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THYROID Disorders For PB BSC
THYROID Disorders For PB BSC
Thyroid Gland
■ Second largest endocrine gland in body
■ Small butterfly shaped gland located at
base of neck.
■ Thyroid is controlled
by the hypothalmus
and pituitary
Functions
■ Stimulates & maintains metabolic
processes
Produces thyroid hormones T3-
triiodothyronine and T4-thyroxine
These hormones regulate metabolism & affect
the growth and function of other systems in
the body
■ Parathyroid gland secretes PTH to raise
serum calcium levels
Calcitonin
Is another important hormone secreted by the thyroid gland.
It is secreted in response to high plasma levels of calcium. It
reduces the plasma level of calcium by increasing its
deposition in bone.
Iodine
Is essential to the synthesis of the thyroid gland hormones.
Is mainly used by the thyroid.
Deficiency alters thyroid function.
Iodide is ingested in the diet, absorbed & its ions are converted
to iodine molecules.
Molecules react with tyrosine (an amino acid) to form the
thyroid hormones.
Iodine
Dietary Iodide is removed from the bloodstream by
means of an active pump
The pump can concentrate iodide in the follicular sacs at
350x greater than the blood concentration
Oxidation of iodide by thyroid peroxidase converts
iodide iodine
Peripheral de-iodination of T4 to T3 is regulated by many
factors including health, nutritional status, and other
hormones
Hormones: T3 & T4
■ T3 (Triiodothyronine) & T4 (Tetraiodothyronine
T4 is converted to T3 by peripheral organs
such as kidney, liver, and spleen
T3 is 10x more active than T 4
Hormones: T4 to T3
Only 20% of total T3 is secreted by thyroid
■ Majority is formed from catalysis of T4 by 5’-
iodthryonine deiodinase (highest activity in liver
and kidney)
Hormones: T4
■ T4-thyroxine contains 4 iodine atoms
■ It is a slow-acting pre-hormone
■ T4 takes 4 days to peak in blood
Half-life 7 days
■ Overall effects take 6 weeks
■ T3 is the active and faster-acting hormone
■ The immediate effects of T3 last 1-2 days
Half-life 1.5 days
Hormones- TSH
■ TSH
TSH is a pituitary hormone
Controlled by TRH-thyrotropin releasing
hormone from hypothalamus
Functions to stimulate thyroid hormone
production
■ May enlarge thyroid (goiter) when under producing
or over producing
Labs:
■ High TSH indicates low thyroid hormone= hypo
■ Low TSH indicates high thyroid hormone = hyper
Hormones-Calcitonin & PTH
■ Produced by thyroid to regulate serum
calcium levels
■ Calcitonin stimulates movement of
calcium into bone
■ Parathyroid hormone (PTH) opposite
effect of calcitonin
Functions
■ Metabolic stimulants of:
Neural and skeletal development
Oxygen consumption at rest
Stimulating bone turnover by increasing formation
and resorption
Increasing number of catecholamine receptors in
heart
Increasing production of RBC
metabolism of carbs, fats, and protein
Diseases
Hypothyroidism-Under Activity
Prevalence
Affects 5-17% of
population
Females> Males
50%.
■ Nursing Interventions
Improving Nutritional Status
■ Up to six well-balanced meals of small size are
offered daily.
■ Foods and fluids are selected to replace fluid
lost through diarrhea and diaphoresis.
■ To reduce diarrhea, highly seasoned foods and
stimulants such as coffee, tea, cola, and
alcohol are discouraged.
■ High-calorie, high-protein foods are
encouraged.
■ Monitor weight, dietary intake, and nutritional
status.
Enhancing Coping Measures
■ Reassure the patient that the emotional reactions will
be controlled with effective treatment.
■ Similar reassurance needs to be made to family and
friends.
■ Minimise stressful experiences for the patient.
■ Keep the patient’s environment quiet and noiseless.
■ The nurse encourages relaxing activities if they do
not overstimulate the patient.
■ Educate patient about medications to be taken in
anticipation for surgical intervention.
Improving Self-esteem
■ The patient with hyperthyroidism may lose self-
esteem due to changes in appearance, appetite, and
weight, and due to his inability to cope well with
family and the illness.
■ Cover or remove mirrors.
■ Remind family members and personnel to avoid
bringing these changes to the patient’s
attention.
■ Explain the temporary nature of these changes.
■ Provide eye care as appropriate. Instruct the patient
on how to use eye preparations.
Maintaining Normal Body Temperature
■ The patient with hyperthyroidism frequently
finds a normal room temperature too warm
because of an exaggerated metabolic rate
and increased heat production.
■ The nurse maintains the environment at a cool,
comfortable temperature and changes bedding
and clothing as needed. Cool baths and cool or
cold fluids may provide relief.
Teaching Patients Self-Care
■ Provide instruction and written plan about the
medications.
■ Provide verbal and written instruction about
the actions and possible side effects of the
medications.
■ Identify adverse effects that should be
reported.
■ Provide information to the patient about what
to expect if total or subtotal thyroidectomy is
anticipated.
Goiter
■ A diet deficient in
iodine
■ Increase in thyroid
stimulating hormone
(TSH) in response
to a defect in
normal hormone
synthesis within the
thyroid gland.
