T2: Thyroid

Question 1

medication for hypothyroid

Answer 1

levothyroxine (synthroid)

Question 2

medications for hyperthyroid

Answer 2

methimazole (Tapazole) &
Propylthiouracil

Question 3

thyrotoxicosis results from

Answer 3

increased circulating levels of T3, T4, or both (hyper metabolism)

Question 4

graves disease

Answer 4

autoimmune disease of unknown etiology characterized by diffuse thyroid enlargement and excess thyroid hormone secretion (hyperthyroid)

Question 5

precipitating factors for graves disease

Answer 5

insufficient iodine supply, cigarette smoking, infection, and stressful life events

Question 6

Related to effect of thyroid hormone excess

Answer 6

↑ Metabolism
↑ Tissue sensitivity to stimulation by sympathetic nervous system

Question 7

goiter

Answer 7

enlarged thyroid gland, auscultating the thyroid gland may reveal bruits, a reflection of increased blood supply.

Question 8

exophthalmos is present in

Answer 8

hyperthyroidism

Question 9

complications of exophthalmos

Answer 9

dry eyes, corneal abrasion , eyes might not close when sleeping

Question 10

clinical manifestations of hyperthyroidism

Answer 10

-rapid pulse
-dyspnea on exertion, increased RR
-increased appetite, weight loss, diarrhea
-warm skin, thins skin and nails
-pretibial myxedema -insomnia
-personality changes
-amenorrhea
-intolerance to heat

Question 11

acute thyrotoxicosis (thyroid storm/crisis)

Answer 11

an acute, severe, and rare condition that occurs when excessive amounts of thyroid hormones are released into the circulation MEDICAL EMERGENCY

Question 12

what needs to be done with a patient in thyroid storm

Answer 12

take out the thyroid (thyroidectomy)

Question 13

what needs to be monitored when taking out the thyroid

Answer 13

calcium levels because of the parathyroid (this can affect the heart)

Question 14

manifestations of acute thyrotoxicosis

Answer 14

-Severe tachycardia, heart failure
-Shock
-Hyperthermia
-Agitation
-Seizures
-Abdominal pain, vomiting, diarrhea
-Delirium, coma

Question 15

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

Answer 15

*low or undetectable TSH levels (< 0.4 mIU/L) and elevated free thyroxine (free T4) levels.

Question 16

The RAIU test is used to

Answer 16

differentiate Graves’ disease from other forms of thyroiditis.
-The patient with Graves’ disease will show a diffuse, homogeneous uptake of 35% to 95%, whereas the patient with thyroiditis will show an uptake of less than 2%.

Question 17

what are the primary treatment options for hyperthyroidism

Answer 17

-Antithyroid medications
-Radioactive iodine therapy (RAI)
-Surgery

Question 18

drug therapy for hyperthyroidsm

Answer 18

-Anti-thyroid drugs
-Iodine
-β-Adrenergic blockers
(not curative)

Question 19

improvement of antithyroid drugs

Answer 19

-Improvement in 1 to 2 weeks
-Good results in 4 to 8 weeks

Question 20

Potassium iodine (SSKI) and Lugol’s solution

Answer 20

Inhibit synthesis of T3 and T4 and block their release into circulation, Decreases vascularity of thyroid gland

Question 21

Before thyroid surgery what is given

Answer 21

Iodine is used with other antithyroid drugs to prepare the patient for thyroidectomy

Question 22

signs of iodine toxicity

Answer 22

swelling of the buccal mucosa and other mucous membranes, excessive salivation, nausea and vomiting, and skin reactions

Question 23

indications for surgical therapy: thyroid

Answer 23

-Large goiter causing tracheal compression
-Unresponsive to anti-thyroid therapy
-Thyroid cancer
-Not a candidate for RAI

Question 24

Subtotal thyroidectomy

Answer 24

Preferred surgical procedure
Involves removal of 90% of thyroid

Question 25

how can we check calcium levels without a blood draw

Answer 25

trousseau and chvostek

Question 26

Nursing Implementation: Acute Thyrotoxicosis-Thyroid storm

Answer 26

-thyroidectomy -anti thyroid medications -monitor for dysrhythmias -fluid and electrolyte replacement (from vomit and diarrhea)

Question 27

environment for hyperthyroidism/thyrotoxicosis

Answer 27

*Calm, quiet room *Cool room *Light bed coverings ensure adequate rest

Question 28

If exophthalmos present:

Answer 28

-Apply artificial tears to relieve eye discomfort -Salt restriction and elevate head of bed -Dark glasses -Tape eyelids closed if needed for sleep -ROM of intraocular muscles

Question 29

Hypothyroidism/Myxedema Coma

Answer 29

-Deficiency of thyroid hormone -Causes general slowing metabolic rate

Question 30

Primary hypothyroidism is caused by

Answer 30

destruction of thyroid tissue or defective hormone synthesis.

Question 31

Secondary hypothyroidism is caused by

Answer 31

pituitary disease with decreased TSH secretion or hypothalamic dysfunction with decreased thyrotropin-releasing hormone (TRH) secretion.

Question 32

what is the most common cause of hypothyroidism

Answer 32

Iodine deficiency

Question 33

hypothyroidism autoimmune

Answer 33

Hashimoto's

Question 34

cretinism

Answer 34

Hypothyroidism that develops in infancy, is caused by thyroid hormone deficiencies during fetal or early neonatal life.

Question 35

Clinical Manifestations of hypothyroidism

Answer 35

slowing of body processes fatigue, cold and dry skin, hoarseness, hair loss, constipation, and cold intolerance

Question 36

since everything is slowed down in hypothyroidism we lose

Answer 36

end organ perfusion

Question 37

myxedema coma is precipitated by

Answer 37

infection, drugs, cold, trauma

Question 38

myxedema coma is characterized by

Answer 38

-Impaired consciousness -Subnormal temperature, hypotension, hypoventilation -Cardiovascular collapse-from hypoventilation, hyponatremia, hypoglycemia, and lactic acidosis

Question 39

treatment for myxedema coma

Answer 39

IV levothyroxine (thyroid hormone)

Question 40

Levothyroxine (Synthroid)

Answer 40

-Start with low dose -Monitor for cardiovascular side effects (chest pain, dysrhythmias), weight loss, nervousness, tremors, insomnia -Increase dose in 4- to 6-week intervals as needed -Lifelong therapy

Question 41

Myxedema coma necessitates acute care

Answer 41

-Mechanical respiratory support -Cardiac monitoring -IV thyroid hormone replacement -Monitoring of CORE TEMP