Lecture 5A (thyroid gland) PowerPoint

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Lecture 5A (thyroid gland) PowerPoint

  1. 1. Endocrine – Thyroid gland Part 1
  2. 2. Description: Thyroid <ul><li>Butterfly shaped </li></ul><ul><li>Two lobes connected by an isthmus </li></ul><ul><li>Straddles the trachea </li></ul><ul><li>Largest endocrine gland </li></ul>
  3. 3. Function: Thyroid <ul><li>Produce thyroid hormones (TH) </li></ul><ul><ul><li>Vital for growth & metabolism </li></ul></ul><ul><li>Iodine storage </li></ul><ul><ul><li>Essential for T3/T4 syntheses </li></ul></ul>
  4. 4. Hormones Hormone Function Stimulated by T3/T4  metabolic rate  protein synthesis  energy production Most important hormone in day today regulation of metabolic rate <ul><li> metabolic rate </li></ul><ul><li>T3/T4 </li></ul><ul><li> TSH </li></ul>
  5. 5. 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
  6. 6. Hormone Loop <ul><li> Metabolic rate  </li></ul><ul><li>Detected by hypothalamus  </li></ul><ul><li>Stimulates anterior pituitary  </li></ul><ul><li>Secretes TSH  </li></ul><ul><li>Blood stream  target organ  thyroid </li></ul><ul><li>Stimulate Thyroid to secrete T3/T4  </li></ul><ul><li>Blood stream  target organs  adrenal medulla  </li></ul><ul><li>Secretes Epinephrine & Norepinephrine  </li></ul><ul><li> Metabolic rate </li></ul>
  7. 7. Thyroid Disorders <ul><li>World-wide </li></ul><ul><ul><li>Iodine deficiency </li></ul></ul><ul><li>United States </li></ul><ul><ul><li>Auto-immune </li></ul></ul>
  8. 8. Hyperthyroidism <ul><li>Definition </li></ul><ul><li> T3/T4 in blood </li></ul><ul><li>Pathophysiology </li></ul><ul><li>Primary hyperthyroidism </li></ul><ul><ul><li>Problem with thyroid gland   T3/T4 </li></ul></ul><ul><li>Secondary hyperthyroidism </li></ul><ul><ul><li>Problem with pituitary gland   T3/T4 </li></ul></ul><ul><ul><li>Pituitary   TSH   T3/T4 </li></ul></ul><ul><ul><li> TSH  thyroid growth  goiter </li></ul></ul>
  9. 9. Hyperthyroidism <ul><li>Etiology </li></ul><ul><li>Auto-immune </li></ul><ul><li>AKA: </li></ul><ul><ul><li>Grave’s disease </li></ul></ul><ul><li>F vs M? </li></ul><ul><ul><li>F > M </li></ul></ul><ul><li>Age </li></ul><ul><ul><li>20-40 yrs </li></ul></ul>
  10. 10. Hyperthyroidism S&S <ul><li>Neurological </li></ul><ul><li>Heat intolerance </li></ul><ul><li>Diaphoresis </li></ul><ul><li> sympathetic nervous response </li></ul>
  11. 11. Hyperthyroidism S&S <ul><li>Affect </li></ul><ul><li>Nervous </li></ul><ul><li>Emotional lability </li></ul><ul><li>Irritable </li></ul><ul><li>I Concentration </li></ul><ul><li>Mood swings </li></ul><ul><li> manic/psychotic </li></ul>
  12. 12. Hyperthyroidism S&S <ul><li>Cardiovascular </li></ul><ul><li>Tachycardia </li></ul><ul><li>Palpitations </li></ul>
  13. 13. Hyperthyroidism S&S <ul><li>Gastrointestinal </li></ul><ul><li>Appetite </li></ul><ul><ul><li> </li></ul></ul><ul><li>Weight </li></ul><ul><ul><li> </li></ul></ul><ul><li>BM </li></ul><ul><ul><li> </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul>
  14. 14. Hyperthyroidism S&S <ul><li>Muscle-skeletal </li></ul><ul><li>Tremors </li></ul><ul><li>Restlessness </li></ul><ul><li>Muscle </li></ul><ul><ul><li>weakness </li></ul></ul>
  15. 15. Hyperthyroidism S&S <ul><li>Skin </li></ul><ul><li>Temperature </li></ul><ul><ul><li>Warm </li></ul></ul><ul><li>Smooth </li></ul><ul><li>Hair </li></ul><ul><ul><li>Fine, soft </li></ul></ul><ul><ul><li>Gray </li></ul></ul><ul><ul><li> Loss </li></ul></ul>
  16. 16. Hyperthyroidism S&S <ul><li>Exophthalmos </li></ul><ul><li>Bulging of the eye </li></ul><ul><li>Stare </li></ul>
  17. 17. Hyperthyroidism S&S <ul><li>Goiter </li></ul><ul><li>Enlarged thyroid </li></ul><ul><li>TSH levels </li></ul><ul><ul><li> </li></ul></ul>
