endocrine and metabolic disorders

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ENDOCRINE AND METABOLIC DISORDERS Metabolic hyperthyroidism

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Page 1: Endocrine and Metabolic Disorders

ENDOCRINE AND METABOLIC DISORDERSMetabolic hyperthyroidism

Page 2: Endocrine and Metabolic Disorders

“IT IS WHEN CONVERGENCE MEETS DEMAND AND THE CRAVING FOR LEARNING IS VERY BADLY NEEDED”

JOY JOHN DIEGO JACQIE JEFF JAYSON DOMINGO BENJO VENESSE ALVIN MARK LOUIE

Page 3: Endocrine and Metabolic Disorders

HYPERTHYROIDISM

Description: Also called Grave’s disease, Basedow’s

disease, thyrotoxicosis or exophtalmos goiter.

A metabolic imbalance resulting from excessive thyroid hormone production; Grave’s disease is the most common form.

Page 4: Endocrine and Metabolic Disorders

ETIOLOGY AND INCIDENCE:

1. Autoimmune dysfunction2. Genetic factors3. Other possible causes: thyroid tumors pituitary tumors Hypothalmic malignancies stress or infection exposure to iodine Incidence is greatest between ages 30 and

40 and is higher in women than in men

Page 5: Endocrine and Metabolic Disorders

HOW IS HYPERTHYROIDISM DIAGNOSED?

If not diagnosed shortly after birth, hyperthyroidism in the newborn can be fatal. In addition to a complete medical history and physical examination, diagnostic procedures for hyperthyroidism may include measurement of thyroid hormone in the bloodstream.

Diagnosis is based on history, physical examination, and thyroid function tests. Serum TSH is the best test, because TSH is suppressed in hyperthyroid patients except when the etiology is a TSH-secreting pituitary adenoma or pituitary resistance to thyroid hormone. Free T4 is increased. However, T4 can be falsely normal in true hyperthyroidism in patients with a severe systemic illness (similar to the falsely low levels that occur in euthyroid sick syndrome) and in T3 toxicosis. If free T4 is normal and TSH is low in a patient with subtle symptoms and signs of hyperthyroidism, then serum T3 should be measured to detect T3 toxicosis; an elevated level confirms that diagnosis.

Page 6: Endocrine and Metabolic Disorders

POSSIBLE LAB FINDINGS

Increased T4 and T3 levelsNon- detectable TSHThyroid Ultrasonography shows an enlarged thyroid gland

A thyroid scan indicates an increased uptake of radioactive iodine (RAI; 131I and 123I)

Page 7: Endocrine and Metabolic Disorders

OTHER TESTS: MEDIA FILE 1:  IODINE 123 NUCLEAR SCINTIGRAPHY: IODINE 123 SCANS OF A NORMAL THYROID GLAND (A) AND COMMON HYPERTHYROID CONDITIONS WITH ELEVATED RADIOIODINE

UPTAKE, INCLUDING GRAVES DISEASE (B), TOXIC MULTINODULAR GOITER (C), AND TOXIC ADENOMA (D).

Page 8: Endocrine and Metabolic Disorders

ANATOMY AND PHYSIOLOGY

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Page 11: Endocrine and Metabolic Disorders

WHY DOES SPONGEBOB HAVE CLAUSTROPHOBIA?

Because he is afraid of the Santa Claus!

Page 12: Endocrine and Metabolic Disorders

PATHOPHYSIOLOGY

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Page 14: Endocrine and Metabolic Disorders
Page 15: Endocrine and Metabolic Disorders

SIGNS AND SYMPTOMS

Page 16: Endocrine and Metabolic Disorders

CLINICAL MANIFESTATIONS Nervousness, irritability, hyperactivity, emotional lability, and

decreased attention span. Weakness, easy fatigability, exercise intolerance Heat intolerance Increased appetite, loses weight Insomnia, interrupted sleep Diarrhea, frequent stools Irregular or scant menses, decreased libido Warm, sweaty, flushed skin with velvety- smooth texture,

elevated body temperature Tremor, hyperkinesias, hyperreflexia Exopthalmos, retracted eye lids, staring gaze Hair loss (silky hair) Goiter Bruits over thyroid gland Tachycardia, moderate hypertension

Page 17: Endocrine and Metabolic Disorders

POSSIBLE NURSING DIAGNOSIS

Activity intoleranceHyperthermiaHigh risk for injuryAltered Nutrition: Less than Body requirements

Page 18: Endocrine and Metabolic Disorders

COMPLICATIONS

Graves ophthalmopathyGraves ophthalmopathy is more common

in women than in men. Dermopathy

. The skin changes usually include a nonpitting erythematous edema of the anterior shins.

