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Thyroid & Parathyroid Disease Cheat Sheet by

Adult Health 2
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Thyroid Disease

Affects metab., growth, develo­pment; temp. regula­tion, HR, RR (every cell, tissue, organ)
Endocrine system = "duct system­"
How does it work?
Negative feedback loop...
- Hypoth­alamus releases TRH Pituitary releases TSH Thyroid releases T3 & T4 T3 & T4 maintain normal levels in blood Normal function maintained Normal levels "turn off" hypoth­alamus

Hypoth­yro­idism

Undera­ctive thyroid; not enough T3 and T4
Prim­ary: dec. thyroid tissue, dec. TH
Seco­nda­ry: inadequate TSH production
Path­oph­ysi­olo­gy: Low metabolism Hypoth­alamus & anterior pituitary release TSH TSH tries to get thyroid to release hormones TSH binds to thyroid cells Inability = thyroid gland enlarges Goiter
Symptoms: (early = fatigue, vague)
- Neuro: memory loss, gait, AMS
- CV: low HR, low BP, eye/face edema
- Lungs: muscle weakness, dec. effort
- GI: dec. bowel, low metab., consti­pat­ion
- Renal: dec. urine output
- M/S: weak­ness, myalgia
- Skin: dec. turgor, dry, stiff, puffy, PM
- Psych: depr­ess­ion
- Repro­duc­tive: irre­gul­ar/­heavy periods
Drug therapy:
- Levoth­yroxine (Synth­roid) (most common), Liothy­ronine (Cytomel, Liotrix)
Educ­ati­on:
- Take first (30 min before/2 hr after meal)
- Therapy is LIFELONG!
- Don't take within 4 hr of GI meds, antacids
- Side effects: signs of hypert­hyr­oidism
Pret­ibial myxedema (PM): r/t accumu­lations of mucopo­lys­acc­har­ides; revers­ible

Hashim­oto's Disease

Most common cause of hypoth­yro­idism
Cause: immune system attacks thyroid
- Also: dec. iodine, tumor, overtr­eated
Mani­fes­tat­ions: dysphagia, enlarged thyroid
Risk Factors: sex, age, heredity, another autoimmune disorder, radiation
Comp­lic­ati­ons: goiter, cardiac problems, mental health, myxedema, birth defects

Myxedema Coma

A medical emergency; "­sev­ere­" hypoth­yro­idism (r/t untreated, stopping meds)
Caus­es: acute illness, surgery (thyroid), chemo, narcotics, d/c replac­ement therapy
Pres­ent­ati­on:
- Coma
- Respir­atory failure & hypote­nsion
- Hypoth­ermia
- Hypona­tremia (r/t dec. glomerular fx)
- Hypogl­ycemia (r/t glucon­eog­enesis)
Moni­tor:
- Labs & electr­olyte imbala­nce(s)
- Resp. rate & heart rhythms
Inte­rve­nti­ons:
- Maintain patent airway
- Cardiac monitoring
- IV: TH replac­ement, glucoc­ort­icoids
- Correct electr­olytes
- Conserve body heat
- Narcan?
- NO vasoco­nst­rictive drugs
- Seizure precau­tions (r/t low Na & AMS)

Hypert­hyr­oidism

Increased secretion of thyroid hormones
Causes:
- Grave's disease (most common)
- Multiple thyroid nodules
- Toxic multin­odular goiter
- Excessive thyroid replac­ement hormones
- Thyroi­ditis
- Too much iodine
Signs & Symptoms:
- Neuro: tremors, restless, irritable, confusion, seizures
- CV: dysr­hyt­hmias, a fib.
- Lungs: inc. resp. drive = dyspnea
- GI: diar­rhea, inc. perist­alsis, dec. nutrients, losing electr­olytes, weight loss
- Renal: r/t HTN
- M/S: restless & nervou­sness = fatigue
- Skin: smooth skin
- Psych: rest­less, moody, insomnia
- Repro­duc­tive: issues, irregular periods
Interv­ent­ions:
- Moni­tor: EKG, HR, RR, VS; thyroid storm
- Comf­ort: calm, cool, comfor­table
- Diet: avoid iodine, > calories (inc. metab.)
- Educ­ati­on: watch for toxicity, med compli­ance, avoid aspirin
Treatment:
Drug therapy: antit­hyroid meds & radioa­ctive iodine = most common treatment
- Thion­ami­des: PTU, Tapazole
- Beta-­blo­ckers (treat symptoms; HTN, inc. HR, palpit­ations)
- Radio­active iodine (kills thyroid slowly, more permanent cure; not if pregnant or BF)
Surg­ery: to remove all or part of thyroid
Comb­ination therapy
Prop­iot­hio­uracil (PTU) - stops T3 & T4; doesn't harm gland; can take in 1st trimester, but can cause liver failure
Tapazole (Methi­maz­ole) - causes anemia, safer
 

Grave's Disease

Auto­immune; most common cause of hypert­hyr­oid­ism
Cause: antibodies attach to TSH receptors inc. # and size of cells thyroid enlarges (goiter) overpr­odu­ction of hormones
Additional Manife­sta­tions:
- Exop­hth­alm­os: autoimmune attacks area behind eyes, causes edema
- Pret­ibial myxedema
- Grave's dermop­athy: resembles orange peel; r/t inc. protein under skin, legs, & feet

Thyroid Storm (Thyro­toxic Crisis)

What is it? - Extreme exacer­bation of hypert­hyr­oidism
Caus­es: illness, Grave's disease, meds that inc. TH, untrea­ted­/un­dia­gnosed tumor
Signs & Symptoms:
- Inc. HR & BP = severe cardiac problems
- Inc. temp = diapho­resis
- Resp. failure
- Anxiety or agitat­ion
Treatment:
- Inte­rve­ntions to counteract symptoms
- Block TH synthe­sis
- Control temp. NO ASA
- Meds to suppress immune system?

