TOPIC 1 - hypo and hyperthyroidism

Question 1

excessive hyperthyroidism

Answer 1

thyrotoxicosis

Question 2

excessive hypothyroidism

Answer 2

myxedema coma

Question 3

primary hypothyroidism

Answer 3

destruction of thyroid tissue or defective hormone synthesis

Question 4

secondary hypothyroidism

Answer 4

pituitary disease with decreased TSH or hypothalamic dysfunction with decreased TRH

Question 5

most common cause of hypothyroidism

Answer 5

iodine deficiency

Question 6

graves is related to

Answer 6

hyperthyroid

Question 7

hashimotos is related to

Answer 7

hypothyroid

Question 8

most common cause of primary hypothyroidism

Answer 8

atrophy of thyroid gland

Question 9

hypothyroidism may develop after …

Answer 9

treatment for hyperthyroidism, RAI therapy, thyroidectomy

Question 10

manifestations of hypothyroidism

Answer 10

systemic effects (slowing body process), fatigue, lethargy, personality and mood change, impaired memory, decreased initiative somnolence, depression, weight gain, slowed speech

Question 11

cardio relationship to hypothyroidism

Answer 11

decreased cardiac contractility and decreased cardiac output - low exercise tolerance and shortness of breath
coronary atherosclerosis - increased cholesterol and triglyceride level
anemia

Question 12

lab values of hypothyroidism

Answer 12

normal T4 and increased TSH

Question 13

management of hypothyroidism

Answer 13

levothyroxine - monitor heart rate (report over 100 bpm), lifelong therapy and follow up care
nutritional therapy to promote weight loss

Question 14

avoid ___ with hypothyroidism

Answer 14

sedatives - monitor LOC and RR
enemas - vagal stimulation = cardiac issues

Question 15

hyperthyroidism causes

Answer 15

thyroiditis, excess iodine, pituitary tumor, thyroid cancer, toxic nodular goiter, graces disease

Question 16

early signs of hyperthyroidism

Answer 16

weight loss, increased nervousness

Question 17

manifestations of hyperthyroidism

Answer 17

hypertension, bounding pulse, angina, dysrhythmias, CHF, fatigue
dyspnea, increased RR
weight loss, increased appetite and thirst, increased peristalsis, increased bowel sounds
warm, moist skin, brittle nails, diaphoresis
difficulty sleeping, tremors, edema, osteoporosis, delirium, lack of concentration
menstrual abnormalities, gynecomastia, decreased fertility
intolerance to heat, elevated basal temp

Question 18

teaching for hyperthyroidism

Answer 18

elevate HOB at night, eye drops, dark glasses for photophobia, steroid therapy for swelling, diuretics for edema

Question 19

labs for hyperthyroidism

Answer 19

low TSH, elevated T4

Question 20

antithyroid drugs

Answer 20

methimazole, propylthiouracil, iodine, propranolol, atenolol, metoprolol

Question 21

nutritional therapy for hyperthyroidism

Answer 21

high calorie, high protein, frequent meals, avoid highly seasoned food and high fiber foods (GI effects), avoid caffeine (decrease restlessness)

Question 22

what causes exophtalmos

Answer 22

increased fat deposits and fluid in the orbital tissues and ocular muscles

Question 23

primary lab finding to confirm diagnosis of hyperthyroid

Answer 23

low TSH

Question 24

the RAIU test can…

Answer 24

distinguish graves disease from other forms of thyroiditis

Question 25

treatment options for hyperthyroid

Answer 25

antithyroid meds, radioactive iodine therapy, surgery

Question 26

supportive therapy of hyperthryoidism

Answer 26

manage resp distress, reduce fever, replace fluids, eliminate stressors

Question 27

propylthiouracil vs methimazole

Answer 27

propyliouracil achieves goal quicker, but is taken 3 times per day methimazole is given in a single daily dose

Question 28

what happens upon abrupt stops of meds

Answer 28

return to hyperthyroid state

Question 29

the use of iodine with other antithyroid drugs

Answer 29

prepare patient for thyroidectomy or for treatment of thyroxicosis

Question 30

is long term iodine therapy effective

Answer 30

no

Question 31

signs of iodine toxicity

Answer 31

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

Question 32

beta blockers are used for what purpose related to hyperthyroidism

Answer 32

symptomatic relief to decrease tachycardia, nervousness, irritability, tremors

Question 33

what is the preferred b blocker for hyperthyroidism

Answer 33

atenolol

Question 34

after RAI treatment, what cautions should patients take to limit exposure to others

Answer 34

private toilet, flush 2-3 times, separate laundry, do not prepare food for others, avoid being close to pregnant women or children (up to 7 days)

Question 35

who are candidates for a thyroidectomy

Answer 35

patients with a large goiter causing tracheal compression, those with a lack of response to antithyroid therapy, people with thyroid cancer

Question 36

postoperative complications of thyroidectomy

Answer 36

hypothyroid, damage to parathyroid, hypocalcemia, hemorrhage, injury to laryngeal nerve, thyrotoxicosis, infection airway obstruction = emergency, keep O2 on hand

Question 37

position for postoperative patients

Answer 37

semi fowlers and support the head with pillows

Question 38

subclinical hypothyroidism occurs when

Answer 38

TSH is greater than 4.5 but the T4 levels are normal

Question 39

drugs causing hypothyroidism

Answer 39

amiodarone (which contains iodine), lithium (which blocks hormone production)

Question 40

there are significant cardiovascular problems in hypothyroid patients who also have ....

Answer 40

CVD it is associated with decreased cardiac contractility and decreased cardiac output

Question 41

what causes myxedema

Answer 41

results from accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues = puffy subcutaneous tissues, facial and periorbital edema, and a masklike affect

Question 42

difference in thyroid defect and pituitary or hypothalamus defect

Answer 42

serum TSH is high when defect is in the thyroid TSH is low when it is in the pituitary or hypothalamus

Question 43

nutritional therapy of hypothyroidism

Answer 43

low calorie diet

Question 44

drug of choice to treat hypothyroidism and implications of it

Answer 44

levothyroxine lifelong therapy, do not stop abruptly or switch brands begin with low doses and monitor for cardiovascular complications may take up to 8 weeks before therapy is effective take in the morning before food