Final Exam: Disorders of the Thyroid Gland (Unit 11) Flashcards
1
Q
The Thyroid produces what 3 hormones ?
A
- Thyroxine (T4)
- Triiodothyrone (T3)
- Calcitonin
2
Q
90% of hormone secreted by the Thyroid is what ?
A
Thyroxine (T4)
3
Q
Which Thyroid hormone is more potent, T3 or T4 ?
A
T3
4
Q
The Thyroid gland works in what type of feedback loop ?
A
Negative
5
Q
When circulating levels of thyroid hormone are low, _______ (_________ _______________ __________) is released by the hypothalamus ?
A
TRH (Thyrotropin releasing hormone)
6
Q
When TRH is released by the hypothalamus, it causes what ?
A
causes TSH (thyroid stimulating hormone) to be released by the anterior pituitary gland)
7
Q
TSH stimulates the production and release of what ?
A
T3 and T4 in the thyroid
8
Q
Where is TSH produced ?
A
Anterior pituitary gland
9
Q
Thyroid cells are stimulated to grow, which may result in what ?
A
Overactive (hyperthyroidism) or Underactive (hypothyroidism) thyroid
10
Q
The most common cause of Thyroid issues worldwide is what ?
A
Lack of iodine in the diet
11
Q
In the US what is the most common cause of thyroid issues ?
A
Over or under production of thyroid hormones or nodules that develop
12
Q
What is a Goiter ?
A
Enlargement of the Thyroid
13
Q
_____ & ____ levels are measured to determine whether a goiter is associated with hyperthyroidism, hypothyroidism, or normal thyroid function ?
A
TSH & T4
14
Q
Thyroid __________ are measured to assess for thyroiditis (inflammation of the thyroid) ?
A
Antibodies
15
Q
What is the Tx for Goiters to prevent further enlargement ?
A
Tx with thyroid hormones
16
Q
What is the Tx for large Goiters ?
A
Surgery
17
Q
What is Levothyroxine ?
A
Synthetic thyroid hormone
18
Q
Thyroid nodules may be _______ (95%) or __________ ?
A
Benign (95%) or Malignant
19
Q
Most thyroid cancers are what ?
A
Treatable
20
Q
What is a Sign of Thyroid Cancer ?
A
Presences of painless, palpable nodule(s) in an enlarged thyroid gland
21
Q
Thyroid cancer can metastasize to what ?
A
cervical nodes, and obstruct trachea
22
Q
What are s/s of an enlarged thyroid gland ?
A
- Changes in voice (increased Hoarseness)
- Difficulty swallowing
23
Q
What is the best diagnostic test to test for Malignant Thyroid cancer ?
A
Ultrasound-guided fine-needle aspiration
24
Q
What is the Tx for Thyroid nodules and cancer ?
A
- Radiation
- Partial or total thyroidectomy
25
What Is Thyroiditis ?
Inflammation of the thyroid gland
26
Acute thyroiditis is due to what type of infections ?
Bacterial or Fungal infections
27
Subacute granulomatous thyroiditis is thought to be cause by what type of infection ?
Viral infection
28
What is another name for Chronic autoimmune thyroiditis ?
Hashimoto's thyroiditis
29
What is Hashimoto's thyroiditis ?
Thyroid tissue is replaced by lymphocytes and fibrous (scar) tissue
30
Recovery from thyroiditis (viral, bacterial, fungal) usually occurs when ?
within weeks to months
31
Acute thyroiditis caused by bacteria can be treated how ?
with Antibiotics
32
How can subacute thyroiditis (viral) be treated ?
NSAIDS
33
Myxedema coma falls under what type thyroid dysfunction ?
Hypothyroidism
34
Thyroid storm falls under what thyroid dysfunction ?
Hyperthyroidism
35
________________: A sustained increase in synthesis and release of thyroid hormones by the thyroid gland ?
Hyperthyroidism
36
Hyperthyroidism occurs most frequently in who ?
Women
| highest frequency in 20 to 40 year olds
37
What is the most common form of Hyperthyroidism ?
