Week 14 • If your thyroid gland produces too many
hormones, you may experience:
Disorders of the
Thyroid Glands
Thyroid Gland
• Iodine regulates body metabolism (oxygen
consumption and heat production)
• Regulate growth and development
TSH- from anterior pituitary stimulates
thyroid gland to release thyroxine,
triiodothyromine, thyrocalcitonin
Euthyroid- normal thyroid function and
secretion
What are Thyroid Problems?
• Through the hormones it produces, the
thyroid gland influences almost all of the
metabolic processes in your body.
• Thyroid disorders can range from a small,
harmless goiter (enlarged gland) that needs
no treatment to life-threatening cancer.
• The most common thyroid problems involve
abnormal production of thyroid hormones.
• Too much thyroid hormone results in a
condition known as hyperthyroidism.
• Insufficient hormone production leads to
hypothyroidism.
Thyroid
What are thyroid function tests?
Available tests include the following:
T3 100-200 (ng/dl)
T3RU (resin uptake) 24% to 37%.
T4 5–12 (mcg/dl)
TSH 0.4 and 4.0 milliunits per
liter (mU/L)
1. weight loss
2. high levels of anxiety
3. tremors
4. a sense of being on a high
➢ This is called hyperthyroidism.
• If your thyroid gland doesn’t produce
enough of these hormones, you may
experience symptoms such as:
• weight gain
• lack of energy
• depression
➢This condition is called hypothyroidism.
Hypothyroidism
Myxedema - deficiency in thyroid synthesis
in adult.
• Asymptomatic to full blown
Nursing Assessment:
• Fatigue and apathetic
• Obesity: puffy and edematous
• Dry and sparse hair, dry flaky skin
• Severe intolerance to cold decreased
metabolic rate
• Fecal impaction, hypersensitive to
narcotics, barbiturates, and anesthetics
Management:
• Hormone therapy for life (synthroid,
cytomel)
Cretinism
• Usually silent baby
• Severe hypothyroid condition of infancy due
to deficiency of thyroid hormone synthesis
during fetal life or soon after birth
Symptoms of Cretinism
1. Stunted growth and mental retardation.
2. Short stature (dwarfism).
3. Mild neurological impairment with reduced
muscle tone and coordination.
4. Hearing and speech defects.
5. Unable to maintain posture and balance with
characteristic walking style.
6. Myxedema.
7. Enlargement of the thyroid gland (goitre)
Causes of Hypothyroidism
1. Hashimoto’s thyroiditis
2. Thyroiditis
3. Previous thyroid treatment
4. Congenital hypothyroidism
1. Hashimoto’s thyroiditis
• In this autoimmune condition, the immune system
mistakenly attacks the thyroid gland.
• Eventually, the damaged thyroid is unable to
produce enough thyroid hormones.
• Hashimoto’s thyroiditis is the most common
cause of hypothyroidism in the United States.
2. Thyroiditis
• Thyroiditis is an inflammation of the thyroid
gland.
• It causes thyroid hormones to leak into the
blood, raising their overall levels and leading to
hyperthyroidism.
• After 1–2 months, this may develop into
hypothyroidism.
3. Previous thyroid treatments
• Certain treatments for hyperthyroidism and
thyroid cancer can cause side effects or
complications that lead to hypothyroidism.
• Examples of these treatments include surgery
or radioactive iodine therapy.
4. Congenital hypothyroidism
• This condition occurs when the thyroid gland
does not function properly from birth.
• It can lead to physical and mental growth
issues, but early treatment can prevent these
complications.
Nursing assessment:
a. Physical and mental retardation
b. Stunted stature
c. Wide open mouth and lolling tongue
d. Small eyes and half closed with swollen lids
e. Stolid expressionless face
f. Squat figure
g. Dry skin
Symptoms
1. slow heart rate
2. tiredness or fatigue
3. slowed thinking
4. depression
5. weight gain
Nursing Assessment
6. constipation
1. Agitated, nervous, irritable
7. joint and muscle pain
2. Goiter (excessive thyroid hormone in blood)
8. dry skin
3. Heat intolerance
9. intolerance to cold
4. Increased appetite
5. Amenorrhea
6. Exophthalmus - Abnormal protrusion of eyes

2. Thyroid nodules
• Thyroid nodules are lumps that can develop on
the thyroid gland. Some contain thyroid tissue,
which contributes to the overproduction of
thyroid hormone.

• Most thyroid nodules are benign, but some may

Treatment be cancerous.

