THE THYROID GLAND
 largest endocrine gland
 butterfly-shaped organ located in the lower
neck, anterior to the trachea
 consists of two lateral lobes connected by an
isthmus
 highly vascularized
 produces three hormones: thyroxine (T4),
triiodothyronine (T3), and calcitonin
T3 and T4
 accelerate metabolic processes by increasing
the level of specific enzymes that contribute to
oxygen consumption and altering the
responsiveness of tissues to other hormones
 influence cell replication and are important in
brain development
 affect virtually every major organ system and
tissue function, including the basal metabolic
rate, tissue thermogenesis, serum cholesterol
levels, and vascular resistance
Calcitonin
 secreted in response to high plasma levels of
calcium
 reduces the plasma level of calcium by
increasing its deposition in bone
HYPERTHYROIDISM
 form of thyrotoxicosis resulting from an
excessive synthesis and secretion of
endogenous or exogenous thyroid hormones by
the thyroid
 Primary: Thyroid gland
 Secondary: Other causes like pituitary gland
disorders
Diagnostic Evaluations
a. Serum Thyroid-Stimulating Hormone
 primary screening test of thyroid
function
b. Serum T3 and T4
 T4 includes protein-bound and free
hormone levels that occur in response
to TSH secretion
 T4 - 5.4 to 11.5 µg/dL
 T3 - more accurate indicator of
hyperthyroidism or severity of the
disorder, 80 to 200 ng/dL
c. Fine-Needle Aspiration Biopsy
 use of a small-gauge needle to sample
the thyroid tissue for biopsy is a safe
and accurate method of detecting
malignancy
 no client preparation needed
 slight pressure is needed in the
puncture site post procedure
d. Thyroid Scan
 used to identify nodules or growth
 includes administration of radioisotope
of iodine or technetium
 level of radioactive medications is not
dangerous to self and others
 ask the patient if any radiographic
contrast agents were received within
the past 3 month – they may invalidate
the scan
 NPO post midnight
 Contraindicated to pregnant women
e. Radioactive Iodine Uptake
 Measures the absorption of an iodine
isotope to determine how the thyroid
gland is functioning
 Small dose of radioactive iodine is given
by mouth or IV
 Elevated values – hyperthyroidism
 Decreased values – hypothyroidism
 Contraindicated to pregnant women
Causes:
 Graves disease
o most common cause
o autoimmune disorder that results from
an excessive output of thyroid
hormones caused by abnormal
stimulation of the thyroid gland by
circulating immunoglobulins
o affects women eight times more
frequently than men
o second and fourth decades (40 years
old)
 Excessive ingestion of thyroid hormone
 Toxic multinodular goiter
 Thyroiditis
Clinical Manifestations
 Nervousness
 Emotionally hyperexcitable, irritable, and
apprehensive
 Cannot sit quietly
 Palpitations
 Tachycardia
 Tolerate heat poorly
 Perspire unusually freely (diaphoresis)
 Flushing of the skin (salmon color in
Caucasians), warm, soft, and moist
 Fine tremor of the hands
  Exophthalmos (abnormal protrusion of one or
both eyeballs) – produces startled facial
expression
 Increased appetite and dietary intake
 Weight loss
 Fatigability and weakness
 Amenorrhea and changes in bowel function
 Myocardial hypertrophy and heart failure may
occur
Management:
a. Pharmacologic Therapy
 Radioactive Iodine Therapy
 use of irradiation by administration of the
radioisotope 131I for destructive effects on
the thyroid gland
 Goal: eliminate the hyperthyroid state with
the administration of sufficient radiation in
a single dose by destroying thyroid cells
without jeopardizing other radiosensitive
tissues
 Advantage: It avoids many of the side
effects associated with antithyroid
medications
 Disadvantage: Radiation
o can contaminate their household and
other persons through saliva, urine, or
radiation emitting from their body
o should avoid sexual contact
o avoid sleeping in the same bed with
other persons
o avoid having close contact with children
and pregnant women
o avoid sharing utensils and cups
 Contraindication: during pregnancy
because it crosses the placenta - pregnancy
test 48 hours before administration of
radioactive iodine
 Propylthiouracil (PTU)
 Action: Blocks the synthesis of hormones
(conversion of T3 and T4)
 recommended during the first trimester of
pregnancy (MMI has teratogenic effects)
 PTU should be discontinued after the first
trimester and the patient should be
switched to MMI for the remainder of the
pregnancy and when breast feeding
(hepatotoxicity)
 Taken after meal to prevent GI irritation
 WOF agranulocytosis
o Decreased WBC
o Sore throat
o Fever
o Notify physician immediately
 Methimazole (Tapazole)
 Inhibits synthesis of thyroid hormone
 More toxic than PTU
 Not given during the first trimester
(teratogenic)
 Lugol’s solution/SSKI/KI
 Suppresses release of thyroid hormone
 Use straw when when drinking to avoid
permanent staining of the teeth
 It has metallic taste – mix with fruit juice
 WOF Side Effects
o allergic reaction to iodine
o local esophageal or duodenal mucosal
injury and hemorrhage as a result of
administration of Lugol’s solution
 Beta Blockers
 To relieve the signs and symptoms of SNS
stimulation
 Example: propranolol, atenolol, metoprolol
 To decrease heart rate, systolic blood
pressure, muscle weakness, nervousness,
tremor, anxiety, and heat intolerance
Nursing Interventions:
 Monitor v/s
 Monitor thyroid hormone level
 Monitor weight
 Instruct client on how to monitor PR
 Instruct the clients in the signs of
hypothyroidism
 Instruct about the importance of medication
compliance and not to abruptly stop the
medication
 Provide adequate rest
 Exophthalmos
o Elevate the head of the bed
o Artificial tears
o Dark glasses
o Tape eyelids closed at night if necessary
 Offer well-balanced meals of small size, even
up to six meals a day
o Avoid highly seasoned foods and
stimulants such as coffee, tea, cola, and
alcohol
o High-calorie, high protein foods
o Low fiber diet
 Provide cool, comfortable temperature
 Cool baths and cool or cold fluids may also
provide relief
 Monitor for signs of complications
Surgical Management:
 Thyroidectomy
 o Before Surgery Management:
 Drink Lugol’s Solution – to decrease  Lugol’s solution
bleeding and to prevent thyroid storm. It  PTU/MMI
also reduces the size and vascularity of the  Beta blockers
thyroid gland  Check neurological status
 Drink beta blockers  Cooling blanket
 Coughing and DBE Nursing Interventions:
o After Surgery  Maintain a patent airway and adequate
 WOF for complications: ventilation
Bleeding  Administer medications
Laryngeal nerve damage  Monitor v/s
Respiratory complications  Monitor for cardiac dysrhythmias
Hypocalcemia  Cooling blanket
 Bedside: Tracheostomy, Oxygen and  Administer nonsalicylate antipyretics
Calcium Gluconate (salicylates increase thyroid hormone level)
 Position: Head, neck, shoulder erect –
elevated – Semi-Fowler’s Position HYPOTHYROIDISM
 WOF for bleeding – in the dressing/behind  suboptimal levels of thyroid hormone.
