THYROID DISORDERS

Thyroid Gland Disorder

THYROID GLAND:
● Secretes the following hormones
● T3 (Triidothyronine)
● Metabolism and growth
● T4 (Thyroxine, tetra
iodothyronine)
● Catabolism and body heat
production
● Thyrocalcitonin
● bring down the blood
Ca++ level
Thyroid Gland Disorder
Diagnostic Tests:
● T3/ T4 levels
● ⭡ level: hyperthyroidism
● ⭡ level: hypothyroidism
● PBI (Protein-bound Iodine)
● Preparation
● No foods, drugs, test
dyes with iodine 7-10
days before the test
Thyroid Gland Disorder
Diagnostic Tests:
● RAIU (Radioactive Iodine Uptake)
● Tracer dose of I131 is used P.O. & at 2°, 6°, and
24° ⭡ exposure to scintillation camera is done
● No foods, drugs, test dyes with iodine 7-10 days
before the test, temporarily discontinue
contraceptive pills (these may ⭡metabolic rate)
● Result:
●⭣ iodine uptake: hyperthyroidism
● ⭣ iodine uptake: hypothyroidism
Thyroid Gland Disorder
Diagnostic Tests:
● RAIU (Radioactive Iodine Uptake)
Thyroid Gland Disorder
Diagnostic Tests:
● Thyroid Scan
● Radioisotope Iodine is injected IV
● Exposure to scintillation camera
Thyroid Gland Disorder
Diagnostic Tests:
● FNB (Fine Needle Biopsy)
● Cytology (detection of malignant cells)
Thyroid Gland Disorder
Diagnostic Tests:
● BMR (Basal Metabolic Rate)
● Measures O2 consumption
at the lowest cellular activity
● Oxygen uptake is measured
as an indirect measurement
of metabolic rate
● increased utilization O2
(hyperthyroid)
Thyroid Gland Disorder
Diagnostic Tests:
● Reflex Testing (Kinemometry)
● Tendon of Achilles Reflex (TAR)

Hyperthyroidism Hypothyroidism
(Hypocalcemia) (Hypercalcemia)

