Endocrine Thyroid gland

Part 1
 Description: Thyroid
Butterfly shaped
Two lobes
connected by an
isthmus
Straddles the
trachea
Largest endocrine
gland
 Function: Thyroid
1. Produce thyroid
hormones (TH)
Vital for growth
& metabolism
2. Iodine storage
Essential for
T3/T4 syntheses
 Hormones
Hormone Function Stimulated by

T3/T4 metabolic rate metabolic

protein synthesis rate
energy production T3/T4
Most important TSH
hormone in day today
regulation of
metabolic rate
 Thyroid Hormones
Hormones Function Stimulated by
T3/T4 metabolism metabolism
Calcitonin blood calcium blood Ca
concentration levels
the reabsorption of
Ca and Ph from
bones to blood
Calcitonin tones
down serum Ca
levels
 Hormone Loop
Metabolic rate
Detected by hypothalamus
Stimulates anterior pituitary
Secretes TSH
Blood stream target organ thyroid
Stimulate Thyroid to secrete T3/T4
Blood stream target organs adrenal
medulla
Secretes Epinephrine & Norepinephrine
Metabolic rate
 Thyroid Disorders
World-wide United States
Iodine deficiency Auto-immune
 Hyperthyroidism
Definition
T3/T4 in blood
Pathophysiology
Primary hyperthyroidism
Problem with thyroid gland T3/T4
Secondary hyperthyroidism
Problem with pituitary gland T3/T4
Pituitary TSH T3/T4
TSH thyroid growth goiter
 Hyperthyroidism
Etiology
Auto-immune
AKA:
Graves disease
F vs M?
F>M
Age
20-40 yrs
 Hyperthyroidism
S&S

Neurological
Heat intolerance
Diaphoresis
sympathetic
nervous response
 Hyperthyroidism
S&S

Affect
Nervous
Emotional lability
Irritable
I Concentration
Mood swings

manic/psychotic
 Hyperthyroidism
S&S

Cardiovascular
Tachycardia
Palpitations
 Hyperthyroidism
S&S

Gastrointestinal
Appetite

Weight

BM

Diarrhea
 Hyperthyroidism
S&S

Muscle-skeletal
Tremors
Restlessness
Muscle
weakness
 Hyperthyroidism
S&S

Skin
Temperature
Warm
Smooth
Hair
Fine, soft
Gray
Loss
 Hyperthyroidism
S&S

Exophthalmos
Bulging of the eye
Stare
 Hyperthyroidism
S&S

Goiter
Enlarged thyroid
TSH levels

 Hyperthyroidism
S&S

Oncholysis
Distal nail
separates from
the nail bed
Nail fragile
 Hyperthyroidism
S&S

Gynecomastia
Abnormal
enlargement
breasts
male
 Hyperthyroidism
S&S

Elderly
Heart failure
Fatigue
Apathy
Depression
 Hormone Review
T3/T4
Pituitary
TSH
Thyroid
T3/T4
___________________
T3/T4
Pituitary
TSH
Thyroid
T3/T4
 Hyperthyroidism
Diagnostic Tests
By definition hyperthyroidism
means what?
T3/T4

Primary Secondary
Hyperthyroidism Hyperthyroidism
T3/T4
TSH
 Hyperthyroidism
Diagnostic Tests
By definition primary hyperthyroidism
means what? (where is the problem what
is causing the problem?)
Thyroid
T3/T4
In primary hyperthyroidism, is the pituitary
gland working correctly?
Yes
 Hyperthyroidism
Diagnostic Tests
If the pituitary gland is working
correctly and there is an T3/T4
level, what will the Pituitary gland
do with the TSH level?
Primary Secondary
Hyperthyroidism Hyperthyroidism
T3/T4
TSH
 Hyperthyroidism
Diagnostic Tests
By definition hyperthyroidism
means what?
T3/T4

Primary Secondary
Hyperthyroidism Hyperthyroidism
T3/T4
TSH
 Hyperthyroidism
Diagnostic Tests
By definition secondary hyperthyroidism
means what? (where is the problem what
is causing the problem?)
Pituitary gland
TSH
T3/T4
 Hyperthyroidism
Diagnostic Tests

By definition secondary hyperthyroidism

means what? (where is the problem
what is causing the problem?)
Pituitary gland TSH T3/T4
Primary Secondary
Hyperthyroidism Hyperthyroidism
T3/T4
TSH
 Question?
Mrs. Goiter has a thyroid panel done
and shows an elevated T3/T4 and
an elevated TSH? Which of the
following diagnosis apply?
A. Primary hyperthyroidism
B. Secondary hyperthyroidism
C. Primary hypothyroidism
D. Secondary hypothyroidism
 Question?
Mrs. Canta Geta Up has a thyroid panel
done and shows an elevated T3/T4
and an decreased TSH? Which of
the following diagnosis apply?
A. Primary hyperthyroidism
B. Secondary hyperthyroidism
C. Primary hypothyroidism
D. Secondary hypothyroidism
 Hyperthyroidism
Medical Treatment

Meds first
Goal
T3/T4 levels
Meds alone
sometimes work -
if not
Surgery
 Hyperthyroidism
Medical Treatment

Anti-thyroid therapy
Propylthioracil /
PTU
Methimazole /
Tapazole
Action
Inhibits synthesis
of T3/T4
 Hyperthyroidism
Medical Treatment

Propranolol
hydrochloride / Inderal
Beta-blocker
sympathetic nervous
system
No smoking
 Hyperthyroidism
Medical Treatment

Meds alone not

Surgery
If Ca Thyroid
Surgery
Euthyroid state
before surgery!
How?
Anti-thyroid meds
 Hyperthyroidism
Medical Treatment

Iodine before
surgery
Potassium iodine
saturated
solution (SSKI)
vascularity of
the thyroid
risk of post-op
bleeding
 Hyperthyroidism
Medical Treatment

Radioactive Iodine
I131
Used instead of
radiation tx
Stop anti-thyroid
meds x 7 days
Single dose
S&S in @ 3wks
full effect in 3
months
 Hyperthyroidism
Medical Treatment

Radioactive Iodine
Safety
No PG nurses
Watch body fluids
Avoid kids x 7
days
 Hyperthyroidism
Medical Treatment
Diet (When hyperthyroid)
Calories

4,000-5,000 cal/day
Fluids

Na

Fiber

Caffeine

 Hyperthyroidism
Nursing Management

Assessment
Vital signs
Lung sounds
Anxiety level
Weight
Bowel function
NEVER palpate
goiter
Release TH
 Hyperthyroidism
Nursing Management

Nrs. Dx
Risk for injury
Hyperthermia
Diarrhea
Alt. Nutrition
Sleep pattern
disturbance
Anxiety
 Hyperthyroidism
Nursing Management

Exophthalmos
Lubricate eyes
Tape closed
Dark glasses
Na diet
HOB
 Hyperthyroidism
Severe
Thyrotoxicosis
AKA: Thyroid Storm
Definition
Sever hyperthyroid
state
Etiology
Stress
Post thyroid
surgery
Undiagnosed
 Hyperthyroidism Severe
Thyrotoxicosis
S&S Depression
TH adrenergic Activity
activity Restlessness
epinephrine Delirium
Pulse SOB
Coma
Temperature

BP

 Hyperthyroidism Severe
Thyrotoxicosis

Death
<2hr
Cardiac Failure
 Hyperthyroidism Severe
Thyrotoxicosis
Treatment
Fever
Tylenol/
acetaminophen
Not aspirin
For pulse & BP
Propranolol / Inderal
Beta-adrenergic
blocker
If SOB
O2
HOB