Hyperthyroidism Flashcards Preview

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Flashcards in Hyperthyroidism Deck (25):
1

Thyroid Hormones

T4, T3
Calcitonin

2

Hyperthyroidism

Excessive secretion of thyroid hormones
Sustained ↑ in synthesis and release

3

Occurrence

Women
Stress, emotional shock, infx

4

Graves Disease

Autoimmune disorder
Abnormal stimulation of thyroid gland

5

Grave’s Disease Manifestations

↓ weight, period
↑ HR, UO
Edema
Diarrhea
Puffy eyes
Anxiety
Tremor

6

Pathophysiology

Antibodies stimulate gland
Exacerbation / Remissions
Destruction of thyroid tissue (hypothyroidism)

7

Thyrotoxicosis

Hyperetabolism
↑ circulating levels of T4 / T3

8

Manifestations

Hyperexcitability
Irritability
Palpitations
Sweating
↑ HR, appetite
Exophthalmos
↓ weight
Amenorrhea
Fatigue

9

Assessment

Goiter (enlarged, soft, palpable thyroid)
Palpate thrill
Auscultate bruit

10

Diagnostic Tests

↓ TSH
↑ T3 / T4
↑ radioactive iodine uptake
Thyroid antibodies

11

Thyroid store

Acute ↑ in thyroid levels
> 101.3
> 130bpm
LOC
Stress, injury, infx

12

Management of Thyroid Storm

Hypothermia blanket
Cool environment
Humid O2
Monitor ABGs
IV fluids
Stabilize heart first

13

Medical Management of Thyroid Storm

Propylthiouracil (antithyroid)
Hydrocortisone (shock)
Iodine (↓ T4)
Propranolol (↓ HR)

14

Collaborative Care

Block adverse fx
Suppress
Prevent complications

15

Tx Options

Antithyroid meds
Radioactive iodine therapy (high dose)
Beta blockers
Surgery

16

PTU

Action: blocks synthesis of hormones (T4 to T3)
Risk of liver injury (failure)
Adverse Fx: thyroid suppression, liver tox, agranulocytosis, thrombocytopenia
3x/day (consistently therapeutic)

17

Methimazole

Inhibits synthesis of thyroid hormone
Onset: 30-60 min
High in breaks milk
Adverse Fx: thyroid suppression, liver tox, agranulocytosis, aplastic anemia, blood dyscrasias

18

Iodine

↓ thyroid storm
Prepare for thyroidectomy / storm
Rapidly inhibits synthesis of T3 / T4
Blocks release of hormones
Decreases vascularity of gland
Adverse Fx: hypothyroidism, iodism
Give through straw (staining), with milk / juice

19

Risk of Adjuvant Iodine Therapy

Mucosal injury and hemorrhage
Irritating to GI tract

20

Beta Blockers

↓ HR, BP, muscle weakness, tremors, anxiety, heat intolerance
Continue to take until T4 / TSH is normal

21

Radioactive Iodine Therapy

I131
Eliminate state with single dose
Category X pregnancy (48h prior, 6months post)
6 weeks post lactation
S/s thyroid storm
CV pts treated first 4-6 week prior
Replacement needed 4-18 weeks after based on TFT
Teach radiation contamination

22

Surgery Indications

Large goiter
Tracheal compression
Unresponsiveness to medication
Cancer
Not a candidate for I131

23

Surgical Management

Hypothyroidism
Edema: airway obstruction
Hemorrhage
Injury to laryngeal nerve
Removal of parathyroid glands (↓ Ca)

24

Nutritional Therapy

Increased metabolic rate
↑ cal diet
6 meals (4000-5000cal)
↑ protein (1-2g/kg/day)
↑ carbs

NO: spicy, fiber, caffeine

25

Nursing Management

Dietary
Copying
Imbalanced body temp