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Thyroid Gland Adam Bein page 893 3/6/2014 2:12 AM
Disorder
Types:
S/S
Risk:
The Thyroid Gland. It contains ‘Thyroid Hormone’ (which consistes of T3 and T4) which is responsible for metabolism.
Hypothyroidism. Low levels of TH result in a slowed metabolic rate.
Hyperthyroidism.
Primary: D/t congenital defects, inflammation of the Thyroid Gland, or deficiency of iodine.
Grave’s Disease: An autoimmune disorder. Younger women get this.
Secondary & Tertiary: May be caused by a Hypothalmic lesion, Pituitary lesion, or by
Thyroid stim. antibodies cause the thyroid gland to make too much Thyroid Hormone.
postpartum Pituitary Necrosis (a rare disorder in which the Pituitary Gland is destroyed
Multinodular Goiter: Older women get this.
following pregnancy & delivery).
Primary Hyperthyroidism: This is when a prob. w/I the Thyroid Gland causes excess hormone release.
Hashimoto’s Thyroiditis: An autoimmune disorder. Destroys the Thyroid tissue & l/t
Seconday Hyperthyroidism: This occurs when the Pituitary releases excess TSH & that causes over
Hypothyroidism.
stimulation of the Thyroid Gland.
Tertiary Hyperthyroidism: This occurs when the Hypothalamus secretes too much TRH.
Thyroid Nodules (Multi-nodular Goiter, Toxic Adenoma), Thyroiditis, Thyroid Tumor, too much TH to trt
Hypothyroidism, radiation exposure.
Manifestions are d/t the reduced metabolic rate: Bradycardia, decreased card. output, cool skin, Many s/s are related to the hypermetabolic state: Heat intol, > app., > wt. loss, > freq. of bowel mvmt.).
cold intol. Heart failure d/t decreased pumping strength of the heart. Fatigue, wt gain, lethargy, > in SNS: Nervousness, tremor, tachycardia, palpitations. These may be more common in young Pts.
slowed mvmt, memory loss, confusion, mental dullness, feeling cold, SOB, decreased sweating. Iincreased CO. Fatigue, restlessness, hyperactive reflexes, tremor, insomina, emotional instablity.
Dyspnea, hypoventilation, constipation. Cool dry skin, brittle dry hair. < appetite, wt. gain,
Dyspnea. Diaphoresis, warm moist skin, soft hair, > appetite, wt. loss, freq. stools, decreased serum lipid
const., >serum lipid lvls. Altered fat metabolism causes hyperlipidemia which can l/t CV
lvls. < libido, amenorrhea, erectile dysfunction, clumsiness, premature graying w/> hair loss,
disease. < libido, erectile dysf. Loss of initiative, apathy, sleepiness, puffy appearance around
cardiomegaly, exophthalmos, shaky handwriting, friable nails, liver enlargement, muscle atrophy,
the skin & eyes, slowed intellectual function.
gynecomastia in males d/t > estrogen lvls.
Increased metabolic rate. Increases the # of Beta Adrenergic receptor sites in the body, & that enhances
Myxedema: A non-pitting type of edema that occurs in connective tissues throughout the
the activity of norepinephrine, & that causes the flight or fight response symptoms. Heart failure can occur
body. It develops in advanced disease. If the metabolic rate drops so low that it becomes life
d/t tachycardia & ineff. pumping of the heart. Manic, Psychotic.
threatening the result is Myxedema Coma (usually occurs in Pts w/long-standing, untreated
Elderly Pts: Atypical s/s. Heart failure, atrial fib, fat., apathy, depression
hypothyroidism & can be trigged by stress, infection, trauma, or exposure to cold. Changes in
intellectual function (impaired memory, decreased attn span, lethargy).
Grave’s Disease S/S: Thickening skin on anterior side of legs, eye probs.: Expohthalmos (eye bulging d/t
The Pt becomes hypothermic, w/a temp. < 95’F & < RR, <mental fxn, lethargy, <blood
tissues behind eyes swelling), photophobia, blurred/double vision.
glucose, <CO l/t decreased perfusion to kids., non-pitting edema of the face, hands, & feet.
.
Death d/t resp. failure.
Trt: Intubation, mech. vent., Pt. slowly warmed w/blankets, IV Levothyroxine/Synthroid. With
therapy, cognitive fxn returns to normal.
Characteristics: Inspect the face for coarse features, edema around the eyes, blank expression.
50+ y.o. women.
Mostly diagnosed in younger women. Smoking, heredity.
Tests:
All babies born in the USA are tested for hypothyroidism at birth. If it occurs in an infant
severe probs. w/growth & dev. occur.
T3 & T4 are low.
TSH levels: Checked. If the Pit. is fxn normally, TSH is elevated.
Serum Chol. & Triglycerides are elevated.
Antibodies are usually present in autoimmune disease.
Trt:
1’: Oral thyroid replacement hormones (Levothyroxine/Synthroid). Start w/low doses and
slowly increased (to prevent Hyperthyroidism & cardiac probs.).
Serum levels are elevated T3 & T4.
TSH is low in Primary Hyperthyroidism.
TSH is high if Hyperthyroidism is d/t the Pit. Gland.
Thyroid Suppression Test: Evals Pituitary ctrl of the Thyroid gland.
Radioactive Iodine Uptake Test. Determine hyperactivity of the gland or to locate a nodule or tumor.
Thyroid Scan. Determine hyperactivity of the gland or to locate a nodule or tumor.
Thyroid Releasing Hormone (TRH) stimulation test for eval. of TSH levels.
BMR
Serum Protein Bound Iodine (PBI)
Serum Cholesterol, Total Lipids
Ultrasound (to eval. subclinical ophthalmopathy).
Grave’s Disease: Thyroid Stimulating Immunoglobulin Test (TSI).
Palpation: Don’t do it. Only Dr’s do this.
Hyperglycemia, Glycosuria.
1) To inhibit the synthesis of TH: Propylthiouracil/PTU, Methimazole/Tapazole. Must be taken for
several months to be effective & cont’d for 12-18 months.
Severe Hyperthyroidism
Thyrotoxic Crisis/Thyrotoxic Storm:
There is a release of lrg amts of TH. It is associated
w/uncontrolled hyperthyroidism.
It’s d/t a breakdown of the body’s tolerance to a chronic excess
of Thyroid hormone.
