ENDOCRINE SYSTEM thyroid problems HYPERTHYROIDISM

Question 1

The thyroid produces what 3 hormones. what are they?

Answer 1

T3, T4, and Calcitonin

Question 2

In order to make these thyroid hormones, what dietary supplement do you need?

Answer 2

Iodine

Question 3

Thyroid hormones give us what?

When you hear/see “thyroid” think____ Thus, HYPERthyroidism (graves disease or hashimoto’s) is having too much____

Answer 3

ENERGY! energy! energy (energy to the grave)

Question 4

HYPERTHYROIDSM S/S:

____ nervousness

____ weight

Heat_____

____ eyes

____ attention span

____ appetite

____ irritability

_____ GI activity

_____ BP

______ Thyroid

Answer 4

• increased nervousness
• decreased weight
• heat intolerance
• bulging eye
• decreased attention
• increased appetite (eating more, but losing weight due to their increased metabolism).
• increased irritability
• increased GI activity
• increased bp
• enlarged thyroid gland

Question 5

What causes exophthalmus?

is this irreversible?

Answer 5

Fluid accumulates behind the eyes and starts to push the eyes forward.

it is irreversible

Question 6

HYPERTHYROID:

If you drew a serum T4 on this patient, would it be increased or decreased?

Why would you do a thyroid scan on this patient?

Answer 6

increased

To see how much Iodine his/her thyroid gland is taking up.

Question 7

• Propaci
• PTU
• Tapazole are all____.

What do they do?

Answer 7

Anti-thyroid meds.

They stop the thyroid gland from making thyroid hormones. we want this patient to become “eu-thyroid”

Question 8

What does “eu-thyroid” mean?

Answer 8

having normal thyroid

Question 9

Upon discharge, your patient tells you that he can stop taking his PTU/ anti-thyroid med once feels better. what do you tell him?

Answer 9

Do not abruptly stop antithyroid meds because it will take you straight to hypothyroidism. they must be tapered off the drug.

Question 10

-Potassium iodide

- Lugol’s solutions

-SSKI (saturated solution of potassium iodide) are all____.

what do they do?

How are they administered?

Answer 10

potassium compounds/ drug iodines

. -They are going to decrease the size and vascularity of the thyroid gland

• give it in milk, juice, and must use a straw because it stains the teeth.

Question 11

Why are beta blockers good for clients with hyperthyroidism?

What is the common beta blocker they get?

what’s 1 bad thing about beta blockers related to heart contractility?

Answer 11

• Because their blood pressure and heart rate is already elevated, the beta blockers will decrease them. this will also decrease their anxiety level because beta blockers block epinephrine and norepinephrine.
• inderal, propranolol
• can decrease cardiac contractility and cause a decrease in cardiac output.

Question 12

DO NOT GIVE BETA BLOCKERS TO ___ and _____. Why?

Answer 12

• Asthma patients and diabetic patients.
• Can give asthma attack and; it can mask the signs and symptoms of hyPOglycemia. (since the signs of hypoglycemia is similar to anxiety, meaning, they start getting shaky, heart rate goes up..etc! it would make general sense to give a beta blocker, but we NEED to know these symptoms are happening so these patients don’t bottom out. We don’t wanna mask these symptoms).

Question 13

RADIOACTIVE IODINE:

How does this work?

What is the end result?

If this patient is taking radioactive iodine, they need to remember 2 rules for 24hrs:

What is the medical emergency we have to keep an eye on when a patient is taking radioactive iodine?

Answer 13

- it DESTROYS thyroid cells

• the patient becomes hypothyroidic
• stay away from children and babies and NO KISSING
• thyroid storm (can be due to a rebound effect post radioactive iodine… the thyroid gland senses low thyroid hormones, so it tries to compensate by firing more hormones.)

Question 14

Thyrotoxicosis, and thyrotoxic crisis are just other names for____ and is a____

How and what happens in a thyroid storm?

T OR F? Anyone with hyperthyroidism can go into a thyroid storm at any time with or without radioactive iodine.

Answer 14

Thyroid storm; medical emergency

• when this patient is taking radioactive iodine, or have part of thyroid removed, the remaining piece senses a major drop in hormone levels, so it tries to compensate by making CRAZY amounts of thyroid hormones. It’s a rebound effect.

S/S much like hyperthyroidism

-T! this can happen on their way to ICU and about to have a stroke or heart attack.

Question 15

THYROIDECTOMY (PARTIAL/ COMPLETE):

POST OP:

• teach them how to support the___.

how?

• how do we wanna position this patient post-op?
• Where do we check for bleeding?
• If this patient develops recurrent hoarseness, what has happened?

why is this bad?

what must be kept at the bedside?

Teach this patient to report ANY sign of ___

Answer 15

• Support the neck when trying to change position or move their head.
• They must interlock their fingers and place it behind their neck with elbows pointed towards the ceiling. that way they’ll have support all the way around because we NEVER WANT TENSION ON THE SUTURE LINE.
• semi fowler (elevate head of bed)
• behind the neck because that’s where the pooling will occur (blood glides from cut to pillow because of gravity). It can also happen inside of the tissue) -

laryngeal nerve damage

• it could lead to vocal cord paralysis, if there is paralysis of both cords, airway obstruction will occur requiring an immediate trache.
• keep a trache set at the bedside -pressure

Question 16

What 3 reasons do we keep a trach set at the bedside?

Answer 16

• Hypocalcemia (since the thyroid hormone produces PTH, and PTH is responsible to serum calcium balance, since their’s no gland, there won’t be PTH and this will cause hypocalcemia, and hypocalcemia will make ur muscles tense).
• swelling
• reccurrent laryngeal nerve damage