Thyroid & Parathyroid Disorders: Hypothyrodism

Slide 1
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Thyroid &
Parathyroid Disorders
Pamela Krupilis RN, MSN, CNS
Schuylkill Health School of Nursing
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Slide 2
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Hypothyrodism
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Slide 3
Hypothyroidism
One of the most common medical
disorders in the United States
Affects 1 in 50 women and 1 in 300 men
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Slide 4
Etiology
Results from insufficient circulating thyroid
hormone
Thyroxin T4
Thiodothyronine T3
Result of a variety of abnormalities
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Slide 5
Pathophysiology
Can be primary or secondary
Primary
Related to destruction of thyroid tissue or defective
hormone synthesis
Hashimotos Disease
Secondary
Related to pituitary disease with TSH secretion
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Slide 6
Pathophysiology
May be transient, related to thyroiditis, or
result from discontinuing thyroid hormone
therapy
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Slide 7
Pathophysiology
Iodine deficiency
Most common cause worldwide and is most
prevalent in iodine-deficient areas
In places where iodine intake is adequate,

the primary cause is atrophy of the gland.
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Slide 8
Pathophysiology
May also develop because of treatment for
hyperthyroidism
Amiodarone and lithium can produce
hypothyroidism.
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Slide 9
Pathophysiology
Cretinism is caused by thyroid hormone
deficiencies during fetal or neonatal life.
All infants are screened at birth for
thyroid function.
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Slide 10
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Clinical Manifestations
Vary depending on
Severity
Duration
Age of onset
Systemic effects characterized by slowing

of body processes
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Slide 11
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Ranges from no symptoms to classic
symptoms and physical changes easily
detected on examination
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Slide 12
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Onset of symptoms may occur over
months to years.
Unless occurs after thyroidectomy, thyroid
ablation, treatment with antithyroid drugs
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Slide 13
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Cardiovascular system
cardiac output
cardiac contractility
Anemia
Cobalamin, iron, folate deficiencies
serum cholesterol and triglycerides
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Slide 14
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Respiratory system
Low exercise tolerance
Shortness of breath on exertion
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Slide 15
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Neurologic system
Fatigued and lethargic
Personality and mood changes
Impaired memory, slowed speech, decreased
initiative, and somnolence
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Slide 16
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Gastrointestinal system
motility
Achlorhydria
Constipation
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Slide 17
Reproductive System
Menorrhagia
Amenorrhea
Decreased Libido
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Slide 18
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Other changes
1.
Cold intolerance
Hair loss
Dry/coarse skin
Brittle nails
Hoarseness
Muscle weakness and swelling
Weight gain
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Slide 19
Can lead to cholesterol level, atherosclerosis,
CAD, & poor left ventricular function.
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Slide 20
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Those with severe long-standing
hypothyroidism may display myxedema.
Accumulation of hydrophilic
mucopolysaccharides in the dermis and other
tissues
Causes puffiness, periorbital edema, masklike
effect
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Slide 21
Myxedema
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Slide 22
Myxedema
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Slide 23
Non-pitting Edema
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Slide 24
Complications
Mental sluggishness
Drowsiness
Lethargy progressing gradually or
suddenly to impairment of consciousness
or coma
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Myxedema coma
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Slide 25
Diagnostic Studies
History and physical examination
Laboratory tests
Serum TSH
Determines cause of hypothyroidism
Free T4
Serum T3
Serum T4
TPOAb (Antithyroid Peroxidase Antibodies)
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Slide 26
Diagnostic Studies
Laboratory findings (contd)
Other abnormal findings are
cholesterol and triglycerides, anemia, and
creatine kinase.
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Slide 27
Diagnostic Studies
TRH stimulation test
in TSH after TRH injection suggests
hypothalamic dysfunction.
No change after TRH injection suggests
anterior pituitary dysfunction.
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Slide 28
Diagnostic Studies
Fine Needle Aspiration Biopsy
Thyroid Scan
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Slide 29
Collaborative Care
Restoration of euthyroid state as safely
and rapidly as possible
Low-calorie diet
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Slide 30
Collaborative Care
Levothyroxine (Synthroid)
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Must take regularly

Monitor for angina and cardiac dysrhythmias.
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Monitor thyroid hormone levels, and adjust

