Thyroid Disorders

Our lessons take you step-by-step into knowing/memorizing the details frequently tested on the NCLEX. Imagine taking a lesson like this one for every disease/disorder/nursing foundamental that you must know for the NCLEX.  You will be an expert on hypothyroidism and hyperthyroidism after this lesson.  

Hypothyroidism

Think Low/Slow Metabolism. Low & Slow

Weight Gain
Fatigue & Depression
Cold Intolerance
↓ HR ↓ BP ↓ Temp ↓ Breathing
Thinning hair
Dry Skin
Fertility Issues
Irregular Menses

Pay Attention to Symptoms

Vital Signs

Low HR, BP, RR, and Temp. Everything is LOW & SLOW

Metabolism

Low appetite but gaining weight. Low metabolism.  Slow GI (Constipation)

Energy

Low mood/sex drive. Low mind/memory. Low interest/Apathy

Physical

Hair loss/Brittle nails. Puffy face. Myxedema (swelling). Intolerance to cold. Slow mentruation

Labs & Treatment

Anterior pituitary increases secretion of TSH (Thyroid-Stimulating Hormone) when it senses that the thyroid is making low levels of T3 & T4. In hypothyroidism, TSH is high and T3 &T4 are low. T3 & T4 are the two main hormones secreted by the thyroid gland to control metabolism.  The treatment is Levothyroxine (Synthroid).

High TSH
Low T3 & Low T4
Synthroid

A thyroid hormone replacement

stomach, anatomy, human body-310730.jpg
Give Synthroid on empty stomach in the morning

Mnemonic

Treatment

  • Levothyroxine (hormone replacement)
  • Side effects of Levothyroxine: Think the opposite of hypothyroidism (yes, hyperthyroidism). Tachycardia, restlessness, & insomnia.
  • Life-long treatment
  • Must take in the morning and on an empty stomach to ↑ absorption.
  • Do not give narcotics to these patients due to hypersensitivity
  • Maintain a warm environment

Complication: Myxedema Coma

Severe hypothyroidism leading to ↓ mental status, hypothermia, and other symptoms related to slowing of metabolism and organ function.  Myxedema refers to the non-pitting edema (especially of the face and eyes). Precipitating factors: Surgery, hypothermia, narcotics, anesthesia & abruptly stopping thyroid medication.

Hyperthyroidism

Think High/Fast Metabolism. High & Fast

Weight Loss
Nervousness & Irritability
Heat Intolerance
↑ HR & ↑ BP ↑ Temp ↑ Respirations
Sweating
↑ Appetite
Diarrhea
Goiter

Pay attention to symptoms

Vital Signs

↑ Temp

↑ BP

↑ Pulse

Palpitations

Heat Intolerance

Physical Signs

↑ Metabolism

Hot & sweaty

Exophthalmos

Irritable

Nervousness 

Insomnia

Tremors

GI Symptoms

↑ Appetite

Losing weight

Diarrhea

Eyes

Exophthalmos

Big protruding

Eyes

Patch eyes

to protect them

Labs & Treatment

Anterior pituitary decreases secretion of TSH (Thyroid-Stimulating Hormone) when it senses that the thyroid is making high levels of T3 & T4. In hyperthyroidism, TSH is high and T3 &T4 are low. T3 & T4 are the two main hormones secreted by the thyroid gland to control metabolism.  The treatment for hyperthyroidism is Propylthiouracil and Methimazole.

Low TSH
High T3 & T4
PTU & Methimazole
Side effect: Agranulocytosis

Monitor for infection

Agranulocytosis and aplastic anemia are side effects of Methimazole and PTU.  PTU can be used in pregnancy. Avoid aspirin because it increases thyroid hormone. NCLEX Alert!

Methimazole

Cannot be used in first trimester. Use only in second trimester.  Take at the same time every day. Avoid foods high in iodine. Avoid aspirin because it increases thyroid hormone. Side effects: Agranulocytosis and aplastic anemia

PTU

Propylthiauracil: Only anti-thyroid medication that can be used in first trimester of pregnancy.  Take at the same time. Avoid foods high in iodine. Avoid Aspirin.  Side effects: Agranulocytosis and aplastic anemia.

Beta Blockers

To decrease heart rate and blood pressure. It is the treatment for palpitations

Iodine Therapy

Side effects: taste changes and swollen salivary glands. Takes 1 to 3 months to work. Client must continue to take antithyroid medication while it starts to work.  Client secretions are radioactive for a few days and must avoid close contact with others.

Thyroidectomy with life-long thyroid replacement

Thyroidectomy = Surgical Treatment

Thyroidectomy

Watch for thyroid storm after thyroidectomy because excessive T3 & T4 enters the bloodstream, causing severe hypertension, tachycardia, and elevated temperature

Hypocalcemia

Parathyroid is close to thyroid. It may have been damaged during surgery.

Laryngeal Nerve

Ask client to speak to check for laryngeal nerve damage after thyroidectomy

Respiratory Status

Swelling and hemorrhage can obstruct airway. Listen for stridor and have the tracheostomy tray at the bedside after thyroidectomy (PRIORITY)

Mnemonic

Provide these clients with a calm, quiet, and cool environment.  A client with hyperthyroidism should avoid eating excessive amounts of iodine-rich foods such as iodized salt, fish, and shellfish.  

Complication: Thyroid Storm

All the symptoms of hyperthyroidism are exaggerated. Serious tachycardia and hypertension.

Is it Hypothyroidism or Hyperthyroidism?

Is it Hypothyroidism or Hyperthyroidism?

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