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Module 4 > UNIT 4-Thyroid Disorders > Flashcards

UNIT 4-Thyroid Disorders Flashcards

1
Q

How does the thyroid hormone feedback loop work?

A
  1. Ant. Pituitary stimulates thyroid hormone production & release
  2. If blood levels of TH low then hypothalamus releases TRH
  3. TRH causes ant. pituitary to release TSH
  4. TSH stimulate thyroid to release TH
  5. High TH levels inhibit secretion of TRH & TSH
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2
Q

What allergies are important for thyroid scans?

A

Shellfish and iodine

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3
Q

What labs would we want to monitor with thyroid disorders?

A
  1. Serum TSH
  2. Free t4
  3. Serum T3, T4
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4
Q

What radiology exams might we see ordered for thyroid disorders?

A
  1. Ultrasound
  2. Thyroid scan
  3. RAI uptake
  4. Needle Biopsy
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5
Q

What is a Goiter?

A

Abnormal enlargement of thyroid gland

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6
Q

A goiter can occur with?

A
  1. Hyperthyroidism
  2. Hypothyroidism
  3. Euthyroidism
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7
Q

True or false: A goiter can tell us exactly what is wrong with the patient?

A

False- Just because a patient has a goiter doesn’t mean we know what is wrong

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8
Q

When looking at a thyroid panel for HYPOthyroidism what might our TSH, T4 and T3 look like?

A

TSH- High
T4- Low
T3- Low or normal

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9
Q

When looking at a thyroid panel for HYPERthyroidism what might our TSH, T4 and T3 look like?

A

TSH- Low
T4- High or normal
T3 - High or normal

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10
Q

What is a normal TSH level?

A

2-10 mU/mL

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11
Q

What is a normal T4 level?

A

4-12 mcg/dL

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12
Q

What is anormal T3 level?

A

70-205 ng/dL

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13
Q

Excess thyroid hormone results in:

A
  1. Increase BMR, CV, GI & Neuromuscular function
  2. Affects metabolism of fats, carbs & Proteins
  3. Wt Loss and heat intolerance

Everything is excited

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14
Q

What are causes of HYPERthyroidism?

A
  1. Autoimmune RXN (Grave’s disease)
  2. Excess dose of thyroid replacement
  3. Thyroiditis
  4. Tumor
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15
Q

Will your BMR, T, P, R & BP be increased or decreased with hyperthyroidism?

A
  1. increased/elevated
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16
Q

On assessment how might your hyperthyroidism patient present?

A
  1. Nervous tremor
  2. Wt. loss, hunger (even after eating)
  3. N/V/D
  4. Weakness, fatigue
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17
Q

Graves’ disease patient may present with? SKIP

A
  1. Goiter, exophthalmos, or raised red rashed
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18
Q

What are s/s of Hyperthryoidism?

A
  1. Intolerance to heat
  2. Fine straight hair
  3. Bulging eyes
  4. Facial flushing
  5. Enlarged thyroid
  6. Tachycardia
  7. increased systolic BP
  8. breast enlargement
  9. Weight loss
  10. Finger clubbing
  11. Tremors
  12. Increased diarrhea
  13. Menstrual changes (amenorrhea)
  14. Localized edema
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19
Q

How is hyperthyroidism managed?

A
  1. Lifelong antithyroid meds
  2. Ablative radioactive I-131
  3. Thyroidectomy (Partial or total)
    • May require thyroid replacement meds post-op
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20
Q

What problems may we need to assess with patients with hyperthyroidism?

A
  1. Knowledge deficit
  2. Insufficient nutrition
    • Avoid spicy foods because it stimulates the GI tract– same with caffeine and fiber
  3. Altered sleep patterns
  4. Altered body imagine
    • Exophthalmos or goiters
  5. May have decreased cardiac output or endurance
  6. May have vision changes
    • altered shape of eye
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21
Q

Nursing problems with hyperthyroidism varies how?

A

Severitity of conditions

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22
Q

What should we educate & evaluate our hyperthyroidism patient about?