Severe tachycardia, high fever (100 degrees up to 106 degrees
F!), extreme vasodilation, hypotn, heart failure), profuse
diarrhea, flushing, sweating, dehydration, marked
agitation/restlessness/extreme irritability, delirium, coma, death
in 2 hrs if untreated. The s/s develop quickly. L/t lifethreatening cardiac, renal, or hepatic failure if not trt immed.
W/a Thryoid Storm the Pts condition can rapidly progress into
cardiovascular collaps/a coma. It is rare, it is a life threatening
event/an emergency, and it is fatal.
Highest in ppl 30- 40 y.o., ppl w/fam. hx of Thyroid disorders.
Usually seen in Pts w/Grave’s Disease (& when preciptated by a
major stressor ie: Severe physiologic stress or psychological
stress (trauma, sepsis, childbirth/toxemia of pregnancy (what is
this?), major surgery), infection, or complications following a
Thyroidectomy.
Occurs in ppl who have Hyperthyroidism who are untreated or
who develop another illness/stressor, or Pts undergoing Thyroid
Sx who’ve not been adeq. prepared w/anti-thyroid meds.,
manipulation of the Thyroid Gland during surgery, diabetic
ketoacidosis.
Too much dietary iodine intake.
Acetaminophine for the fever (no aspirin cuz aspirin binds w/the
same serum protein as T4, thus freeing up addl T4 into
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Nursing:
Activity Intolerance. Constipation. Impaired Skin Integrity. Nutrition: More than req.
Misc:
2) A Beta Blocker to relieve SNS sx: Propranolol/Inderal.
3) To suppress the rel. of TH: Iodine (orally, high doses).
4) To destroy a portion of the Thyroid Gland: Radioactive Iodine (R.A.I./I-131). Pt takes 1 dose & it
destroys some cells which make TH.
5) Surgery. 1st, antithyroid meds are given to calm the Thyroid Gland, slow the HR, reduce S/S, & make
Sx safer. Iodine is given to reduce vasc. of the Thyroid Gland to < risk of bleeding during Sx.
6) Thyroidectomy. 1) Open. 2) Min. invasive. Pt goes home same day, will prob req. Thyroid
replacement hormone (Levothyroxine/Synthroid).
7) Vision: Surgical orbital decompression can be done to trt exophthalmos.
circulation).
IV fluids. Cooling blankets.
Beta-Adrenergic blocker (Propranolol) for tachycardia &
symptom ctrl.
Oxygen, >HOB (the high metabolic state reqs more oxygen).
Maintain a hemodynamic status.
Satured Soln of Potassium Iodide (SSKI0 or I-131. These inhibit
TH.
Glucocorticoids inhibit TH release.
Meds to trt CHF.
Hyperthermia. Diarrhea. Nutrition: Less. Sleep: Disturbed. Anxiety. Injury.
Get the Pt to a euthyroid state before sugery to prevent a Post-Op Thyrotoxic Crisis.
Monitor Pts temp. & give acetaminophen & cooling blankets, low fiber diet, small bland meals (banana,
rice, applesauce), monitor Na & K (d/t diarrhea), dehydration, wkly wts, eyedrops/dark glasses, tape eyes
shut to sleep, > HOB to < edema behind eyes.
Hypothyroidism: Can occur from long term Hyperthyroidism or as a result of trt. Pts w/Hyperthyroidism
should be monitored for the onset of Hypothyroidism.
Radioactive Iodine: Given as 1 oral dose. Flush toilet 2x +. High dose: InPt. Low dose, OutPt. Avoid
close contact w/fam. members for 1 wk, no kissing, symptoms subside in 6-8 wks, eye drops, >fluids.
Have Pt expectorate/cough freq. after I-133 therapy.
Saliva is radioactive for 24 hrs.
More notes from book page 232 ‘Davis NCLEX PN Review’.
Thyroid Facts from Clinical Pharm book notes. Page 588
The Thyroid gland is located in the neck in front of the trachea.
The Thyroid Gland is highly vascular.
The Thryoid Gland secretes two hormones: T3 & T4.
Iodine is an essential element for the manufacture of both T3 & T4.
The activity of the Thyroid gland is regulated by TSH.
TSH is produced by the anterior side of the Pituitary gland.
The Anterior Pituitary gland secretes TSH when the level of circulating Thyroid hormones decrease.
Secretion of TSH causes the cells of the thyroid to activate & release stored thyroid hormones (where are they stored-ant. or post.?).
There are 2 diseases assoc. w/the hormone producing activity of the Thyroid gland: 1) Hypothyroidism, 2) Hyperthyroidism.
1) Hypothyroidism is a decrease in the amount of thyroid hormones manufactured & secreted.
2) Hyperthyroidism is an increase in the amount of thyroid hormones manufactured & secreted.
A normal thyroid state is called ‘Euthyroid’.
Info about Hypothyroidism being treated w/Thyroid Meds; Types, Indications, Med names, Effects, Dosages, Contraindications & Exceptions, Precautions/Cautions, Use during Pregnancy:
If a Pt has decreased thyroid hormone production & secretion, exogenous thyroid hormones are given.
There are 2 types of exogenous thyroid hormones: 1) Natural (it comes from animals), 2) Synthetic. The synthetic hormones are better becasu they are more uniform in potency.
Thyroid hormones are used to trt/prevent: 1) Thyroid nodules, 2) Subacture & Chronic (Lymphocytic) thyroiditis (aka ‘Hashimoto’s Disease’), 3) Enlargement of the normal thryoid gland (‘Euthyroid Goiter’), 4) Multinodular goiter, 5) Thyroid cancer.
Hypothyroidism is treated w/Levothyroxine/Synthroid.
Not all thyroid hormone replacement meds are the same/equivalent. Pts should not change brands/types w/o consulting a Dr.
Levothyroxine/Synthroid info: 1) It’s inexpensive, 2) Dosage: 1x/day., 3) Potency: More uniform potency than other TH replacement meds., 4) To trt Thyrotoxisis is used w/anti-thyroid meds., 5) Is used to dx suspected Hyperthryoidism.
Thyroid hormones influence every organ & tissue of the body (the MOA is unclear).
Thyroid hormones increase the metabolic rate of tissues. Thyroid hormones increasing the metabolic rate of tissues results in this: > RR, > HR, > CO, > O2 consumption, > body temp., > metabolism of fats, proteins, & carbs.
Hypothyroidism trt is based on individualized doses. Adverse rxns are rare, but OD s/s are on the table/chart.
