The document discusses thyroid and parathyroid disorders, outlining conditions such as goiter, hypothyroidism, and hyperthyroidism, along with their causes, clinical manifestations, nursing diagnoses, and management strategies. It emphasizes the importance of restoring normal metabolic states, managing symptoms, and educating patients about lifelong therapies and dietary considerations. Additionally, it addresses the roles of medications, interventions, and evaluations in the treatment and monitoring of these endocrine disorders.

1. THYROID AND
PARATHYROID
DISORDERS
SHEEN MARKT. BILBAO, RN MAN
LEVEL 4 FACULTY
UNIVERSITY OF CEBU - BANILAD CAMPUS
COLLEGEOF NURSING

2. GOITER

3. GOITER
Enlargement of
the thyroid
gland
Usually caused
by an iodine-
deficient diet

4. Usually caused by an
iodine-deficient diet
• Foods rich in iodine:
Seaweeds
Most fresh fish
Sea salt
Iodized salt

5. TYPES OF
GOITER
• Toxic goiter – accompanied by
hyperthyroidism
• Non-toxic goiter – associated
with a euthyroid state
• Simple/colloid goiter – caused by
iron deficiency; usually
asymptomatic
• Nodular goiter – may be due to
hyperplasia; asymptomatic;
some may become malignant &
some associated with a
hyperthyroid state

6. HYPOTHYROIDISM

7. HYPOTHYROIDISM
Deficiency of the
thyroid hormones
Occurs most
frequently in older
women

8. Causes:
1.Autoimmune thyroiditis
(Hashimoto’s disease)
2.Radioiodine (I131) or
antithyroid drug therapy
3.Thyroidectomy
4.Central hypothyroidism
5.Thyroid deficiency
present at birth:
CRETINISM

9. ASSESSMENT
Clinical manifestations (adults) are based on 3
concepts:
1. Decreased metabolic rate
2. Decreased body heat production
3. Hypercalcemia – leads to decreased
neuromuscular irritability

10. SIGNS & SYMPTOMS
- extreme fatigue
- hair loss, brittle nails & dry skin
- numbness & tingling of fingers
- menstrual disturbances, loss of libido
- Myxedema
- weight gain, subnormal temperature, & HR, cold intolerance
- thickened skin, hair thins &B falls out
- dulled mental processes, apathy
- slow speech, husky hoarse voice, enlarged tongue, hands &
feet; deafness may occur
- constipation
- personality and cognitive changes

11. - Myxedema coma – rare, life-threatening
- hypothermia
- depressed respiratory drive
- unconsciousness
-precipitated by infection/systemic disease, use of sedatives/opioid
analgesics, cold
Complications:
Pleural effusion, pericardial effusion, respiratory
muscle weakness, increased serum cholesterol level,
CAD, poor left ventricular function.

12. “Everything is low, slow and dry.”
In myxedema coma, all vital signs
are profoundly depressed. It is
potentially fatal.

13. NURSING
PROCESS

14. NURSING
DIAGNOSES
1.Activity intolerance r/t fatigue and depressed cognitive process
2.Risk for imbalanced body temperature
3.Constipation r/t depressed GI function
4.Deficient knowledge about therapeutic regimen for lifelong
thyroid replacement therapy
5.Ineffective breathing pattern r/t depressed ventilation
6.Disturbed thought processes r/t depressed metabolism and
altered cardiovascular and respiratory status

15. PLANNING
• Medical Management Goal: To restore a normal metabolic
state by replacing the missing hormone
a.Increased participation in activities & increased dependence
b.Maintenance of normal body temperature
c. Return of normal bowel function
d.Knowledge and acceptance of prescribed therapeutic regimen
e.Improved respiratory status and maintenance of normal breathing
pattern
f. Improved thought processes
g.Absence of complications

16. INTERVENTIONS
o Administer pharmacologic medication:
Synthetic levothyroxine (Synthroid or Levothyroid)
 monitor for s/s of angina, ⇧ BP & tachycardia
 Take in the morning without food
 May cause bone loss & osteoporosis
 IV administration (if myxedema coma) continued with oral therapy
 Drug interactions:
o increase: blood sugar levels, effects of digitalis glycosides, anticoagulants,
indomethacin
o phenytoin (Dilantin) & TCA’s increase effects of thyroid hormone meds

17. INTERVENTIONS
Corticosteroids
o Monitor vital functions
 ABG, pulse oximetry
 Administer fluids cautiously
 Deep breathing & coughing exercises, incentive spirometry
 Administer hypnotics and sedatives with caution
 Maintain patent airway through suction & ventilator support