(as needed).
Liotrix (Thyrolar)
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Slide 31
Collaborative Care
Patient Education
Take medication same time daily.
Take at least 4 hours before taking
antacids.
Contact healthcare provider.
Symptoms should subside within 2 weeks.
Maintain regular visits.
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Slide 32
Nursing Management
Nursing Assessment
Health history
Weight gain
Mental changes
Fatigue
Slowed/slurred speech
Cold intolerance
Skin changes
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Slide 33
Nursing Management
Nursing Assessment
Health history (contd)
Constipation
Dyspnea
Recent introduction of iodine medications
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Slide 34
Nursing Management
Nursing Assessment
Physical examination
Bradycardia
Distended abdomen
Dry, thick, cold skin
Thick, brittle nails
Paresthesias
Muscular aches and pains
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Slide 35
Nursing Management
Nursing Diagnosis
Imbalanced nutrition: More than body
requirements
Activity intolerance
Impaired memory
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Slide 36
Nursing Management
Planning
Experience relief of symptoms.

Maintain a euthyroid state.
Maintain a positive self-image.
Comply with lifelong thyroid replacement
therapy.
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Slide 37
Nursing Management
Nursing Implementation
Health promotion
No consensus for thyroid function screening
High-risk populations screened for subclinical
thyroid disease
Family history of thyroid disease, history of neck
radiation, women over 50, and postpartum
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Slide 38
Nursing Management
Acute intervention
Most individuals do not require acute nursing
care.
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Managed on outpatient basis
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Slide 39
Nursing Management
Acute intervention (contd)
Individual with myxedema coma requires
acute nursing care.
Mechanical respiratory support

Cardiac monitoring
IV thyroid hormone replacement
If hyponatremic, hypertonic saline may be
administered.
Monitor core temperature.
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Slide 40
Nursing Management
Acute intervention (contd)
Individual with myxedema coma (contd)
Vital signs
Weight
I&O
Visible edema
Cardiovascular response to hormone
Energy level
Mental alertness
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Slide 41
Nursing Management
Ambulatory and home care
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Explain nature of thyroid hormone deficiency

and self-care practices to prevent
complications.
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Patient and family must understand replacement

therapy and that it is lifelong.
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Slide 42
Nursing Management
Ambulatory and home care (contd)
Teach measures to prevent skin breakdown.
Emphasize need for warm environment.
Caution patient to avoid sedatives or use
lowest dose possible.
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Slide 43
Nursing Management
Discuss measures to minimize constipation.
Avoid enemas because of vagal stimulation in
cardiac patient
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Slide 44
Nursing Management
Teach patient to notify physician immediately if
signs of overdose appear.
Orthopnea, dyspnea, rapid pulse, palpitations,
nervousness, insomnia
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Slide 45
Nursing Management
Patient with diabetes should test blood
glucose at least daily.
Return to euthyroid state frequently.
insulin requirements.
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Slide 46
Nursing Management
Thyroid preparations potentiate the effects of
some common drug groups.
Teach patient toxic signs and symptoms of these
drugs.
Anticoagulants
Digitalis compounds
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Slide 47
Nursing Management
Provide handouts that include verbal
instructions for patients and family members.
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Slide 48
Nursing Management
Evaluation
Expected outcomes
Have relief from symptoms.
Maintain euthyroid state as evidenced by
normal thyroid hormone and TSH levels.
Adhere to lifelong therapy.
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Slide 49
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Hyperthyroidism
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Slide 50
Hyperthyroidism
A sustained increase in synthesis and
release of thyroid hormones by thyroid
gland
Occurs more often in women
Highest frequency in 20- to 40-year-olds
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Slide 51
Etiology
Most common form
Graves disease
Other causes
Thyroiditis
Toxic nodular goiter
Exogenous iodine excess
Pituitary tumors
Thyroid cancer
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Slide 52
Etiology
Thyrotoxicosis
Physiologic effects/clinical syndrome of
hypermetabolism resulting from increased
circulating levels of T3, T4
Hyperthyroidism and thyrotoxicosis occur

together as Graves disease.
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Slide 53
Pathophysiology
Graves disease
Autoimmune disease of unknown origin
Diffuse thyroid enlargement
Excessive thyroid hormone secretion
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Slide 54
Pathophysiology
Graves disease (contd)
Precipitating factors
Insufficient iodine supply
Infection
Stressful life events interacting with genetic
factors
Accounts for 75% of cases of

hyperthyroidism
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Slide 55
Pathophysiology
Graves disease (contd)
Antibodies are developed to TSH receptor.
Leads to clinical manifestations of
thyrotoxicosis
May progress to destruction of thyroid tissue,
causing hypothyroidism
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Slide 56
Pathophysiology
Toxic nodular goiters
Thyroid hormonesecreting
nodules independent of
TSH
If associated with
hyperthyroidism, termed
toxic
Multiple or single nodules

