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kol- Med Surg 320 Spring > Thyroid > Flashcards

Thyroid Flashcards

1
Q

• T4 low, TSH high = problem with the thyroid or the pituitary gland? explain…

A

Problem is with the thyroid - negative feedback is working and keeps releasing more

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2
Q

Why do we measure T4 and not so much T3?

A

b/c T3 converted to T4

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3
Q

• T4 low, TSH low= problem with the thyroid or the pituitary gland? explain…

A

Problem with pituitary gland - the pituitary gland is not sending out signal/receiving TSH

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4
Q

why is thyroid hormone so important?

A

-life sustaining –> increases metabolism - O2 and Heat production
• takes iodine out of diet, combines w/ tyrosine and converts it T3 and T4. T3 and T4 released into bloodstream and control metabolism

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5
Q

difference in labs b/w hypo and hyperthyroidism? T4/T3/TSH?

A 
HYPERthyroidism = low TSH, HIGH T3/T4 
HYPOthyroidism = high TSH, LOW T3/T4
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6
Q

1 cause of hyperthyroidism?

A

graves disease

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7
Q

term to describe hyperthyroidism symptoms regardless of what is causing it = increased metabolism …..

A

Thyrotoxicosis

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8
Q

s/s of Thyrotoxicosis

A

• fingers clubbing, tremors, fatigue, diarrhea, amenorrhea, fine straight hair, facial flushing, enlarged thyroid, tachycardia, systolic BP, breast enlargement, weight loss, muscle wasting, heat intolerance, restlessness

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9
Q

Things that thyroid hormone increases in your body? what functions?

A 
• Stimulates the heart
↑ stroke volume
↑ heart rate
↑ cardiac output
↑ SBP
• ↑ protein building and breakdown  --> Net loss of protein
• ↑ glucose tolerance --> hyperglycemia
↑ fat metabolism= Low body fat
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10
Q

3 causes of hyperthyroidism

A
  1. graves disease
    - autoimmune antibodies stimulate TSH to increase production
2. toxic multinodular goiter- 
• Thyroid nodules caused by
	◦ Enlarged thyroid tissue
	◦ Benign tumors
-More common in women
-More common > 50 years
  1. exogenous hyperthyroidism
    =Overuse of thyroid replacement hormone
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11
Q

what happens in graves disease?

A
  • antibodies stimulate TSH to increase production
  • autoimmune: increase chance of child developing autoimmune disorders
  • antibodies attack thyroid
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12
Q

2 characteristics of graves disease

A
  1. exophthalmos -dry eyes, can cause pressure on optic nerve, can’t close eyes all the way (drops), blurred vision
  2. tibial myxedema - dried skin on front of legs
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13
Q

hyperthyroidism assessment- long ass list (see “hypo or hyper thyroid?” deck for matching style)

A 
• History
• Thermoregulation/ Heat intolerance
• High Heart Rate, High BP
• Breathing pattern
• Visual changes
• Fatigue
• Insomnia
• Irritability
• Menstruation change- amenorrhea 
• Libido, increase initially then decreases 
• -GRAVES- Exophthalmos - need lubricating drops, eye lids don't close all the way 
	◦ Lid Lag (Eyelid retraction)
	◦ Eye Lag (Globe lag)
• Thyroid --> don't palpate it!
	◦ Size 
	◦ Symmetry
• Presence of a bruit
• Increased SBP
• Widened Pulse Pressure
• Thinning hair/ fine, silky, soft
• Warm, smooth, moist skin
• Weak muscles
• Presence of a tremor
• Diarrhea 
• Increase appetite + weight loss
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14
Q

Diagnostics for Hyperthyroidism?

A 
Triiodothyronine T3
*Thyroxine T4
*Thyroid stimulating hormone TSH
TSH antibodies
Thyroid Scan
Ultrasound
Electrocardiography
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15
Q

What temp change are we monitoring for in hyperthyroidism?

A

• Fever- notify provider if temp increase 1 degree : s/s of thyroid storm

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16
Q

3 main medical interventions for hyperthyroidism

A 
• Pharmaceuticals
	◦ Methimazole- contact provider if you have a fever 
	◦ Propylthioracil
• *Radioactive Iodine Therapy
	◦ *Radiation Precautions (unsealed)
	◦ takes weeks to work 
	◦ can completely destroy the gland --> hypothyroidism --> life long thyroid replacement 
	◦ Not safe for pregnancy! 
• Surgery
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17
Q

nursing interventions for hyperthyroidism?

A

• Reduce Stimulation
• Promote comfort
-Monitor

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18
Q

how long does it take for radioactive iodine to work?

A

weeks!

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19
Q

considerations for patient with radioactive iodine therapy? (4)

A
  1. takes weeks to work
  2. Radiation precautions (unsealed)
  3. can completely destroy the gland –> hypothyroidism –> life long thyroid replacement
  4. Not safe for pregnancy!
20
Q

2 types of surgery for hyperthyroid - do you need hormone replacement with these?

A
  1. Subtotal Thyroidectomy- still get some t3/t4

2. Total Thyroidectomy- Requires Thyroid replacement therapy

21
Q

when do we consider doing thyroidectomy? (2)

A

when goiter places pressure on trachea

when medication is not effective

22
Q

before Dr. Shuli Archer can remove your thyroid what needs to happen first?

A

• need thyroid levels lowered before surgery so take radioactive iodine first/meds

23
Q

Postop care for thyroidectomy (2 main+ complications)

A 
• Monitor patient
• Assess and manage pain/comfort
• Potential Complications
	◦ Breathing problems
	◦ Bleeding
	◦ Thyroid Storm
	◦ Parathyroid injury (Calcium issues)
	◦ Laryngeal nerve damage
24
Q

What is a thyroid storm?

A
  • Thyroid crisis: Excessive thyroid hormone release

* Occurs with uncontrolled hyperthyroidism

25
Q

triggers for thyroid storm?

A 
• Triggers--STRESS
	◦ Surgery
	◦ Pregnancy
	◦ Infection
	◦ RAI
	◦ Physical manipulation of thyroid gland
26
Q

is a thyroid storm a big deal?

A

YES, FATAL if untreated!

27
Q

thyroid storm assessment (8)

A
  • Fever , 1 degree temp increase is sign of thyroid storm- report to provider
  • Tachycardia
  • Hypertension (systolic)
  • Abdominal Pain
  • Nausea/ Vomiting/ Diarrhea
  • Tremors
  • Anxiety
  • Seizures
28
Q

Thyroid storm management (interventions + meds)

A 
• ABC, protect airway, decrease BP/HR, cardiac monitor 
• Reduce Fever
	◦ Cooling blanket, Tylenol, ice packs
• Monitor Telemetry 
• Monitor VS’s Q 30 minutes
• Administer medications (methimazole, Propylthiouracil)
• Administer Sodium Iodide
• Administer propranolol
• Administer glucocorticoids
• Normal Saline due to dehydration

• patient treated in ICU

29
Q

what is hypothyroidism?

A

-reduced cellular metabolism

30
Q

Why do HYPOthyroid patients get myxedema?

A

• Decreased cellular energy –> Glycosaminoglycans (GAG) build up in all cells –> Increased GAG increases mucus and water in cell –> cellular edema called myxedema

(usually occurs on face/eyes)

31
Q

can you have a goiter w/ hypothyroidism- why or why not?

A

YES- If the thyroid is the problem then we get excessive amounts of TSH triggering thyroid to release T3, T4 , TSH builds up and causes goiter

32
Q

simple definition of myxedema?

A

mucous edema

mucous is such a gross word!!

33
Q

causes of hypothyroidism?

A
  • Thyroid Disease
  • Radioactive Iodine therapy –> destroys thyroid gland
  • More common in women
  • 30-50 years of age
34
Q

hypothyroidism assessment (long list- remember to see hypo/hyper thyroid matching deck!)

A
  • History
  • Activity- fatigue
  • Sleep Habits- increased sleep
  • Weakness
  • Anorexia
  • Muscle aches
  • Parasthesias
  • Cold Intolerance + low body temp
  • Constipation
  • Infertility
  • Decreased Libido
  • Not wanting to eat but gaining weight (low metabolism)
  • edema in eyes/ face
  • thickening of the tongue
  • depression
35
Q

monitor and assess for what sxs for hypothyroidism?

A
  • Decreased Blood Pressure - systolic should be >90
  • Bradycardia
  • Decreased Respirations/ Decreased Depth of breathing –> acidosis (CO2) , irritable then coma
  • Shock
  • Cardiovascular Disease
36
Q

interventions for hypothyroidism are aimed at

A

Optimizing…
• Gas Exchange
• Perfusion
• Cognition- change in mental status and depression

37
Q

community based interventions for hypothyroidism

A 
• Managed as outpatient unless they need Acute Care or Rehabilitation due to low heart rate or BP
• Drug therapy
	◦ Monitor for Therapy Effectiveness -- if too effective = HYPERthyroid 
	◦ Lifelong therapy
	◦ Signs of Hypo/Hyperthyroidism
• Adjustments to home environment
	◦ Rest
	◦ Medical Alert
	◦ Assistance
38
Q

if drug therapy for hypothyroidism is too effective it leads to….

A

hyperthyroidism!

39
Q

s/s of myxedema

A 
=Responsible for most of the physical attributes of hypothyroidism
• Non-pitting edema
	◦ Causes a thickened tongue /vocal chords- change speech ability 
	◦ All over body
	◦ Around eyes
	◦ Hands and feet swelling 
	◦ Fatty deposit Between shoulder blades
• Husky voice
40
Q

reduced metabolism from hypothyroidism leads to….

A

◦ Flabby heart muscle
◦ Increased heart chamber size
◦ Reduced perfusion to brain and organs

41
Q

what can trigger a myxedema coma?

A 
◦ Acute illness
	◦ Surgery               
	◦ Chemotherapy
	◦ Sedation 
	◦ Stopping replacement therapy
42
Q

is a myxedema coma hypo to hyper thyroid?

A

hypo!

43
Q

what things can get our of whack w/ myxedema coma?

A

◦ Respiratory Failure
◦ Hypotension
◦ Hyponatremia

44
Q

Myxedema coma is emergent situation- what ya gonna go?

A 
◦ ABC
	◦ ICU
	◦ IV administration of Thyroid Hormone 
	◦ IV cortisol
	◦ IV fluids
	◦ Hyperthermia (heating blanket)
	◦ Electrolyte replacement
45
Q

good job! joke time: Have you seen the new movie called “Constipation”?

A

No? Well, it hasn’t come out yet….

kol- Med Surg 320 Spring (43 decks)

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