Thyroid Hormones T3 and T4 Functions

<p>Enlarged thyroid  Dysphagia  Difficulty breathing- can compromise airway!  Goiters can develop into cancer  Nursing Concerns:  ABCs  Stridor is an emergency!  Assess swallowing</p> Signup and view all the answers

<p>reatment:  Goals of treatment are to protect the airway and stop enlargement of the goiter  Medications: dependent on etiology of goiter  Thyroidectomy</p> Signup and view all the answers

<p>n the early morning on an empty stomach (at least 30-60 minutes before food is consumed); food reduces the absorption of this medication Extra Info • Drug of choice for those who require thyroid hormone replacement • Treat s/s caused by hypothyroidism • Started at a low dose and gradually increased to prevent causing hyperthyroidism • Monitor for S/S of hyperthyroidism when beginning therapy or increasing dose • When administered in the appropriate dosage, levothyroxine rarely causes adverse effects • Educate patient to monitor for s/s of hyperthyroidism • S/S include: Tachycardia, angina/chest pain, palpitations, tremors, nervousness, hyperthermia, heat intolerance, and sweating • If these s/s occur, notify the physician right awa</p> Signup and view all the answers

<p>Deficiency of thyroid hormone causing a general slowing of metabolic rate  Classified as primary or secondary  Iodine deficiency is most common cause worldwide  Other causes:  Hashimoto’s thyroiditis  Thyroidectomy  Congenital  Discontinuance of thyroid hormone therapy</p> Signup and view all the answers

<p>ssue is with the thyroid gland itself • Unable to produce thyroid hormones T3 and T4 Low • No issue with Anterior Pituitary Gland • Anterior Pituitary Gland is continuously releasing Thyroid Stimulating Hormone, attempting to stimulate the thyroid to release T3 &amp; T4 High TSH</p> Signup and view all the answers

<p>Issue is with the Anterior Pituitary Gland • Unable to produce Thyroid Stimulating Hormone(TSH)  TSH Low • No issue with Thyroid Gland • TSH is not being released, so the thyroid gland isn’t being stimulated to release its hormones  T3 &amp; T4 Low</p> Signup and view all the answers

<p>Bradycardia  Weight gain  Fatigue &amp; Lethargy  Intolerant to cold  Personality and mental changes  Shortness of breath on exertion  Atherosclerosis  Constipation  Dry skin and hair  Heart failure  Decreased cardiac output  Can progress to myxedema</p> Signup and view all the answers

<p>Hormone replacement therapy with Levothyroxine (Synthroid)  Education  Lifelong medication  Do not abruptly stop and avoid discontinuation  S/S of hyperthyroidism after HRT  Diabetic patients should check BG regularly</p> Signup and view all the answers

<p>Autoimmune disease  Antibodies attack healthy thyroid tissue  Leads to inflammation  Thyroid cells are destroyed  hypothyroidism  Women affected more than men  Can cause goiter  Signs and symptoms similar to hypothyroidism  Diagnostic tests:  Autoimmune antibody testing  TSH, T3, T4 levels  Thyroid scan  Therapeutic measures:  Thyroid hormone therapy</p> Signup and view all the answers

<p>Hypoventilation (can lead to respiratory acidosis)  Hypothermia (less than 95°F)  Hypotension  Bradycardia  Hypoglycemia  Change in LOC  Lethargy</p> Signup and view all the answers

<p>Metabolic rate drops so low that it becomes life threatening  Usually occurs in long-standing undiagnosed hypothyroidism  Precipitated by infection, drugs (opioids, barbiturates), exposure to cold, trauma  Mental sluggishness, drowsiness and lethargy have progressed to coma state  T3/T4 low, TSH high or low</p> Signup and view all the answers

<p>ntubation and mechanical ventilation  Maintain patent airway!  Respiratory support and frequent assessment  Cardiac Monitoring  IV fluids  All medications administered intravenously  IV Levothyroxine  Warm patient with blankets or BAIR hugger  When patients have recovered and are being discharged:  Provide short, written reminders for care information</p> Signup and view all the answers

<p>ncrease in synthesis and release of thyroid hormones  Excess circulating T3 and T4  Most commonly caused by Grave’s Disease  antibodies cause thyroid to overproduce hormones</p> Signup and view all the answers

<p>ssue is with the thyroid gland itself • Over production of the thyroid hormones • T3 and T4 High • Anterior Pituitary Gland is not releasing Thyroid Stimulating Hormone, attempting to stop the thyroid from releasing T3 &amp; T4 • TSH Low</p> Signup and view all the answers

<p>Issue with the Anterior Pituitary Gland • Over production of Thyroid Stimulating Hormone (TSH) • TSH High • No issue with Thyroid Gland • TSH is being over produced, which is over stimulating the thyroid gland &amp; the thyroid is continuously producing and releasing T3 &amp; T4 • T3 &amp; T4 High</p> Signup and view all the answers

<p>Pathophysiology  Increased Metabolic Rate  Increased Beta-Adrengergic Receptor Sites in body  Enhances activity of epinephrine &amp; norepinephrine  Etiology  Graves Disease  Autoimmune disease  Characterized by thyroid enlargement and excessive thyroid hormone secretion  Thyroid nodules  Multinodular goiter  Thyroiditis  Thyroid tumor  Pituitary tumor</p> Signup and view all the answers

<p>Signs and Symptoms  Hypermetabolic State  Everything is sped up!  Heat Intolerance  Internal temperatures are elevated, warm skin  Tachycardia, Palpitations, Hypertension, Chest Pain  Due to increased epinephrine/norepinephrine activity  Risk for angina and dysrhythmias  Increased Appetite, Weight Loss, Frequent Stools  Fatigued &amp; Irritable  Nervousness, Tremors  Goiter  Exophthalmos (occurs only with Graves’ disease)  Tissues behind eyes swell</p> Signup and view all the answers

