Endocrine Disorder

1. DISORDER OF THYROID GLAND
Hypo & Hyper Thyroidism

2. INTRODUCTION
• It is a butterfly shaped, two lobed gland situated in
the neck in front of larynx and trachea at the level
of 5th, 6th and 7th cervical and 1st thoracic vertebra.
• It is vitally important hormonal gland that plays a
major role in the metabolism, growth and
maturation of the human body.
• It helps to regulate many body functions by
constantly releasing a steady amount of hormones
into the bloodstream.

3. HYPERTHYROIDISM

4. INTRODUCTION
• Hyperthyroidism is an over production of
thyroid hormone, which creates far reaching
metabolic effects.
• The condition is more common in female than
in male and occurs in several forms.

5. CAUSES
i. Grave’s disease
ii. Toxic multi-nodular goiter
iii. Excessive intake of thyroid hormone
iv. Thyroiditis
v. Excessive intake of iodine

6. CLINICAL FEATURES
• Palpitations & nervousness
• Heat intolerance
• Trembling hands
• Increased bowel movement
• Weight loss
• Light or absent menstrual
period
• Fatigue
• Hair loss

7. DIAGNOSIS
• Thyroid function test:
 Thyroid stimulating hormone(TSH): normal value:
0.5-1.5mU/L
 Thyroxine(T4): normal value: 5.0-12.0µg/dL
 Tri-iodothyronine(T3): normal value: 80-230ng/dL
• ECG
• 24 hrs-Radioactive iodine uptake(RAIU)

8. MANAGEMENT
• Medical management:
 Drug therapy:
Antithyroid drugs: Blocks synthesis of thyroid
hormone. e.g. Propylthrouracil, methimazole
Adrenergic blocking agents: Used to decrease
sympathetic activity and alleviate tachycardia.
e.g. Propanolol

9. Contd…
 Radioactive iodine therapy:
Radioactive isotope of iodine is given to
destroy thyroid gland, thereby decreasing
production of thyroid gland.
• Surgical management:
Thyroidectomy is performed in patient for
whom drug therapy is not been effective.

10. NURSING INTERVENTION
• Monitor and record vital signs, intake and output.
• Assess the signs of heart failure.
• Provide diet high in calorie, carbohydrates, protein,
vitamin and minerals with supplement feeding.
• Minimize the stress in environment and excess
activity.
• Administer the prescribed medications on time.

11. Contd…
• Assess the patient for diarrhea and provide with
antidiarrheal preparation.
• Patient teaching about the disease condition.
• Stress the importance of medication to patient
and family.
• Reassure the patient understanding for side
effects of the medicine.

12. Chovstek sign
When the facial nerve is
tapped at the angle of
jaw, the facial muscle on
the same side of the face
will contract
momentarily due to
hyperexcitability of the
nerves

14. Complications
Besides the usual complications of any
surgery;
• The client is at risk of thyrotoxicosis
• Hypocalcaemia- tetany, spasm
• Recurrent laryngeal nerve palsy
• Vocal cord injury, paralysis,
• permanent hypoparathyroidism

15. HYPOTHYROIDISM

16. INTRODUCTION
• Hypothyroidism is a condition in which the
thyroid gland does not make enough thyroid
hormone.

17. CAUSES
i. Primary hypothyroidism
ii. Autoimmune disease (Hashimoto’s Disease)
iii. Iatrogenic hypothyroidism
iv. Drugs e.g. Lithium
v. Secondary hypothyroidism

18. CLINICAL FEATURES
• Early symptoms
 Cold intolerance
 Constipation
 Heavier menstrual bleed
 Paleness and dry skin
 Weight gain(unintentional)
 Joint and muscle pain
 Fatigue
• Late symptoms
 Hoarseness
 Slow speech
 Puffy face, hands &
feet
 Decreased taste and
smell

20. DIAGNOSIS
• History taking
• Physical examination
• Thyroid function test
• Blood investigations: cholesterol, triglyceride,
sodium

21. MANAGEMENT
• Medication :
 Thyroxine (levothyroxine) is the drug of
choice.
 Need for lifelong treatment.
 The average replacement dose is 1.6µg/kg.

22. NURSING INTERVENTION
• Monitor vital signs (temperature, heart rate).
• Instruct the client in low calorie intake, low
saturated fat diet.
• Assess the client for constipation.
• Encourage high roughage diet and plenty of fluid
intake.

23. SUMMARY
Hypo function
Cretinism(child)
Myxedema(adult)
Normal function Hyper function
Grave’s disease
Thyrotoxicosis
se CNS development
Loss of memory,
dullness
Development of
CNS
Emotional and restless
Loss of skeletal
development
Growth &
development
Increase physical activity,
tremors, hyperactive
reflexes
BMR
 Decrease heat
production, body
temperature
 Weight increased
 Constipation
Control BMI BMR
Increase heat
production, body
temperature
Diaphoresis, polyphasia
Weight decrease
Loose motion
Exopthalamus

24. THANK
YOU !!!