Thyroid & Parathyroid
Dysfunction
Kelly DeCoste, Ellie O’Brien & Clare Dearing
Objectives

Thyroid Statistics

Anatomy & Physiology of the Thyroid Gland

Thyroid Hormones, Calcitonin & Iodine

Thyroid Function Tests

Thyroid Dysfunctions (Definition, Cause, Diagnosis, Treatment, Medical
Management)


Hypothyroidism & Hyperthyroidism
Hypoparathyroidism & Hyperparathyroidism

Thyroiditis

Thyroid Cancer

Case Study

Conclusion
Thyroid Statistics
 Worldwide: estimated that 200 million people are affected
by thyroid disease
 1 in 10 Canadians suffer from some type of thyroid
disease (Thyroid Foundation of Canada)
 6,000 Canadians will be diagnosed with thyroid cancer.
(Canadian Cancer Society)
Anatomy & Physiology of the
Thyroid
 The thyroid gland is a small
butterfly-shaped gland located in
the anterior portion of the neck.
 It is the regulator of all body
functions, with the major function
being the production, storage, and
release of the thyroid hormones,
which are essential to all growth
and metabolism.
Thyroid Hormones
T3-Thyroxine
T4-Tri-iodthyronine
Actions:
•Influence every major organ system
•Control cellular metabolic activity
•Increase metabolic processes
•Help convert food into energy & heat
•Influence cellular replication
•Important in brain development
•Necessary for normal growth
•Increase body temperature
Calcitonin & Iodine
Thyroid Function Tests
 Thyroid Stimulating Hormone (TSH)
 Free Thyroxine (FT4)
 Thyroxine (T4)
 Tri-Iodothyronine (T3)
The two tests most
commonly used
Thyroxine (T4) &
Tri-Iodothyronine (T3)
 T4 is one of the first tests
performed to diagnose thyroid
function and makes up nearly all
of thyroid hormone.
 T3 is a measurement used to
primarily diagnose
hyperthyroidism. Only 7-10% of
thyroid hormone is composed of
T3.
Hypothyroidism

Thyroid gland becomes underactive
and does not produce enough thyroid
hormones.

Deficient levels of thyroid hormone
can range from mild (subclinical
forms) to myxedema (advanced,
severe symptoms).

Primary: due to the malfunctioning
of the thyroid gland itself.

Secondary: due to malfunctioning of
pituitary gland, thyroid is not being
stimulated by pituitary to produce
hormones.

Most commonly affects women
aged 30-60
Hypothyroidism: Causes
 Hashimoto’s disease

Autoimmune disorder attacking
the thyroid gland, damaging it
resulting in underproduction of
thyroid hormones. Results in
inflammation of the thyroid and
possibly goiter

Other causes:

Radiation of the head and neck

Patients with previous
hyperthyroidism who have been
treated with anti-thyroid
medications/surgery
Hypothyroidism: S&S
 Early Signs and Symptoms
 Usually non-specific
 Extreme fatigue
 Hair loss, brittle nails, dry
skin, numbness/tingling of
fingers.
Myxedema



Severe/prolonged hypothyroidism
leads to myxedema
Myxedema: physiological
reaction to lack of sufficient
thyroid hormone
Accumulation of
mucopolyshaccharides in subQ
tissues

Subnormal temp & pulse

Thickened skin

Mental processes dulled, enlarged
tongue, slow speech

Cognitive changes similar to
dementia

Cardiovascular changes: inc.
cholesterol, atherosclerosis,
coronary artery disease, poor left
ventricular function
Myxedema Coma

If prolonged/untreated

Most extreme and severe stage
of hypothyroidism

Pt is hypothermic and
unconscious

High mortality rate
Medical Management

Restore metabolic state with
hormone replacement therapy

Synthetic Levothyroxine
(Synthroid)

Prevention of Cardiac
Dysfunction
Nursing Management
Remember: administer medications with caution as metabolic rates slowed.
** Opioids, anesthetic agents**

