1. 3 Primary thyroid hormones
    and their actions.
    • T3 ~Triiodothyronine
    • T4~ Thyroxine
    • Thyrocalcitonin
    • Actions:
    • Controls metabolic rate of all cells
    • Regulates protein, carbohydrate and fat metabolism
    • Increase red blood cell formation
    • Affects growth and development of all cells
    • Acts as an insulin antagonist
    • Increases bone formation and resorption
    • Cand be thought of as a check/balance for the pancreas.
  2. Four Steps of Thyroid hormone synthesis.
    • Active transport of iodide into thyroid
    • Oxidation of iodide into iodine
    • Iodine incorporated into thyrosine
    • Thyroid hormones released by proteolytic enzymes
  3. Thyroid Function Test
    • Serum T4 Test: Measures total thyroxine; for screening and monitoring replacement therapy
    • Serum T3 Test: Measures total Triiodothyronine; Tests for hyperthyroidism and monitoring therapy
    • Serum TSH: Most sensitive method for diagnosing hypothyroidism
  4. Terms for hypothyroidism
    • Mild deficiency: Hypothyroidism
    • Severe Deficiency: Myxedema
    • Cretinism: Hypothyroidism in infants
  5. Hypothyroid SnSs
    • Face: Pale, puffy and expressionless
    • Skin: Cold and dry
    • Hair: brittle
    • HR and T: lowered
    • Lethargy and fatigue
    • Intolerance to cold
    • Slowed mentality
    • Enlarged thyroid
  6. Causes of Hypothyroidism
    • Autoimmune thyroiditis (Hashimoto’s Disease)
    • Surgical removal of thyroid
    • Destruction of thyroid by radioactive iodine
    • Insufficient secretion of TSH and TRH
  7. Levothryroxine (T3)
    • Converts to T4
    • Highly protein bound (eat on empty stomach)
    • Half-life 7 days
    • Adverse effects:
    • Tachycardia: might be getting too much
    • Angina: might be getting too much
    • Tremors: might be getting too much
    • Nursing Implications
    • Teach pt that Rx will not get to therapeutic level for ~ 1 month.
    • Check apical pulse prior to administration
    • Withhold if pulse above 100
    • Report chest pain
    • Administer early in am to prevent insomnia
    • Caffeine will also inhibit absorption.
    • Don't want to take generic equivilant if you've already started with name brand.
  8. Hyperthyroid general info
    • AKA Graves Disease: Most Common, especially in females
    • Toxic Nodular Goiter (Plummer’s Disease): Result of Thyroid adenoma
    • Thyrotoxic Crisis (Thyroid Storm): Occurs when thyroid hormone levels are extremely high
  9. SnSs of Hyperthyroid
    • HR: strong and rapid with possible dysrhythmias, angina, and tachycardia.
    • CNS effects
    • --Rapid speech
    • --Nervousness
    • --Insomnia
    • Exophthalmos (bug-eyed): good teaching point.
    • Muscle weakness and atrophy
    • Metabolic rate is raised with increased T4
    • Intolerance to heat
    • Warm, moist skin
    • Increased appetite with weight loss
  10. Propylthiouracil (PTU)
    • Inhibits thyroid hormone synthesis
    • Short half-life
    • Adverse Effects
    • --Agranulocytosis: destruction of wbcs (Within first 2 months of therapy)
    • --Hypothyroidism (Occurs with excessive dosing)
    • Neonatal hypothyroidism
    • --Crosses the placenta
    • --Enters breast milk
  11. Radioactive Iodine I 131
    • Most typical treatment
    • Radioactive isotope
    • Emits gamma and beta rays--> destruction of thyroid tissue.
    • Half-life 8 days
    • Candidates Generally not for those under 30 years of age
    • Action
    • Produces clinical remission with destruction of thyroid gland
  12. Thyrotoxic Crisis
    • Occurs with extreme levels of thyroid hormone
    • Symptoms
    • Hyperthermia (105 or higher! Will occure immediately postop. Take full set of vitals!)
    • Severe tachycardia
    • Profound weakness
    • Unconsciousness
    • Heart failure
  13. Treatment of Thyroid Crisis
    • Propylthiouracil
    • Suppress synthesis and conversion of T4 to T3
    • Propranolol (beta blocker--> decreased HR)
    • High doses of Potassium iodide
    • Sedation
    • Cooling
    • Glucocorticoids
    • IVF’s
Card Set
Thyroid/Endocrine drugs