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Advanced Hypothyroidism

- depressed respirations (hypoxia, hypercapnia)
- decreased cardiac output
- cerebral hypoxia
- lethargy, stupor, coma
- hypothermia
- bradycardia, hypotension
- hyponatremia
- edema that is mutinous, rather than water

synthetic thyroid replacements


myxedema coma

long term untreated hypothyroidism. life-threatening condition that occurs when hypothyroidism is untreated or when a stressor (such as an infection, heart failure, stroke, or surgery), affects an individual who hs hypothyroidism.


diabetes insipidus

a disease that results from underproduction of ADH



The syndrome of inappropriate antidiuretic hormone (SIADH) involves the excessive secretion of ADH. Clients with SIADH cannot excrete dilute urine. Fluid retention and ultimately water intoxication occur, along with sodium deficiency. SIADH can result from central nervous system (CNS) disorders, chemotherapy, ADH production by some cancers, and overuse of vasopressin therapy.


graves disease

An immune system disorder of the butterfly-shaped gland in the throat (thyroid).

The thyroid overproduces hormones. The condition is more common in women under age 40.
Symptoms include anxiety, hand tremor, heat sensitivity, weight loss, puffy eyes and enlarged thyroid.
Treatment includes medications. Sometimes the thyroid is removed.


cushing's disease

caused by an oversecrsetion of the adrenal cortex

A condition that occurs from exposure to high cortisol levels for a long time.

weight gain in midsection, small peripherals


cushion's syndrome

(hyperadrenalism) results from overproduction of hormones secreted by the adrenal cortex. It can also result from overuse of corticosteroids or tumors of the adrenal glands or the pituitary.

Fat distribution is abnormal. The face is rounded (“moon face”), the abdomen is heavy and hangs down, and the arms and legs are thin. There is a noted fat pad in the neck and supraclavicular area sometimes referred to as a “buffalo hump.”

hypokalemia present



a tumor, usually benign, that originates in the adrenal medulla. A tumor of the adrenal medulla increases secretion of the hormones epinephrine and norepinephrine, which in turn causes extreme hypertension, tremor, headache, nausea and vomiting, dizziness, and increased urination. Treatment is surgical removal of the tumor—a dangerous operation because it may cause sudden and extreme changes in blood pressure.


thyroid storm/crisis

Thyroid storm is a life-threatening health condition that is associated with untreated or undertreated hyperthyroidism. During thyroid storm, an individual’s heart rate, blood pressure, and body temperature can soar to dangerously high levels. Without prompt, aggressive treatment, thyroid storm is often fatal.


hashimotos thyroiditis

is hypothyroidism believed to be autoimmune in origin. It is of the type of autoimmune disorders known as organ specific because the body builds up antibodies against thyroid tissue only.



a generalized continuous muscle spasm of the entire body. It is most often caused by accidental removal of the parathyroid glands during thyroidectomy.
Chvostek’s sign (abnormal spasm of the facial muscles in response to light taps on the facial nerve) and Trousseau’s sign (wrist spasm with BP cuff)



enlarged thyroid gland, but no symptoms of T4 deficiency are there.


Addison's disease

A disorder in which the adrenal glands don't produce enough hormones.

Specifically, the adrenal glands produce insufficient amounts of the hormone cortisol and sometimes aldosterone, too. When the body is under stress (e.g. fighting an infection), this deficiency of cortisol can result in a life threatening Addisonian crisis characterized by low blood pressure.
Symptoms tend to be non-specific and include fatigue, nausea, darkening of the skin, and dizziness upon standing.
Treatment involves taking hormones to replace those not produced by the adrenal glands.


addisonian crisis

serious medical emergency caused by extremely low levels of cortisol. Cortisol is an important hormone produced by the adrenal glands and is normally released as part of the body's response to stress. People with Addison's disease are at the greatest risk of developing an Addisonian crisis



A disorder in adults in which the pituitary gland produces too much growth hormone.