Contraindications for TH meds: 1) If the Pt has an uncorrected adrenal cortical insufficiency, 2) If the Pt has Thyrotoxosis, 3) As a trt for obesity, 4) As a trt for infertilit, 5) If the Pt recently had a MI.
TH meds are used cautiously in Pts w/: 1) Cardiac Disease, 2) Lactating.
Use during pregnancy: Pregnant Pts should continue the use of Thyroid Hormones during pregnancy.
If a Pt has heart disease or had a MI & Hypothyroidism was the cause/a contributing factor, a Dr. may prescribe small doses of TH.
Info about Hyperthyroidism treatement: Anti-Thyroid Meds.
Hyperthyroidism is treated with 1) Antithyroid Meds/Thyroid Antagonists (Methimazole/Tapazole, Propylthiouracil/PTU), 2) Radioactive iodine (Iodine 131/131-Iodine), or 3) Surgery (partial/sub-total or total removal of the Thyroid gland).
Antithyroid meds inhibit the manufacture of thyroid hormones. They do not affect existing thyroid hormones that are stored in the thyroid gland or are circulating in the blood.
Since antithyroid meds do not effect existing thryoid hormones that are stored in the thyroid gland or that are circulating in the blood, the therapeutic effects will not be observed for 1 month.
The Thyroid gland has an affinity for iodine. Therefore, iodine that is radioactive is used to trt Hyperthyroidism. It does this by destroying the Thyroid cells when the radioactive iodine isotope accumulates in the cells of the Thyroid gland.
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Radioactive iodine is given orally.
Not all Pts respond adequately to antithyroid meds. This l/t surgical intervention options.
Prior to surgery, Pts receive antithyroid meds (Potassium iodide w/Methimazole or Propylthiouracil) which: 1) Temporarily return the Pt to a euthyroid state, 2) Reduce the vascularity of theThyroid gland (potassium iodide does this), 3) Cause excessive bleeding during & after surgery
to be decreased.
Adverse rxns, generalized sx reactions, severe sx reactions: 1) Hay fever, sore throat, skin rash, fever, HA, N/V, paresthesia. 2) < in the # of WBC’s (‘agranulocytosis’), exfoliative dermatitis (the Pt sheds skin like a snake. Do not use soaps. Soothing cream/lubricants are ok.),
granulocycopenia (low WBCs), hypoprothrombinemia (low prothrombin l/t impaired blood clotting).
Contraindications, Precautions, Interactions:
Methimazole or Propylthiouracil: 1) No breastfeeding when taking because they can cause hypthyroidism in the fetus. 2) Propylthiouracil does not cross the placenta so if is necessary for a pregnant Pt to take antithyroid med, propylthiouracil is the preferred med. 3) The most serious
adverse rxn to Methimazole & Propylthiouracil is Agranulocytos. Monitor/notify Dr. for: SOB, fever, sore throat, rash, HA, hay fever, yellow skin, vomiting.
Radioactive Iodine (is pregnancy cat. X) is contraindicated during pregnancy & lactation.
When antithyroid meds are taken w/oral anticoagulants the risk for bleeding increases.
Thyroidectomy precautions: Hemorrhage is one of the most severe complications. Monitor neck dressing & V/S. Deep breathing is okay, coughing is not. No pressure dressing. Monitor the dressing & loosen if necessary. To assess for post op edema, neck circumferance is monitored
Q4/hrs.
Post Thyroidectomy surgery: Hoarsness is a result of pressure or edema & should resolve in a few days. It is d/t laryngeal pressure or edema.
Post Thyroid surgery low CA s/s: Tingling around the mouth/fingertipes, muscle twitching/spasms, palpitations/dysrhythmias, + Chvostek’s/Trousseaus’s signs. Assess for this & tetany.
Preadministration
Assessment
Ongoing Assessment
Nursing Diagnosis
Implementation
Education of Pt &
Family
Hypothyroidism
V/S, weight, history of s/s, general physical assessment to determine outward s/s of Hypothyroidism.
S/s in the elderly may be confused w/ s/s of aging (depression, intolerance to cold, weight gain, confusion, unsteady
gait). Assess & eval. thse in the pre-admin assessment & thru therapy.
Diabetes: TH replacement may > the intensity of s/s of diabetes.
CV Disease: Development/worsening of chest pn.
Full effects take several wks, early effects seen in a min of 48 hrs.
Observe for s/s of Hyperthyroidism (nervousness, anxiety, > appetite, > body temp, > HR, moderate htn, warm/
flushed skin) d/t OD (especially during the initial stages of dosage adjustment).
Monitor V/S
Signs of therapeutic response: Wt loss, mild diuresis, > appetite, > HR, < puffiness of face, hands, feet. > sense of
well being & mental activity.
W/diabetic Pts: S/S hyperglycemia.
Chest pn (cardiac issues).
Risk for Ineffective Therapeutic Regimen Mgmt.
Anxiety
Imbalanced Nutrition (More than Body Requirements d/t <metabolic needs). Give Pt low calorie foods.
Thyroid hormones are adminstered 1x/day, early in the AM, before breakfast (an empty stomach > absorbtion of
Levothyroxine/Synthroid & Liothyronine/Triostat. They can also be given IV. They are prepared immed. before use.
Several upward or downward dosage adjustments may be made until the optimal dosage is met/the Pt becomes
euthyroid.
If the HR is > 100 bpm, don’t admin med. Notify Dr.
TH meds are usually given on an outpt basis.
Meds must be taken exactly as directed.
Meds therapy is for life-except in transient hypothyroidism (seen in Pts w/Thyroiditis).
Notify Dr. of S/E (HA, nervousness, palps, diarrhea, excessive sweating, heat intol., chest pn, > HR).
Adjustment of dosage occurs perodically. This is normal.
Evals q 2 wks at the beginning, 6-12 mos later.
Wkly wts.
Don’t change brands.
Hyperthyroidism
V/S, weight, outward s/s of Hyperthyroidism.
Allergy history (for allergies to iodine or seafood).
Adverse drug rxns are usually minimal. Longterm therapy is outpatient.
Relief of s/s, < RBCs (aeb: Easy bruising, easy bleeding, infection S/Sfever (cough, fever, sore throat, fatigue).
Monitor for Thyroid Storm s/s: (High fever, extreme tachycardia, altered mental status).
Monitor for s/s of infections.
Risk for Ineffective Therapeutic Regimen Mgmt.
Risk for Infection.
