Thyroid disorder for BSN 3 polytechnic college

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1. Hypothyroidism
Hyperthyroidism
Thyroid Tumors
Thyroid Cancer

2. Thyroid Hormone
Thyroxine(T4) and triiodothyronine(T3)
are amino acids that have the unique
property of containing iodine molecules
Control cellular metabolic activity
T3 five times more potent than T4
Accelerate metabolic process by
increasing the levels of enzymes that
contribute to oxygen consumption

3. Calcitonin
Thyrocalcitonin
Secreted in response to high
plasma levels of calcium
Reduces plasma levels of calcium
by increasing its deposition in
bones

4. Iodine
Essential to the thyroid gland for the
synthesis of its hormones
Thyroid gland efficient in taking up
iodide from the blood and
concentrating it within the cells, where
iodide ions are converted to iodine
molecules which react with tyrosine to
form thyroid hormones

6. Thyroid-Stimulating Hormone
Single best screening test of
thyroid function
Normal range: 0.4-6.15 uU/mL
↑in hypothyroidism
↓in hyperthyroidism

7. Serum Free Thyroxine(FT4)
Free, unbound thyroxine
Normal range: 0.9 to 1.7 mg/dL

8. Serum T3 and T4
Protein bound and free hormone
levels that occur in response to TSH
secretion
Normal range:
✓T4: 4.5-11.5 mg/dL
✓T3: 70-220 mg/dL

9. Thyroid Antibodies
Test of autoimmune thyroid
diseases like Hashimoto’s or
Grave’s disease

10. Radioactive Iodine Uptake
Measure rate of iodine uptake
Iodine 123 (T123)/ radionuclide
Measure proportion of
administered dose present in
thyroid gland at a specific time
after its administration

11. Thyroid Scan
Scintillation detector/ gamma
camera moves back and forth
across the area to be studied
in a series of parallel tracks

13. Goiter Classification
Goiter Grade Description
0 No palpable or visible goiter.
1 Mass is notvisible with neck in the
normal position.
Goiter can be palpated and moves
up when the client swallows.
2 Massis visible as swelling when the
neck is in the normal position.
Goiter is easily palpated and is
usually asymmetric.

14. HYPOTHYROIDISM
Suboptimal levels of thyroid hormone
More common in older women
5x more common in women than men
CRETINISM-if present at birth
MYXEDEMA-accumulation of
mucopolysaccharidesin subcutaneous
tissue and other interstitial tissue

16. Pathophysiology
Primary or thyroidal hypothyroidism-
dysfunction of the thyroid gland itself
Central hypothyroidism-caused by
failure of the pituitary gland,
hypothalamus, or both
✓Secondary-pituitary
✓Tertiary-hypothalamus

17. Clinical Manifestations
Extreme fatigue
Hair loss
Brittle nails, dry skin
Numbness and tingling of fingers
Husky voice
Menorrhagia/ amenorrhea
Elevated serum cholesterol
Advanced: personality and cognitive changes
(dementia)
Myxedemacoma: hypothermic, unconscious,
depressed respiratory drive

18. Myxedema
Low metabolic rate
causes build up of
metabolites inside
cells, which increases
the mucous and
water causing
edema
Non-pitting edema
around the eyes,
hands, and feet

19. MyxedemaComa
Rare, serious complication of untreated
hypothyroidism
Decreased metabolism causes the heart
muscle to become flabby and the
chamber size to increase resulting to
decreased cardiac output
Decreased cardiac output leads to
hypoperfusion of the brain and other vital
organs making slow metabolism worse
and results in organ and tissue failure

20. Pharmacological Management
IV levothyroxine(Synthroid/Levothyroid)-
dose based on TSH concentration
O2 demand increases
O2 delivery impeded by atherosclerosis
angina/dysrhythmias
discontinue thyroid meds

22. Medication interactions:
✓Increase blood glucose levels so
adjustment in dosage of insulin or
oral anti-diabetics must be made
✓Effects increased by phenytoin
(Dilantin) and TCAs
✓Increase effect of cardiac
glycosides, anticoagulants
✓Hypnotic and sedative agents may
cause profound somnolence

