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From Flashcardlet > (2) Exam 2- Thyroid Gland > Flashcards

(2) Exam 2- Thyroid Gland Flashcards

0
Q

What is a goiter

A

An enlarged thyroid gland

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1
Q

What thyroid hormones regulate energy metabolism and growth and development

A

T3 and T4

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2
Q

What is the most common cause of a goiter worldwide

A

Lack of iodine in the diet

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3
Q

In a person with a goiter, what levels are measured to determine whether a goiter is associated with normal thyroid function, hyperthyroidism, or hypothyroidism

A

TSH and T4

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4
Q

Thyroiditis is an inflammation of the thyroid gland and is a frequent cause of

A

Goiter

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5
Q

Subacute Grandulomatous thyroiditis is thought to be caused by

A

Viral infections

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6
Q

Acute thyroiditis is caused by

A

Bacterial and fungal infections

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7
Q

Hashimoto’s thyroiditis destroys thyroid tissue by antibodies and results in

A

Hypothyroidism

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8
Q

What is the hallmark of Hashimoto’s thyroiditis

A

Goiter

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9
Q

Silent, painless thyroiditis occurs in postpartum women and is usually seen in what timeframe after delivery

A

In the first six months

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10
Q

The patient with Hashimoto’s thyroiditis is at risk for

A

Other autoimmune diseases

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11
Q

What is the most common form of hyperthyroidism

A

Graves disease

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12
Q

Graves disease is characterized by

A

Thyroid enlargement and excessive thyroid hormone secretion

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13
Q

What is the classic finding and graves disease

A

Exophthalmos

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14
Q

What is Exophthalmos

A

Protrusion of the eyeballs from the orbits that is usually bilateral

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15
Q

When they eyelids do not close completely what are potential serious consequences

A

Corneal ulcers, loss of vision, muscle weakness, diplopia

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16
Q

What is it called when an excessive amount of thyroid hormones are released into the circulation and is considered a life-threatening emergency

A

Thyrotoxicosis (thyroid storm)

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17
Q

What patients are particularly prone to thyrotoxicosis

A

Those having a thyroidectomy since manipulation of the hyperactive thyroid gland result in an increase in hormones released

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18
Q

What are the manifestations of thyrotoxicosis

A

Severe tachycardia, heart failure, shock, hyperthermia (up to 105.3°), seizures, abdominal pain, vomiting, delirium, and coma

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19
Q

What are the two primary laboratory findings used to confirm the diagnosis of hyperthyroidism

A

Decreased TSH levels and increased T4 levels

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20
Q

The RAIU test is used to

A

Differentiate graves disease from other forms of thyroiditis

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21
Q

Clinical manifestations related to appetite and weight in patients with hyperthyroidism

A

Increased appetite and decreased weight

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22
Q

What three hormones are produced by the thyroid

A

T3, T4, calcitonin

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23
Q

Cardiovascular manifestations in patient with hyperthyroidism

A

Increased vital signs, arrhythmias, bounding Pauls, murmurs, angina

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24
Q

GI manifestations and patient with hyperthyroidism

A

Weight loss, increased appetite, thirst, diarrhea, changes in liver and spleen

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25
Q

Manifestations of skin and patient with hyperthyroidism

A

Warm, smooth, moist, brittle nails, clubbing, hair loss, sweating, vitiligo

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26
Q

Heat intolerance is found in patients with

A

Hyperthyroidism

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27
Q

Psychosocial manifestations and patient with hyperthyroidism

A

Nervousness, irritability, exhaustion, inability to concentrate

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28
Q

Management of patient with thyrotoxicosis

A

Reduce circulating hormone

Man is respiratory and cardiac distress

Decrease fever

Replace fluids

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29
Q

What type of drugs are used in the treatment of hyperthyroidism

A

Anti-thyroid drugs, iodine, and B – adrenergic blockers

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30
Q

What are the first line antithyroid drugs

A

Pylthiouracil (PTU) and Methimazole (tapazole)

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31
Q

How long is drug therapy continued for patients with hyperthyroidism

A

6 to 15 months

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32
Q

What are B – Adrenergic blockers used for in patients with hyperthyroidism

A

Symptomatic relief of thyrotoxicosis

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33
Q

What is the treatment of choice for most nonpregnant adults with hyperthyroidism

A

Radioactive iodine therapy (RAI)

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34
Q

Radioactive iodine therapy has a delayed response, and the maximum effect may not be seen for up to