Risk for Impaired Skin Integrity
Pt may have diff. swallowing the med tablet d/t enlarged Thyroid gland.
Effects of PO radioactive iodides are evident in 24 hrs, maximu effects in 10 days/2 wks.
Radiation safety precautions.
Radiation may l/t Hypothyroidism-be prepared to admin a replacment Thyroid hormone med.
Since hyperthryoidism Pts are likely to have Cardiac issues (>HR, >palpitations), the Adrenergic Blocker Propranolol may be given for
several wks.
Anti-Hyperthyroid meds are given Q/8hrs around the clock.
Cohorting/contact issues: D/t agranulocytosis, Pt is at risk for infections (upper Resp.). Protect Pt from ppl w/infections.
Admin prescribed iodine med. w/milk (to prevent GI distress) & w/a straw (to prevent tooth discoloration).
Give a high calorie, high carb, high protein, high vitamin diet.
Weights 2x/wk.
Monitor HR
Don’t use nonprescription meds unless Dr. approves the med.
Post Radioactive Iodine procedure: Sore throat, cough, & tenderness may occur in 2-3 days.
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Thyroid Gland Adam Bein page 901 1/19/2014 3:31 AM
Disorder:
Goiter
Enlargement of the Thyroid Gland is called a goiter. D/t >TSH (TSH is elevated in response to <TSH, <iodine,
Etiology/types:
pregnancy, viral, genetic) response to Graves’ Diseases’ autoimmune response.
Endemic Goiter: When a goiter is d/t <iodine or other environmental factors.
Goitrogens/Goitrogenic Meds. (they interfere w/the body’s use of iodine): Turnips, cabbage, broccoli, horeseradish,
cauliflower, carrots, Propylthiouracil, Sulfonamides, Lithium, Salicylates/Aspirin.
Toxic Goiter: Goiter that occurs w/Hyperparathyroidism.
Enlargened gland/swelling @ base of the neck. Posterior swelling can interfere w/swallowing or breathing.
S/S:
Tests:
Serum TSH, T3, T4 levels, Ultrasound/Thyroid Scan.
Trt:
The gland usually returns to normal size when the cause is removed. Give iodine, remove goitrogenic food/meds.
Levothyroxine/Synthroid to reduce TSH levels via negative feedback. Radioactive Iodine therapy, Thyroidectomy,
Nursing:
Cancer of the Thyroid Gland
Rare. The most common cancer of the Endocrine Sx. Women get it more than men, not malignant.
D/t: Thyroid Hyperplasia ???, radiation exposure, iodine deficiency, prolonged exposure to
goitrogens.
Tetany
D/T: Low Ca levels. Can occur if the
Parathyroid Glands are removed during
Thyroid sx.
S/S: Hard, painless nodule, diff. breathing & swallowing, persistent cough, voice changes.
S/S: Tingling of the fingers, perioral
muscle spasms, twitching, cardiac
dysrhythmias, larynx spasms may l/t resp.
obstruction.
Normal TSH levels. A Thyroid Scan shows a cold nodule (d/t maligant tumors do not take up the
radioactive iodine) (hot nodules indicate a benign tumor). Fine needle aspiration biopsy.
Partial/Subtotal (leaves in some of the Thyroid Gland to secrete TH) or Total Thyroidectomy
(usually performed if cancer is present). Chemo, Radioactive Iodine, External Beam Radiation.
Ineffective Airway. Injury (Tetany, Thryotoxic Crisis). Pain. Pt needs to be in a euthyroid state
before the Thyroidectomy. Potassium iodide (SSKI) decreased the size & vascularity of the Thyroid
Gland l/t <risk for bleeding during sx.
Post Sx: Tachycardia, fever, & mental status changes may be s/s of a Thyrotoxic Crisis. Check
back of neck for pooling of blood. If Pt’s voice is hoarse there may be trauma to the recurrent
laryngeal nerve. Monitor serum Ca lvls for tetany. Keep a trach set bedside incase the airway gets
obstructed by edema.
IV Calcium Gluconate is given to trt acute
tetany.
Thyroid notes from Introductory Clinical Pharm. Pages 588-595.
The Thyroid Gland manufactures & secretes only 2 hormones: T3 & T4. Iodine is an essential ingredient for the manufacturing of these two hormones.
Activity of the Thyroid gland is regulated by TSH. TSH his made in the Ant. Pit. gland.
When lvls of circulating thyroid hormones decrease, the Ant. Pit. secretes TSH. TSh activates the Thyroid’s cells to release stored thyroid hormones.
Disease-wise, you can only have high or low amts of thyroid hormones.
Myexedema is severe Hypothyroidism.
S/S of Myexedma are: Lethargy, apathy, memory impairment, emotional changes, slow speech, deep coarse voice, thick dry skin, cold intolerance, slow HR, constipation, wt gain,
absence of menses.
A Thyroid Storm/Thyrotoxicosis is a severe form of Hyperthyroidism.
S/S of of a Thyroid Storm/Thyrotoxicosis are: High fever, extreme tachycardia, altered mental status.
Hypothyroidism is treated with Thyroid hormones.
Hyperthyroidism is treated with anti-thyroid meds & radioactive iodine.
Thyroid meds to trt Hypothyroidism
Two types: 1) Natural (from animals). 2) Synthetic.
The synthetic version are more uniform in potency than the natural ones.
Thyroid hormones iunfluence every organ and every tissue in the body.
Thyroid hormones: Increase the metabolic rate of tissues.
Increasing the metabolic rate of tissues does this: > HR, > RR, > Body temp, > CO, > Oxygen consumption, > the metabolism of fats, proteins, & carbs.
Thyroid hormones are used to trt these: 1) ‘Euthyroid Goiter’ (enlargement of a normal Thyroid gland). 2) Thyroid Nodules. 3) Multinodal Goiter. 4) Lymphocytic Thyroiditis
(Chronic or sub-acute)/”Hashimoto’s Disease”. 5) Thyroid cancer.
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The drug of choice to trt Hypothyroidism is:
Levothyroxine/Synthroid
Levothyroixine/Synthroid is inexpensive, given 1x/day, & has a more uniform potency than other TH replacement meds.
Levothyroxine/Synthroid may be used with ANTI-Thyroid drugs to trt Thyrotoxicosis. It falls under Preg. cat. “A”.
Thyroid hormones are also used to diagnose/differentiate:
Suspected Hyperthyroidism from Euthyroidism
All Thyroid meds are not equal. Pts should nto change brands.
