Term
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Definition
| An imbalance of metabolism caused by overproduction of thyroid hormones |
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Term
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Definition
| the term for the manifestations of hyperthyroidism |
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Term
| What does hyperthyroidism affect and what does it increase? |
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Definition
Hypermetabolism affecting protein, lipid and carbohydrate metabolism;
Increased sympathetic nerve stimulation |
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Term
| Causes of Hyperthyroidism |
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Definition
Graves' disease-Toxic diffuse goiter (85% is due to this);
Thyroid Adenoma-Non-cancerous growths of the thyroid gland;
Toxic multinodular goiter;
Tumors elsewhere such as testes or ovaries;
Thyroiditis-Inflammation due to viral infections or radiation;
Factitious hyperthyroidism-Ingestion of excessive amounts of thyroid hormone;
Ingestion of excessive iodine |
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Term
| Features of Hyperthyroidism |
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Definition
Heat intolerance;
Diaphoresis;
Thinning hair;
Pretibial myxedema;
SOA–rapid shallow breathing;
Muscle weakness and wasting;
Goiter-thyroid enlargement;
Exopthalmos;
Lid lag;
Photophobia;
Irritability and restlessness;
Emotional lability |
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Term
| MORE features of hyperthyroidism |
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Definition
Hypertension;
Chest pain;
Palpitations*;
Dysrhythmias;
Weight loss*;
Muscle wasting;
Fatigue;
Amenorrhea |
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Term
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Definition
Triiodothyronine (T₃) increased;
Thyroxine (T₄) increased;
T₃ resin uptake (T₃RU) increased;
Thyroid-stimulating hormone (TSH)**(this will be low in Grave's disease, but high in secondary or tertiary hyperthyroidism);
TSH antibodies (TSH-Rab) for Graves disease |
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Term
| Diagnostic Testing for hyperthyroidism |
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Definition
Thyroid scan: radioactive iodine is given by mouth or IV (RAI[¹²³]) and the uptake by the thyroid is monitored.;
Ultrasound;
EKG;
CT or MRI |
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Term
| Fine Needle Aspiration Biopsy for Hyperthyroidism |
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Definition
A fine needle (25 or 27 gauge) inserted 4 to 7 times to obtain cells for examination.;
Outpatient procedure lasts about 20 min. and uses local anesthetic; can't swallow and must hold breath during this; fasting not required |
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Term
| Fine Needle Biopsy: What to watch for and pt teaching |
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Definition
| Swelling, bleeding, excessive bruising or trouble breathing |
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Term
| What kind of treatment options are there for hyperthyroidism? |
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Definition
| Anti thyroid agents, Iodine preparations,surgical management, thyroidectomy |
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Term
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Definition
Propylthiouracil (PTU);
Methimazole (Tapazole);
Carbimazole;
Ltihium-rarely used due to side effects |
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Term
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Definition
Strong iodine (Lugol’s) solution;
Saturated solution of potassium iodide (SSK);
Potassium iodide tablets, solution or syrup |
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Term
| what can a goiter do if it's really large? |
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Definition
| restrict breathing and eating |
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Term
| Surgical Management of hyperthyroidism |
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Definition
Surgery usually lasts 2 to 4 hours;
Work to avoid the superficial laryngeal nerve;
Closure with steri-strips, skin glue or sutures or combo;
do not hyperextend your neck post-op but do encourage some movement to loosen the muscles |
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Term
| Thyroidectomy: Post-op Care |
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Definition
Sore throat/ difficulty swallowing;
Stiff neck;
Check blood levels for PTH and calcium;
Educate on s/s of low calcium;
Bleeding;
Respiratory distress;
Hoarseness;
Peri-incisional numbness;
monitor Ca2+ levels |
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Term
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Definition
Life threatening: 20-25% mortality even with treatment
Signs: fever, systolic hypertension, and tachycardia, GI distress, anxiety, tremors, confusion, psychosis, seizures and coma; 90% mortality rate if left untreated; usually caused by Grave's disease |
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Term
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Definition
Trauma/post surgical;
Uncontrolled diabetes/ketoacidosis;
Pregnancy (during labor);
Severe drug reaction;
MI;
Acute infections;
Radioactive iodine therapy/iodine load;
Vigorous palpation of a goiter |
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Term
| Infiltrative Ophthalmopathy |
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Definition
Elevate the head of the bed.;
Use artificial tears.;
Tape eyes shut at night.;
Dark glasses for photophobia;
Surgery |
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Term
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Definition
| Absent or insufficient production of thyroid hormone resulting in decreased metabolism. |
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Term
| hyperthyroidism causes... |
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Definition