A

Three months

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35
Q

Although radioactive iodine therapy is usually effective, it has a high incidence of post treatment

A

Hypothyroidism and results in the need for lifelong thyroid hormone therapy

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36
Q

A pregnancy test is done before initiation of radioactive iodine therapy on all women who experience

A

Menstrual cycles

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37
Q

To limit radiation exposure to others what instructions should you give the patient receiving radioactive iodine therapy

A

use private toilet facilities and flush two or three times

Separately longer towels, bed linens, enclosed daily at home

Not preparing food for others that require prolonged handling with bare hands

Avoid being close to pregnant women or children for seven days after therapy

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38
Q

Thyroidectomy is indicated for individuals who have

A

A large goiter causing tracheal compression

Has been unresponsive to anti-thyroid therapy

Thyroid cancer

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39
Q

What is an advantage that thyroidectomy has over radioactive iodine therapy

A

More rapid reduction and T3 and T4 levels

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40
Q

What is often the preferred surgical procedure involves the removal of a significant portion (90%) of the thyroid gland

A

Subtotal thyroidectomy

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41
Q

Nutritional therapy and diet for hyperthyroidism

A

High calorie (4000 to 5000 cal/day)

Six full meals a day

Snacks high in proteins, carbohydrates, minerals, and vitamins

Avoid highly seasoned and high fiber foods

Avoid caffeine containing liquids

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42
Q

What does propylthiouracil do

A

Inhibit synthesis of thyroid hormones

Most common med

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43
Q

What does iodine therapy do

A

Inhibit synthesis of T3 and T4

Reduces vascularity of gland

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44
Q

If thyroiditis stays inflamed it eventually becomes

A

Hypothyroidism

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45
Q

What are the overall goals for patients with hyperthyroidism

A

Relief of symptoms

Have no serious complications related to the disease or treatment

Maintain nutritional balance

Cooperate with the therapeutic plan

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46
Q

Priority Interventions for acute thyroidtoxicosis

A

Marcher for cardiac dysrhythmias and decompensation, ensuring adequate oxygen, and administering IV fluids

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47
Q

Interventions to increase patient comfort with acute thyrotoxicosis

A

Calm quiet room

Change linens frequently

Encourage and assist with exercise to allow release of nervous tension

Dark glasses

Lightly tape eyelids shut for sleep if they cannot be closed

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48
Q

What may be administered before thyroid surgery

A

Anti-thyroid drugs, b-adrenergic blockers, and iodine

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49
Q

What are the signs of iodine toxicity

A

Swelling of the buccal mucosa

Excessive salivation

Nausea and vomiting

Skin reactions

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50
Q

What may be difficult for a short time after thyroid surgery

A

Talking

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51
Q

What are the postoperative complications of thyroid surgery

A

Hypothyroidism, hypoparathyroidism, hypocalcemia, hemorrhage, thyrotoxicosis, and infection

52
Q

What should be kept readily available in the patient’s room after thyroid surgery

A

Calcium gluconate, Oxygen, suction equipment, and a tracheostomy tray

53
Q

In the incidents where the parathyroid glands are removed or damaged during surgery and leads to hypocalcemia, what is kept at bedside and used to treat tetany

A

IV calcium salts (calcium gluconate)

54
Q

Interventions after a thyroidectomy

A

Assess VS Q2 x 24 hours for signs of hemorrhage or tracheal compression (laryngeal strider)

Semi Fowler’s position and support head with pillows

Monitor vital signs and calcium levels (trousseaus and chvosteks sign)

Expect some hoarseness for three or four days

Control pain by getting meds

55
Q

If postoperative recovery of a thyroidectomy is uneventful, the patient will

A

Ambulate within hours after surgery

Take fluid as soon as tolerated

Eat a soft diet the day after surgery

56
Q

Discharge teachings after a thyroidectomy

A

The administration of thyroid hormone is avoided

Avoid high environmental temperatures

See the healthcare provider biweekly for a month and then at least semi annually

Hypothyroidism is relatively easy to manage with oral administration of thyroid replacement

57
Q

What is hypothyroidism

A

And efficient see if thyroid hormone that causes a general slowing of the metabolic rate

58
Q

What causes primary hypothyroidism

A

Destruction of thyroid tissue or defective hormone synthesis

59
Q

What causes secondary hypothyroidism

A

Pituitary disease with decreased TSH secretion

60
Q

What is the most common cause of hypothyroidism worldwide

A

Iodine deficiency

61
Q

What is the most common cause of hypothyroidism in the United States

A

Atrophy of the thyroid gland

62
Q

Atrophy of the thyroid gland is the end result of what auto immune diseases

A

Hashimoto’s thyroiditis or Graves disease

63
Q

What drugs can cause hypothyroidism

A

Lithium (blocks hormone production)

