State the cause of Hyperthyroidism
Anything that increases levels of circulating thyroid hormone (TH) - its all about energy
List risk factors for Hyperthyroidism
- Women age 30 to 40
- Family History
What is Primary Thyrotoxicosis?
- Not caused by elsewhere
- Too much of a good thing
- Graves Dx
- Toxic multinodular goiter
- Follicular thyroid cancer (rare)
List clinical manifestations for Hyperthyroidism
- Reflects Increased Basal Metabolic Rate
- CV- tachycardia, palpitations, angina, chest pain
- Neuro- hyperactive reflexes, sleeplessness, nervousness
- GI- Inc appetite with wt loss, inc gastric motility, diarrhea
- Heat intolerance
- Eye syndrome- exophthalamos (tissue buildup behind orbit)
- Dec or absent menses
- Inc thyroid hormone levels
What is the pathophysiology of Graves Dx?
- Thyroid antibodies (autoimmune)
- Rate of onset: slow insedious
- Multisystem syndrome
What does Graves Dx result in?
- Inc thyroid hormone (TH) levels
- Inc iodide uptake
- Inc rate of thyroid gland metabolism leads to goiter
What characteristics must be present to have Graves Dx?
- Hyperthyroidism- test serum level
What is a Thyrotoxic Crisis (Thyroid Storm)?
- Stressors (infection or lung/ heart disorders)
- Dead in 48 hours
- Huge outflow of thyroid hormone
List manifestations of Thyrotoxic Crisis
- Think catecholamines- epinephrine (fight or flight)
- Agitation or delirium
- Heart failure
What is the prototype drug for Antithyroid agents?
State MOA of propylthiouracil (PTU)
Blocks hormone synthesis by inhibiting conversion of T4 to T3 in peripheral circulation
What is the therapeutic use of propylthiouracil (PTU)?
Restore euthyroid (nml levels- not too high or too low) and metabolic levels
State the MOA of Radioactive Iodine (131I)- tx for hyperthyroidism
Localized radiation effect, slowing thyroid production
State mode of delivery for Radioactive iodine (131I)
Capsule or solution
List Nsg implications of Radioactive iodine (131I)
- Localized radiation therapy- safe to be around, gone in 2-3 days
- Lugol solution is a strong iodine solution with K+ that protects thyroid to some extent, it slows it down w/o knocking it down
What is the cause of hypothyroidism?
- Anthing that decreases levels of circulating thyroid hormone (TH)
- Ex. Hashimoto's thyroiditis or overtreatment of hyperthyroidism
List risk factors for Hypothyroidism
- More common in aging people
Describe S&S of Hypothyroidism
- Opposite of hyperthyroidism (or no energy)
- Bradycardia, dyspnea, low energy, constipation, dry hair and skin, cold, inc menses, depressed, no energy
List major S&S of Congenital Hypothyroidism (Cretinism)
- Neuro- floppy, dull appearing facial features, hypotonia, hoarse sounding cry
- Integumentary- dry, brittle hair, and low hairline
- Musculoskeletal- thick, protruding tongue, large fontanelles, broad and short
- GI- poor feeding, choking episodes, constipation
What is Hashimoto Thyroiditis?
- Aka Hashimoto dx or lymphocytic thyroiditis
- Autoimmune disorder
- all about size not fxn!
- Inflammation/ Destruction
List clinical manifestations of Hashimoto Thyroiditis
- Enlarged thyroid gland
- Sx typical of hypothyroidism (hypoactive goiter)
What is Myxedema (Hypothyroid Crisis)?
- Severe or prolonged thyroid deficiency
- A crisis level lack of metabolism that can kill
- pts in infurmed condition- nsg home, chronic illness
What is the clinical presentation for Myxedema?
- Altered mental state
- "myxedema coma" from too little energy
- Cold intolerance
List clinical presentations of severe Myxedema
- Cardiovascular collapse
- Lactic acidosis
State the natural and synthetic drugs for Thyroid agents
- Natural- Thyroid (Armour thyroid)
- Synthetic- Levothyroxine (Synthroid) synthetic T4
What is the MOA for thyroid agents?
Exogenous replacement of thyroid hormone to achieve euthyroid levels and normalize metabolism
What are the indications and contraindications of Levothyroxine Na (Sythyroid)?
