The thyroid gland produces _____ hormones. What are they?
3;
-T3
-T4
-Calcitonin
Calcitonin
decreases serum calcium levels by taking calcium
... [Show More] out of the blood and pushing it back into the bone
You need _____________ to make hormones
iodine (this is dietary iodine-comes from salt)
Thyroid hormones give us
energy
Hyperthyroid is AKA
Graves' disease (most common cause)
Hyperthyroidism: Signs/Symptoms
-nervous
-irritable
-decreased attention span
-increases appetite
-decreased weight
-sweaty/hot
-exophthalmos (can be irreversible)
-GI fast
-increased BP and pulse
-arrhythmia/palpitations
-thyroid size will increase (any overworked organ
will increase in size)
Hyperthyroidism Diagnosed using
-serum thyroxine (T4) levels
-TSH levels
-thyroid scan
-ultrasound
-MRI
-CT
Hyperthyroidism Diagnosis: The serum thyroxine (T4) level will be
increased
Hyperthyroidism Diagnosis: TSH will be
decreased
Hyperthyroidism Diagnosis: Client must discontinue any iodine containing medication ________________ prior to the thyroid scan and must wait _________________ to restart medications
1 week; 6 weeks
amiodarone (Cordarone)
an antiarrhythmic drug that contains high levels of iodine and may affect thyroid function
Hyperthyroidism: Treatment Methods
1. Anti-thyroids
2. Iodine compounds
3. Beta blockers - supportive therapy
4. Radioactive iodine therapy
5. Surgery
Anti-thyroid medications
-methimazole (Tapazole)
-propylthiouracil (PTU)
What to anti-thyroid medications do?
stop the thyroid from making thyroid hormones
When are anti-thyroid medications used?
pre-op to stun the thyroid
What does euthyroid mean?
normal thyroid
Iodine compounds
potassium iodine (SSKI and Lugol's solution)
What are iodine compounds are used for?
decreasing the size and vascularity of the gland
ALL endocrine glands are
VERY VASCULAR!
Iodine compounds should be given with _________ or ___________ and use a __________. Why?
milk; juice; straw
because they stain teeth
Beta Blockers (supportive therapy)
propanolol (Inderal)
What do beta blockers do?
block epi- and norepi-
-decrease myocardial contractility
-could decrease CO
-decrease HR and BP
-decrease anxiety
Do NOT give beta blockers to
asthmatics or diabetics
Radioactive iodine therapy: How many doses?
1
Radioactive iodine therapy: What form and route is it given in?
PO in liquid or tablet form
Radioactive iodine therapy: BEFORE giving, rule out
pregnancy
Radioactive iodine therapy: Purpose
destroy thyroid cells -->hypothyroidism
Radioactive iodine therapy: Radioactive precautions
-stay away from babies for 1 week
-don't kiss anyone for 1 week
Radioactive iodine therapy: Potential rebound effect
thyroid storm (thyrotoxicosis and thyrotoxic crisis)
-it is hyperthyroidism multiplied by 100
Thyroidectomy can be _________ or ________
partial; complete
Thyroidectomy: Post-Op Priority
hemorrhage
Thyroidectomy: Sign of bleeding
feelings of pressure in neck area
Thyroidectomy: Where should you check for bleeding?
at the incision site and behind the neck (pooling)
Thyroidectomy: How should you assess for recurrent laryngeal nerve damage?
listen for hoarseness
Thyroidectomy: Laryngeal nerve damage can lead to
vocal cord paralysis
Thyroidectomy: When there is paralysis of both cords, ____________ obstruction will occur requiring immediate _______________.
airway; tracheotomy
Thyroidectomy: What should be kept at the bedside?
trach set
Thyroidectomy: A trach set should be kept at the bedside in case of
-swelling
-recurrent laryngeal nerve damage (vocal cord
paralysis)
Thyroidectomy: What imbalance can occur?
hypocalcemia
Thyroidectomy: What assessment should be made pertaining to hypocalcemia?
-assess for parathyroid removal
-assess for signs of hypocalcemia
Thyroidectomy: Hypocalcemia patients are
NOT sedated
Thyroidectomy: Post-Op Positioning
-teach client how to support neck
-elevate the head of bed to decrease edema
-put personal items close to the client
Thyroidectomy: Pre- & Post-Op Nutrition
client needs MORE calories
Hypothroidism can be confused with
depression & hyperthyriodism with mania
Hypothyroidism: Signs/Symptoms
-no energy
-fatigue
-no expression
-speech slow and slurred
-weight increased
-GI slow
-cold
-amenorrhea
Hypothyroidism: Diagnosis
-thyroxine (T4) levels
-TSH levels
-just the opposite of lab values for hyperthyroidism
Hypothyroidism: Thyroxine (T4) levels will be
decreased
Hypothyroidism: TSH levels will be
increased
Hypothyroidism: Treatment Medications
-levothyroxine (Synthroid)
-liothyronine (Cytomel)
Hypothyroidism: Medications should be taken
on an empty stomach
Hypothyroidism: Are their medications going to be taken forever?
yes
Hypothyroidism: What will happen to energy level when meds are started?
they will go up
People with hypothyroidism tend to have
CAD d/t increased LDLs
Hypothyroidism: Since CAD tends to be a problem, what should we worry about when thyroid medications are started?
an MI
The parathyroids secrete ________ which makes you____________________________. Therefore, the serum calcium level goes _______
PTH; pull calcium from the bone and place it in the blood; up
If you have too much parathormone in your body, the serum calcium level will be
increased
If you do not have any parathormone in your body, the serum calcium level will be
decreased
Hyperparathyroidism = ________________________ = ________________________
hypercalcemia; hypophosphatemia
Hyperparathyroidism: Signs/Symptoms
-too much PTH
-serum calcium high
-serum phophorus is low
-sedation (high calcium)
Hyperparathyroidism: Treatment
partial parathyroidectomy
Hyperparathyroidism: Partial Parathyroidectomy is
when you take out 2 of your parathyroids (causes PTH secretion to decrease)
Partial Parathyroidectomy: What to monitor for post-op
hypocalcemia
Hypoparathyroidism = ________________________ = _______________________
hypocalcemia; hyperphosphatemia
Hypoparathyroidism: Treatment
-IV calcium
-phosphorus binding drugs
What do phosphorus binding drugs do?
brings phosphorus levels down and, in turn, increase calcium levels
Example of a phosphorus binding drug
calcium acetate
We need adrenal glands to
handle stress
2 parts of adrenal gland
1. adrenal medulla
2. adrenal cortex
Adrenal medulla secretes
epinephrine and norepinephrine
Adrenal Medulla Problem
pheochromocytoma
What is pheochromocytoma?
benign tumors that secrete epi and norepi in boluses
Pheochromocytoma tend to be
familial (will want to screen the family)
Pheochromocytoma: Signs/Symptoms
-increased BP
-increased HR
-palpitations
-flushing/extremely diaphoretic
-headache
Pheochromocytoma: Diagnosis
-catecholamine levels
-24 hour urine specimen
How are catecholamine levels measured?
-vanillylmandelic acid (VMA) test
-metanephrine (MN) test
Foods that alter the VMA and MN test
-anything with vanilla in it
-caffeine
-vitamin B
-fruit juices
-bananas
A 24-hour urine specimen is done to screen for increased levels of _________ and ___________
epi-;norepi
(also called catecholamines)
With a 24-hour urine, you should ____________________ the first voiding and ___________________________
throw away; keep the last voiding [Show Less]