The thyroid gland produces thyroid hormones (T3 and T4) and calcitonin that regulate metabolism. It is composed of follicles filled with colloid containing thyroglobulin, which produces the hormones. Hypothyroidism results from inadequate hormone production and causes a slowed metabolism. Hyperthyroidism is excessive hormone production and causes a hypermetabolic state. Thyroiditis is inflammation of the thyroid that can be acute due to infection or chronic like Hashimoto's disease. Thyroid tumors include benign and malignant types like papillary carcinoma.
The thyroid is a small, butterfly-shaped gland located at the base of your neck just below the Adam’s apple.
Several different disorders can arise when your thyroid produces too much hormone (hyperthyroidism) or not enough (hypothyroidism).
Four common disorders of the thyroid are Hashimoto’s disease, Graves’ disease, goiter, and thyroid nodules.
AUM ENT Clinic is dedicated to the delivery of compassionate, quality, state-of-the-art and cost effective health care with best-in-class technology and equipment.
Contact us @https://www.aumentclinic.com/contact-us.php
The thyroid is a small, butterfly-shaped gland located at the base of your neck just below the Adam’s apple.
Several different disorders can arise when your thyroid produces too much hormone (hyperthyroidism) or not enough (hypothyroidism).
Four common disorders of the thyroid are Hashimoto’s disease, Graves’ disease, goiter, and thyroid nodules.
AUM ENT Clinic is dedicated to the delivery of compassionate, quality, state-of-the-art and cost effective health care with best-in-class technology and equipment.
Contact us @https://www.aumentclinic.com/contact-us.php
This presentation about thyroid gland :
- Anatomy of thyroid gland
- Physiology of thyroid gland
- Pathology of thyroid gland
- Treatment and prevention of thyroid disease
The endocrine system is a chemical messenger system comprising feedback loops of the hormones released by internal glands of an organism directly into the circulatory system, regulating distant target organs. In vertebrates, the hypothalamus is the neural control center for all endocrine systems.
Hypothyroidism Diagnosis, Etiopathogenesis and TreatmentPranatiChavan
Hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone.
Hypothyroidism's deficiency of thyroid hormones can disrupt such things as heart rate, body temperature and all aspects of metabolism. Hypothyroidism is most prevalent in older women.
Major symptoms include fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain.
Treatment consists of thyroid hormone replacement.
its all about thyroid gland,functions of thyroid gland,disorders of thyroid gland,signs and symptoms and medications.hope it will be useful for you.thank you,
Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
This presentation about thyroid gland :
- Anatomy of thyroid gland
- Physiology of thyroid gland
- Pathology of thyroid gland
- Treatment and prevention of thyroid disease
The endocrine system is a chemical messenger system comprising feedback loops of the hormones released by internal glands of an organism directly into the circulatory system, regulating distant target organs. In vertebrates, the hypothalamus is the neural control center for all endocrine systems.
Hypothyroidism Diagnosis, Etiopathogenesis and TreatmentPranatiChavan
Hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone.
Hypothyroidism's deficiency of thyroid hormones can disrupt such things as heart rate, body temperature and all aspects of metabolism. Hypothyroidism is most prevalent in older women.
Major symptoms include fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain.
Treatment consists of thyroid hormone replacement.
its all about thyroid gland,functions of thyroid gland,disorders of thyroid gland,signs and symptoms and medications.hope it will be useful for you.thank you,
Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Thyroid Gland Disorders
1. THYROID GLAND
THYROID GLAND – largest endocrine organ; produces thyroid
hormones (T4 and T3) and calcitonin.
ANATOMY AND PHYSIOLOGY
I. THYROID HORMONE
Thyroid gland composed of follicles filled with colloid
consists of thyroglobulin contains 140 tyrosine amino
acids thyroid synthesis produces T4 and T3 stored
until needed for release into the bloodstream.
A.Thyroid Hormone Synthesis
T4 = 90% and T3 = 10%released in the blood.
B. Thyroid Hormone Regulation
Hypothalamic-Pituitary-Thyroid Feedback System
C. Thyroid Hormone Function
Increases metabolic rate
Increases body temperature in response to an elevated
metabolism, which produces body heat.
Increases the use of oxygen as metabolism increases.
Aids in the development of the neural and skeletal systems
in fetuses.
Affects respiratory rate: too much thyroid hormone
increases respiratory rate, and too little decreases
respiratory rate.
Aids in normal growth and development.
II. CALCITONIN–↓es serum calcium level
↑ed serum Cal signals thyroid gland (C cells) release of calcitonin
in blood ↓es Cal resorption; ↓es osteoclast activity in the bone;
↓es intestines’ ability to absorb Cal.