23. Medical Management
ABG analysis
Pulse oximetrymonitoring
External heat application is
contraindicated
Meet increased O2
requirements

24. Common Nursing Diagnoses
1.Decreased cardiac output related
to altered heart rate and rhythm as
a result of decreased myocardial
metabolism
2.Ineffective breathing pattern r/t
decreased energy
3.Disturbed thought processes r/t
impaired brain metabolism and
edema

25. Nursing Management
Respiratory Monitoring
Monitor for bradypnea
Assess rate, rhythm, depth, use of
accessory muscles, dsypnea

26. Nursing Management
Shock Prevention
Monitor temperature and respiratory
status
Monitor circulatory status: BP, skin
color, skin temperature, heart sounds,
rate, rhythm
MIO
Monitor for signs of inadequate tissue
oxygenation

27. Nursing Management
Hypothermia
Monitor temperature
Cover with warmed blankets
Administer heated oxygen as appropriate
Give warm oral fluids, if alert and able to
swallow
Emphasize importance of wearing warm,
protective clothing when going into the
cold environment

29. HYPERTHYROIDISM
(Thyrotoxicosis)
Grave’s disease
Excessive output of thyroid hormones
caused by abnormal stimulation of
the thyroid gland by circulating
immunoglobulins
Women are prone 8x more than men
May occur after emotional shock,
stress, or infection

30. HYPERTHYROIDISM
(Thyrotoxicosis)
The normal feedback control over
thyroid hormone secretion fails
Produce hypermetabolismand
increased sympathetic nervous system
activity
Affect protein, lipid, and
carbohydrate metabolism leading to
increased protein synthesis and
degradation

32. Pathophysiology
Underlying hyperthyroidism
Increased T3 and T4
↑sympathetic adrenergic unregulated hypermetabolic
response responses
↑CO, wide pulse pressure fever, diaphoresis
↑HR, contractility flushing
dysryhthmias diarrhea
↑O2 consumption
Irritability, confusion, angina

33. Clinical Manifestations
System Manifestations
Skin •Diaphoresis
•Thinning of scalp hair
•Smooth, warm, moist skin
Pulmonary •Shortness of breath with or without exertion
•Rapid, shallow respirations
•Decreasedvital capacity
Cardiovascular•Palpitations
•Chest pain
•Increased systolic BP
•Widened pulse pressure
•Tachycardia
•Dysrhythmias

34. Clinical Manifestations
System Manifestations
Gastrointestinal•Weight loss
•Increasedappetite
•Increased stools
•Hypoproteinemia
Musculoskeletal•Muscle weakness
•Muscle wasting
Neurologic •Eye fatigue
•Corneal ulcers
•Photophobia
•Tremors
•Insomnia

35. Clinical Manifestations
System Manifestations
Metabolic •Increased basal metabolic rate
•Heat intolerance
•Low-grade fever
•Fatigue
Psychological/
Emotional
•Decreased attention span
•Restlessness
•Irritability
•Emotionallability
•Manic behavior
Reproductive•Amenorrhea
•Decreased menstrual flow
•Increased libido

38. Pharmacologic Therapy
Radioactive iodine therapy-destroy
overactive thyroid cells
✓Single oral dose (tasteless,
colorless)
✓Observe for thyroid storm
(maybe controlled by propanolol)
✓Symptoms subside 3-4 weeks

40. Pharmacologic Therapy
propylthiouracil(PTU, Propacil); methimazole
(Tapazole)
✓S/E: agranulocytosis, thrombocytopenia
✓STOP MEDICATIONS IF WITH INFECTION
(especially pharyngitis, mouth ulcers)
✓Block extrathyroidalconversion of T3 and
T4 but do not interfere with release or
activity of previously formed thyroid
hormones (may take several weeks for
relief of symptoms)

42. Pharmacologic Therapy
Iodine preparations to decrease
blood flow through the thyroid
gland
Lithium carbonate to inhibit
thyroid hormone release
Beta blockers to relieve
diaphoresis, anxiety, tachycardia,
and palpitations

