Endocrine Handout 5
Thyroid & Parathyroid Glands
I.
Reading Assignment: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing,
A. Chapter 42, Pages 1448 - 1473
II.
Student Learning Outcomes
A. The student will be able to describe etiology, pathophysiology, clinical manifestations,
nursing management and patient education for the following
1.Graves’s disease
2.Throiditis
3.Hashimoto’s thyroiditis
4.Hypothyroidism
5.Thyroid neoplasm
6.Hyperparathyroidism
7.Hypoarathyroidism
8.Thyrotoxic crises
9.Myxedema
B. The student will be able to discuss medical terms commonly used in the endocrine system
C. The student will be able to review and identify anatomy and physiology of the endocrine
system
D. The student will be able to identify components of a complete endocrine physical
assessment
E. The student will be able to discuss nursing management and patient education in the pre
and post operative care of patients undergoing the following surgeries
1.Thyroidectomy
F. The student will be able to identify the clinical significance and related nursing
responsibilities of the following test and procedures used for diagnostic assessment of the
patient with an endocrine disorder
1.Thyroid scan
2.Thyroid ultrasonography
3.Thyroid biopsy
4.Thyroxine serum (T4)
5.Triodothyronine serum (T3)
6.Thyroid – stimulating hormone assay (TSH)
7.Radioactive iodine uptake
8.Parathyroid function test
III.
Thyroid
A. Description
1._________________ shaped
2.Two _______________ connected by an ____________________
3.Straddles the ____________________
4.__________________ endocrine gland
B. Function
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1.Produce _________________ __________________ (TH)
a. Vital for ___________________ & _______________________
2._________________ storage
a. Essential for T3/T4 _______________________
C. Hormones
Hormone
Function
Thyroixine (T4) &

_______Metabolic rate
Triiodothyronine (T3)

_______Protein synthesis
Stimulated by…


Calcitonin

___Blood___________ concentration

Decreases the reabsorption of
__________ & ____________ from
___________ to ________

