thyroid ppts

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  1. The thyroid gland secretes


    Calcitonin in parafollicular cells
  2. The thyroid gland is regulated by
    TRH & TSH
  3. The thyroid gland is a
    Vascular, two lobed, surrounds trachea
  4. The Hypothalamus secretes
  5. Once secreted by the Hypothalamus TRH goes to the
    Anterior Pituitary
  6. Anterior Pituitary secretes
  7. Once the Anterior Pituitary secretes TSH, TSH goes to the
    Thyroid gland
  8. Thyroid hormones have three principle actions
    Stimulation of energy use

    Stimulation of the heart

    Promotion of growth and development
  9. Conditions of the thyroid


    Iodine deficiency
  10. Severe hypothyroidismin adults
    myxedema/ slowing down of the body, gain weight, increased tolerance to cold, constipation
  11. Hyperthyroidism:
    unexplained weight loss, always sweaty, hair can be thin, agitated and HR is always elevated, iodine (needed to create T3 and T4)

    graves disease, exophthalamus (protrusion of the eyes) lidlag (above the iris there is white)
  12. Lid drop
    crainial nerve is not working well
  13. TFT (Thyroid function test)
    • TSH,
    • T3
    • T4
  14. Total T4 normal values
    4.5-12.5 mcg/dL
  15. Free T4 normal values
    0.9-2 ng/dL
  16. Total T3 normal values
    80-220 ng/dL
  17. Free T3 normal values
    230-620 pg/dL
  18. TSH normal values
    0.3-6 microunits/mL
  19. Antithyroid agents
    –propylthiouracil (PTU)

    –methimazole (Tapazole)
  20. Thyroid Hormone Replacement
    –levothyroxine (Synthroid)=synthetic T4

    –Dessicated thyroid=bovine & porcine T4 +T3

    –liothyronine (Cytomel, Triostat)=synthetic T3

    –Liotrix (Euthroid)=synthetic T4+T3 in 4:1 fixed ratio
  21. Dessicated thyroid
    no need to use this
  22. Synthetic T3 has a _______half life and is _____
    short half life, expensive
  23. Liotrix:
    fixed T3 and T4 (useless)
  24. Thyroid Agents
    levothyroxine (Synthroid, Levothroid)

    Other drugs in the class: liothyronine (Cytomel), liotrix (Thyrolar), Thyroid (Thyroid USP)
  25. Thyroid Agents Therapeutic Uses
    Replacement therapy for hypothyroidism, treatment of goiter

    Emergency treatment for myxedema coma
  26. Thyroid Agents Physiologic action
    • Synthetic form of thyroxine (T4) that increases:
    • metabolic rate,
    • protein synthesis,
    • cardiac output,
    • renal perfusion,
    • oxygen use,
    • body temperature,
    • blood volume
    • growth processes
  27. Thyroid Agents Side Effects
    Thyrotoxicosis: Hyperthyroidism manifestations

    Allergic reactions-skin lesions, rash

    Transient alopecia3
  28. Thyroid Agents Interactions
    warfarin (Coumadin)



  29. cardiac rhythm abnormalities with
  30. Drugs that accelerate levothyroxine metabolism
    • Dilantin,
    • Tegretol,
    • rifampin,
    • Zoloft,
    • phenobarbitol
  31. Thyroid Agents žInteractions:

    Absorption decreased by
    Calcium supplements



    –Cholesterol binding agents

  32. Cumatin interferes with
    Blood clotting
  33. Beta blockers decrease the
    affectiveness of synthroid
  34. Epinephrine and norepinephrine and dopamine are
  35. Dilantin is used for
  36. Thyroid Agents Nursing Implications
    Monitor height and development in infants and children

    Monitor for reversal of hypothyroid manifestations

    Life long treatment controls symptoms, not a cure

    Frequent follow up and lab monitoring
  37. Thyroid Agents Patient education
    Optimal administration & course of therapy

    Symptoms of hyper & hypothyroidism

    Evaluate laboratory data for effective dose
  38. For Thyroid Agents what form is given to a pt in a coma
    IV form
  39. Highly protein bound
    thyroid-binding globulin
  40. propylthiouracil (PTU);

    Other Drugs in the class
    methimazole (Tapazole) -Longer half life
  41. Propylthiouracil (PTU) Therapeutic Uses
    • Treatment for Hyperthyroid state and Graves’
    • disease, adjunct treatment to irradiation, emergency treatment of thyrotoxicosis
  42. Propylthiouracil (PTU) Physiologic Action
    Block the synthesis of thyroid hormones, prevent oxidation of iodide, block conversion of T4 into T3
  43. propylthiouracil (PTU) side effects
    Agranulocytosis (>40 y.o., high doses, usually in first 2 months of treatment)



    Nausea, arthalgia, headache, dizziness, paresthesias, liver injury
  44. propylthiouracil (PTU) Interactions
    Opposes Vitamin K—enhanced anticoagulant effects
  45. propylthiouracil (PTU) Labs and Monitoring
    Wt, Vital signs, T4 levels, CBC, LFT
  46. propylthiouracil (PTU) Half life
    • Half-life 1-2 hours;
    • Long time to onset of action—3-12 weeks
  47. propylthiouracil (PTU) caution
    Pregnancy and Lactation , PTU safer than methimazole

    Bc passes the placenta and a greater rate than tapizole
  48. Radioactive Iodine is Treatment for
    • Graves Disease
    • thyroid cancer and diagnostic procedures
  49. Radioactive Iodine Treatment for Graves’ Disease
    Delayed hypothyroidism frequent complication



    Very young children, caution under the age of 30 yr
  50. A client tells a nurse that she has been taking levothyroxine (Synthroid) everyday for 9 days. She asks why there has been no improvement in her condition. The nurse’s best response is:
    “It may take several weeks for you to notice a therapeutic effect from the drug”
  51. Propanolol (beta blocker) (Inderal) may be prescribed to clients with hyperthyroidism to
    Decrease tachycardia and tremors
  52. For which of the following clients would radioactive
    iodine (131 I) be contraindicated?
    A client who is pregnant
Card Set:
thyroid ppts
2011-07-24 18:28:14

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