Chapter 43
Assessment and Management of
Patients With Endocrine
Disorders
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Major Hormone-Secreting Glands of the
Endocrine System (Fig. 43-1)
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Thyroid Gland
 Thyroid hormones: T3 and T4; also produces calcitonin
 Iodine is contained in the thyroid hormone
 TSH from the anterior pituitary controls the release of the
thyroid hormone
 TRH from the hypothalamus controls the release of TSH
 Thyroid hormone controls cellular metabolic activity
 T3 is more potent and more rapid-acting than T4
 Calcitonin is secreted in response to high plasma calcium
level and increases calcium deposition in bone
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Thyroid Gland (contd.) (Fig. 43-3)
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Hypothalamic—Pituitary--Thyroid Axis
(Fig. 52-4)
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Function of Thyroid Hormone
Control cellular metabolic activity
Important in brain development and necessary for
normal growth
Affects virtually every major organ system and
tissue function
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Thyroid Diagnostic Tests
Thyroid-stimulating hormone (TSH)
Serum-free T4
T3 and T4
T3 resin uptake
Thyroid antibodies
Radioactive iodine uptake
Fine-needle aspiration biopsy
Thyroid scan, radio scan, or
scintiscan
Serum thyroglobulin
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Thyroid Disorders
Cretinism
Hypothyroidism
Hyperthyroidism
Thyroiditis
Goitre
Thyroid cancer
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Hypothyroidism #1
Causes: autoimmune thyroiditis and Hashimoto’s
disease (most common cause) (see Chart 43-3)
Affects women five to eight times more frequently
than men
Manifestations
o Early symptoms may be nonspecific
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Hypothyroidism #2
Manifestations (contd.)
o Fatigue; hair, skin and nail changes; numbness
and tingling of fingers; menstrual disturbances;
subnormal temperature and pulse; weight gain;
subdued emotional and mental responses; slow
speech; tongue, hands, and feet may enlarge;
personality and cognitive changes; and cardiac
and respiratory complications
o Myxedema may progress to stupor, coma, and
death
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Medical Management of Hypothyroidism
Synthetic levothyroxine replacement therapy
Medication interactions
o Effects of hypnotic and sedative agents: reduce
dosage
Support of cardiac function and respiratory function
Prevention of complications
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Hyperthyroidism
The second most prevalent endocrine disorder
Excessive output of thyroid hormone
Graves’ disease (most common cause)
Affects women 8 more frequently than men
Manifestations of thyrotoxicosis: nervousness;
palpitations; rapid pulse; poor heat toleration;
tremors; skin is flushed, salmon colour, warm, soft,
and moist (however, elders’ skin may be dry and
pruritic); exophthalmos; increased appetite and
dietary intake; weight loss; elevated systolic BP;
may progress to cardiac dysrhythmias and heart
failure
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Medical Management of Hyperthyroidism
Radioactive 131I therapy – see Chart 43-6
THYROID STORM
Medications: see Table 43-3
o Propylthiouracil and methimazole
o Sodium and potassium iodine solutions
o Beta-adrenergic blockers
Surgery: subtotal thyroidectomy
Relapse of disorder is common
Disease or treatment may result in
hypothyroidism
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Hyperthyroidism---Nursing Diagnoses
Imbalanced nutrition
Ineffective coping
Low self-esteem
Altered body temperature
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Additional Thyroid Disorders
Thyroiditis
o Acute
o Subacute
o Chronic (Hashimoto’s disease)
Thyroid tumours
o Endemic (iodine-deficient) goitre
o Nodular goitre
o Thyroid cancer
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Thyroidectomy
Treatment of choice for thyroid cancer
Cancer surgery may include modified or radical neck
dissection, and may include treatment with
radioactive iodine to minimize metastasis
Preoperative goals include the reduction of stress
and anxiety to avoid precipitation of thyroid storm
Preoperative teaching includes dietary guidance to
meet patient metabolic needs and to avoid
caffeinated beverages and other stimulants,
explanation of tests and procedures, and
demonstration of proper postoperative head support
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