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D. Hormone Loop
1.____________ metabolic rate 
2.Detection by the _______________________ 
3.Stimulates the _______________________________ 
4.Secretes _____________________ 
5.Blood stream  target organ  Thyroid 
6.Stimulates the thyroid to _________________________________ 
7.Blood stream  target organ  Adrenal medulla
8.Secretes ____________________ & ______________________ 
9.____________ metabolic rate
II.
Thyroid disorders
A. World-wide
1._________________ deficiency
B. United States
1. _____________________ disease
III.
Hyperthyroidism
A. Definition
1.
B. Pathophysiology
1.Primary hyperthyroidism
a. Problem with the __________________  ___________________
2.Secondary
a. Problem with the _______________________  _______________
b. Pituitary  _______________  ____________________
c. __________________  __________________  _______________
C. Etiology
1.Auto-immune
2.AKA:
a.
3.Female _________ Male
4.Age
D. Signs and Symptoms
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Neurological
Affect
Cardiovascular
Gastrointestinal
Muscle/skeletal
Skin
1.Exophthalmos
a.
b. Characteristic ______________________
2.Goiter
a.
b. D/T ____________________
3.Oncholysis
a.
b.
4.Gynecomastia
a. Abnormal enlargement of the ____________________
b. Female / Male
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5.Elderly
a. ____________ failure
b.
_________________
c. Apathy
d. _________________
E. Hormone Review
1. T3/T4 
2._____________ 
3._____________ 
4._____________ 
5. T3/T4
6. T3/T4 
7._____________ 
8._____________ 
9._____________ 
 T3/T4
10.
F. Diagnostic tests
1.By definition hyperthyroidism means _________________
2.By definition primary hyperthyroidism means what?
________________________
3.In primary hyperthyroidism, is the pituitary gland working correctly?
4.If the pituitary gland is working correctly and there is an  T3/T4 level, what will
the pituitary gland do with the TSH level?
5.By definition secondary hyperthyroidism means what?
a.
Primary Hyperthyroidism
Secondary Hyperthyroidism
T3 & T4
TSH
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G. Medical Treatment
1.Meds first
a. Goal __________________
2.Antithyroid therapy
a. Propylthoiracil (PTU)
b. Methimazole (Tapazole)
a. Action
3.Propranolol hydrochloride (Inderal)
a. Classification
b. Action
c. Warning
4.Meds alone sometimes work if not 
a.
b. Ca of Thryoid 
a.
5.Euthyroid State ______________ surgery
a.
6.Iodine before surgery
a. Potassium Iodide Saturated Solution (SSKI)
b. ______________________________ of the thyroid
c. ________ risk of post –op _________________________
7.Radioactive Iodine
a.
b. Used instead of ______________________ treatment
c. Stop anti-thyroid meds _________________________
d. ___________ dose
e. S&S decrease in about ___________________________ but full affect is
not known until _____________________________
f. Safety
a. No __________________________
b. Watch __________________________________
c. Avoid __________________ for 7 days
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H. Diet
1.Calories
a.
2.Fluids
a.
3.Na+
a.
4.Fiber
a.
5.Caffeine
a.
I. Nursing Management hyperthyroidism
1.Assessment
a.
_____________________
b. _______________ sounds
c. Anxiety level
d. ________________
e. Bowel function
f. _____________ palpate the goiter
2.Nursing Diagnosis
a. Risk of _______________________
a.
b. ___________ thermia
c. Diarrhea
d. Alt __________________
e. Sleep pattern disturbance
f. Anxiety
3.Exophthalmos
a. ___________________ eyes
b. _____________ closed
c. ______________ glasses
d. _______________ diet
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e. HOB _______________
J. Thyrotoxicosis: AKA ___________________________________
1.Definition
a. _________________ __________thyroid state
2.Etiology/Pathophysiology
a. Stress
b. Post ________________ surgery
c.
3.Signs & symptoms
a. ____TH  ____ adrenergic activity  __ epinephrine
b. Pulse _________
c. Temperature
d. BP
e. Depression
f. Activity
g. Delirium
h. SOB
i. Coma
j. Death
a.
b. 2nd __________________________
4.Treatment
a. Fever
a. Tylenol/Acetaminophen
b. Not: __________________
b. For pulse / BP
a. Propranolol / Inderal
b.
c. If SOB
a. ______________
b. HOB ___________
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IV.
Hypothyroidism
A. Definition
B. Pathophysiology
1.Primary hypothyroidism
2.Secondary hypothyroidism
C. Etiology
1.Primary
a. _____________________
b. ______________ deficiency
c. _______________________
d. Thyroidectomy
2.Secondary
a. ______________________ or ________________ changes
D. Signs and Symptoms
1.THINK _____________________
Neurological
Affect
Cardiovascular
Gastrointestinal
Muscle/skeletal
Skin
E. Cretinism
1._________________ in the US
2.___________________ condition d/t ________________  physical and mental
