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Thyroid & Parathyroid Disease Cheat Sheet by

Adult Health 2

Thyroid Disease

Affects metab., growth, develo­pment; temp. regula­tion, HR, RR (every cell, tissue, organ)
Endocrine system = "duct system­"
How does it work?
Negative feedback loop...
- Hypoth­alamus releases TRH Pituitary releases TSH Thyroid releases T
& T
& T
maintain normal levels in blood Normal function maintained Normal levels "turn off" hypoth­alamus


Undera­ctive thyroid; not enough T
and T
Primary: dec. thyroid tissue, dec. TH
Secondary: inadequate TSH production
Pathop­hys­iology: Low metabolism Hypoth­alamus & anterior pituitary release TSH TSH tries to get thyroid to release hormones TSH binds to thyroid cells Inability = thyroid gland enlarges Goiter
Symptoms: (early = fatigue, vague)
- Neuro: memory loss, gait, AMS
- CV: low HR, low BP, eye/face edema
- Lungs: muscle weakness, dec. effort
- GI: dec. bowel, low metab., consti­pation
- Renal: dec. urine output
- M/S: weakness, myalgia
- Skin: dec. turgor, dry, stiff, puffy, PM
- Psych: depression
- Reprod­uctive: irregu­lar­/heavy periods
Drug therapy:
- Levoth­yroxine (Synth­roid) (most common), Liothy­ronine (Cytomel, Liotrix)
- Take first (30 min before/2 hr after meal)
- Therapy is LIFELONG!
- Don't take within 4 hr of GI meds, antacids
- Side effects: signs of hypert­hyr­oidism
Pretibial myxedema (PM): r/t accumu­lations of mucopo­lys­acc­har­ides; reversible

Hashim­oto's Disease

Most common cause of hypoth­yro­idism
Cause: immune system attacks thyroid
- Also: dec. iodine, tumor, overtr­eated
Manife­sta­tions: dysphagia, enlarged thyroid
Risk Factors: sex, age, heredity, another autoimmune disorder, radiation
Compli­cations: goiter, cardiac problems, mental health, myxedema, birth defects

Myxedema Coma

A medical emergency; "­sev­ere­" hypoth­yro­idism (r/t untreated, stopping meds)
Causes: acute illness, surgery (thyroid), chemo, narcotics, d/c replac­ement therapy
- Coma
- Respir­atory failure & hypote­nsion
- Hypoth­ermia
- Hypona­tremia (r/t dec. glomerular fx)
- Hypogl­ycemia (r/t glucon­eog­enesis)
- Labs & electr­olyte imbala­nce(s)
- Resp. rate & heart rhythms
- Maintain patent airway
- Cardiac monitoring
- IV: TH replac­ement, glucoc­ort­icoids
- Correct electr­olytes
- Conserve body heat
- Narcan?
- NO vasoco­nst­rictive drugs
- Seizure precau­tions (r/t low Na & AMS)


Increased secretion of thyroid hormones
- Grave's disease (most common)
- Multiple thyroid nodules
- Toxic multin­odular goiter
- Excessive thyroid replac­ement hormones
- Thyroi­ditis
- Too much iodine
Signs & Symptoms:
- Neuro: tremors, restless, irritable, confusion, seizures
- CV: dysrhy­thmias, a fib.
- Lungs: inc. resp. drive = dyspnea
- GI: diarrhea, inc. perist­alsis, dec. nutrients, losing electr­olytes, weight loss
- Renal: r/t HTN
- M/S: restless & nervou­sness = fatigue
- Skin: smooth skin
- Psych: restless, moody, insomnia
- Reprod­uctive: issues, irregular periods
- Monitor: EKG, HR, RR, VS; thyroid storm
- Comfort: calm, cool, comfor­table
- Diet: avoid iodine, > calories (inc. metab.)
- Education: watch for toxicity, med compli­ance, avoid aspirin
Drug therapy: antith­yroid meds & radioa­ctive iodine = most common treatment
- Thiona­mides: PTU, Tapazole
- Beta-b­lockers (treat symptoms; HTN, inc. HR, palpit­ations)
- Radioa­ctive iodine (kills thyroid slowly, more permanent cure; not if pregnant or BF)
Surgery: to remove all or part of thyroid
Combin­ation therapy
Propio­thi­ouracil (PTU) - stops T
& T
; doesn't harm gland; can take in 1st trimester, but can cause liver failure
Tapazole (Methi­mazole) - causes anemia, safer

Grave's Disease

Autoim­mune; most common cause of hypert­hyr­oidism
Cause: antibodies attach to TSH receptors inc. # and size of cells thyroid enlarges (goiter) overpr­odu­ction of hormones
Additional Manife­sta­tions:
- Exopht­halmos: autoimmune attacks area behind eyes, causes edema
- Pretibial myxedema
- Grave's dermopathy: resembles orange peel; r/t inc. protein under skin, legs, & feet

Thyroid Storm (Thyro­toxic Crisis)

What is it? - Extreme exacer­bation of hypert­hyr­oidism
Causes: illness, Grave's disease, meds that inc. TH, untrea­ted­/un­dia­gnosed tumor
Signs & Symptoms:
- Inc. HR & BP = severe cardiac problems
- Inc. temp = diapho­resis
- Resp. failure
- Anxiety or agitation
- Interv­entions to counteract symptoms
- Block TH synthesis
- Control temp. NO ASA
- Meds to suppress immune system?