Grave's disease
38
What are other causes of Hyperthyroidism ?
- Thyroiditis
- Toxic nodular goiter
- Exogenous iodine excess
- pituitary tumors
- Thyroid cancer
39
What is another name for Thyrotoxicosis ?
Thyroid storm
40
What does Thyrotoxicosis (AKA: thyroid storm) result from ?
excess circulating levels of T3, T4, or both
41
_______________ and ________________ occur together in Grave's disease ?
Hyperthyroidism and thyrotoxicosis
42
Grave's disease is characterized by what ?
- Diffuse thyroid enlargement
| - Excessive thyroid hormone secretion
43
Grave's disease accounts for ____% of cases of hyperthyroidism ?
75%
44
Graves disease may progress to what ?
Destruction of thyroid tissue, causing hypothyroidism
45
What is the patho/etiology of Graves disease ?
Overproduction of T3 and T4
46
What are the clinical manifestations of Graves' disease/Hyperthyroidism ?
- Increased metabolism
- Increased tissue sensitivity to stimulation by sympathetic nervous system
- Abnormal eye appearance or function
- Exophthalmos
47
What is Exophthalmos ?
Protrusion of eyeballs from the orbits
48
Cardiovascular manifestations such as...
- Bruit over thyroid gland
- Systolic hypertension
- increased cardiac output
- Dysrhythmias
are seen with what type of Thyroid dysfunction ?
Graves' disease (Hyperthyroidism)
49
GI manifestations such as...
- increased appetite
- thirst
- weight loss
- diarrhea
- Hepatosplenomegaly
are seen with what type of Thyroid dysfunction ?
Graves' disease (hyperthyroidism)
50
Integumentary manifestations such as...
- Warm, smooth, moist skin
- Thin, brittle nails
- Hair loss
- Clubbing of fingers
Are seen in what type of Thyroid dysfunction ?
Graves' disease (Hyperthyroidism)
51
Musculoskeletal clinical manifestations such as...
- Fatigue
- Muscle weakness
- Proximal muscle wasting
- Dependent edema
Are seen in what type of Thyroid dysfunction ?
Graves' disease (Hyperthyroidism)
52
Nervous system manifestation such as...
- Fine tremors
- Insomnia
- Ability of mood
- Delirium
- Hyperreflexia of tendon reflexes
- Inability to concentrate
Are clinical manifestation of what ?
Graves' disease (Hyperthyroidism)
53
Reproductive manifestations such as....
- Menstrual irregularities
- Amenorrhea
- Decreased libido
- Impotence
- Decreased fertility
Are clinical manifestations of what ?
Graves' disease (Hyperglycemia)
54
General clinical manifestations such as...
- intolerance to heat
- increased sensitivity to stimulant drugs
- Elevated basal temperatures
Are clinical manifestations seen with what ?
Graves' disease (Hyperthyroidism)
55
What laboratory values are used to confirm Hyperthyroidism ?
- Decreased TSH
| - Elevated T3 & T4 levels
56
What are the Tx goals of Hyperthyroidism ?
- Block adverse effects of thyroid hormones
| - Stop hormone oversecretion
57
What are 3 primary Tx options for Hyperthyroidism ?
- Anithyroid medications
- Radioactive iodine therapy (RAI)
- Subtotal thyroidectomy
58
In general, what is the treatment of choice for Hyperthyroidism ?
Radioactive iodine therapy
59
True or False: Hyperthyroidism is not considered curative ?
True
60
How does Iodine work to treat Hyperthyroidism ?
Large doses rapidly inhibit the synthesis of T3 and T4 and block their release into circulation
61
True or False: long term iodine therapy in not effective in treating Hyperthyroidism ?
True
62
How do Antithyroid drugs work to treat Hyperthyroidism ?
Inhibit the synthesis of Thyroid hormone
63
How does Iodine work in the body to treat Hyperthyroidism ?
