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ENDOCRINE 1. Thyroid Problems a. The thyroid produces THREE hormones i. T3 ii. T4 iii. Calcitonin b.

You need IODINE to makes these hormones (T3,T4, calcitonin). [this is dietary iodine] c. Thyroid hormones gives us energy A. HYPERthyroid *TOO much energy* {aka Graves Disease} S/S for hyperthyroid: ii. Subjective: 1. Nervous 2. Irritable 3. Sweaty/hot 4. Decreased attention span 5. Increased appetite (eat more but lose weight) 6. Weight (decreased) iii. Objective: 1. Exophthalmus (bulging eyes) 2. Enlarged thyroid normally, you shouldnt be able to palpate but you might ATM 3. GI (fast) 4. Increased BP *if you drew a serum T4 level on this patient, it would in INCREASED. DX for hyperthyroid: i. Thyroid scan (looking for enlargement of the thyroid) a. Pt must d/c any iodine containing meds 1 wk prior to thyroid scan Txt for hyperthyroid: i. Antithyroids: a. Propacil Prop/a/cil b. PTU c. Tapazole Tap/a/zole * These stops the thyroid from making THs * We want pt to become euthyroid (eu=normal) * These meds have to be tapered and d/c if not, can take from hyper to hypo

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ii. Iodine Compounds: a. SSKI (potassium iodide) b. Lugols solution (strong iodine solution) *decrease the size and the vascularity of the glands *REMEMBER: ALL endocrine glands are VERY vascular!!!! *give in 1) milk, 2) juice & 3) use straws (meaning it can strain teeth) Txt for hyperthyroid: iv. Beta Blockers: (-olol endings) a. Inderal (Ind/e/ral) propanolol i. Decrease myocardial contractility ii. Decreases HR, BP iii. Could decrease cardiac output RULE: DO NOT GIVE BETA BLOCKERS TO ASTHMATICS OR DIABETICS *diabetics/s of hypoglecemia are increased HR, nervous, shaking, etc when taking beta blocker, these signs are masked.NOT GOOD* Txt for hyperthyroid: v. radioactive iodine (one dose): a. Given PO (liquid or tablet form) i. r/o pregnancy first b. destroys thyroid cells hypothyroid pt c. follow radioactive precautions: i. stay away from BABIES for 24 hrs ii. dont KISS anyone for 24 hrs d. watch for thyroid storm i. thyroid storms, thyrotoxicosis (thyr/o/toxic/o/sis), thyrotoxic (thyr/o/toxic) crisis are the SAME ii. it is hyperthyroid X 100 COULD BE A rebound effect POST-RADIOACTIVE IODINE

TXT FOR HYPERTHYROID CONT..

Txt for hyperthyroid: vi. Surgery: thyroidectomy (partial/complete) 1. post op treatment: a. teach how to support neckif lifting up, interlock finger behind neck; no tension on suture line b. positionelevate hob c. check for bleedingcheck behind neck b/c pooling will occur there d. nutrition (pre & post-op) need extra calories e. assess for recurrent laryngeal nerve damage (by listening for hoarseness) i. could be to vocal cord paralysis; if there is paralysis for both cords airway, obstruction will occur requiring immed trach a. Unilateral laryngeal nerve damage= voice changes including HOARSENESS b. Bilateral laryngeal nerve damage = breathing difficulties & aphonia (inability to speak)

ii. trach set at bedside 1. hypocalcemiacan occur b/c parathyroid can be taken away 2. swelling 3. reccurent laryngeal nerve damage iii. teach pt to report any c/o pressure iv. assess for parathyroid removal EYE CARE is important for pt w/ HYPERthyroid If pt cant close eyelids, hypoallergenic tape may be applied to close lid (to prevent injury or irritation) Dark glasses may be worn if photosensitivity is present Artificial tears are used to prevent drying of the eyes Txt of hyperthyroidism DOES NOT correct any eye or vision problems

B. HYPOthyroid (myxedema my/x/edema) *no energy *present at birthcalled CRETINISM very dangerous, can lead to slowed mental & physical development if undetected S/S of hypothyroid: 1. 2. 3. 4. 5. 6. no expression fatigue slow or slurred speech cold weight gain slow GI YOU MAY BE TAKING CARE OF A TOTALLY IMMOBILE PT TXT for Hypothyroid: 1. 2. 3. 4. 5. 6. Synthroid (syn/throid) [levothyroxine] Proloid [thyroglobulin thyro/globulin] Cytomel [liothyronine --- i/o/thyro/nine] Yeswill have to take these meds FOREVER Energy level will INCREASE after taking these meds People with hypothyroidism tend to have coronary heart dx

Previously: Endocrine thyroid problems: o hyperthyroid, hypothyroid parathyroid problems: