Thyroid disorders -Study material for nursing students

Includes disorders pertaining to hyperthyroidism, hypothyroidism and Goitre

1. Thyroid Disorders Mrs. Lorita Furtado Asst. Lecturer QHC College of Nursing Lor's Class

2. Thyroid Gland Thyroid gland is a small butterfly shaped gland located below the Thyroid cartilage(Adam’s apple). It consists of two lobes lying on either side of trachea Lor's Class

3. T3 & T4 Thyroid Gland makes Thyroxine (T4 )& Triiodothyronine (T3) T3 is made up of 3 atoms of Iodine and T4 by 4 atoms of Iodine.T4 is converted to T3 by peripheral organs like kidney, liver and spleen. These hormones regulates the speed with which our body cell works which means if too much of hormones are secreted the body cells work faster(hyperthyroidism) and vice versa. Lor's Class

4. Calcitonin Thyroid gland also produces Calcitonin. Its main function is to regulate serum Calcium levels which it does by stimulating the movement of calcium into bones. Lor's Class

5. The release of thyroid hormones from the thyroid gland is controlled by Thyrotrophin -Releasing Hormone(TRH ) from the hypothalamus in the brain and by the Thyroid stimulating Hormone (TSH) produced by the Pituitary Gland. This forms a part of a feedback loop called the Hypothalamic-Pituitary-Thyroid Axis . Lor's Class

6. Hyperthyroidism Occurs due to over activity of thyroid gland l eading to increased T4,T3 or both. Prevalence Females>Males, common in young Causes Graves’s Disease( an autoimmune disorder that causes antibodies to stimulate thyroid to secrete too much of hormone). Excess Iodine intake Thyroiditis Tumors of the ovaries or testes Tumors of Thyroid or pituitary Glands Excess intake of thyroxine containing medications or dietary supplements Lor's Class

7. Signs and Symptoms of Hyperthyroidism Lor's Class

8. And Graves’ Opthalmopathy Signs and Symptoms include Dry eyes Red or swollen Eyes Excessive Lacrimation Light Sensitivity Protruding eyeballs Lor's Class

9. Complications of Hyperthyroidism Atrial Fibrillation Brittle Bones and Osteoporosis Eye Problems –if Graves’Opthalmopathy is present and not treated on time then it can cause vision loss Red, Swollen Skin due to Graves’ dermopathy Thyrotoxic Crisis = sudden intensification of symptoms leading to fever, rapid pulse and even delirium Thyroid Storm - A rare but life threatening complication of Graves’ Disease and decompensated hyperthyroidism. Symptoms include: Hyperthyroid symptoms with agitation,confusion,delirium , psychosis. G.I. symptoms like Nausea/ vomitting , Abdominal pain Tachycardia associated with CHF Lor's Class

10. Diagnosis of Hyperthyroidism History Collection Physical Examination-Swelling/asymmetry in neck sometimes accompanied with bruit. Thyroid Function Tests- Elevated T3&T4 and abnormally low TSH Low Cholesterol and triglycerides levels due to increased metabolic rate Thyroid scan-reveals whether the entire or just a single area of the gland is overactive. Radioactive Iodine Uptake test USG CT or MRI Scans Fine Needle Aspiration Cytology Lor's Class

11. Treatment of Hyperthyroidism Antithyroid Medications – Eg : Methimazole , Propylthiouracil (PTU). Beta Blockers like Popranolol for symptom control. Radioactive Iodine(Radionuclide ablation) – Destroys hormone producing cells. Surgery-Total or Partial thyroidectomy. Lor's Class

12. Hypothyroidism Lor's Class

13. Hypothyroidism Occurs when thyroid gland doesn’t produce enough thyroid hormones. Lor's Class

14. Causes of Hypothyroidism Iodine deficiency Radiation Therapy to the Neck area Radioactive Iodine Treatment Use of certain medications like those used in treatment of cardiac conditions, Psychiatric medications and Cancer drugs Thyroid Surgery Pregnancy Disorders of Pituitary and or Hypothalamus gland. Lor's Class

15. Risk Factors of Hypothyroidism Asian/white Older ages Prematurely grey hair Autoimmune disorders like RA,DM,Addison’s etc. Bipolar disorder Down and Turner Syndrome. Lor's Class

16. Types of Hypothyroidism PRIMARY HYPOTHYROIDISM Caused by problems with thyroid gland itself. Can be Drug induced or iatrogenic (due to surgical removal of thyroid or radiation therapy) Can also be due to Hashimoto’s Disease - an autoimmune disorder in which antibodies are directed against thyroid sites inhibiting thyroid peroxidase and effects of TSH and stimulating thyroid growth. Can also be due to thyroid gland failure Lor's Class

17. Types of Hypothyroidism SECONDARY HYPOTHYROIDISM Occurs when another problem interferes with the thyroid’s ability to produce hormones Can occur with Pituitary tumors, radiation, surgery and or necrosis; Autoimmune mechanisms TERTIARY HYPOTHYROIDISM Occurs when there is Hypothalamic failure Lor's Class

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19. Complications of Hypothyroidism Goitre - Enlargement of thyroid g land. However Goitre can be caused either due to hyper or hypothyroidism. Increased incidence of heart disease and LDL Cholesterol. Mental health Issues like depression. Peripheral Neuropathy due to long term uncontrolled damage of peripheral nerves. Myxedema -a life threatening condition resulting due to long term undiagnosed hypothyroidism. Symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness. Infertility. Birth defects in babies born to women with untreated thyroid diseases. Lor's Class

20. Diagnosis of Hypothyroidism History Collection Physical Examination Thyroid Function Tests- Low T4 or Increased TSH with normal T4 Thyroid scan or USG CT or MRI Scans Fine Needle Aspiration Cytology Lor's Class

21. Treatment of Hypothyroidism Daily use of synthetic Thyroid Hormone- Levothyroxine. it may take few weeks for the physician to determine the proper dosage . Lor's Class

22. Goitre Lor's Class

23. Goitre Its an abnormal enlargement of thyroid gland Most common cause is lack of iodine in the diet. Other causes are over or under production of thyroid hormones or nodules in the glands. Symptoms: Swelling at base of the neck, tightness in the throat, cough, voice hoarseness, dysphagia and dyspnea. Treatment: depends upon the size and the cause of the goitre . Lor's Class

24. Role of a Nurse Lor's Class

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