ASSESSMENT AND DIAGNOSTIC FINDINGS
I. PHYSICAL EXAMINATION(palpate and auscultate)
Isthmus – firm and of a rubber-band consistency.
Lateral lobes – 2 thin, smooth and nontender lobes.
Enlarged thyroid – auscultate for a bruit sound indicating an
increased bloodflow.
II.LABORATORY AND DIAGNOSTIC PROCEDURES
1. Serum Thyroid-Stimulating Hormone – used to
distinguishsubclinical thyroid disease from euthyroid states
in patients with low or high normal values.
2. Serum Free T4–used for direct measurement of free
(unbound) T4; NR: 0.9 – 1.7 ng/dL
3. Serum T3 andT4– used to measure the total T3 andT4; NRT4: 4.5
– 11.5 ng/dL and NRT3: 70 – 220 ng/dL.
4. T3 Resin Uptake Test– used to determine the amount of
thyroid hormone bound to TBG; NR: 25% - 35%.
5. Thyroid Antibodies – test the presence of antithyroid antibodies:
NR: 5% - 10%.
6. Radioactive Iodine Uptake – measures the rate of iodine uptake
by the thyroid gland; NR vary with the intake of iodine.
7. Fine-Needle Aspiration Biopsy – safe and accurate test for
malignancy; results: (-) benign; (+) malignant; (indeterminate)
suspicious; (inadequate) nondiagnostic.
8. Thyroid Scan, Radioscan, or Scintiscan – used to determine the
location, size, shape, and anatomic function.
9. Serum Thyroglobulin – used to detect persistence of thyroid
carcinoma.
DISORDERS OF THYROID GLAND
A. HYPOTHYROIDISM (myxedema)
I. DEFINITION:
Hyposecretion of the thyroid hormone characterized by
decreased rate of body metabolism.
Myxedema Coma is are but serious d/o which result from
persistently low thyroid hormone precipitated by acute illness,
rapid withdrawal of thyroid meds, use of sedatives & narcotics. It
is used to describe extreme symptoms of severe hypothyroidism
II. CLASSIFICATION:
Primary or thyroidal hypothyroidism – refers to dysfunction of
the thyroid gland itself.
2. Central hypothyroidism – the cause of thyroid dysfunction is
failure of the pituitary gland, the hypothalamus, or both.
Pituitary or secondary hypothyroidism - the cause of thyroid
dysfunction is entirely a pituitary disorder
Hypothalamic or tertiary hypothyroidism – the cause is a
disorder of the hypothalamus resulting in inadequate secretion of
TSH due to decreased stimulation of TRH.
Cretinism – thyroid deficiency is present at birth
III. CAUSES:
Autoimmune disease (Hashimoto’s thyroiditis, Post Graves’
disease)
Atrophy of thyroid gland with aging
Therapy for hyperthyroidism: radioactive iodine, thyroidectomy
Medications: lithium, iodine compounds, antithyroid medications
Radiation to head & neck for treatment of head & neck cancers,
lymphoma
Infiltrative diseases of the thyroid (amyloidosis, scleroderma,
lymphoma)
Iodine deficiency & iodine excess
IV. SIGNS AND SYMPTOMS:
Hypotension
Bradycardia
Hypothermia
Hyponatremia
hypoglycemia
respiratory failure
death
V. MANAGEMENTS:
1. Medical Management:
a. Synthetic levothyroxine (Synthroid or Levothroid) is the
preferred preparation for treating hypothyroidism a
suppressing nontoxic goiters.
2. Nursing Management:
a. Provide for comfort and safety
b. monitor for infection or trauma
c. provide warmth
d. prevent heat loss & vascular collapse
e. administer thyroid meds as ordered
f. Monitor HR including rhythm.
g. Instruct patient re: thyroid replacement therapy.
h. Instruct on low-calorie, low-cholesterol, low-saturated fat
diet.
i. Assess for constipation & provide roughage.
j. Provide for warm environment.
k. Monitor for overdose of thyroid meds.
l. Patent airway
m. Keep patient warm & check V/S frequently
n. Administer IV fluids & levothyroxine Na (Synthroid)
o. Give IV glucose & corticosteroids
p. Health teaching:
Diet: low calorie, high protein
S/Sx of hypothyroidism & hyperthyroidism
Lifelong meds, dosage, desired effects, side effects.
Stress-management techniques
Exercise program
B. HYPERTHYROIDISM
I. DEFINITION:
Hypersecretion of the thyroid gland.
