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Lecture 5B (Thyroid Gland) PowerPoint

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Lecture 5B (Thyroid Gland) PowerPoint

  1. 1. Thyroid part 2 Hypothyroidism
  2. 2. Hypothyroidism <ul><li>Definition </li></ul><ul><li> TH </li></ul><ul><li>Pathophysiology </li></ul><ul><li>Primary hypothyroidism </li></ul><ul><ul><li>Thyroid fails to produce enough TH </li></ul></ul><ul><li>Secondary Hypothyroidism </li></ul><ul><ul><li> stimulation  Thyroid (pituitary or hypothalmus) </li></ul></ul>
  3. 3. Hypothyroidism <ul><li>Etiology </li></ul><ul><li>Primary </li></ul><ul><ul><li>Congenital </li></ul></ul><ul><ul><li>I deficiency </li></ul></ul><ul><ul><li>Auto-immune </li></ul></ul><ul><ul><li>Thyroidectomy </li></ul></ul><ul><li>Secondary </li></ul><ul><ul><li>Pituitary / hypothalamus </li></ul></ul>
  4. 4. Hypothyroidism <ul><li>S&S </li></ul><ul><li>Think ______ </li></ul><ul><ul><li>Slow </li></ul></ul>
  5. 5. Hypothyroidism S&S <ul><li>Neurology </li></ul><ul><li>Slow mentation </li></ul><ul><li>Slurred speech </li></ul><ul><li>Affect </li></ul><ul><li>Lethargy </li></ul><ul><li>depression </li></ul>
  6. 6. Hypothyroidism S&S <ul><li>Cardiovascular </li></ul><ul><li>Bradycardia </li></ul><ul><li>Gastro-intestinal </li></ul><ul><li>Constipation </li></ul><ul><li>Weight gain </li></ul><ul><li>Appetite loss </li></ul>
  7. 7. Hypothyroidism S&S <ul><li>Muscular-skeletal </li></ul><ul><li>Clumsy slow movements </li></ul><ul><li>Fatigue </li></ul><ul><li>Cold intolerance </li></ul><ul><li>Dull facial expression </li></ul>
  8. 8. Hypothyroidism S&S <ul><li>Skin </li></ul><ul><li>Dry, pale </li></ul><ul><li>Hair dry </li></ul><ul><li>Thick lips </li></ul><ul><li>Puffy eyes </li></ul>
  9. 9. Hypothyroidism <ul><li>Cretinism </li></ul><ul><li>Rare in the US </li></ul><ul><li>Congenital condition d/t  TH  physical & mental retardation </li></ul><ul><li>18yr old </li></ul>
  10. 10. Hypothyroidism <ul><li>Hashimoto’s thyroiditis </li></ul><ul><li>Most common adult hypothyroidism </li></ul><ul><li>Auto-immune </li></ul><ul><li>Female > male </li></ul><ul><li>Age: </li></ul><ul><ul><li>30-50 </li></ul></ul>
  11. 11. Hypothyroidism Diagnostic Tests <ul><li>By definition hypothyroidism means what? </li></ul><ul><ul><li>T3/T4 </li></ul></ul><ul><ul><li> </li></ul></ul>Primary Hypothyroidism Secondary Hypothyroidism T3/T4  TSH
  12. 12. Hypothyroidism Diagnostic Tests <ul><li>By definition primary hypothyroidism 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 hypothyroidism, is the pituitary gland working correctly? </li></ul><ul><ul><li>Yes </li></ul></ul>
  13. 13. Hypothyroidism 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 Hypothyroidism Secondary Hypothyroidism T3/T4  TSH 
  14. 14. Hypothyroidism Diagnostic Tests <ul><li>By definition hypothyroidism means what? </li></ul><ul><ul><li>T3/T4 </li></ul></ul><ul><ul><li> </li></ul></ul>Primary Hypothyroidism Secondary Hypothyroidism T3/T4   TSH 
  15. 15. Hypothyroidism Diagnostic Tests <ul><li>By definition secondary hypothyroidism 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>
  16. 16. Hypothyroidism Diagnostic Tests <ul><li>By definition secondary hyporthyroidism 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 Hypothyroidism Secondary Hypothyroidism T3/T4   TSH  
  17. 17. Hypothyroidism Medical Treatment <ul><li>Rx / life time </li></ul><ul><li>Thyroid (Armour thyroid) </li></ul><ul><ul><li>Natural form </li></ul></ul><ul><li>Levothyroxine sodium / Levothroid, Synthroid </li></ul><ul><ul><li>Synthetic </li></ul></ul><ul><li>Time of dose </li></ul><ul><ul><li>AM </li></ul></ul><ul><li>Monitor __________system </li></ul><ul><ul><li>C/V </li></ul></ul><ul><li>Gradually  meds </li></ul><ul><ul><li>takes 2 wks to know full affect </li></ul></ul><ul><li>Blood level monitoring </li></ul><ul><ul><li>Annually </li></ul></ul><ul><li>Know S&S and report </li></ul>
