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12882725-Endocrine

12882725-Endocrine - Thyroid Disorders...

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Thyroid Disorders Thyroid Disorders HYPERTHYROIDISM HYPERTHYROIDISM (GRAVE’S DISEASE) (GRAVE’S DISEASE) Result from an excessive output of thyroid hormones caused by abnormal stimulation of thyroid gland by circulating immunoglobulin. Affects women 8x more frequently than men.
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HYPERTHYROIDISM HYPERTHYROIDISM (GRAVE’S (GRAVE’S DISEASE) DISEASE) Signs and Symptoms: Signs and Symptoms: irritability and apprehension palpitation poor heat tolerance (heat intolerance) flushed skin (salmon color), warm, soft and moist skin dry skin & diffuse pruritus ( in elderly ) increase appetite muscular fatigue & weakness increase systolic BP, sinus tachycardia, dysrrhythmias exopthalmos Accumulation of fluids, mucopolysaccharides at the fat-pads behind the eyeballs, pushing the eyeballs forward
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Pathophysiology: Abnormal stimulation of the thyroid gland Excessive circulating TH hypermetabolism Increase cardiac stimulation Increase cardiac output, palpitations Grave’s disease exopthalmos Increase appetite, easy fatigability, weight loss Increase sensitivity to catecholamines and neurotransmitters Nervousness, hyperexcitability, irritable and apprehensive Heart failure
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Pharmacotherapy Beta – blockers : Propranolol These drugs are given to control tachycardia and HPN Iodides : Lugol’s solution SSKI (Saturated Solution of Potassium Iodide) Are given to inhibit release of thyroid hormone Mix with fruit juice with ice or glass of water to improve its palatability Provide drinking straw to prevent permanent staining of teeth Side effects Allergic reaction, Increased salivation, colds
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Pharmacotherapy Thioamides- PTU and Methimazole PTU (Propylthiouracil) & Tapazole (Methimazole) These are given to inhibit synthesis of thyroid hormones Side effects of PTU AGRANULOCYTOSIS / NEUTROPENIA This is manifested by unexplained Fever, Sore throat, Skin rashes The nurse must elicit these symptoms and if present, the physician must be alerted.
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Pharmacotherapy Ca – channel blockers For fever, Paracetamol is given. Aspirin must be avoided because it can displace the T3/T4 from the albumin in the plasma causing increased manifestations. Dexamethasone Inhibit the action of thyroid hormones. Steroids are given to prevent the conversion of T4 to T3 in the peripheral tissues
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Radiation therapy Radiation therapy ( Iodine131) Isolation for few days; body secretions are radioactive contaminated. This is NOT recommended in pregnant women because of potential teratogenic effects. Pregnancy should be delayed for 6 months after therapy.
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Surgery Subtotal Thyroidectomy – Usually about 5/6 of the gland is removed Pre-op Care Promote euthyroid state Control of thyroid disturbance Stable VS Administer Iodides as ordered To reduce the size & vascularity of thyroid gland, thereby prevent post-op hemorrhage and thyroid crisis ECG Heart failure / cardiac damage results from HPN / tachycardia.
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