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 is called
toxic 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
 Tetanyoccurs 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