• To treat this condition, a person takes the 3. Excessive iodine intake

synthetic hormone:
• A person who takes additional iodine in
• Levothyroxine daily to increase levels of the supplements or medicines can cause their thyroid
natural thyroid hormone thyroxine. gland to produce too much of the hormones.

Symptoms of hyperthyroidism
Hyperthyroidism 1. fast heartbeat
2. increased risk of heart rhythm problems
3. anxiety or irritability
4. difficulty sleeping
Causes of Hyperthyroidism 5. weight loss
6. muscle weakness
1. Graves’ disease 7. shakiness
8. frequent bowel movements or diarrhea
2. Thyroid nodules 9. sweating and intolerance to heat
3. Excessive iodine intake

1. Graves’ Disease
• Is an autoimmune condition where the immune
system mistakenly attacks the thyroid gland,
causing it to overproduce thyroid hormone.

Grave’s Disease
▪ Excessive production of T3 or T4 or both
▪ Toxic diffuse goiter or exophthalmic goiter
▪ Incidence: females
Treatment for Symptoms of goiter
hyperthyroidism 1. A swelling in the front of the neck, just below
the Adam's apple
• Medication: Thionamides stop the thyroid from 2. A feeling of tightness in the throat area
producing too many hormones.
3. Hoarseness (scratchy voice)
• Radioiodine therapy: This type of radiotherapy
destroys the cells in the thyroid gland, reducing 4. Neck vein swelling
the level of hormones that the thyroid produces. 5. Dizziness when the arms are raised above
• Surgery the head

Nursing Management
Home remedies and a. Prevention
lifestyle changes • Iodized salt, avoid goitrogenic foods

b. Lugol’s solution or Potassium Iodide

Home Treatment Saturated Solution (KISS)
• Fish: Oily fish contains omega-3 fatty acids • Dose comes in drops; mixed with cold
that can help prevent a dry scalp. water and given with a straw

• Dark green vegetables: Vegetables such c. Thyroid hormone replacement

as spinach have high levels of vitamins A and C.
• Watch for thyrotoxicosis
These vitamins can improve the condition of hair.
• Tachycardia, increase appetite,
diarrhea, sweating, tremor, palpitations,
• Protein-rich foods: Eating foods rich in shortness of breath
protein can help prevent weak and brittle hair.
Dairy foods, legumes, nuts, and lean meats all
contain high levels of protein.

• Biotin-rich food: Biotin is a vitamin that is

important for hair growth. Biotin deficiency can
lead to brittle hair or hair loss.

• Calcium-rich foods: Calcium is key to hair

growth. Good sources of calcium include dairy
products, such as milk and cheese.

Nursing Management
Goiter
a. Antithyroid therapy
• Iodine deficiency is the most common cause of • To suppress thyroid secretions
goiter.
• Prophylthiouracil PTU; methimazole tapazole
• The body needs iodine to produce thyroid
hormone.
b. Iodine- lugol’s solution or KISS Management on Hypocalcemia
• To decrease the vascularity and size of the • Increase Ca – 100% sol of calcium carbonate
thyroid or gluconate or calcium lactate

c. Radioactive Iodine Therapy • Calcium supplement and Vit D

• to middle aged and elderly clients

Week 15
d. Surgery
• When patient is euthyroid
Thyroid storm
• Overactivity of thryroid characterized by
Post-operative increased temperature, severe tachycardia,
delirium, dehydration and irritability, hypotension
• Semifowler’s position when conscious

• tracheostomy set at bedside Nursing management:

• Ambulate 2nd post-operative day • Cool darkened quiet room

Nursing Management • Antipyretic oral or parenteral antithyroid drug

followed by K iodine; corticosteroids,
• Complications propanolol- to relieve heart arrythmias
• Hemorrhage
Check dressings by sliding hand
on the patient’s nape
Hyperparathyroidism
• Respiratory obstruction
• Laryngeal edema- observe for • Increased serum levels of calcium
sudden difficulty in breathing
• Keep tracheostomy set at
bedside
Management:
• Accidental injury to the • Parathyroidectomy
laryngeal nerve
• Hydration therapy/cranberry juice
• Watch for decreasing voice
• Treatment of GI disorders
• Hypocalcemia or tetany
• WOF: Hypercalcemic crisis
• Accidental removal of
parathyroid gland • Diuretics, hydration, dialysis, calcitonin

• (+) Chvostek’s sign

Hypoparathyroidism
Spasms of the facial
muscles when tapped

• (+) Troussaeu’s sign

• Decreased serum levels of calcium
• Carpopedal spasms
upon constriction of
the extremities
Management: ▪ Addison’s Crisis
• IV calcium gluconate
• Parenteral parathormone Causes
• Noise-free environment
• Aluminum hydroxide gel • Injury to the adrenal glands

