Thyroid Flashcards
1
Q
What is the thyroid hormone feedback loop?
A
Ant. Pituitary stimulates thyroid hormone production & release
If blood levels of TH are low then the hypothalamus release TRH
TRH causes the Ant Pituitary to release TSH
TSH stimulates the thyroid to release TH
High TH levels inhibit the secretion of TRH & TSH
2
Q
If blood levels of TH are low then the
A
hypothalamus releases TRH
3
Q
Hormone Orders IF LOW LEVELS
A
Thyroid releasing hormone
Thyroid-stimulating hormone
T3 and T4
4
Q
TRH causes
A
Anterior pituitary to release TSH
5
Q
TSH releases what
A
T3 and T4 from thyroid
6
Q
High T3 and T4 levels inhibit the secretion
A
TRH
TSH
7
Q
TRH
A
Thyroid releasing hormone
8
Q
TSH
A
thyroid-stimulating hormone
9
Q
Thyroid assessment
A
physical
Lab work (serum TSH, T3, T4, and free T4)
Ultrasound with bx (remove portion)
Thyroid scan
RAI uptake
10
Q
If questioning hyperthyroidism/enlarged thyroid,
A
listen for bruit and audible vibration
11
Q
Is the thyroid normally palpable?
A
no, only when enlarged or hyperthyroidism
12
Q
How do you assess the thyroid?
A
stand posterior to pt
warn and place hands around the neck
pt swallows - brings it forward to feel for nodules in thyroid
13
Q
When should you not palpate the thyroid?
A
pt has Thyroiditis
esp if notice visibly enlarged gland bc palpation triggers release of thyroid hormones
14
Q
RAI uptake
A
Radioactive Iodine uptake test
- if low iodine in thyroid with test hypoactive visa versa
15
Q
RAI uptake contraindications
A
allergies to shellfish and iodine
Meds need to be withheld
16
Q
Goiter
A
abnormal enlargement of the thyroid gland
17
Q
Goiter occurs with
A
Hyperthyroidism (too much)
hypothyroidism (too little)
Euthyroidism (correct amount)
18
Q
T/F: The presence of a goiter does mean the thyroid gland is malfunctioning.
A
False
19
Q
Goiter pts c/o
A
inability to swallow
shirt collars too small
20
Q
TSH normal
A
2-10
21
Q
T4 normal
A
4-12
22
Q
T3 normal
A
70-205
23
Q
Hypothyroidism lab values
TSH
T3
T4
A
TSH high
T3 low
T4 low
24
Q
Hyperthyroidism lab values
TSH
T3
T4
A
TSH LOW
T3 HIGH
T4 HIGH
25
TSH is used when monitoring
thyroid replacement therapy
26
TSH STIMULATES
T3 and T4
27
T3
accurate meaure of hyperthyroidism
after admin of iodine
28
Free T4
measures the free unbound thyroxine levels of the bloodstream
29
Hyperthyroidism
excess of thyroid hormone
30
Hyperthyroidism results in
Increase BMR, CV, GI & neuromuscular function
Affects metabolism of fats, carbs & proteins
**Wt loss & heat intolerance**
31
Hyperthyroidism caused by
Autoimmune rxn **(Graves’ disease)**
Excess of dose of thyroid replacement
Thyroiditis
Tumor
32
Thyrotoxicosis
thyroid storm
33
Assessment of Hyperthyroidism
**High Temp, Pulse, Resp. and BP**
-clubbing, localized edema
Nervous, tremors
wt loss, hunger
N/V/D
**breast enlargement**
weakness, fatigue
**intolerance to heat**
**Grave's disease**
34
S/S of hyperthyroidism is related to
directly increases metabolism and tissue sensitivity to stimulation by the sympathetic nervous system
35
Graves' disease s/s
Goiter
**Bulging eyes
raised red rash not painful**
36
Hyperthyroidism is prone to
comorbidities
* irregular heartbeats
chest pain
cognition low
excess fatigue**
37
Hyperthyroidism Mgmt
lifelong antithyroid med
**Iodine 131
Thyroidectomy**
infertility specialist
38
Nursing problems with Hyperthyroidism
knowledge deficit
insufficient nutrition (give them frequent small meals with more protein and carbs)
altered sleep patterns
altered body image due to goiter and eye bulging
low CO or endurance
vision changes (dry and shape)
39
Exophthalmos
bulging eyes
40
Hyperthyroidism pts have a
high active
can't sit still
Revved up constantly but tired from overexertion
41
Hyperthyroid pts should avoid
spicy
high fiber foods
caffeine
**decongestants and diet pills**
42
Hyperthyroid pts need to monitor weight loss if and be notified if they
more than 10% of body wt
43
Hyperthyroidism education
meds
**wt and nutrition increased**
balance activity and rest (fatigue)
lifestyle changes
**Eye exams with drops and protection** due to bulging
HOB elevated
44
Hyperthyroid meds
Methimazole/propylthiouracil (PTU)
45
PTU goal
inhibits thyroid hormone synthesis
46
PTU adverse effects
**agranulocytosis
hypothyroidism
47
PTU contraindications
allergy to thioamides
impaired liver
**Pregnancy leads to fetal harm**
48
PTU care
signs of hypothyroidism and hyperthyroidism
Lab work WNL