Usually benign follicular
adenomas
Occur equally in men and
women
Slide 57
Related to effect of thyroid hormone
excess
metabolism
tissue sensitivity to stimulation by
sympathetic nervous system
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Slide 58
Ophthalmopathy
Abnormal eye appearance or function
Exophthalmos
Protrusion of eyeballs from the orbits
Impaired drainage from orbit
Increased fat and edema in retroorbital tissues
Seen in 20% to 40% of patients
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Slide 59
Exophthalmos and
Goiter of Graves Disease
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Slide 60
Cardiovascular system
Bruit over thyroid gland
Systolic hypertension
cardiac output
Dysrhythmias
Cardiac hypertrophy
Atrial fibrillation
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Slide 61
GI system
appetite, thirst
Weight loss
Diarrhea
Splenomegaly
Hepatomegaly
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Slide 62
Integumentary system
Warm, smooth, moist skin
Thin, brittle nails
Hair loss
Clubbing of fingers
Diaphoresis
Vitiligo
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Slide 63
Acropachy
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Slide 64
Musculoskeletal system
Fatigue
Muscle weakness
Proximal muscle wasting
Dependent edema
Osteoporosis
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Slide 65
Nervous system
Fine tremors
Insomnia
Ability of mood, delirium
Hyperreflexia of tendon reflexes
Inability to concentrate
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Slide 66
Reproductive system
Menstrual irregularities
Amenorrhea
Decreased libido
Impotence
Gynecomastia in men
Decreased fertility
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Slide 67
Intolerance to heat
sensitivity to stimulant drugs
Elevated basal temperature
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Slide 68
Complications
Thyrotoxic crisis
Acute, rare condition, where all
manifestations are heightened
Life-threatening emergency
Death rare when treatment initiated
Presumed causes are additional stressors.
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Slide 69
Complications
Thyrotoxic crisis
Manifestations include
Tachycardia
Heart failure
Shock
Hyperthermia
Restlessness
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Slide 70
Complications
Thyrotoxic crisis
Manifestations (contd)
Agitation
Seizures
Abdominal pain
Nausea
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Slide 71
Complications
Thyrotoxic crisis
Manifestations (contd)
Vomiting
Diarrhea
Delirium
Coma
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Slide 72
Complications
Thyrotoxic crisis
Treatment
Thyroid hormone levels and clinical
manifestations with drug therapy
Therapy
Aimed at managing respiratory distress, fever
reduction, fluid replacement, and management
of stressors
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Slide 73
Diagnostic Studies
History
Physical examination
Ophthalmologic examination
ECG
Radioactive iodine uptake (RAIU)
Indicated to differentiate Graves disease from
other forms of thyroiditis
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Slide 74
Diagnostic Studies
Laboratory tests
TSH
Free thyroxine (free T4)
Total T3 and T4
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Slide 75
Collaborative Care
Goals
Block adverse effects of thyroid hormones.
Stop hormone oversecretion.
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Slide 76
Collaborative Care
Three primary treatment options
Antithyroid medications
Radioactive iodine therapy (RAI)
Subtotal thyroidectomy
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Slide 77
Collaborative Care
Drug therapy
Useful in treatment of thyrotoxic states
Not considered curative
Antithyroid drugs
Iodine
-adrenergic blockers
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Slide 78
Collaborative Care
Antithyroid drugs
Inhibit synthesis of thyroid hormone
Improvement in 1 to 2 weeks
Good results in 4 to 8 weeks
Therapy for 6 to 15 months
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Slide 79
Collaborative Care
Antithyroid drugs (contd)
Disadvantages include
Patient noncompliance
Increased rate of recurrence
First-line examples
Propylthiouracil (PTU)
Also blocks conversion of T4 to T3
Methimazole (Tapazole)
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Slide 80
Collaborative Care
Iodine
Used with other antithyroid drugs in
preparation for thyroidectomy or treatment of
crisis
Large doses rapidly inhibit synthesis of T3 and
T4 and block their release into circulation.
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Slide 81
Collaborative Care
Iodine (contd)
vascularity of thyroid gland
Maximal effect seen within 1 to 2 weeks
Long-term iodine therapy is not effective.
Examples
Saturated solution of potassium iodine (SSKI)
Lugols solution
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Slide 82
Collaborative Care
-adrenergic blockers
Symptomatic relief of thyrotoxicosis resulting
from -adrenergic receptor stimulation
Propranolol (Inderal) administered with other
antithyroid agents
Atenolol (Tenormin) is the preferred adrenergic blocker for patients with asthma or
heart disease.
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Slide 83
Collaborative Care
Radioactive iodine therapy (RAI)
Treatment of choice in nonpregnant adults
Damages or destroys thyroid tissue
Delayed response
2 to 3 months
Treated with antithyroid drugs and Inderal

