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Lecture 5B (Thyroid Gland) PowerPoint
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Lecture 5B (Thyroid Gland) PowerPoint

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  • 1. Thyroid part 2 Hypothyroidism
  • 2. Hypothyroidism
    • Definition
    •  TH
    • Pathophysiology
    • Primary hypothyroidism
      • Thyroid fails to produce enough TH
    • Secondary Hypothyroidism
      •  stimulation  Thyroid (pituitary or hypothalmus)
  • 3. Hypothyroidism
    • Etiology
    • Primary
      • Congenital
      • I deficiency
      • Auto-immune
      • Thyroidectomy
    • Secondary
      • Pituitary / hypothalamus
  • 4. Hypothyroidism
    • S&S
    • Think ______
      • Slow
  • 5. Hypothyroidism S&S
    • Neurology
    • Slow mentation
    • Slurred speech
    • Affect
    • Lethargy
    • depression
  • 6. Hypothyroidism S&S
    • Cardiovascular
    • Bradycardia
    • Gastro-intestinal
    • Constipation
    • Weight gain
    • Appetite loss
  • 7. Hypothyroidism S&S
    • Muscular-skeletal
    • Clumsy slow movements
    • Fatigue
    • Cold intolerance
    • Dull facial expression
  • 8. Hypothyroidism S&S
    • Skin
    • Dry, pale
    • Hair dry
    • Thick lips
    • Puffy eyes
  • 9. Hypothyroidism
    • Cretinism
    • Rare in the US
    • Congenital condition d/t  TH  physical & mental retardation
    • 18yr old
  • 10. Hypothyroidism
    • Hashimoto’s thyroiditis
    • Most common adult hypothyroidism
    • Auto-immune
    • Female > male
    • Age:
      • 30-50
  • 11. Hypothyroidism Diagnostic Tests
    • By definition hypothyroidism means what?
      • T3/T4
    Primary Hypothyroidism Secondary Hypothyroidism T3/T4  TSH
  • 12. Hypothyroidism Diagnostic Tests
    • 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
  • 13. Hypothyroidism 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 Hypothyroidism Secondary Hypothyroidism T3/T4  TSH 
  • 14. Hypothyroidism Diagnostic Tests
    • By definition hypothyroidism means what?
      • T3/T4
    Primary Hypothyroidism Secondary Hypothyroidism T3/T4   TSH 
  • 15. Hypothyroidism Diagnostic Tests
    • By definition secondary hypothyroidism means what? (where is the problem – what is causing the problem?)
      • Pituitary gland 
        •  TSH 
        •  T3/T4
  • 16. Hypothyroidism Diagnostic Tests
    • 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  
  • 17. 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
  • 18. Hypothyroidism Medical Treatment
    • Diet
    • Fiber
    • Protein
    • Fluids
    • Calories
    • Avoid food  in I (interferes with meds)
  • 19.
    • Avoid food  in I
      • Kelp
      • Shellfish
      • Iodized salt
      • Cabbage
      • Turnips
      • Pears
      • Peaches
  • 20. Hypothyroidism Nursing management
    • Rest
      • Space
    • Skin
      • Protect
    • Diet
      • Adjust
  • 21. Severe Hypothyroid State
    • Myxedema
    • Definition
      • Advanced hypothyroidism
    • Etiology
      • Iodine deficiency
      • Atrophy of thyroid
      • Surgery
      • Destruction of thyroid by I 131
  • 22. 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
  • 23. Hypothyroidism Severe
    • Myxedema Coma
    • Met. Rate drops so low  life threatened
    • Temperature
      • < 95 F
    • Blood pressure
    • Glucose
    • Mental function
      • 
  • 24. Hypothyroidism Severe
    • Myxedema Coma
    • Death d/t…
      • Respiratory Failure
  • 25. Goiters
    • Definition
    • Enlarged thyroid
    • Pathophysiology
  • 26. Review!
    • What hormone causes the thyroid to grow?
      • TSH
    • What hormonal change causes goiters?
      •  TSH
  • 27. Goiters
    • Definition
    • Enlarged thyroid
    • Pathophysiology
    •  TSH levels  goiters
    • Etiology
    •  TH levels
    •  Iodine
    • PG
  • 28. Goiters
    • Endemic goiter
      • Caused by environmental factors
        •  iodine
  • 29. Goiters
    • Are goiters assoc. with
      • Hyperthyroidism
        • YES!
      • Hypothyroidism
        • YES!
      • Euthyroid state
        • YES!
    • All of the above
  • 30. Goiters
    • Goitrogens
    • Suppress thyroid function
      • Broccoli
      • Cauliflower
      • Cabbage
      • Turnips
      • Sulfonamide
      • Lithium
      • Salicylates
  • 31. Goiters
    • S&S
    • Enlarged thyroid
    • Complications
    • May interfere with
      • Respiration
      • Swallowing
  • 32. Goiters
    • Nursing Management
    • Diet
      • Limit goitrogens
    • Assess
      • Breathing
        • Stridor
      • Swallowing
    • Palpate????
      • NO!
  • 33. Cancer of the Thyroid gland
    • Etiology
    • Rare
    • F>M
    • Thyroid hyperplasia
    • Radiation
    • Iodine deficiency
  • 34. Cancer of the Thyroid gland
    • #1 S&S
      • Nodule on thyroid
      • Hard
      • Painless
  • 35. Cancer of the Thyroid gland
    • S&S
    • Difficulty swallowing or breathing
    • Changes in voice
    • Lab values
      • Normal TH levels
  • 36. Cancer of the Thyroid gland
    • Diagnostic Tests
    • Thyroid scan
      • Shows “cold” spot
        • Area that did not take up radioactive material
        • Indicates malignancy
    • Biopsy
      • Confirms diagnosis
  • 37. Cancer of the Thyroid gland
    • Medical Management
    • Thyroidectomy
      • Partial
      • Total
    • Chemotherapy
  • 38. Cancer of the Thyroid gland
    • Nursing Management- thyroidectomy
    • Pre-op
      • Euthyroid state
      • Verify meds taken
  • 39. Cancer of the Thyroid gland
    • Nursing Management- thyroidectomy
    • Post-op
      • Vital Signs
      •  BP &  Pulse =
        • Shock d/t hemorrhaging
      •  Pulse  fever  BP =
        • Thyrotoxic crisis
  • 40. Cancer of the Thyroid gland
    • Nursing Management- thyroidectomy
    • Post-op
      • Check hemohaggin
        • back of neck for pooling blood
      • Check for S&S of dyspnea or resp distress
      • Check speech
      • Semi-fowlers position
  • 41. Cancer of the Thyroid gland
    • Nursing Management- thyroidectomy
    • 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
  • 42. Thyroidectomy Complications
    • Thyrotoxic crisis
      • D/t manipulation of thyroid during surgery 
      • release large amount of TH
  • 43. 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

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