_____________________
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F. Hashimoto’s thyroiditis
1.Most common cause of ________________ hypothyroidism
2._______________________ disease
3.Female _________ Male
4.Age:
G. Diagnostic Tests
1.By definition hypothyroidism means? _______________
2.By definition primary hypothyroidism means what?
3.In primary hypothyroidism is the pituitary working correctly?
4.If the pituitary gland is working correctly & there is a T3/T4, what will the
Pituitary gland do with the TSH level?
5.By definitions secondary hypothyroidism means what?
a.
Secondary Hypothyroidism
Primary Hypothyroidism
T3/T4
TSH
H. Medical Treatment
1.Pharmacology
a. Thyroid (Armout Thyroid)
a.
b. Levothyroxine sodium (Levothroid, Synthroid)
a.
c. Time of dose _______________________
d. Monitor _______________________ system
e. Gradually __________ meds
a. Take ______________ to know full affect of dose
f. _____________blood level monitoring
g.
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2. Diet
a. Fiber
b. Protein
c. Calories
d. Avoid foods high in _________________
a.
b.
c.
d.
e.
f.
g.
I. Nursing Management
1.Rest
2.Skin
3.Diet
V.
Severe Hypothyroid State
A. Myxedema
1.Definition
a. _____________hypothyroidism
2.Etiology
a. Iodine
b. Atrophy
c. Surgery
d. Destruction of thyroid by ________________
3.Characteristics
a. Growing ________________ and _________________of skin
b. Dry, waxy ________________ (non-pitting)
c. Abnormal deposits of ______________in the skin
d. Distinctive ________________ changes
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B. Myxedema Coma
1._________________rate drops so low  _______________ threatening
a. Temperature
b. Respirations
c. Blood pressure
d. Glucose level
e. Mental functioning
f. Death 2nd _________________________________
VI.
Goiters
A. Definition
1.
B. Pathophysiology
1.What hormone causes the thyroid to grow?
2.What hormonal change causes goiter?
3._______________level  goiters
C. Etiology
1.Low __________
2.Deficiency of __________________
3.Pregnancy
D. Endemic Goiter
1.Caused by _______________________ factors
a. i.e.
E. Are goiters associated with Hyperthyroidism, Hypothyroidism or Euthyroid state?
F. Goitrogens
1.__________________ thyroid function
a.
b.
c.
d.
e.
f.
g.
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G. S&S of a goiter
1.___________________ thyroid
H. Complications
1.May interfere with
a.
b.
I. Nursing Management of Goiters
1.Diet
a.
Limit _________________________
2.Assess
a.
b.
3.Palpate?
Quick Quiz: Thyroid Disorders
Label each of the following symptoms as associated with hyper or hypo thyroidism:
1. _________ Bradycardia
2. _________ Lethargy
3. _________ Restlessness
4. _________ Frequent stools
5. _________ Hypercholesterolemia
6. _________ Dry hair
7. _________ Tremor
8. _________Insomnia
9. _________ Mental dullness, confusion
10. _________Weight loss
11. _________ Decreased appetite
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VII.
Cancer of the Thyroid
A. Etiology
1.
2.Female _________ Male
3.Thyroid _____________________
4.Radiation
5._________________ deficiency
B. Signs & symptoms
1.1st sign:
a.
b.
c.
2.Difficulty ____________________________
3.Difficulty ____________________________
4.Changes in ___________________________
5.Lab values ___________________________
C. Diagnostic tests
1.______________________________ = Shows a “cold” nodule
a. Area that did not __________________________________
b. Indicates _______________
2.Biopsy
D. Medical treatment
1.Thyroidectomy
a. __________________________ or
b. ___________________________
VIII. Thyroidectomy
A. Pre-op
1.________________ state
2.Verify ________________________
B. Post-op
1.Vital signs
a. Drop in BP + Tachycardia = _______________________
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b.  pulse +  Fever +  BP = ________________________
2.Check for hemorrhage
a.
3.Check for S&S of ________________ or _______________
4.Check _______________________
5.Position:
6.Activity level:
7.Monitor for _______________
a.
8._______________________ at the bed side
9.Diet changes (if due to hyperthyroidism)
C. Complications
1.Thyrotoxic Crisis
a. D/T manipulation of __________________ during surgery 
______________________________
2.Tetany
a. Continuous __________________ spasm of a muscle
b. Caused by ___________________________________
c. Characterized by
a. Finger and perioral area
b. ________________ spasms
c. _____________________
d. Etiology
a. D/T ______________________________________
e. Treatment
a. IV _______________________________
b. Breath into a paper bag  ___________________  ____________________
in the blood
IX. Parathyroid
A. Description
1.________ parathyroid glands
2.Behind _________________________
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B. Function of the Parathyroid
1.Secrete ___________
C. Hormone
Hormone
PTH
Function

