Thyroid Gland Quiz

Medical Surgical Nursing (MSN) 2 - Thyroid Gland

• Course title: Medical Surgical Nursing
• Course level: 2
• Topic: Thyroid Gland
• Lecturer: Ns. Jon Parulian Simarmata M. Kep.
• University: Universitas Pelita Harapan (UPH)

Sub-Competency Measurement Criteria (CPMK)

• Holistic Nursing Care: Apply principles of holistic nursing care in lab and clinical practice for patients with thyroid disorders.
• Assessment, Diagnosis, Intervention, Implementation, and Evaluation: Formulate appropriate and systematic assessment, diagnosis, intervention, implementation, and evaluation of nursing care for patients with thyroid disorders.
• Evidence-Based Practice: Interpret and apply evidence-based practice in nursing care for patients with thyroid disorders.

Endocrine System

• The endocrine system is a complex network of glands producing hormones regulating various bodily functions.
• Diagram shows the hypothalamus, pituitary gland, thyroid and parathyroid glands, pancreas, adrenal glands, ovaries (female), testes (male), and placenta.

Thyroid Gland Anatomy

• Location: Butterfly-shaped gland in the neck, below the larynx.
• Structure: Two lobes connected by an isthmus. Parathyroid glands located behind the thyroid.
• Diagram: Provides a clear anatomical view of the thyroid gland from both front and back perspectives, showing the relation to the larynx, trachea, and parathyroid glands.

Thyroid Gland Function

• Regulates metabolic processes throughout the body which includes:
  • Body growth and cell maturation
  • Development of nervous system in infants and children
  • Cardiovascular and respiratory function throughout life
  • Increasing metabolism of protein, fat, and glucose leading to increased heat production and oxygen demand.
  • Optimizing the functioning of other hormones and neurotransmitters

Thyroid Disorders - Hyperthyroidism

• General: The most common form is Graves' disease
• Metabolic state: Condition with excessive metabolic activity.
• Hormone levels: Increased levels of T3 and T4.
• Symptoms: Include weight loss, increased appetite, heat intolerance, insomnia, irritability, nervousness, tremors etc.
• Types:
  • Primary: directly related to disorders of the thyroid gland
  • Secondary: due to disorders affecting the pituitary gland.
• Causes: Graves' disease, Toxic multinodular goiter (TMG), Toxic adenoma, thyroiditis (inflammation of the thyroid gland.

Specific to Graves' Disease

• Prevalence: Women are more commonly affected (higher ratio)
• Cause: Autoimmune disease; antibodies trigger excessive thyroid hormone production.
• Symptoms: Enlargement of the thyroid gland, eye changes, and skin changes (edema, exophthalmos, etc).

Specific to TMNG

• Prevalence: More common in older adults
• Symptoms: Milder manifestations compared to Graves' disease. Elevation of FT4 and FT3. Clinically multiple nodules are common, firm nodules/plowers and hot and normal areas detected in the scintigraphy
• Cause: Multiple nodules within the thyroid gland leading to increased thyroid hormone production.

Subacute Thyroiditis

• Cause: Inflammation related to viral infections.
• Characteristics: Characterized by pain in the front of the neck, tender and enlarged thyroid gland that goes through periods with excessive and suppressed hormone levels
• Symptoms: Painful thyroid gland, elevated temperature

Toxic Single Adenoma (TSA)

• Cause: Single nodule within the thyroid gland causing increased thyroid hormone production.
• Symptoms: Typically is associated with a more defined painful nodule/region.

Age and Sex Differences

• Graves' disease tends to affect patients between 20 and 40 years old and is more common in females.
• Other types of disorders may have different age ranges

Diagnosis Tests

• TSH measurements: Highly suppressed TSH (<0.05 μIU/mL)
• Serum T3 and T4 levels: Increased levels are common
• Thyroid Antibodies (anti-TPO,TSI): Present in some cases
• EKG for heart conditions
• Nuclear scintigraphy to assess thyroid function

Treatment

• Medications: Anti-thyroid drugs such as methimazole, carbimazole, and propylthiouracil (PTU), Radio-active iodine treatment, corticosteriods and NSAIDs.
• Surgery: Thyroidectomy (subtotal or total, lobectomy).

Nursing Care Management for Hyperthyroidism

• First Step: Rehydration
• Supportive Measures: Managing symptoms associated with cardiac distress and preventing complications
• Pharmacological Interventions: Medication Administration and Management
• Monitoring: Monitoring cardiac and metabolic function and symptoms
• Nutrition: Providing nutritional guidance for managing symptoms and complications

Differential Diagnosis - Hypothyroidism

• Definition: Low levels of thyroid hormones (T3 and T4).
• Cause: Resulting either from decreased thyroid hormone production or reduced release of thyroid hormones (from hypothalamus, pituitary or thyroid gland)
• Symptoms: Fatigue, cold intolerance, weight gain, constipation, reduced heart rate, and depression amongst others and some can be seen from the reproductive standpoint

Hypothyroidism - Types and Causes

• Types: Primary (directly related to problems of the thyroid gland), and Secondary (due to problems from hypothalamus, pituitary, or both)
• Causes: Thyroiditis (inflammation of the thyroid), Autoimmune disorders, Iodine deficiency, Medications, and possibly pregnancy.

Hypothyroidism - Clinical Manifestations

• General Symptoms: Fatigue, intolerance to cold, weight gain, constipation, dry skin.
• Eye Symptoms: Puffy eyelids.
• Respiratory Symptoms: Shortness of breath.
• Cardiovascular Symptoms: Bradycardia.
• Reproductive Symptoms: Irregular periods (menorrhagia), infertility.
• Psychological Symptoms: Memory issues, concentration problems, depression, emotional instability.

Nursing Interventions for Treating Hypothyroidism

• Management: The goal is to alleviate symptoms with medical intervention (hormonal therapy), lifestyle modification (dietary and activity, stress and sleep management)

Hypothyroidism - Nursing Assessments

• Thyroid Gland Assessment: Inspect, palpate, and auscultate the thyroid gland.
• Medications: Assessing medication records, confirming adherence.
• Monitoring: Vital signs, especially for heart rate (bradycardia) and others
• Nutrition: Dietary recommendations for optimal health
• Symptoms: Gathering and evaluating all symptoms exhibited or relayed by patient.

Evaluation - Hypothyroidism

• Goals: Monitor patient's recovery and adaptation.
• Effectiveness of Treatment: Assess to what degree the treatment regime is alleviating the symptoms and helping the body adapt to the normalization.
• Patient Participation: Observe for any positive changes in the patient's ability to carry out their daily tasks.
• Body temperature regulation: Observe for any improvements in body temperature regulation
• Intestinal function monitoring: Assessing bowel activity and regularity
• Respiratory status monitoring: Observation of respiratory function to achieve a normal status