or back of the neck
 Use interlace fingers when moving the Causes:
neck to prevent pressure  Hashimoto disease
 No flexion, extension of the neck o autoimmune thyroiditis
 WOF for hypocalcemia o immune system attacks the thyroid gland
Tetany  Surgery
o Cardiac dysrhythmias  Radiation therapy
o Carpopedal spasms  Anti-thyroid medications
o Dysphagia
o Muscle and abdominal cramps Clinical Manifestations:
o Positive Chvostek’s signs  hair loss, brittle nails, and dry skin
o Positive Trousseau’s sign  fatigue and lethargy
o Wheezing and dyspnea  bradycardia
o Seizures  numbness and tingling of the fingers
 Encourage the patient to speak hourly  weakness, muscle ache
Mild hoarseness – normal  hoarseness of voice/husky voice
Severe hoarseness – laryngeal nerve  menorrhagia or amenorrhea
damage  loss of libido
Thyroid Storm  Weight gain
 Thyroidectomy complication, infection and  Expressionless and masklike facial feature
stress  Generalized puffiness and edema around the
 During surgery the thyroid gland releases T3 eyes and face
and T4  Cold intolerance/Heat tolerance
 Exaggerated signs and symptoms of  Constipation
hyperthyroidism  elevated serum cholesterol level,
 Life threatening atherosclerosis, coronary artery disease
Signs and Symptoms:
 Hyperthermia Management:
 Tachycardia a. Hormone replacement
 Hypertension o Levothyroxine or Synthroid
 Irregular heart beat o Take medications at the same time each
 Palpitation day, in the morning, without food
 Nausea, vomiting and diarrhea o Check BP and PR before giving medications
 Confusion, irritability, restlessness
 Coma, death
 o Take 4 hours apart from magnesium- o Provide stimulation through
containing antacids because these decrease conversation and nonthreatening
the absorption of thyroid replacements activities
o Avoid OTC medications o Monitor cognitive and mental processes
o MedicAlert bracelets and response of these to medication
o WOF for symptoms of hyperthyroidism and other therapy
(toxicity) o Avoid sedatives and opioid analgesics –
o Sign that medication is working: Weight may precipitate myxedema coma
reduction Myxedema Coma
Nursing Management:  Rare but serious disorder results from
 Diagnosis: Activity Intolerance persistently low thyroid hormone
o Goal: increase participation in activities  Precipitated by acute illness, rapid withdrawal
and increase independence of thyroid medication, anesthesia and surgery,
o Space activities and exercise use of sedatives and opioid analgesics
o Assist in self care activities when patient Clinical Manifestations:
is fatigued  Hypotension
o Monitor patient’s response to  Bradycardia
increasing activities  Hypothermia
 Risk for imbalance body temperature  Hypoglycemia
o Goal: Maintain normal body  Generalized edema
temperature  Respiratory failure
o provide extra layer of clothing or extra  Coma
blanket Management:
o avoid and discourage the use of  Maintain a patent airway
external heat source (heating pads,  Aspiration precaution
electric or warming blankets) – reduces  IV fluids as prescribed
peripheral vasodilation and vascular  IV hormone replacement
collapse  Glucose as ordered
o avoid exposure cold and draft  Monitor v/s
 Keep the client warm
 Constipation
 Monitor LOC changes
o Goal: Return of normal bowel function
o Increase fluid intake
o High fiber diet
o Encourage increase mobility
o Low calorie, low cholesterol, low
saturated fat, low protein diet
 Deficient knowledge
o Goal: Knowledge and acceptance of the
prescribed therapeutic regimen
o Explain rationale for thyroid
replacement therapy
o Describe desired effects of medication
o Assist patient to develop schedule and
checklist to ensure administration of
thyroid replacement
o Describe signs and symptoms of over
and underdose of medications
o Explain the necessity of for long term
follow up to patient and family
 Acute confusion
o Orient patient to time, place, date and
events