  18. 18. Hypothyroidism Medical Treatment <ul><li>Diet </li></ul><ul><li>Fiber </li></ul><ul><ul><li> </li></ul></ul><ul><li>Protein </li></ul><ul><ul><li> </li></ul></ul><ul><li>Fluids </li></ul><ul><ul><li> </li></ul></ul><ul><li>Calories </li></ul><ul><ul><li> </li></ul></ul><ul><li>Avoid food  in I (interferes with meds) </li></ul>
  19. 19. <ul><li>Avoid food  in I </li></ul><ul><ul><li>Kelp </li></ul></ul><ul><ul><li>Shellfish </li></ul></ul><ul><ul><li>Iodized salt </li></ul></ul><ul><ul><li>Cabbage </li></ul></ul><ul><ul><li>Turnips </li></ul></ul><ul><ul><li>Pears </li></ul></ul><ul><ul><li>Peaches </li></ul></ul>
  20. 20. Hypothyroidism Nursing management <ul><li>Rest </li></ul><ul><ul><li>Space </li></ul></ul><ul><li>Skin </li></ul><ul><ul><li>Protect </li></ul></ul><ul><li>Diet </li></ul><ul><ul><li>Adjust </li></ul></ul>
  21. 21. Severe Hypothyroid State <ul><li>Myxedema </li></ul><ul><li>Definition </li></ul><ul><ul><li>Advanced hypothyroidism </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>Iodine deficiency </li></ul></ul><ul><ul><li>Atrophy of thyroid </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Destruction of thyroid by I 131 </li></ul></ul>
  22. 22. Hypothyroidism Severe Myxedema <ul><li>Characteristics </li></ul><ul><li>Growing puffiness & sogginess of the skin </li></ul><ul><li>Dry, waxy edema (non-pitting) </li></ul><ul><li>Abnormal deposits of mucin in the skin </li></ul><ul><li>Distinctive facial changes </li></ul>
  23. 23. Hypothyroidism Severe <ul><li>Myxedema Coma </li></ul><ul><li>Met. Rate drops so low  life threatened </li></ul><ul><li>Temperature </li></ul><ul><ul><li>< 95 F </li></ul></ul><ul><li>Blood pressure </li></ul><ul><ul><li> </li></ul></ul><ul><li>Glucose </li></ul><ul><ul><li> </li></ul></ul><ul><li>Mental function </li></ul><ul><ul><li> </li></ul></ul>
  24. 24. Hypothyroidism Severe <ul><li>Myxedema Coma </li></ul><ul><li>Death d/t… </li></ul><ul><ul><li>Respiratory Failure </li></ul></ul>
  25. 25. Goiters <ul><li>Definition </li></ul><ul><li>Enlarged thyroid </li></ul><ul><li>Pathophysiology </li></ul>
  26. 26. Review! <ul><li>What hormone causes the thyroid to grow? </li></ul><ul><ul><li>TSH </li></ul></ul><ul><li>What hormonal change causes goiters? </li></ul><ul><ul><li> TSH </li></ul></ul>
  27. 27. Goiters <ul><li>Definition </li></ul><ul><li>Enlarged thyroid </li></ul><ul><li>Pathophysiology </li></ul><ul><li> TSH levels  goiters </li></ul><ul><li>Etiology </li></ul><ul><li> TH levels </li></ul><ul><li> Iodine </li></ul><ul><li>PG </li></ul>
  28. 28. Goiters <ul><li>Endemic goiter </li></ul><ul><ul><li>Caused by environmental factors </li></ul></ul><ul><ul><ul><li> iodine </li></ul></ul></ul>
  29. 29. Goiters <ul><li>Are goiters assoc. with </li></ul><ul><ul><li>Hyperthyroidism </li></ul></ul><ul><ul><ul><li>YES! </li></ul></ul></ul><ul><ul><li>Hypothyroidism </li></ul></ul><ul><ul><ul><li>YES! </li></ul></ul></ul><ul><ul><li>Euthyroid state </li></ul></ul><ul><ul><ul><li>YES! </li></ul></ul></ul><ul><li>All of the above </li></ul>
  30. 30. Goiters <ul><li>Goitrogens </li></ul><ul><li>Suppress thyroid function </li></ul><ul><ul><li>Broccoli </li></ul></ul><ul><ul><li>Cauliflower </li></ul></ul><ul><ul><li>Cabbage </li></ul></ul><ul><ul><li>Turnips </li></ul></ul><ul><ul><li>Sulfonamide </li></ul></ul><ul><ul><li>Lithium </li></ul></ul><ul><ul><li>Salicylates </li></ul></ul>
  31. 31. Goiters <ul><li>S&S </li></ul><ul><li>Enlarged thyroid </li></ul><ul><li>Complications </li></ul><ul><li>May interfere with </li></ul><ul><ul><li>Respiration </li></ul></ul><ul><ul><li>Swallowing </li></ul></ul>
