Podcast
Questions and Answers
Which of the following is NOT a clinical manifestation of hyperthyroidism?
Which of the following is NOT a clinical manifestation of hyperthyroidism?
Which of the following medications is used to block synthesis of thyroid hormone?
Which of the following medications is used to block synthesis of thyroid hormone?
Hypothyroidism is more common in men than women.
Hypothyroidism is more common in men than women.
False
What is the treatment of choice for thyroid cancer?
What is the treatment of choice for thyroid cancer?
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Hypothyroidism can affect all body functions.
Hypothyroidism can affect all body functions.
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Which of the following is a potential complication of thyroidectomy?
Which of the following is a potential complication of thyroidectomy?
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Match the following terms with their definitions.
Match the following terms with their definitions.
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What is the name of the hormone secreted by the anterior pituitary that controls the release of thyroid hormone?
What is the name of the hormone secreted by the anterior pituitary that controls the release of thyroid hormone?
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T3 is more potent and rapid-acting than T4.
T3 is more potent and rapid-acting than T4.
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What is the name of the condition that can occur in response to therapy in patients with severe, long-standing hypothyroidism?
What is the name of the condition that can occur in response to therapy in patients with severe, long-standing hypothyroidism?
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What is the name of the hormone that is released by the posterior pituitary and helps regulate water balance in the body?
What is the name of the hormone that is released by the posterior pituitary and helps regulate water balance in the body?
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The pituitary gland is responsible for the production of all hormones in the body.
The pituitary gland is responsible for the production of all hormones in the body.
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Choose the best answer: What is considered the treatment of choice for hyperthyroidism?
Choose the best answer: What is considered the treatment of choice for hyperthyroidism?
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Hypothyroidism during pregnancy requires monitoring of TSH levels.
Hypothyroidism during pregnancy requires monitoring of TSH levels.
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What is the name of the autoimmune disorder that is the most common cause of hypothyroidism?
What is the name of the autoimmune disorder that is the most common cause of hypothyroidism?
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Which of the following is NOT a symptom of hypothyroidism?
Which of the following is NOT a symptom of hypothyroidism?
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Myxedema coma is a life-threatening condition.
Myxedema coma is a life-threatening condition.
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What is the name of the synthetic levothyroxine medication used to treat hypothyroidism?
What is the name of the synthetic levothyroxine medication used to treat hypothyroidism?
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What is the name of the sign that can be observed after thyroidectomy when tapping on the facial nerve?
What is the name of the sign that can be observed after thyroidectomy when tapping on the facial nerve?
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The use of radioactive iodine is a treatment option for both hyperthyroidism and hypothyroidism.
The use of radioactive iodine is a treatment option for both hyperthyroidism and hypothyroidism.
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Thyroid hormone production increases during pregnancy.
Thyroid hormone production increases during pregnancy.
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The use of beta-blockers can help manage symptoms of hyperthyroidism.
The use of beta-blockers can help manage symptoms of hyperthyroidism.
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What is the name of the endocrine gland located in the neck that produces thyroid hormones?
What is the name of the endocrine gland located in the neck that produces thyroid hormones?
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What is the primary function of the endocrine system?
What is the primary function of the endocrine system?
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The thyroid gland is essential for regulating calcium levels in the body.
The thyroid gland is essential for regulating calcium levels in the body.
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The thyroid gland can be affected by both autoimmune disorders and medical conditions.
The thyroid gland can be affected by both autoimmune disorders and medical conditions.
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What is the name of the medical condition that is characterized by the overproduction of thyroid hormones?
What is the name of the medical condition that is characterized by the overproduction of thyroid hormones?
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What is the name of the hormone that is secreted by the adrenal glands and helps regulate the body's response to stress?
What is the name of the hormone that is secreted by the adrenal glands and helps regulate the body's response to stress?
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Which of the following glands is responsible for producing growth hormone?
Which of the following glands is responsible for producing growth hormone?
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The endocrine system is closely interconnected with the nervous system, often working in concert to regulate bodily functions.
The endocrine system is closely interconnected with the nervous system, often working in concert to regulate bodily functions.
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The thyroid gland is a small gland located in the abdomen.