Thyroid meds are contraindicated in Pts w/ this:
1) An uncorrected cortical insufficiency 2) Thyrotoxicosis. 3) A recent MI. 4) To trt obesity. 5) To trt infertility.
6) Cardiac Diseae. 7) Lactating. ???What is #1?!
It is okay for lactating women to take Thyroid supplement meds.
Several upward or downward dosage adjustments of meds may be needed. Full effects of TH replacement therapy will not be seen for several weeks.
TH is given 1x/day in the morning before breakfast on an empty stomach (to increase absorption).
Liothyronine/Triostat is also a Thyroid supplement med.
Thyroid meds to trt Hyperthyroidism
They are called Antithyroid drugs & Thyroid antagonists.
They inhibit the manufacture of TH. They do not affect existing TH that are stored in the Thyroid gland or are already in the bloodstream.
Therapeutic effects take a month.
This is how radioactive iodine works: It is given, the radioactive iodine accumulates in the Thyroid gland, the radioactive idodine destroys some Thyroid cells. It falls under Preg.
cat. “X”.
Potassium Iodide is given before sugery to reduce the vascularity of the Thyroid gland (the Thyroid gland is very vascular).
Methimazole/Tapazole & Propylthiouracil/PTU are used to manage Hyperthyroidism
S/s of severe rxns of anti-thyroid meds: A decease in the # of WBC (“Agranulocytosis). (??? Why?). 2) Exfoliative dermatitis, ganulocytopenis, hypoprothrombinemia.
Breastfeeding women should not take Antithyroid meds. Extreme caution is used in pregnant women at it can cause Hypothyroidism in the fetus.
If an anti thyroid med use is necessary during pregnancy, Propylthiouracil is given because it does not cross the placenta.
Pt’s who take oral coagulants & anti-thyroid meds are at an > risk for bleeding.
Adverse rexns of anti-thyroid meds. are r/t a < in RBCs and WBCs. Agranulocytosis is the most serious advercse rxn to Methimazole & Propylthiouracil.
Methimazole & Propylthiouracil are taken Q8hrs around the clock/at regular intervals.
Pt’s on anti-Hyperthyroid meds get their wt taken 2x/wk.
Pt’s taking antiHyperthyroid meds should avoid non-prescription meds.
Tenderness, sore throat, & cough may occur 2-3 days after the Pt was given radioactive iodine.
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Quizlet questions:
Is this a cause of Primary, Secondary, or Tertiary Hypothyroidism?:
Is this a cause of Primary, Secondary, or Tertiary Hypothyroidism?:
Is this a cause of Primary, Secondary, or Tertiary Hypothyroidism?:
Is this a cause of Primary, Secondary, or Tertiary Hypothyroidism?:
Congenital Defects: Primary
Inflammation of the Thyroid Gland: Primary
Deficiency of Iodine:
Primary
A Hypothalmic lesion:
EZ: Thyroid. 1. Intro. Hormone of the Thyroid Gland, Hypothyroidism, Hyperthyroidism, and Severe Hyperthyroidism. Thyrotoxic Crisis/Thyrotoxic Storm. Younger women/Older women, Baby testing at birth, Pituitary Necrosis/Pregnancy & Delivery, Trt of exophthalmos ‘Surgical
Orbital Decompression’, Tetany trt med: IV Calcium Gluconate, Serum CA lvls. LVN LPN NCLEX.
This is the hormone found in the Thyroid Gland:
Thyroid Hormone
These are the two subcategories of Thyroid Hormone:
T3 & T4
Thyroid Hormone is responsible for this:
T3 & T4
These are the 2 types of disorders that happen to the Thyroid Gland:
Hypothyroidism and Hyperthyroidism
These are the 2 types of Hyperthyroidism: Hyperthyroidism itself and Severe Hyperthyroidism
These are the 4 types of Hypothyroidism: Primary, Secondary, Tertiary, and Hashimoto’s Thyroiditis.
These are the 5 types of Hyperthyroidism: Primary, Secondary, Tertiary, Grave’s Disease, and Multinodular Goiter.
This is the 1 type of Severe Hyperthyroidism:
Thyrotoxic Crisis/Thyrotoxic Storm.
This is true:
One Thyroid issue effects younger women, one Thyroid issue effects older women.
This is true:
All babies born in the USA are tested for Hypothyroidism at birth.
Which gets tested at birth for all babies born in the USA-Hypothyroism or Hyperthyroidism?
Hypothyroidism.
Older women are more at risk than younger women for which-Hypothyroidism or Hyperthyroidism?
Hypothyroidism
Younger women are more at risk than older women for which-Hypothyroidism or Hyperthyroidism?
Hyperthyroidism
This is true:
There is a rare disorder (called ‘Pituitary Necrosis’) that occurs following pregnancy & delivery. The Pituitary Gland is destroyed!
This is true:
Your Pituitary gland is in your head.
These are the two types of Thyroidectomies:
1) Open. 2) Min. invasive (Pt goes home the same day & will prob req. Thyroid replacement hormone (Levothyroxine/Synthroid).
This is a type of surgery that can be used to treat ‘exophthalmos’:
‘Surgical Orbital Decompression’
This is kept at the bedside in case a Pt’s airway gets obstructed by edema:
A trach set.
This serum levels are monitored (and rationale):
Serum Calcium levels are monitored. They are monitored for tetany.
This med is given to trt acute tetany:
IV Calcium Gluconate
This is true:
Posterior swelling (at the back fo the neck) and enlargened glands can interfere w/swallowing or breathing.
EZ. Thyroid. 2. Hypothyroidism. ‘Postpartum Pituitary Necrosis’, ‘Hashimoto’s Thyroiditis’. Causes, who is at risk/who is not at risk, lab levels of TSH, Serum Chol., & Triglycerides. Nursing Considerations. LVN LPN NCLEX. Nursing.
This is an autoimmune disorder. It destroys the Thryoid tissue and l/y Hypothyroidism: ‘Hashimoto’s Thyroiditis’
This is a rare disorder in which the Pituitary Gland is destroyed following pregnancy & delivery: ‘Postpartum Pituitary Necrosis’
Is Hashimoto’s Thyroiditis a form of Hypothyroidism or Hyperthyroidism?
Hypothyroidism
Is Postpartum Pituitary Necrosis a form of Hypothyroidism or Hyperthyroidism?:
Hyporthyroidism
Are manifestions Hypothyroidism d/t an increase or reduction of metabolism? Reduction
This causes hyperlipidemia in Hypothyroidism:
Altered fat metabolism.