  18. 18. Hyperthyroidism S&S <ul><li>Oncholysis </li></ul><ul><li>Distal nail separates from the nail bed </li></ul><ul><li>Nail fragile </li></ul>
  19. 19. Hyperthyroidism S&S <ul><li>Gynecomastia </li></ul><ul><li>Abnormal enlargement breasts </li></ul><ul><li>male </li></ul>
  20. 20. Hyperthyroidism S&S <ul><li>Elderly </li></ul><ul><li>Heart failure </li></ul><ul><li>Fatigue </li></ul><ul><li>Apathy </li></ul><ul><li>Depression </li></ul>
  21. 21. Hormone Review <ul><li> T3/T4  </li></ul><ul><li>Pituitary  </li></ul><ul><li> TSH  </li></ul><ul><li>Thyroid  </li></ul><ul><li> T3/T4 </li></ul><ul><li>___________________ </li></ul><ul><li> T3/T4  </li></ul><ul><li>Pituitary  </li></ul><ul><li> TSH  </li></ul><ul><li>Thyroid  </li></ul><ul><li> T3/T4 </li></ul>
  22. 22. Hyperthyroidism Diagnostic Tests <ul><li>By definition hyperthyroidism means what? </li></ul><ul><ul><li>T3/T4 </li></ul></ul><ul><ul><li> </li></ul></ul>Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4  TSH
  23. 23. Hyperthyroidism Diagnostic Tests <ul><li>By definition primary hyperthyroidism means what? (where is the problem – what is causing the problem?) </li></ul><ul><ul><li>Thyroid  </li></ul></ul><ul><ul><ul><li> T3/T4 </li></ul></ul></ul><ul><li>In primary hyperthyroidism, is the pituitary gland working correctly? </li></ul><ul><ul><li>Yes </li></ul></ul>
  24. 24. Hyperthyroidism Diagnostic Tests <ul><li>If the pituitary gland is working correctly and there is an  T3/T4 level, what will the Pituitary gland do with the TSH level? </li></ul>Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4  TSH 
  25. 25. Hyperthyroidism Diagnostic Tests <ul><li>By definition hyperthyroidism means what? </li></ul><ul><ul><li>T3/T4 </li></ul></ul><ul><ul><li> </li></ul></ul>Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4   TSH 
  26. 26. Hyperthyroidism Diagnostic Tests <ul><li>By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?) </li></ul><ul><ul><li>Pituitary gland  </li></ul></ul><ul><ul><ul><li> TSH  </li></ul></ul></ul><ul><ul><ul><li> T3/T4 </li></ul></ul></ul>
  27. 27. Hyperthyroidism Diagnostic Tests <ul><li>By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?) </li></ul><ul><ul><li>Pituitary gland   TSH   T3/T4 </li></ul></ul>Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4   TSH  
  28. 28. Question? <ul><li>Mrs. Goiter has a thyroid panel done and shows an elevated T3/T4 and an elevated TSH? Which of the following diagnosis apply? </li></ul><ul><li>Primary hyperthyroidism </li></ul><ul><li>Secondary hyperthyroidism </li></ul><ul><li>Primary hypothyroidism </li></ul><ul><li>Secondary hypothyroidism </li></ul>
  29. 29. Question? <ul><li>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? </li></ul><ul><li>Primary hyperthyroidism </li></ul><ul><li>Secondary hyperthyroidism </li></ul><ul><li>Primary hypothyroidism </li></ul><ul><li>Secondary hypothyroidism </li></ul>
  30. 30. Hyperthyroidism Medical Treatment <ul><li>Meds first </li></ul><ul><li>Goal </li></ul><ul><ul><li> T3/T4 levels </li></ul></ul><ul><li>Meds alone sometimes work - if not  </li></ul><ul><ul><li>Surgery </li></ul></ul>
  31. 31. Hyperthyroidism Medical Treatment <ul><li>Anti-thyroid therapy </li></ul><ul><li>Propylthioracil / PTU </li></ul><ul><li>Methimazole / Tapazole </li></ul><ul><ul><li>Action </li></ul></ul><ul><ul><ul><li>Inhibits synthesis of T3/T4 </li></ul></ul></ul>
  32. 32. Hyperthyroidism Medical Treatment <ul><li>Propranolol hydrochloride / Inderal </li></ul><ul><li>Beta-blocker </li></ul><ul><li> sympathetic nervous system </li></ul><ul><li>No smoking </li></ul>