A

Education
1. Medication
- Avoid decongestants and diet pills because it contains stimulants
2. Monitor weight & nutrition
3. Balance activity & rest
- avoid overexertion and manage energy to prevent fatigue
4. Lifestyle & self imagine change prn
5. Eye care PRN (exophthalmos)
- regular eye exams, teach patient to use saline eye drops. They are at an increased risk for light sensitivity or sun damage. Elevate HOB at night

Evaluation
1. Verbalize/demonstrate understanding
2. Follow up with HCP & Lab work..

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23
Q

What are two examples of hyperthyroid medications?

A
  1. Methimazole
  2. Propylthiouracil (PTU)
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24
Q

What is the MOA for Methimazole or propylthiouracil (PTU)

A

Inhibits thyroid hormone synthesis

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25
What are adverse effects of Methimazole or Propylthiouracil (PTU)
1. Agranulocytosis, - condition where the body has a low level of granulocytes, a type of white blood cell. This can weaken the immune system, making it harder for the body to fight off infections 2. Hypothyroidism
26
What are some contraindication of methimazole or propylthiouracil?
1. Allergy to thioamides 2. impaired liver function 3. pregnancy
27
Nursing care for PTU includes?
1. Monitor for signs of hypothyroidism 2. Monitor for signs of hyperthyroidism 3. Monitor thyroid & LFT, PT, INR, CBC 4. Assess vital signs and weight 5. TAKE WITH FOOD 6. Do not STOP abruptly
28
What do we teach patients who take PTU?
1. Report fever, sore throat, unusual bleeding 2. Take medication at the same time of day with meals or snack - space doses 3. Signs of hypo- and hyper- thyroid 4. Do not stop abruptly
29
Warning for patients taking methimazole for hyperthyroidism
1. Peripheral neuropathy 2. Fever, rash, pruritis 3. GI upset 4. Dizziness
30
MOA of Radioactive Iodine (I-131) hyperthyroid treatment
Destroys thyroid cells at high doses
31
What are adverse effects of Radioactive Iodine (I-131)?
1. Radiation sickness 2. Bone marrow suppression 3. Hypothyroid
32
Radioactive Iodine is contraindicated for what patients?
1. Pregnancy & Young children
33
What is the dosage of a radioactive Iodine (I-131) for hyperthyroid treatment?
4-10 mCI orally
34
True or False: We can expect hypothyroidism after a Radioactive Iodine I-131 tx?
True
35
What should we teach a patient in regards to radioactive Iodine I-131 tx?
1. Monitor CBC 2. Use private toilet facilities/flush twice after use 3. Bathe daily & frequent handwashing 4. Use disposable eating utensils 5. Sleep alone & avoid prolonged intimate contact for 3-4 days 6. Launder linens, towels, clothes daily & separately 7. Avoid coughing & expectoration
36
What is the MOA of strong iodine solution- nonradioactive?
1. Reduces iodine uptake, inhibits thyroid hormone production, & blocks release of T3 & T4
37
What are the adverse effects of strong iodine solution-nonradioactive hyperthyroidism treatment?
1. Iodism - Metallic taste in mouth - Irritation in mouth - Sore teeth/gum - Swelling in upper throat possible
38
What is the dose of strong iodine solution-nonradioactive hyperthyroidism treatment?
1. 2-6 drops 3x a day for 10 days
39
As the nurse what should we monitor for in a patient receiving strong iodine solution nonradioactive hyperthyroidism txs?
1. Signs of iodism -metallic taste in mouth - irritation in mouth - sore teeth/gum - Swelling in upper throat possible. 2. Vital signs, weight, I & O
40
What should we teach patients on a strong iodine solution-nonradioactive hyperthyroidism tx?
1. Dilute medication in juice to help with taste 2. Avoid foods high in iodine 3. Take medication same time each day 4. Increase fluid intake
41
What are the common causes of hyperthyroidism in younger and older adults?
Younger Adult 1. Graves disease in > 90% of cases Older Adult 1. Graves' disease or toxic nodular goiter
42
What are common symptoms of hyperthyroidism in younger adults vs. older adults.
Younger adult 1. Nervousness, irritability, weight loss, heat intolerance, warm moist skin Older adult 1. Anorexia, weight loss, apathy, lassitude, depression, confusion
