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Med-Surg Nursing Chapter 66
Care of Patients with Problems of the Thyroid and Parathyroid Glands
58
Nursing
Undergraduate 2
11/19/2013

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Term
Hyperthyroidism
Definition
Excessive thyroid hormone secretion from the thyroid gland. Can be temporary or permanent, depending on the cause.
Term
Thyrotoxicosis
Definition
Manifestations of hyperthyroidism, regardless of the origin of the thyroid hormones.
Term
Hyperthyroidism Manifestations
Definition
Increased basal metabolic rate
Increased sympathetic nervous system activity
Increased heart rate
Increased stroke volume
Diaphoresis
SOB
Palpations, chest pain
Weight loss
Muscle weakness/wasting
Blurred vision
Restlessness, Irritability
Amenorrhea
Goiter
Exophthalmos
Increased libido
Decreased fertility
(Figure 66-1, pg 1394)
Term
Synthesis
Definition
Buildup of protein. Increased in hyperthyroidism.
Term
Degredation
Definition
Breakdown of protein. Increased and exceeds buildup in hyperthyroidism.
Term
Negative nitrogen balance
Definition
Net loss of body protein, caused by higher rate of degradation vs synthesis in hyperthyroidism.
Term
Hyperglycemia
Definition
Elevated blood glucose levels, caused by decreased glucose tolerance in hyperthyroidism.
Term
Graves' Disease
Definition
Autoimmune disorder in which antibodies (thyroid-stimulating immunoglobulins) are made and attach to TSH receptors on thyroid tissues.
Term
Goiter
Definition
Enlargement of the thyroid gland
Term
Manifestations of Graves' Disease
Definition
Goiter
Exophthalamos
Pretibial Myxedema
Term
Exophthalmos
Definition
Abnormal protrusion of the eyes
Term
Pretibial myxedema
Definition
Dry, waxy swelling of the front surfaces of the lower legs
Term
Toxic multinodular goiter
Definition
Multiple thyroid nodules that can cause hyperthyroidism
Term
Exogenous hyperthyroidism
Definition
Hyperthyroidism caused by excessive use of thyroid replacement hormones
Term
Graves' Disease Incidence
Definition
Is most often diagnosed in women (10 times more often then men) between ages 20-40
Term
Diaphoresis
Definition
Increased sweating, caused by heat intolerance in hyperthyroidism
Term
Photophobia
Definition
Sensitivity to light, due to ocular edema in hyperthyroidism
Term
Bruits
Definition
Turbulence from increased blood flow, may be heard in the neck with hyperthyroidism. Usually present with goiter.
Term
Hyperthyroidism laboratory profile
Definition
Increased Serum T3
Increased Serum T4
Increased Free T4 index
Increased T3 resin uptake
Little or not TSH response in TRH stimulation test.
Fails to suppress RAIU or T4 levels in thyroid suppression test
High titer of antithyroglobin antibodies
High titers indicate Graves' Disease in thyrotropin receptor antibodies test
Low TSH levels in Graves' disease
High TSH levels in secondary or tertiary hyperthyroidism
Term
Hypothyroidism laboratory profile
Definition
Decreased Serum T3 levels
Decreased Serum T4 levels
Decreased Free T4 index
Decreased T3 resin uptake
Delayed TSH response in secondary hypothyroidism in TRH stimulation test
Elevated TSH response in primary hyperthyroidism
No change in RAIU or T4 levels in thyroid suppression test
No response in primary hyperthyroidism of TSH stimulation test
Normal response in secondary hyperthyroidism of TSH stimulation test
Increased titers of thyroid antibodies
High TSH in primary disease
Low TSH in secondary disease
Term
Normal Thyroid Laboratory Profile
Definition
Serum T3 = 70-205 ng/dL
Serum T4 = 4-12 mcg/dL
Free T4 index = 0.8-2.4 ng/dL
T3 resin uptake = 24%-34%
TSH stimulation test = >10% or >1.5 mcg/dL
Thyroid antibodies = Titer <1:100
TSH = 0.3-5.0 uU/mL or 0.3-5.0 SI units
Term
Thyroid storm, or thyroid crisis
Definition
Life-threatening event that occurs with uncontrolled hyperthyroidism, characterized by high fever and severe hypertension
Term
Total thyroidectomy
Definition
Removal of all of the thyroid
Term
Subtotal thyroidectomy
Definition
Removal of part of the thyroid
Term
Euthyroid
Definition
Near normal thyroid function, patient is treated with drugs to achieve this prior to surgery
Term
Drug therapy for mild to moderate hyperthyroidism
Definition
Propylthioracil
Methimazole
Lithium Carbonate
Term
Drug therapy for severe hyperthyroidism or thyrotoxicosis
Definition
Iodine and iodine-containing agents
-Lugol's solution
-Saturated solution of potassium iodide
Term
Hypocalcemia
Definition
Low serum calcium levels, that can be caused by parathyroid gland injury
Term
Tetany
Definition
Hyper excitability of nerves and muscles, that can be caused by parathyroid gland injury
Term
Hypothyroidism
Definition
Insufficient thyroid hormone secretion from the thyroid gland.