Large doses rapidly inhibit the synthesis of T3 & T4 and block their release into circulation
(maximal effect seen within 1-2 weeks)
64
What are First-line examples of Antithyroid drugs ?
- Propylthiouracil (PTU)
| - Methimazole (Tapazole)
65
What is the treatment of choice for Hyperthyroidism in non pregnant adults ?
Radioactive iodine therapy (RAI)
66
How does RAI work ?
Damages or destroys thyroid tissue
67
There is a High incidence of what after Radioactive iodine when used to treat Hyperthyroidism ?
**Post-treatment Hypothyroidism**
68
Pt's who undergo Radioactive iodine therapy (RAI) for hyperthyroidism, need lifelong what ?
Lifelong thyroid hormone replacement
69
Why do pt's who undergo Radioactive Iodine therapy need lifelong thyroid hormone replacement ?
B/c RAI therapy damages or destroys thyroid tissue
70
Of the 2 thyroid disorders (Hypo & Hyper), which one is easier to treat ?
Hypothyroidism
71
Pt's with acute thyrotoxicosis or pt's undergoing thyroidectomy require what type of care ?
Hospitalization and acute care
72
What is a Thyrotoxic crisis (aka Thyroid storm) ?
Acute, rare condition, where all Hyperthyroid manifestations are heightened
73
True or False: A Thyrotoxic crisis (aka thyroid storm) is a Life-threatening emergency ?
True
74
What are Manifestations of a thyrotoxic crisis (aka thyroid storm) ?
- Tachycardia
- Heart failure
- Shock
- Hyperthermia
- Restlessness
- Agitation
- Seizures
- Nausea
- Vomiting
- Diarrhea
- Delirium
- Coma
75
What is the Tx goal for a Thyrotoxic crisis (aka thyroid storm) ?
Decrease thyroid hormone levels and clinical manifestations with drug therapy
76
Acute Thyrotoxicosis requires what ?
Agressive treatment
77
what do we want to administer in acute thyrotoxicosis ?
administer medications to block thyroid hormone production
78
Why do we want to administer IV fluids in pt's suffering from Acute Thyrotoxicosis ?
B/c of dehydration from increased metabolism
79
True or False: in pt's suffering from Acute Thyrotoxicosis, we want to change linens frequently if diaphoretic ?
True
80
With Acute Thyrotoxicosis, we want to apply what to relieve eye discomfort ?
artificial tears
81
True or False: with Acute Thyrotoxicosis, we want to elevate the HOB ?
True
82
True or False: In pt's with Acute Thyrotoxicosis, we want to restrict salt for edema ?
True
83
What type of diet is usually ordered for pt's with Hyperthyroidism ?
High-calorie diet
(usually need 4,000 - 5,000 cal/day)
- To compensate for the increased metabolism
84
When talking about Nutrition therapy for Hyperthyroidism, pt's should Avoid what ?
Avoid:
- caffeine
- highly seasoned foods
- high fiber foods
(to not add to SNS effects on CV and GI system)
85
What are indications that Surgery should be done as therapy for Hyperthyroidism ?
- Unresponsive to drug therapy
- Large goiters causing tracheal compression
- Possible malignancy
- Individuals who are not a good candidate for RAI therapy
86
What MUST be at the bedside of pt's who just had Thyroid surgery ?
- Oxygen
- Suction equipment
- Tracheostomy tray
(B/c they just had neck surgery & edema may cause airway obstruction and need for emergent trach)
87
True or False: You should support the head while turning in bed ?
True !
| Don't want to stress the sutures in the neck
88
True or False: Its who just had Thyroid surgery, may have speaking difficulty for a short time after surgery ?
True
89
What should we assess for postoperatively in pt's who just had Thyroid surgery ?
Assess for tracheal compression & signs of hemorrhage
90
What are signs of Tracheal compression ?
- Irregular breathing
- Neck swelling
- Frequent swallowing
- Choking
91
Frequent swallowing after Thyroid surgery is a sign of what ?
Hemorrhaging (swallowing the blood)
92
What position should pt's be in after Thyroid surgery ?