• Infection, including tuberculosis, HIV/AIDS

related infections, and fungal infections
Adrenal Gland • Cancer cells from another part of the body
that have invaded the adrenal glands

Diagnostic Assessment: • Bleeding into the adrenal glands

• Surgical removal of the adrenal glands

1. Adrenal cortex functions
• Amyloidosis (abnormal buildup of certain
proteins in the organs)
a. Hematologic level of steroids
• Genetic defects
• cortisol, aldosterone, and
testosterone level

b. Urinary level- 24 hr urine

collection
• 17-ketosteroid test

2. Adrenal medulla function

• Vanillylmandelic acid VMA- 24 hrs.
urine collection
Nursing management:
1. Hydrocortisone (solu-cortef) IV 2. Monitor
Disorders of the vital signs
3. Prevent infection
Adrenal Cortex 4. Daily weight
5. Electrolyte balance

❖ Addison’s Disease- 6. High carbohydrate and protein diet

adrenocortical insufficiency Disorders of

Clinical Manifestation
- Muscle weakness, anorexia, fatigue, Adrenal Cortex
hypotension and low blood glucose level, low
sodium and high potassium
• Aldosteronism- aldosterone excess
a. Primary (Conn’s syndrome)
Nursing Assessment
b. Secondary
• Hypertension- main symptom
• Results from the presence of
exogenous conditions that stimulates • Persistent, fluctuating, pounding headache
renin-angiotensin-aldosterone system
• Sweating palpitations, nausea or vomiting

• Hyperglycemia and glycosuria

Nursing Assessment
• Shock-like state
a. Hypertension
• Pupils dilate, cold extremities, diaphoresis
b. Muscular weakness, paralysis, edema
• Management or choice
c. Increased cardiac output, increased K
• Surgical excision
• ECG changes
d. Diminished deep tendon reflexes
e. Increased blood volume Pancreas- Islets of Langerhans
f. Decreased concentrating kidney ability Insulin (beta cells) - hypoglycemic agent
g. Polyuria, polydipsia, nocturia • Transports and metabolizes glucose for energy

• Stimulates storage of glucose in the liver and

muscle (in the form of glycogen)
Nursing Management • Signals the liver to stop the release of glucose
a. K-sparing diuretics
• Enhances storage of dietary fat in adipose
b. K replacement tissue
c. Na restriction • Accelerates transport of amino acids into cells.
Glucagon (alpha cells) - hyperglycemic agent

Disorders of the
Diabetes Mellitus
Adrenal Medulla
Chronic disorder of carbohydrate metabolism
(imbalance between the supply and demand)
Pheochromocytoma
• Types:
• Tumor which results in hypersecretion of
adrenal medulla • Type I- insulin dependent (IDDM)

• Typically benign; curable if detected early • Type II- non-insulin dependent (NIDDM)

• Precipitating factors: pregnancy and stress • Gestational diabetes mellitus

• Secondary diabetes mellitus

 Diagnostic Assessment

Nursing Assessment
1. Polyuria Management of Diabetes
• Water not reabsorbed by renal tubules because 1. Activity (exercise)
osmotic activity of glucose 2. Diet
3. Blood sugar monitoring
2. Polydipsia 4. Pharmacologic therapy
A. Insulin therapy
• Severe dehydration, causes thirst B. Oral hypoglycemic agents

3. Polyphagia
• Tissue breakdown and wasting causes
starvation

4. Weight loss (IDDM)- no glucose available

to cells, therefore body breaks down fat and
protein stores for energy

Management of Diabetes
Compications of Treatments
▪ Hypoglycemia
▪ Blood glucose falls to less than 50 to 60
mg/dL because of too much insulin or oral
hypoglycemic agents, too little food, or
excessive physical activity.
▪ Mild, moderate, severe

▪ Diabetic Ketoacidosis
• Fatty acids are broken down to
ketone bodies because of absolute
ore relative deficiency in insulin
• Etiology:
• Too little insulin
dose/omitting insulin dose
• Increased need for insulin
due to surgery, trauma,
pregnancy, puberty, or
febrile illness
• Insulin resistance
secondary to development
of insulin antibodies or
severe emotional stress

▪ HHNK – Hyperglycemic, Hyperosmolar, Non-

Ketotic Coma
• Non-Insulin dependent diabetics who
have enough insulin but unable to
use insulin to combat hyperglycemia
• Nursing Assessment
• Same as DKA but no
Kussmaul’s breathing and
acetone breath
Nursing Management