Lecture 5B (Thyroid Gland) PowerPoint

Thyroid part 2 Hypothyroidism

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

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

Hypothyroidism
S&S
Think ______
Slow

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

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

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

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

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

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

Hypothyroidism Diagnostic Tests
By definition hypothyroidism means what?
T3/T4

Primary Hypothyroidism Secondary Hypothyroidism T3/T4  TSH

By definition primary hypothyroidism means what? (where is the problem – what is causing the problem?)
Thyroid 
 T3/T4
In primary hypothyroidism, is the pituitary gland working correctly?
Yes

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 Hypothyroidism Secondary Hypothyroidism T3/T4  TSH 

By definition hypothyroidism means what?
T3/T4

Primary Hypothyroidism Secondary Hypothyroidism T3/T4   TSH 

By definition secondary hypothyroidism means what? (where is the problem – what is causing the problem?)
Pituitary gland 
 TSH 
 T3/T4

By definition secondary hyporthyroidism means what? (where is the problem – what is causing the problem?)
Pituitary gland   TSH   T3/T4
Primary Hypothyroidism Secondary Hypothyroidism T3/T4   TSH  

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  meds
takes 2 wks to know full affect
Blood level monitoring
Annually
Know S&S and report

Hypothyroidism Medical Treatment
Diet
Fiber

Protein

Fluids

Calories

Avoid food  in I (interferes with meds)

Avoid food  in I
Kelp
Shellfish
Iodized salt
Cabbage
Turnips
Pears
Peaches

Hypothyroidism Nursing management
Rest
Space
Skin
Protect
Diet
Adjust

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

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

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

Hypothyroidism Severe
Myxedema Coma
Death d/t…
Respiratory Failure

Goiters
Definition
Enlarged thyroid
Pathophysiology

Review!
What hormone causes the thyroid to grow?
TSH
What hormonal change causes goiters?
 TSH

Goiters
Definition
Enlarged thyroid
Pathophysiology
 TSH levels  goiters
Etiology
 TH levels
 Iodine
PG

Goiters
Endemic goiter
Caused by environmental factors
 iodine

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

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

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

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

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

#1 S&S
Nodule on thyroid
Hard
Painless

S&S
Difficulty swallowing or breathing
Changes in voice
Lab values
Normal TH levels

Diagnostic Tests
Thyroid scan
Shows “cold” spot
Area that did not take up radioactive material
Indicates malignancy
Biopsy
Confirms diagnosis

Medical Management
Thyroidectomy
Partial
Total
Chemotherapy

Nursing Management- thyroidectomy
Pre-op
Euthyroid state
Verify meds taken

Post-op
Vital Signs
 BP &  Pulse =
Shock d/t hemorrhaging
 Pulse  fever  BP =
Thyrotoxic crisis

Post-op
Check hemohaggin
back of neck for pooling blood
Check for S&S of dyspnea or resp distress
Check speech
Semi-fowlers position

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

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

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 
 Calcium in blood

Lecture 5B (Thyroid Gland) PowerPoint

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