Thyroid part 2
Hypothyroidism
Hypothyroidism
Definition
• i TH
Pathophysiology
• Primary hypothyroidism
– Thyroid fails to produce
enough TH
• Secondary Hypothyroidism
– i stimulation  Thyroid
(pituitary or hypothalmus)
Hypothyroidism
Etiology
• Primary
–
–
–
–
Congenital
I deficiency
Auto-immune
Thyroidectomy
• Secondary
– Pituitary /
hypothalamus
Hypothyroidism
S&S
• Think ______
– Slow
Hypothyroidism
S&S
Neurology
• Slow mentation
• Slurred speech
Affect
• Lethargy
• depression
Hypothyroidism
S&S
Cardiovascular
• Bradycardia
Gastro-intestinal
• Constipation
• Weight gain
• Appetite loss
Hypothyroidism
S&S
Muscular-skeletal
• Clumsy slow
movements
• Fatigue
• Cold intolerance
• Dull facial expression
Hypothyroidism
S&S
Skin
• Dry, pale
• Hair dry
• Thick lips
• Puffy eyes
Hypothyroidism
Cretinism
• 18yr old
• Rare in the US
• Congenital condition d/t
i TH  physical &
mental retardation
Hypothyroidism
Hashimoto’s thyroiditis
• Most common adult
hypothyroidism
• Auto-immune
• Female > male
• Age:
– 30-50
Hypothyroidism
Diagnostic Tests
• By definition hypothyroidism means what?
– T3/T4
–i
Primary
Hypothyroidism
T3/T4
TSH
i
Secondary
Hypothyroidism
Hypothyroidism
Diagnostic Tests
• By definition primary hypothyroidism means what?
(where is the problem – what is causing the
problem?)
– Thyroid 
• i T3/T4
• In primary hypothyroidism, is the pituitary gland
working correctly?
– Yes
Hypothyroidism
Diagnostic Tests
• If the pituitary gland is working correctly and
there is an i T3/T4 level, what will the
Pituitary gland do with the TSH level?
Primary
Hypothyroidism
T3/T4
i
TSH
h
Secondary
Hypothyroidism
Hypothyroidism
Diagnostic Tests
• By definition hypothyroidism means what?
– T3/T4
–i
Primary
Hypothyroidism
Secondary
Hypothyroidism
T3/T4
i
i
TSH
h
Hypothyroidism
Diagnostic Tests
• By definition secondary hypothyroidism means
what? (where is the problem – what is causing the
problem?)
– Pituitary gland
• i TSH 
• i T3/T4
Hypothyroidism
Diagnostic Tests
By definition secondary hyporthyroidism means
what? (where is the problem – what is causing
the problem?)
– Pituitary gland i TSH  i T3/T4
Primary
Hypothyroidism
Secondary
Hypothyroidism
T3/T4
i
i
TSH
h
i
Hypothyroidism
Medical Treatment
Rx / life time
• Thyroid (Armour thyroid)
– Natural form
• Levothyroxine sodium /
Levothroid, Synthroid
– Synthetic
• Time of dose
– AM
• Monitor __________system
– C/V
• Gradually h meds
– takes 2 wks to know full affect
• Blood level monitoring
– Annually
• Know S&S and report
Hypothyroidism
Medical Treatment
Diet
• Fiber
–h
• Protein
–h
• Fluids
–h
• Calories
–i
• Avoid food h in I (interferes
with meds)
• Avoid food h in I
–
–
–
–
–
–
–
Kelp
Shellfish
Iodized salt
Cabbage
Turnips
Pears
Peaches
Hypothyroidism
Nursing management
• Rest
– Space
• Skin
– Protect
• Diet
– Adjust
Severe Hypothyroid State
Myxedema
• Definition
– Advanced
hypothyroidism
• Etiology
–
–
–
–
Iodine deficiency
Atrophy of thyroid
Surgery
Destruction of thyroid
by I 131
Hypothyroidism Severe
Myxedema
Characteristics
• Growing puffiness &
sogginess of the skin
• Dry, waxy edema (nonpitting)
• Abnormal deposits of
mucin in the skin
• Distinctive facial
changes
Hypothyroidism Severe
Myxedema Coma
• Met. Rate drops so low 
life threatened
• Temperature
– < 95 F
• Blood pressure
– i
• Glucose
– i
• Mental function
– i
Hypothyroidism Severe
Myxedema Coma
• Death d/t…
–Respiratory
Failure
Goiters
Definition
• Enlarged thyroid
Pathophysiology
Review!