This type of person is at risk of Hypothyroidism:
50 y.o. women.
This type of person is not at risk of Hypothyroidism: Younger women.
These are low in Pts w/Hypothyroidism:
T3 & T4
These levels are checked in Pts w/Hypothyroidism: TSH, Serum Cholesterol, Triglycerides
These levels are high in Pts w/Hypothyroidism:
Cholesterol, Triglycerides
These are 4 Nursing considerations in Pts w/Hypothyroidism: 1) Activity Intolerance. 2) Constipation. 3) Impaired Skin Integrity. 4) Nurtirion: More than req.
Levothyroxine/Synthroid, infant w/Hypothyroidism, Myxedema Coma issues.
This is a Thyroid Hormone replacement:
Levothyroxine/Synthroid
How is Levothyroxine/Synthroid taken?
Orally
This is true:
Pt’s taking levothyroxine/Synthroid start w/low doses and slowly increase.
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This is the reason why Pt’s taking Levothyroxine/Syhthroid start w/low doses & slowly increase: It prevents Hyperthyroidism & cardiac problems.
This is what happens if an infant at birth has Hypothyroidism: Severe problems w/growth & development occur.
If a Pts metabolic rate drops so low that it becomes life threatening the result is this:
‘Myxedema Coma’
A ‘Myxedema Coma’ occurs in Pt’s w/this: Long standing, untreated Hypothyroidism.
These can trigger a ‘Myxedema Coma’:
Stress, infection, trauma, exposure to cold.
These are S/S of a ‘Myxedema Coma’:
The Pt becomes hypothermic (Temp < 95’), < RR, < mental fxn, lethargy, <blood glucose, non-pitting edema of the face, hands, feet.
Pt’s w/Myxedema Coma can die from this: Respiratory Failure.
This can occur in a ‘Myxedema Coma’:
Low Cardiac Output l/t decreased perfusion to the kidneys.
EZ. Thyroid. 3. Hypothyroidism. S/S. Myxedema Coma. Primary, Secondary, and Tertiary Hypothyroidism & Hyperthyroidism. Etiology of Hypothyroidism. LVN LPN NCLEX Nursing.
Thyroid Hormone is abbreviated tot his:
TH
Low levels of TH result in this:
A slowed metabolic rate.
A slowed metabolic rate can be due to this: Low levels of TH
The following are s/s of Hypothyroidism: Bradycardia, decreased cardiac output, cool skin, cold intolerance.
The following are s/s of Hypothyroidism: Fatigue, wt gain, lethargy, slowed mvmt, memory loss, feeling cold.
The following are s/s of Hypothyroidism: Dyspnea, hypoventilation, constipation, confusion, heart failure (d/t decreased pumping strength of the heart).
The following are s/s of Hypothyroidism: SOB, < appetite, wt gain, cool dry skin, brittle hair.
The following are s/s of Hypothyroidism: Elevated serum lipid lvls, < libido, erectile dysfunction, Myxedema.
The following are s/s of Hypothyroidism: Altered fat metabolism (causes hyperlipidemia which can l/t CV disease).
This is a non-pitting type of edema: Myxedema
Is Myxedma a pitting or non-pitting type of edema? Non-pitting.
This is where Myxedema occurs: Connective tissues throughout the body.
Does Myxedema occur in the beginning or the advanced stages of Hypothyroidism?
Advanced stages.
This is true:
There is something called a ‘Myxedma Coma’.
This is true:
Hypothyroidism can end up occuring d/t a deficiency in iodine.
This is true:
Hypothyroidism can end up occuring d/t congenital defects.
This is true:
Hypothyroidism can end up occuring d/t inflammation of the Thyroid Gland.
This is true:
The manifestations of Hypothyroidism are d/t the reduced metabolic rate.
This is true:
There is something called Primary, Seconady, and Tertiary Hypothyroidism
This is true:
There is something called Primary, Secondary, and Tertiary Hyperthyroidsim
This is true:
Primary Hypothyroidism can be d/t: 1) Congenical Defects, 2) Inflammation of the Thyroid Gland, 3) Deficiency of Iodine.
This is true:
Seconday and Tertiary Hypothyroidism may be caused by 1) Hypothalmic lesion, 2) Pituitary lesion, or 3) Postpartum Pituitary Necrosis.
This is true:
There is something called ‘Hashimoto’s Thyroiditis’. It’s a form of Hypothyroidism.
This is true:
‘Hashimoto’s Thyroiditis’ is an autoimmune disorder.
This is true:
‘Hashimoto’s Thyroiditis’ destroys the Thyroid tissue & leads to Hypothyroidism.
EZ. Thyroid. 4. Hyperthyroidism. Primary, Seconday, Tertiary, Multinodular Goiter, Grave’s Disease. Tests-Radioactive Iodine Uptake Test, Thyroid Scan, Thyroid Stimulating Immunoglobulin Test. Thyroidectomy. Meds: Names, Routes, Precautions. Thyroidectomy. LVN LPN
NCLEX Nursing.
This is Hyperthyroidism: Excessive release of Thyroid Hormone
These are types of Hyperthyroidism:
Primary, Secondary, Tertiary, Multnodular Goiter, Grave’s Disease
Older women get this type of Hyperthyroidism:
Multinodular Goiter
Excessive release of Thyroid Hormone is called this: Hyperthyroidism
Younger women get this type of Hyperthyroidism: Grave’s Disease
This is when a problem within the Thyroid Gland causes excess hormone release:
Primary Hyperthyroidism
Many s/s of Hyperthryoidism are r/t a hypo or a hyper metabolic state?:
Hypermetabolic state
Grave’s Disease cauases these s/s: Bulging eyes (‘Exopthalmos) (it’s d/t tissues behind the eyes swelling), thickening of the skin on the anterior side of the legs, blurred/double vision, photophobia.
This is a test used to check Hyperthyroidism:
A “Radioactive Iodine Uptake Test’.
The ‘Radioactive Iodine Uptake Test’ does this:
It determines hyperactivity of the gland or is used to locate a nodule or a tumor.
This is a test used to check Hyperthyroidism:
A “Thyroid Scan’.
The ‘Thyroid Scan’ Test does this: It determines the hyperactivity of the gland or to locate a nodule or a tumor.
Name two tests used to check for Hyperthyroidism: A ‘Radioactive Iodine Uptake Test’. A ‘Thyroid Scan’ test.
