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Endocrine Dysfunction THYROIDand Parathyroid DISORDERSs 2009 Student
Endocrine Dysfunction THYROIDand Parathyroid DISORDERSs 2009 Student
HYPERTHYROIDISM
HYPOTHYROIDISM
PATHOPHYSIOLOGY
• thyroid hormone secretion leads to
hyperthyroidism
• What you see in this is called: thyrotoxicosis
WHAT DO THYROID HORMONES
AFFECT?
• Metabolism in all body organs
• Stimulate the heart
– heart rate
– stroke volume
– cardiac output
– blood flow
HYPERTHYROIDISM
INCREASED THYROID HORMONES:
• Hypermetabolism
• sympathetic nervous system activity
• Effects protein, lipid and carbohydrate
metabolism
EFFECTS ON PROTEIN METABOLISM
• Protein synthesis and degradation
• More breakdown than buildup
• Leads to loss of protein
• Called negative nitrogen balance
EFFECTS ON GLUCOSE
• Glucose tolerance decreased
• Leads to hyperglycemia
EFFECTS ON FAT METABOLISM
• fat metabolism
• body fat
• appetite
• food intake; food intake does not meet energy
demands
• weight
• nutritional deficiencies with prolonged disease
CAUSES
GRAVES DISEASE:
• Client has a goiter (enlarged thyroid gland (p1484)
• Autoimmune problem
• Antibodies attach to gland causing it to enlarge
• SYMPTOMS:
– exophthalmos (protrusion of the eyes) p1484)
– Pretibial myxedema (dry, waxy swelling of the frontal
surfaces of the lower legs)
•
ADDITIONAL CAUSES OF
HYPERTHYROIDISM
1. TOXIC MULTINODULAR GOITER: multiple thyroid
nodules, milder disease
2. EXOGENOUS HYPERTHYROIDISM: excessive use of
thyroid replacement hormones
3. THYROID STORM: untreated or poorly controlled
hyperthyroidism; life threatening
WHO GETS IT
• Most often women between 20-40 yrs
ASSESSMENT
• Recent wgt loss
• Increased appetite
• Increase in # BM/day
• ****heat intolerance
• Diaphoresis even when temperatures comfortable
for others
• Palpitations/chest pain
• Dyspnea with or without exertion
ASSESSMENT
VISUAL PROBLEMS MAY BE EARLIEST PROBLEM:
• Infiltrative Exophthalmopathy (abnormal eye
appearance or function)
• Blurring/double vision/tiring of eyes
• Increased tears
• Photophobia
• Eyelid retraction(eyelid lag) (p1483)
• Globe lag (eyeball lag) (p1483)
GOITER
• Thyroid gland may be 4 X normal
• Bruits (turbulence from increased blood flow)
heard with stethoscope
CARDIAC PROBLEMS
• systolic BP
• tachycardia
• dysrhythmia
FURTHER SYMPTOMS
• Fine, soft, silky hair
• Smooth, moist skin
• Muscle weakness
• Hyperactive deep tendon reflexes
• Tremors of hands
• Restless, irritable, mood swings
• Decreased attention span
• Fatigued, inability to sleep
LABORATORY ASSESSMENT
IN HYPERTHYROIDISM:
• T3
• T4
• TSH in Graves disease
• Radioactive Thyroid Scan
• Ultrasonography: used to determine goiter or
nodules
• EKG: note tachycardia
DRUG THERAPY
• ***antithyroid drugs: thioamides
– propylthiouracil (PTU)
– methimazole (Tapazole)
– carbimazole (Neo-Mercazole)
• ACTION: blocks thyroid hormone production; takes
time
Need to control cardiac manifestations (tachycardia,
palpitations, diaphoresis, anxiety) until hormone
production reduced: use beta-adrenergic blocking
drugs: propranolol (Inderal, Detensol)
DRUG THERAPY
Iodine preparations:
• Lugol’s Solution
• SSKI (saturated solution of potassium iodide)
• Potassium iodide tablets, solution, and syrup
ACTION:
– decreases blood flow through the thyroid gland
– This reduces the production and release of thyroid
hormone
– Takes about 2 wks for improvement
– Leads to hypothyroidism
DRUG THERAPY
• Lithium Carbonate
• ACTION: inhibits thyroid hormone release
• NOT USED OFTEN BECAUSE OF SIDE EFFECTS:
depressions, diabetes insipidus, tremors, N&V
DRUG THERAPY
RADIOACTIVE IODINE THERAPY:
• Receives RAI in form of oral iodine
• Takes 6-8 Weeks for symptomatic relief
• Additional drug therapy used during this type
of treatment
• Not used on pregnant women
SURGICAL MANAGEMENT
Why use surgery?
• Used to remove large goiter causing tracheal or
esophageal compression
• Used for pts who do not have good response to
antithyroid drugs
TWO TYPES OF SURGERIES:
1. Total thyroidectomy (must take lifelong thyroid
hormone replacement)
2. Subtotal thyroidectomy
PREOPERATIVE CARE
Low weight:
• Hi protein, hi CHO diet for days/weeks before
surgery
PRE-OPERATIVE CARE
Decreased levels
of
Thyroid Hormone
CAUSES
• Cells damaged; no longer function
• Cells might be normal, person doesn’t ingest
enough iodide & tyrosine needed to make
thyroid hormones
SYMPTOMS
• Blood levels of thyroid hormones are low
• Decreased metabolic rate
• Hypothalamus and anterior pituitary gland
make stimulatory hormones (TSH) as
compensation
• Thyroid gland enlarges forming goiter
MYXEDEMA DEVELOPS
• With low metabolism metabolites build up inside the
cells which increases mucous and water leading to
cellular edema
• Edema changes client’s appearance
• Nonpitting edema appears everywhere especially
around the eyes, hands, feet, between shoulder
blades
• Tongue thickens, edema forms in larynx, voice husky
INCIDENCE OF HYPOTHYROIDISM
• 30-60 yrs of age
• Mostly women
ASSESSMENT
HYPERPARATHYROIDISM
HYPOPARATHYROIDISM
RESPONSIBILITY OF GLANDS
• Maintain calcium and phosphate balance
INCREASED PTH
EFFECTS ON KIDNEY
• acts directly on the kidney causing increased
kidney reabsorption of calcium and increased
phosphate excretion
• Leads to hypercalcemia and
hypophosphatemia
INCREASED PTH
EFFECTS ON BONE
• Increase bone resorption (bone loss of
calcium)
• by decreasing osteoblastic (bone production)
activity and increasing osteoclastic (bone
destruction activity)
• This process releases Ca and phosphate into
the blood and reduces bone density
CHRONIC CALCIUM EXCESS