Specific Disorders of The Thyroid Gland
Specific Disorders of The Thyroid Gland
Specific Disorders of The Thyroid Gland
hypothyroidism
Commonly occurs in patients with previous hyperthyroidism that has been treated with radioiodine or
antithyroid medications and thyroidectomy.
THYROID DEFICIECY- affects all body functions and can be range from mild, subclinical forms to
myxedema.
2 types:
b. Central hypothyroidism- when the cause of thyroid dysfunction is failure of the pituitary gland
or the hypothalamus or both.
CAUSES:
A. AUTOIMMUNE DSE.
C. THERAPY OF HYPERTHYROIDISM
E. Radiation of the neck and head as treatment for cancers and lymphoma
Clinical manifestations:
a. Fatigue
d. Husky voice
f. Loss of libido
g. Subnormal temperature
l. ADVANCE hypothyroidism:
- Dementia
MYXEDEMA COMA
- depression
- cardiovascular collapse and shock, require aggressive and intensive supportive and
hemodynamic therapy if the patient is to survive
MEDICAL MANAGEMENT
A. PHARMACOLOGY
Desiccated thyroid- used infrequently today, because it often results in transient elevated serum
concentrations of T3, with occasional symptoms of hyperthyroidism.
Thyroid hormones
* Bone loss and osteoporosis may also occur with thyroid therapy.
B. SUPPORTIVE THERAPY
HYPERTHYROIDISM
second most prevalent endocrine disorder, after diabetes mellitus.
Graves’ disease
- results from an excessive output of thyroid hormones caused by abnormal stimulation of the
thyroid gland by circulating immunoglobulins.
- may appear after an emotional shock, stress, or an infection, but the exact significance of these
relationships is not understood.
CLINICAL MANIFESTATION
NERVOUSNESS
they suffer from palpitations and their pulse is abnormally rapid at rest as well as on exertion.
The skin is flushed continuously, with a characteristic salmon color, and is likely to be warm, soft,
and moist.
amenorrhea,
-It is soft and may pulsate; a thrill often can be palpated, and a bruit is heard over the thyroid arteries
-a decrease in serum TSH, increased free T4, and an increase in radioactive iodine uptake.
MEDICAL MANAGEMENT
-Use of radioactive iodine is the most common form of treatment for Graves’ disease.
- Beta-adrenergic blocking agents (eg, propranolol [Inderal]) are used as adjunctive therapy for
symptomatic relief, particularly in transient thyroiditis
PHARMACOLOGICAL THERAPY
1. use of irradiation by administration of the radioisotope iodine 131 (131I) for destructive effects
on the thyroid gland
2. antithyroid medications that interfere with the synthesis of thyroid hormones and other agents
that control manifestations of hyperthyroidism
- the radioactive isotope of iodine is concentrated in the thyroid gland, where it destroys thyroid
cells without jeopardizing other radiosensitive tissues.
- The patient is instructed about what to expect with this tasteless, colorless radioiodine, which
may be administered by the radiologist
thyroid storm - life-threatening condition manifested by cardiac dysrhythmias, fever, and neurologic
impairment . Propranolol (Inderal) is useful in controlling these symptoms.
After treatment with radioactive iodine, the patient is monitored closely until the euthyroid state is
reached. In 3 to 4 weeks, symptoms of hyperthyroidism subside. Close follow-up is required to evaluate
thyroid function, because the incidence of hypothyroidism after this form of treatment is very high.
Radioactive iodine has been used to treat toxic adenomas, multinodular goiter, and most varieties of
thyrotoxicosis (rarely with permanent success).
It is preferred for treating patients beyond the childbearing years who have diffuse toxic goiter.
Radioactive iodine is contraindicated during pregnancy (because it crosses the placenta) and while
breast-feeding (because it is secreted in breast milk) to prevent hypothyroidism in the fetus
ANTITHYROID MEDICATIONS
- objective :to inhibit one or more stages in thyroid hormone synthesis or hormone release.
- propylthiouracil (PTU) or methimazole (Tapazole) - used until the patient is euthyroid (ie,
neither hyperthyroid nor hypothyroid).
Patients taking antithyroid medications are instructed not to use decongestants for nasal stuffiness,
because these agents are poorly tolerated.
Another goal of therapy is to reduce the amount of thyroid tissue, with resulting decreased thyroid
hormone production.
-Surgery is reserved for special circumstances-for example, in pregnant women who are allergic to
antithyroid medications, in patients with large goiters, or in patients who are unable to take antithyroid
agents.
