Transcript Disorders of the Thyroid and Parathyroid

Disorders of the Thyroid and
Parathyroid
ACC, RNSG 1247
Created by Lydia Seese, RN
Thyroid Enlargement/Goiter
Maybe caused by:
 Increased TSH stimulation
Growth-stimulating immunoglobulins &
other growth factors
Goitrogens
Iodine-deficiency areas (endemic goiter)
Thyroid nodules
Mostly benign
Malignant nodules: usually hard &
painless
Diagnostics: US, US-guided FNA,
thyroid scan
Treatment: unilateral to total
thyroidectomy
Thyroiditis
 Subacute and acute thyroiditis:
Subacute - viral (as in subacute granulomtous thyroiditis)
Acute fungal or bacterial
 Chronic autoimmune thyroiditis
 Silent painless thyroiditis
Hashimoto’s thyroiditis
Chronic autoimmune disease
Most common cause of hypothyroidism in
US
Diagnostics: T3 T4 usually low, TSH
high, (+) for antithyroid antibodies
HYPERTHYROIDISM
Graves’ Disease
Toxic nodular goiters
Thyroiditis (hyper) – usually caused by virus
as in viral subacute granulomatous thyroiditis
Thyrotoxic crisis (thyroid storm)
Graves Disease
Autoimmune, unknown etiology
Antibodies attach to the TSH receptors
and stimulate the thyroid to release T3 &
T4
May lead to destruction of thyroid tissue ,
thus hypothyroidism
Toxic Nodular Goiters
Release thyroid hormones independent of
TSH stimulation
Maybe single or multinodular
Diagnostics for
Hyper/Hypothyroid Dysfunction
1.
2.


History and PE
Most reliable blood tests are:
TSH
Free T4
Diagnostics Continued
T3, T4
Radioactive iodine uptake (RAIU )
TRH stimulation test
ECG
US
Thyroid scan
Antibody assay
Hyperthyroidism: Manifestations
 S/sx of increased metabolism &
stimulation of SNS
 Goiter
 Opthalmopathy; exophthalmus in
Graves’
Exopthalmus
Thyroid storm
 Rare but dangerous
 Systemic symptoms: examples
Hyperthermia
Tachycardia, esp. atrial arrhythmias
Agitation or delirium
Hyperthyroidism:
Collaborative Care
 Medications/Drugs
 Radioactive Iodine
 Nutritional
 Surgical
Drug Therapy: Antithyroid drugs
Preferred Tx for pregnant women
Methimazole - tapazole
 PTU - prophylthiouracil
 Improvement begins 1-2 weeks
 Good results in 4-8 weeks
 Remission in 6-15 mos. in < 50% of cases
Patient concern: noncompliance
Drug Therapy: B adrenergic
blockers
Symptomatic relief of thyrotoxicosis
Propranolol - Inderal
Atenolol - Tenormin
Drug Therapy: Iodine
 Maximal effect in 1-2 weeks
 Saturated solution of potassium iodine
(SSKI)
 Lugol’s solution
Radioactive Iodine Therapy
 Preferred for most nonpregnant women
 Damages thyroid hormone
 Effect in 2-3 mos.
Acute Intervention
Support ABC’s
Rest, minimal stimulation
Eye care
Pre/Post operative Care
CDB, turning, ambulate w/in hrs post op
ROM of neck
Airway and incision site monitoring
Semi fowlers to prevent tension on suture
lines
VS monitoring including tetany
Pain management
Fluids if tolerated, soft diet day after
Post operative & home care
 Remaining thyroid tissue is allowed to
regenerate post-op
Reduced caloric intake, adequate iodine
Regular exercise
Avoid temperature extremes
Regular follow up to monitor for
hypothyroidism
HYPOTHYROIDISM
Primary – RT destruction of thyroid
tissue or defective hormone synthesis
Secondary – RT pituitary disease
Hypothyroidism: Manifestations
Slowing of body process which develops
over months to years
Exs: fatigue, cold intolerance, weight
gain, systemic symptoms
Myxedema
Myxedema Coma
Rare but life threatening
Severe metabolic disorders, hypothermia,
cardiovascular collapse, coma
Factors: infection, trauma, failure to take
thyroid replacements
Hypothyroidism:
Collaborative care
Goal – euthyroid state
Low calorie diet
Thyroid hormone
Natural hormones
Hypothyroidism:
Acute Intervention
 IV thyroid hormone
 Hypertonic saline solution
 Close assessment
 VS monitoring
Thyroid malignancies
Occur more often in people who have
undergone radiation of the head, neck or
chest.
Symptoms of thyroid cancer include
hoarseness, dysphagia
Most Common Types of
Thyroid Cancer
Papillary thyroid cancer
Follicular thyroid cancer
The parathyroid glands
Disorders of the parathyroid
glands
Hyperparathyroidism (hypercalcemia)
Hypoparathyroidism (hypocalcemia)
Tumors
Hyperparathyroidism
Primary
Secondary
Tertiary
Hyperparathyroid
Major S/Sx: depression, fatigue, loss of
appetite, constipation, osteoporosis,
fractures, kidney stones
DX: bone x-rays, Ca & PTH levels
TX: decrease high serum levels, surgical
removal of parathyroid
Hyperparathyroidism:
Nonsurgical Treatment
Close follow up
Active lifestyle.
 Dietary measures
 Drugs
Common Medications used in
Hyperparathyroidism
Phosphorus
Biphosphates
Estrogen or progestin
Oral phosphate
Diuretics
Calcimimetic agents
Signs that indicate calcium
levels are abnormal
Trousseau’s sign: temporarily occlude
arterial blood flow (with BP cuff inflated)
above the normal systolic pressure. A +
Trousseau”s sign occurs when the hand
and fingers contract from ischemia
Chvostek’s sign: tap on the facial nerve
just below the temple. Sign is + when
nose, eye, lip & facial muscles twitch
Hypoparathyroidism
Results from abnormally low levels of
PTH low Ca level
Symptoms: painful spasms of face, hands,
arms, and feet; seizures
TX: IV Calcium; CalMag & vit D;
Rebreathing
Parathyroid Tumors
Grow inside the gland itself
May cause  levels of PTH leading to
hyper states.
Most are benign adenomas;
malignancies are very rare
Nursing Diagnosis for
thyroid/parathyroid patients
Imbalanced nutrition: _______ r/t
hypermetabolic or hypometabolic state
Disturbed body image: r/t changes in
appearance AEB exopthalmus (myxedema),
skin changes, facial edema, presence of goiter
Risk for constipation r/t slowed metabolic states
and decreased activity tolerance
Risk for fluid/electrolyte imbalance r/t changes
in production of thyroid hormones 2°
hypothyroidism
Nursing Diagnosis, cont.
Electrolyte imbalance r/t decreased/increased
levels of calcium AEB….
Knowledge deficit: dietary, r/t decreased
parathyroid function AEB calcium serum levels
of_____, facial twitching, muscle cramps, …..
R/F impaired cardiac output
R/F Imbalanced body temperature
RF acute pain RT effects of renal stone