| decreased energy; cellular edema forms (non-pitting); everything is thick, gooey and clogged |
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Term
| If hypothyroidism is left untreated in children, what happens? |
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Definition
| cretinism: mental retardation |
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Term
| Risk Factors for Thyroid Failure |
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Definition
| Family history of thyroid disease; Personal history of thyroid disease; Presence of antithyroid antibodies; Radiation treatment to head, neck or chest**; Other autoimmune disease; Medications: lithium, amiodarone (Cordarone), iodine; Old age |
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Term
| Why won't you treat hypothyroidism aggressively in the elderly? |
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Definition
| it will lead to heart problems |
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Term
| Causes of Thyroid Failure |
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Definition
Chronic autoimmune thyroiditis (Hashimoto’s thyroiditis);
Treated Graves' disease;
Radioactive iodine therapy; Subtotal thyroidectomy; Antithyroid drugs; Head and neck surgery; Radiation therapy to the head, neck or chest area; Iodine deficiency Medications: lithium, iodine, amiodarone (Cordarone); Secondary hypothyroidism (hypopituitarism); Idiopathic; Congenital |
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Term
| Signs and Symptoms of hypothyroidism |
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Definition
Weakness, lethargy, fatigue;
Dry skin/ Coarse hair/brittle nails;
Thick tongue/hoarse voice;
Cold intolerance;
Constipation/ Weight gain;
Mental impairment;
Muscle cramps/slow muscle movements;
Depression/blank expression; Bradycardia/dysrythymias/cardiomyopathy; Everything is thick, swollen and slow |
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Term
| what is the most common reason for seeking medical attention for hypothyroidism? |
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Definition
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Term
| more signs and symptoms of hypothyroidism |
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Definition
Edema of eyelids, face, legs (nonpitting; Hearing loss; Menorrhagia; Slowing of return phase of reflexes (e.g., knee jerk);
Goiter |
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Term
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Definition
Life threatening emergency and a
Complication of long standing or poorly treated hypothyroidism |
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Term
| What can trigger a myxedema coma? |
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Definition
| illness, surgery, trauma, anesthesia, hypothermia, CNS depressants, rapid thyroid medication withdrawal. |
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Term
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Definition
Coma;
Respiratory failure;
Hypotension;
Hypothermia**Temp can be as low as 75 degrees!!;
Hyponatremia;
Hypoglycemia;
Shock, organ failure and death; |
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Term
| what is the first thing you do in myxedema coma? |
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Definition
| do ABCs first--airway, breathing, circulation; then treat the problem |
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Term
| Hypothyroidism: Treatment |
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Definition
Lifelong thyroid replacement-start low and slowly build up dose.;
Final dose determined by Pt. response and TSH levels;
Treat with either synthetic or desiccated animal source thyroid;
Patient education* |
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Term
| what are some very important things to remember with hypothyroidism? |
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Definition
| Don’t give IM or SQ injections to someone with untreated hypothyroidism; Make sure don’t take too much; take same brand, same dose, same time; take medication 1-2 hours before all other meds and meals*** b/c a lot of meds can interfere with absorption |
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Term
| what is the important patient education information? |
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Definition
| treatment will be lifelong; take the same brand at the same dose at about the same time of day; take one hour before meals or two hours after other medications; teach them the signs and symptoms of hyper and hypothyroidism and when to call the dr. |
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Term
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Definition
| Inflammation of the thyroid gland; cycles of hypo and hyper and it's hard to treat and diagnose |
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Term
| Three main types of thyroiditis |
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Definition
Chronic: Hashimoto’s or autoimmune thyroiditis is most common
Sub-acute: granulomatous or painful thyroiditis after a viral infection
Acute: rarest-due to bacterial infection |
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Term
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Definition
| Autoimmune destruction of the thyroid leading to scarring and hypothyroidism. |
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Term
| What does Hashimoto's Thyroiditis cause? |
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Definition
| Causes enlargement of one or both lobes of the thyroid. |
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Term
| How is Hashimoto's Thyroiditis diagnosed? |
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Definition
| Diagnosed by testing TSH, thyroid hormone and anti-thyroid antibodies. |
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Term
| How is Hashimoto's Thyroiditis treated? |
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Definition
May require fine needle biopsy.
