Endocrine Disorders: Hypothyroidism vs. Hyperthyroidism

Endocrine Disorders: Hypothyroidism and Hyperthyroidism

• Hypothyroidism: Characterized by insufficient thyroid hormone. Affects women more frequently (5-8x) than men, usually between ages 40-70.
• Causes: Autoimmune disease (e.g., Hashimoto's thyroiditis), post-Graves disease, and treatment for hyperthyroidism.
• Clinical Manifestations: Mild to severe symptoms affecting all body functions. May include depression, lethargy, decreased consciousness, somnolence, hypoventilation and coma. Common signs include hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, and hypothermia. Myxedema coma is a severe, life-threatening form.
• Assessment: Serum TSH (0.4-6.15 µu/ml), serum free T4 (0.9-1.7 ng/dL), serum T3 (80-200 ng/dL), serum T4 (5.4-11.5µg/dL). Other tests include T3 Resin uptake, Radioactive Iodine Uptake, Thyroid Antibodies, Fine-needle aspiration biopsy, and Thyroid scan.
• Medical Management: Replaces missing thyroid hormone with synthetic levothyroxine. Carefully monitors for associated dysrhythmias and angina. Discontinue thyroid hormone if dysrhythmias or angina occur. Start at low dosages and monitor closely, and use caution when medications interact.
• Nursing Interventions: Careful monitoring of analgesic, sedative, and anesthetic agent effects. Educating patients on medication administration, side effects, follow-up importance, and dietary needs. Closely monitor patients with severe hypothyroidism/myxedema coma.

Endocrine Disorders: Hyperthyroidism

• Hyperthyroidism: Excessive thyroid hormone production (endogenous or exogenous). Affects women 8x more frequently, onset usually between 20s and 40s.
• Causes: Graves' disease (autoimmune disorder), toxic multinodular goiter, toxic adenoma, thyroiditis, and excessive thyroid hormone ingestion. Associated or preceded by events such as shock, stress, or infection.
• Clinical Manifestations: Enlarged, often soft, pulsating thyroid gland. Palpable thrill, and bruit heard over thyroid arteries. Symptoms include exophthalmos (bulging eyes).
• Assessment: Decreased serum TSH, increased free T4, increased radioactive iodine uptake.
• Medical Management: Varied treatment depending on cause: antithyroid agents, radioactive iodine (131I), or surgery (total or subtotal thyroidectomy). Radioactive iodine therapy destroys thyroid cells, and sometimes is preceded by antithyroid medications (e.g., methimazole)
• Side Effects of Treatment: Relapse or recurrent hyperthyroidism or permanent hypothyroidism,
• Thyroid Storm: A severe, life-threatening condition characterized by cardiac dysrhythmias, fever, and neurologic impairment. Management: hypothermia measures, hydrocortisone, acetaminophen, humidified oxygen, IV fluids.
• Nursing Management: Monitor patients for malnutrition (due to the increased metabolic rate and appetite increase). Support, and help patients with coping mechanisms.

Endocrine Disorders: Parathyroid Disorders

Hyperparathyroidism

• Hyperparathyroidism: Overproduction of parathyroid hormone (PTH) causing elevated serum calcium. 2-4 times more common in women than men, typically occurring between 60 and 70 years old.
• Causes: Overproduction of parathyroid hormone
• Clinical Manifestations: May be asymptomatic. Can include osteoporosis, hypercalcemia, hypertension & cardiac dysrhythmias, renal calculi, constipation, apathy, fatigue, depression, nausea, vomiting, peptic ulcers, pancreatitis, and skeletal pain.
• Assessment: Serum calcium levels, parathyroid hormone level, X-rays/bone scans, ultrasound, MRI, and fine-needle biopsy.
• Medical Management: Surgical removal of abnormal parathyroid tissue (parathyroidectomy). Minimally invasive techniques are increasingly common.
• Medical Management: hydration therapy (increased fluid intake). avoiding thiazide diuretics. mobility encouragement. appropriate diet and medication management.
• Nursing Management: Maintain calcium-phosphorus balance. Monitor for complications such as hypercalcemic crisis. Monitor patients undergoing parathyroidectomy and educating patients/families.

Hypoparathyroidism

• Hypoparathyroidism: Low production of PTH leading to hypocalcemia and hyperphosphatemia.
• Causes: Thyroidectomy, parathyroidectomy, autoimmune responses, vitamin D deficiency.
• Clinical Manifestations: Hypocalcemia symptoms (Tetany), muscle spasms, numbness and tingling, stiffness, bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia and photophobia, cardiac dysrhythmias, seizures, anxiety and depression.
• Assessment: Positive Chvostek's and Trousseau's signs, serum calcium and phosphate levels, and X-rays showing increased bone density.
• Medical Management: Increasing serum calcium levels to 9-10 mg/dL, often with calcium supplementation (oral or IV). Vitamin D supplementation to enhance calcium absorption. Use of medications like aluminum hydroxide to bind phosphate and increase excretion.
• Nursing Management: Close monitoring of postoperative patients. Immediate availability of calcium gluconate for emergency use. Patient education about diet and medication to control hypocalcemia. ECG monitoring for cardiac patients.