Endocrine – Thyroid gland

Endocrine – Thyroid gland

Part 1

Description: Thyroid

• Butterfly shaped• Two lobes connected

by an isthmus• Straddles the trachea• Largest endocrine

gland

Function: Thyroid

1. Produce thyroid hormones (TH) Vital for growth &

metabolism

2. Iodine storage Essential for T3/T4

syntheses

Hormones

Hormone Function Stimulated by

T3/T4 metabolic rate

protein synthesis

energy production

Most important hormone in day today regulation of metabolic rate

metabolic rate

T3/T4 TSH

Thyroid Hormones

Hormones Function Stimulated by

T3/T4 metabolism metabolism

Calcitonin blood calcium concentration

the reabsorption of Ca and Ph from bones to blood

Calcitonin “tones” down serum Ca levels

blood Ca levels

Hormone Loop• Metabolic rate • Detected by hypothalamus • Stimulates anterior pituitary • Secretes TSH • Blood stream target organ thyroid• Stimulate Thyroid to secrete T3/T4 • Blood stream target organs adrenal medulla • Secretes Epinephrine & Norepinephrine • Metabolic rate

Thyroid Disorders

• World-wide– Iodine deficiency

• United States– Auto-immune

Hyperthyroidism

Definition• T3/T4 in bloodPathophysiology• Primary hyperthyroidism

– Problem with thyroid gland T3/T4

• Secondary hyperthyroidism– Problem with pituitary gland T3/T4– Pituitary TSH T3/T4 – TSH thyroid growth goiter

Hyperthyroidism

Etiology• Auto-immune• AKA:

– Grave’s disease• F vs M?

– F > M• Age

– 20-40 yrs

HyperthyroidismS&S

Neurological• Heat intolerance• Diaphoresis• sympathetic nervous

response

HyperthyroidismS&S

Affect• Nervous• Emotional lability• Irritable• I Concentration• Mood swings• manic/psychotic

HyperthyroidismS&S

Cardiovascular• Tachycardia• Palpitations

HyperthyroidismS&S

Gastrointestinal• Appetite

– • Weight

– • BM

– – Diarrhea

HyperthyroidismS&S

Muscle-skeletal• Tremors• Restlessness• Muscle

– weakness

HyperthyroidismS&S

Skin• Temperature

– Warm• Smooth• Hair

– Fine, soft– Gray– Loss

HyperthyroidismS&S

Exophthalmos• Bulging of the eye• Stare

HyperthyroidismS&S

Goiter• Enlarged thyroid• TSH levels

–

HyperthyroidismS&S

Oncholysis• Distal nail separates

from the nail bed• Nail fragile

HyperthyroidismS&S

Gynecomastia• Abnormal enlargement

breasts• male

HyperthyroidismS&S

Elderly• Heart failure• Fatigue• Apathy• Depression

Hormone Review

• T3/T4 • Pituitary • TSH • Thyroid • T3/T4___________________ • T3/T4 • Pituitary • TSH • Thyroid • T3/T4

HyperthyroidismDiagnostic Tests

Primary Hyperthyroidism

Secondary Hyperthyroidism

T3/T4

TSH

• By definition hyperthyroidism means what?– T3/T4–

HyperthyroidismDiagnostic Tests

• By definition primary hyperthyroidism means what? (where is the problem – what is causing the problem?)– Thyroid

• T3/T4

• In primary hyperthyroidism, is the pituitary gland working correctly?– Yes

HyperthyroidismDiagnostic Tests

Primary Hyperthyroidism

Secondary Hyperthyroidism

T3/T4

TSH

• If the pituitary gland is working correctly and there is an T3/T4 level, what will the Pituitary gland do with the TSH level?

HyperthyroidismDiagnostic Tests

Primary Hyperthyroidism

Secondary Hyperthyroidism

T3/T4

TSH

• By definition hyperthyroidism means what?– T3/T4–

HyperthyroidismDiagnostic Tests

• By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?)– Pituitary gland

• TSH • T3/T4

HyperthyroidismDiagnostic Tests

Primary Hyperthyroidism

Secondary Hyperthyroidism

T3/T4

TSH

By definition secondary hyperthyroidism means what? (where is the problem – what is causing the problem?)– Pituitary gland TSH T3/T4

Question?

Mrs. Goiter has a thyroid panel done and shows an elevated T3/T4 and an elevated TSH? Which of the following diagnosis apply?

A. Primary hyperthyroidismB. Secondary hyperthyroidismC. Primary hypothyroidismD. Secondary hypothyroidism

Question?

Mrs. Canta Geta Up has a thyroid panel done and shows an elevated T3/T4 and an decreased TSH? Which of the following diagnosis apply?

A. Primary hyperthyroidismB. Secondary hyperthyroidismC. Primary hypothyroidismD. Secondary hypothyroidism

HyperthyroidismMedical Treatment

Meds first• Goal

– T3/T4 levels• Meds alone sometimes

work - if not – Surgery

HyperthyroidismMedical Treatment

Anti-thyroid therapy• Propylthioracil / PTU• Methimazole /

Tapazole– Action

• Inhibits synthesis of T3/T4

HyperthyroidismMedical Treatment

Propranolol hydrochloride / Inderal

• Beta-blocker• sympathetic nervous system• No smoking

HyperthyroidismMedical Treatment

• Meds alone not – Surgery

• If Ca Thyroid – Surgery

• Euthyroid state before surgery!– How?

• Anti-thyroid meds

HyperthyroidismMedical Treatment

• Iodine before surgery– Potassium iodine

saturated solution (SSKI)

– vascularity of the thyroid

– risk of post-op bleeding

HyperthyroidismMedical Treatment

Radioactive Iodine• I131

• Used instead of radiation tx

• Stop anti-thyroid meds x 7 days

• Single dose• S&S in @ 3wks full

effect in 3 months

HyperthyroidismMedical Treatment

Radioactive Iodine• Safety

– No PG nurses– Watch body fluids– Avoid kids x 7 days

HyperthyroidismMedical Treatment

Diet (When hyperthyroid)

• Calories– – 4,000-5,000 cal/day

• Fluids–

• Na–

• Fiber–

• Caffeine–

HyperthyroidismNursing Management

Assessment• Vital signs• Lung sounds• Anxiety level• Weight• Bowel function• NEVER palpate goiter

– Release TH

HyperthyroidismNursing Management

Nrs. Dx• Risk for injury• Hyperthermia• Diarrhea• Alt. Nutrition• Sleep pattern

disturbance• Anxiety

HyperthyroidismNursing Management

• Exophthalmos– Lubricate eyes– Tape closed – Dark glasses– Na diet– HOB

HyperthyroidismSevere

Thyrotoxicosis• AKA: Thyroid Storm• Definition

– Sever hyperthyroid state

• Etiology– Stress– Post thyroid surgery– Undiagnosed

Hyperthyroidism SevereThyrotoxicosis

S&S• TH adrenergic activity

epinephrine• Pulse

– • Temperature

– • BP

–

• Depression• Activity

– Restlessness• Delirium• SOB• Coma

Hyperthyroidism SevereThyrotoxicosis

• Death– <2hr– Cardiac Failure

Hyperthyroidism SevereThyrotoxicosis

Treatment• Fever

– Tylenol/ acetaminophen – Not aspirin

• For pulse & BP– Propranolol / Inderal– Beta-adrenergic blocker

• If SOB– O2– HOB