Acromegaly is usually caused by a noncancerous tumor. Middle-aged adults are most commonly affected.
Symptoms include enlargement of the face, hands, and feet.
Prompt treatment is needed to avoid serious illness. Drugs can reduce the effects of growth hormone. If needed, surgery and radiation may be used to remove tumor cells.


kidney stones

A small, hard deposit that forms in the kidneys and is often painful when passed.

The most common symptom is severe pain, usually in the side of the abdomen, that's often associated with nausea.
Treatment includes pain relievers and drinking lots of water to help pass the stone. Medical procedures may be needed to remove or break up larger stones.



clinical syndrome caused by excessive circulating thyroid hormone. Thyroid hormone exaggerates normal body functions and produces a hyper metabolic state and increased sympathetic nervous system



condition in which there is an inadequate amount of circulating thyroid hormones T3 and T4 causing a decrease in metabolic rate that affects all body systems



stems from an excess of PTH that causes blood calcium levels to rise, resulting in calcium depletion in bones (osteomalacia). Bones become soft and weak, leading to skeletal tenderness. They tend to break easily.

The skull may enlarge. Muscles weaken, and the client complains of fatigue, nausea, and constipation. Kidney stones, urinary tract infections, and uremia may develop. The person may become disoriented and paranoid and may lose consciousness. This condition may be secondary to chronic nephritis.



the deficiency of PTH, results from lowered production of the hormone, with a consequent reduction in the amount of calcium available to the body and an accumulation of phosphorus in the blood. Accidental removal of the parathyroid glands during a thyroidectomy may cause hypoparathyroidism.



aka cushing syndrome


acute adrenal insufficiency

also known as an acute adrenal crisis.

People who have a condition called Addison's disease or who have damaged adrenal glands may not be able to produce enough cortisol. Low levels of cortisol can cause weakness, fatigue, and low blood pressure.


pituitary adenoma

Noncancerous tumors in the pituitary gland that don't spread beyond the skull.

The pituitary gland is in the skull, below the brain and above the nasal passages. A large tumor can press upon and damage the brain and nerves.
Vision changes or headaches are symptoms. In some cases, hormones can also be affected, interfering with menstrual cycles and causing sexual dysfunction.
Treatments include surgery and medications to block excess hormone production or shrink the tumor. In some cases, radiation may also be used.


normal ranges for adult
Blood Sugar

Temp: 96.8 - 101.3
Pulse: 60 - 100 BPM
Resp: 12 - 20 RPM
BP: 90/60 ,<120/<80, 139/89

Blood Sugar: 70 - 110 ATI


vasopressin (pitressin)



demeclocycline (declomycin)


monitor I and O


levothyroxine (synthroid)

thyroid hormone replacement therapy
-- increases effects of warfarin and increases need for insulin and digoxin
-- meds that decrease levothyroxine - cimetidine, lasoprazole, and colestipol

- use caution with older clients and those who have CAD to avoid coronary ischemia. start with low doses
- monitor cardiovascular compromise

- tx begins slowly and is increased every 2-3 weeks until desired response is obtained
- serum TSH is monitored
- take on an empty stomach 1-2 hours before
- fiber supplements, calcium, iron, and antacids interfere with absorption


spironolactone (aldactone)

- Aldosterone antagonist
- Potassium-sparing diuretic
- Used when bilateral adrenal hyperplasia is the underlying case

Monitor electrolytes (sodium and potassium), vital signs and weight

- take with food to promote absorption
- restrict high potassium intake
- use NO salt substitutes
- report indications of hyperkalemia
- report menstrual changes


prednisone (deltasone)


adrenocorticoid replacement for adrenal insufficiency

- monitor weight, BP, and electrolytes
- increase dosage during periods of stress or illness
- tape if d/c'ing
- take with food

- take as directed
- report symptoms of cushing's syndrome (round face, edema, weight gain)
- report symptoms (fever, fatigue, muscle weakness, anorexia)


calcium chloride (IV route)

calcium supplemento