It is a type of thyrotoxicosis, a hypermetabolic clinical syndrome
which occurs when there are elevated serum levels of T3 and/or
T4.
The most common underlying cause of hyperthyroidism is
“Graves' disease”,an autoimmune disesase.
In its most severe form, untreated hyperthyroidism may result in
"thyroid storm," a condition involving high blood pressure, fever,
and heart failure. (S/Sx: fever, tachycardia, hypotension, marked
respiratory distress, pulmonary edema, irritability,
apprehension, agitation, restlessness, confusion, seizures.)
II. SIGNS AND SYMPTOMS:
V/S: increased systolic BP, widened pulse pressure, tachycardia
Excessive sweating
Heat intolerance
Increased bowel movements
Tremor (usually fine shaking)
Nervousness; agitation
Rapid heart rate
Weight loss despite of increased appetite
Fatigue
Enlarged thyroid
Irregular and scant menstrual flow
dyspnea
exophthalmos
In older patients, irregular heart rhythms and heart failure can
occur.
III. DIAGNOSTIC FINDINGS:
blood tests that show a decreased thyroid-stimulating hormone
(TSH) level and elevated T4 and T3 levels
radioactive iodine uptake test and thyroid scan
Thyroid scintigraphy
IV. MANAGEMENTS:
1. Medical Management:
Antithyroid drugs(carbimazole, methimazole,
propylthiouracil) - drugs that inhibit the production of thyroid
hormones.
Beta-blockers (Propranolol (Inderal), atenolol (Tenormin),
metoprolol (Lopressor)- used to treat high blood pressure, are
a class of drugs that offset this effect, reducing rapid pulse
associated with the sensation of palpitations, and decreasing
tremor and anxiety.
Radioactive Iodine Therapy-destroy the overactive thyroid
cells; treat toxic adenomas,multinodular goiter and
thyrotoxicosis.
Iodine preparations (SSKI, Lugol’s Solution) - decrease size &
vascularity of the thyroid gland; palatable if diluted with
water, milk or juice; give through straw tp prevent staining of
teeth; takes 2-4 weeks before results are evident.
2. Surgical Management:
Thyroidectomy-removal of thyroid tissue that was producing
the excessive thyroid hormone.
PRE-OPERATIVE CARE:
Assess V/S, weight, electrolyte & glucose level
Teach DBE & coughing as well as how to support neck in
post-op period when coughing & moving
Administer antithyroid meds etc. to prevent thyroid storm
POST-OP CARE:
Monitor for respiratory distress & have tracheostomy set,
O2 & suction machine at bed side
Maintain semi-Fowler’s position to reduce edema
Immobilize head with pillows/sandbags; prevent flexion &
hyperextension of neck
Check surgical site for edema & bleeding
3. Limit client talking & assess for hoarseness
Assess for laryngeal nerve damage…high-pitched voice,
stridor, dysphagia, dysphonia & restlessness
Monitor for signs of hypocalcemia & tetany & have calcium
gluconate at bed side
3. Nursing Management:
Protect from stress: private room, restrict visitors, quiet
environment.
Promote physical & emotional equilibrium:cool, quiet, cool
well ventilated environment; eye care: sunglasses to protect
from photophobia, protective drops (methylcellulose) to
soothe cornea; diet: high calorie, protein, vit. B; avoid
stimulants
Prevent complications: give medications as ordered.
Monitor for thyroid storm.
Health teaching: stress reduction techniques; importance of
medications; methods to protect eyes from environment; s/sx
of “Thyroid Storm”.
Measure neck circumference daily to check for progression of
thyroid enlargement.
Weigh patient.
C. THYROIDITIS
I. DEFINITION: The inflammation of the thyroid gland.
II. TYPES
a.Acute thyroiditis
Definition: Is a rare disorder caused by infection of the thyroid
gland by bacteria, fungi, mycobacteria, or parasites
Causes: Staphylococcus aureus are the most common
S & Sx: Anterior neck pain and swelling, fever, dysphagia,
dysphonia, pharyngitis, or pharyngeal pain
Examination: Reveals warmth, erythema (redness), and
tenderness of the thyroid gland
Treatment: Antimicrobial agents and fluid replacement,
surgical incision and drainage may be needed if an abscess
is present
b.Subacute Thyroiditis
Definition: May be of two kinds: Subacute granulomatous
thyroiditis and painless thyroiditis
Subacute Granulomatous Thyroiditis
Definition: Is an inflammatory disorder of the thyroid gland
that predominantly affects women between 40-50 ages of
years. It is also associated with a viral respiratory infection
and has a summer peak incidence that coincides with
coxsackievirus groups A and B and echovirus infections.