(PT, INR, CBC, Liver, and Ts)
VS and wt
49
Do not stop PTU abruptly or
risk of severe HYPERTHYROIDISM
- fever, sore throat, unusual bleeding
50
PTU should be taken
same time of day
with food
51
Radioactive Iodine 131 goal
destroy thryoid cells at high doses
52
Radioactive Iodine 131 adverse effects
radiation sickness
bone marrow suppression
hypothyroid
53
Radioactive Iodine 131 contraindications
pregnancy
young children
54
Radioactive Iodine 131 dosage
4-10 PO
55
Radioactive Iodine 131 TEACHING
baseline and monitor CBC
**private toilet and flush twice
Bathe daily and frequent handwashing
disposable utensils
sleep alone and avoid prolonged intimate contact for 3-4 days
separate linens
limit visitors and private room needed**
56
Radioactive Iodine 131 can jar the thyroid when the pt does this so avoid
avoid coughing and expectoration
57
Strong Iodine solution - NONradioactve goals
reduces iodine uptake, inhibits hormone production
blocks release of T3 and T4
58
Strong Iodine solution - NONradioactve ADVERSE EFFECTS
iodism
59
Strong Iodine solution - NONradioactve dosage
2-6 drops TID for 10 days
60
Iodism
corrosive and toxicity
metallic taste with irritation sore gums, teeth, ulcers, swelling in the upper throat
61
Strong Iodine solution - NONradioactve mixed with
juice
62
Strong Iodine solution - NONradioactve mgmt
signs of iodism
VS , WT gain, I&O
under and overdosing
63
Strong Iodine solution - NONradioactve TEACHING
Dilute medication in juice to help with taste
Avoid foods high in iodine (ionized salt)
Take medication same time each day
Increase fluid intake
64
Hyperthyroidism in older adults
2x wt loss from anorexia as well
apathy
lassitude
depression
confusion
dysrhythmia to heart failure
exophthalmos less common
65
Thyrotoxic Crisis aka
Thyroid storm
66
Causes of thyroid storm
severe infection/stress
manipulation of thyroid gland
67
Thyroid storm assessment
**101.3+ temp**
**increase HR 130+, HTN**
agitation, confusion, seizure
exaggerated s/s of hyperthyroidism
68
Dx testing of thyroid storm
plus cardiac testing
69
Tx of Thyroid Crisis
Stabilize Cardiac
**beta blockers**
O2
Replace fluids and electrolytes - **D5NS or D5LR**
When stabile = Antithyroid meds **PTU, corticosteroids, lithium or iodinated contrast**
Calm environment - cold, dark, limits visits, no kids
70
Thyroiditis
inflammation of thyroid
acute, subacute, chronic
71
Acute Thyroiditis is caused by
bacteria
fungal
parasite
72
Acute Thyroiditis s/s
**painful**
swelling
dysphagia
dysphonia
s/s of hyperthyroidism
73
Tx of Acute Thyroiditis
antibiotics
fluid replacement
74
Acute Thyroiditis function
returns after tx
75
Subacute thyroiditis caused by
granulomatous - viral
76
Subacute Thyroiditis s/s
low fever
fatigue
swelling
pain
77
Subacute Thyroiditis s/s
Phases
Phase 1: hyperthyroid (1-3 months)
Phase 2: hypothyroid (9-12 months)
78
Subacute Thyroiditis Tx
NSAIDs
Beta-blockers in Phase 1 (heart beats)
steroids for swelling
79
Subacute Thyroiditis function
normal after 12-18 months
80
Subacute Thyroiditis Miantain good
birth control
because babies pop out more
81
Chronic Thyroiditis s/s
lymphocytic - autoimmune
82
Chronic Thyroiditis aka
Hashimoto's disease
83
Chronic Thyroiditis s/s
**painless**
hypothyroid s/s
84
Chronic Thyroiditis Tx
thyroid replacement
85
Chronic Thyroiditis function
never returns slowly
86
Thyroidectomy
tx of choice for thyroid CA and goiters if airway problems
87
CA surgery may include
modified or radical neck dissection
88
Radioactive Iodine in Thyroid CA
minimize metastasis
shrink thyroid
89
Thyroidectomy Pre-op teachings
nutrition soft foods (soups, mash, Jello)
avoid caffeine and stimulants
90
Thyroidectomy post-op care
head & neck support (pillows, no rocking forward with head to strain the neck, use arms to side for pushing)
HOB for swelling
feeding tubes
incision painful to swallow for 24 hours
Incision & **airway**: bleeding (anterior and side collarbones), airway obstruction
thyroid hormone: depends on the amount left, if total lifelong thyroid replacement, weaning can occur but usually very slow
91
Thyroidectomy Post-Op Care
BOW TIE
Bleeding
Open airway: HOB 30, avoid hyperextending
Whisper: laryngeal nerve next to the thyroid to reassess with a small voice
Trache set depends
Incision
Emergency: muscle twitching
92
Pain meds for thyroidectomy
before eating to ease swallowing of foods
93
Why do you need to watch for muscle twitching after thyroidectomy?