Diagnostic Tests for Thyroid Problems

 
HYPO
HYPER
T3
T4
TSH = 0.4-4
TSH Assay
Thyroid Labs - T3, T4, TSH
TSH Assay - r/t central hypoth­yro­idism
Thyroid Peroxidase (TPO) - enzyme in follicle cells important to hormone produc­tion; converts T4 to T`3; (+) may indicate autoim­mune, not definite for thyroid disease
Radi­ois­otope Uptake Scan - evaluates size, areas of over- or under-­act­ivity
Thyroid Scan
Thyroid US - uses sound waves to image, charac­ter­istics (nodules, blood flow)
Fine Needle Aspiration (FNA) - malignant vs. benign

Thyroid Surgery

Total or subtotal thyroi­dectomy
When?
- Large goiter, poor response to drugs
- Can't/­won't take meds
- Malignancy
Pre-Op:
- Meds: dec. hormone secretion,
beta-b­locker, steroids to dec. immune system (w/ autoimmune dx)
- Cont­rol: HTN, dysrhy­thmias, tachyc­ardia
Post-Op: (BOWTIE)
- B leeding
- O pen airway
- W hisper
- T rach kit & suctioning ready
- I ncision (asses­s/clean dressing & splint)
- E mergency
- Also: monitor VS, semi-F­owl­er's, labs, humidify air, diet, cough & deep breathe
Comp­lic­ati­ons: hemorr­hage, resp. distress, parath­yroid injury
 

Hypopa­rat­hyr­oidism

Abnormally low levels of PTH
Causes:
- Iatr­oge­nic
- Idio­pat­hic
- Hypo­mag­nes­emia (inhibits PTH secretion)
- Other: auto­imm­une
Signs & Symptoms:
- P = parest­hesias, positive Chvostek's & Trouss­eau's signs
- T = tetany (bronc­hos­pams, seizures, EKG)
- H = hypoca­lcemia & hyperp­hos­pha­temia
Diagno­stics:
- EKG = seizure activity, slow brain waves
- Blood tests = labs
- CT scans = specific compared to US, may show brain calcif­ica­tions
- MRIs may be even more specific
Interv­ent­ions:
- Symp­tomatic hypoca­lce­mia: give Ca, vitamin D, Mg & seizure precau­tions
- Other meds: phos­phate binders, PTH inj.
- Moni­tor: Ca, GI, parest­hesias
- Educ­ati­on: medication regimen
- Diet: inc. Ca
Chvo­stek's sign: tap facial nerve, + when twitches (= dec. Ca)
Trou­sseau's sign: inflate BP cuff 20-30 mm Hg above normal for 3-5 min; + when involu­ntary arm movement
PTH inj. (Natpa­ra) - last resort (inc. risk of osteos­arcoma)

Calcium in Parath­yroid Disease

Major contro­lling factor of PTH secretion
Ca & PTH are dire­ctly related
- Increase in PTH = increase in Ca
Affects kidneys (regu­lates P), bones, GI tract

Hyperp­ara­thy­roidism

Abnormally high levels of PTH
Causes:
- Prim­ary: hyperp­lasia, cancer growth
- Seco­nda­ry: CKD (PTH overworked = inc. Ca absorbed), vitamin D deficiency
Signs & Symptoms:
- B = bones (inc. fractures)
- E = epigastric pain, consti­pation (r/t smooth muscle dec.)
- D = dehydr­ation (r/t kidney compen­sation for inc. Ca)
- S = short QT interval (r/t inc. Ca)
Interv­ent­ions:
- Diag­nos­tics - inc. Ca & PTH, dec. P
- Moni­tor: labs, EKG (telem­etry)
- Diet: dec. Ca, inc. P - watch in renal pt! (already inc. Ca & dec. P)
Medica­tions: GOAL = LOWER Ca LEVELS
- Loop diuret­ics: hypoca­lcemia = side effect
- Biph­oph­ates: given for osteop­orosis, protect against losing Ca, sit upright for 30 min & w/ full glass of water
- Calc­imi­met­ics (ex - Sensipar): deceive thyroid that there's enough PTH
Education:
- Medi­cation compli­ance
- Monitor for s/s of hypoca­lce­mia
- Diet
- Prevent compli­cat­ions: osteop­orosis, traumatic fractures

Diagostic Tests for Parath­yroid Problems

Labs:
- Calcium (total) = 8.5-10 mg/dL - usually high enough, ionized if specif­icity desired
- Phos­phate = 2.7-4.5 mg/dL
- Magn­esium = 1.3-2.1 mEq/L
- PTH = 10-55 picogr­ams­/mm
Hypopa­rat­hyr­oidism:
- Decrea­sed... Ca, Mg, PTH, vitamin D
- Increa­sed... phosphate
X-rays
24-hour urine collection for calcium

Parath­yro­ide­ctomy

Total or subtotal
Pre-Op:
- Get Ca in check
- Coags
Post-Op:
- Similar to thyroi­dectomy (dres­sing, emergency equip., etc.)
- Check Ca levels
- Monitor for s/s hypopa­rat­hyr­oidism
- Voice (r/t laryngeal edema) - hoar­sen­ess
- May need lifelong treatment

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Comments

harpieee harpieee, 06:07 4 Jan 19

I LOVE your cheat sheets!

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