Thyroid Disorder.pptx

Title: Thyroid disorder
Presented by: Mekonnen Urgessa &
Merga Wekwaya
Presented to: Mr Tedele. K. (Asst professor )
Sep. 2023
Fitche
SALALE UNIVERSITY COLLEGE OF
MEDICINE AND HEALTH SCIENCE
DEPARTMENT OF ADULT HEALTH
NURSING II
Thyroid disorders
10/2/2023 1

Course Out line
 Introduction
 Objective
 Definition
 Etiology
 Pathophysiology and Clinical manifestation
 Diagnosis
 Medical & Nursing mgt
10/2/2023 Thyroid disorders 2

Objectives
 To understand basic thyroid axis physiology
 To know the common causes of hypo and
hyperthyroidism
 To recognise the signs and symptoms
associated with hypo and hyperthyroidism
 To know the Management for hypo and
hyperthyroidism
 To identify Thyroid cancer

Introduction
Thyroid Gland
 Is the largest endocrine
gland in body
 Small butterfly shaped
gland located at base of
neck.
 Thyroid is controlled by the
hypothalamus and pituitary

Anatomy and physiology overview
Functions of Thyroid Gland
 Regulate the body’s overall basal metabolic rate
 Increase oxygen consumption of the cell
 Essential for normal growth & mental development
 Sexual maturation
 Controlling heart, muscle and digestive function
and bone maintenance

Anatomy and physiology overview…
Calcitonin
 Its produced from Para follicular C-cells
 It is secreted in response to high plasma levels of
calcium by:
 It increasing osteoblast and decreasing
osteoclast activity.
 Decreasing the calcium absorption from GIT
 Increasing urinary calcium excretion

Iodine
 Deficiency alters thyroid function.
 Iodide is ingested in the diet, absorbed & its ions
are converted to iodine molecules.
 Molecules react with tyrosine (an amino acid) to
form the thyroid hormones.

Triiodotyronine(T3) and Tetraiodotyronine(T4)
 The synthesis of thyroid hormone is a complex
multistep process.
 Follicular cell transport iodide anion from the
blood to cytoplasm from blood stream.
 Iodide moves toward colloid stores and oxidized
to form neutral iodine two molecules.

 Colloid stores Thyroglobulin(Tg), thyroperoxidase,
and tyrosine.
 A tyrosine iodinated by a single iodine molecule
and form monoiodotyrosine
 If iodinated by two iodine molecules it forms
diiodotyrosine(DIT)

 DIT and monoiodotyrosine forms covalent and
forms thyroid hormones
 T4 is converted to T3 by peripheral organs such
as kidney, liver, and spleen

Hormones: T4
 T4-thyroxine contains 4 iodine atoms
 It is a slow-acting pre-hormone
 T4 takes 4 days to peak in blood
 Half-life 7 days
 Overall effects take 6 weeks

Hormones: T3
 T3 is the active and faster-acting hormone
 The immediate effects of T3 last 1-2 days
 Half-life 1.5 days
 T3 is 10x more active than T 4

Hormones- TSH
 TSH is a pituitary hormone
 Controlled by TRH-thyrotropin releasing hormone
from hypothalamus
 Functions to stimulate thyroid hormone production
 May enlarge thyroid (goiter) when under
producing or over producing

Negative Feedback System
- Inhibiter y
activity
+ excitory
activity

Thyroid disorders
 Hypothyroidism
 Underactive thyroid
 Hyperthyroidism
 Overactive thyroid
 Goiter
 Thyroid enlargement
 Thyroid cancer

Hypothyroidism
Definition
 A clinical and biochemical syndrome that results
from a deficiency in thyroid hormone secretion
from thyroid gland or in the action
 TSH, T3 and T4

Hypothyroidism
Epidemiology
 It is a common disorder with prevalence ranges
from 2-15% population
 Female to male ratio = 10:1
 ↑ with age
 Mean age at diagnosis is 60 years

Hypothyroidism…
Causes
Primary
 Congenital : Agenesis,& ectopic thyroid
remnants
 Defects of hormone synthesis: Iodine deficiency,
dyshormonogenesis, antithyroid drugs & other
drugs (e.g. lithium, amiodarone, interferon)

