Hyper/Hypo-thyroidism
Hyperthyroidism Pathophysiology
Excessive secretion of thyroid hormones (T3/T4) leading to increased BMR, increased CV fx, increased GI fx, increased Neuro fx, weight loss, heat intolerance
Medications for Hypothyroidism
-Synthroid -Give 1 hr prior or 2 hrs after meals -Withhold if HR >100
Cardiovascular Manifestations of Hyperthyroidism
-Tachycardia -Palpitations -Chest pain -Systolic HTN -Dysrhythmias
Thyroid Storm/Crisis Pathophysiology
-Uncontrolled hyperthyroidism caused by untreated Graves Disease
Gastrointestinal Manifestations of Hypothyroidism
-Anorexia -Weight gain -Constipation -Abdominal distention
Psychological Manifestations of Hypothyroidism
-Apathy -Depression -Paranoia -Withdrawal
Indications of Total Thyroidectomy
-Certain types of CA -Pt will have to take TH forever
Psychological Manifestations of Hyperthyroidism
-Decreased attention span -Restlessness -Irritability -Manic, labile behavior
Hypothyroidism Pathophysiology
-Decreased secretion of T3/T4 hormones leads to: -Decrease production of hydrochloric acid by stomach -Reduced gastrointestinal motility -Decreased HR & CO -Impaired neurological fx -Decreased heat production -Decreased lipid metabolism -Anemia -Increased interstitial fluids (leads to pleural/cardiac effusions)
Respiratory Manifestations of Hypothyroidism
-Dyspnea -Hypoventilation -Pleural effusion
Respiratory Manifestations of Hyperthyroidism
-Dyspnea at rest or upon exertion
Indications for Subtotal Thyroidectomy
-Enough remaining tissue to produce adequate amounts of hormones
Causes of Hyperthyroidism
-Excess secretion of TSH by pituitary gland -Thyroiditis -Graves' Disease -Tumor -Excessive dose of supplemental TH
Neurological Manifestations of Hyperthyroidism
-Exophthalamus (associated w/ Graves disease) -Visual changes -Eye fatigue -Eyelid retraction -Global lag -Tremors
Clinical Manifestations of Thyroid Storm/Crisis
-Fever > 102 (can reach 105-106) -Tachycardia -Systolic HTN -HF -Shock -N/V -Agitation, confusion -Seizures
Complications from Surgery
-Hemorrhage -Respiratory distress -Parathyroid gland injury (results in hypocalcemia & tetany) -Damage to laryngeal nerves
Cardiovascular Manifestations of Hypothyroidism
-Hypotension -Bradycardia -Dysrhythmias -Periorbital edema -Facial puffiness
Metabolic Manifestations of Hyperthyroidism
-Increased BMR -Heat intolerance -Low grade fever
Gastrointestinal Manifestations for Hyperthyroidism
-Increased appetite -Weight loss -Diarrhea
Nursing Interventions for Thyroid Storm/Crisis
-Maintain patent airway and adequate ventilation -Medications that lower thyroid levels -Cardiac monitor for dysrhythmias -Monitor vitals frequently -IV fluids -Provide comfort measures
Nursing Interventions for Hyperthyroidism
-Monitor VS -Assess respiratory effort -Assess energy/activity tolerance -Monitor diet (make sure getting enough during hyper-metabolic state) -Exophthalamus education
Nursing Interventions for Hypothyroidism
-Monitor cardiac status (BP/HR regularly) -Assess hemodynamic fx (urine output/BP) -Monitor for mental status & neurologic changes -Administer hypothyroid medications as ordered -Adjust environment with blankets as needed to temperature & comfort -Encourage fluids of at least 2 L -Encourage diet high in fiber to promote regular bowel movements
Post-Surgical Nursing Interventions
-Monitor for sx of respiratory distress (tachypnea/stridor) -Inspect neck dressing every hour, then every 4 hours -Monitor amount of drainage: notify MD for bleeding -Maintain client in Semi-Fowler's position w/ ice to neck -Assess for numbness, tingling, voice quality (dysphonia), dysphagia, hypocalcemia) -Keep emergency tracheostomy kit at bedside
Musculoskeletal Manifestations of Hyperthyroidism
-Muscle weakness/wasting -Fatigue
Exophthalamus Education for pt w/ Hyperthyroidism
-Need for regular eye exams -Reports changes in vision -Protects eyes with tinted glasses -Moistens eyes frequently -Sleeps with head of bed elevated to decrease pressure on optical nerve
Medications to Lower Thyroid Hormone Levels
-Porpylthiouracil (PTU), Methimazole (Tapazole) -Iodine (blocks release & inhibits synthesis of T3/T4; decreases vasculature of thyroid gland) -Inderal/beta blockers (decreases heart activity) -Glucocorticoids (Hydrocortisone, Prednisone) -Antipyretics (Non-aspirin based)
Non-Surgical Treatment of Choice for Hyperthyroidism
-Radioactive Iodine -Make sure pt is not pregnant
Neurologic Manifestations of Hypothyroidism
-Slow, slurred speech -Decreased memory, concentration -Lethargy, somnolence -Paresthesias
Surgical Treatments for Hyperthyroidism
-Subtotal Thyroidectomy -Total Thyroidectomy
Non-Surgical Treatments for Hyperthyroidism
-Symptom management -Medications
