ENDOCRINE SYSTEM

ENDOCRINE ASSESSMENT – CH 61

ANATOMY & PHYSIOLOGY REVIEW

Endocrine system

 Hypothalamus
 Pituitary glands
› Anterior
› Posterior
 Gonads
 Adrenal glands
› Cortex
› Medulla
› Problems  Kidney problems
 Thyroid gland
 Parathyroid gland
 Pancreas
› Islet of Langerhans

Purpose: Secrete hormones (through the blood to specific tissues)

HPA axis = Hypothalamus, Pituitary, & Adrenal

 If you have a problem w/ one, you’ll most likely have a problem w/ the others.

Function: Endocrine works with the nervous system to control / regulate:

 Metabolism
 Nutrition
 Elimination
 Temperature
 Growth
 Reproduction
 Maintain hemostasis

1
HORMONES
 General characteristics
› Affects only cells w/ a specific receptor
» “Lock and key” like
› The liver inactivates hormones by making them water soluble for excretion
» Liver problems  buildup of hormones
› Regulation
» Negative feedback = Hormone secreted to cause opposite reaction of condition change
-  BG = insulin secreted =  BG
» Positive feedback = a disturbance exacerbates the tissue
› Hormones regulated by chemical, hormonal, or neural factors
» Neural factors such as fight or flight
» Chemical such as Na+

 Hypothalamus › Oxytocin
› (CRH) Corticotropin-releasing hormone  Thyroid
› (TRH) Thyrotropin-releasing hormone › T3
› (GnRH) Gonadotropin-releasing hormone › T4
› (GHRH) Growth hormone-releasing hormone › Calcitonin
› (Somatostatin GHIH) Growth hormone-  Parathyroid
inhibiting hormone › (PTH) Parathyroid hormone
› (PIH) Prolactin inhibiting hormone  Adrenal cortex
› (MIH) Melanocyte-inhibiting hormone › Glucocorticoids
 Anterior pituitary » Cortisol
› (TSH) Thyroid-stimulating hormone › Mineralocorticoids
› (ACTH) Adrenocorticotropic hormone » Aldosterone
› (LH) Luteinizing hormone  Ovary
› (FSH) Follicle-stimulating hormone › Estrogen
› (PRL) prolactin › Progesterone
› (GH) Growth hormone  Testes
› (MSH) Melanocyte stimulating hormone › Testosterone
 Posterior pituitary  Pancreas
› (ADH) Antidiuretic hormone › Insulin
» Vasopressin › Glucagon
› Somatostatin

2
ADRENAL GLANDS
Adrenal Cortex

 Glucocorticoids (Cortisol)
› Antagonize effect of insulin
» Prevents hypoglycemia
› Inhibits inflammatory response
»  WBC, even when infection is present
- Immunosuppressant
› Inhibits fibroblastic activity
» Degradation of collagen & connective tissue
› Release regulated by CRH  ACTH  Glucocorticoid
» Stress increases release
 Mineralocorticoids (Aldosterone)
› Control fluid & electrolyte balance
» