Hyperthyroid

Card Set Information

Author:
julie.satterfield
ID:
59925
Filename:
Hyperthyroid
Updated:
2011-01-15 14:53:22
Tags:
endocrine
Folders:

Description:
Hyperthyroidism
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user julie.satterfield on FreezingBlue Flashcards. What would you like to do?


  1. Signs and Symptoms
    • HEAT INTOLERANCE
    • tachycardia
    • full bounding pulse
    • tachydysthythmias (A-fib)
    • > stroke volume
    • > CO and blood flow
    • Dyspnea
    • Tachypnea
    • > appetite and thirst
    • Weight loss
    • Hyperactive bowel sounds
    • > peristaltic activity (N/V/D)
    • Splenomegaly
    • Hepatomegaly
    • Muscle weakness & fatigue
    • Muscle wasting
    • dependent edema
    • osteoporosis
    • Difficulty concentrating
    • Tremors
    • Nervousness
    • Restlessness
    • Emotional lability
    • Insomnia
    • Depression/Fatigue
    • Hyperreflexia
    • Stupor
    • Profuse perspiration
    • >basal temperature
    • Rapid speech
    • Goiter
    • Exopthalamus
    • Menstrual irregularities/ammenorrhea
    • <libido
    • gynecomastia in men
    • impotence
    • < fertility
    • Hair loss (patchy)
    • fine-silky hair
    • warm smooth moist skin
    • thin brittle nails
    • clubbing of fingers or thyroid acropachy
    • palmer erythema
    • diaphoresis
    • bitilago
    • pretibial myxedema
    • elelid retraction
    • lid Lag (stare)
    • >tearing
  2. Complications
    • Grave's Disease
    • Thyrotoxicosis
    • Thyrotoxic Crisis (Thyroid Storm)
  3. Grave's Disease
    • Autoimmune disorder
    • Diffuse thyroid enlargement
    • Excessive TSH secretion
    • 75% of cases of hyperthyroidism
    • Most common in Women 20-40 yo
    • Too much T3 & T4 production
    • Remission & Exacerbation with or without tx
    • May progress to destruction of Thyroid tissue i.e. causing HYPOthyroidism
    • Both Hyperthyroidism & Thyrotoxicosis found
    • S/S
    • Directly related to hyperthyroidism
    • Goiter possible
    • Exophthalmus
    • Bruit possible
    • A-Fib in older adults
  4. Thyrotoxicosis
    • Physiological effects or clinical syndrome of hyper metabolism resulting fron excess circulating levels of T3, T4 or both
    • Causes: Stress, Infection, Surgery or trauma, MI, CVA, texemia in preg., DKA
    • Complication: Thyrotoxic Crisis (Thyroid Storm)
  5. Thyrotoxic Crisis/Thyroid Storm
    Signs/Symptoms
    • SEVERE tachycardia (230-280)
    • SEVERE Hyperthermia (up to 105.3)
    • Restlessness
    • Heart failure
    • Shock
    • Agitation
    • Seizures
    • Abd pain with N/V
    • Dehydration
    • Delirium
    • Coma
    • Severy HTN
  6. Thyrotoxic Storm
    Treatment
    Centers on reducing circulating thyroid hormone levels and reducing clinical minifestations.

    We want to block adverse effexcts and stop oversecretion.

    • Antithyroid drugs (PTU)
    • Beta blocker (Inderol, Tenormin)
    • Iodine
    • Radio active Iodine
    • Surgical therapy
    • Manage respiratory distress
    • Fever reduction
    • Fluid replacement
    • Eliminate stressors
  7. Drug Therapy for Hyperthyroidism
    • Antithyroid drugs
    • Beta blockers
    • Iodine
    • Radioactive Iodine (RAI)
  8. First Line Antithyroid Drugs
    • Propylrthioeruacil (PTU)
    • Methimazole (Tapazole)

    • Must continue for 6-16 months
    • NOT curative
    • High rate of NONcompliance
    • High rate of reoccurrence when drugs d/c
  9. Propylthiouracil
    (PTU)
    • Lowers hormone levels quickly
    • Must be taken TID
  10. Methimazole
    (Tapazole)
    Administered qd
  11. Indications for Antithyroid Drugs
    • Grave's in young pt
    • Hyperthyroidism during pregnancy
    • May be admin to achieve euthroid state prior to surgery or radiation therapy
  12. Beta-Adrenergic Blockers
    • Propranolol (Inderal)
    • Atenolol (Tenormin)
  13. Propranolol
    (Inderal)
    • Rapidly provides symptomatic relief
    • Usually admin with other antithyroid meds
    • SE: arrhythmias; bradycardia; chf; pulmonary edema; fatigue; weakness; erictile dysfunction
  14. Atenolol
    (Tenormin)
    • Preferred for pt with asthma or heart disease
    • SE: Bradycardia; chf; pulmonary edema' fatigue; weakness; erectile dysfunction
  15. Iodine Therapy
    (SSKI, Lugols)
    • Decreases vascularity of thyroid gland
    • Used with other antithyroid drugs to prep for thyroidectomy or tx of thyrotoxic crisis
    • Lg dose rapidly inhibits synthesis of T3 & T4
    • blocks te release of these hormones into circulation
    • Max effects seen within 1-2 wks
    • NOT effective in controlling hyperthyroidism long term
  16. Nursing Interventions for Iodine Therapy
    • Sip through straw
    • Mix with juice or water d/t GI irritatation
    • Assess for Toxicity: swelling of mucus membranes & buccal mucosa; excessive salivation; N/V; Skin reactions
  17. Radioactive Iodine Therapy
    (RAI)
    • Tx choice for NON pregnant adults
    • Pt is NOT radioactive
    • Destroys thyroid tissue resulting in limited thyroid hormone secretion
    • Delayed response: may not see results for 2-3 months
    • Treat with antithyroid drgs & beta blocker until effects become apparent (3 mo)
    • Necessitates need for life long thyroid hormone replacement!
    • Usually effecxtive but with high incidence of post tx hypothyroidism.
  18. Surgical treatments
    • Thyroidectomy
    • Subtotal thyroidectomy
  19. Thyroidectomy
    • Used for:
    • pt unresponsive to antithyroid therapy
    • Barg goiters causing tracheal compression
    • possible malignancy
    • not good candidate for RAI
    • Advantages:
    • Rapid reduction in T3 & T4 levels than RAI alone
  20. Endoscopic Thyroidectomy
    • Indications:
    • Minimally invasive
    • Appropriate for pt with sm nodules (<3cm)
    • No evidence of malignancy
    • Advantages:
    • Less scaring
    • Less pain
    • Faster return to normal activity
  21. Subtotal Thyroidectomy
    • Preferred surg. proceedure
    • Remove 90% of thyroid tissue
    • Too much tissue removal results in hypothyroidism
    • Complication:
    • parathyroid gland removed or damaged-this leads to hypocalcemia and tetany. Can cause laryngeal stridor and need trach tube.
  22. Preop Care For Subtotal Thyroidectomy
    Euthyroid state by admin Iodine, Antithyroid med, beta blocker
  23. Preop Teaching for Thyroidectomy/subthyroid
    • Deep breathing/cough/leg exercises
    • post op positioninbg & turning
    • Practice neck ROM exercises
    • Inform talking may be difficult for short time post op
    • expect hoarseness d/t edema
    • Avoid caffeine
    • scar will fade over time
    • High calorie diet (4000-5000 Kcal/day); 6 sm meal/day; high protein, carb mineral & vitamin snacks
    • AVOID spicy & high fiber foods
  24. Post op care
    • O2
    • suction equipment
    • trach tube
    • ***If tetany r/t parathyoid damage and hypocalcemia: IV calcium gluconate or IV gluceptate
    • Assess q2h for 24hr
    • hemorrhage
    • trach compression (irregular breathing)
    • Neck swelling
    • frequent swallowing
    • sensations of fullness @ incisiuon line
    • choking
    • Blood on anterior or posterior dressing
    • support in semi-fowlers position
    • support head with pillows
    • avoid flexion of neck & any tension on suture lines
    • monitor & assess VS per protocol
    • Check for tetany (tingling around mth, toes, fingers; muscular twitching) for @ least 72 hrs
    • Pain/admin meds to control
    • Ambulate within hrs of surg
    • fluids asatolerated
    • soft diet day after surgery

What would you like to do?

Home > Flashcards > Print Preview