before and during first 3 months of RAI
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Slide 84
Collaborative Care
RAI (contd)
High incidence of posttreatment
hypothyroidism
Need for lifelong thyroid hormone replacement
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Slide 85
Collaborative Care
Surgical therapy
Indications
Unresponsive to drug therapy

Large goiters causing tracheal compression
Possible malignancy
Individual not a good candidate for RAI
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Slide 86
Collaborative Care
Surgical therapy (contd)
Subtotal thyroidectomy
Preferred surgical procedure
Involves removal of significant portion of thyroid
90% removed to be effective
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Slide 87
Collaborative Care
Endoscopic thyroidectomy appropriate with
small nodules and no malignancy
Less scarring, pain, and recovery time
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Slide 88
Collaborative Care
Before surgery
Antithyroid drugs, iodine, and
-adrenergic blockers may be administered
To achieve euthyroid state
To control symptoms
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Slide 89
Collaborative Care
Nutritional therapy
High-calorie diet may be ordered
For hunger and prevention of tissue breakdown
Protein allowance 1 to 2 g/kg ideal body

weight
Avoid caffeine, highly seasoned foods, and
high-fiber foods
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Slide 90
Thyroid Storm
Life threatening
Potential can occur during the postoperative period
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Slide 91
Thyroid Storm
Undiagnosed cases or poorly treated
hyperthyroidism
Precipitated by stress such as infection
(URI), diabetic ketoacidosis, physical or
emotional trauma, or during manipulation
of the thyroid gland.
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Slide 92
Thyroid Storm
Clinical manifestations
Very high fever
Extreme cardiovascular effects (tachycardia,
CHF, and angina)
Severs CNS effects (agitation, restlessness, &
delirium)
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Slide 93
Thyroid Storm
Treatment
Peripheral cooling
Replace fluids, glucose, and electrolytes
Beta-adrenergic blocking agents
Glucocorticoids
Antithyroid medications
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Slide 94
Nursing Management
Nursing Assessment
Health history
Preexisting goiter
Recent infection or trauma
Immigration from iodine-deficient area
Medications
Family history of thyroid or autoimmune
disorders
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Slide 95
Nursing Management
Nursing Assessment
Weight loss
Nausea
Diarrhea
Dyspnea on exertion
Muscle weakness
Insomnia
Heat intolerance
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Slide 96
Nursing Management
Nursing Assessment
Decreased libido
Impotence
Amenorrhea
Irritability
Personality changes
Delirium
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Slide 97
Nursing Management
Nursing Assessment
Objective Data
Agitation
Hyperthermia
Enlarged or nodular thyroid gland
Eyelid retraction
Diaphoretic skin
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Slide 98
Nursing Management
Nursing Assessment
Brittle nails
Edema
Tachypnea
Tachycardia
Hepatosplenomegaly
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Slide 99
Nursing Management
Nursing Assessment
Hyperreflexia
Fine tremors
Muscle wasting
Coma
Menstrual irregularities
Infertility
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Slide 100
Nursing Management
Nursing Diagnoses
Activity intolerance
Risk for injury
Imbalanced nutrition: Less than body
requirements
Anxiety
Insomnia
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Slide 101
Nursing Management
Planning
Overall goals
Experience relief of symptoms.
Have no serious complications related to
disease or treatment.
Maintain nutritional balance.
Cooperate with therapeutic plan.
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Slide 102
Nursing Management
Acute intervention
Usually treated in outpatient setting
Those with acute thyrotoxicosis or undergoing
thyroidectomy require hospitalization and
acute care.
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Slide 103
Nursing Management
Acute thyrotoxicosis
Requires aggressive treatment
Administer medications to block thyroid
hormone production.
Administer IV fluids.
Ensure adequate oxygenation.
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Slide 104
Nursing Management
Acute thyrotoxicosis (contd)
Calm, quiet room
Cool room
Light bed coverings
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Slide 105
Nursing Management
Change linens frequently if diaphoretic.
Encourage and assist with exercise.
Establish supportive relationship.
Apply artificial tears to relieve eye discomfort.
Elevate HOB and salt restriction for edema.
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Slide 106
Nursing Management
Do eye exercises.
Tape eyelids shut for sleep if they cannot
close.
Wear dark glasses to reduce glare and
prevent environmental irritants.
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Slide 107
Nursing Management
Thyroid surgery
Preoperative care
Alleviate signs/symptoms of thyrotoxicosis.

