Thyroid Gland Disorders

Thyriod Gland Disorder
Thyroid Gland Disorders
V.THYROID GLAND DISORDERS
 
A. Hypothyroidism
 
1. Description
a. Hypothyroid state resulting from hyposecretion of thyroid
hormones T3 and T4.
b. Characterized by a decreased rate of body metabolism

2. Assessment
 
a. Lethargy and fatigue
b. Weakness, muscle aches, paresthesias
c. Intolerance to cold
d. Weight gain
e. Dry skin and hair and loss of body hair
f. Bradycardia
g. Constipation
h. Generalized puffiness and edema around theveyes and face
(myxedema)
i. Forgetfulness and loss of memory
j. Menstrual disturbances
k. Cardiac enlargement, tendency to developbcongestive heart
failure
l. Goiter may or may not be present.
3. Interventions
 
a. Monitor vital signs, including heart rate and rhythm.
b. Administer thyroid replacement; levothyroxine sodium
(Synthroid) is most commonly prescribed.
c. Instruct the client about thyroid replacement therapy and
about the clinical manifestations of both hypothyroidism and hyperthyroidism
related to underreplacement or overreplacement of the hormone.
d. Instruct the client in low-calorie, lowcholesterol,
low–saturated fat diet.
e. Assess the client for constipation; provide roughage and
fluids to prevent constipation.
f. Provide a warm environment for the client.
g. Avoid sedatives and opioid analgesics because of
increased sensitivity to these medications.
h. Monitor for overdose of thyroid medications,
characterized by tachycardia, chest pain, restlessness, nervousness, and
insomnia.
i. Instruct the client to report episodes of chest pain or other signs of overdose immediately.
B. Myxedema coma
1. Description (Box 54-12)
2. Assessment
a. Hypotension
b. Bradycardia
c. Hypothermia
d. Hyponatremia
e. Hypoglycemia
f. Generalized edema
g. Respiratory failure
h. Coma
3. Interventions
a. Maintain a patent airway.
b. Institute aspiration precautions.
c. Administer IV fluids (normal or hypertonic saline) as
prescribed.
d. Administer levothyroxine sodium intravenously as
prescribed.
e. Administer glucose intravenously as prescribed.
f. Administer corticosteroids as prescribed.
g. Assess client’s temperature hourly.
h. Monitor blood pressure frequently.
i. Keep the client warm.
j. Monitor for changes in mental status.
k. Monitor electrolyte and glucose levels.
C. Hyperthyroidism
 
1. Description
a. Hyperthyroid state resulting from hypersecretion of
thyroid hormones (T3 and T4)
b. Characterized by an increased rate of body metabolism
c. A common cause is Graves’ disease, also known as toxic diffuse goiter.
d. Clinical manifestations are referred to as thyrotoxicosis.
2. Assessment for hyperthyroidism
caused by Graves’ disease
 
a. Enlarged thyroid gland (goiter)
b. Palpitations, cardiac dysrhythmias, such as tachycardia
or atrial fibrillation
c. Protruding eyeballs (exophthalmos) may be present
d. Hypertension
e. Heat intolerance
f. Diaphoresis
g. Weight loss
h. Diarrhea
i. Smooth, soft skin and hair
j. Nervousness and fine tremors of the hands
k. Personality changes such as irritability, agitation, and mood swings
3. Interventions
 
a. Provide adequate rest.
b. Administer sedatives as prescribed.
c. Provide a cool and quiet environment.
d. Obtain weight daily.
e. Provide a high-calorie diet.
f. Avoid the administration of stimulants.
g. Administer antithyroid medications (propylthiouracil, PTU) that block thyroid synthesis as prescribed.
h. Administer iodine preparations that inhibit the release
of thyroid hormone as prescribed.
i. Administer propranolol (Inderal) for tachycardia as prescribed.
j. Prepare the client for radioactive iodine therapy, as prescribed, to destroy thyroid cells.
k. Prepare the client for thyroidectomy if prescribed.
D. Thyroid storm
 
1. Description
2. Assessment
a. Elevated temperature (fever)
b. Tachycardia
c. Systolic hypertension
d. Nausea, vomiting, and diarrhea
e. Agitation, tremors, anxiety
f. Irritability, agitation, restlessness, confusion, and
seizures as the condition progresses
g. Delirium and coma
3. Interventions
a. Maintain a patent airway and adequate ventilation.
b. Administer antithyroid medications, sodium iodide
solution, propranolol, and glucocorticoids as prescribed.
c. Monitor vital signs.
d. Monitor continually for cardiac dysrhythmias.
e. Administer nonsalicylate antipyretics as prescribed (salicylates increase free thyroid hormone levels).
f. Use a cooling blanket to decrease temperature as prescribed.
E. Thyroidectomy
 
1. Description
a. Removal of the thyroid gland
b. Performed when persistent hyperthyroidism exists
2. Preoperative interventions
a. Obtain vital signs and weight.
b. Assess electrolyte levels.
c. Assess for hyperglycemia.
d. Instruct the client in how to perform coughing and
deep-breathing exercises and how to support the neck in the postoperative
period when coughing and moving.
e. Administer antithyroid medications, sodium iodide
solution, propranolol, and glucocorticoids as prescribed to prevent the
occurrence of thyroid storm.
3. Postoperative interventions
 
a. Monitor for respiratory distress.
b. Have a tracheotomy set, oxygen, and suction at the bedside.
c. Limit client talking, and assess level of hoarseness.
d. Monitor for laryngeal nerve damage, as evidenced by
respiratory obstruction, dysphonia,
high-pitched voice, stridor, dysphagia, and restlessness.
e. Monitor for signs of hypocalcemia and tetany, which can
be caused by trauma to the parathyroid gland (Box 54-14).
f. Prepare to administer calcium gluconate as prescribed for tetany.
g. Monitor for thyroid storm.

 

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