  32. 32. Goiters <ul><li>Nursing Management </li></ul><ul><li>Diet </li></ul><ul><ul><li>Limit goitrogens </li></ul></ul><ul><li>Assess </li></ul><ul><ul><li>Breathing </li></ul></ul><ul><ul><ul><li>Stridor </li></ul></ul></ul><ul><ul><li>Swallowing </li></ul></ul><ul><li>Palpate???? </li></ul><ul><ul><li>NO! </li></ul></ul>
  33. 33. Cancer of the Thyroid gland <ul><li>Etiology </li></ul><ul><li>Rare </li></ul><ul><li>F>M </li></ul><ul><li>Thyroid hyperplasia </li></ul><ul><li>Radiation </li></ul><ul><li>Iodine deficiency </li></ul>
  34. 34. Cancer of the Thyroid gland <ul><li>#1 S&S </li></ul><ul><ul><li>Nodule on thyroid </li></ul></ul><ul><ul><li>Hard </li></ul></ul><ul><ul><li>Painless </li></ul></ul>
  35. 35. Cancer of the Thyroid gland <ul><li>S&S </li></ul><ul><li>Difficulty swallowing or breathing </li></ul><ul><li>Changes in voice </li></ul><ul><li>Lab values </li></ul><ul><ul><li>Normal TH levels </li></ul></ul>
  36. 36. Cancer of the Thyroid gland <ul><li>Diagnostic Tests </li></ul><ul><li>Thyroid scan </li></ul><ul><ul><li>Shows “cold” spot </li></ul></ul><ul><ul><ul><li>Area that did not take up radioactive material </li></ul></ul></ul><ul><ul><ul><li>Indicates malignancy </li></ul></ul></ul><ul><li>Biopsy </li></ul><ul><ul><li>Confirms diagnosis </li></ul></ul>
  37. 37. Cancer of the Thyroid gland <ul><li>Medical Management </li></ul><ul><li>Thyroidectomy </li></ul><ul><ul><li>Partial </li></ul></ul><ul><ul><li>Total </li></ul></ul><ul><li>Chemotherapy </li></ul>
  38. 38. Cancer of the Thyroid gland <ul><li>Nursing Management- thyroidectomy </li></ul><ul><li>Pre-op </li></ul><ul><ul><li>Euthyroid state </li></ul></ul><ul><ul><li>Verify meds taken </li></ul></ul>
  39. 39. Cancer of the Thyroid gland <ul><li>Nursing Management- thyroidectomy </li></ul><ul><li>Post-op </li></ul><ul><ul><li>Vital Signs </li></ul></ul><ul><ul><li> BP &  Pulse = </li></ul></ul><ul><ul><ul><li>Shock d/t hemorrhaging </li></ul></ul></ul><ul><ul><li> Pulse  fever  BP = </li></ul></ul><ul><ul><ul><li>Thyrotoxic crisis </li></ul></ul></ul>
  40. 40. Cancer of the Thyroid gland <ul><li>Nursing Management- thyroidectomy </li></ul><ul><li>Post-op </li></ul><ul><ul><li>Check hemohaggin </li></ul></ul><ul><ul><ul><li>back of neck for pooling blood </li></ul></ul></ul><ul><ul><li>Check for S&S of dyspnea or resp distress </li></ul></ul><ul><ul><li>Check speech </li></ul></ul><ul><ul><li>Semi-fowlers position </li></ul></ul>
  41. 41. Cancer of the Thyroid gland <ul><li>Nursing Management- thyroidectomy </li></ul><ul><li>Post-op </li></ul><ul><ul><li>Activity </li></ul></ul><ul><ul><ul><li>Support neck </li></ul></ul></ul><ul><ul><li>Monitor for Tetany </li></ul></ul><ul><ul><ul><li>Continuous tonic spasm </li></ul></ul></ul><ul><ul><li>Tracheostomy set at bed side </li></ul></ul><ul><ul><ul><li>Resp. obstruction </li></ul></ul></ul><ul><ul><li>Diet Changes (esp. if hyperthyroidism) </li></ul></ul><ul><li>Tetany </li></ul><ul><li>Tetanus </li></ul>
  42. 42. Thyroidectomy Complications <ul><li>Thyrotoxic crisis </li></ul><ul><ul><li>D/t manipulation of thyroid during surgery  </li></ul></ul><ul><ul><li>release large amount of TH </li></ul></ul>
  43. 43. Thyroidectomy Complications <ul><li>Tetany </li></ul><ul><li>D/T low Ca levels </li></ul><ul><li>Characterized by </li></ul><ul><ul><li>Fingers & perioral area tingling </li></ul></ul><ul><ul><li>Muscle spasm </li></ul></ul><ul><ul><li>Twitching </li></ul></ul><ul><ul><li>Cardiac Dysrhythmias </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>D/t removal of parathyroid gland </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>IV Calcium gluconate </li></ul></ul><ul><ul><li>Breath into a paper bag  </li></ul></ul><ul><ul><li>mild acidosis  </li></ul></ul><ul><ul><li> Calcium in blood </li></ul></ul>

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