This test is used to check for Grave’s Disease:
‘Thyroid Stimulating Immunoglobulin Test’ (TSI).
Is TSH high or low in Primary Hyperthyroidism?
Low
This is true:
A Nurse should not palpate the Thyroid Gland. Only Dr’s palpate the Thyroid Gland.
These are meds that inhibit the synthesis of TH:
1) Propylthiouracil/PTU 2) Methimazole/Tapazole.
This is true:
The TH synthesis inhibiting meds 1) Propylthiouracil/PTU 2) Methimazole/Tapazole must be taken for several months to be effective & con’t for 12-18 mo.
This is a beta blocking med thatis used to trt SNS s/s of Hyperthryroidism:
Propranolol/Inderal
This is given orally to suppress the release of TH:
Iodine (high doses)
This is given to destroy a portion of the Thyroid Gland:
Radioactive Iodine (R.A.I.-/I-181).
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This is a surgical procedure performed on the Thyroid Gland: Thyroidectomy
These are the two types of a Thyroidectomy surgery: 1) Open 2) Min. invasive.
This med is given as one oral dose:
Radioactive Iodine
It is important for Pts who are taking oral Radioactive Iodine to do this:
Flush the toilet at least 2x or more after urinating.
EZ Hyperthyroidism 5. Primary, Secondary, Tertiary. Levothyroixine/Synthroid, Low/highTSH. LVN LPN NCLEX
Iodine does this: Reduces the vasc. of the Thyroid Gland to <the risk of bleeding during surgery.
This is given prior to surgery to reduce the risk of bleeding: Iodine
After Thyroid surgery the Pt will prob. require taking this med:
Levothyroxine/Synthroid (a Thyroid replacement hormone).
These are s/s of Hyperthyroidism: (Fight/Flight responses) Heat intolerance, hyperthermia, warm moist skin, dehydration, diaphoresis.
These are s/s of Hyperthyroidism: (Fight/Flight responses) Tachycardia, palpitations, increased CO, restlessness, hyperactive reflexes, tremors, nervousness.
Serum levels of T3 and T4 are elevated in this:
Hyperthyroidism
If TSH is high in Hyperthyroidism it is because of this gland: The Pituitary Gland
Are TSH levels high or low in Hyperthryoidism d/t the Pituitary gland? High
Are TSH levels high or low in Primary Hyperthyroidism?
Low
Prior to Thyroid surgery, this is given to calm the Thyroid gland:
Anti-Thyroid meds.
This occurs when a prob. w/i the Thyroid Gland causes excessive hormone rel.: Primary Hyperthyroidism
This occurs when the Pituitary rel. excess TSH & that causes over stimulation of the Thyroid Gland:
Secondary Hyperthyroidism
This occurs when the Hyptothalamus secretes too much TRH:
Tertiarty Hyperthyroidism
The are all causes of Tertiary Hyperthyroidism:
Thyroid Nodules (Multi-nodular Goiter, Toxic Adenoma), Thyroiditis, Thyroid Tumor, too much TH to trt Hypothyroidism, radiation exposure.
EZ. Thyroid. 6. Severe Hyperthyroidism: Thyrotoxic Crisis/Thyrotoxic Storm Signs & symptoms. Acetaminophine/Aspirin precautions, Interventions.
These are forms of Severe Hyperthryroidism:
A Thyrotoxic Crisis/Thyrotoxic Storm
There is a release of large amounts of Thyroid Hormone during this conditions: Thyrotoxic Crisis/Thyrotoxic Storm
Manipultation of the Thyroid Gland during surgery can cause this:
Thyrotoxic Crisis/Thyrotoxic Storm
A Thyrotoxic Crisis/Thyrotoxic Storm can result from this:
Manipulation of the Thyroid Gland during surgery.
This can occur in ppl who have Hyperthyroidism:
Thyrotoxic Crisis/Thyrotoxic Storm
This can occur in ppl who have Hyperthyroidism who are untreated:
Thyrotoxic Crisis/Thyrotoxic Storm
This can occur in ppl who have Hyperthyroidism who develop another illness/stressor: Thyrotoxic Crisis/Thyrotoxic Storm
This can occur in ppl who are undergoing Thyroid surgery who’ve not been adeq. prepared w/anti-Thyroid meds: Thyrotoxic Crisis/Thyrotoxic Storm
These are s/s of a Thyrotoxic Crisis/Thyrotoxic Storm:
Tachycardia, high fever, htn l/t heart failure & hypotension, dehydration, restlessness, delirium.
These are s/s of a Thyrotoxic Crisis/Thyrotoxic Storm:
Coma, death (in 2 hrs if not treated).
This is why you don’t give Thyroid Pts aspirin:
Acetaminophine for the fever (no aspirin cuz aspirin binds w/the same serum protein as T4, thus freeing up addl T4 into circulation).
It it okay or not okay to give Thyroid Pts asprin/Acetaminophen?
Not okay.
This med is given to Pts exp. a Thyrotoxic Crisis/Thyrotoxic Storm to trt tachycardia & symptom ctrl:
Propranolol/A Beta-Adrenergic blocker.
This are inteventions used in Pts exp. a Thyrotoxic Crisis/Thyrotoxic Storm:
Pt is given oxygen, > HOB (the high metabolic state reqs more oxygen).
EZ. Thyroid 7. Goiter. Types (Endemic, Toxic), Goitrogens (Aspirin, Lithium, Turnips, Broccoli), Tests (TSH, T3, T4, Ultrasound Thyroid Scan), returns to normal, Meds (Iodine, Levothyroxine/Synthroid), Radioactive Iodine Therapy. LVN LPN NCLEX
The enlargement of the Thyroid gland is called this: Goiter
This is the definition of Goiter:
Enlargement of the Thyroid gland.
There are how many different types of Goiter?
Two. 1) Endemic Goiter. 2) Toxic Goiter.
This type of Goiter is d/t < iodine lvls or other environmental factors: Endemic Goiter
This type of Goiter is d/t Hyperparathyroidism:
Toxic Goiter
Meds which interefere with the body’s use of iodine are called this:
Goitrogenic Meds
Foods which interfere with the body’s use of iodine are called this:
Goitrogens
Which causes ‘Toxic Goiter’: Hyperthyroidism, Hypothyroidism, Hyperparathyroidism, Hypoparathyroism, the Pituitary Gland?:
Hyperparathyroidism
These are s/s of Goiter: Enlargened gland/swelling @ the base of the neck.
