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↑ cholesterol and triglycerides, anemiaCollaborative CareRestoration of euthyroid state as safely and rapidly as possibleLow-calorie dietDrug therapy (education required) Patient/family teachingOutcome GoalsExperience relief of symptomsMaintain a euthyroid stateMaintain a positive self-imageComply with lifelong thyroid replacement therapyThyroid Preparationslevothyroxine (Synthroid, Levothyroid)oSynthetic thyroid hormone T4liothyronine (Cytomel)- Synthetic thyroid hormone T39
Lecture Notes liotrix (Thyrolar)- Synthetic thyroid hormone T3and T4combinedThyroid- Desiccated (dried) animal thyroid glandIndicationsTo treat all three forms of hypothyroidismLevothyroxine is the preferred drug because its hormonal content is standardized;therefore, its effect is predictableoStay on ONE BRAND ALWAYS “Euthyroid” is the goalAdverse EffectsCardiac dysrhythmia is the most significant adverse effectMay also cause hyperthyroidism symptoms oTachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, appetite changes, sweating, heat intolerance, othersPatient TeachingTeach patient to take thyroid drugs once daily in the morningo(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 approvalreport any unusual symptoms, chest pain, or heart palpitationsnot to take over-the-counter medications without physician approvaltherapeutic effects may take several months to occurimportance of alerting health care providers of thyroid medication use (wear medical alert bracelet)oMay enhance activity of anticoagulants- Warfarin (Coumadin)- monitor INR levels oDiabetic patients may need increased dosages of hypoglycemic meds oMay decrease serum digoxin levelsMonitor serum digoxin level- 0.8 to 2.0 nanograms per milliliterParathyroid PTH: parathyroid hormoneRegulates Ca2+and Po4oIncrease kidney Ca2+reabsorptionoIncrease intestinal absorption of Ca2+oIncrease bone matrix release of Ca2+and Po4Main effect is to maintain plasma Ca2+levelsPrimary Hyperparathyroidism10
Lecture Notes 85% adenomas; F: 3:1increase Ca2+bone resorption (taking Ca+2 from bone) oOsteopenia (weak, brittle bones) Bones, stones, abdominal groans, and psychic moansHypertension, bradycardia, shortened QT intervalDiagnosis albumin levels and ionized calcium (truly reflective of free calcium levels- better value than just total calcium) Ultrasound; MRIHypercalcimia TreatmentLoop diuretics (Lasix) w/ hydration NSS (give fluid andurinate out excess Ca+2)Calcitonin (promote calcium to be REABSORBED bybone) and IV bisphosphonate Surgical removalorisks for injury to the recurrent laryngeal nerves ohypoparathyroidism due to resection ordevascularization of all parathyroid glands.