MED. SURG. STUDY GUIDE – TEST 3 LATEST PAPER 2021/2022
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Course
UNRS 212
Institution
UNRS 212
E. Thyroid disorders: hypo/ hyper, medications, labs, and treatments – Surgery,
radioactive iodine.
Thyroid gland
o Principal actions
Stimulation of energy use
Stimulation of the heart
Promotion of growth and development
Thyroid gland is all about metabolism
o Hormones...
med surg study guide – test 3 latest paper 20212022
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MED. SURG. STUDY GUIDE – TEST 3
E. Thyroid disorders: hypo/ hyper, medications, labs, and treatments – Surgery,
radioactive iodine.
Thyroid gland
o Principal actions te
Stimulation of energy use
Stimulation of the heart
Promotion of growth and development
Thyroid gland is all about metabolism
o Hormones secreted
T – 4 thyroxine
T – 3 triiodothyronine
T3, t4 influence heart and increased levels can causes palpitaions
Calcitonin
Works with the parathyroid gland to manage calcium levels
Iodine is necessary for production of thyroid hormones
Low iodine in diet can result in hypertrophy of gland – simple
goiter
o The goiter itself doesn’t tell if the patient has hyper or
hypothyroidism
Physiological Role of the Thyroid Hormones
They have a diffuse effect and do not seem to have any specific
target organ
o Negative Biofeedback controls the thyroid system
When too much of the hormone is present, biofeedback slows down the
release
When too little, the release is sped up
There are 3 levels of Neg. biofeedback
When T3, T4 are low:
o 1. Hypothalamus recognizes low levels, releases TRH
o 2. TRH stimulates the anterior pituitary gland to release
TSH
o 3. TSH stimulates the thyroid gland to increase production
of T3, T4
When T3, T4 are high:
o 1. Hypothalamus recognizes high levels, stops or slows
down release of TRH
o 2. Anterior pituitary will then stop/slow down release of
TSH
o 3. Thyroid will then stop/ slow down release of T3, T4
Hypothyroidism
o Not enough production/release of T3, T4
o Slow metabolic rate
o More common in women than men
o Deficiency of thyroid hormone causes:
Myxedema: face swelling
,MED. SURG. STUDY GUIDE – TEST 3
Cretinism
Occurs in children and can lead to mental growth deficiencies
o Pathology
Primary hypothyroidism
Caused by destruction of thyroid tissue or defective hormone
synthesis
Most common cause in U.S is atrophy pf thyroid gland
o Atrophy occur after autoimmune disease such and
hyperthyroidism like graves and hasimoto
Secondary hypothyroidism
Caused by pituitary or hypothalamic dysfunction (↓ TSH or TRH)
o Etiology
Iodine deficiency – most common cause worldwide
Atrophy of the gland
Treatment for hyperthyroidism
Drugs
amiodarone (Cordarone) (which contains iodine) and lithium
(which blocks hormone production)
Cretinism if occurs in infancy
Caused by thyroid hormone deficiencies during fetal or early
neonatal life.
All infants in the United States are screened for decreased thyroid
function at birth.
o Clinical Manifestations
Regardless of the cause, hypothyroidism has systemic effects
characterized by a slowing of body processes.
Manifestations vary depending on the severity and the duration of thyroid
deficiency, as well as the patient’s age at the onset of the deficiency.
The onset of symptoms may occur over months to years unless
hypothyroidism occurs after a thyroidectomy, thyroid ablation, or during
treatment with anti-thyroid drugs.
Cardiovascular system
↓ Cardiac contractility and output
Angina, heart failure, myocardial infarction
Anemia
o Erythropoietin levels may be low or normal. Because the
metabolic rate is lower, oxygen demand is reduced.
Cobalamin, iron, folate deficiencies
o May cause patient to bruise easily
↑ Serum cholesterol and triglycerides
o Can cause coronary atherosclerosis
Respiratory system
Low exercise tolerance
Shortness of breath on exertion
Myxedema
,MED. SURG. STUDY GUIDE – TEST 3
o Physical swelling of skin and subcutaneous tissue
o This edema causes puffiness, facial and periorbital edema,
and a masklike affect.
o Individuals with hypothyroidism may describe an altered
self-image related to their disabilities and altered
appearance.
o Myxedema coma – Medical emergency
Impaired consciousness or come
Precipitated by infection, drugs, cold, trauma
Characteristics are subnormal temperature,
hypotension, hypoventilation
Cardiovascular collapse
results from hypoventilation, hyponatremia,
hypoglycemia, and lactic acidosis
Treat with IV thyroid hormone
o Medications and Treatment
Replacement therapy
Levothyroxine (T4)(Synthroid): Highly protein bound, drug of
choice
o Each different strength of the medication is represented by
a specific color of pill
o Half-life 7 days
o Uses
All forms of hypothyroidism
o When thyroid hormone therapy is initiated, it is important
that the initial dosages are low to avoid increases in resting
heart rate and blood pressure.
o Interactions: Coumadin, Insulin, Digoxin
o Pharmacokinetics: Best taken on empty stomach
o Adverse effects
Tachycardia
Angina
Tremors
o Must use caution
Overdosing can occur if the dose is too high
Symptoms would be similar to
hyperthyroidism
Underdosing can also occur if not enough med
Symptoms would be similar to
hyperthyroidism
Liothyronine (T3)(Cytomel
o Labs
Low T –3, T-4
High TSH with primary
, MED. SURG. STUDY GUIDE – TEST 3
Production of T3 and T4 decreased due to gland problem /
damage
o Body tries to correct low level by sending out more TSH
but gland doesn’t work properly
These labs could also indicate dose of med (like not enough
medication)
Low TSH with Secondary
Low because damage to either pituitary or hypothalamus
o NO TSH released so thyroid cannot be stimulated to
release T3 or T4
Constant blood test, every couple of months, are required to monitor
levels of T3 and T4 to ensure the current dose is still effective
If not, the dose can be increased or decreased
o Nursing Management
Compliance is essential and life-long
Each patient will have their one personalized and individual dosing
strength
Patient shouldn’t switch the brand of medication
Caution with elderly – need frequent with labs
Elderly have a decreased metabolism; the levels of T3/T3 may
start to rise too high. The dosage may need to be decreased
Hyperthyroidism
o Excess production/release of T3, T4
o A sustained increase in synthesis and release of thyroid hormones by thyroid
gland
Occurs more often in women
Highest frequency between ages 20 to 40 years
o Types
Graves’ disease (Most Common Form)
Excessive thyroid hormone secretion
Etiology - unknown
o In Graves’ disease the patient develops antibodies to the
TSH receptor.
o These antibodies attach to the receptors and stimulate the
thyroid gland to release T3, T4, or both.
o The excessive release of thyroid hormones leads to the
clinical manifestations associated with thyrotoxicosis.
o The disease is characterized by remissions and
exacerbations with or without treatment.
o It may progress to destruction of the thyroid tissue,
causing hypothyroidism.
Pathology
o Autoimmune disease
Diffuse thyroid enlargement
Excessive thyroid hormone secretion
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