- Indications: Hypothyroidism
- Contra: CHD (do not overwork the heart) and allergy
List SE and Interactions for Levothyroxine Na (Synthyroid)
- SE: associated with overdose
- Oral anticoagulants
- Cholestyramine (antilipemic agent)- binds to thyroid hormone in GI track- dec absortion of thyroid
List pt teaching for Synthyroid
- Take in AM, on empty stomach, at least 30 minutes before eating (to give you energy)
- S&S of hypo and hyperthyroidism
List monitoring for levothyroxine (Synthyroid)
- Relief of symptoms of hypothyroidism
- Absence of symptoms of hyperthyroidism
- Labs of Serum TSH and T4 levels
What are the major post pituitary problems?
- Syndrome of inappropriate Antidiuretic hormone secretion (SIADH)
- Diabetes Insipidus (DI)
What are the problems of Anterior Pituitary gland?
- High levels of antidiuretic hormone (ADH) in absence of nml physiologic stimuli for its release
- (high levels w/o reason to be there)
List common causes for SIADH
- Ectopically produces ADH - adenocarcinomas
- Transient SIADH- post-pituitary surgery
List Sx of Hyponatremia
- Dyspnea (movement of fluid)
- Dulled sensorium, confusion, lethargy
- Muscle twitching, convulsions
- Impaired taste, anorexia, vomitting, cramps
- Severe (100-115): irreversible damage, coma, death
What is the prototype drug for Demeclocycline?
What is the classification and drug use of Demeclocycline?
- Tetracycline broad-spectrum antibiotic
- Antibiotic therapy
- Treatment of persistent SIADH
What is the MOA of Demeclocycline (Declomycin)?
Interferes with renal response to ADH
Define Diabetes Insipidus
- Inability to concentrate urine due to insufficiency of ADH
- Body water floods out- causing dilute urine
What does DI do to neurogenic (central)?
- Causes head trauma, brain death
- sudden onset
What does DI do to nephrogenic (renal)?
- Causes CRF, lithium, water based urine
- Slow onset
List clinical manifestations for DI
- Polyuria and polydipsia
- Dec urine specific gravity and osmolality (like water)
- Serum osmolality concentrated in body
What is the prototype drug for Neurogenic DI?
- Desmopressin (DDAVP)
- aka Vasopressin
What is the MOA of Desmopressin (DDAVP)?
Synthetic ADH, replacement therapy
What is the delivery mode for Desmopressin?
What are the common SE of Desmopressin?
None, except for nasal
What are the nsg implications for Desmopressin?
Monitor and baseline data- serum and urine osmolality, and fluid balance/ weight (I&O)
What is the client teaching for Desmopressin?
- Careful adjustment of water intake w/ tx to avoid water intoxication and dilutional hyponatremia (do not overload)
- Missed dose? Take now, do not double
- Tolerance possible
- Nasal may be irritating
What drug is given for nephrogenic DI?
What is HCTZ therapy used for?
- Paradoxical effect in DI (dec polyuria, inc osmolality)- reverses Sx
- MOA unknown
- Taken with K+ sparing diuretic
What is Addison's Dx?
- Primary adrenocortical insufficiency
- Dx of adrenal cortex
- Results in loss or lack of cortisol hormones
- Idiopathic, autoimmune, or other
- Can result in permanent gland damage
What does Addison's Dx cause a decrease in?
Discuss early clinical manifestations of Addison's Dx
- Results from sodium and water problems
- Slow degenerative destruction w/ rapid onset
- Anorexia, wt loss
- Weakness, malaise, apathy
- Electrolyte imbalances
- Skin hyperpigmentation (very tan appearance)
What causes Addisonian (Adrenal) Crisis?
- Sudden insufficiency of serum corticosteroids from...
- sudden loss of adrenal gland
- sudden increase in stres in chronic condition
- sudden cessation of corticosteroid drug therapy
What are the Sx of Addisonian (Adrenal) Crisis?
- Sudden penetrating pain in the lower back, abdomen, or legs
- Severe vomitting and diarrhea
- Low BP
- Loss of conciousness- coma (severe sodium/ water balance)
What is the drug therapy for Addison's Dx?
- Replace those deficient hormones
- Cortisol- hydrocortizone (Cortef) 1-2 x/day
- Aldosterone- mineralocorticoid (fludrocortisone- Florinef) and inc salt intake
What are Nsg Implications for Addison's Dx?
- Closely follow Rx dosing schedule
- Never abruptly stop therapy
- Replacement therapy is lifelong (chronic dx)
- Dosage will need to be inc during stress- 3x3 (3 times dose for 3 days)
- Always maintain emergency supply
- Wear Medic Alert bracelet
How do you treat Addisonian Crisis and why?
- IV- hydrocortisone, saline, and dextrose (replace what is lost)
- B/c PO- dec hydrocortisone and aldosterone until achieved over days