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DYSFUNCTION

1) Thyroiditis >inflammation of the thyroid gland >inflammation, fibrosis, or lymphocytic infiltration of the thyroid gland. 1.1) ACUTE THYROIDITIS

ETIOLOGY

SIGNS AND SYMPTOMS

NURSING/MEDICAL MANAGEMENT

infection of the thyroid gland by bacteria, fungi, mycobacteria, or parasites. Staphylococcus aureus and other staphylococci are the most common causes.

1.2) SUBACUTE THYROIDITIS Subacute thyroiditis may be subacute granulomatous thyroiditis (deQuervain’s thyroiditis) or painless thyroiditis (silent thyroiditis or subacute lymphocytic thyroiditis): often occurs in the postpartum period and is thought to be an autoimmune process.

caused by a viral infection. The condition often occurs after a viral infection of the upper respiratory tract, such as mumps and influenza.

anterior neck pain and swelling, fever, dysphagia, and dysphonia. Pharyngitis or pharyngeal pain is often present. warmth, erythema (redness), and tenderness of the thyroid gland painful swelling in the anterior neck that lasts 1 to 2 months and then disappears spontaneously without residual effect thyroid enlarges symmetrically overlying skin is often reddened and warm. Swallowing may be difficult and uncomfortable. Irritability, nervousness, insomnia, and weight loss—manifestations of hyperthyroidism—are common, and many patients experience chills and fever as well.

antimicrobial agents and fluid replacement. Surgical incision and drainage(if an abscess is present)

aims to control the inflammation >(NSAIDs) are used to relieve neck pain. >Acetylsalicylic acid (aspirin) is avoided >Beta-blocking agents (eg, propranolol [Inderal]) may be used to control symptoms of hyperthyroidism. Antithyroid agents, which block the synthesis of T 3 and T4, are not effective > in severe cases, oral corticosteroids may be prescribed to reduce swelling and relieve pain; > may necessitate thyroid hormone therapy. >Treatment is directed at symptoms, and yearly follow-up is recommended

1.3) CHRONIC THYROIDITIS (HASHIMOTO’S DISEASE)

caused by a reaction of the immune system against the thyroid gland. related to

usually not accompanied by pain, pressure symptoms, or fever, and thyroid activity is usually normal

objective of treatment is to reduce the size of the thyroid gland and prevent hypothyroidism. Thyroid

>When surgery is recommended. > Providing children in iodine-poor regions with iodine compounds . the risk for postoperative complications is minimized by ensuring a preoperative euthyroid state by treatment with antithyroid medications and iodide to reduce the size and vascularity of the goiter. progressive course. thyroid hormone therapy is prescribed. such as SSKI. is prescribed to suppress the pituitary’s thyroid-stimulating activity.) 2)may be caused by an intake of large quantities of goitrogenic substances (excessive amounts usually cause no symptoms swelling in the neck. the disease runs a slow. Surgery may be required 2) THYROID TUMORS Classifications: 1) benign or malignant 2) the presence or absence of associated thyrotoxicosis 3) diffuse or irregular quality of the glandular enlargement. which may result in tracheal compression when excessive. the tumor is referred to as a goiter.) most common type of goiter.1) ENDEMIC (IODINE-DEFICIENT) GOITER (simple or colloid goiter. Hashimoto's disease can occur with adrenal insufficiency and type 1 diabetes. the condition is called type 2 polyglandular autoimmune syndrome (PGA II). the thyroid gland hypertrophies. 1)encountered chiefly in geographic regions where the natural supply of iodine is deficient(If the mean iodine intake is less than 40 fg/day. In these cases.diagnosis is based on the histologic appearance of the inflamed gland other endocrine (hormonal) disorders caused by the immune system. >Supplementary iodine. If the enlargement is sufficient to cause a visible swelling in the neck. or low rather than increased. 2. leading eventually to hypothyroidism hormone therapy is prescribed to reduce thyroid activity and the production of thyroglobulin.

