THYROID DISRORDERS - often occurs in the postpartum period and is thought to
be an autoimmune process.  Women > Men (4:1)
THYROIDITIS
Definition
- Inflammation of the thyroid glands
Forms
 Acute suppurative
- a rare disorder caused by infection of the thyroid gland
by bacteria, fungi, mycobacteria, or parasites
- Staphylococcus aureus and other staphylococci are the
most common causes.
- Infection typically causes anterior neck pain and swelling,
fever, dysphagia, and dysphonia. Pharyngitis or
pharyngeal pain is often present. Examination may reveal
warmth, erythema (redness), and tenderness of the
thyroid gland.
- treatment includes antimicrobial agents and fluid
replacement. Surgical incision and drainage may be
needed if an abscess is present.
- activity and the production of thyroglobulin.
 Subacute granulomatous
- presents as a painful swelling in the anterior neck that
lasts 1 to 2 months and then disappears spontaneously
without residual effect.
- often follows a respiratory infection.
- thyroid enlarges symmetrically and may be painful. The
overlying skin is often reddened and warm. Swallowing
may be difficult and uncomfortable. Irritability,
nervousness, insomnia, and weight loss—manifestations
of hyperthyroidism—are common, and many patients
experience chills and fever as well.
- pharmacologic agents used are NSAIDs, aspirin, beta-
adrenergic blocker, antithyroid hormones and
corticosteroids
 Subacute lymphocytic
- also called painless thyroiditis
Incidence
- Symptoms of hyperthyroidism or hypothyroidism are  30 – 60 years of age
possible.  More than 95% - primary form
- Treatment is directed at symptoms
- Etiology
 Chronic (Hashimoto’s disease)  Primary Hypothyroidism
- also called chronic lymphocytic thyroditis  Cretinism
- most common form of thyroiditis  Defective hormone synthesis
- has an autoimmune basis and genetic predisposition may  Iodine deficiency
play role to its causation  Antithyroid drugs
- usually not accompanied by pain, pressure symptoms, or  Surgery or radioactive therapy for hyperthyroidism
fever, and thyroid activity is usually normal or low rather  Chronic inflammatory diseases (Hashimoto’s disease,
than increased. amyloidisis, sarcoidisis)
- If untreated, the disease runs a slow, progressive course,
leading eventually to hypothyroidism.  Secondary Hypothyroidism
- May lead to respiratory distress and dysphagia because  Pituitary dysfunction
of painless, asymmetrical enlargement of the gland  Peripheral resistance to thyroid hormone
- Thyroid hormone therapy is prescribed to reduce thyroid
 Tertiary Hypothyroidism
- If hypothyroid symptoms are present, thyroid hormone  Hypothalamic dysfunction
therapy is prescribed. Surgery may be required if
pressure symptoms persist.  Simple Goiter – enlargement of thyroid due to iodine
- insufficiency
HYPOTHYROIDISM  Endemic Goiter – geographic
Definition  Sporadic Goiter– genetic defect, ingestion of large amounts
 Hypothyroidism – deficiency of thyroid hormone resulting in of nutritional goitrogens, and ingestion of medical goitrogens
slowed body metabolism due to decreased oxygen consumption
by the tissues and pronounced personality changes. Risk Factors
 Myxedema – complication of hypothyroidism characterized by a  Endemic Goiter
generalized metabolic state
 Myxedema Coma – life-threatening situation in which all body Clinical Manifestation
systems are severely compromised by the hypometabolic state Cardiovascular: HR + SV= CO ; possible hypertension
Hematologic: anemia
Respiratory: dyspnea, respiratory muscle weakness,
Renal: fluid retention
Gastrointestinal: decrease motility, achlorhydria
