Chapter 45 Thyroid and Parathyroid Disorders Med/Surg Highlighted Facts

The amount of iodine taken up by the thyroid is measured to assess the activity level of the gland. Isotopes show increase in urine. S/s of thyroid disease may be mistaken for the aging process. Pt. needs to tell nurse about these s/s.

Levels: Serum T3: normal= 80-230 Free T3- normal= 1.8-2.4; free because not attached to protein. T4- normal= 5-140 TSH- normal= 1.4-4.5; assess amt. of TSH in blood.

Hyperthyroidism: Characterized by abnormally increased synthesis and secretion of thyroid hormones. Treated by meds or surgery. Graves disease is the most common type. S/s mild to severe. Weight loss and nervousness might be the only symptoms in pts. with a mild form. In more severe cases, the pt.'s history may reveal restlessness, irritable behavior, sleep disturbances, emotional labilty, personality changes, hair loss, and fatigue. Weight loss, even when the pt. is eating well is common.

Exophthalmos. Exophthalmos is the most apparent effect of hyperthyroidism on the eyes. Usually subsides several weeks after TX. Tachycardia, increased systolic BP, and sometimes atrial fibrillation. Also, increased respirations. Thyrotoxicosis is excessive stimulation caused by elevated thyroid hormone levels that produce dangerous tachycardia and hyperthermia. A risk of H exists. Thyrotoxicosis is a medical emergency. TX: drug therapy, surgery, and radiation therapy. May be treated initially with antithyroid drugs. Assess med levels, need to check for hyperthyroidism due to overdose. Iodine solutions can cause discoloration of the teeth and gastric upset. These effects are minimized if the iodine solution is diluted with milk, fruit juice, or some other beverage and sipped thru a straw. Radioactive iodine quickly accumulates in the thyroid gland, where it causes destruction of the tissue. Decrease thyroid hormone production, excreted in urine. Surgical TX: Graves disease is often treated by removing most of the thyroid gland. This is called a subtotal thyroidectomy. Nonsurgical care of pt. w/ hyperthyroidism: Encourage pt. to arrange the day to allow periods of rest. Caffeine should be avoided because of its stimulating effects. Encourage bedtime rituals. Provide a restful environment and a soothing back rub to promote relaxation. Give sedatives as ordered. Most s/s caused by increased MBR, especially sleep disturbances. Hypocalcaemia- may occur due to decrease in parathyroid hormone. Twitching/cramps are signs. Weigh daily. Pts. must have 4000 to 5000 calories q day. Nursing care of pt. having a thyroidectomy:

Tell the pt. to expect a dressing on the front of the neck. Avoid straining the neck incision by supporting the head when rising. Assess for drainage or bleeding behind neck or upper back. Suction equipment and tracheotomy tray must be available at bedside. Trousseaus sign: carpopedal spasm that occurs when a BP cuff is inflated above the pt.s systolic BP and left in place for 2-3 minutes. Hypothyroidism Inadequate secretion of thyroid hormones. If TSH level is high, and thyroid hormone is low, then it is a thyroid problem. Cause/Risk factors: Dietary iodine deficiency. Diagnosed based on lab determination of free T4 and TSH. Muscle aches, pain, and constipation, MD will order T3, T4 (will show decrease) to confirm dx. Teach pts. s/s, meds may need to be adjusted. Occurs early. Despite having a poor appetite, pt. may gain weight. Weigh weekly. Foods: turnips, soybeans. Dry skin is common, prone to breakdown. Apply lotions and creams to help maintain moisture and control itching. Reduce bathing. Pt. may live normal life if treated with thyroid replacement therapy. Elderly have a slower drug metabolism. Drug stays in their system. All pts. receiving hormone replacement therapy need to be periodically evaluated. Goiter Simple goiter causes include iodine deficiency and long-term exposure to gotrogen agents. Suppresses function of thyroid gland.

Use iodized salt because iodine is needed to convert thyroid hormones. Without it, TSH continues to send message to thyroid gland to increase production of thyroid hormones. May also prevent development of goiter. Hypoparathyroidism Occurs in women more than men. If left untreated, severe demineralization of bone tissue occurs. S/s- mental and personality changes, cardiac dysrhythmias, weight loss, and urinary calculi (stones.) Urinary calculi is due to increased uric acid. Drug TX: 1. Biophospates: a. pamidronate (areda) = inhibits bone resorption, reduces serum calcium. b. Etidronate disodium (Didronel) = reduces serum level in calcium 2. Other a. Calcitonin (Calcimar) = treats hypercalcemia. Side effect: anaphylaxis. Sensitivity test done before giving. b. Gallium nitrate (ganite) = reduces serum calcium level in hypercalcemia Nursing care: Monitor increased BP, poor muscle tone, pain in bones. Maintain accurate I/O records. Report decreasing urine output and sharp pain the flank (kidney area) to MD. Urine may be strained and examined for crystals and calculi. Increase fluids <---#1 Nursing Dx. Keep an emergency tracheotomy tray at bedside in the event of acute obstruction. Show pt. how to support the head when changing positions.