Thyroid and Parathyroid Glands

NUR 111

Functions of the Thyroid

Pg. 1450

Metabolic rate

Regulate protein, carbs and fat metabolism

Increase RBC production

Inc bone formation, decrease bone resorption of Ca+

Regulation of Metabolism

Hormones T3 & T4 increase BMR

Secretion controlled by hypothalamic-pituitary-thyroid gland axis

TRH » TSH » T3 & T4 (neg feedback)

Protein and Iodine very important for T3 & T4 production

Calcium and Phosphorus Balance

Calcitonin (thyrocalcitonin, or TCT)

Reduces bone resorption, lowers serum Ca+

Low serum Ca+ suppress TCT:

Elevated serum Ca+ trigger TCT

Causes of Hyperthyroidism

Pg. 1482

Graves’ disease (Autoimmune)

Toxic multinodular goiter

Thyroid adenoma (benign tumor)

Pituitary hyperthyroidism

Excessive use of thyroid hormone

Goiter and Exophthalmos in Graves' Disease

Hyperthyroidism

More common in women

Lab assessment p.1485: T3, T4

TSH (Graves’)

Thyroid Scan (RAIU) = increased

Nursing Diagnosis

Depends on condition of client Possible Dx. IncludeImbalanced nutrition: > body

requirementsFatigueAnxiety If large goiter present: what is priority???

Interventions

Nonsurgical: monitor V/S, rest, cool environment

Medications: PTU (propylthiouracil), SSKI, beta blockers

Radioactive Iodine Therapy

Remember eye care

Interventions

Surgical: total or subtotal thyroidectomy

Preop = antithyroid meds, SSKI

Postop = very important Monitor for Bleeding, respiratory

distress, tetany, weak voice, thyroid storm (p.1487)

Causes of Hypothyroidism

Pg. 1489

Removal or destruction of thyroid

Autoimmune (Hashimoto’s Disease)

Iodine deficiency

Medications (ex.Lithium)

Hypothyroidism

More common in womenLab assessment: T3, T4

TSH

Monitor for depression

Nursing Diagnosis

Decreased cardiac output

Ineffective breathing pattern

Altered thought process

Constipation

Interventions

Levothyroxine sodium (Synthroid)

Avoid sedatives & narcotics

Monitor vital signs

Monitor for S&S of hyperthyroidism

Family teaching re: mental status

Myxedema Coma

Hypothyroid CrisisHypothyroid Crisis --> rare but serious

Etiology:Etiology: acute illness/ trauma * rapid withdrawal of thyroid meds.* rapid withdrawal of thyroid meds. use of sedatives / narcotics surgery exposure to cold

Myxedema Coma

temp / BP

Na+

blood glucose

Lactic acidosis

Coma

Collaborative Nursing Care

IVF

Airway

IV:SynthroidGlucose

Warming blanket

Thyroiditis

Acute– Bacterial

Pain Temp. Malaise Dysphagia

– TX Antibiotics

Subacute– Viral

Temp. Chills Pain in jaw

and/or ear– TX

ASA and steroids

Thyroid Cancer

Painless nodule in thyroid

Treatment :RAISurgery

Parathyroid Glands:

4 in number

can be removed w/ thyroid during surgery

Parathyroid secretes: Parathyroid hormone (PTH)

REMEMBER :

Thyroid -> Calcitonin -> decreases serum calcium

PTH - increases serum calcium

Major Role: Regulate blood levels of calcium and phosphate

PTH acts on: GI tract Kidney Bones

If serum CA PTH secretion

PTH - activates Vit. D --Increase calcium absorption from g.i. tract

Parathyroid Glands:

Remember:Thyroid also Remember:Thyroid also secretes Calcitoninsecretes Calcitonin

Calcitonin helps-->keep Ca in bonesmaintain balance of Ca and PhosphorusCalcium -- 8.8 - 10.5Calcium -- 8.8 - 10.5 Phosphorus - 3 - 4.5Phosphorus - 3 - 4.5

HyperparathyroidismPathophysiology

PTH secretion = Ca+ PhPhosos increased reabsorption of calcium by

kidneys =increased excretion of Phosphateincreased excretion of PhosphateCausesCauses

tumorstumorshyperplasia of parathyroid glandhyperplasia of parathyroid gland

Data Collection :

PTH renal calculi nephrocalcinosis bone decalcification

serum Ca GI: anorexia, N&V, epigastric pain, constipation, M/S: fatigue & lethargy [serum Ca] > 12 mg/dl = mental status

Complications:Complications:

Renal Failure

Fractures

Collapse of vertebra

Collaborative Management : focuses to decrease serum calcium

Diuretic & Fluid Therapy Lasix /0.9% Na Cl

Drug therapy Phosphates Calcitonin -miacalin spray Skel. Release Renal clearance

Calcium Chelators - binds with Ca. -< dec. Levels of free calcium

Parathyroidectomy

Nursing Interventions :

Diuretic & Fluid Rx: Monitor:

cardiac function I & O renal status serum Ca

Calcium Chelator Rx: Monitor:

LFT, BUN & Creatinine, CBC

Post - op careParathyroidectomy

Same as thyroidectomy

Monitor for *** Tetany *** Tetany continuous spasm spasm of hands / feet --->

convulsionsconvulsionscalcium levelsCalcium supplements ( Tums, Oscal )Maintain airway

PathophysiologyHypoparathyroidism

PTH

Etiology (rare) thyroid / thyroid /

parathyroid parathyroid surgerysurgery

HypomagnesemiaHypomagnesemia IdiopathicIdiopathic

Data CollectionHypoparathyroidism

TetanyTetany CheckCheck :

• Chvostek’sChvostek’s• Trousseau’sTrousseau’s• tinglingtingling• severe muscle crampingsevere muscle cramping• irritabilityirritability

Collaborative management of care

IV calcium gluconate

Oscal

Vitamin D

High Calcium diet

Magnesium IM or IV