Control cardiac problems.
Assess for signs of iodine toxicity.
Oxygen, suction equipment, and tracheostomy tray
are available in room.
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Slide 108
Nursing Management
Thyroid surgery (contd)
Preoperative teaching
Coughing, deep breathing, and leg exercises

Supporting head while turning in bed
Range-of-motion exercises of neck
Speaking difficulty for a short time after surgery
Routine postop care
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Slide 109
Nursing Management
Postoperative care
Every 2 hours for 24 hours
Assess for signs of hemorrhage.
Assess for tracheal compression.
Irregular breathing, neck swelling, frequent
swallowing, choking
Semi-Fowlers position
Support head with pillows.
Avoid flexion of neck.
Tension on suture lines
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Slide 110
Nursing Management
Postoperative care
Monitor vitals.
Control pain.
Check for tetany.
Trousseaus and Chvosteks signs should be monitored.
Monitor for 72 hours.
Evaluate difficulty in speaking/hoarseness.

Some hoarseness is expected for 3 to 4 days.
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Slide 111
Nursing Management
Ambulatory and home care
Discharge teaching
Monitor hormone balance periodically.
Decrease caloric intake to prevent weight gain.
Adequate iodine
Perform regular exercise.

Avoid environmental temperature.
Avoid goitrogens.
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Slide 112
Nursing Management
Discharge teaching
Regular follow-up care
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Biweekly for a month and then semiannually
After complete thyroidectomy

Lifelong thyroid replacement instruction
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Signs/symptoms thyroid failure
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Slide 113
Nursing Management
Evaluation
Relief of symptoms
No serious complications related to
disease or treatment
Cooperate with therapeutic plan.
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Slide 114
Thyroid Cancer
Affects women more than men
Low mortality rate
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Slide 115
Etiology
Radiation exposure
Radioactive fallout from nuclear weapons
tests
Exposure to radioactive iodine from
nuclear accidents
Diets high or low in iodine
X-Rays of the neck or thymus.
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Slide 116
Benign Nodule
Family history
Hashimotos thyroiditis
Soft, smooth, mobile nodule
Multinodular goiter without a predominating
nodule
Gradual or sudden onset of pain or
tenderness
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Slide 117
Malignant Nodule
Age
Nodule plus hoarseness, difficulty
swallowing, or shortness of breath
External neck irradiation during childhood
Firm, irregular, fixed nodule
Cervical lymphadenopathy, especially one
sided
Previous
history of thyroid cancer
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Slide 118
Diagnosis
Sensitive TSH assay