43
How common is goiter in comparison to younger and older adults with hyperthyroidism?
Younger 1. Present in 90% of cases Older 1. Present in about 50% of cases
44
Ophthalmopathy in patients with hyperthyroidism in younger vs. older adults
Younger 1. exophthalmos present in 20-40% of cases Older 1. Exophthalmos less common
45
Cardiac features in patients with hyperthyroidism in younger vs. older adults?
Younger 1. Tachycardia and palpitations but without heart failure Older 1. Angina, dysrhythmia (especially atrial fibrillation with rapid ventricular response), heart failure may occur
46
Why is thyrotoxic crisis?
Extreme hyperthyroidism
47
What causes thyrotoxic crisis "Thyroid storm"?
1. Severe infection - can trigger a release of excess thyroid hormones into the bloodstream. 2. Manipulation of thyroid gland
48
What would we expect to see upon assessment of a patient in thyrotoxic crisis?
1. Temp > 101.3 F 2. increase HR, systolic HTN 3. Agitation, confusion, seizure 4. Exaggerated s/s of hyperthyroidism
49
What is the dx testing for thyrotoxic crisis?
1. Same as hyperthyroidism. May need additional cardiac testing
50
How do we treat thyroid crisis?
1. Stabilize CV function - beta blockers 2. Oxygen 3. Replace fluids & Electrolytes 4. Anti-thyroid medication - propylthiouracil, corticosteroids, lithium or iodinated contrast 5. Calm environment
51
True or False: Avoid aspirin during a thyroid crisis event?
True- can worsen
52
What is thyroiditis?
1. Inflammation of thyroid
53
What are the 3 types of thyroiditis?
acute, subacute, chronic
54
What causes acute thyroiditis?
Infection-- bacteria, fungal, parasites
55
What are the symptoms of acute thyroiditis?
1. pain 2. swelling 3. dysphagia 4. Dysphonia - difficulty or abnormality in producing voice 5. S/S of hyperthyroidism
56
What is the treatment for acute thyroditis?
1. Antibiotics 2. Fluid replacement
57
Does function return after acute thyroiditis?
Yes, returns after treatment
58
What causes subacute thyroiditis?
1. Granulomatous- Viral
59
What are the s/s of subacute thyroiditis?
1. Low fever 2. Fatigue 3. Swelling 4. Pain (Varies)
60
What are the two phases of subacute s/s of thyroiditis?
1. Phase 1- Hyperthyroid s/s (1-3months) 2. Phase 2- Hypothryroid s/s (9-12 mo.)
61
How is subacute thyroiditis treated?
1. NSAIDS 2. Beta Blockers 3. Steroid's
62
When does function of the thyroid return after subacute thyroiditis?
Normal function after 12-18 months
63
True or false: Subacute thyroiditis does not exhibit both hypo and hyper thyroid s/s
False- it can
64
Chronic thyroiditis aka Hashimoto's disease is caused by what?
Chronic lymphocytic - autoimmune
65
What are the symptoms of Chronic thyroiditis (Hashimoto's disease)?
1. Painless 2. hypothyroid s/s
66
What is the treatment for chronic thyroiditis (Hashimoto's disease) ?
Thyroid replacement
67
When does function return after chronic thyroiditis (Hashimoto's disease)?
Never-- thyroid is too damaged and destroyed
68
What type of thyroiditis is the biggest cause of hypothyroidism?
1. Hashimoto's disease aka chronic thyroiditis
69
What is the treatment of choice for thyroid cancer or goiters that cause issues with the airway?
1. Thyroidectomy
70
When treating thyroid cancer the surgery may include which approch?
1. Modified or radical neck dissection 2. Radioactive iodine to minimize size and reduce metastasis
71
What should our pre-op teaching for thyroidectomy include?
1. Nutrition - the bigger the surgery the more important nutrition becomes - pain with swallowing may occur-- eat foods as tolerated. Recommended soft foods for the 1st 24 hours 2. Avoid caffeine & stimulants 3. Tests & procedures
72
What post-op teaching should be included for thyroidectomy?
1. Head and neck support - support with pillows 2. Incision & airway - #1 priority is airway and then assess for bleeding 3. Thyroid hormone - depending on how much thyroid is left will depend on the need for thyroid hormone postop
73
Using the acronym BOW TIE what is our post op care for thyroidectomy?