and a bruit is heard over the thyroid arteries > an increase in serum T4 and an increased 123I or 125I uptake by the thyroid in excess of 50%. > The World Health Organization recommends that salt be iodized to a concentration of 1 part in 100. may report dry skin and diffuse pruritus. and is likely to be warm. stress. however. notify the physician immediately. The skin is flushed continuously. rapid pulse at rest as well as on exertion. increased appetite and dietary intake. Patients may exhibit exophthalmos (bulging eyes). urticaria. A fine tremor of the hands may be observed. MEDICAL MANAGEMENT > directed toward reducing thyroid hyperactivity to relieve symptoms and remove the cause of important complications. 3) HYPERTHY ROIDISM second most prevalent endocrine disorder. rash. They tolerate heat poorly and perspire unusually freely. progressive weight loss. > the importance of periodic follow-up is emphasized because medication sensitization. > Measurement of TSH is indicated in elderly patients with unexplained physical or mental deterioration NURSING MANAGEMENT > The patient is observed for signs of thyroid storm. 3) thyroiditis and excessive ingestion of thyroid hormone. cannot sit quietly. irritable. > With any sign of infection.000. DIAGNOSTIC TEST > thyroid gland invariably is enlarged to some extent. the most common type of hyperthyroidis m 3. and apprehensive. or an infection. or even agranulocytosis and may develop. propranolol is useful in controlling these symptoms. which produces a startled facial expression. after diabetes mellitus. fever. It is soft and may pulsate. and moist. 2)may appear after an emotional shock. soft. > Two forms of pharmacotherapy are available for treating hyperthyroidism and controlling excessive thyroid activity: (1) use of irradiation by administration of the radioisotope 123I or 131I to destroy the overactive thyroid cells contraindicated in pregnancy and in nursing mothers because radioiodine crosses the placenta and is secreted in breast milk. which is used in treating bipolar disorders) 3)recede after iodine imbalance is corrected. DYSFUNCTI ON ETIOLOGY 1)results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulin s. which is adequate for the prevention of endemic goiter > The introduction of iodized salt has been the single most effective means of preventing goiter in at-risk populations.of iodine or lithium. a thrill often can be palpated. especially pharyngitis and fever or the occurrence of mouth ulcers. palpitations. emotionally hyperexcitable. with a characteristic salmon color. SIGNS AND SYMPTOMS exhibit a characteristic group of signs and symptoms (sometimes referred to as thyrotoxicosis) nervousness. Elderly patients.1) Recurrent Hyperthyroi dism >etiology: No treatment > instructed not to use decongestants for nasal stuffiness because they are . the patient is advised to stop the medication. A major advantage of treatment with radioactive iodine is Graves’ disease.