Thyrotoxicosis/Thyroid stormHemorrhageHypocalcemia

Page 19: Endocrine and Metabolic Disorders

PREVENTION

The frequency and severity of symptoms of thyrotoxicosis vary from person to person.

Radiation exposure Recording a careful family history of

autoimmune disease, thyroid disease, and emigration from iodine-deficient areas is important.

Review a complete list of medications.

Page 20: Endocrine and Metabolic Disorders

HEALTH TEACHINGSMEDICATIONS:

Iodine: Potassium Iodide (Lugol’s Solution) saturated K iodide

Propylthiouracil and methimazole: Tapazole

β-Blockers: Propranolol (Inderal)Radioactive sodium iodine (131I, radioiodine): Radioiodine

Page 21: Endocrine and Metabolic Disorders

TREATMENT

Subtotal thyroidectomy (partial removal of the thyroid gland)

Total thyroidectomy (removal of the thyroid gland) Treatment of infiltrative dermopathy and

ophthalmopathy: In infiltrative dermopathy (in Graves' disease), topical corticosteroids sometimes relieve the pruritus. Dermopathy usually remits spontaneously after months or years. Ophthalmopathy should be treated jointly by the endocrinologist and ophthalmologist and may require corticosteroids, orbital radiation, and surgery.

Page 22: Endocrine and Metabolic Disorders

DIET

No special diet must be followed by patients with thyroid disease.

Notably, excess amounts of iodide found in some expectorants, x-ray contrast dyes, seaweed tablets, and health food supplements should be avoided because the iodide interferes with or complicates the management of both antithyroid and radioactive iodine therapies.

Page 23: Endocrine and Metabolic Disorders

ACTIVITY

Often, in otherwise healthy patients with hyperthyroidism, exercise tolerance is not affected significantly. For these people, no reduction in physical activity is necessary. For elderly patients or for those with cardiopulmonary comorbidities, a decrease in activity is prudent until hyperthyroidism is medically controlled.

Often with severe thyrotoxicosis, systolic and diastolic cardiac dysfunction manifested by dyspnea upon exertion exists.

Page 24: Endocrine and Metabolic Disorders

NURSING MANAGEMENT

The Nurse monitors Heart rate and Blood pressure

He or she records the client’s sleep pattern and daily weights

The nurse promotes rest and helps the client avoid excess physical stimulation.

Increased caloric intake can compensate for increased metabolism.

The nurse informs the client that effects of anti-thyroid therapy usually are not apparent until the thyroid gland has secreted the excess thyroid hormone into the blood stream. This process may take several weeks or more.

Page 25: Endocrine and Metabolic Disorders

NURSING CARE PLANSASSESSMENT NURSING

DXANALYSIS OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

SUBJECTIVE: “Ang takaw kopo pero

ang payat-payat ko pa rin”

OBJECTIVE: Underweight Loss of weight with

adequate food intake Poor muscle tone (+) diarrhea Hyperactive bowel

sounds noted

Nutrition imbalanced, less than body requirement r/t inability to ingest adequate nutrient AMB hypermetabolic rate

Metabolic imbalance

Excessive thyroid hormone

Increased metabolic rate

HypermetabolismLose of weight

STO: After 8 hours of nursing intervention the patient will verbalize understanding of causative factor.LTO:After 2 weeks of quality nursing care the patient will: Display

normalization of laboratory values and be free of signs of malnutrition

Demonstrate behaviors, lifestyle changes to regain and maintain appropriate weight

Assess weight, age, body built, strength, activity/rest level

Review indicated laboratory data (eg. Serum albumin)

Assist in developing individualized regimen

Provide diet modifications as indicated, for example increase caloric intake

Weigh weekly and as necessary and document result

Develop stress reduction program

Administer pharmaceutical agent like antidiarrheals

Emphasize importance of well-balanced, nutritions intake

Provide/ reinforce client teaching regarding pre-op & post-op dietary needs when surgery is planned.

