tsh
low
t3 and t4
high
thyrotoxicosis
excessive thyroid hormone secretion from thyroid gland
cardiopulmonary symptoms
-palpitations
-chest pain
-increased bp
-tachycardia
-dysrythmia
-rapid shallow respirations
metabolic symptoms
-increased metabolic rate
-heat intolerance
-low grade fever
-fatigue
-hyperglycemia
-weight loss
neurological symptoms
-blurred or double vision
-eye fatigue
-increased tears
-photophobia
-eye lid retraction, eyelid lag
-globe lag
-tremors
-insomnia
skin symptoms
-diaphoresis
-fine, soft, silky body hair
-smooth, warm, moist skin
-thinning of scalp hair
gi symptoms
-weight loss
-increased appetite
-increased stool frequency
reproductive symptoms
-amenorrhea
-increased libido
psychosocial symptoms
-restlessness and irritability
-emotional instability
-manic behavior
other symptoms
-goiter
-exopthalmos
-enlarged spleen
causes
-graves’ disease
-benign adenomas
-excessive use of thyroid hormones exogenous hyperthyroidism)
-women are more affected
nursing interventions
-minimize client energy
-promote calm environment
-increased calories, protein
-frequent balanced meals
-patches, eye lubricant, tape to close eyelids
-monitor vital signs and hemodynamics
-reduce room temp
-provide cool shower
-report temp increase >1*
-avoid excessive palpating of thyroid gland
-administer anti thyroid medications
pharmacology: thionamides
-methimazole and Propylthiouracil (PTU)
-monitor for hypothyroid
-monitor for leukopenia/thrombocytopenia
-monitor for hepatoxicity
radioactive iodine
-destruction of thyroid tissue in pts who are not candidates for surgical removal of the gland
-common adverse effect hypothyroidism
-bone marrow suppression
-excreted through urine, sweat, tears
radioactive iodine side effects
-iodism
-burning in mouth
-sore teeth and gums
-diarrhea
-cold symptoms
-stomach upset
-staining of teeth
-skin rash
radioactive iodine considerations
-isolation (radioactive)
-no contact with children and pregnant women
-do not share personal items
-laundry needs to be done separately
-flush toilet at least 3 times
thyroidectomy pre op
-lifelong thyroid hormone needed
-high protein, high carb before surgery
-receive iodine 10-14 days before surgery (reduces gland size and prevents bleeding)
-hoarseness and sore throat can cut after intubation
-notify for tingling in the mouth, extremities, muscle twitches
thyroidectomy post op
-semi fowler w pillows, avoid neck extension
-deep breathing w neck support
-check dressing for bleeding
-assess for stridor
-check for laryngeal nerve damage by asking pt to speak asap and q2hr
-check for hypocalcemia (tetany)
-ensure CaGl and CaCl available bedside
-emergency ET at bedside
-report signs for thyrotoxicosis
thyrotoxicosis interventions
-maintain patent airway
-continuous cardiac monitoring
-admin. acetaminophen for fever
-no aspirin (releases thyroxine)
-cool baths
-admin. thianomines
-beta blockers
-administer iv fluids