Thyroid Storm
■ Life threatening syndrome
■ Decompensated hyperthyroidism
■ Symptoms
Hyperthyroid symptoms with agitation,
confusion, delirium, psychosis
Gastrointestinal: Nausea/Vomiting, Abdominal
pain
Tachycardia associated with CHF
Thyroid Storm Treatment
Antithyroids
PTU 200-400mg po/NG q4-8h
Methimazole 60-120mg/d PO/NG divided q6-8h
Potassium Iodide 2-5 drops PO/NG q6h
Lugol Solution-Strong Iodine10 drops po TID
Glucorticoids: block conversion of T4 to T3
Hydrocortisone succinate 100-200mg IV
q6-8
Dexamethasone 2mg Po/IV q6-8h
BB
Esmolol: 500mcg/kg/min
Propranolol 20-80mg/dose
Hyperthyroidism-Treatment
■ Drug Therapy
Beta blocker
■ Atenolol 50mg-100mg po daily
■ Propranolol 20-40mg po TID
Antithyroids
■ Methimazole 15-30mg po daily
■ Propylthiouracil (PTU) 300mg TID
Hyperthyroid-Treatment
■ Procedural Therapy
Radionuclide albation of thyroid gland
Total thyroidectomy
Methimazole
■ Reduces T3 & T4 production.
■ Dosage
15-30mg PO daily
Methimazole
■ Adverse Effects
Skin rash
Loss of taste
GI upset
Drowsiness
Decreased Platelets
Propylthiouracil -PTU
■ Thio-urea derivative
■ Preferred agent in pregnant women
severe thyrotoxicosis
■ Dosage
Adults: 300-450mg/day divided q8h
Severe cases: 600-1200mg/day
Maintenance dose 100-150mg/day divided q 8-12
hours
PTU
■ Adverse reactions
Rash
Itching
hives(urticaria-redness,swelling,itching)
Agranulocytosis (when bone marrow is unable
to produce mature white cells that
neutrophills)
vasculitis(inflammation pf blood vessels)
Carbimazole
■ Dosage
15-40mg PO daily until normal function
Reduce to 5-15mg po daily maintenance dose
■ Adverse Effects
Bone marrow suppression
Neutropenia
Agranulocytosis
Sodium Iodide I-131 (Iodotope)
■ Quickly absorbed and taken up by thyroid
■ No other tissue capable of retaining
radioactive iodine therefore low adverse
effects
■ Dose
Adult75-150mCi/g of thyroid x estimated
thyroid gland size
24hour radioiodine uptake
Discontinue antithyroid therapy 3-4days
before
Treatment
Hypothyroidism
• Hypothyroidism is the clinical state resulting from
decreased production of thyroid hormones
or very rarely from tissue resistance.
Epidemiology
• Accurate assessment of the prevalence and incidence
of hypothyroidism is difficult due to variation in
definitions and population samples.
■ Pituitary radiation
■ Pituitary necrosis
■ Autoimmune mechanisms
Tertiary Hypothyroidism
■ Hypothalamic Failure- very rare
■ Insufficient TRH release as a result of:
Trauma
Irradiation
Tumors
Hypothyroidism-Treatment
Drug Therapy
Levothyroxine Sodium-DOC synthetic T4
■ Adults 1-1.5mcg/kg/day orally initially, adjust as
mcg/kg/day
Hypothyroidism-Treatment
■ Adverse Effects
MI
Osteopenia
HA
■ Contraindicated
Acute MI
Treatment of obesity
Uncontrolled HTN
Monitoring
■ Obtain baseline FT4, TSH, LFT, CBCs
before initiation of therapy
■ Repeat FT4 and TSH after 4-6 weeks on
therapy and 4-6 weeks after adjustments
■ Once euthyroid state obtain thyroid
function test after 3-6 months
Nursing Implications for
Thyroid tests
Determine whether the patient has taken drugs or agents that contain
iodine. These include:
Contrast agents (radiopaque, dye-like substances that may contain
iodine) and medications used to treat thyroid disorders.
Topical antiseptics, multivitamin preparations, cough syrups; an
antiarrhythmic agent.
Estrogens, salicylates, amphetamines (drugs that produce
increased wakefulness and focus ),chemotherapeutic agents,
antibiotics, and corticosteroids.
Ask the patient about the use of these drugs and note their use on the
laboratory requisition.
Nursing Management
Modifying Activity
■ The patient experiences decreased energy and
lethargy. As a result, the risk for complications from
immobility increases.
■ The patient has decreased ability to exercise and
participate in activities due to changes in
cardiovascular and pulmonary status.
■ The nurse’s role is to assist with care and hygiene
while encouraging the patient to participate in
activities as tolerated to prevent the complications of
immobility.
Modifying Activity
■ The patient experiences decreased energy and
lethargy. As a result, the risk for complications
from immobility increases.
■ The patient has decreased ability to exercise
and participate in activities due to changes in
cardiovascular and pulmonary status.
■ The nurse’s role is to assist with care and
hygiene while encouraging the patient to
participate in activities as tolerated to prevent
the complications of immobility.
Monitoring Physical Status
Close monitoring of the vital signs and cognitive level to
detect the following:
Deterioration of physical and mental status
Signs and symptoms indicating that treatment has resulted
in the metabolic rate exceeding the ability of the
cardiovascular and pulmonary systems to respond
Continued limitations or complications of myxedema
Promoting Physical Comfort
■ Extra clothing and blankets are provided.
■ Use of heating pads and electric blankets is
avoided. This is because the patient could be
burned by these items without being aware of
it because of delayed responses and
decreased mental status.
Providing Emotional Support