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 Body systems affected by the thyroid gland
 Hypersecretion effects vs. hyposecretion effects
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Thyrotoxicosis
 Graves’ disease: goiter, exophthalmos, pretibial
myxedema
 Assessment
 History
 Physical assessment
 Clinical manifestations
 Psychosocial assessment
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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T3, T4, T3RU, TSH, TSH-RAb
Thyroid scan
Ultrasonography
ECG
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Monitoring
Reducing stimulation
Promoting comfort
Drug therapy (antithyroid drugs, iodine preparations,
lithium, beta-adrenergic blocking drugs)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Total or subtotal thyroidectomy
 Postoperative complications:
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Hemorrhage
Respiratory distress
Hypocalcemia and tetany
Laryngeal nerve damage
Thyroid storm or thyroid crisis
Eye and vision problems of Graves’ disease
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Hoarseness or stridor
Suture line pressure
Hypocalcemia and tetany
Thyroid storm
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Causes
Differentiating: aging vs. hypothyroidism
Decreased metabolism from low thyroid hormone levels
Myxedema
Myxedema coma
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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History
Physical assessment
Clinical manifestations
Psychosocial assessment
Laboratory assessment
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Inflammation of thyroid gland
 Three types—acute; subacute (granulomatous); chronic
(Hashimoto’s disease—most common type)
 Thyroiditis vs. hyperthyroidism, hypothyroidism
 Nonsurgical management, drug therapy
 Surgical management
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Four types:
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Papillary
Follicular
Medullary
Anaplastic
 Collaborative management
 Surgery
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 Parathyroid glands—calcium and phosphate balance
 Hypercalcemia and hypophosphatemia
 Nonsurgical vs. surgical management
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Decreased function of parathyroid gland
Iatrogenic
Idiopathic
Hypomagnesemia
Interventions—correcting hypocalcemia, vitamin D
deficiency, hypomagnesemia
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
A 45-year-old woman who is seeing her health care
provider states that she is tired all the time and has muscle
aches and pains. Assessment reveals a heart rate of 56/min
and a BP of 96/58. She has non-pitting edema of her face,
especially around her eyes, and in her hands and feet. Her
health history includes radioactive iodine (RAI) for
hyperthyroidism.
What diagnosis does the nurse expect for this patient?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
The provider orders laboratory work that includes thyroid
function tests.
Which results does the nurse expect to see?
A. Increased T3 and T4 levels
B. Decreased TSH level
C. Decreased T3 and T4 levels
D. Normal T3 and T4 levels
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Which statement by the patient indicates the need for
additional teaching about her condition?
“When I go home I should check my heart rate and BP
every day.”
B. “I will call my provider if I notice any change in level of
consciousness.”
C. “I will be sure to include fiber in my diet and drink
plenty of water.”
D. “When I am feeling better in a few months I will no
longer need to take the Synthroid pills.”
A.
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The patient is preparing to go home.
What important teaching points should the nurse include? (Select all
that apply.)
A.
B.
C.
D.
E.
“Report any difficulty with orientation to time, place, or person.”
“Note how many hours you sleep in a 24-hr period.”
“Be sure that you take your medication every day at the same
time.”
“Your diet should be low-fiber, but with plenty of fluids.”
“Call the provider if you develop an unsteady gait or tremors in
your hands.”
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
21
What parameter should be critically evaluated when
providing care to a patient with Graves’ disease?
A.
B.
C.
D.
Irregular heart rate and rhythm
Elevated blood pressure
Elevated temperature
Change in respiratory rate
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What is a priority intervention for an older female patient
with a history of hyperparathyroidism?
A.
B.
C.
D.
Encourage small frequent meals.
Implement fall precautions.
Provide pain medications as prescribed.
Encourage oral fluid hydration.
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A postoperative plan of care for a patient after a total
thyroidectomy should include which intervention?
A.
B.
C.
D.
Avoiding extending the patient’s neck
Administering oxygen via nasal cannula as needed
Assessing the patient’s voice once per shift
Encouraging the patient to be out of bed in a chair
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