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Med Surg 2 > 49 - Thyroid + Parathyroid > Flashcards

49 - Thyroid + Parathyroid Flashcards

(58 cards)

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1
Q

goiter

A

enlarged thyroid gland

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2
Q

goiter is caused by

A
  • hyperthyroid
  • hypothyroid
  • lack of iodine
  • nodules
  • goitrenogens
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3
Q

if goiter enlargens rapidly…

A

it may compress trachea or laryngeal nerves

-changes voice + affects breahting

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4
Q

most common cause of hyperthyroid

A

Grave’s disease

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5
Q

possible causes of hyperthyroid

A
  • toxic nodular goiter
  • thyroiditis
  • excess iodine
  • pituitary tumors
  • thyroid cancer
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6
Q

subclinical hyperthyroidism

A

TSH< 0.4

T4/T3 is norm range

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7
Q

over hyperthryoidism

A

low TSH

high T3/T4

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8
Q

Graves’ Disease

A

autoimmune> antibodies TSI binds w TSH receptors

  • thyroid enlargement
  • secretes TSI which is unregulated hormone that causes a nonstop secretion of T3/T4
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9
Q

Grave’s Diseases causes

A
  • low iodine
  • smoking
  • infection
  • stressful life events
  • genetic factors
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10
Q

auscultating the hyperthyroid thyroid gland may reveal…

A

bruits

-increased blood supply

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11
Q

exophtalmus

A
  • hyperthyroid
  • protrusion of eyes
  • incr fat deposits + fluids
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12
Q

acropachy

A

clubbing of digits

-advanced hyperthyroid

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13
Q

manifestations of hyperthyroid

A
  • palpitations
  • tremors
  • wt loss
  • restless
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14
Q

acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm

A
  • life threatening but rarely death if treated early

- usually results fr stressors (infection, trauma, surgery like thyroidectomy)

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15
Q

acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm

manifestations

A
  • severe tachycardia
  • HF
  • shock
  • hyperthermia (106f+)
  • delirium
  • seizure
  • ab pain
  • vomit
  • diarrhea
  • coma
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16
Q

diagnostics for hyperthyroid

A

low TSH + high T3/T4

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17
Q

free vs bound

A

bound means attached to protein

free is active form

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18
Q

radioactive iodine uptake [RAIU] test

A

distinguish bw Grave’s + other thyroiditis

Graves: 35-95% uptake
others: less than 2% uptake

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19
Q

drug therapy for hyperthyroid

A
  • antithyroid: PTU + methimazole
  • iodine
  • beta blockes
  • none cure it tho*
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20
Q

first line anti thyroid drugs

A

propylthiouracil + methimazole

-inhibit thyroid synth

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21
Q

which antithyroid med for pregnancy

A

propylthiouracil

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22
Q

propylthiouracil indication

A
  • first line for THYROTOXICOSIS
  • FASTer resuls than others
  • 1st trimester
  • a/e w methimazole
  • need rapid reduction
  • need to be euthyroid for surgery
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23
Q

