ISABELA STATE UNIVERSITY

CITY OF ILAGAN CAMPUS

COLLEGE OF NURSING
BACHELOR OF SCIENCE IN NURSING

CARE OF THE CLIENTS WITH

ENDOCRINE AND METABOLIC
DISORDER
CHARLES Z. ARIOLA JR., RN, MSN, LPT.
THE THYROID
HORMONE/ORGAN
- Butterfly shaped organ located in the lower neck
anterior to the trachea
- Consists of two lateral lobes connected by an isthmus
- 5 cm long, 3 cm wide and weigh 30 g
- Blood flow is 5 mL/min per gram of thyroid tissue
approximately 5 times the blood flow to the liver
 THRE HORMONES PRODUCED

1. T4 or Thyroxine Produced by thyroid

2. T3 or Triiodothyronine follicular cells

3. Calcitonin Produced by thyroid C cells

ANATOMIC AND PHYSIOLOGIC
OVERVIEW
 THYROID HORMONES

T3 & T4
- two separate hormones and are amino acids that contain
iodine molecules bound in each molecule
- synthesized and stored bound to protein in the cell of the
thyroid gland until needed for release in the bloodstream.
- 75% of bound thyroid hormone is bound to thyroxine binding
(protein) globulin (TBG) and the remaining is bound to thyroid-
binding prealbumin and albumin
SYNTHESIS OF THYROID HORMONE
IODINE Iodide absorbed in the blood
– essential to the thyroid Iodide concentrates in the cells
gland for synthesis of its
hormones Conversion of iodide ions to
- The major use is for iodine molecules

thyroid React to tyrosine (amino acid)

- Deficiency may lead to
alteration in thyroid Form thyroid hormones
function
 REGULATION OF THYROID HORMONES
A. TSH (THYROID STIMULATING HORMONE)
- or known as thyrotropin
- controls the rate of thyroid hormone through negative feedback mechanisms
Euthyroid- thyroid hormone production in normal limits

B. THYROTROPIN-RELEASING HORMONE
- secreted by hypothalamus
- exerts a modulating influence on the release of TSH from pituitary
- affected by environmental factors such as decrease in temperature which leads to
increase in TRH and therefore increase of thyroid hormones
 FUNCTIONS OF THYROID HORMONES

1. Control of cellular and metabolic activity

2. Increase level of enzymes that contribute to oxygen
consumption
3. Influence cell replication
4. Brain development
5. Essential for normal growth
 HYPOTHYROIDISM
-results from suboptimal level of thyroid hormone
- More often in women ages 30-60
- Most common cause is autoimmune thyroiditis
known as HASHIMOTO’S DISEASE in which
immune system attacks thyroid gland.
 TERMS ASSOCIATED WITH
HYPOTHYROIDISM
PRIMARY OR THYROIDAL HYPOTHYROIDISM
- Dysfunction of thyroid gland itself
CENTRAL HYPOTHYROIDISM
- If the cause of thyroid dysfunction is the failure of the pituitary
gland or hypothalamus or both
SECONDADY OR PITUITARY HYPOTHYROIDISM
- If the cause is pituitary disorder
 TERMS ASSOCIATED WITH
HYPOTHYROIDISM
TERTIARY OR HYPOTHALAMIC HYPOTHYROIDISM
- If the cause is due to disorder of hypothalamaus which causes decrease
in TRH and TSH thereby decreasing secretion of T3 and T4.
IATROGENIC
- Surgical removal of gland or overtreatment of the disease
MYXEDEMA
- Accumulation of mucopolysaccharides in subcutaneous and interstitial
 PATHOPHYSIOLOGY
Deficient Thyroid Hormone
Decrease metabolic activity

Affects Fetal Growth Affects Physical and

Mental Growth
Stunted Physical and Mental
Growth Lethargy, slow mentation and
Cretinism slowing body function
Hypothyroidism
 CLINICAL MANIFESTATIONS
1. Hair Loss
LATE SIGNS (SEVERE)
2. Brittle Nails
1. Subnormal Temperature
3. Dry Skin
2. Decreased pulse rate
4. Numbness and Tingling Skin and
Fingers 3. Anorexia

5. Husky voice 4. Weight gain

6. Hoarseness 5. Constipation

7. Menorrhagia 6. Fatigue

8. Amenorrhea 7. Slowed mental process

9. Loss of libido 8. Dullness

9. Increased sensitivity to sedatives, narcotics and
anesthetics
 CLINICAL MANIFESTATIONS

MYXEDEMA
- Syncope
- Lethargy
- Bradycardia
- Hypotension
- Hypoventilation
- Subnormal Temperature
 MEDICAL MANAGEMENT
A. PHARMACOLOGIC THERAPY
1. SYNTHETIC LEVOTHYROXINE (Synthroid or Levothroid)

NURSING CONSIDERATIONS
A. Prevention of Cardiac Dysfunction due to:
a.1. Increase serum cholesterol
a.2. atherosclerosis
a.3. coronary artery disease

