Endocrine – Thyroid gland
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Endocrine – Thyroid gland Part 1 Description: Thyroid • Butterfly shaped • Two lobes connected by an isthmus • Straddles the trachea • Largest endocrine gland Function: Thyroid 1. Produce thyroid hormones (TH) Vital for growth & metabolism 2. Iodine storage Essential for T3/T4 syntheses Hormones Hormone Function T3/T4 h metabolic rate h protein synthesis h energy production Most important hormone in day today regulation of metabolic rate Stimulated by i metabolic rate iT3/T4 h TSH Thyroid Hormones Hormones Function Stimulated by T3/T4 h metabolism i metabolism Calcitonin i blood calcium concentration i the reabsorption of Ca and Ph from bones to blood Calcitonin “tones” down serum Ca levels h blood Ca levels Hormone Loop • • • • • • • • • i Metabolic rate Detected by hypothalamus Stimulates anterior pituitary Secretes TSH Blood stream target organ thyroid Stimulate Thyroid to secrete T3/T4 Blood stream target organs adrenal medulla Secretes Epinephrine & Norepinephrine h Metabolic rate Thyroid Disorders • World-wide – Iodine deficiency • United States – Auto-immune Hyperthyroidism Definition • h T3/T4 in blood Pathophysiology • Primary hyperthyroidism – Problem with thyroid gland h T3/T4 • Secondary hyperthyroidism – Problem with pituitary gland h T3/T4 – Pituitary h TSH h T3/T4 – h TSH thyroid growth goiter Hyperthyroidism Etiology • Auto-immune • AKA: – Grave’s disease • F vs M? – F>M • Age – 20-40 yrs Hyperthyroidism S&S Neurological • Heat intolerance • Diaphoresis • h sympathetic nervous response Hyperthyroidism S&S Affect • • • • • • Nervous Emotional lability Irritable I Concentration Mood swings manic/psychotic Hyperthyroidism S&S Cardiovascular • Tachycardia • Palpitations Hyperthyroidism S&S Gastrointestinal • Appetite –h • Weight –i • BM –h – Diarrhea Hyperthyroidism S&S Muscle-skeletal • Tremors • Restlessness • Muscle – weakness Hyperthyroidism S&S Skin • Temperature – Warm • Smooth • Hair – Fine, soft – Gray – h Loss Hyperthyroidism S&S Exophthalmos • Bulging of the eye • Stare Hyperthyroidism S&S Goiter • Enlarged thyroid • TSH levels –h Hyperthyroidism S&S Oncholysis • Distal nail separates from the nail bed • Nail fragile Hyperthyroidism S&S Gynecomastia • Abnormal enlargement breasts • male Hyperthyroidism S&S Elderly • • • • Heart failure Fatigue Apathy Depression Hormone Review • i T3/T4 • Pituitary • h TSH • Thyroid • h T3/T4 ___________________ • h T3/T4 • Pituitary • i TSH • Thyroid • i T3/T4 Hyperthyroidism Diagnostic Tests • By definition hyperthyroidism means what? – T3/T4 –h Primary Hyperthyroidism T3/T4 TSH h Secondary Hyperthyroidism Hyperthyroidism Diagnostic Tests • By definition primary hyperthyroidism means what? (where is the problem – what is causing the problem?) – Thyroid • h T3/T4 • In primary hyperthyroidism, is the pituitary gland working correctly? – Yes Hyperthyroidism Diagnostic Tests • If the pituitary gland is working correctly and there is an h T3/T4 level, what will the Pituitary gland do with the TSH level? Primary Hyperthyroidism T3/T4 h TSH i Secondary Hyperthyroidism Hyperthyroidism Diagnostic Tests • By definition hyperthyroidism means what? – T3/T4 –h Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4 h h TSH i Hyperthyroidism Diagnostic Tests • By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?) – Pituitary gland • h TSH • h T3/T4 Hyperthyroidism Diagnostic Tests By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?) – Pituitary gland h TSH h T3/T4 Primary Hyperthyroidism Secondary Hyperthyroidism T3/T4 h h TSH i h Question? Mrs. Goiter has a thyroid panel done and shows an elevated T3/T4 and an elevated TSH? Which of the following diagnosis apply? A. Primary hyperthyroidism B. Secondary hyperthyroidism C. Primary hypothyroidism D. Secondary hypothyroidism Question? Mrs. Canta Geta Up has a thyroid panel done and shows an elevated T3/T4 and an decreased TSH? Which of the following diagnosis apply? A. Primary hyperthyroidism B. Secondary hyperthyroidism C. Primary hypothyroidism D. Secondary hypothyroidism Hyperthyroidism Medical Treatment Meds first • Goal – i T3/T4 levels • Meds alone sometimes work - if not – Surgery Hyperthyroidism Medical Treatment Anti-thyroid therapy • Propylthioracil / PTU • Methimazole / Tapazole – Action • Inhibits synthesis of T3/T4 Hyperthyroidism Medical Treatment Propranolol hydrochloride / Inderal • Beta-blocker • i sympathetic nervous system • No smoking Hyperthyroidism Medical Treatment • Meds alone not – Surgery • If Ca Thyroid – Surgery • Euthyroid state before surgery! – How? • Anti-thyroid meds Hyperthyroidism Medical Treatment • Iodine before surgery – Potassium iodine saturated solution (SSKI) – i vascularity of the thyroid – i risk of post-op bleeding Hyperthyroidism Medical Treatment Radioactive Iodine • I131 • Used instead of radiation tx • Stop anti-thyroid meds x 7 days • Single dose • S&S i in @ 3wks full effect in 3 months Hyperthyroidism Medical Treatment Radioactive Iodine • Safety – No PG nurses – Watch body fluids – Avoid kids x 7 days Hyperthyroidism Medical Treatment Diet (When hyperthyroid) • Calories –h – 4,000-5,000 cal/day • Fluids –h • Na –i • Fiber –i • Caffeine –i Hyperthyroidism Nursing Management Assessment • Vital signs • Lung sounds • Anxiety level • Weight • Bowel function • NEVER palpate goiter – Release TH Hyperthyroidism Nursing Management Nrs. Dx • Risk for injury • Hyperthermia • Diarrhea • Alt. Nutrition • Sleep pattern disturbance • Anxiety Hyperthyroidism Nursing Management • Exophthalmos – – – – – Lubricate eyes Tape closed Dark glasses i Na diet HOB h Hyperthyroidism Severe Thyrotoxicosis • AKA: Thyroid Storm • Definition – Sever hyperthyroid state • Etiology – Stress – Post thyroid surgery – Undiagnosed Hyperthyroidism Severe Thyrotoxicosis S&S • h TH h adrenergic activity h epinephrine • Pulse – h • Temperature – h • BP – h • Depression • Activity – Restlessness • Delirium • SOB • Coma Hyperthyroidism Severe Thyrotoxicosis • Death – <2hr – Cardiac Failure Hyperthyroidism Severe Thyrotoxicosis Treatment • Fever – Tylenol/ acetaminophen – Not aspirin • For h pulse & h BP – Propranolol / Inderal – Beta-adrenergic blocker • If SOB – O2 – HOB h
