AH Exam 3 AH3 notes.pdf - CH. 58 Care of Patient with...

CH. 58 Care of Patient with Problems of the Thyroid and Parathyroid Glands:
Hyperthyroidism- Excessive thyroid hormone secretion
It can be temporary or permanent, depending on the cause.
- Symptoms called thyrotoxicosis’. Increases metabolism in all body organs
o S/S: finger clubbing, diarrhea, amenorrhea, Heat intolerance , straight hair,
bulging eyes, facial flushing, tachycardia, systolic BP, Breast enlargement, Weight
loss, localized edema, fever, nausea, tremors, confusion
o Assessment: heat intolerance, increased appetite, increase in BM, increased HR,
dyspnea without exertion, manic behavior, hyperglycemia, amenorrhea
 Graves’ disease “toxic diffuse goiter”: most common form.
Autoantibodies form a ‘goiter’ which overproduces thyroid hormones
 Women 20-40 years old (sex-linked). Nodules, tumors’ goiter
form. Not all patients with goiters have hyperthyroidism.
o Associated with disorders such as diabetes mellitus,
vitiligo, and rheumatoid arthritis and occurs in twins
 S/S are the same as hyperthyroidism, including exophthalmos,
pretibial myxedema (dry, waxy swelling of the front surfaces of
the lower legs resembling tumors)
o Wide-eyed or startled look is due to edema in the
extraocular muscles and increased fatty tissue behind the
eye, which pushes the eyeball forward and may cause
problems with focusing. Pressure on the optic nerve will
impair vision
o Eye retraction (eyelid lag)- upper eyelid fails to descend
when pt. gazes slowly downward
o Globe lag- upper eyelid pulls back faster than eyeball when
pt. gazes upward
o Labs: T3 (70-205 ng/dL), T4 (4-12 mcg/dL), TSH (>1.5 mcg/dL) (elevated). TSH is
low in Graves’ disease
 ECG
 RAIU (radioactive iodine uptake)- increased in hyperthyroidism and can
be used to identify active thyroid nodules
 thyroid scan- evaluates position, size, and function of the thyroid
 ultrasound- can determine the size and the general composition of any
nodules
 TRAbs= test for Graves’ disease
o Drug therapy: reduces the effect on cardiac function and decreases hormone
secretion
 Anti-thyroid drugs- initial treatment for hyperthyroidism
 Preferred drugs are: thionamides like methimazole (tapazole)
o These drugs block thyroid hormone production by
preventing iodine binding in the thyroid. Response of
these drugs is delayed
 iodine preparations- short-term therapy before surgery usually.
EVERYTHING is
increased (HR,
BP, RR, manic
behavior)
Heat intolerance
is hallmark sign

 Decrease BF through the thyroid gland. Improvement usually
occurs within two weeks. Can result in hypothyroidism
 used to decrease thyroid size and vascularity, thereby reducing
the risk for hemorrhage and the potential for thyroid storm during
surgery
 Radioactive iodine therapy (RAI)- is not used in pregnant women because
it can cross the placenta and damage the fetal thyroid gland.