Pathophysiology:
Negative Feedback Loop (ex. correction of a thermostat) activated by a disturbance in homeostasis. |
Thyroid Gland
T3- Triiodothyronine
T4- Thyroxine
Purpose:
1. Metabolic Process (burn calories)
2. Cellular replacement
3. Digestion
4. Sympathetic Stimulation
5. Regulate T & HR
6. Brain Function |
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Hyperthyroidism "Fight or Flight"
Causes |
Graves Disease, Toxic Modular Goiter, Exogenous Hyperthyroidism (taking to much thyroid med), Thyroiditis, Excessive Iodine consumption |
S/S |
Anxiety, increased HR, weight loss, restlessness, jittery, heat intolerance, palpitations, insomnia, increased systolic BP, hands tremor, hyperactive reflexes, possible goiter |
Graves Disease |
Autoimmune, genetic component, production of TSI, TSI mimics TSH = increased thyroid hormone production |
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S/S: Exophthalmos, pretibial myxedema |
Treatments |
Anti-thyroid Medications (Stop T3 & T4 production)- Methimazole, PTU |
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Supportive- Beta Blockers |
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Glucocorticoids- inflammation/swelling |
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RAI- destroys thyroid tissue |
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Thyroidectomy- total or partial |
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Potassium Iodine- blocks uptake of iodine |
Nursing Interventions |
Monitor heart, VS, I&O. Improve nutritional status, enhanced coped measures (quiet cool room), regulate temperature, monitor for thyroid storm |
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Must have tracheostomy tray/oxygen/suction/calcium gluconate after thyroidectomy! |
Thyroid Storm
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Life-Threatening |
Causes: |
Excessive thyroid hormone release. Often with infection, trauma, DKA, pregnancy, surgery, or deep palpitation |
S/S: |
fever, tachycardia, HTN, abdominal pain, sweating, anxiety, seizures, coma, death |
Treatment: |
Maintain ventilation, temp, safety, seizure precautions, bed in low position, cool room, suction |
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Hypothyroidism "Rest & Digest"
Causes: |
Hashimotos Thyroiditis, glucocorticoids, thyroid cancer, pituitary tumors, decreased ingestion of iodine, treatment of hyperthyroidism |
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Increased TSH= Decreased T3 & T4 |
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Decreased TSH = Increased T3 & T4 |
S/S: |
Slow, fatigue, weakness, constipation, cold intolerance, fertility issues, low HR/RR/T, weight gain, depression |
Treatment: |
Lifelong meds (ex.synthroid) on an empty stomach, don't take w/in 4 hours of GI meds (specifically calcium) |
Hypothyroidism Myxedema Coma
Causes: |
Abrupt stopping of thyroid replacement medication |
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Post thyroidectomy |
S/S: |
Early signs- depression, diminished cognitive status, lethargy, somnolence |
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Advancing signs: respiratory depression, coma, narcosis, hyponatremia, hypoglycemia, hypotension, bradycardia, and hypothermia |
Treatment: |
REPLACE THYROID HORMONE |
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Avoid sedatives and opioids |
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