Treated with thyroid hormone replacement. |
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Term
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Definition
Most common cause of a painful thyroid.*; Noted for referred pain to the throat or jaw.;
Accompanied by fever, chills and painful swallowing. |
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Term
| what does subacute thyroiditis usually follow? |
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Definition
| Usually follows a viral infection. |
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Term
| Does subacute thyroiditis occur more in women or in men? |
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Definition
| occurs more in women than in men |
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Term
| What is the only treatment for subacute thyroiditis? |
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Definition
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Term
| what is the only treatment for subacute thyroiditis? |
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Definition
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Term
| Thyroid Cancer is usually identified as what? |
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Definition
| a single, painless lump or nodule |
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Term
| Is the nodule in thyroid cancer fixed? |
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Definition
| Yes--Nodule fixed to the location and does not move with swallowing. |
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Term
| what occurs if the nodule in thyroid cancer is large? |
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Definition
| hoarseness or pain on swallowing |
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Term
| How is thyroid cancer diagnosed? |
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Definition
Blood test;
Thyroid scan;
CT or MRI |
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Term
| how is thyroid cancer treated? |
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Definition
| Surgery followed by radioactive iodine is the treatment of choice; 95% cure rate |
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Term
| What are some considerations with radioactive iodine therapy? |
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Definition
| never use in a nursing or pregnant woman; private room is required; radiation precautions: label room, limit time in room and flush twice; avoid close contact with pregnant women, children and pets for 5-11 days (at least 10 feet away) |
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Term
| what does the parathyroid hormone do? |
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Definition
| acts on the kidney to increase reabsorption of calcium and increase phosphate excretion |
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Term
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Definition
| increased Ca2+ reabsorption and increased phosphate excretion |
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Term
| Causes of Hyperparathyroidism |
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Definition
96% due to Benign adenoma of the gland;
Parathyroid carcinoma;
Congenital hyperplasia;
Neck trauma or radiation;
Vitamin D deficiency;
Chronic renal failure with hypocalcemia;
Parathyroid hormone secreting tumors of other organ |
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Term
| What are the signs and symptoms of hyperparathyroidism? |
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Definition
“Moans, groans, stones and bone”***
Gastrointestinal: peptic ulcers, N/V, pancreatitis, constipation, anorexia;
Renal-kidney: kidney stones;
Skeletal: bone pain, osteoporosis, spontaneous fracture, weakness;
Mental: depression, anxiety, sleep disturbances, psychosis, coma |
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Term
| how is hyperparathyroidism diagnosed? |
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Definition
Lab results: High levels of PTH along with hypercalcemia and low phosphate;
Bone density studies;
CT or Nuclear Medicine Scans |
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Term
| what are the treatment options for hyperparathyroidism? |
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Definition
Surgical removal of affected gland.;
Drug therapy to lower serum calcium levels, including fluid and diuretics, phosphates, calcitonin and calcium chelators. |
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Term
| what are some things to watch for post-op parathyroidectomy? |
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Definition
Respiratory distress from compression of the trachea by hemorrhage or swelling;
Hypocalcemic crisis due to atrophy of remaining glands-monitor calcium every 4 hours-Trousseau’s and Chvostek’s signs;
Watch for hoarseness and voice changes |
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Term
| What is Hypoparathyroidism? |
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Definition
Too little parathyroid hormone production;
Extremely rare, usually due to surgical removal of the glands.; it can occur spontaneously in which case it's d/t an autoimmune disease |
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Term
| what does hypoparathyroidism cause? |
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Definition
| Hypomagnesiemia--too little magnesium can cause heart arrythmias |
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Term
| symptoms of Hypoparathyroidism are... |
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Definition
| related to hypocalcemia: tingling, muscle cramps, tetany and convulsions |
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Term
| what are some diagnostic tests for hypoparathyroidism? |
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Definition
| EEG, CT, and blood levels of calcium, Mg, phosphate and Vitamin D; |
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Term
| what are the treatment options for hypoparathyroidism? |
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Definition
Vitamin D and calcium supplements;
Magnesium supplement if needed;
Supplementation is life long;
Wear a med alert bracelet |
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Term
| what is the goal for calcium supplementation and hypoparathyroidism? |
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Definition
| is to keep the patient in the low normal range. High calcium can lead to kidney stones |
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