Musculoskeletal: muscle cramps and weakness, transient pain, slow Medical Management: Nursing Management
movements Hypothyroidism. NURSING DIAGNOSES:
Integumentary: dry coarse scaly skin, hair fall and brittle nails, Thyroid Hormone: replacement therapy for hypothyroidism  Altered nutrition: less than body requirements r/t slowed
periorbital edema, thick puffy skin in face and pretibial areas, cold Prototype: LEVOTHYROXINE SODIUM (Levothroid, Synthroid) metabolic rate
intolerance  Uses: to treat hypothyroidism, myxedema and cretinism  Activity intolerance r/t weakness and apathy secondary to
Endocrine: normal to enlarged thyroid  Action: increases levels of T4 and T3 thus increasing metabolic rate decrease metabolic rate
Neurologic: decrease DTR, fatigue, somnolence, apathy, depression, of tissues, oxygen consumption and body growth  Constipation r/t decrease peristalsis secondary to slowed
slow deliberate speech, impaired short-term memory, lethargy  S/E: irritability, insomnia, nausea, vomiting, diarrhea, cramps, metabolic rate and activity intolerance
Reproductive: decrease libido, menorrhagia, irregular menses, tremors, nervousness, headache, weight loss  High risk for impaired skin integrity r/t edema and dryness
anovulation, impotence  Adverse Reactions: tachycardia, hypertension, palpitations, secondary to infiltration of fluid into interstitial spaces
Other: Myxedema thyroid crisi, cardiovascular collapse, dysrhythmias  Hypothermia r/t slowed metabolic rate
 Contraindication: thyrotoxicosis, MI, severe renal disease  Social isolation r/t lethargy, weakness, apathy and change in
 MYXEDEMA  Caution in: cardiovascular disease, hypertension, angina pectoris appearance
 Dry, waxy type of swelling with abnormal deposits of mucin in  Nursing Considerations:  High risk for decreased cardiac output r/t sustained
the skin and other tissues  Monitor VS especially pulse, RR and BP bradycardia, edema and decreased urine output
 Edema is nonpitting type and common in facial and pretibial  Encourage client to take drug at the same time each day,  Knowledge deficit r/t pharmacologic and nutrition care
areas preferably before breakfast. Food will hamper absorption rate. NURSING INTERVENTIONS:
 Instruct client to report signs of hyperthyroidism.  Careful history taking
 MYXEDEMA COMA  Do not change brands.  Modifying activity
 Drastic decrease in the metabolic rate  Avoid foods that can inhibit thyroid secretion.  Monitoring physical status
 Hypoventilation leading to respiratory acidosis Other Thyroid Hormones include:  Promoting physical comfort
 Hypothermia  LIOTHYRONINE (Cytomel) – synthetic T3  Providing emotional support
 Hypotension  LIOTRIX (Euthroid, Thyrolar) – mixture of levothyroxine  Promote self-care
sodium and liothyronine sodium in a 4:1 ratio
Laboratory Findings HYPERTHYROIDISM
TRH: increased Myxedema Coma. Definition
TSH: increased  Administer oxygen  Hyperthyroidism – excessive secretion of thyroid hormone
Serum T4: normal-low  IV fluids  Thyrotoxicosis – refers to clinical manifestations that occur
Serum T3: normal-low  Sodium levothyroxine IV with glucose and corticosteroids when the body tissues are stimulated by increase thyroid hormone
Free T4: decreased  Graves’ disease - most common type of hyperthyroidism, results
Free T3: (not used) Surgical Management from an excessive output of thyroid hormones caused by
RAUI: decreased  Thyroidectomy if goiter is very large, not responding to abnormal stimulation of the thyroid gland by circulating
 Hypercholesterorlemia, hyperlipidemia, hyperproteinemia, dilutional treatment or putting too much pressure on other structures in immunoglobulins.
