Endocrine disorder hypothyroidism

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  1. Hormones
    • secreted cyclically
    • minute amounts
    • deactivated by the liver/excreted by the kidney
    • - so if these don't work we have a problem
  2. Hypothalamus
    • top of the chain
    • link between the CNS and endocrine
    • releasing and inhibiting hormones
  3. Pituitary Gland
    • middle management
    • anterior pituary
    • produces and secretes hormones to target glands
    • located at the base of the brain and connected to the hypothalmus
    • Target tissues
    • - thyroid
    • - parathyroid
    • - adrenal
  4. Thyroid Gland
    METABOLISM
    • in neck just below the cricoid cartilage
    • H butterfly shape
    • largest endocrine gland
    • highly vascular
  5. Thyroid hormones
    • Metabolism:
    • - Thyroxine - T4
    • - triiodothyroxine- T3
    • Ca levels
    • - thyrocalcitonin (TCT)
    • works on negative feedback
  6. Thyroid hormones
    • Thyroxine (T4) and Triiodothyroxine (T3)
    • - metabolism
    • - CHO, protein, Fat metabolism
    • - cell replication, tissue growth
    • - brain development- (protein synth)
    • - thermogenesis
    • - resistance to infection
    • - serum cholesterol level
  7. Thyroid hormones
    TCT
    • Thycalcitonin
    • - lowers plasma Ca and elevates phosphate
    • - when the body has too much Ca this hormone is released.
  8. Thyroid disorders
    • Hypothyroid
    • hyperthyroid
    • Goiter- enlarged thyroid- can be caused by both
  9. hypothyroidism
    • can effect all body systems
    • risk:
    • more common in women than men
    • genetic disposition- ?
    • inc incidence between- 40-70 yo
  10. Hypothyroidism
    Primary 95%
    • in the gland itself- problem with gland
    • atrophy** - due to aging (primary cause)
    • autoimmune (Hashimoto's)- attacks thyroid itself causing < T3, T4
    • congential
    • iodine insufficiency- not usually in the US
    • antithyroid drugs (lithium)- for bipolar
    • surgery/radiation for hyperthyroidism (in neck)
  11. Hypothyroidism
    secondary
    tertiary
    • secondary- pitutary malfunction TSH
    • tertiary (central)- hypothalamus malfunction (TRH)- top of the chain
  12. Hypothyroidism
    Patho
    • iodine necessary for thyroid gland to synthesize and secrete its hormes T3 and T4
    • with insufficient iodine, error in feedback mechanism and/or suppressed TH
    • gland can hypertrophy in compensation (goiter)
    • need iodine to produce T3 or T4
  13. Goiter
    worry about airway
  14. Hypothyroidism 2
    • decrease in TH leads to slowed metabolism
    • - dec HCl in stomach
    • - dec GI motility
    • - bradycardia, dec cardiac contractility, increa trig/chol- atheroscerosis- incr risk for HTN
    • - slow neuro function?
    • decr heat production- cold intolerance
    • anemia- dec in erythopoten- RBC
  15. Hypothyroidism
    manifestation
    • mild, asymptomatic or vague- very individual
    • fatigue, lethargy
    • dry skin, brittle nails, hair loss
    • symptoms of dec metabolism
    • - weight gain
    • - muscle weakness
    • -- d/t altered protein metabolism
    • chx in memory, speech, flat affect
    • sensitive to opioids
  16. Myxedema
    • missing thyroid hormone- undx
    • seen in times of stress
    • complication of hypothyroidism
    • - significant lack of TH
    • s/s dry, waxy type of swelling with abnormal mucopolysaccharide deposits in skin and other tissues
    • - nonpitting edema - pretibial, facial
    • early prevention and tx
    • untx associated with atherosclerosis- greater risk for HTN
  17. diagnostic testing
    • **most sensitive test- TSH- incre (body making too much)
    • - decre T3, T4
    • - decre T3U- has much hormones is bound to protein
    • - decr RAIU (I 131)- Inc TH- dec bind empty (not enough to bind too)- scanning radioisotype iodine?
    • - incr chol- hyperlipidemia
    • - dec HCT- anemia
    • - inc TRH
  18. dx test cont
    • Thyroid scan- size
    • US
    • CT, MRI
    • biopsy- malignancy
  19. Goals and management
    • correct TH deficiency
    • reverse manifestations
    • prevent further damage
    • correct underlying cause- improve iodine intake(if r/t iodine)
    • thyroid hormone replacement
    • - synthroid (levothyroxine)- most pt on this is r/t aging
  20. Levothyroxine
    • T4 converts to t3
    • dosage is based on TSH
    • s/e incr metabolism
    • NI- slow onset, peak in 1-3 weeks
    • - assess HR, incr cardiac demand (tachy, chest pain discomfort)
    • - best on empty stomach
    • - multiple drug interaction ie warafin
    • - life long
    • titrate up slowly watch the heart rate
  21. nursing interventions
    hypothyroidism
    • low cal diet w/incre fiber and H20
    • temperature regulation-
    • adjust insulin (thyroid may inc BS), careful use of sedatives/narcotics
    • skin care/risk of infection
    • constipation
    • cardiac assessment (esp when u start synthroid), activity intolerance
    • - assess hr, palpitations, edema
    • teaching with these pt- simple instructions, teach back, handouts d/t their memory problem ans issue was concentrating
    • memory, depression, concentration
  22. Simple goiter
    • thyroid enlargement
    • cause: excess TSH, inadequate iodine, 'goitrogens". immunoglobulins
    • - goitrogens- cabbage, peanuts, peaches, strawberries, thyroid inhibitors like lithium- drugs and food that block thyroid
    • manifestations- hoarness, dysphagia, and enlarged thyroid
    • AIRWAY
  23. Dx goiter
  24. TSH
    • T4 t3
    • thyroid antibodies0 immunoglubins attack thyroid gland
    • US
  25. simple goiter
    management
    • goal: stop enlargement, encourage regression
    • thryoid hormone- synthroid
    • incr iodine intake dec goitrogens intake
    • subtotal thyroidectomy
    • never palpate an enlarged thyroid- remember it is vascular can cause a rapid release of TH into the blood stream
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319202
Card Set
Endocrine disorder hypothyroidism
Description
thyroid etc
Updated
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