Thyroid

Thyroid

1. Hyperthyroidism [Graves Disease]

   • Women more than men highest frequency between 20 to 40
   • Clinical Manifestations
     • Diaphoresis
     • Goiter [Bruit]
     • Bulging Eyes [exophthalmus]
       • Fat deposits and edema in orbital area *Artificial tears to reduce risk of abrasion
     • Diagnostics
       • Elevated Free T4
       • Decreased TSH
       • RAIU
         • Differentiate Graves disease (radioactive iodine uptake) In grave disease 35-95% & thyroiditis less than 2%
       • BMR
     • Acropatchy
       • Swelling of the hands & clubbing of the years (soft tissue swelling)
     • Heat intolerance
   • Interventions
     • Acute Thyrotoxicosis [Thyroid Storm]
       • Excessive T3 & T4 usually  [severe tachycardia, heart failure shock, hyperthermia,  up to 105. restlessness, irritability, seizures, abd. pain, vomiting, diarrhea, delirium, coma]
     • Thyroidectomy
       • 1) large goiter causing trqacheal compression  2) unresponsive antithyroid therapy 3) thyroid cancer  *More rapid reduction in T3 & T4 levels  [subtotal thyroidectomy is preferred] & Endoscopic thyroidectomy vs. Open 
       • Teach she will need iodine for the rest of her life
       • Swelling: oxygen, suctioning & tracheostomy tray should be readily available (Yoncher)
       • Laryngeal nerve damage
       • Stridor
         • harsh vibratory sounds or related to tetany 
       • IV calcium
       • before surgery teach to move head manually
         • semi fowler position
       • lower calories
     • Stay on brand specific Medication
       • Anti-thyroid
         • Begin to start 1-2w and good results within 4-8w
         • Propylthiouracil
         • methimazole
       • Iodine
         • used pre-thyroidectomy administered after meals  mixed with water or juice 
         • Saturated Solution of Potassium Iodine [SSKI]
         • Lugol's Solution
       • Beta Adrenergic Receptor Blockers
         • Block sympathetic Nervous System 
         • Propranolol
         • atenolol
         • Metaprolol
     • Nutrition
       • Avoid Highly seasoned & High fiber & Caeffine
       • 4000-5000cal/day
       • 1-2g/kg protein
     • Radioactive Iodine Therapy
       • Nonpregnant adults Maximum effect may not be seen up to 3m (Teach about symptoms of hypothyroidism)
       • 1tsp salt, 1tsp baking soda & 2cups of water gargle, sips of water, ice chips
   • Causes
     • Graves disease
     • Toxic Nodular Goiter
     • Thyroiditis
     • Excessive Iodine Intake
     • Pituitary Tumors & Thyroid Cancer

2. Hypothyroidism

   • Causes
     • Primary
       • Autoimmune
       • Trauma
       • Increase TSH
       • Iron deficiency
       • atrophy
         • END result in Graves disease
       • Treatment of Hyperthyroidism:
     • Secondary
       • Decrease TSH
       • Pituitary Problem
   • Clinical Manifestations
     • Fatigue, lethargy, peronsality mood changes, impaired memory, slowed speech
     • Cardiovascular decreased Contractility/output
     • Low appeptite, scaly tongue
     • Puffy face, decreased sweating, pallor
     • Myxedema coma
       • accumulation of hydrophilic mucopolysaccharrides
     • depressed/weight gain
     • diagnostics
       • Subclinical: TSH <4.5 & Normal T4
       • NTIS T3, T4 & TSH low
       • free T4 & TSH
       • EPO low
       • Cobalamin/iron/folate deficiencies
       • HIgh cholestrol & triglycerides
     • Bruise easily
   • Interventions
     • Low calorie diet
     • Levothyroxine (for life)
       • inital dose low to avoid increasing HR &amp; BP Increased O2 demand can causes angina &amp; cardiac dysrthmias (increase 4-6w intervals)
       • Keep with same brand
       • May increase need of insulin & potentiate effects of anticoagulants
     • Warm environment
     • Myexedema
       • All Thyroid replacement IV- Paralytic ileus, monitor core temp (hypothermia), cardiac monitoring, fluid I&amp;O,&nbsp;
     • Comprehension Level
     • Skin breakdown precaution
       • soap sparingly &amp; use lotion
     • Constipation