Semi-Fowler's position
- support head with pillows
- Avoid flexion of neck
93
What is Laryngeal stridor ?
Harsh vibratory sound that can occur during inspiration or expiration, due to edema on the larynx
94
What mineral should you think of when you hear Parathyroid gland ?
CALCIUM & phosphorus
95
Post-op from Thyroid surgery, what should you check for signs of ?
Hypocalcaemia
96
What are signs of Hypocalcaemia ?
- Numbness and tingling around the mouth
- tetany
- Trousseau's sign
- Chvostek's sign
97
What does Trousseau's sign present as ?
Carpal spasms induced by inflating a blood pressure cuff on the arm.
(pressure on upper arm induces twitching)
98
What does Chvostek's sign present as ?
Contraction of the facial muscle in response to a tap on the facial nerve in front of the ear
99
Surgery on the Thyroid gland can inadvertently harm what ?
Harm the Parathyroid gland
100
Some hoarseness is expected for ___ to ___ days after Thyroid surgery ?
3 to 4
101
What is important discharge teaching for pt's who just had Thyroid surgery ?
They will require Lifelong thyroid replacement
| b/c they just removed the thyroid gland, so they can no longer make thyroid hormones
102
Pt's with Hypothyroidism have what type of metabolism ?
SLOWER metabolic rate
103
What does Hypothyroidism result from ?
Insufficient circulating thyroid hormone
104
What is the most common cause of Hypothyroidism worldwide ?
Iodine deficiency
| and most prevalent in iodine deficient areas
105
In places where iodine intake is adequate (USA), what is the primary cause ?
atrophy of the thyroid gland
106
Hypothyroidism may develop b/c of treatment for what ?
Hyperthyroidism
107
What 2 drugs can produce hypothyroidism ?
- Amiodarone
| - Lithium
108
Hypothyroidism can vary depending on what ?
- Severity
- Duration
- Age of onset
109
Systematic effects of Hypothyroidism are characterized by what ?
Slowing of body processes
110
Onset of symptoms for Hypothyroidism may occur when ? Unless it occurs after what ?
Over months to years
- Unless it occurs after: thyroidectomy, thyroid ablation, Tx w/ antithyroid drugs
111
How do symptoms present in pt's with Hypothyroidism ?
Ranges from no symptoms to classic symptoms
| physical changes easily detected on examination
112
What are some clinical manifestations of Hypothyroidism ?
- decreased cardiac output
- decreased cardiac contractility
- decreased motility (GI)
- constipation
- fatigued & Lethargic
- slowed speech
- personality and mood changes
- cold intolerance
- hair loss
- dry coarse skin
- thick, brittle nails
- hoarseness
- muscle weakness and swelling
- weight gain
113
Those with severe long-standing hypothyroidism may display what ?
Myxedema
114
What does Myxedema cause ?
- Puffiness
- Periorbital edema
- masklike effect
115
How does hypothyroidism present Lab value wise ?
- TSH (may be high or low depending on cause)
| - T3 & T4 will be low
116
What kind of diet should individuals with Hypothyroidism be on and why ?
Low-calorie diet b/c of slow metabolism/weight gain
117
What is a drug that is used to treat Hypothyroidism ?
Levothyroxine (Synthroid)
* must take regularly
118
True or False: Myxedema coma is a medical emergency ?
True!
119
True or False: Most individuals do not require acute nursing cure for general Hypothyroidism ?
True
| Managed on outpatient basis
120
Individuals with Myxedema coma require ______ nursing care ?
acute
121
What are complications of Myxedema ?
- Mental sluggishness
- Drowsiness
- Lethargy progressing gradually or suddenly to impairment of consciousness or coma
- Myxedema coma
122
What are common features of myxedema ?
- Dull, puffy skin
- Coarse sparse hair
- Periorbital edema
- Prominent tongue
123
True or False: Soap should be used sparingly in pt's with Hypothyroidism ?
True
124
In pt's with Hypothyroidism, we need to emphasize the need for a ________ environment ?
Warm
