HYper and Hypo TG

8/11/2019 HYper and Hypo TG

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Objectives:

Students will be able to explain the topic.Students will be able to understand what

it is all about.

Students will be able to differentiate thetopics.

Students will be able to give care to the

patient with that kind of problem.


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The Thyroid Gland

- A butterflyshaped

organ located in thelower neck, anterior to

the trachea

- About 5 cm long and 3cm wide- A highly

vascularize gland (5x >

liver)- This reflects the high

metabolic activity of

the thyroid gland

- This produces 3 hormones:

THYROXINE (T4)

TRIIODOTHYRONINE (T3)

THYROCALCITONIN


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Hyperthyroidism


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-Hyper functioning of the TG-Hyper Secretion of TH

increase levels of T3 and T4. leading increase toBasal metabolism


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CAUSES


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-Autoimmune(graves Dse)

-thyroiditis

-tumor

-infxn-irritates cell leading to increasesecreation of cell

-Radiation-same as infxn


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SIGN AND SYMPTOMS


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WEIGHT LOSS


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HEAT INTOLERANCE OR FEELING WARM


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TACHYCARDIA


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HYPERTENSION


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LOSS OF STRENGTH


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DIAPHORESIS


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EXOPTHALMUS (irreversible)


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Diarrhea ( hyper motility )


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EX. Fear and Irritability


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Thyroid strom

-life threathening all symptoms

become severe.

Complication


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Diagnosis

-Thyroid gland enlarge-T3 & T4 elevated

-RAIU higher than 30%


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Nursing intervention


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1.Must monitor V/S

2.Rest in a quiet room no stressors or stimulus, and to

preserve the clients energy

3.Administer anti thyroid

-methemazole and PTU given with food to preventgastric distress,can cause agranulucytosis or decrease in

production of WBC. Check for any sign of fever, if he has,give paracetamol not aspirin because it convert globulininto thyroid globulin that will increase the secreation of TH.

4.Administer iodine preparation

(lugolssolution) inhibits the synthesis of thyroid hormones


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5.Administer propanolol, for thetachycardia and the HPN

6.DIET

Provide HIGH Caloric and high protein diet

To compensate for the lost enegy

7.Manage Diarrhea with LOW fiber DIET

Cause fiber is bulk forming which mayjust make it worse.


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NOTE: DO NOT MASSAGE PTs THYROID, IT

MAY LEAD TO OVERSECRETION OF TH


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SURGERY AND Treatment

Thyroidectomy- removal of the TG,

1.total- entire TGlarge T that impedes air to the lungs

2.subtotal- a part of the TG will be removed

incision

PRE-OPobtain VS and WT.

Assess for electrolyte levels, glucose levels and T3/T4levels

Teach to support the neck while moving to preventdisruption of the Suture LINE


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Post op

Pxn-semifowlers

Neck in midline only.What to bring?

Tracheostomy set, O2 tank, suction machine and Calciumgluconate to compensate for broncho or laryngo

Check for sign of bleeding, check at nape of the pt.

Assess for hoarseness of voice,acute larygeal nervedamage, instruct the PT to say AHHHHH..usallydone 4-5 days after surgery

Monitor sign of hypocalcemia


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Hypothyroidism


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Hypothyroidism

-Hypo functioning of the TG

-Hypo Secretion of TH

Decrease levels of T3 and T4. leading decreaseto Basal metabolism


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Causes

Autoimmune(hashimotosDse)

Iodine Deficiency-decrease synthesation of

TH

congenital Radiation therapy

Pituitary Dso

Thyroid surgery


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Sign and symptoms


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Lethargy & fatigue


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Cold intolerance


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Weight gain


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Bradycardia


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Dry hair and skin, with hair loss


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Menstrual irregularities


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Generalized puffiness and edema around the

eyes and face


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constipation


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Diagnoses

-low levels of serum T3 &T4

-serum cholesterol level elevated

-RAIU lower than 5%


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Nursing intervention


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1.Monitor VS, especially HR, may lead to coma

2.Administer meds: levothyroxine.best given in

the morning.

3.DIET is LOW calorie,cholesterol and fat.

4.Provide warm environmentexposure to coldmay cause myxedema coma.

5.Manage constipation appropriately. Give high

fiber diet.


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Avoid!

Sedatives

Anesthetics

Narcotics

Stress must be minimizeInfxn

Exposure to extreme cold may lead to

myxedema coma


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TO MAKE A LONG STORY SHORT

Disorders of the


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Disorders of the

THRYROID GLAND

1. Hyperthyrodism

- hypersecretion of thyroidhormone

- common cause is Graves

Dse. (toxic diffuse goiter)

- S/SX

EVERYTHING IS

High

Fast

2. Hypothyroidism

- hyposecretion ofthyroid hormone

- common cause is hashimotosDse.

- MYXEDEMA (adult)

- CRETINISM (child)

- S/SX

EVERYTHING IS

Low

Slow

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HYper and Hypo TG