Hyperactive TAR Hypoactive TAR

Thyroid Gland Disorder
● Goiter
● Enlargement of
the thyroid gland
associated with
hyperthyroidism,
hypothyroidism or
euthyroidism
● A hyperthyroid goiter
toxic
is called
goiter
Thyroid Gland Disorder
Hyperthyroidism (Thyrotoxicosis)
● Grave’s Disorder
● Parry’s Disorder
● Basedow’s Disorder
● Exophthalmic Goiter
● Toxic Diffuse Goiter
● common in female, below 40 y/o
● Causes:
● Severe emotional stress
● Autoimmune Disorder
● Thyroid inflammation
Thyroid Gland Disorder
Hyperthyroidism: Assessment Findings
● Restlessness, nervousness, irritability, agitation,
fine tremors, tachycardia, hypertension,
voracious appetite to eat, weight loss,
diaphoresis, diarrhea, heat intolerance,
amenorrhea, fine silky hair, pliable nails
● Exophthalmos
● Due to accumulation of fluids at the fat-pads behind
the eyeballs
● It can lead to corneal ulceration, opthalmitis,
blindness
Thyroid Gland Disorder
Thyroid Gland Disorder
Hyperthyroidism: Assessment Findings
● Dermopathy
● Warm, flushed sweaty
skin
● Thickened hyper-
pigmented skin at the
pretibial area
Thyroid Gland Disorder
Hyperthyroidism: Management
● Rest (non-stimulating cool environment)
● Diet
● HIGH Calorie, HIGH protein; vitamin and mineral
supplement
● Increased fluid intake (if with diarrhea)
● Replace F&E losses
● Avoid stimulants like coffee, tea and nicotine
● Promote safety
● Protect the eyes
● Artificial tears at regular intervals
● Wear dark sunglasses when going out under the
sun
Thyroid Gland Disorder
Hyperthyroidism: Management
Thyroid Gland Disorder
Hyperthyroidism: Management
Pharmacotherapy
● ß-blockers: Propranolol
● Ca++ channel blockers
● These drugs are given to control
tachycardia and HPN
Thyroid Gland Disorder
Hyperthyroidism: Management
Pharmacotherapy
● Iodides : Lugol’s solution
● SSKI (Saturated Solution of Potassium Iodide)
● Are given to inhibit release of thyroid hormone
● Mix with fruit juice with ice or glass of water to
improve its palatability
● Provide drinking straw to prevent permanent
staining of teeth
● Side effects:
● Allergic reaction, Increased salivation, colds
Thyroid Gland Disorder
Hyperthyroidism: Management
Pharmacotherapy
● Thioamides
● PTU (Propylthiouracil) & Tapazole (Methimazole)
● inhibit synthesis of thyroid hormones
● Side effects of PTU
● AGRANULOCYTOSIS / NEUTROPENIA
● This is manifested by unexplained Fever, Sore
throat, Skin rashes
Thyroid Gland Disorder
Hyperthyroidism: Management
Pharmacotherapy
● Paracetamol for fever
● Aspirin must be avoided because
it can displace the T3/T4 from the
albumin in the plasma causing
increased manifestations
● Dexamethasone
● inhibit the action of thyroid
hormones
● prevent the conversion of T4 to
T3 in the peripheral tissues
Thyroid Gland Disorder
Hyperthyroidism: Management
Radiation therapy (Iodine131)
● Need isolation for few days; body
secretions are radioactive
contaminated
● NOT recommended in pregnant
women because of potential
teratogenic effects. Pregnancy
should be delayed for 6 months
after therapy
Thyroid Gland Disorder
Hyperthyroidism: Management
Surgery
● Subtotal Thyroidectomy- Usually about 5/6
of the gland is removed
Thyroid Gland Disorder
Hyperthyroidism: Management
Surgery
● Pre-op Care
● Promote euthyroid state
● Control of thyroid disturbance
● Stable VS
● Administer Iodides as ordered
● To reduce the size & vascularity of thyroid
gland, thereby prevent post-op hemorrhage and
thyroid crisis
● ECG
● Heart failure/ cardiac damage results from HPN/
tachycardia
Thyroid Gland Disorder
Hyperthyroidism: Management
Surgery
● Post-op Care
● Position : Semi-fowler’s with head, neck &
shoulder erect
● Prevent Hemorrhage: ice collar over the neck
● Keep tracheostomy set available for the first 48°
post-op
● Ask the patient to speak every hour (to assess for
recurrent laryngeal nerve damage)
● Keep Ca++ gluconate readily available
● Tetany occurs if hypocalcemia is present. This may be
secondary to the removal of the parathyroid gland
Thyroid Gland Disorder
Hyperthyroidism: Management
Surgery
● Post-op Care
● Monitor Body Temperature: hyperthermia is an
initial sign of thyroid crisis
● Monitor BP (hypertension may be a manifestation of
thyroid storm)
● assess for Trousseau’s sign (hypocalcemia)
● Steam inhalation to soothe irritate airways
● Advise to support neck with interlaced fingers when
getting up from bed
Thyroid Gland Disorder
Hyperthyroidism: Management
Surgery
● Post-op Care
● Observe for signs and symptoms of potential
complications
● Hemorrhage
● Airway obstruction
● Tetany
● Recurrent laryngeal nerve damage
● Thyroid crisis / storm / thyrotoxicosis
● Myxedema
Thyroid Gland Disorder
Hyperthyroidism: Management
Surgery
● Post-op Care
● Client Teaching
● ROM exercises of the neck 3 to 4 days after
discharge
● Regular follow – up care
Thyroid Gland Disorder
Hypothyroidism
● results from deficiency of thyroid hormones

Myxedema (adult) Cretinism (children)

Thyroid Gland Disorder
Hypothyroidism
● Causes
● Autoimmune
● Hashimoto’s disease or chronic lymphocytic
thyroiditis - an autoimmune disorder in which
your immune system inappropriately attacks your
thyroid gland causing an inflammation
● after surgery (thyroidectomy)
● after radiation therapy (radioactive iodine)
● antithyroid drugs
Thyroid Gland Disorder
Hypothyroidism
Assessment:
● Slowed physical, mental
reactions, apathy
● Dull, expressionless, mask-like
face
● Anorexia
● Obesity
● Bradycardia
● Hyperlipidemia & atherosclerosis
● Cold intolerance, subnormal
temperature
Thyroid Gland Disorder
Hypothyroidism
Assessment:
● Constipation
● Coarse, dry, sparse
hair
● Brittle nails
● Irregular
menstruation
Thyroid Gland Disorder
Hypothyroidism: Management
● Monitor vital signs
● Be alert for signs and symptoms of
cardiovascular disorders
● Monitor the weight daily
● Diet:
● LOW Calorie
● High fiber (constipation)
● Provide warm environment during cold
climate
Thyroid Gland Disorder
Hypothyroidism: Management
Pharmacotherapy
● Thyroid hormonal replacement
● Proloid (Thyroglobulin)
● Synthroid (Levothyroxine)
● Dessicated Thyroid Extract
● Cytomel (Liothyronine)
● Before administration, the nurse should
monitor BP & PR
● Start with low dose and gradually increase