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.
History and PE
2.
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