18. INTERVENTIONS
• Corticosteroids con’t.
o Promote independence in self-care activities
o Provide extra layer of clothing or extra blanket
o Manage constipation
o Improve thought process
 orient to time, place, and person
 provide stimulation through conversation and nonthreatening
activities
 monitor cognitive & mental processes

19. INTERVENTIONS
• Corticosteroids con’t.
o Promote independence in self-care activities
o Provide extra layer of clothing or extra blanket
o Manage constipation
o Improve thought process
 orient to time, place, and person
 provide stimulation through conversation and nonthreatening
activities
 monitor cognitive & mental processes

20. INTERVENTIONS
• Corticosteroids con’t.
o Monitor & manage complications
 ⇩ LOC, dementia
 ⇩ V/S
 Difficulty in awakening patient
 Turn & reposition at intervals to avoid risks associated with
immobility

21. INTERVENTIONS
• Corticosteroids con’t.
o Teach patients on self-care
 desired action & side effects of meds
 importance of continuing meds as prescribed even after s/s improve
 nutrition & diet ( high fiber, low calorie, adequate fluid intake) to promote
weight loss & normal bowel patterns
 Foods that can inhibit thyrod secretion: strawberries, peaches, pears,
cabbage, turnips, spinach, Brussel sprouts, cauliflower, radish, peas
 Avoid infections
 Prevention: screening of TSH levels recommended for women >50 y.o.
with 1 or more symptoms

22. EVALUATION
 Reports decreased level of fatigue; no chest pain or
breathlessness
 Maintains baseline body temperature
 Reports normal bowel function
 Describes therapeutic regimen correctly
 Shows improved respiratory status & maintenance of normal
respiratory rate, depth, and pattern
 Shows improved cognitive functioning

23. HYPERTHYROIDISM

24. HYPERTHYROIDISM
Hypersecretion of thyroid hormones
Severe form:
THYROID STORM/
THYROTOXIC CRISIS (THYROTOXICOSIS)
Occurs most frequently in older women

25. CAUSES oGraves’ Disease (Toxic diffuse
goiter)
oToxic nodular goiter
oThyroiditis after irradiation of
the thyroid
oPresence of tumor
oExcessive ingestion of thyroid
hormone
oAssociated with emotional
shock, stress, or infection

26. ASSESSMENT • Clinical manifestations
are based on 3 concepts:
oIncreased metabolic rate
oIncreased body heat
production
oHyp0calcemia – leads to
increased neuromuscular
irritability

27. ASSESSMENT
Thyroid hormones increase response to catecholamines
 Presenting symptom: nervousness
 Emotionally hyperexcitable, irritable, and apprehensive
 Tachycardia, palpitations
 Heat intolerance
 Salmon skin
 Exophthalmos

28. ASSESSMENT
 Others: ⇧ appetite, progressive weight loss, abnormal muscular
fatigability & weakness, amenorrhea, changes in bowel function
 Enlarged thyroid gland
 Advanced cases: ⇩ serum TSH, increased free T4, increased
radioactive iodine uptake

29. ASSESSMENT
 THYROID STORM/THYROTOXIC CRISIS:
1. Hyperpyrexia (above 38.5°C)
2. extreme tachycardia (>130 bpm)
3. exaggerated s/s of hyperthyroidism with disturbances of a major
system
4. altered mental state
 Precipitated by stress – injury, infection, surgery, tooth
extraction, DKA, pregnancy abrupt withdrawal of
antithyroid meds
 Complications: dysrhythmias, heart failure, osteoporosis,
and fractures

30. “Everything is high, fast and wet.”
Eye manifestations (exopththalmos, lid lag,
bright-eyed stare

31. NURSING
PROCESS

32. NURSING
DIAGNOSES
1.Imbalanced nutrition: less than body
requirements r/t exaggerated metabolic
rate, excessive appetite, and increased
GI activity
2.Ineffective coping r/t irritability,
hyperexcitability, apprehension, and
emotional instability
3.Low self-esteem r/t changes in
appearance, excessive appetite, and
weight loss
4.Altered body temperature

33. PLANNING
• Medical Management Goal: To reduce thyroid
hyperactivity
a.Improve nutritional status
b.Improve coping ability
c. Improve self-esteem
d.Maintenance of normal body temperature
e.Absence of complications

34. INTERVENTIONS
oAdminister pharmacologic medications:
Radioactive Iodine Therapy
Use of irradiation with the radioisotope iodine 131
Monitor for hypothyroidism
Contraindicated during pregnancy & BF
Place pt on isolation for a few days – use gloves
when handling body secretions

