ATI Unit 12 Hyperthyroidism

Question 1

what 3 hormones are produced by the thyroid gland

Answer 1

1. T4 = thyroxine
2. T3 = triiodothyronine
3. thyrocalcitonin = calcitonin

*first two regulated by anterior pituitary through negative feedback (eg T3/T4 serum level decreased, anterior pituitary released TSH)

Question 2

what do T3/T4 due

Answer 2

regulators of overall body functioning

• metabolism
• energy production
• fluid/electrolyte balance
• tissue use of fats/proteins/carbs

Question 3

what does calcitonin do?

Answer 3

• inhibits mobilization of Ca+ from bone and reduces blood calcium levels

Question 4

so if we have too many hormones from the thyroid what is that?

Answer 4

called hyperthyroidism

there’s too many thyroid hormones in our blood and their create extreme body processes, hypermetabolic states

Question 5

what are the causes of hyperthyroidism?

Answer 5

`1) Grave’s disease (most common) = autoimmune antibodies results in hypersecretion

2) toxic nodular goiter = presence of thyroid nodules cause overproduction
3) exogenous drugs

Question 6

what are the clinical manifestations of hyperthyroidism

Answer 6

can’t be vigilant with that hot body

1. Group 1 = vigilant
   - nervousness, irritable, hyperactive, no attention
   - insomnia
   - tremor, hyperkinesia, hyperreflexia

2) Group 2 = hot body
- frequent stools/diarrhea
- menstural irregularities
- warm/sweaty flushed skin
- weight change, hair loss, vision changes
- goiter

3) Group 3 - can’t be
- weakness, fatigue, exervise intolerance
- libido initially increased then decreases

Question 7

what is a unique marker of Grave’s disease

Answer 7

exophthalmos = eyes bulging out

Question 8

would hyperthyroidism display tachycardia or bradycardia?

Answer 8

tachycardia, elevated systolic, dysrhythmias

Question 9

which test clarifies the size and funciton of the thyroid gland?

Answer 9

• radioiodine (123I) uptake and thyroid scan
• 123I admin PO 24hrs before test and then measured; elevated uptake = hyperthyroidism
• • confirm client not preg before scan
• recent oral contraceptive may elevated levels
• avoid iodized salt, fish, shellfish, milk, canned fruits/veggies

Question 10

nursing care for hyperthyroidism

Answer 10

• provide rests
• increase calories/protein
• eye protection/lubricant if exophthalmos of Grave’s disease
• don’t palpate thyroid gland
• airway due to goiter

Question 11

Medications for hyperthyroidism

Answer 11

1) thionamide: inhibit thyroid hormone production
- methimazole (Tapazole)
- propylthiouracil (PTU)
these drugs are used to treat Graves’ disease along with radioactive iodine therapy, todecrease hormone levels in prep for surgery, and to treat thyrotoxicosis
monitor for
a. hypothyroidism manifestionsL intolerance ot cold, edema, bradycardia, increase in weight, depression
b. leukopenia or thrombocytopenia (brusing, sore throat, fever)
c. hepatotoxicity

Education

• typcially taken for 1-2 years
• jaundice (yellow skin/eyes, darkening of urine)
• guidelines for intake of iodine

2) propranolol (Inderal) (beta-adrenergic blocker, treats tachycardia, palpitations)
Monitor for….
- BP, HR, ECG
- hpoglycemia

Education

• if dizziness, sit on bedside
• bheck pulse before dose

3) Iodine solutions - Lugol's solution and saturated solutions of K+ iodine (SSKI) inhibit release of thyroid hormone
Considerations
- short-term use ONLY
- admin 1 hr after antithyroid med
- NO PREG

Education

• fever, sore throat, mouth ulcers
• med available as solution, mix with juice to mask taste, use straw to avoid staining teeth, take with food

Question 12

what is 131I

Answer 12

radioactive iodine

• therapy used, taken up by thyroid an destroys hormone-producing cells
• no preg
• monitor for hypothyroidism

Education
6-8 weeks effect
- stay away from infants/small children for 2-4 days

radiation precaution

• no same toilet for 2 weeks, sit down to urinate/flush toilet three times
• take laxative 2-3 days after treatment to ride body of stool
• wear washable clothing
• avoid contamination from saliva, no shared toothbrush, use disposable food items

Question 13

what is the surgical interventino for hyperthyroidism

Answer 13

Thyroidectomy

• usually prescribed thionamides before surgery (propylthiouracil/methimazole)
• recieve iodine 10-14 days before surgery (reduces gland’s size/bleeding)
• propranolol may be given

Post

• high Fowler’s, supoort head/neck pillows, avoid neck extension
• hemorrhage = compression of tachea, resp distress, or due to edema -> ensure trach supplies available, humidy air, cough , deep breath, suction
• laryngeal nerve damage = ask client to speek when awake an q2hrs
• if parathyroid damaged/removed = hypocalcemia/tetany possible -> tingling toes or around mouth, muscle twitches (positive Chvostek’s Trousseu’s signs), have calcium gluconate or chloride available
• hoarseness normal
• hypothyroidism manifestations
• if total thyroidectomy - replacement needed lifelong

Question 14

Medications for thyroidectomy

Answer 14

1) calcium gluconate/chloride
- supplements if parathyroid damaged/gone

2) prednisone )Deltasone)
- corticosteroids reduce postop edema
- taper slowly to discontinue

3) furosemide (Lasix)
- reduces swelling

Question 15

What are the five complications of post-thyroidectomy

Answer 15

1. hemorrhage at incision site
   - 50mL in first 24 hours of drainage expected
   - support neck, no flexion/extension
   - cough, deep breath
2. thyroid storm crisis: large amt of thyroid hormones in serum at once = great increase in metab, medical emergency high mortality rate
   - manifestations: hyperthermia, hypertension, delirium, vomitting, ab pain, hyperglycemia, achydysrhythmias
   - plus angina, dyspnea, palpitation
   CAUTION: salicylate antipyretics contraindicated b/c release thyroxine
   CAUTION: administer iodie 1 hr after PTU (propylthiouracil, that thionamide); if given before can make manifestations worse
   - admin small doses of insulin
   - O2
3. airway obstruction
   - keep trach near
   - may report dressings feel tight
4. hypocalcemia/tetany
   - talked aobut it earlier
5. nerve damage
   - already earlier, hoarseness occurs, need to speek q2h