<p>Goiter  Assess airway and ability to swallow  Cardiac Complications (HTN, Tachycardia, Palpitations)  Administer beta blockers as ordered  Irritability &amp; Restlessness  Provide quiet environment  Exophthalmos  Relieve dry eyes &amp; discomfort (eye drops)  Weight Loss  Increase carbs, proteins, fats, overall calorie intake</p> Signup and view all the answers

<p>Many treatments to attempt to slow the thyroid down  Antithyroid Medications  Methimazole or PTU  Radioactive iodine therapy (RAI)  Thyroidectomy- removal of all or part of the thyroid  Chosen when patient is unresponsive to other tx., has a goiter causing tracheal compression, thyroid cancer  Will cause hypothyroidism, must be placed on Synthroid for life</p> Signup and view all the answers

<p>Destroys thyroid tissue – symptoms of hypothyroidism may occur as RAI therapy takes effect  Nursing care (in hospital):  Limit time spent with patient.  Glove and gown.  Avoid if pregnant.  Take precautions with urine, emesis, body fluids.  Double flush toile</p> Signup and view all the answers

<p>First line treatment for hyperthyroidism • Inhibits thyroid hormone synthesis......................Although methimazole inhibits thyroid hormone synthesis, it does not destroy existing stores of thyroid hormone • It can take 3 to 12 weeks to produce a euthyroid state • If doses administered are too high, it can put the patient into a hypothyroid state • Educate the patient on s/s of hypothyroidism, report to the provider if s/s present • If hypothyroidism occurs, dose should be decreased • Other medications may need to be administered to treat s/s while methimazole is being given to reach a euthyroid state</p> Signup and view all the answers

<p>second line treatment for hyperthyroidism • Inhibits thyroid hormone synthesis...............................lthough PTU inhibits thyroid hormone synthesis, it does not destroy existing stores of thyroid hormone • It can take 3 to 12 weeks to produce a euthyroid state • If doses administered are too high, it can put the patient into a hypothyroid state • Educate the patient on s/s of hypothyroidism, report to the provider if s/s present • If hypothyroidism occurs, dose should be decreased • Other medications may need to be administered to treat s/s while PTU is being given to reach a euthyroid state</p> Signup and view all the answers

<p>Thyrotoxic crisis/thyroid storm----------------------Acute, rare condition in which hyperthyroid manifestations are HEIGHTENED  Life-threatening emergency  Can be caused by stressors in a patient with preexisting hyperthyroidism or after thyroid surgery</p> Signup and view all the answers

<p>Symptoms:  Tachycardia (&gt;150-160 bpm)  Extreme HTN  Hyperthermia  Seizures  N/V/D  Brief attention span, apprehension and restlessness  Delirium  Shock  Heart failure  Coma</p> Signup and view all the answers

<p>Beta Blockers  Antipyretics/cooling blanket  Fluid Replacement  Elevate HOB  Administer O2  Reduce circulating thyroid hormones  Antithyroid drugs: PTU and Methimazole (block synthesis)  Radioactive iodine (inhibits release of hormones into circulation)  Results are not immediate – may take months to reach maximum effec</p> Signup and view all the answers

<p>Total or subtotal thyroidectomy Monitor breathing and swallowing Assess nutrition status Monitor vital signs Administer iodine or antithyroid drugs to achieve euthyroid state</p> Signup and view all the answers

<p>Neck swelling/airway complications Stridor – emergency! Tracheostomy equipment at bedside Monitor vitals! Worried for thyroid storm 18 hours post-op 101 greater risk for seizures BP increasing 180/100 stroke HR over 150 Restlessness increased confusion Stridor on excalation Hypothyroidism complications Monitor drain Semi-fowler position Suction equipment at bedside</p> Signup and view all the answers

<p>Increased secretion of PTH  Increased serum calcium  Etiology:  Hyperplasia  Benign tumor of parathyroid glands  Hereditary  Secondary:  Kidney disease</p> Signup and view all the answers

<p>Diagnostic tests  Serum calcium elevated  24-hour urine for calcium  Phosphate decreased  PTH elevated  X-rays for bone density</p> Signup and view all the answers

<p>Clinical Manifestations:  Can be asymptomatic, or...  Osteoporosis  fractures  Kidney Stones (hypercalciuria)  Muscle weakness, lethargy  Loss of appetite, N/V, constipation  Peptic ulcers  Coma  Cardiac arrhythmias  Cardiac arrest  Patients at risk for injury!</p> Signup and view all the answers

<p>Most effective treatment? Remove it!  Parathyroidectomy  Nonsurgical therapy  For asymptomatic patients  Weight-bearing exercise, high fluid intake, moderate calcium intake  Drugs to lower calcium levels -do not correct underlying problem</p> Signup and view all the answers

<p>Similar to that of thyroidectomy: Monitor for hemorrhage, fluid/electrolyte imbalance, airway  Tetany can occur due to sudden decrease of calcium levels  At risk for seizures and compromised airway issues  Muscular spasms, laryngospasms –  Administer IV Calcium! Keep IV Calcium Gluconate readily available for patients post-op  Monitor I&amp;Os to assess fluid/electrolyte balance  Calcium and Vitamin D supplements  Encourage mobility Tetany</p> Signup and view all the answers

<p>IV Calcium gluconate</p> Signup and view all the answers

<p>High calcium diet</p> Signup and view all the answers

<p>Chvostek's sign</p> Signup and view all the answers

<p>PTH administration</p> Signup and view all the answers

<p>High calcium diet</p> Signup and view all the answers