Hypothyroidism…
Causes
 Autoimmune
 Atrophic thyroiditis
 Hashimoto's thyroiditis
 Infective
 Post-subacute thyroiditis

Hypothyroidism…
Causes
 Iatrogenic
 Radioactive iodine therapy
 External neck irradiation
 Post-surgery
 Infiltration
 Amyloidosis, sarcoidosis, hemochromatosis,
scleroderma

Hypothyroidism…
Causes
Secondary
 Hypopituitarism: tumors, pituitary surgery or
irradiation, infiltrative disorders, Sheehan's
syndrome, trauma, genetic
 Isolated TSH deficiency or inactivity

Hypothyroidism…
Causes
 Tertiary Hypothyroidism
 Hypothalamic disease: tumors, trauma,
Irradiation, idiopathic

Goiter
Thyroid disorders 24
 A diet deficient in iodine
 Increase in thyroid
stimulating hormone (TSH)
in response to a defect in
normal hormone synthesis
within the thyroid gland.
10/2/2023

Hashimoto’s Disease
 Autoimmune disorder in which antibodies are
directed against a thyroid sites to :
 Inhibit thyroid peroxidase(T4 –T3)
 Inhibit effects of TSH
 Stimulate thyroid growth
 Lymphocytes are attracted to attacking thyroid
gland leading to inflammation and swelling

Myxoedema coma
 Severe hypothyroidism, associated with:
confusion or even coma, hypothermia, severe
cardiac failure, hypoventilation ,hypoglycaemia,
hyponatraemia.
 Patients require full intensive care.

Myxoedema coma…
 occurs in the elderly
 usually precipitated by factors that impair respiration
 drugs (especially sedatives, anesthetics,
antidepressants)
 pneumonia, congestive heart failure, myocardial
infarction, gastrointestinal bleeding, cerebrovascular
accidents, Sepsis

10/2/2023 28
Symptoms
 Tiredness, weakness
 Dry skin
 Feeling cold
 Hair loss
 Difficulty concentrating
and poor memory
 Constipation
 Weight gain with poor
appetite
 Dyspnea
 Hoarse voice
 Oligomenorrhea or
amenorrhea)
Symptoms of Hypothyroidism
Thyroid disorders

10/2/2023 29
Signs
 Dry coarse skin; cool
peripheral extremities
 Puffy face, hands, and
feet (myxedema)
 Diffuse alopecia
 Bradycardia
 Peripheral edema
 Delayed tendon reflex
relaxation
 Serous cavity effusions
Signs of Hypothyroidism
Thyroid disorders

Diagnostic Methods
• History and PE
• Anti TBO(TBOAb), Anti-Tg (TgAb), anti TSH
receptor (TRAb)
• T3, T4 & TSH
• Ultra Sound of neck
• MRI, CT- Scan

Hypothyroidism-Medical management
 Replacement of thyroid hormone with synthetic
preparation of T3 &T4
 Levothyroxine (preferred agent).

Nursing Management
 Provide a comfortable, warm environment
 Prevent skin break down.
 Avoid using sedatives.
 Prevent constipation.
 Close monitoring of the vital signs and cognitive
level

Nursing Management…
 Assist the client in adhering to a low calorie diet to
reduce weight.
 Teach the clients the nature of the thyroid
hormone deficiency, self care practice, and sign
and symptoms to monitor & asses future health.
 Providing Emotional Support.

Hyperthyroidism

Hyperthyroidism
 TSH, T3 and T4
 Thyrotoxicosis - as the state of thyroid hormone
excess
 Hyperthyroidism - result of excessive thyroid
function

Hyperthyroidism…
Common:-
 Graves' disease (autoimmune)
 Toxic multi nodular goiter
 Solitary toxic nodule/adenoma

Causes of Thyrotoxicosis
Primary hyperthyroidism
 Graves' disease
 Toxic multinodular goiter
 Toxic adenoma
 Functioning thyroid carcinoma metastases
 Struma ovarii
 Drugs: iodine excess

Causes of Thyrotoxicosis…
Secondary hyperthyroidism
 TSH-secreting pituitary adenoma
 Chorionic gonadotropin-secreting tumors
 Gestational thyrotoxicosis

Graves' disease
 The most common cause of hyperthyrodism
 It is an autoimmune disorder.
 More common in adults –b/n 20 and 50 years
 Can be familial and associated with other
autoimmune diseases
 Characterized by exophthalmos.

