Disorders
of the
Thyroid and Parathyroid Glands
Lisa Halcomb, DNP, MSN, RN
Thyroid Gland
• Major function is the
production, storage,
and release of thyroid
hormones
• Thyroxine (T4)
• Triiodothyronine (T3)
• Thyrocalcitonin (CT)
Hypothyroidism
• One of the most
common medical
disorders
• Destruction of thyroid
tissue
• Disease of the anterior
pituitary
• After stopping thyroid
hormones
• Cretinism
Hypothyroidism
Clinical Manifestations
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Fatigue, lethargy
Slowed speech
Cold intolerant
Hair loss
Dry, course skin, hair
Constipation
Weight gain
Menstrual disturbances
Cardiac disorders
Anemia
Myxedema
Hypothyroidism
Diagnostic Assessment
• Free Thyroxine levels
(FT4) are low
• TSH may be high or low
• These lab values, when
combined with the
history and physical
assessment provide the
diagnosis.
Hypothyroidism
Management
• Managed on an out patient
bases, unless becomes acute
• Restore a euthyroid state
with thyroid replacement:
levothyroxine Sodium
(Synthroid)
– Caution with CAD
– Start on smaller doses for
these pts.
– Instruct to report chest
pain ASAP
Hypothyroidism
Management
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Nutrition
Decreased calories
Written
Life long therapy
S/S of hyper and
hypothyroidism
Periodic levels checked
Assess for constipation
Avoid sedatives, narcotics
Anticoagulants, digitalis
Hypothyroidism
Myxedema Coma
• Untreated
hypothyroidism
leads to coma
• Patients who are
compromised
• Hypotension
• Bradycardia
• Hypothermia
• Hyponatremia
• Hypoglycemia
• Respiratory failure
Hyperthyroidism
• Sustained, increased
production of thyroid
hormone
• Second most common
endocrine disorder
• Can be temporary or
permanent.
• Hypermetabolism and
increased sympathetic
nervous system activity
Hyperthyroidism
Grave’s Disease
• A multisystem autoimmune disease of
unknown etiology
• Thyroid enlargement
(goiter)
• Increased production of
thyroid hormones
• Usually ophthalmopathy
(exophthalmos)
Hyperthyroidism
Clinical Manifestations
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increased HR, RR, and BP
intolerance to heat
hyperglycemia
palpitations
increased appetite
weight loss
diarrhea
warm, moist skin
thin nails and hair loss
fatigue
nervousness and tremors
rapid speech menstrual
irregularities
• exophthalmos
Hyperthyroidism
Exopthalmus
• Bulging of eyeball
• Impaired venous return
• Corneal ulcerations, loss
of vision
• Dark glasses if light
sensitive
• Elevate HOB
Hyperthyroidism
Diagnostic Assessment
• TSH is the single
best screening tool
• TSH will be low
• T3 and T4 will be
high
• A thyroid scan
Hyperthyroidism
Management
• Pharmacological measures
• PTU and Tapazole inhibit
the synthesis of thyroid
hormones
• Iodine – SSKI and Lugol’s
solution
– Only for short-term use
– s/s of Iodine toxicity
• Beta-blockers – for
symptomatic relief of
thyrotoxicosis
• Thyroid ablation
Hyperthyroidism
Thyroidectomy
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Subtotal thyroidectomy
Endoscopic
Watch for hypothyroidism
Monitor for hypocalcemia!
Explain about monitoring
for airway following surgery
Hyperthyroidism
Thyroidectomy Pre-op Care
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Alleviate symptoms
Give Iodine
Client education
Room preparation
– O2
– Suction
– Tracheostomy tray
• Tetany
– IV calcium available
Hyperthyroidism
Thyroidectomy Post-op Care
• Assessment
– Hemorrhage
– Tracheal compression
• Semi-fowlers, avoid movement of
neck and tension on suture line
• Monitor V/S freq.
• Assess for tetany
– tingling of toes, fingers, around
mouth, muscle twitching, or
apprehension, and hoarseness
– Trousseau’s sign
– Chvostek’s sign
• Pain medication
Hyperthyroidism
Thyroidectomy Discharge Care
• Thyroid levels must be
monitored biweekly x 1
month
• Avoid synthetic thyroid
replacement
• Reduce calorie intake to
reduce weight gain
• Adequate Iodine, but not
excessive
• Exercise to help stimulate
thyroid gland regeneration
• Avoidance of heat
Hyperthyroidism
Nutritional Considerations
• High calories
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4000 – 5000 cal/day
Six meals a day
High protein snacks
Increase carbohydrates for energy
• Avoid
– Highly seasoned
– High fiber
– Caffeine
Hyperthyroidism
Thyroid Storm
• Precipitated by a
stressor
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Infection
Trauma
Surgery
Too much Synthroid
• Clinical manifestations
– Fever
– Tachycardia
– HTN
Hyperthyroidism
Thyroid Storm
• Thyroid Storm
– PTU and Tapozole
– K+ Iodide (SSKI) and
Dexamethasone
– Beta-blockers
• Specifically:
– Hyperthermia
– Cardiovascular
– Fluid and electrolytes
– Neurological
Parathyroid Glands
• Four small glands on the
thyroid
• Parathyroid hormone (PTH)
• Bone
– Ca+
– Phosphorous
• Kidney
– Vitamin D
– Ca+ and phosphorous
• GI
– Vitamin D
– Ca+ absorption
Hypoparathyroidism
• Decreased PTH
• Clinical
manifestations are
due to low Ca+
levels
• Tingling
• Muscle tension
• Muscle spasms
• Laryngeal spasms
• Anxiety
Hypoparathyroidism
Nursing Interventions
• Manage acute
conditions
• IV calcium
• Rebreathing CO2 in a
bag
• Home Care:
– Ca+ supplements
– Vit. D
– High Ca+ food
– Monitor Ca+ levels
– Teach s/s
Hyperparathyroidism
• Increased secretion of
PTH
• These high levels of PTH
result in hypercalcemia
and hypophosphatemia
• Problems with bone
density
• Kidneys can’t handle the
excess Ca+
• Excess Ca+ also is
deposited in soft tissue
Hyperparathyroidism
Clinical Manifestations
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May be overt symptoms or asymptomatic
If Ca > 12, may see mental status changes
May lead to coma and death
Diagnostic assessment
Increased PTH
Increased Ca (usually > 10 mg/dl)
Decreased Phosphorous (usually < 3
mg/dl)
• Treatment is based on the severity of
manifestations
Hyperparathyroidism
Non-Surgical Management
• Conservative
management
• Medications
• Phosphates can also be
used to decrease Ca
levels
• Monitor calcium levels
• Encourage ambulation
Hyperparathyroidism
Parathyroidectomy
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Criteria
Usually per scope
Auto-transplantation
Ca+ supplements
Post-op care is similar
to thyroidectomy
• Tetany, may need IV
calcium gluconate
Hypopituitarism
• Hyposecretion of the pituitary hormones. A
deficiency of only one is “selective
hypopituitarism”. A total destruction is
“panhypopituitarism”
• The most common cause is a tumor
• Other causes include trauma, or accidental
destruction in surgery
• Lab results will determined by which
hormones are affected
• Surgery or radiation to tumor
• Hormone replacement therapy