increased pulse pressure. with resulting decreased thyroid hormone production > propylthiouracil (Propacil. and palpitations Myocardial hypertrophy and heart failure may occur if the hyperthyroidism is severe and untreated. and skin eruptions. atrial fibrillation may occur. coryza. (2) antithyroid medications that interfere with the synthesis of thyroid hormones and other agents that control manifestations of hyperthyroidism.for thyrotoxicosis is without side effects > patients who had very severe disease. ocular and cardiac symptoms. Such symptoms may also occur with excessive administration of thyroid hormone for treatment of hypothyroidism. > Foods and fluids are selected to replace fluid lost through diarrhea and diaphoresis. The use of radioactive iodine is generally recommended for treatment of thyrotoxicosis in elderly patients unless an enlarged thyroid gland is pressing on the airway. large goiter. the heart fails. delirious. > Solutions of iodine and iodide compounds are more palatable in milk or fruit juice and are administered through a straw to prevent staining of the teeth. > The nurse periodically assesses and monitors the patient’s cardiac status. a long history of dysfunction. > monitor for symptoms of iodism include swelling of the buccal mucosa. > elderly patients are more likely to develop granulocytopenia. PTU) or methimazole (Tapazole): These medications block extrathyroidal conversion of T4 to T3. Symptoms of hyperthyroidism may occur with the release of excessive amounts of thyroid hormone as a result of inflammation after irradiation of the thyroid or destruction of thyroid tissue by tumor. and relapse after previous treatmen abnormal muscular fatigability and weakness. heart sounds. to reduce the amount of thyroid tissue. and peripheral pulses. discontinuatio n of antithyroid medications before therapy is complete. > Antithyroid medications are contraindicated in late pregnancy because they may produce goiter and cretinism in the fetus. . and even disoriented. blood pressure is elevated. the untreated person becoming emaciated. and changes in bowel function. eventually. blood pressure. Osteoporosis and fracture Cardiac effects may include sinus tachycardia or dysrhythmias. and cardiac decompensation in the form of heart failure is common. Surgical removal of most of the thyroid gland is a nonpharmacologic alternative. excessive salivation. especially in elderly patients. The pulse rate ranges constantly between 90 and 160 beats/min.( highly seasoned foods and that it avoids many of the side effects associated with antithyroid medications. Long-standing use of thyroid poorly tolerated.amenorrhea. intensely nervous. including heart rate.

making the surgical procedure safer. High-calorie. stimulants such as coffee. making disorders hard to detect. and its action is of short duration. These agents reduce the activity of the thyroid hormone and the vascularity of the thyroid gland. and alcohol are discouraged. Lugol’s solution. cola. >improving self esteem: If changes in appearance are very disturbing to the patient. comfortable temperature and changes > Thyroid hormone is occasionally administered with antithyroid medications to put the thyroid gland at rest > Thyroid hormone is available as thyroglobulin (Proloid) and levothyroxine sodium (Synthroid) > Liothyronine sodium (Cytomel) has a more rapid onset. high-protein foods are encouraged) > need reassurance that these symptoms are expected to disappear with treatment > The nurse encourages relaxing activities if they do not overstimulate the patient. fatigue. mirrors may be covered or removed >exopthalmus: eye care and protection may become necessary: patient may need instructions about instillation of eye drops or ointment prescribed to soothe the eyes and protect the exposed cornea. tea. > Beta-adrenergic blocking agents are important in . Gerontologic considerations: Elderly patients commonly present with vague and nonspecific signs and symptoms. change in bowel habits.hormone in the absence of close monitoring may be a cause of symptoms of hyperthyroidism. weight loss. > MAINTAINING NORMAL BODY TEMPERATURE: The nurse maintains the environment at a cool. and saturated solution of potassium iodide (SSKI) may be used in combination with antithyroid agents or beta-adrenergic blockers to prepare the patient with hyperthyroidism for surgery. Symptoms such as tachycardia. mental confusion. > Compounds such as potassium iodide (KI).

Oxygen is administered to prevent hypoxia. > MONITORING AND MANAGING POTENTIAL COMPLICATIONS Cardiac and respiratory function are assessed by measuring vital signs and cardiac output. anxiety. and heat intolerance. tachycardia. Of decreased attention span r/t hyperexcitability) Continuing Care importance of adhering to the therapeutic controlling the sympathetic nervous system effects of hyperthyroidism. >subtotal thyroidectomy: reserved for large goiters. For example. Cool baths and cool or cold fluids may provide relief. and provides instruction about the essential role of the medication in the broader therapeutic plan. presence of obstructive symptoms. tremor. ECG monitoring. to improve tissue oxygenation. or when there is a need for rapid normalization of thyroid function .bedding and clothing as needed. pregnant women. Teaching Patients Self-Care how and when to take prescribed medication. arterial blood gases. and pulse oximetry. propranolol (Inderal) is used to control nervousness. This information is repeated as the time of surgery approaches(bec.

. avoid stressful situations that may precipitate thyroid storm.regimen and the recommended follow-up monitoring.