Diagnostic Tests for Thyroid Problems

TSH = 0.4-4
TSH Assay
Thyroid Labs - T
, T
TSH Assay - r/t central hypoth­yro­idism
Thyroid Peroxidase (TPO) - enzyme in follicle cells important to hormone produc­tion; converts T
to T`3; (+) may indicate autoim­mune, not definite for thyroid disease
Radioi­sotope Uptake Scan - evaluates size, areas of over- or under-­act­ivity
Thyroid Scan
Thyroid US - uses sound waves to image, charac­ter­istics (nodules, blood flow)
Fine Needle Aspiration (FNA) - malignant vs. benign

Thyroid Surgery

Total or subtotal thyroi­dectomy
- Large goiter, poor response to drugs
- Can't/­won't take meds
- Malignancy
- Meds: dec. hormone secretion,
beta-b­locker, steroids to dec. immune system (w/ autoimmune dx)
- Control: HTN, dysrhy­thmias, tachyc­ardia
Post-Op: (BOWTIE)
- B leeding
- O pen airway
- W hisper
- T rach kit & suctioning ready
- I ncision (asses­s/clean dressing & splint)
- E mergency
- Also: monitor VS, semi-F­owl­er's, labs, humidify air, diet, cough & deep breathe
Compli­cations: hemorr­hage, resp. distress, parath­yroid injury


Abnormally low levels of PTH
- Iatrogenic
- Idiopathic
- Hypoma­gne­semia (inhibits PTH secretion)
- Other: autoimmune
Signs & Symptoms:
- P = parest­hesias, positive Chvostek's & Trouss­eau's signs
- T = tetany (bronc­hos­pams, seizures, EKG)
- H = hypoca­lcemia & hyperp­hos­pha­temia
- EKG = seizure activity, slow brain waves
- Blood tests = labs
- CT scans = specific compared to US, may show brain calcif­ica­tions
- MRIs may be even more specific
- Sympto­matic hypoca­lcemia: give Ca, vitamin D, Mg & seizure precau­tions
- Other meds: phosphate binders, PTH inj.
- Monitor: Ca, GI, parest­hesias
- Education: medication regimen
- Diet: inc. Ca
Chvostek's sign: tap facial nerve, + when twitches (= dec. Ca)
Trouss­eau's sign: inflate BP cuff 20-30 mm Hg above normal for 3-5 min; + when involu­ntary arm movement
PTH inj. (Natpara) - last resort (inc. risk of osteos­arcoma)

Calcium in Parath­yroid Disease

Major contro­lling factor of PTH secretion
Ca & PTH are directly related
- Increase in PTH = increase in Ca
Affects kidneys (regulates P), bones, GI tract


Abnormally high levels of PTH
- Primary: hyperp­lasia, cancer growth
- Secondary: CKD (PTH overworked = inc. Ca absorbed), vitamin D deficiency
Signs & Symptoms:
- B = bones (inc. fractures)
- E = epigastric pain, consti­pation (r/t smooth muscle dec.)
- D = dehydr­ation (r/t kidney compen­sation for inc. Ca)
- S = short QT interval (r/t inc. Ca)
- Diagno­stics - inc. Ca & PTH, dec. P
- Monitor: labs, EKG (telem­etry)
- Diet: dec. Ca, inc. P - watch in renal pt! (already inc. Ca & dec. P)
Medica­tions: GOAL = LOWER Ca LEVELS
- Loop diuretics: hypoca­lcemia = side effect
- Biphop­hates: given for osteop­orosis, protect against losing Ca, sit upright for 30 min & w/ full glass of water
- Calcim­imetics (ex - Sensipar): deceive thyroid that there's enough PTH
- Medication compliance
- Monitor for s/s of hypoca­lcemia
- Diet
- Prevent compli­cations: osteop­orosis, traumatic fractures

Diagostic Tests for Parath­yroid Problems

- Calcium (total) = 8.5-10 mg/dL - usually high enough, ionized if specif­icity desired
- Phosphate = 2.7-4.5 mg/dL
- Magnesium = 1.3-2.1 mEq/L
- PTH = 10-55 picogr­ams/mm
- Decrea­sed... Ca, Mg, PTH, vitamin D
- Increa­sed... phosphate
24-hour urine collection for calcium


Total or subtotal
- Get Ca in check
- Coags
- Similar to thyroi­dectomy (dressing, emergency equip., etc.)
- Check Ca levels
- Monitor for s/s hypopa­rat­hyr­oidism
- Voice (r/t laryngeal edema) - hoarseness
- May need lifelong treatment


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