyperthyroidism S&S
    • Cardiovascular
    • Tachycardia
    • Palpitations
  • Hyperthyroidism S&S
    • Gastrointestinal
    • Appetite
    • Weight
    • BM
      • 
      • Diarrhea
  • Hyperthyroidism S&S
    • Muscle-skeletal
    • Tremors
    • Restlessness
    • Muscle
      • weakness
  • Hyperthyroidism S&S
    • Skin
    • Temperature
      • Warm
    • Smooth
    • Hair
      • Fine, soft
      • Gray
      •  Loss
  • Hyperthyroidism S&S
    • Exophthalmos
    • Bulging of the eye
    • Stare
  • Hyperthyroidism S&S
    • Goiter
    • Enlarged thyroid
    • TSH levels
  • Hyperthyroidism S&S
    • Oncholysis
    • Distal nail separates from the nail bed
    • Nail fragile
  • Hyperthyroidism S&S
    • Gynecomastia
    • Abnormal enlargement breasts
    • male
  • Hyperthyroidism S&S
    • Elderly
    • Heart failure
    • Fatigue
    • Apathy
    • Depression
  • Hormone Review
    •  T3/T4 
    • Pituitary 
    •  TSH 
    • Thyroid 
    •  T3/T4
    • ___________________
    •  T3/T4 
    • Pituitary 
    •  TSH 
    • Thyroid 
    •  T3/T4
  • Hyperthyroidism Diagnostic Tests
    • By definition hyperthyroidism means what?
      • T3/T4
    Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4  TSH
  • 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
  • Hyperthyroidism Diagnostic Tests
    • If the pituitary gland is working correctly and there is an  T3/T4 level, what will the Pituitary gland do with the TSH level?
    Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4  TSH 
  • Hyperthyroidism Diagnostic Tests
    • By definition hyperthyroidism means what?
      • T3/T4
    Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4   TSH 
  • Hyperthyroidism Diagnostic Tests
    • By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?)
      • Pituitary gland 
        •  TSH 
        •  T3/T4
  • Hyperthyroidism Diagnostic Tests
    • By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?)
      • Pituitary gland   TSH   T3/T4
    Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4   TSH  
  • Question?
    • Mrs. Goiter has a thyroid panel done and shows an elevated T3/T4 and an elevated TSH? Which of the following diagnosis apply?
    • Primary hyperthyroidism
    • Secondary hyperthyroidism
    • Primary hypothyroidism
    • Secondary hypothyroidism
  • 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?
    • Primary hyperthyroidism
    • Secondary hyperthyroidism
    • Primary hypothyroidism
    • Secondary hypothyroidism
  • Hyperthyroidism Medical Treatment
    • Meds first
    • Goal
      •  T3/T4 levels
    • Meds alone sometimes work - if not 
      • Surgery
  • Hyperthyroidism Medical Treatment
    • Anti-thyroid therapy
    • Propylthioracil / PTU
    • Methimazole / Tapazole
      • Action
        • Inhibits synthesis of T3/T4
  • Hyperthyroidism Medical Treatment
    • Propranolol hydrochloride / Inderal
    • Beta-blocker
    •  sympathetic nervous system
    • No smoking
  • Hyperthyroidism Medical Treatment
    • Meds alone not 
      • Surgery
    • If Ca Thyroid 
      • Surgery
    • Euthyroid state before surgery!
      • How?
        • Anti-thyroid meds
  • Hyperthyroidism Medical Treatment
    • Iodine before surgery
      • Potassium iodine saturated solution (SSKI)
      •  vascularity of the thyroid
      •  risk of post-op bleeding
  • 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
  • Hyperthyroidism Medical Treatment
    • Radioactive Iodine
    • Safety
      • No PG nurses
      • Watch body fluids
      • Avoid kids x 7 days
  • Hyperthyroidism Medical Treatment
    • Diet ( When hyperthyroid)
    • Calories
      • 4,000-5,000 cal/day
    • Fluids
    • Na
    • Fiber
    • Caffeine
  • Hyperthyroidism Nursing Management
    • Assessment
    • Vital signs
    • Lung sounds
    • Anxiety level
    • Weight
    • Bowel function
    • NEVER palpate goiter 
      • Release TH
  • Hyperthyroidism Nursing Management
    • Nrs. Dx
    • Risk for injury
    • Hyperthermia
    • Diarrhea
    • Alt. Nutrition
    • Sleep pattern disturbance
    • Anxiety
  • Hyperthyroidism Nursing Management
    • Exophthalmos
      • Lubricate eyes
      • Tape closed
      • Dark glasses
      •  Na diet
      • HOB 
  • Hyperthyroidism Severe
    • Thyrotoxicosis
    • AKA: Thyroid Storm
    • Definition
      • Sever hyperthyroid state
    • Etiology
      • Stress
      • Post thyroid surgery
      • Undiagnosed
  • Hyperthyroidism Severe Thyrotoxicosis
    • S&S
    •  TH   adrenergic activity   epinephrine
    • Pulse
      • 
    • Temperature
    • BP
    • Depression
    • Activity
      • Restlessness
    • Delirium
    • SOB
    • Coma
  • Hyperthyroidism Severe Thyrotoxicosis
    • Death
      • <2hr
      • Cardiac Failure
  • Hyperthyroidism Severe Thyrotoxicosis
    • Treatment
    • Fever
      • Tylenol/ acetaminophen
      • Not aspirin
    • For  pulse &  BP
      • Propranolol / Inderal
      • Beta-adrenergic blocker
    • If SOB
      • O2
      • HOB 