-Surgery for treatment of hyperthyroidism is performed soon after the thyroid function has returned
to normal (4 to 6 weeks)
-surgical removal of about five sixths of the thyroid tissue (subtotal thyroidectomy) reliably results in a
prolonged remission in most patients with exophthalmic goiter.
Its use today is reserved for patients with obstructive symptoms, for pregnant women in the second
trimester, and for patients with a need for rapid normalization of thyroid function.
PTU is administered until signs of hyperthyroidism have disappeared. A beta-adrenergic blocking agent
(eg, propranolol) may be used to reduce the heart rate and other signs and symptoms of
hyperthyroidism
Long-term use of antithyroid medications is not generally recommended for elderly patients.
THYROIDITIS
-inflammation of the thyroid gland, can be acute, subacute, or chronic
3 TYPES:
A. Acute thyroiditis -rare disorder caused by infection of the thyroid gland. Staphylococcus aureus
and other staphylococci are the most common causes
- causes anterior neck pain and swelling, fever, dysphagia, and dysphonia.
- Examination may reveal warmth, erythema (redness), and tenderness of the thyroid gland.
- Treatment : antimicrobial agents and fluid replacement. Surgical incision and drainage may be
needed if an abscess is present
- The thyroid enlarges symmetrically and may be painful. The overlying skin is often reddened and
warm
C. Chronic thyroiditis-occurs most frequently in women between the ages of 30 and 50 years, has been
termed Hashimoto’s disease
-not accompanied by pain, pressure symptoms, or fever, and thyroid activity usually is normal or low
rather than increased
-If untreated, the disease runs a slow, progressive course, leading eventually to hypothyroidism
-objective : to reduce the size of the thyroid gland and prevent hypothyroidism.
-Thyroid hormone therapy is prescribed to reduce thyroid activity and the production of thyroglobulin
THYROID CANCER
Cancer of the thyroid is much less prevalent than other forms of cancer; however, it accounts for 90%
of endocrine malignancies
External radiation of the head, neck, or chest in infancy and childhood increases the risk of thyroid
carcinoma
-Lesions that are single, hard, and fixed on palpation or associated with cervical lymphadenopathy
-Thyroid function tests may be helpful in evaluating thyroid nodules and masses
Needle biopsy -Used as an outpatient procedure to make a diagnosis of thyroid cancer, to differentiate
cancerous thyroid nodules from noncancerous nodules, and to stage the cancer if detected.
ultrasound,
MRI,
CT,
thyroid scans,
MEDICAL MANAGEMENT:
- Modified neck dissection or more extensive radical neck dissection if there is lymph node
involvement.
- After surgery, thyroid hormone is administered in suppressive doses to lower the levels of TSH to
a euthyroid state
The patient who receives external sources of radiation therapy is at risk for mucositis, dryness of the
mouth, dysphagia, redness of the skin, anorexia, and fatigue
Postoperatively, the patient is instructed to take exogenous thyroid hormone to prevent hypothyroidism.
Total-body scans are performed 2 to 4 months after surgery to detect residual thyroid tissue or
metastatic disease
A repeat scan is performed 1 year after the initial surgery. If measurements are stable, a final scan is
obtained in 3 to 5 years
Free T4, TSH, and serum calcium and phosphorus levels are monitored
NURSING MANAGEMENT
- Important preoperative goals are to gain the patient’s confidence and reduce anxiety
1. instructs the patient about the importance of eating a diet high in carbohydrates and proteins. A high
daily caloric intake is necessary
3. informs the patient about the purpose of preoperative tests, if they are to be performed, and explains
what preoperative preparations to expect
4. Preoperative teaching includes demonstrating to the patient how to support the neck with the hands
after surgery to prevent stress on the incision.
1. The nurse periodically assesses the surgical dressings and reinforces them if necessary.
2. monitoring the pulse and blood pressure for any indication of internal bleeding, it is important to
be alert for complaints of a sensation of pressure or fullness at the incision site.
4. intensity of pain is assessed, and analgesic agents are administered as prescribed for pain.
5. anticipate apprehension in the patient and inform the patient that oxygen will assist breathing.
6.When moving and turning the patient, the nurse carefully supports the patient’s head and avoids
tension on the sutures.
7 .The most comfortable position is the semi-Fowler’s position, with the head elevated and supported
by pillows.
8. IV fluids are administered during the immediate postoperative period. Water may be given by mouth
as soon as nausea subside
9. The patient is advised to talk as little as possible to reduce edema to the vocal cords
11. Monitoring and Managing Potential Complications such as Hemorrhage, hematoma formation,
edema of the glottis, and injury to the recurrent laryngeal nerve
TETANY- blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and
feet and muscle twitching.