The thyroid gland is a small gland located in the abdomen.
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Hormones travel throughout the body through the bloodstream.
Hormones travel throughout the body through the bloodstream.
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Study Notes
Assessment and Management of Patients With Endocrine Disorders
-
Outcomes:
- Compare hyper/hypothyroidism in terms of causes, clinical manifestations, management, and nursing interventions.
- Use the nursing process as a framework for care of patients with hyper/hypothyroidism.
- Develop a plan of nursing care for patients undergoing a thyroidectomy.
Introduction
-
Thyroid disorders:
- Hypothyroidism
- Hyperthyroidism and thyrotoxicosis
- Graves' disease
- Thyroiditis
- Toxic adenoma
- Toxic multinodular goiter
- Thyrotoxicosis factitia
- Struma ovarii
- Hydatidiform mole
- TSH-secreting pituitary adenoma
- Nontoxic goiter
- Thyroid nodules & thyroid cancer
- Benign thyroid nodules
- Thyroid cancer
- Papillary carcinoma
- Follicular carcinoma
- Medullary carcinoma
- Anaplastic carcinoma
- Lymphoma
- Cancer metastatic to the thyroid
Key Term
- Euthyroid: State of normal thyroid hormone production.
- Exophthalmos: Abnormal protrusion of one or both eyeballs.
- Goiter: Enlargement of the thyroid gland.
- Graves' disease: A form of hyperthyroidism; characterized by a diffuse goiter and exophthalmos.
- Myxedema: Severe hypothyroidism; can be with or without coma.
Endocrine System
- Plays a vital role in orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions.
- Negative feedback mechanism
- Hormones
- Amines and amino acids
- Peptide (protein) - act on cell surface
- Steroid - act inside the cell
- Fatty acid derivative
Major Hormone-Secreting Glands
- Hypothalamus
- Pineal
- Pituitary (hypophysis)
- Thyroid
- Parathyroid (posterior)
- Thymus
- Adrenals
- Islets of Langerhans (in pancreas)
- Testes
- Ovaries
Pituitary Gland: Hypophysis
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Anterior:
- FSH, LH, prolactin, ACTH, TSH, GH
- Hyper: Cushing syndrome, gigantism, acromegaly
- Hypo: dwarfism, panhypopituitarism
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Posterior:
- ADH, vasopressin
- Oxytocin
- Hyper: syndrome of inappropriate antidiuretic hormone (SIADH)
- Hypo: diabetes insipidus (DI)
- Tumors: 95% benign
- Surgery: hypophysectomy
Pituitary Gland and Hormones Secreted
- Diagrams illustrating internal/external stimuli, neurotransmitters, hormones, and their targets.
Thyroid
- Thyroid hormones: T3, T4, calcitonin
- Iodine is contained in thyroid hormone.
- TSH from the anterior pituitary controls the release of thyroid hormone.
- Controls cellular metabolic activity.
- T3 is more potent and rapid-acting than T4.
- Calcitonin is secreted in response to high plasma calcium level and increases calcium deposit in bone.
Thyroid Gland
- Diagram of thyroid anatomical structure
Hypothalamic-Pituitary-Thyroid Axis
- Diagram illustrating the regulatory interactions between the hypothalamus, pituitary, and thyroid.
Thyroid Diagnostic Tests
- TSH
- Serum-free T4
- T3 and T4
- T3 resin uptake
- Thyroid antibodies
- Radioactive iodine uptake
- Fine-needle biopsy
- Thyroid scan, radioscan, or scintiscan
- Serum thyroglobulin
- Refer to Chart 52-2 for medications that alter test results
Hyperthyroidism
- A common endocrine disorder resulting from an excessive synthesis and secretion of endogenous or exogenous thyroid hormones.
-
Causes:
- Graves' disease (most common)
- Toxic multinodular goiter
- Toxic adenoma
- Excessive ingestion of thyroid hormone
- Autoimmune disorder
- Affects women eight times more than men
Hyperthyroidism: Clinical Manifestations
- Nervousness
- Rapid pulse and palpitation
- Heat intolerance and tremors
- Skin flushed, warm, soft, and moist
- Exophthalmos
- Increased appetite, weight loss
- Elevated systolic BP and cardiac dysrhythmias
Hyperthyroidism: Clinical Manifestations (Graphic)
- Includes images/graphics of symptoms.