35. INTERVENTIONS
Antithyroid medications
 Action: block the utilization of iodine by interfering with the
iodination of tyrosine and coupling of iodotyrosines in the
synthesis of thyroid hormones
 Agents:
a. Propylthiouracil (PTU)
b. Methimazole (Tapazole)
 Toxic complications: fever, rash, urticaria, agranulocytosis,
thrombocytopenia, pharyngitis, mouth ulcers
 Instruct not to use decongestants for nasal stuffiness

36. INTERVENTIONS
Iodine or Iodide compounds
suppresses release of thyroid hormone/ reduce activity
of thyroid hormone and the vascularity of the thyroid
gland
usually given with antithyroid meds to prepare the
patient for surgery
give with milk or fruit juice, using straw
avoid cough medications, expectorants, bronchodilators,
and salt substitutes
monitor for iodine toxicity (iodism): swelling of the
buccal mucosa, excessive salivation, coryza, skin
eruptions

37. Potassium
iodide (KI)

38. Lugol’s
solution

39. Saturated
solution of
potassium
iodide
(SSKI)

40. INTERVENTIONS
Other medications:
a. Beta-adrenergic blocking agents
- Reduces peripheral symptoms, myocardial oxygen
consumption, heart rate and improve myocardial efficiency
b. Glucocorticoids (dexamethasone)

41. SURGICAL
MANAGEMENT
Subtotal thyroidectomy
 Preop: Promote euthyroid state

42. SURGICAL
MANAGEMENT
Subtotal thyroidectomy
 Postop:
oPosition: fowlers with head, neck, and shoulders erect
oMonitor for bleeding and edema
oMonitor for hypocalcemia
oAssess for recurrent laryngeal nerve damage
oMonitor for thyroid storm

43. o Improve nutritional status
 Small frequent feedings
 Replace fluids lost through diarrhea and diaphoresis
 Avoid highly-seasoned foods and stimulants such as coffee,
tea, cola, and alcohol
 High calorie, high protein foods
 Monitor weight and dietary intake

44. o Provide a non-stimulating, quiet, and cool
environment
o Change beddings & clothing as needed; give cool
baths, cool or cold fluids
o Improve self-esteem
o Eye care and protection for ocular changes – instill
artificial tears and wear dark sunglasses under the sun

45. o Monitor s/s of thyroid storm, cardiac and respiratory
function
 Monitor ECG, ABG, pulse oximetry
 Administer oxygen
o Teach patients on self-care
 desired action & side effects of meds
 importance of continuing meds indefinitely & consequences
of failing to take meds
 avoid stressful situations that may precipitate thyroid storm
 s/s of hypothyroidism

46. EVALUATION
 Shows improved nutritional
status
 Demonstrates effective
coping methods
 Achieves increased self-
esteem

47. HYPOPARATHYROIDISM

48. Hypoparathyroidism
• Hyposecretion of parathormone
• Characterized by: decreased intestinal
absorption of dietary calcium and
decreased resorption of calcium from
bone

49. Causes
1. Interruption in blood supply or surgical
removal of parathyroid gland after
thyroidectomy, parathyroidectomy, or
radical neck dissection
2. Atrophy of the parathyroid glands

50. Assessment
• Clinical manifestations are based on:
ohyperphosphatemia
oHypocalcemia: causes irritability of neuromuscular
system

51. Manifestations
Chief symptom: tetany
Latent tetany:
 Numbness, tingling, and cramps in the extremities;
 Stiffness in hands and feet

52. Manifestations
(+) Trousseau’s sign
 occluding blood flow to the arm for 3 mins with a
BP cuff induces carpopedal spasm
(+) Chvostek’s sign
 sharp tapping over the facial nerve just in front of
the parotid gland and anterior to the ear causes
spasm or twitching of the mouth, nose, and eye

53. Manifestations
Overt tetany:
 Bronchospasm
 laryngeal spasm
 carpopedal spasm
 dyphagia, photophobia
 cardiac dysrhythmias
 seizures
Anxiety, irritability, depression, delirium
ECG changes and hypotension

54. Laboratory Findings
Overt tetany:
 Bronchospasm
 laryngeal spasm
 carpopedal spasm
 dyphagia, photophobia
 cardiac dysrhythmias
 seizures
Anxiety, irritability, depression, delirium
ECG changes and hypotension