parathyroid triggered and can go into hypocalcemia
94
Hypothyroidism
Insufficient T3 & T4 leads to BMR, *low heat production*
95
Hypothyroidism Causes
tx of hyperthyroidism - PTU
antibody destruction of thyroid
iodine deficiency
96
Hypo/Hyper Thyroidism analogy
Hypo - tortoise
Hyper - energizer bunny
97
Hypothyroidism Assessment LABS
high TSH and lipids
low T4 and T3
98
Hypothyroidism VS
low BMR, Temp, Pulse, BP
99
Hypothyroidism ASSESSMENTS
wt gain
dry skin and hair
constipation
**lethargic and fatigued**
intolerance to cold
**mixed edema**
100
Hypothyroidism late s/s
**mixed edema**
subnormal temp
bradycardia
wt gain
low LOC
thickened skin
cardiac complications
101
Hypothyroidism mgmt
thyroid replacement (T3 and T4)
102
Hypothyroidism NURSING Problems
Knowledge deficit: don't know how or when to meds
low CO, endurance, & temperature
Excess nutrition: fatter
Constipation
Skin integrity: dry (need hydration)
Body image: fat and skin integrity
103
Hypothyroidism anaesthesiology and sedation meds need to be
minimal dose
-increase risk of oversedation and respiratory compensation
104
Hypothyroidism meds to caution
sedatives
hypnotics
narctoics
105
Hypothyroid meds
levothyroxine (Synthroid)
106
levothyroxine (Synthroid) goal
Synthetic T4 – produces various physiologic effects, including increasing metabolism
107
levothyroxine (Synthroid) adverse effects
thyrotoxicosis
Extremes; jitters, grumpy, thyroid storm
wt loss too much too quickly
108
levothyroxine (Synthroid) is dosed in
micrograms
109
levothyroxine (Synthroid) contraindications
acute MI
CVD
Thyroid storm
110
levothyroxine (Synthroid) nursing care
Assess vital signs, BP, weight, history of; weight change, diet, energy level, mood, temperature response
**Monitor thyroid function test results & glucose levels**
Give dose in **morning before breakfast**
Teach symptoms of thyrotoxicosis
111
levothyroxine (Synthroid) teaching
Daily lifelong if not mixed edema
report any signs of chest pain, nervousness, tremors, sleeplessness, heat intolerance, & excessive sweating
Do not discontinue medication suddenly
112
What is the major warning sign for med attention in thyroid storm
chest pain
113
If Synthroid dose is too low
bradycardia
lethargy
constipation
excessive fatigue and sleeping
114
If Synthroid dose is too high
irritability
palpations
tachycardia
diarrhea
tremors
insomnia
115
Hypothyroid clients need
follow up
contact if unplanned wt loss/gain of 5 lbs in a week
avoid sedatives
take in the morning
116
Mixed edema
severe hypothyroidism
117
Mixed edema causes
sudden d/c thyroid replacement
acute illness, trauma
118
Mixed edema assessment
s/s of hypothyroid
edema non pitting
low T4, Na, glucose
High TSH
possible CV collapse and coma
HR less than 50
tongue swells
119
Myxedema Management
Replace T4
Treat precipitating factors
Respiratory & CV support**
Increase body temperature
Maintain fluid, electrolytes, & acid-base
HIGH flow O2warming blanket
Vasopressors
120
The nurse is completing a health assessment of a patient with suspected hyperthyroidism. What should the nurse assess the client for?
Anorexia
Tachycardia
Weight gain
Cold skin
Tachycardia
121
The nurse is evaluating a patient who is taking PTU for hyperthyroidism. Which patient statement indicates the drug is effective?
I have excess energy.
I can sleep at night.
I have lost weight since taking this medication.
I perspire throughout the day w/o exertion.
I can sleep at night.
122
Following a subtotal thyroidectomy, a patient begins to have tingling in the fingers and toes. What should the nurse do first?
Encourage the patient to flex & extend fingers & toes
Notify the healthcare provider
Assess for thrombophlebitis
Ask the client to speak
Notify the healthcare provider
hypocalcemia factor