B- bleeding O- Open airway W- Whisper T- Trache set - Dr. may order for bedside. I- Incision - avoid hyperextension of neck E- Emergency
74
Hypothyroidism leads to
1. Insufficient T3 & T4 leading to a decreased BMR and decreased heat production
75
What causes Hypothyroidism?
1. Treatment for hyperthyroidism 2. Antibody destruction of thyroid 3. Iodine deficiency
76
What would you expect to see in a patient with hypothyroidisms assessment?
1. Wt gain 2. Dry skin, Hair 3. constipation 4. Lethargy & Fatigue 5. Intolerance to cold
77
What would you expect to see as far as lab values go for a patient with hypothyroidism?
1. Increased TSH and lipids, 2. Decreased T4, low/normal T3 3. Decreased BMP, T,P, BP
78
What are s/s of hypothyroidism?
1. Hair loss 2. Apathy 3. Lethargy 4. Dry skin (course/scaley) 5. Muscle aches and weakness 6. Constipation 7. Intolerance to cold 8. Receding hairline 9. Facial and eyelid edema 10. Thick tongue- slow speech 11. Anorexia 12. Brittle nails and hair 13. Menstrual disturbances
79
What are late clinical manifestations of hypothyroidism
1. Subnormal temp 2. Bradycardia 3. Weight gain 4. Decreased LOS 5. Thickened skin 6. Cardiac complications
80
How is hypothyroidism managed?
1. Thyroid replacement (T3 or T4)
81
What are some nursing problems that a nurse should be aware of when taking care of a hypothyroid patient
1. Knowledge deficit 2. Decreased cardiac output & temperature 3. Excess nutrition - wt gain 4. Constipation 5. Skin integrity 6. Body image
82
What is the MOA of Levothyroxine (hypothyroidism)
1. Synthetic T4- produces various physiologic effects, including increasing metabolism
83
What are adverse affects of levothyroxine (tx for hypothyroidism)
Thyrotoxicosis
84
What are the contraindications for levothyroxine?
1. Acute MI - Wouldn't want to give because it may be stimulating if they have never had hypothyroid meds before 2. CVD 3. Thyrotoxicosis
85
What is the nursing care for levothyroxine?
1. Assess vital signs, BP, weight, history of; weight change, diet, energy level, mood, temperature response 2. Monitor thyroid function test results & glucose levels 3. Educate patient that labs will need to be done prior to starting medication regimen and then again in 30 mins because the meds can take that long to take effect and those results will tell us if drug is effective at dose 4. Give dose in morning before breakfast - given on empty stomach and try to avoid other medication 5. Teach symptoms of thyrotoxicosis
86
What patient teaching do we need to give patients on levothyroxine?
1. Take daily- lifelong therapy 2. Immediately report any signs of chest pain, nervousness, tremors, sleeplessness, heat intolerance, & excessive sweating 3. Do not discontinue medication suddenly.
87
What symptoms might a patient exhibit if the dose of levothyroxine is too low?
1. Bradycardia 2. Lethargy 3. Constipation 4. Excessive fatigue 5. Excessive sleeping
88
What symptoms might a patient exhibit if the dose of levothyroxine is too high?
1. Irritability 2. Palpations 3. Tachycardia 4. Diarrhea 5. Tremors 6. Insomnia
89
What education should we give to our hypothyroid patients?
1. Medication 2. Follow-up w/ HCP & labs 3. Unplanned wt. loss/gain >5lbs 4. Nutrition, fluids, & fiber intake 5. Avoid sedatives
90
What should the nurse be evaluating in a patient with hypothryoidism?
1. medication administration 2. Sleep & Elimination 3. Follow-up w/ HCP & lab 4. Vital signs 5. Activities 6. Weight
91
What is Myxedema?
Severe hypothyroidism
92
What are the causes of myxedema?
1. Sudden d/c thyroid replacement 2. Acute illness, trauma
93
What should our assessment include in a patient who has myxedema?
1. S/S of hypothyroidism - decreased bp, hr less than 50, decreased body temp, edema, spongy swelling in face/tongue 2. Edema-non pitting 3. Decreased T4, Na, glucose and increased TSH 4. Possible CV collapse & coma
94
How do we manage myxedema?
1. Replace T4 2. Treat precipitating factors 3. Respiratory & CV factors 4. Increase body temperature 5. Maintain fluid, electrolytes & Acid-base

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