Hyperthyroidism: Management
- Antithyroid agents (e.g., Propylthiouracil, Methimazole)
- Radioactive iodine (131I therapy) - refer to Table 52-3
- Adjunctive therapy:
- Sodium or potassium iodine solutions
- Dexamethasone
- Beta-blockers
- Surgery: thyroidectomy
Question #1 (Hyperthyroidism)
- Which medication blocks thyroid hormone synthesis?
- Methimazole
Thyroidectomy
- Treatment of choice for thyroid cancer
- Preoperative goals
- Reduce stress and anxiety to prevent thyroid storm.
- Preoperative education
- Dietary guidance to meet metabolic needs, avoid caffeine
- Explanation of tests and procedures/head and neck support
Postoperative care
- Monitor respirations (airway impairment/tracheostomy)
- Monitor for bleeding/hematoma (check posterior dressing)
- Assess pain and provide pain relief measures
- Semi-Fowler position, support head/neck
- Assess voice, discourage talking
- Potential hypocalcemia related to parathyroid injury/removal; refer to Chart 52-6
- More details about Nursing Process (PP 4017)
Thyroidectomy: Signs
- Chvostek's sign
- Trousseau's sign
Hypothyroidism
- Hypothyroidism results from suboptimal levels of thyroid hormone.
- Thyroid deficiency affects all bodily functions; can range from mild/subclinical to myxedema.
- Hypothyroidism affects women 5-8 times more frequently than men and occurs most often between 40 and 70 years.
-
Causes:
- Hashimoto disease (autoimmune thyroiditis) (most common)
- Post radioiodine or antithyroid medications or thyroidectomy
- Other causes listed in Charts 52-3 and 52-3
Hypothyroidism: Clinical Manifestations
- Extreme fatigue
- Hair loss, brittle nails, dry skin
- Numbness/tingling of fingers
- Voice husky/hoarse
- Menstrual disturbances (menorrhagia/amenorrhea), libido loss
- Subnormal body temperature/pulse rate
- Weight gain
- Thickened skin due to mucopolysaccharide accumulation in subcutaneous tissues
- Myxedema coma: life-threatening hypothermic/unconscious state
Hypothyroidism (Comparison to Hyperthyroidism): Summary
- A table comparing symptoms of hypothyroidism and hyperthyroidism.
Hypothyroidism: Medical Management
- Objectives: Restore normal metabolic state by replacing missing hormone.
- Prevent disease progression and complications.
- Synthetic levothyroxine (Synthroid or Levothroid).
- Note: Angina/dysrhythmias can occur when thyroid replacement is initiated due to enhanced cardiovascular effects of catecholamines.
Hypothyroidism: Management
- Start patient on L-thyroxine (0.05-0.1mg PO daily).
- L-thyroxine causes goiter regression.
- If patient is elderly or has IHD, start at 0.025mg PO daily.
- Monitor TSH level after 4-6 weeks to adjust L-thyroxine dose.
- In case of secondary hypothyroidism, monitor T4 instead of TSH.
- Hypothyroidism during pregnancy: Check TFT every month. L-thyroxine dose goes up with pregnancy progression.
Quality and Safety Nursing Alert
- Monitor for signs/symptoms of ACS (acute coronary syndrome) especially during early hypothyroidism/myxedema coma treatment.
- Treatment required to avoid complications like myocardial infarction.
Supportive Therapy (Hypothyroidism)
- Monitor oxygen saturation levels using pulse oximetry.
- Cautiously administer fluids because of water intoxication risk.
- Progressive myxedema coma may occur if hypothyroidism is severe.
Nursing Care Summary
- Nursing care for hypothyroidism and myxedema is summarized in Chart 52-4.
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Description
This quiz focuses on the assessment and management of patients with endocrine disorders, particularly thyroid conditions such as hypothyroidism and hyperthyroidism. Through comparison of causes, clinical manifestations, and nursing interventions, it emphasizes the nursing process in developing care plans, especially for patients undergoing thyroidectomy.