Provides comparative baseline data

To check for changes in the lab result

To correct/control underlying causative factors

To/can compensate for increased metabolism

To monitor effectiveness of treatment/ effort/ dietary plan

To decrease instance of hypermetabolism

To prevent dehydration due to frequent BM

Provide info regarding individual nutritional needs & ways to meet these needs within financial constraints

To promote wellness

STO:Goals met as evidence by patient discuss/ recited about illness condition and know necessary modification and regimen.LTO:Goal partially met as evidence by the patient is under/ still in the plan of care

Page 26: Endocrine and Metabolic Disorders

ASSESSMENT NURSINGDX

ANALYSIS OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

SUBJECTIVE:“Mainit po ang aking pakiramdam ko” as verbalized by the patient

OBJECTIVE: Increased in body

temperature Flushed skin Warm to tough Increase RR Tachycardia

Hyperthermia r/t increasing metabolic rate secondary to hyperthyroidism

Metabolic imbalance

Inc. thyroid hormone

Inc. metabolic rate

Inc. heat production

hyperthermia

STO:After 8 hours of quality nursing intervention the patient will: Decrease body

temperature w/n the range of normal eg. From 38.2- 37.7 degrees C

LTO:After 2 days of nursing intervention the patient will: Maintain core

temperature w/n normal range

Monitor V/S Promote surface

cooling by means of loosen clothing

Remote tepid sponge bath

Administer medication as indicated such as

Beta blockersAntipyretics

Maintain bedrest Administer

replacement fluids and electrolytes

Provide high-calorie diet

Discuss importance of adequate fluid intake

Review specific cause such as specific cause such as underlying disease

Process such as thyroid storm

To provide comparative baseline data

Reduce body temp. by radiation and conduction

Heat loss by evaporative and conduction

To treat underlying cause for thyroid storm

To reduce body temperature

To reduce metabolic demands

To support circulating volume and tissue perfusion

To meet meet increased metabolic demands

To prevent dehydration

Indicates need for prompt intervention

STO:Goal is met as evidenced by patient know the causative of the hyperthermia. Body

decreases and reach within Normal range

LTO:Goal is met as manifested by patient temperature stay in normal

Page 27: Endocrine and Metabolic Disorders

DRUG STUDY DRUG NAME INDICATION ACTION CONTRAINDICATION SIDE

EFFECTSROUTE

AND DOSAGE

NURSING IMPLICATION

GENERIC:methimazole

BRANDNAME:tapazole

Hyperthyroidism and prior to surgery or radiotherapy of the thyroid; may be used cautiously to treat hyperthyroidism in pregnancy

Thioamide with actions and use similarto those of propyl –thiouracil but 10 times as potent-actions are less consistent, but effects appear more promptly than with propyl thiouracil. Inhibits of synthesis of thyroid hormones as the drug accumulates in the thyroid gland. Does not affect existing T3 or T4 levels.

Pregnancy (category D), lactation

GI: Hepatotoxicity(rare)Endocrine: HypothyroidismHematologic: ThrombocytopeniaMuscoskeletal: ArthralgiaCNS: Peripheral neuropathy,vertigoSkin: Rash, alopeciaUrogenital: Nephrotic Syndrome

Route: per orem

Onset: 30-40 minutes

Peak: 1hour

Duration: 2-4 hours

Lab test: Periodic blood work, since agranulocytosis is a rare, but possible adverse effect

Closely monitor PT and INR in patients

on oral anti-coagulants. An anti-coagulant activity

may be potentiated. Be aware that skin

rash or swelling of cervical lymp nodes may indicates need to discontinue drug

and change to another anti- thyroid

agent. Consult physician.

Notify physician promptly if the

following symptoms appear, bruising,

unexplained bleeding, sore throat, fever,

jaundice Do not breast feed

while using this drug.

Page 28: Endocrine and Metabolic Disorders

DRUG NAME INDICATION ACTION CONTRAINDICATION SIDE EFFECTS ROUTE AND DOSAGE

NURSING IMPLICATION

GENERIC:Propranolol HydrochlorideBRANDNAME:Inderal

Management of cardiac arrhythmias, myocardial infarction, tachyarrhythmias associated with digitalis intoxicosis, hypertropic subaortic stenosis, angina pectoris due to coronary atherosclerosis, hereditary, essential tremor.

Non selective beta-blocker of both cardiac and bronchial adrenoreceptors which competes with epinephrine and norepinephrine for available beta-receptor sites. In higher doses, exerts direct quinidine-like effect, which depresses cardiac function including contractility and arrhythmias.

Greater than first degree heart block; CHF, right ventricular failure secondary to pulmonary hypertension; cardiogenic shock

Body as a whole: fever; pharyngitis; respiratory distress, weight gain, LE-like reaction, cold extremities, leg fatigue, Urogenital: Impotence or decreased libidoSkin: Erythematous, psoriasis- like eruptions;pruritus, dry skin. AlopeciaCNS: drug- induced psychosis, sleep disturbances, depression, confusion,agitation, vertigo, syncope, weakness, drowsiness, insomniaMetabolic: Hypoglycemia, hyperglycemia hypocalcemiaRespiratory: dyspnea, laryngospasm, brochospasm.