T3 and T4 levels
Ultrasound
MRI
CT scan
Fine Needle Aspiration
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Slide 119
Types of Thyroid Cancer
Papillary Carcinoma
Follicular Carcinoma
Medullary Carcinoma
Anaplastic Carcinoma
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Slide 120
Papillary Carcinoma
Most common
Female greater than male by 3:1
Affects individuals from 30 60 more
frequently.
Slow growing and is present for several
years before spreading to lymph nodes
Prognosis
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Slide 121
Follicular Carcinma
Accounts for 10% of all thyroid cancers
Common among elderly patients and
iodine deficiency regions.
Invades blood vessels and spreads to
bone and lung
Rarely spreads to lymph nodes
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Slide 122
Medullary Carcinoma
3% of all types of thyroid cancers
Presents as a mass in the neck/thyroid and
may have lymphadenopathy
Aggressive, metastasize early, and have a
poor prognosis
Total Thyroidectomy is required
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Slide 123
Anaplastic Carcinoma
Accounts for 10% of thyroid cancers
Grows rapidly and spreads locally to the
neck and airway
Surgery, radiation, and chemotherapy
80% of patients die within a year of
diagnosis
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Slide 124
Questions ???
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Slide 125
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Parathyroid Disorders
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Slide 126
Hyperparathyroid
Women > Men
Unknown
Benign Tumor
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Slide 127
Pathophysiology
Primary
Benign Tumor
Secondary
Vitamin D deficiency, malabsorption
Chronic Renal Failure
Hyperphosphatemia.
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Slide 128
Pathophysiology
Tertiary
Hyperplasia
Loss of negative feedback system
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Slide 129
Bone effects
Decrease bone density
Kidney effects
Nephrolithiasis
Gastrointestinal
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Slide 130
Asymptomatic
Major
Muscle weakness, loss of appetite,
constipation, fatigue, emotional disorders,
shortened attention span
Osteoporosis
Nephrolithiasis
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Slide 131
Complications
Renal Failure
Pancreatitis
Cardiac
Long bone fractures
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Slide 132
Diagnosis
PTH, Ca+ and PUrine Ca+

Creatinine
Amylase/Lipase
Alkaline Phosphatase
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Slide 133
Diagnosis
Bone Density
DEXA Scan
MRI/CT sound
Ultrasound
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Slide 134
Surgery
Parathyroidectomy
Partial
Total
Autotransplantation of normal parathyroid

gland
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Slide 135
Nonsurgical Treatment
Annual examination
Serum PTH, Calcium, Phosphorous,
Alkaline Phosphatase, Creatinine, & BUN
X-Rays
Urinary calcium excretion
Reinforce mobility
Dietary
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Slide 136
Medications
Biphosphonates (alendronate[Fosamax])
Inhibits osteoclastic bone
resorption and normalizes
Calcium levels.
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Slide 137
Phosphates
Oral administration
Inhibits calcium-absorbing effects of Vitamin D
in the GI tract
Contraindicated with poor renal function
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Slide 138
Calcimimetic agents ( cinacalet [Senispar])
FDA approved for Secondary Hyperparathyroidism and
Parathyroid carcinoma
Increases sensitivity of the calcium receptor on the
parathyroid gland.
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Slide 139
Nursing Management
Parathyroidectomy
Hemorrhage
Fluid and electrolyte disturbance
Tetany
Monitor intake and output
Encourage mobility
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Slide 140
Nursing Management
Non-surgical Candidate
Meal plan
Consult Dietitian
Exercise program
Encourage to maintain regular appointments
Educate patient on the s/s hyper/hypocalcemia
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Slide 141
Hypoparathyroid
Etiology
Uncommon
Iatrogenic
Idiopathic
Parathyroidectomy
Autoimmune
Pseudohypoparathyrodism
Chronic Renal Failure
Alcoholics
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Slide 142
Pathophysiology
Inadequate PTH
Decrease Ca+
Increase P-
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Slide 143
Tetany
Painful tonic spasms of smooth and
skeletal muscles
Dysrhythmias
Decrease PTH and Ca+ levels
Increase P- levels
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Slide 144
Nursing Management
Treat hypocalcemia
Ca+ gluconate, Ca+ chloride, or Ca+
gluceptate IV slowly
Rebreathing
Nutrition
Medication
Ca+ supplements
Hytakerol, calcitrol, Calciferol
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Slide 145
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Questions???
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Thyroid & Parathyroid Disorders: Hypothyrodism

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Slide 1

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

In places where iodine intake is adequate,

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Systemic effects characterized by slowing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Must take regularly

Monitor thyroid hormone levels, and adjust

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Experience relief of symptoms.

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Managed on outpatient basis

Mechanical respiratory support

Schuylkill Health School of Nursing

Explain nature of thyroid hormone deficiency

Patient and family must understand replacement

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Hyperthyroidism and thyrotoxicosis occur

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Accounts for 75% of cases of

Schuylkill Health School of Nursing

Multiple or single nodules

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing

Schuylkill Health School of Nursing