alterations in.....

 metabolic function

heat production

electrolyte balance

hyperthyroidism--increased secretion of T3 and T4

hypothyroidism--decreased secretion of thyroid hormones

graves disease

toxic nodular goiter

exogenous iodine excess

pituitary tumors and thyroid cancers

an autoimmune disorder where antibodies attach to TSH receptor sites in the thyroid tissue

**results in thyroid gland enlargement and over production of thyroid hormones---AKA toxic diffuse goiter and most common cause of hyperthyroidism

diaphoresis

smooth fragile skin

thin scalp hair

SOB

rapid shallow respirations

tachycardia

increased systolic BP

dysrhythmias

palpitaitons

 s/s of hyperthyroidism

GI--

musculoskeletal--

--weight loss

increased appetite

increased stools

--muscle weakness

muscle wasting

blurred or double vision

photophobia

hyperactive reflexes

tremors

insomnia

restlessness

irritability

emotional lability

manic behavior

amenorrhea

increased libido

goiter

increased metabolic rate

heat intolerance

low grade fever

fatigue

decreased WBCs

exophthalmos--wide eyed startled appearance

drug therapy

thioamides--thiourea derivatives

beta blockers

radioactive iodine therapy (RAI)

more common in women

highest frequency in people b/w 20-40 yrs. old

autoimmune disorder

antibodies attach to TSH

results in thyroid gland enlargement

aka: toxic diffuse goiter

skin-diaphoresis, smooth fragile skin, thin scalp hair

respiratory-sob, rapid shallow respirations

cardiac-tachycardia, increased sys. bp, dysrythmias, palpitations

GI-weight loss, increased appetite, increased stools

musculoskeletal-muscle weakness, muscle wasting

neurologic-blurred or double vision, photophobia, hyperactive reflexes, tremors, insomnia

personality changes-restlessness, irritability, manic behavior

reproductive-amenorrhea, increased libido

S&S of hyperthyroidism cont...

GOITER

Increased metabolic rate

Heat intolerance

Low grade fever

Fatigue

Decreased WBC's

EXOPHATHALMOS-wide eyed, startled appearance

Non-Surgical management of Hyperthyroidism

Drug Therapy

Thioamides(thiourea derivatives): drug of choice

Beta Adrenergic Blockers (adjunctive therapy)

Radioactive Iodine therapy (RAI)

Surgical Management of Hyperthyroidism

Thyroidectomy- for people that do NOT respond to drug therapy or those who have a LARGE goiter.

Post op: MUST observe for LARYNGEAL STRIDOR, hemorrhage, hypocalcemia, tetany

Monitoring: VS, BP, pulse, temp, lab tests (T3, T4, TSH)

Assess: s&s of hemorrhage, check behind neck for bleeding

Dressing: check tightness due to swelling

Cardiac: monitor ECG, SOB, or chest pain

Environment: reduce stress, noisy environment

Nutrition: high calorie, high protein, frequent meals, consult dietitian for guidance.

Self medication administration

Follow up w/ HCP

Avoid stress

Wear medical ID bracelet at all times

Thyroid Crisis: Thyroid storm, Thyrotoxic crisis

Acute, life threatning, rare

Occurs w/ uncontrolled hyperthyroidism & graves disease

Cause usually due to stressors in pt's w/ pre-existing hyperthyroidism.

Stressors can be: trauma, infection, DKA, pregnancy, SX, vigorous palpitation of goiter, exposure to iodine, radioactive iodine therapy, and complications following thyroid sx.

Excessive thyroid hormones

dramatically increased metabolic rate

Fever

Tachycardia

Systolic HTN

GI problems-n/v, abdominal pain, diarrhea

Psyc/Soc. disturbances-anxious, restless, confused, psychotic

Progressive deterioration-tremors, seizures, coma, death

Identify & treat cause

Keep airway patent

Continuous EGC, CVP monitoring

Control BP & heart rate

Give anti-thyroid med as prescribed

Give glucocorticoids as prescribed

Administer sodium iodine as prescribed

Monitor vitals

Correct dehydration-NS IV

Reduce fever-cooling blanket, ice packs, anti pyretics

Result of decreased metabolism due to:

insufficient levels of circulating thyroid hormone

Two kinds:

PRIMARY hypothyroidism-thyroid can't produce amount of hormones pituitary calls for

and

SECONDARY hypothyroidism-thyroid is not being stimulated by pituitary to produce hormones

Affects more women than men

Increases w/ age

Most b/w age of 30-60 yrs. old

Association b/w development of hypothyroidism & DM

Endemic iodine deficiency-usually in places where soil & water have little natural iodince

Decreased amount of functional thyroid tissue-SX, RAI therapy, HASHIMOTO'S disease.

Certain meds: Lithium (inteferes w/ thyroid function)

Most common cause of hypothyroid disorder

Autoimmune disorder where anti-thyroid antibodies attach thyroid tissue

Metabolic-decreased rate, decreased temp, cold intolerance, extreme fatigue

Neurologic-impaired memory, masklike expression, slurred speech, diffuculty concentrating, decreased tendon reflexes.

Cardiac-bradycardia, dysrythmias, hypotension

Respiratory-dyspnea, SOB

GI-anorexia, weight gain, constipation

Skin-dry pale scaly yellowish skin, hair loss, brittle nails

Personality changes-depression, withdrawal, apathy, paranoia

S&S of hypothyroidism cont...

weakness

muscle aching

periorbital edema

nonpitting edema of extremeties

facial puffiness

hoarse husky voice

ecchymosis

poor wound healing

goiter

nutritional deficiencies

Drug therapy: Thyroid hormone

Levothyroxine sodium (T4, Levoxyl, Levothyroid, Synthroid)

Monitor VS

Monitor cardiac function

Monitor changes in weight

Monitor edema

Monitor serum T3, T4, and TSH

Thyroid meds: give 1 hour before meals or 2 hours after meals for best absorption

KNOW THAT THYROID REPLACEMENT DRUGS INCREASE METABOLIC RATE AND DECREASE EFFECT OF INSULIN AND ORAL ANTI-DIABETIC MEDS.

Nutrition therapy: maintain low calorie diet, decrease weight gain, adequate fiber intake to reduce constipation

Self medication administration

MOST IMPORTANT need for pt. is EDUCATION on hormone replacement therapy:

routine follow-up w/ HCP

Is a life long condition

Healthy diet

Myxedema Coma:

life threatening medical emergency

caused by untreated severe prolonged hypothyroidism

precipitated by-stresses-trauma, infection, sx, ingestion of CNS depressants, excessive exposure to cold, failure to take thyroid meds.

Myxedema face-thickened sub-q tissues, expressionless, mask-like.

Cardiovascular collapse-hypotension, shock, organ damage, death

Hypoventilation-decreased resp. rate

Hypothermia-decreased temp.

Severe metabolic disorders-hypoglycemia, hyponatremia, lactic acidosis

Progressively decreased cognitive function-lethargy, increased confusion, stupor, unconscious, coma

Collaborative management of Myxedema coma (complication of hypothyroidism)

Mxyedema coma requires intensive, aggressive therapy; w/out this mortality is high

Management focuses on:

maintaining airway

stabilizing cardiovascular functioning

correcting acid-base imbalance

correcting thyroid hormone deficiency

addressing precepitating factors

 ER care of Myxedema coma

maintain patent airway

replace fluids-IV NS or hypotonic

levothyroxine sodium as ordered

IV glucose as ordered

monitor temp & BP hourly

keep pt. warm

aspiration precautions