propylthiouracil action

A

blocks conversion of T4 to T3

**must be taken 3x a day

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24
Q

iodine action

Study These Flashcards
A

large doses inhibits synth of T3 + T4

  • blocks release into circulation
  • decreases vascularity of thyroid»> makes surgery safer + easier
25
iodine teaching
- mix w water/juice - AFTER meals - sip w straw
26
iodine toxicity
- swelling of buccal mucosa - excess salivation - n/v - skin rxn ***STOP + notify HCP**
27
radioactive iodine [RAI]
- tx of choice for nonpregnant - damages + destroys thyroid tissue - takes 3 months for effects
28
radiation thyroiditis + parotitis teaching
- frequent sips of water - ice chips - salt + baking soda gargle - antacid, diphenhydramine, lidocaine for swish + spit
29
RAI home teaching
- pricate toiler - flush 2-3x - separate laundry - dont prep food for others - stay away fr pregnant + kids
30
preferred surgery for hyperthyroid
subtotal thyroidectory | -remvoes 90% of thyroid
31
nutrition for hyperthyroid
high cal diet (4k-5k cals) - 6 full meals - snacks high in protein, cabs, minerals, vitamins - protein intake 1-2g/kg * *avoid high fiber * *avoid high seasoned * *avoid caffeine
32
is exercise good for hyperthyroid?
yes assist w exercise involving LARGE muscle groups - release of nervous tension + restlessness - tremors interfere w sml muscles
33
exophthalmos teaching
- artificial tears - restrict salt - elevate head - take them shut for sleep - exercise intraocular muscles several times w ROM
34
postop care
- support head manually while turning to minimize stress on suture - monitor O2 - keep suction + tracheostomy nearby - monitor signs of hypo-Ca (if parathyroid was removed)
35
complications
- hypothyroid - thyrotoxicosis - laryngeal nerve damage> vocal cord paralysis> spastic airway - hypo-Ca> tetany - excess swelling in neck, hemorrhage, or hematoma can make resp difficult - laryngeal stridor (harsh vibratory sound)
36
do you give thyroid hormone after a thyroidectomy?
avoided bc exogenous hormones inhibits pituitary production of TSH -delays the restoration of normal gland function + tissue regeneration
37
discharge
- reduce caloric intake - adequate iodine intake (seafood or iodized salt) - avoid high temperatures bc inhibit thyroid regeneration
38
acute thyrotoxicosis aka thyrotoxic crisis aka thyroid storm interventions
- VS Q30 min - continuous O2 + ECG monitoring - assess for manifestations of HF or pulmo edema (extra hrt sound, adventitious lung sound) - lower temp, acetaminophen drugs: beta blockers, antithyroid, iodine, glucocorticoids
39
subclinical hypothyroid
TSH>4.5 | T4 levels are normal
40
overt hypothyroid
high TSH | low T3/T4
41
nonthyroidal illness ysndrom NTIS
low TSH | low T3/T4
42
primary vs secondary hypothyroidism
P: destruction of thyroid tissue or defective hormone synth S: pituitary disease w decr TSHm or hypothalamic dysfunction w low TRH
43
most common causes of hypothyroid
- hashimoto | - low iodine
44
Hashimoto's thyroiditis
autoimmune | -atrophy of thyroid gland
45
cretinism
hypothyroid in infancy
46
hypothyroid manifestations
- decr cardiac contractility - decr CO - high cholesterol - low exercise tolerance/SOB - accumulation of mucopolysaccharides> atherosclerosis
47
myxedema
severe long standing hypothyroid - from accumulation of mucopolysaccharides in dermis + tissues - puffy face + periorbital edema
48
accumulation of mucopolysaccharides in hypothyroid causes...
- atherosclerosis | - myxedema
49
myxedema coma
- medical emergency | - cardiovasc collapse fr hypoventilation, hypo-Na, hypoglycemia, lactic acidosis
50
myxedema coma | caused by..
- illness - infection - drugs (esp opioids, tranquilizers, barbs) - exposure to cold - trauma
51
serum TSH helps determine...
cause of hypothyroidism - high> defect in thyroid - low> defect in pituitary/hypothalamus
52
drug therapy for hypothyroid
LEVOthyroxine
53
levothyroxine teaching
- low dose to avoid incr in resting HR + BP - monitor w CVD - monitor HR or pulse greater than 100 - report chest pain, wt loss, nervous, tremor, insomnia - 1-3 wks to take effect - lifelong - take in AM before food
54
thyroid therapies given via...
IV bc severe gastric hypomotility prevents absorption
55
hypothyroid teaching
- take levo in morning before meals - dont switch brands - warm place - use soap sparingly, always use lotion - avoid sedatives - incr activity - incr fiber - stool softeners - avoid enema> vagus nerve stimulation
56
parathyroid hormone
regulates calcium + phosphate levels (inversely) | -by bone reabsorption of Ca + renal absorption of Ca, + activation of vitamin D
57
hyper PTH
- high Ca> renal calculi, osteoporosis, decr muscle tone | - low Ph
58
hypo PTH
- low Ca> muscle cramps, low CO, ab cramps | - high Ph

Med Surg 2 (13 decks)

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