Causes: Virus
S & Sx: Myalgias, pharyngitis, low-grade fever, and fatigue,
painful swelling at the anterior neck, symmetric
enlargement of the thyroid, difficulty of swallowing
Treatment: NSAIDs to relieve neck pain, Acetylsalicylic acid
(aspirin) is avoided if Sx of hyperthyroidism occur, oral
corticosteroids, follow up monitoring
Painless thyroiditis (Subacute Lymphocytic Thyroiditis)
Definition: Often occurs in the postpartum period and is
thought to be an autoimmune process
S & Sx: Sx of hyperthyroidism and hypothyroidism
Treatment: Directed at symptoms, and a yearly follow-up is
recommended
c. Chronic Thyroiditis
Definition: Also known as Hashimoto’s disease or chronic
lymphocytic thyroiditis, it occurs most frequently in
women between 30-50 ages of years.Cell mediated
immunity may play a significant role in the pathogenesis of
chronic thyroiditis and there may be a genetic
predisposition to it.
Cause: Unknown
S & Sx: initially the Sx of hyperthyroidism, such as restlessness,
tremors, chest pain, increased appetite, diarrhea, moist
skin, heat intolerance, and weight loss.
III. DIAGNOSTIC TESTS:Immunofluorescent assay, a test that detects
antigens on cells using an antibody with a fluorescent tag, detects
antithyroid antibodies. TSH is elevated, while (T3) and (T4) levels
are low. A thyroid scan is also done.
IV. TREATMENT: The objective is to reduce the size of the thyroid
gland and the prevent hypothyroidism, thyroid hormone therapy
D.THYROID TUMORS
Tumors are classified on the basis of:
Being benign or malignant
The presence or absence of thyrotoxicosis
The diffuse or irregular quality of glandular enlargement.
If the enlargement is sufficient to cause a visible swelling in the
neck, the tumor is referred to as GOITER.
Grades of goiter:
Barely visible and producing disfigurement.
Symmetric and diffuse
Nodular
Accompanied by hyperthyroidism
Toxic or non-toxic
I. ENDEMIC (IODINE-DEFICIENT) GOITER
SIMPLE OR COLLOID GOITER
Most common type of goiter encountered chiefly in geographic
regions where the natural supply of iodine is deficient. (e.g., Great
Lakes areas of the United States)
May be caused by an intake of large quantities of goitrogenic
substance in patients with unusually susceptible glands. These
substances include excessive amounts of iodine or lithium, which
is used in treating bipolar disorders.
Represents a compensatory hypertrophy of the thyroid gland,
caused by stimulation by the pituitary gland. Its production
increases if there is subnormal thyroid activity, as when
insufficient iodine is available for production of the thyroid
hormone.
Such goiters usually cause no symptoms, except for the swelling in
the neck.
SSKI, a supplementary iodine which is prescribed to suppress the
pituitary’s thyroid-stimulating activity
Ensuring a preoperative euthyroid state through treatment with
antithyroid medication and iodide will minimize the risk of
postoperative complications.
Providing children in iodine-poor regions with iodine compounds
can prevent simple or endemic goiter.
The introduction of iodized salt has been the single most effective
means of preventing goiter in at-risk populations.
II. NODULAR GOITER
Some thyroid glands are nodular because of areas of hyperplasia
(overgrowth)
No symptoms may arise as a result of this condition, but not
uncommonly these nodules slowly increase in size, with some
4. descending into the thorax, where they cause local pressure
symptoms.
Some nodules become malignant
Some are associated with a hyperthyroid state
III. THYROID CANCER
Much less prevalent than other forms of cancer; however it
accounts for 90% of endocrine malignancies
According to American Cancer Society, such cases are more
occurring to men than the women.
Types:
Papillary adenocarcinoma 70%- most common, least aggressive,
asymptomatic, starts in childhood or early adult life/ more
aggressive in adults life, metastasizes along the lymphatics if
untreated
Follicular adenocarcinoma 15%- appears after 40 yrs. of age,
encapsulated, feels elastic or rubbery on palpation, spreads
through the blood stream to bone, liver and lung, prognosis is
not as favorable as papillary adenocarcinoma
Medullary 5%- after 50 yrs. of age, occurs as part of multiple
endocrine neoplasia (MEN), hormone producing tumor causing
endocrine dysfunction symptoms, metastasizes by lymphatics
and bloodstream, moderate survival rate
Anaplastic 5%- after 60 yrs. of age, hard, irregular mass that
grows quickly and spreads by direct invasion to adjacent tissues,
may be painful or tender, survival is usually less than 6 months
Thyroid lymphoma 5%- after 40 yrs. of age, may have history of
goiter, hoarseness, dyspnea, pain and pressure, good prognosis
External radiation of the head, neck or chest in infancy and
childhood increases the risk of thyroid carcinoma.