• What hormone causes the thyroid to grow?
– TSH
• What hormonal change causes goiters?
– h TSH
Goiters
Definition
• Enlarged thyroid
Pathophysiology
• h TSH levels  goiters
Etiology
• i TH levels
• i Iodine
• PG
Goiters
• Endemic goiter
– Caused by
environmental factors
• i iodine
Goiters
•
Are goiters assoc.
with
a. Hyperthyroidism
a. YES!
b. Hypothyroidism
a. YES!
c. Euthyroid state
a. YES!
•
All of the above
Goiters
Goitrogens
• Suppress thyroid
function
–
–
–
–
–
–
–
Broccoli
Cauliflower
Cabbage
Turnips
Sulfonamide
Lithium
Salicylates
Goiters
S&S
• Enlarged thyroid
Complications
• May interfere with
– Respiration
– Swallowing
Goiters
Nursing Management
• Diet
– Limit goitrogens
• Assess
– Breathing
• Stridor
– Swallowing
• Palpate????
– NO!
Cancer of the Thyroid gland
Etiology
• Rare
• F>M
• Thyroid hyperplasia
• Radiation
• Iodine deficiency
Cancer of the Thyroid gland
• #1 S&S
– Nodule on thyroid
– Hard
– Painless
Cancer of the Thyroid gland
S&S
• Difficulty swallowing
or breathing
• Changes in voice
• Lab values
– Normal TH levels
Cancer of the Thyroid gland
Diagnostic Tests
• Thyroid scan
– Shows “cold” spot
• Area that did not take
up radioactive
material
• Indicates malignancy
• Biopsy
– Confirms diagnosis
Cancer of the Thyroid gland
Medical Management
• Thyroidectomy
– Partial
– Total
• Chemotherapy
Cancer of the Thyroid gland
Nursing Managementthyroidectomy
• Pre-op
– Euthyroid state
– Verify meds taken
Cancer of the Thyroid gland
Nursing Managementthyroidectomy
• Post-op
– Vital Signs
– i BP & h Pulse =
• Shock d/t hemorrhaging
– h Pulse h fever h BP =
• Thyrotoxic crisis
Cancer of the Thyroid gland
Nursing Managementthyroidectomy
• Post-op
– Check hemohaggin
• back of neck for pooling
blood
– Check for S&S of dyspnea or
resp distress
– Check speech
– Semi-fowlers position
Cancer of the Thyroid gland
Nursing Managementthyroidectomy
• Post-op
– Activity
• Support neck
– Monitor for Tetany
• Continuous tonic spasm
– Tracheostomy set at bed side
• Resp. obstruction
– Diet Changes (esp. if
hyperthyroidism)
Tetany
Tetanus
Thyroidectomy
Complications
• Thyrotoxic crisis
– D/t manipulation of
thyroid during
surgery 
– release large amount
of TH
Thyroidectomy
Complications
Tetany
• D/T low Ca levels
• Characterized by
– Fingers & perioral area
tingling
– Muscle spasm
– Twitching
– Cardiac Dysrhythmias
• Etiology
– D/t removal of
parathyroid gland
• Treatment
– IV Calcium gluconate
– Breath into a paper
bag 
– mild acidosis 
– h Calcium in blood