Graves' disease…
 Autoimmune disease with breakdown of helper-T-
cell tolerance Excessive production of thyroid
autoantibodies: Thyroid-stimulating antibody (TSI)
Antibodies bind to the TSH receptor of the follicular
cell Stimulation of the cell resulting in:
Increased levels of thyroid hormones &
Hyperplasia of the thyroid gland
Hyperthyroidism and Thyroid gland enlargement

Hyperthyroidism-Symptoms
 Weight loss, Increased
appetite, Irritability
 Tremor, Goiter
 Restlessness
 Stiffness, Muscle
weakness
 Breathlessness
 Palpitation
 Heat intolerance
 Excessive sweating
 Itching
 Thirst, Vomiting,
Diarrhoea
 Oligomenorrhoea

Hyperthyroidism-Signs
 Tremor, Irritability,
Psychosis,
Tachycardia or atrial
fibrillation, Warm
peripheries, Systolic
hypertension, Cardiac
failure
 Papilledema
 Proximal myopathy
 Proximal muscle
wasting
 Onycholysis
 Palmar erythema

Assessment and Diagnostic Findings
 History and PE
 It is soft and may pulsate; with a bruit.
 Increased T3 & T4, decreased TSH
 Serum auto Anti bodies
 Ultra Sound, MRI & CT-Scan
 CBC

Hyperthyroidism-Managment
Thyroid disorders 44
Drug Therapy
 Beta blocker
 Atenolol 50mg-100mg po daily
 Propranolol 20-40mg po TID
 Antithyroids
 Methimazole 15-30mg po daily
 Propylthiouracil (PTU) 300mg TID
10/2/2023

Hyperthyroidism-Managment…
 Procedural Therapy
 Radioactive iodine ablation of the thyroid
gland
 Total thyroidectomy

Nursing Management
 Monitor vital signs, especially heart rate and
blood pressure
 Ask if the patient has chest pain (Due to
increased heart work)
 Listen to the heart for murmurs,
 Obtain ECG
 Teach the patient to relax.

Nursing Management...
 Administer medications as prescribed
 Check intake and output
 Weigh patient daily
 Educate the patient about thyroid surgery and
radioactive iodine
 Provide oxygen if the saturation is less than 94%
 Provide a cooling blanket

10/2/2023 48
Benign
1. Hyperplasia
 Colloid nodules
2. Follicular epithelial cell adenoma
 Conventional
 Oncocytic (hurthlecell)
Thyroid cancer
Thyroid disorders

10/2/2023 49
Thyroid Malignant
1. Papillary Carcinoma (80-85%)
2. Follicular Carcinoma (5-12%)
3. Anaplastic Carcinoma (1%)
4. Medullary Carcinoma (<10%)
-
Thyroid Cancer…
Thyroid disorders

Symptoms of thyroid cancer include:
 A lump in the front, lower part of your neck
 – the lump usually feels hard, slowly gets bigger
and is not painful
 A hoarse voice, a sore throat, diarrhea, weight
loss and a cough, difficulty swallowing or
breathing

Diagnostic Finding
 Blood tests
 Ultrasound scan of neck
 CT and MRI
 Histology

Thyroid cancer Management
The treatment you have will depend on:
 the size and type of thyroid cancer you have
 if it has spread
 General health
 Surgery, hormone therapy, radioactive iodine
treatment, targeted medicines, radiotherapy or
chemotherapy.

Summery
Problems with the thyroid include a variety of
disorders that can result in the gland producing too
little thyroid hormone (hypothyroidism) or too much
(hyperthyroidism). Thyroid disorders can affect
heart rate, mood, energy level, metabolism, bone
health, pregnancy and many other functions.

Reference
 Harrison’s 21st edition,2022, principle of internal
medicine, Mcgraw-hill education, Vol.1
 Sabiston text book of Surgery 21th edition, 2020:
the Biological bases of modern surgical practice

Thank You !

Thyroid Disorder.pptx

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