Route: Per oremintravenous

Onset:15-20 min

Peak:3-4 hours

Duration:6-8 hours

>obtain careful medical history to rule out allergies>monitor apical pulse, RR,BP>Evaluate adequate control or dosage interval for hypertension >LAB Test: obtain periodic hematologic, kidney, liver and cardiac functions when propranolol is given for prolonged period>monitor I and O ratio and daily weighing>be aware that propranolol suppresses clinical signs of hypoglycemia>do not discontinue abruptly; can precipitate withdrawal syndrome>make position changes slowly and avoid prolonged standing> do not breast feed while taking this drug without consulting physician

Page 29: Endocrine and Metabolic Disorders

UPDATES!

Page 30: Endocrine and Metabolic Disorders

FREQUENCY

United States Graves disease is the most common form of hyperthyroidism.

Approximately 60-80% of cases of thyrotoxicosis are due to Graves disease. The annual incidence of the disease is 0.5 cases per 1000 persons during a 20-year period, with the peak occurrence in people aged 20-40 years. Toxic multinodular goiter (15-20% of thyrotoxicosis) occurs more frequently in regions of iodine deficiency. Most persons in the United States receive sufficient iodine, and the incidence of toxic multinodular goiter is less than the incidence in areas of the world with iodine deficiency. Toxic adenoma is the cause of 3-5% of cases of thyrotoxicosis.

International The incidences of Graves disease and toxic multinodular goiter

change with iodine intake. Compared to regions of the world with less iodine intake, the United States has more cases of Graves disease and fewer cases of toxic multinodular goiters.

Page 31: Endocrine and Metabolic Disorders

Race Autoimmune thyroid disease occurs with the same

frequency in Caucasians, Hispanics, and Asians, and it occurs less frequently in the black population.

Sex All thyroid diseases occur more frequently in women

than in men. Graves autoimmune disease occurs in a male-to-female ratio of 1:5-10. Toxic multinodular goiter and toxic adenomas occur more frequently in women than in men, with a ratio of 1:2-4.

Age Autoimmune thyroid diseases have a peak incidence in

people aged 20-40 years. Toxic multinodular goiters occur in patients who usually have a long history of nontoxic goiter and, therefore, usually present when they are older than 50 years. Patients with toxic adenomas present at a younger age than patients with toxic multinodular goiter.

Page 32: Endocrine and Metabolic Disorders

OTHER UPDATES:Seasonal Health News

Fatigued or Full Throttle: Is Your Thyroid to Blame?By Debra BruceReviewed by: Brunilda Nazario

Feeling all revved up, even at bedtime? Or maybe your throttle's on idle with symptoms of depression , fatigue, and weight gain. In both cases, the root cause may be your thyroid.

The thyroid -- a butterfly-shaped gland in the front of your neck -- makes hormones that control the way your body uses energy. Your thyroid controls your metabolism, which is how your body turns food into energy, and also affects your heart, muscles, bones, and cholesterol.

While thyroid disorders can range from a small, harmless goiter (enlarged gland) to life-threatening cancer, the most common thyroid problems involve an abnormal production of thyroid hormones. Too much of these vital body chemicals results in a condition known as hyperthyroidism. Too little hormone production leads to hypothyroidism.

Although the effects of thyroid problems are unpleasant or uncomfortable, most thyroid conditions can be managed well if properly diagnosed and treated.

What is an overactive thyroid? Hyperthyroidism happens when the thyroid becomes overactive and produces too much of

its hormones. Hyperthyroidism affects women five timesto 10 times more often than men, and is most common in people younger than 40. People with hyperthyroidism have problems that reflect overactivity of the organs of the body, resulting in symptoms such as sweating, feeling hot, rapid heartbeats, weight loss, and sometimes eye problems.

Page 33: Endocrine and Metabolic Disorders

Kung ikaw ay sinabihan ko na ihanda mo ang iyong bulsa (bago at pagkatapos ng board exam) para magblow-out!, maniwala ka at magkakatotoo yon!

*it is already proven from the previous batch

Page 34: Endocrine and Metabolic Disorders

To be a GREAT ONEIs You have to POSSESS ONE!

Don’t just dream,

DREAM BIG!

Page 35: Endocrine and Metabolic Disorders

WE WISH THAT EVERYONE WILL TAKE TEST OVERSEAS AND TO LIVE, WORK AND INVEST,

BUT ALWAYS REMEMBER THE SAYING:

“WHEN YOU FLY, YOU CRY”

Page 36: Endocrine and Metabolic Disorders

FIN