55. NURSING
PROCESS

56. NURSING
DIAGNOSES
1. Ineffective airway clearance r/t spasm of
airways
2. Risk for injury and aspiration r/t seizure
activity
3. Ineffective cardiac tissue perfusion r/t altered
rate and rhythm of contraction of the heart

57. PLANNING
a.Promote and maintain airway clearance
b.Promote safety and prevent injury
c.Absence of complications

58. INTERVENTIONS
• Medical management goal: To increase serum
Ca to 9 – 10 mg/dL and eliminate symptoms of
hypoparathyroidism and hypocalcemia

59. INTERVENTIONS
oFor hypocalcemia and tetany after thyroidectomy:
administer IV calcium gluconate slowly and
cautiously
place pt. on continuous cardiac monitoring for
cardiac dysrhythmias
oParenteral parathormone

60. INTERVENTIONS
oProvide an environment free of noise, drafts,
bright lights, or sudden movement
oPlace on seizure precaution
oPrepare for tracheostomy or mechanical
ventilation, plus bronchodilators

61. INTERVENTIONS
oDiet: high in calcium, low in phosphorus
 Avoid milk, milk products, and egg yolk
 Avoid spinach
 Oral calcium supplements
 Aluminum hydroxide (Gelusil, Amphojel)
 Vitamin D preparation (eg, dihydrotachysterol,
ergocalciferol, or cholecalciferol)

62. EVALUATION
 Absence of respiratory difficulties
 Free from injury and aspiration
 Absence of cardiac dysrhythmias

63. HYPERPARATHYROIDISM

64. Hyperparathyroidism
Overproduction of parathormone
Characterized by:
a.bone decalcification
b.high serum Ca levels ⇢ development of renal
calculi

65. Causes
1.Primary hyperparathyroidism (PHPT)
- Adenoma due to overgrowth of cells in one of the glands; 85%
- Hyperplasia in more than one gland; 15%
- Parathyroid cancer; <1% (rare)
2.Secondary hyperparathyroidism (SHPT)
- Excessive secretion of parathyroid hormone (PTH) in response to
hypocalcemia and associated hyperplasia
- Seen in patients with chronic renal failure (CRF)

66. Assessment
• Clinical manifestations are based on:
oHypercalcemia: decreases excitation potential of
nerve and muscle tissue
oBone demineralization

67. Manifestations
May have no symptoms
⇧ serum calcium level:
Apathy
Fatigue
Muscle weakness
Nausea, vomiting, constipation
Hypertension, cardiac dysrhythmias

68. Manifestations
Psychological effects: irritability and neurosis to
psychoses
Formation of renal stones, abdominal pain and
hematuria
Complication: renal damage – obstruction,
pyelonephritis, and renal failure

69. Manifestations
Musculoskeletal symptoms:
Skeletal pain and tenderness
Pain on weight-bearing
Pathologic fractures
Deformities
Shortening of body stature

70. Complication
• HYPERCALCEMIC CRISIS
o Serum Ca >15 mg/dL
o Life-threatening neurologic, CV, and renal
symptoms

71. NURSING
PROCESS

72. Nursing
Diagnoses 1.Risk for injury r/t
demineralization of bone
2.Impaired mobility r/t skeletal
pain and pain on weight-
bearing
3.Ineffective renal tissue
perfusion r/t presence of renal
stones

73. Planning
a.Promote safety
b.Improve mobility
c.Absence of renal
complications

74. Interventions
oPrepare patient for surgery
Parathyroidectomy: recommended
treatment for primary disease
Postop:
 constipation is common
 early postop complication: hypocalcemia –
monitor for s/s of tetany

75. Interventions
oHydration therapy
OFI of 2000 mL or more
Cranberry juice or cranberry extract tablets
Avoid dehydration
oAvoid thiazide diuretics
oMove patient slowly and carefully

76. Interventions
oEncourage mobilization
oAdminister oral phosphates – long-term use not
recommended due to risk of ectopic calcium
phosphate deposition in soft tissues
oAvoid a diet with restricted or excess calcium

77. Intervention (Hypercalcemic Crisis)
Rehydration with IV fluids
Diuretics
Phosphate therapy
 Biphosphonates (eg, etidronate [Didronel]) – prevent loss of
bone density
 Pamidronate [Aredia]) – to treat high blood calcium levels;
diseases that causes abnormal & weak bones
Cytotoxic agents ( Mithramycin), calcitonin (to decrease
skeletal Ca release and increase renal clearance of Ca),
and dialysis

78. Evaluation
 Free from injury and fractures, identifies
safety hazards and methods of injury
prevention
 Improved mobility
 Absence of renal complications

79. END