Stimulated by…
Increase reabsorption of __________ &
______________ from the bone to the
blood

_____ absorption by small ___________

________ absorption by ___________

Increases _____________________

Antagonist to _________________

It is the most important regulator of
______________________
D. Why do we need Calcium
1._________
2.____________
3.Blood __________________
4.Transmission of __________________ impulses
5.Muscle ____________________ & ______________________
6.Normal ___________________
X.
Hyperparathyroidism
A. Pathophysiology
1.__________ parathyroid activity 
2.___________ PTH 
3.____________ blood Ca. levels 
4.____________________
5.
B. Etiology
1.Hyperplasia or benign tumor
2.
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C. Signs and symptoms
1.D/t ____________in serum __________________ levels
2.
3.
4.
5.
6.N/V  ____________________
7.____________________ AKA __________________________
8.Cardiac _________________  ________________________
9.Peptic ______________
10.
Pathological ______________________
a. _____________ pain
b. _____________ pain / tenderness
11.
Coma
D. Diagnostic tests
1.Lab
2.X-ray
E. Medical management
1.Goal =
2._________ fluids
3.Lasix
a.
4.Pamidronate (Aredia)
a. Calcitonin
b.
F. Surgical Management
1.If severe  ____________
2.
3.Post-op
a. Bone pain ________________________
b. Renal damage _____________________
XI.
Hypoparathyroid
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A. Pathophysiology
1.A decrease in PTH 
2.__________________ blood reabsorption of ____________ from the
_____________ 
3._______________ Ca level
4.AKA: ______________________
B. Etiology
1.Heredity
2._______________________
C. Signs & Symptoms
1.Neuromusclar ___________________
2.Acute ___________________
a.
_________________ of fingers
b. __________________ spasms
c. ________________________
d. + __________________________ sign
a. Tap ___________ nerve 
b. ______________________
e. + __________________________ sign
a. Occlusion of ____________ artery x 3 min 
b. ______________ spasm
3.Chronic S&S
a. ___________________
b. Muscle Spasms
c. _____________________ in the eyes or brain
d. _____________________________
e. Laryngospasms
a. Obstruction of the ____________________
D. Diagnostic Tests
1.Chvostek’s sign
2.Trousseau’s sign
3.Labs
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a.
b.
E. Medial-surgical management
1.IV calcium gluconate
2.Breathing into a paper bag  ______________  ____________
3.Diet
a.
b.
4.Vitamin
5.___________________ diuretics
F. Nursing management
1.Monitory closely for S&S of ___________________
2.Monitor for ____________________
Case Study: Sally is a 43-year-old office worker admitted to the hospital with a high
fever. While collecting data for her history and find that she has recently lost her job
Case
because of inability to handle job stress. She has also had recent weight loss, fatigue,
insomnia, palpitations, and heat intolerance. After an endocrine workup, her physician
diagnoses Grave’s disease. A subtotal Thyroidectomy is scheduled for 2 months later,
and she is started on Propylthiouracil and Propranolol (Inderal).
1. Why is Sally having palpitations? (Which other hormones might be involved?)
2. Why does Sally have a fever?
3. Why is surgery delayed for 2 months?
4. How will the Propranolol help?
5. Why was the Propylthioracil ordered?
6. What is the advantage of a subtotal over a total Thyroidectomy?
7. What will you teach Sally before the surgery?
8. Why should a tracheostomy set be at the bedside after surgery?
9. Sally develops tingling in her fingers and toes after surgery. What do you
suspect? What is the cause?
10. How will Sally’s dietary needs change after surgery?
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Questions:
1. Where are the parathyroid glands located?
2. How many parathyroid glands do most people have?
3. What hormone(s) does the parathyroid gland secrete?
4. The Parathyroid hormones regulate the blood levels of what two elements?
5. What three diagnostic tests can be performed to test parathyroid function?
6. Name 3 medications that decrease serum Calcium levels
7. What are normal serum calcium levels?
8. How can hyperparathyroidism be treated surgically?
9. What medications are used to treat hypercalcemia?
10. Hyperparathyroidism leads to _______ serum calcium levels
11. Describe Chvosteks and Trousseau’s sign and what they indicate
12. Name 5 foods high in calcium
13. Define primary and secondary hyperthyroidism
14. Be able to complete the following
PTH
S&S
Hyper
Parathyroidism
Dx
Tx
Rx
Severe
Nursing
Labs
Hypo
Parathyroidism
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