  33. 33. Hyperthyroidism Medical Treatment <ul><li>Meds alone not  </li></ul><ul><ul><li>Surgery </li></ul></ul><ul><li>If Ca Thyroid  </li></ul><ul><ul><li>Surgery </li></ul></ul><ul><li>Euthyroid state before surgery! </li></ul><ul><ul><li>How? </li></ul></ul><ul><ul><ul><li>Anti-thyroid meds </li></ul></ul></ul>
  34. 34. Hyperthyroidism Medical Treatment <ul><li>Iodine before surgery </li></ul><ul><ul><li>Potassium iodine saturated solution (SSKI) </li></ul></ul><ul><ul><li> vascularity of the thyroid </li></ul></ul><ul><ul><li> risk of post-op bleeding </li></ul></ul>
  35. 35. Hyperthyroidism Medical Treatment <ul><li>Radioactive Iodine </li></ul><ul><li>I 131 </li></ul><ul><li>Used instead of radiation tx </li></ul><ul><li>Stop anti-thyroid meds x 7 days </li></ul><ul><li>Single dose </li></ul><ul><li>S&S  in @ 3wks  full effect in 3 months </li></ul>
  36. 36. Hyperthyroidism Medical Treatment <ul><li>Radioactive Iodine </li></ul><ul><li>Safety </li></ul><ul><ul><li>No PG nurses </li></ul></ul><ul><ul><li>Watch body fluids </li></ul></ul><ul><ul><li>Avoid kids x 7 days </li></ul></ul>
  37. 37. Hyperthyroidism Medical Treatment <ul><li>Diet ( When hyperthyroid) </li></ul><ul><li>Calories </li></ul><ul><ul><li> </li></ul></ul><ul><ul><li>4,000-5,000 cal/day </li></ul></ul><ul><li>Fluids </li></ul><ul><ul><li> </li></ul></ul><ul><li>Na </li></ul><ul><ul><li> </li></ul></ul><ul><li>Fiber </li></ul><ul><ul><li> </li></ul></ul><ul><li>Caffeine </li></ul><ul><ul><li> </li></ul></ul>
  38. 38. Hyperthyroidism Nursing Management <ul><li>Assessment </li></ul><ul><li>Vital signs </li></ul><ul><li>Lung sounds </li></ul><ul><li>Anxiety level </li></ul><ul><li>Weight </li></ul><ul><li>Bowel function </li></ul><ul><li>NEVER palpate goiter  </li></ul><ul><ul><li>Release TH </li></ul></ul>
  39. 39. Hyperthyroidism Nursing Management <ul><li>Nrs. Dx </li></ul><ul><li>Risk for injury </li></ul><ul><li>Hyperthermia </li></ul><ul><li>Diarrhea </li></ul><ul><li>Alt. Nutrition </li></ul><ul><li>Sleep pattern disturbance </li></ul><ul><li>Anxiety </li></ul>
  40. 40. Hyperthyroidism Nursing Management <ul><li>Exophthalmos </li></ul><ul><ul><li>Lubricate eyes </li></ul></ul><ul><ul><li>Tape closed </li></ul></ul><ul><ul><li>Dark glasses </li></ul></ul><ul><ul><li> Na diet </li></ul></ul><ul><ul><li>HOB  </li></ul></ul>
  41. 41. Hyperthyroidism Severe <ul><li>Thyrotoxicosis </li></ul><ul><li>AKA: Thyroid Storm </li></ul><ul><li>Definition </li></ul><ul><ul><li>Sever hyperthyroid state </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>Stress </li></ul></ul><ul><ul><li>Post thyroid surgery </li></ul></ul><ul><ul><li>Undiagnosed </li></ul></ul>
  42. 42. Hyperthyroidism Severe Thyrotoxicosis <ul><li>S&S </li></ul><ul><li> TH   adrenergic activity   epinephrine </li></ul><ul><li>Pulse </li></ul><ul><ul><li> </li></ul></ul><ul><li>Temperature </li></ul><ul><ul><li> </li></ul></ul><ul><li>BP </li></ul><ul><ul><li> </li></ul></ul><ul><li>Depression </li></ul><ul><li>Activity </li></ul><ul><ul><li>Restlessness </li></ul></ul><ul><li>Delirium </li></ul><ul><li>SOB </li></ul><ul><li>Coma </li></ul>
  43. 43. Hyperthyroidism Severe Thyrotoxicosis <ul><li>Death </li></ul><ul><ul><li><2hr </li></ul></ul><ul><ul><li>Cardiac Failure </li></ul></ul>
  44. 44. Hyperthyroidism Severe Thyrotoxicosis <ul><li>Treatment </li></ul><ul><li>Fever </li></ul><ul><ul><li>Tylenol/ acetaminophen </li></ul></ul><ul><ul><li>Not aspirin </li></ul></ul><ul><li>For  pulse &  BP </li></ul><ul><ul><li>Propranolol / Inderal </li></ul></ul><ul><ul><li>Beta-adrenergic blocker </li></ul></ul><ul><li>If SOB </li></ul><ul><ul><li>O2 </li></ul></ul><ul><ul><li>HOB  </li></ul></ul>

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