B. Prevention of Medications Interactions

b.1. thyroid hormones increase blood glucose which may need to adjust with insulin dosage
b.2. effect of Phenytoin (Dilantin and TCA
 MEDICAL MANAGEMENT
B. SUPPORTIVE THERAPY
1. Maintaining vital functions
2. ABG
3. Pulse Oximetry
4. Fluid Cautiously administered
5. No pad or heating pad allowed because it increases oxygen
requirement and may lead to vascular collapse
 NURSING MANAGEMENT
1. Monitor vital signs
2. Monitor Input and Output
3. Weigh patient daily
4. Observe for edema
5. Watch out for signs if cardiovascular complication
6. Observe signs of thyrotoxicosis:
(tachycardia, palpitation, nausea, vomiting, diarrhea, sweating,
tremors, agitation, dyspnea)
 NURSING MANAGEMENT
7. Provide comfortable position and warm environment
- provide extra blanket
Rationale: patient has cold intolerance
8. Low calorie diet
9. Avoid sedatives
10. Institute measure to prevent skin breakdown
11. Increase fiber intake
12. Stool softener as ordered
13. Teaching patient about medication
- take meds in the morning to avoid insomnia
- self monitoring for signs of thyrotoxicosis
HYPERTHYROIDI
SM
-second most prevalent disorder in endocrine after
diabetes
- Known as Grave’s Disease
- Results from excessive output of thyroid hormones
- More often in women ages 30-50
- Exact cause is unknown but may be an autoimmune
process
 PATHOPHYSIOLOGY
Iodine Deficiency

Low levels of circulating thyroid hormones

(Feedback)
Stimulates release of TSH
Overproduction of thyroglobulin (Precursor of T3 and T4
Hyperthrophy of thyroid gland
Hyperthyroidism
 CLINICAL
MANIFESTATIONS
THYROTOXICOSIS -Sweating
- Nervousness - Insomnia
- Irritability - Diarrhea
- Apprehension - Weight loss
- Can’t sit quietly - Exopthalmos
- Palpitations - Warm, smooth skin
- Rapid pulse at rest and exertion - Fine, soft hair
- Heat intolerance - Pliable nails
- Flushed skin - Tachycardia
- Fine tremor - Increased BP
- Increased appetite
DIAGNOSTIC
TESTS
- Elevated T3 and T4
- RAIU Elevated
 MEDICAL MANAGEMENT
PHARMACOLOGIC THERAPY

a. Radioisotopes Iodine 131

- used to destroy overactive thyroid cells
b. Antithyroid Medication
 DRUGS ACTION NURSING FUNCTION
1. PROPHYTHIOURACIL (PTU) Blocks synthesis of hormones 1. Watch out for rash, nausea and
vomiting
2. Monitor cardiac parameters
3. Give by mouth
2. Methimazole Blocks synthesis of thyroid hormones 1. Watch out for rash, nausea and
vomiting
2. Monitor cardiac parameters
3. Give by mouth
3. Sodium Iodide Suppress release of thyroid hormones 1. Give 1 hour after PTU or
methimazole
2. Watch out for edema, hemorrhage
and GI upset
4. Potassium Iodide Suppress release of thyroid hormones 1. Discontinue with rashes

5. Saturated Solution of Potassium Suppress release of thyroid hormones 1. Mix with juice or milk
Iodide (SSKI) 2. Give with straw to prevent staining
of teeth
 DRUGS ACTION NURSING FUNCTION
6. Dexamethasone Suppress release of thyroid hormones 1. Monitor input and output
2. Monitor glucose
3. May cause HPN, anorexia, nausea,
vomiting, infection
7. Beta-blockers (Propranolol) Beta-adrenergic blocking agent 1. Monitor cardiac status
2. Hold for bradycardia or decreased
cardiac output
3. Use with caution in heart failure
 SURGICAL
MANAGEMENT
THYROIDECTOMY

- Partial or total removal of the thyroid gland

Subtotal – Hyperthyroidism
Total – Thyroid cancer
 SURGICAL
MANAGEMENT
THYROIDECTOMY

PRE-OP
1. Ensure that client is adequately prepared
2. Give PTU
3. Give PROPRANOLOL to reduce heart rate
4. Give Lugol’s Solution to reduce vascularity
5. No ASPIRINS weeks before the surgery
 SURGICAL
MANAGEMENT
THYROIDECTOMY

POST-OP
1. Monitor vital signs
2. Monitor input and output
3. Check dressings for hemorrhage
4. Semi-fowler’s position with head pillows
5. Observe respiratory distress from hemorrhage , edema of
glottis, laryngeal nerve damage or tetany
 SURGICAL
MANAGEMENT
THYROIDECTOMY
POST-OP
6. Keep tracheostomy, oxygen and suction set available
7. Assess tetany – due to hypocalcemia from accidental removal ;of the
parathyroid gland
8. Encourage to rest voice
9. Observe for thyroid storm
10. Administer IV fluids
11. Analgesics
12. Relieve discomfort from sore throat