THYROID AND PARATHYROID GLAND DISORDERS

1.HYPOTHYROIDISM

  • It is a state resulting from hyposecretion of thyroid hormones T3 and T4 ,characterized by a decreased rate of body metabolism

Assessment

  • Lethargy and fatigue
  • Intolerence to cold
  • Weight gain
  • Bradycardia
  • Generalized puffiness and edema around the eyes and face (myxedema)
  • Cardiac enlargement, tendency to develop congestive heart failure
  • Goiter may or may not be present






Interventions

  • Monitor vitalsigns including heart rate and rhythm
  • Administer thyroid replacement; levothyroxine sodium(Synthyroid) is most commonly prescribed
  • Low calorie , low cholesterol, low saturated fat diet
  • Avoid sedatives and opioid analgesics because of increased sensitivity to these medications

2. MYXEDEMA COMA

  • This rare but serious disorder results from persistently low thyroid production
  • It can be precipitated by acute illness, rapid withdrawel of medication, anesthesia and surgery, hypothermia, or the use of sedatives opioid analgesics

Assessment

  • Hypotension, bradycardia
  • Hypothermia, hyponatremia
  • Hypoglycemia, genaralized edema
  • Respiratory failure , coma

Interventions

  • Maintain a patent airway
  • Administer IV fluids, normal or hypertonic saline as prescribed
  • Administer IV levothyroxine sodium as prescribed
  • Keep client calm

3. HYPERTHYROIDISM

  • State resulting from hypersecretion of thyroid hormones, characterized by an increased rate of body metabolism
  • A common cause is Grave’s disease, also known as toxic diffuse goiter
  • Clinicalmanifestations are referred to as thyrotoxicosis

Assessment

    • Enlarged thyroid gland (goiter)
    • Protruding eye balls (exophthalmos)
    • Heat intolerence
    • Weight loss
    • Nervousness and fine tremors of hands
    • Palpitations, cardiac dysrhythmias




4. THYROID STORM

  • Acute and life threatening condition occurs in a client with uncontrollable hypothyroidism
  • Caused by manipulation of thyroid gland during surgery and the release of thyroid hormone in to the bloodstream ; it also can occur from severe infection and stress
  • Antithyroid medications, beta blockers, glucocorticoids and iodides are administered to the client before thyroid surgery to prevent its occurence

Assessment

  • Fever
  • Tachycardia
  • Systolic hypertension
  • Nausea, vomitting and diarrhea
  • Delirium and coma

5. THYROIDECTOMY

  • Removal of the thyroid gland
  • Performed when persistent hyperthyroidism exists
  • Maintain client in semi fowler’s position postoperatively
  • Moniter for signs of hypocalcemia and tetany; which can be caused by trauma to the parathyroid gland

6.HYPOPARATHYROIDISM

  • Condition caused by hyposecretion of parathyroid hormone ,can occur following thyroidectomy because of removal of parathyroid tissue

Assessment

  • Hypocalcemia and hyperphosphatemia
  • Numbness and tingling in the face
  • Positive Trousseau’s sign or Chvostek’s sign
  • Signs of overt tetany such as bronchospasm, laryngospasm, carpopedal spasm, dysphagia, photophobia, cardiac dysrhythmias, seizures
  • Anxiety, irritability, depression

Interventions

  • Monitor vitalsigns
  • Place a tracheostomy set, oxygen and suctioning at the bedside
  • Prepare to administer calcium gluconate intravenously for hypocalcemia
  • Provide a high calcium ,low phosphorus diet
  • Vitamin D enhances the absorption of calcium from the gastrointestinal tract

7.HYPERPARATHYROIDISM

  • Hypersecretion of parathyroid hormone by parathyroid gland
  • Hypercalcemia and hypophosphtemia
  • Fatigue and muscle weakness
  • Hypertension
  • Cardiac arrhythmias

 

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