Thyroid and Parathyroid Glands

• Calcitonin, secreted by cells within the thyroid gland, increases bone formation, inhibits bone breakdown, and decreases blood calcium levels.
• T3 and T4 are secreted by the thyroid and require iodine for formation.
• Imbalances in iodine levels can cause goiter due to the impact on T3 and T4 production. The body attempts to compensate for these imbalances.
• Thyroid hormone increases metabolic rate and is essential for normal growth and development.
• Medications that interfere with thyroid study levels include Beta Blockers, Lasix (furosemide), and Aspirin.
• After a thyroidectomy, monitor for hypothyroid conditions and parathyroid function, specifically calcium levels.
• Monitor for Trousseau's sign (spasm during BP check) indicating hypocalcemia.
• Immediately administer IV calcium gluconate if Trousseau's sign is present.
• The parathyroid gland monitors parathyroid hormone and calcium levels.
• ECG monitoring is important for patients with calcium imbalances due to the impact on the QT interval.
• Hyperparathyroidism is often caused by a tumor, leading to increased PTH and elevated calcium levels.
• Hyperparathyroidism manifestations can range from asymptomatic to flank discomfort, potentially indicating kidney failure.

Primary and Secondary Hypothyroidism

• Primary hypothyroidism arises from thyroid gland dysfunction.
• Secondary hypothyroidism is due to cancer, brain infection, neurosurgery, or severe head trauma.
• Myxedema Coma is a complication characterized by generalized edema, altered mental status, and low temperature.
• Females with hypothyroidism may experience heavy menstruation.
• Other clinical manifestations include muscle cramping, fatigue, anxiety, depression, and a prolonged QT interval.
• Treatment for hypothyroidism involves levothyroxine.
• Patients on levothyroxine should contact their healthcare provider if chest pain occurs.
• Levothyroxine increases the workload on the heart and can be dangerous for those with cardiac conditions.
• Monitor TSH levels periodically during levothyroxine treatment.
• Hold levothyroxine if the heart rate is greater than 100 bpm.
• Suction at the bedside is a priority intervention for patients experiencing Myxedema Coma.

Hyperthyroidism and Grave's Disease

• Hyperthyroidism stems from thyroid hypersecretion.
• In Graves' Disease, lab results show high levels of TSH autoantibodies. Sunlight or light exposure can cause associated headaches.
• Hashimoto thyroiditis involves thyroid cell destruction and the release of stored T3 and T4.
• Thyroid storm is a complication of hyperthyroidism.
• Clinical manifestations of hyperthyroidism are elevated temperature, diarrhea, and high heart rate.
• Priority attention Patients include those experiencing delirium, further increases in temperature, increased peripheral pulses, or crackles in lungs.
• Monitor for worsening hyperthyroidism, especially with increased temperature (thyroid storm), after radioactive iodine treatment.
• Cardiac monitoring is necessary due to the potential for dysrhythmia.

Addison's Disease

• Addison’s Disease is an adrenocortical insufficiency.
• Primary Addison's Disease is caused by the patient failing to produce cortisol, resulting in adrenal insufficiency (autoimmune).
• Secondary Addison's Disease is caused by corticosteroid therapy.
• Diagnosis is confirmed with an ACTH provocation test when cortisol production is insufficient.
• Treatment consists of hydrocortisone, a steroid that causes immunosuppression.
• Patients should keep an emergency steroid kit readily available.
• Advice to Avoid strenuous activity, especially in hot weather.
• A diet high in salt, carbohydrates, and protein is recommended

Cushing's Disease

• Cushing’s Disease involves increased or elevated cortisol levels.
• Clinical manifestations of Cushing’s include hyperglycemia, hypokalemia, and hypertension.
• Testing for ACTH helps differentiate between primary and secondary conditions.
• Dexamethasone Suppression Test result is decreased serum cortisol level in the morning.
• If cortisol levels remain high, it may indicate a tumor (adrenal or pituitary) or hypersecretion of cortisol.