43. Pharmacologic Therapy
Adjunctive therapy (to decrease
release of thyroid hormones and
reduce vascularity and size):
✓Potassium iodide-give with
milk or fruit juice through straw
to prevent staining of teeth
✓Lugol’ssolution

45. Iodine Toxicity
Swelling of the buccalmucosa
Excessive salivation
Coryza
Skin eruption
Require immediate withdrawal of
the medication

46. Surgical Management
Subtotal thyroidectomy-
removal of about five sixths of
thyroid tissue ensures a
prolonged remission
Total thyroidectomy

47. Surgical Management
Remove thyroid tissue
Done 4-6 weeks after thyroid
function has returned to normal
(euthyroid) achieved through the
use of iodine preparations to
help reduce vascularity and
bleeding during surgery

48. Surgical Management
POST-OP CARE
Place in semi-Fowler’s position,
avoid neck extension to prevent
tension on suture line
Assist in deep breathing exercises

49. Surgical Management
(Post-Op Complications)
Complication Definition/Management
Hemorrhage Most likely to occurduring the first 24 hours
•Inspect the neck dressing and behind the
client’s neck from blood
•May cause respiratory distress due to tracheal
compression
Respiratory
Distress
Can result fromswelling or tetany
Laryngeal stridormay be heard in acute
respiratory obstruction
•Keep tracheostomyset ready
•Make sure oxygen and suctioning equipment
are nearby and ready

50. Surgical Management
(Post-Op Complications)
Complication Definition/Management
Hypocalcemia
and Tetany
Parathyroid glands can be damaged or their
blood supply impaired during surgery
•Assess for any tingling in tongue or mouth, toes
and fingers
•Assess for muscle twitching as signs of calcium
deficiency
•Calcium gluconate or calcium chloride must be
ready for IV use
Laryngeal
NerveDamage
Hoarsenessand weak voice
•Assess voice at 2-hour intervals
•Reassure that hoarseness is usually temporary

51. Surgical Management
(Post-Op Complications)
Complication Definition/Management
ThyroidStormFever, tachycardia, systolic hypertension
Abdominal pain, N/V, diarrhea
Anxiety, tremors
Seizures leading to coma
Restlessness, confused, psychotic

52. Nursing Management
Improving Nutritional Status
Six well-balanced small meals a day
Replace caloric loss with adequate
foods and fluids
Avoid highly seasoned foods and
stimulants to prevent diarrhea from
rapid movement of food through the
GI

53. Nursing Management
Enhancing Coping Measures
Calm, unhurried approach
Keep a quiet environment
Provide relaxing activities
Improve Self-Esteem
Convey understanding
Mirrors may be covered if patient is
concerned with appearances
Increased appetite may embarrass patient;
arrange time to eat alone

54. Nursing Management
Maintaining Normal Body
Temperature
Provide a cool
environment
Cool baths
Cool/cold fluids

55. THYROID TUMORS
ENDEMIC GOITER
(Iodine-Deficient)
Hypertrophy of thyroid gland
caused by the stimulation of the
pituitary gland
CM: swelling of neck which can
cause tracheal compression

56. ENDEMIC
GOITER
(Iodine-
Deficient)

57. THYROID TUMORS
NODULAR GOITER
With areas of hyperplasia, may
become malignant

58. NODULAR
GOITER

59. THYROID CANCER
Lesions that are single, hard,
and fixed on palpation or
associated with cervical
lymphadenopathy
Diagnostics: needle biopsy, CT,
MRI

60. THYROID
TUMOR

61. Surgical Management
Thyroidectomy-spare parathyroid
tissue to reduce risk of
postoperative hypocalcemiaand
tetany
Post-op: ablation with radioactive
iodine

63. Nursing Management
Post-op:
Check for bleeding
Feeling of fullness may indicate
presence of hemorrhage or
hematoma
Keep tracheostomyset at bedside if
breathing becomes difficult
Instruct to avoid talking