hyponatremia, elevated creatine phosphokinase, aspartate the neck
aminotransferase and LDH (Thyroidectomy discussed on Hyperthyroidism) Incidence
 Women > Men (4:1)
 20 – 40 years of age
Etiology Other Thyroid Hormones include:
 overfunctioning of entire gland Medical Management  LUGOL’S SOLUTION
 single or multiple functioning adenomas of thyroid cancer Antithyroid Hormone:
 overtreatment of myxedema with thyroid hormone Prototype: PROPYLTHIOURACIL (PTU) Beta-adrenergic Blokers
 thyroiditis  Uses: to treat hyperthyroidism - Adjunctive therapy to control activity of sympathetic nervous
 excessive ingestion of thyroid hormone  Action: inhibits synthesis of thyroid hormone system
 S/E: nausea, vomiting, diarrhea, loss of taste, dizziness,
GRAVES’ DISEASE drowsiness Radioiodine Therapy (131I)
THREE HALLMARKS:  Adverse Reactions: agranulocytosis Uses: to treat hyperthyroidism
1. hyperthyroidism  Contraindication: hypersensitivity  Action: destroys thyroid tissue
2. thyroid gland enlargement (goiter)  Caution in: bone marrow depression  S/E: feeling of fullness in neck, metallic tatse, hypothyroidism
3. exophthalmos  Nursing Considerations:  Nursing Considerations:
 Monitor CBC  Stop all antithyroid medications one week before I
131

Clinical Manifestations  Advise client to take drug with food. administration.

Cardiovascular: HR + SV= CO ; palpitations, rapid bounding  Instruct client to report signs of hypothyroidism.  Give on empty stomach.
pulse, possible CHF,  Assess for signs of infection.  Monitor thyroid function closely.
Respiratory: respiratory rate and depth, SOB  Emphasize the importance of drug compliance.  Institute radiation precautions on body secretions 3 days after
Renal: fluid retention Other Thyroid Hormones include: ingestion.
Gastrointestinal: increase motility, increase GI secretions  METHIMAZOLE (Tapazole) – has longer half-life than PTU
Musculoskeletal: muscle weakness, fatigue, malnutrition, tremors Surgical Management
Integumentary: flushed moist warm skin, fine soft straight hair, Iodine: THYROIDECTOMY
profuse sweating, heat intolerance Prototype: SATURATED SOLUTION OF POTASSIUM IODIDE or SSKI - Surgical removal of thyroid either total or partial
Endocrine: usually enlarged thyroid, bruit over thyroid (Iostat, Pima, Thyro-block)  Total Thyroidectomy
Neurologic: increase DTR, nervousness, restlessness, anxiety,  Uses: to treat hyperthyroidism, adjunct therapy before - total removal of thyroid gland
increased SNS activity thyroidectomy  Subtotal Thyroidectomy
Reproductive: decrease libido, amenorrhea, irregular menses,  Action: rapidly inhibits thyroid hormone synthesis and release, - partial removal of thyroid gland (5/6 of the gland)
impotence decrease vascularity of thyroid gland Nursing Considerations:
Other: exophthalmos  S/E: nausea, vomiting, hypothyroidism, irregular heartbeat Preoperative:
Adverse Reactions: hypersensitivity, iodine poisoning  The client must be euthyroid.
Laboratory Findings  Contraindication: hypersensitivity  The client must be adequately rested, at optimal weight and
TRH: decreased  Caution in: tuberculosis, impaired renal and cardiac function in good health.
TSH: decreased  Nursing Considerations:  Answer questions, and allow time for the client to verbalize
Serum T4: increased  Monitor potassium levels. concerns.
Serum T3: increased  Advise client to take drug after meals with fruit juice, water or  NPO at least 6 hours preop.
Free T4: High normal-increased milk. Postoperative:
Free T3: increased  Restrict iodine rich foods.  Provide comfort measures: Administer analgesic pain
RAUI: increased  Emphasize the importance of drug compliance. medications as ordered, and monitor their effectiveness;
 place the client in a semi-Fowler’s position after recovery
from anesthesia; support head and neck with pillows.
 WOF for signs of hemorrhage, respiratory distresss, laryngeal
nerve damage, thyroid storm and tetany.

Nursing Management
NURSING DIAGNOSIS:
 Imbalanced nutrition, less than body requirements, r/t
exaggerated metabolic rate, excessive appetite, and
increased gastrointestinal activity
 Ineffective coping related to irritability, hyperexcitability,
apprehension, and emotional instability
 Low self-esteem related to changes in appearance, excessive
appetite, and weight loss
 Altered body temperature

NURSING INTERVENTIONS:
 Provide adequate rest
 Provide non – stimulating, quiet and cool environment
 Provide high calorie diet
 Promote safety
 Protect eyes, if exophthalmos is present