Cordarone (contains iodine)

64
Q

Assessment findings of hypothyroidism

A

Fatigue, lethargic, personality and mental changes, slowed speech, weight gain, shortness of breath, somnolence, myxedema, bruise easily

65
Q

Clinical manifestations of hypothyroidism

A

Decreased cardiac output it, anemia, cobalamin deficiency, and efficiency, folate deficiency, increased cholesterol and triglyceride levels

66
Q

What are the clinical manifestations of myxedema and why does it occur

A

Puffiness, facial and periorbital edema, and a mask like affect.

It occurs due to the accumulation of hydrophilic mucopolysaccharides

67
Q

Typical manifestations of hypothyroidism and older adults (fatigue, cold and dry skin, hoarseness, hair loss, constipation, and cold intolerance) may be attributed to

A

Normal aging

68
Q

What is a complication of hypothyroidism and is considered a medical emergency

A

Myxedema

69
Q

What is Myxedema is precipitated by

A

Infection, drugs (see opioids, tranquilizers, and barbiturates), exposure to cold, and trauma.

70
Q

What must be done for a patient to survive Myxedema

A

Vital functions must be supported and IV thyroid hormone replacement administered

71
Q

What is the most common and reliable laboratory test to diagnose hypothyroidism

A

Increased TSH and decreased T4

TSH is high when the defect is in the thyroid in low when it is in the pituitary or the hypothalamus

72
Q

What are other abnormal laboratory findings for hypothyroidism

A

Elevated cholesterol and triglycerides, anemia, and increased creatine kinase

73
Q

What is the treatment goal for a patient with hypothyroidism

A

Safe and rapid hormone replacement therapy

74
Q

What is the drug of choice for hypothyroidism

A

Synthroid (levothyroxine)

75
Q

When thyroid hormone therapy is initiated, the initial doses are low to avoid

A

Increase and resting heart rate and BP

76
Q

In a patient without side effects, what intervals is the dose of Synthroid increased at

A

4 to 6 weeks intervals

77
Q

What are the drug alerts for Synthroid toxicity

A

Monster patients with cardiovascular disease

Report pulse greater than 100 or irregular heartbeat

Report chest pain, weight loss, nervousness, tremors, or insomnia

78
Q

What are the common causes of myxedema

A

Radiotherapy, deficiency of iodine and destruction of the thyroid gland

79
Q

What individuals are at high risk for hypothyroidism

A

There was with a family history of thyroid disease, history of neck radiation, women over 50, and postpartum women

80
Q

Interventions for myxedema coma

A

Mechanical respiratory support and cardiac monitoring

Edmester thyroid hormone therapy and all other medications IV

Position changes and low pressure mattress

Monitor vital signs, bodyweight, fluid intake and output, and visible edema

81
Q

With treatment, energy level and mental alertness and Myxedema should increase within how many days

A

2 to 14 days

82
Q

Patient teaching for hypothyroidism upon discharge

A

Provide written instructions, repeat the information often, and assess the patient’s comprehension level

Teach manifestations of overdose

83
Q

What are the manifestations of overdose

A

Orthopnea, dyspnea, rapid pulse, palpitations, chest pain, nervousness, or insomnia

84
Q

What is a thyroid nodule

A

Growth in the thyroid gland

85
Q

Benign nodules are usually not dangerous, but they can cause

A

Tracheal compression

86
Q

What is the most common form of an endocrine system cancer

A

Thyroid cancer

87
Q

What is the most common type of thyroid cancer

A

Papillary thyroid cancer

88
Q

What is the most advanced and aggressive thyroid cancer

A

Anaplastic thyroid cancer

89
Q

What is the primary manifestation of thyroid cancer

A

Painless, palpable nodule or nodules in an enlarge thyroid gland

90
Q

Tumors that take up radioactive iodine are called

A

Hot nodules

91
Q

If the nodule does not take up radioactive iodine, it appears as “cold” and has a higher risk of

A

Being malignant

92
Q

Multiple endocrine neoplasia is an inherited condition caused by

A

The mutation of one or two genes

93
Q

What is hyperparathyroidism

A

Condition involving an increased secretion of parathyroid hormone (PTH)

94
Q

What does PTH help regulate

A

Serum calcium and phosphate levels

95
Q

What are normal calcium ranges

A

8.5 to 10.5

96
Q

What is the calcium level for hyperparathyroidism?

