Cholesterol and triglycerides anemia collaborative

↑ cholesterol and triglycerides, anemia
Collaborative Care
 Restoration of euthyroid state as safely and rapidly as possible
 Low-calorie diet
 Drug therapy (education required)
 Patient/family teaching
Outcome Goals
 Experience relief of symptoms
 Maintain a euthyroid state
 Maintain a positive self-image
 Comply with lifelong thyroid replacement therapy
Thyroid Preparations
 levothyroxine (Synthroid, Levothyroid)
o Synthetic thyroid hormone
T
4
 liothyronine (Cytomel)- Synthetic thyroid hormone T
3
9

Lecture Notes
 liotrix (Thyrolar)- Synthetic thyroid hormone T
3
and T
4
combined
 Thyroid- Desiccated (dried) animal thyroid gland
Indications
 To treat all three forms of hypothyroidism
 Levothyroxine is the preferred drug because its hormonal content is
standardized; therefore, its effect is predictable
o Stay on ONE BRAND ALWAYS
 “Euthyroid” is the goal
Adverse Effects
 Cardiac dysrhythmia is the most significant adverse effect
 May also cause hyperthyroidism symptoms
o Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache,
anxiety, nausea, diarrhea, menstrual irregularities, weight loss, appetite
changes, sweating, heat intolerance, others
Patient Teaching
 Teach patient to take thyroid drugs once daily in the morning
o (on empty stomach in the morning at least 30 minutes before
breakfast)
 don’t want to take it later in the day because will stay up
 will have blood work taken initially
 Teach patient to take the medications at the same time every day and not to switch
brands without physician approval
 report any unusual symptoms, chest pain, or heart palpitations
 not to take over-the-counter medications without physician approval
 therapeutic effects may take several months to occur
 importance of alerting health care providers of thyroid medication use (wear medical
alert bracelet)
o May enhance activity of anticoagulants- Warfarin (Coumadin)- monitor
INR levels
o Diabetic patients may need increased dosages of hypoglycemic meds
o May decrease serum digoxin levels
 Monitor serum digoxin level- 0.8 to 2.0 nanograms per milliliter
Parathyroid
PTH: parathyroid hormone
 Regulates Ca 2+ and Po
4
o Increase kidney Ca 2+ reabsorption
o Increase intestinal absorption of Ca
2+
o Increase bone matrix release of Ca 2+ and Po
4
 Main effect is to maintain plasma Ca 2+ levels
Primary Hyperparathyroidism
10

Lecture Notes
 85% adenomas; F: 3:1
 increase Ca 2+ bone resorption (taking Ca+2 from bone)
o Osteopenia (weak, brittle bones)
 Bones, stones, abdominal groans, and psychic moans
 Hypertension, bradycardia, shortened QT interval
Diagnosis
 albumin levels and ionized calcium (truly reflective of free calcium levels- better
value than just total calcium)
 Ultrasound; MRI
Hypercalcimia Treatment
 Loop diuretics (Lasix) w/ hydration NSS (give fluid and
urinate out excess Ca+2)
 Calcitonin (promote calcium to be REABSORBED by
bone) and IV bisphosphonate
 Surgical removal
o risks for injury to the recurrent laryngeal nerves
o hypoparathyroidism due to resection or
devascularization of all parathyroid glands.