Appears to increase 5 to 40 years after
Consequently, people who underwent radiation treatment or
were otherwise exposed to radiation as children should
consult a physician and request an isotope thyroid scan as part
of the evaluation.
Assessment and Diagnostic Findings
Single, hard, and fixed lesions on palpation suggest malignancy usually
associated with cervical lymphadenopathy.
Thyroid Function Test- helpful in evaluating thyroid nodules and
masses.
Needle Biopsy- used as an outpatient procedure to make a diagnosis
of the thyroid Cancer
- Procedure is safe and usually requires only a local anesthesia.
Large Bore needle- may be used when the result of the standard
biopsy are in convulsive or with rapidly growing tumors.
Additional Diagnostic Studies
Ultrasound
MRI
CT
Thyroid Scan
Radioactive iodine uptake test
Thyroid Suppression Test
Medical Management
Surgical Removal- Treatment of Choice for Thyroid Carcinoma
Total or near-total Thyroidectomy
Modified neck dissection- performed if there is lymph node
involvement
Ablation Procedure- carried out with radioactive iodine to eradicate
residual thyroid tissue if the tumor is radiosensitive.
Radioactive Iodine- also maximizes the chance of discovering
thyroid metastasis at a later date if total body scans are carried out.
After Surgery Administer;
Thyroid Hormone- to prevent hypothyroidism
Thyroxine
Several routes for administering radiation therapy to the thyroid or
tissue of the neck:
1. Oral Administration of radioactive iodine
2. External administration of radiation therapy
Nursing Management
Important preoperative goals are to gain the patient’s confidence and
reduce anxiety.
a. PROVIDING PREOPERATIVE CARE
The nurse instructs the patient about the importance of eating a diet
high in carbohydrates and proteins.
A high daily caloric intake.
The patient is reminded to avoid tea, coffee, cola, and other
stimulants.
The nurse also informs the patient about the purpose of
preoperative tests, if they are to be performed, and explains what
preoperative preparations to expect.
Preoperative teaching includes demonstrating to the patient how to
support the neck with the hands after surgery.
b. PROVIDING POSTOPERATIVE CARE
The nurse periodically assesses the surgical dressings and reinforces
them when necessary.
When the patient is in a recumbent position, the nurse observes the
sides and the back of the neck as well as the anterior dressing for
bleeding.
Difficulty in respiration occurs as a result of edema of the glottis,
hematoma formation, or injury to the recurrent laryngeal nerve.
The intensity of pain is assessed and analgesic agents are
administered as prescribed for pain.
Intravenous fluids are administered during the immediate
postoperative period.
The patient is advised to talk as little as possible to reduce edema to
the vocal cords.
An overbed table may be used to provide easy access to items that
are needed frequently, such as paper tissues, water pitcher and
glass, and a small emesis basin.
The patient is usually permitted out of bed as soon as possible and is
encouraged to eat foods that are easily eaten.
c. MONITORING AND MANAGINGPOTENTIAL COMPLICATIONS
Hemorrhage, hematoma formation, edema of the glottis, and injury
to the recurrent laryngeal nerve are common complications.
Producing a disturbance in calcium metabolism.
Tetany- this type is usually treated with intravenous calcium
gluconate.
d. PROMOTING HOME AND COMMUNITY-BASED CARE
Teaching Patients Self-Care.
The patient may be discharged the evening of surgery or within 1 or
2 days.
The patient and family need to be knowledgeable about the signs
and symptoms of the complications that may occur and those that
should be reported.
The nurse explains to the patient and family the need for rest,
relaxation, and nutrition.
The patient is permitted to resume his or her former activities and
responsibilities completely once recovered from surgery.
Continuing Care.
If indicated, a referral to home care is made.
The home care nurse assesses the patient’s recovery from surgery.
The nurse also assesses the surgical incision and reinforces
instruction about limiting activities that put strain on the incision
and sutures.
5. Family responsibilities and factors relating to the home environment
that produce emotional tension have often been implicated as
precipitating causes of thyrotoxicosis.
A home visit provides an opportunity to evaluate these factors and
to suggest ways to improve the home and family environment.
The nurse gives specific instructions regarding follow-up visits to the
physician or the clinic, which are important for monitoring the
thyroid status.