This can happen d/t Goiter:
Posterior swelling can interfere w/swallowing or breathing.
These are tests done for Goiter:
Serums TSH, T3, & T4 levels, Ultrasound/Thyroid Scan
This is what happens when the cause of Goiter is removed:
The gland usually returns to normal size.
These trts are given to Pts w/Goiter:
Iodine, Levothyroxine/Synthroid, removal of goitrogenic foods/meds, Radioactive Iodine Therapy, Thyroidectomy.
These are examples of Goitrogenic Meds: Salicylates/Aspirin, Propylthiouracil, Sulfonamides, Lithium.
These are examples of Goitrogenic foods: Turnips, cabbage, broccoli, horseradish, cauliflower, carrots.
TSH is elevated in response to this:
< TSH, < iodine, pregnancy, viral, gentic, response to Grave’s Disease immune response.
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EZ. Thyroid Gland. 8 Cancer of the Thyroid Gland. Women, malignant, causes, s/s, test, types of Thyroidectomy & rationale, post-surgery. LVN LPN NCLEX.
Is cancer of the Thyroid gland common or rare?:
Rare
This is the most common cause of cancer in the Endocrine system:
Thyroid Cancer
Who gets Thyroid Cancer more often-men or women?:
Women
Is Thyroid Cancer benign or malignant?
Malignant
These are causes of Thyroid Cancer:
Thyroid Hyperplasia, radiation exposure, iodine deficiency, prolonged exposure to goitrogens.
The following are s/s of cancer of the Thyroid gland:
A hard, painless nodule, diff. breathing & swallowing, persistent cough, voice changes.
The following are tests done to test for Thyroid Cancer:
A Thyroid Scan, Fine Needle Aspiration Biopsy.
This is what a Thyroid Scan test does:
It shows a cold nodule (d/t maligant tumors do not take up the radioactive iodine) (hot nodules indicate a benign tumor).
These are the types of Thyroidectomy:
1) Partial/Subtotal Thyroidectomy, 2) Total Thyroidectomy
These are interventions to trt Thyroid Cancer:
Partial/Subtotal Thyroidectomy, Total Thyroidectomy, Chemo, Radioactive Iodine, External Beam Radiation
This is the reason behind performing a Partial/Subtotal Thyroidectomy: It leaves in some of the Thyroid gland to secrete TH
This is when a Total Thyroidectomy is performed: If cancer is present.
This can occur post-surgery (for Thyroid Cancer):
Thyrotoxic Crisis
The nurse should check this post Thyroid Cancer surgery:
The back of the neck (for pooling of blood), serum CA levels (for tetany), Ineffective Airway.
The nurse should monitor this post Thyroid Cancer surgery: Tachycardia, fever, mental status changes (all may be s/s of a Thyrotoxic Crisis).
This is a post Thyroid cancer surgery problem:
The Pt may be hoarse d/t trauma of the recurrent laryngeal nerve.
EZ. Thyroid Gland 9. Tetany. Periorial muscle spasms, tingling of the fingertips, twitching, resp. obstruction, IV CA Gluconate.
This occurs d/t low Ca lvls:
Tetany
This can occur if the Parathyroid Glands are removed during Thyroid surgery: Tetany
These are s/s of tetany:
Tingling of the fingers, perioral muscle spasms, twitching, cardiac dysrhythmias, larynx spasms.
Larynx spasms (in tetany) may l/t this:
Respiratory obstruction
This med is given to trt acute Tetany:
IV Calcium Gluconate
Thyroid Cancer
Thyroid cancer does not effect Thyroid Hormone secretion.
Causes: Chronic overstimulation of the Pit. . , Chronic overstimulating of the Thymus gland, radiation of the neck.
> CA, > serotonin, > prostaglandin lvls
RAIU test shows cold/non-functioning nodules.
Meds: 1) Antiemetics. Prochlorperazine/Compazine, Ondansetron/Zofran 2) Chemo. Chlorambucil/Leukeran, n Doxorubicin/Adriamycin, Vincristine/Oncov 3) Thyroid hormone replacement (Levothyroxine/Synthroid, Liothyronine/Cytomel, Thyroglobulin/Proloid.
Thyroiditis
Thyroiditis is inflammation of the thyroid gland.
Forms:
1) Autoimmune Thyroiditis (a long term inflammatory disease). Aka: “Hashimoto’s Thyroiditis”.
2) Subacute Granulomatous Thyroiditis (a self limiting inflammation).
3) Riedel’s Thyroiditis (a rare & invasive fibrotic process. Causes compression of the esophagus. Trt w/a Partial Thyroidectomy).
4) Misc. Thyroiditis
1) Acute Supperative
2) Chronic Infective
3) Chronic Non-Infective
Cause: 1) Antibodies to thyroid antignes (what’s a thyroid antigen?), 2) Bacterial invasion, 3) Mumps, influenza, coxsakievirus, adenovirus infection.
In Hyperthyroidism, iodine is taken up in increased amounts/higher amounts than normal so that more hyroid Hormones can be synthesized.
In Hypothyroidis, iodine is taken up in decreased amounts/lesser amounts because few Thyroid hormoens are being synthesized.
The s/s of Hyperthyroidism are all seen in adrenergic/Sympathetic stimulation.
The s/s of Hypothyroidism are the same as one would see w/benzodiazepine OD, manifestiosn of hypovolemic shock, & Addison’s Disease.
Levothyroixine enhances the effect of Warfarin/Coumaidn. Therefore, if a Pt was on Warfarin/Coumadin and came down w/Hypothyroidism, the Warfarin/Coumadin dosage would be decreased.
If a post Thyroid Gland surgery Pt has numbness, tingling, muscle twitching, & spasms, it is because the Parathryoid Gland is hyposecreting PTH/ Since Parathyroid Gland Hormone (Parathyroid Hormone) regulates Calcium (and thus?) and Phosphorous Metabolism (only-no other
minerals or anything), the Pt may have to be given Ca.
If tetany occurs post Thyroid surgery, 10% Ca Gluconate IM is given.
Hashimoto’s Thyroiditis is a type of Thyroiditis/Swelling.
Hyperthryroidism can occur d/t:
Autoimmune disease, Infection, Pituitary tumors, Thyroid adenma.
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Hyperthyroidism s/s:
Bruit/Thrill over the Thyroid. Diaphoresis, Atrial Fib./Tachycardia/Palps.