Term
Myxedema
Definition
Mucinous edema
Term
Myxedema coma
Definition
Rare serious complication of untreated hypothyroidism. Decreased metabolism causes the heart muscle to become flabby, and chamber size to increase. Extremely high mortality rate.
Term
Hypothyroidism Manifestations
Definition
Cool, pale skin
Brittle nails and hair
Hypoventilation
Dyspnea
Bradycardia
Dysrhythmias
Enlarged heart
Decreased basal metabolic rate
Muscle aches and pains
Slowing intellectual function
Depression
Anorexia
Weight gain
Anovulation
Decreased libido
Periorbital edema
Facial puffiness
Goiter
Weakness, fatigue
Term
Hypothyroidism incidence
Definition
Occurs most often in women (7-10 times more often than men) between 30-60 years of age
Term
Causes of Hypothyroidism
Definition
Decrease thyroid tissue
Decreased synthesis of thyroid hormone
Inadequate production of TSH
Term
Myxedema coma emergency care
Definition
Maintain airway
Replace fluids
Give levothyroxine
Give IV glucose
Give corticosteroids
Check temp hourly
Monitory BP hourly
Warm the patient
Monitor mental status
Turn every 2 hours
Institute aspiration precautions
Term
Thyroiditis
Definition
Inflammation of the thyroid gland. Three types; acute, subacute, and chronic.
Term
Hashimoto's disease
Definition
Chronic thyroiditis. Affects women more often them men, in the 30s to 50s
Term
Thyroid cancer
Definition
Four types; papillary, follicular, medullary, and anaplastic. Manifests as nodule on the thyroid gland.
Term
Metastasis
Definition
Spread of cancer cells
Term
Stridor
Definition
Harsh, high pitched respiratory sounds, caused by anaplastic carcinoma.
Term
Papillary carcinoma
Definition
Most common. Slow growing tumor.
Term
Follicular carcinoma
Definition
Most common in older patients. Invades blood vessels and spreads to bone and lung tissue.
Term
Medullary carcinoma
Definition
Most common in patients older than 50. Often occurs as part of multiple endocrine neoplasia type II.
Term
Anaplastic carcinoma
Definition
Rapid growing, aggressive tumor that invades nearby structures.
Term
Ablative
Definition
Enough of something to destroy tissue
Term
Hyperparathyroidism
Definition
Excessive PTH production causes excessive amounts of calcium and inadequate amounts of phosphate.
Term
Hypercalcemia
Definition
Excessive calcium levels
Term
Hypophosphatemia
Definition
Inadequate phosphate levels
Term
Osteoblastic
Definition
Bone production, decreased in hyperparathyroidism
Term
Osteoclastic
Definition
Done destruction, increased in hyperparathyroidism
Term
Renal calculi
Definition
Kidney stones, caused by high levels of PTH
Term
Hyperplasia
Definition
Tissue overgrowth, can cause hyperparathyroidism
Term
Hypoparathyroidism
Definition
Rare endocrine disorder in which parathyroid function is decreased. Caused either by a lack of PTH or decreased effectiveness of PTH on tissues.
Term
Hypocalcemia
Definition
Decreased calcium levels, caused by hypoparathyroidism
Term
Iatrogenic hypoparathyroidism
Definition
Caused by the removal of all parathyroid tissue. Most common
Term
Idiopathic hypoparathyroidism
Definition
Can occur spontaneously. Is suspected to be an autoimmune problem
Term
Hypomagnesemia
Definition
Decreased serum magnesium levels, can cause hypoparathyroidism
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