Modifying activity

Monitor Physical Status

Promote Physical comfort

Provide emotional Support
Hyperthyroidism
 Thyroid gland produces an
excess of thyroid hormones
 More common in women
 Most frequent between the ages
of 20-40
 Thyrotoxicosis-hypermetabolic
state caused by excess T3 or T4
Clinical
Manifestations
Hyperthyroidism
 Causes
 Graves’ Disease
 Toxic Nodular Goitres
 Thyroditis
 Excessive ingestion of thyroid hormone
 Diagnosis
 Medical history
 Physical exam
 Blood tests (TSH & thyroxine)
 Radioactive iodine uptake test
 Thyroid scan
Graves’ Disease
Treatment of
Hyperthyroidism
 Drug Therapy
 Anthithyroid drugs
 Iodine
 Beta Blockers
 Radioactive Iodine Therapy
 Surgical Therapy
 Thyroidectomy
 Nursing Management
Thyrotoxic Crisis
“Thyroid Storm”
 Manifestations of
HYPERthyroidism are
heightened
 Life-threatening emergency!!!
 Cause-infection, trauma, surgery
 Signs & Symptoms
 Treatment
Parathyroid Glands
Hypoparathyroidism
 A rare condition associated with inadequate circulating PTH.
 Signs & Symptoms:
-
Tetany, increased muscle tension, stiffness, painful tonic spasms,
dysphagia, laryngospasms, Chvostek’s & Trousseau’s signs.
 Diagnosis:
-
Abnormal laboratory findings which include decreased serum
calcium and PTH levels and increased serum phosphate levels.
 Management:
-
Treat acute complications, maintain normal serum calcium levels,
and prevent long-term complications.
Inadvertent surgical
removal =
hypoparathyroidism
Calcium levels
FALL
Phosphate
levels RISE
Trousseau’s Sign
 A carpal spasm induced by inflating a blood pressure cuff
above the systolic pressure for a few minutes.
Chvostek’s Sign
 A contraction of facial muscles in response to a light tap
over the facial nerve in front of the ear.
Hyperparathyroidism
 An excess secretion of
parathyroid hormone (PTH) from
the parathyroid gland
 Primary-benign neoplasm or a
single adenoma, malignant tumor
(rare), hyperplasia
 Secondary-compensatory
response to other causes of
hypocalcemia
Hyperparathyroidsim
 Manifestations
 Loss of appetite, need more
sleep, forgetfulness
 Complications
 Renal failure, pancreatitis,
cardiac changes, fractures
 Diagnosis
 Blood tests, urine tests, bone
mineral density test,
diagnostic imaging
Hyperparathyroidism
Treatment
 Surgical-Parathyroidectomy
 Most effective treatment
 Non-Surgical
 Annual tests (blood, urine &
diagnostic imaging)
 Drugs

Biophosphates, estrogen &
progestin, oral phosphate,
calcimimetics
 Exercise
 Nutrition
 Nursing Management
Thyroiditis
 There are three types of thyroiditis, each type characterized by
inflammation, fibrosis or lymphocytic infiltration.
 Can cause thyrotoxicosis,
hypothyroidism or both
 Acute Thyroiditis
 Subacute Thyroiditis (2 types)
 Chronic Thyroiditis
(Hashimoto’s disease)
Thyroid Cancer
 Accounts for 90% of endocrine malignancies. 47,000 new
cases are diagnosed each year.
 Papillary Adenocarcinoma (most common)
 Follicular Adenocarcinoma
 Medullary
 Anaplastic
 Thyroid lymphoma
 Treatment: surgical removal, radioactive iodine used to eradicate
residual affected thyroid tissue, thyroid replacement therapy
(lifelong)
Case Study
 Mrs. Graves is a 26 year-old female who presented to your
clinic describing feelings of nervousness and irritability
and difficulty sleeping at night. She has lost 15lbs in the
last two months even though her eating & exercise
patterns have not changed. Vitals signs are: BP 142/60, P
106, R 22, T 36.9. Your physical exam reveals that she
appears thin, restless & tearful. Her hair is thinning at the
temples, her thyroid is enlarged & her eyes are protruding.
Nursing Diagnoses
QUESTIONS??
References

Canadian Cancer Society. (2014). Anatomy and physiology of the thyroid gland. Retrieved from
http://www.cancer.ca/en/cancer-information/cancer-type/thyroid/anatomy-and-physiology/?region=bc

Endocrine Web. (2012). How Your Thyroid Works: “A Delicate Feedback Mechanism”. Retrieved from
http://www.endocrineweb.com/conditions/thyroid/how-your-thyroid-works

Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., O’Brien, P.G.,& Bucher, L. (2010). Medical-surgical nursing in
Canada: Assessment and management of clinical problems Toronto: Elsevier Mosby

Mayo Clinic. (2012). Hyperthyroidism (overactive thyroid). Retrieved from http://www.mayoclinic.org/diseasesconditions/hyperthyroidism/basics/definition/con-20020986

Mayo Clinic. (2014). Hyperparathyroidism. Retrieved from http://www.mayoclinic.org/diseasesconditions/hyperparathyroidism/basics/definition/con-20022086

National Instituites of Health. (2014). Iodine: Fact Sheet for Health Professionals. Retrieved from
http://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/#h3

Pike-MacDonald, S. (2013). Mosby’s Canadian manual of diagnostic and laboratory tests. Toronto, ON: Elsevier

Thyroid Foundation of Canada. (2014). Hyperthyroidism (Thyrotoxicosis). Retrieved from
http://www.thyroid.ca/thyrotoxicosis.php