A

> 10.5

97
Q

What is primary hyperparathyroidism do to

A

And increase secretion of PTH leading to disorders of calcium, phosphate, and bone metabolism

98
Q

Tertiary hyperparathyroidism is seen in patients who have had

A

A kidney transplant after a long period of dialysis treatment for chronic kidney disease

99
Q

Assessment findings for hyperparathyroidism

A

Weakness, loss of appetite, constipation, fatigue, emotional disorders, and shortened attention span

100
Q

Clinical manifestations of hyperparathyroidism

A

Osteoporosis, fractures, kidney stones, renal failure, pancreatitis, cardiac changes, and long bone, rib, and vertebral fractures

101
Q

Diagnostic studies for hyperparathyroidism

A

PTH levels are elevated

Serum calcium levels elevated (exceed 10 mg)

Serum phosphorus level is usually <3 mg

102
Q

What screening maybe used for bone density measurements to detect bone loss

A

DEXA

103
Q

What is the most effective treatment of primary and secondary hyperparathyroidism

A

Surgery- removal of parathyroid

104
Q

Parathyroidectomy leads to rapid reduction of what serum levels

A

High calcium

105
Q

What are the major postoperative complications with a parathyroidectomy

A

Hemorrhage, fluid and electrolyte disturbances, and tetany

106
Q

What is given if tetany become severe

A

IV calcium

107
Q

Interventions after parathyroidectomy

A

Monitor I&O

Assess calcium, potassium, phosphate, magnesium levels, and chvosteks and Triusseaus signs

Encourage mobility

108
Q

Discharge teaching for patient with hyperparathyroidism

A

Meal plan

Exercise program

Signs and symptoms of hypo and hypercalcemia

109
Q

Hypoparathyroidism is characterized by hypocalcemia resulting from a lack of

A

PTH

110
Q

What is the most common cause of hypoparathyroidism

A

Iatrogenic (relating to illness caused by medical examination or treatment)

111
Q

Clinical manifestations of hypoparathyroidism

A

Tetany (sudden decrease in calcium)

lethargy, anxiety, and personality changes may occur

112
Q

Laboratory findings with hypoparathyroidism

A

Decreased serum calcium

Decreased PTH levels

Increased serum phosphate levels

113
Q

Emergency treatment of tetany after surgery requires the administration of

A

IV calcium

114
Q

At what rate is IV calcium chloride, calcium gluconate, or calcium gluceptate given

A

Slowly

115
Q

Because high serum calcium blood levels can cause hypotension, serious cardiac dysrhythmias, or cardiac arrest; what is used for monitoring during calcium administration

A

ECG

116
Q

IV calcium chloride can cause Venus irritation and inflammation, and extravasation may cause

A

Cellulitis, necrosis, and tissue sloughing

117
Q

To temporarily relieve the manifestations of hypocalcemia, instructed patient to

A

Breathe in and out of a paper bag or breathing mask

118
Q

A patient with hypoparathyroidism needs how many grams per day in divided doses of oral calcium supplement

A

1.5 to 3 g per day

119
Q

What high calcium foods would be included in the meal plan for a patient with hypoparathyroidism

A

Dark green vegetables, soybeans, and tofu

120
Q

What foods should you instruct the patient with hypoparathyroidism to avoid

A

Foods containing oxalic acid (spinach, rhubarb) because they inhibit the absorption of calcium

121
Q

Upon discharge of a patient with hypoparathyroidism how often should there calcium levels be monitored

A

Three or four times a year

122
Q

What type of dairy products may be consumed if patient is lactose intolerant

A

Aged cheese and some yogurts

123
Q

How does the parathyroid hormone regulate serum calcium and phosphate levels

A

Stimulating bone reabsorption of calcium

Renal reabsorption of calcium

Activation of vitamin D

Decrease phosphorus

124
Q

What do you need to remember about the relationship between calcium and phosphorus

A

It’s inverse

125
Q

What drug is used for hyperparathyroidism

A

Biphosphates

126
Q

Serum calcium and phosphate levels for hypoparathyroidism

A

Calcium <8.6

Phosphate >4.4

127
Q

For a thyroid test what allergy do you want to ask about due to iodine

A

Seafood

128
Q

Hypoparathyroidism is usually seen as a result from

A

Treatment of hyperparathyroidism

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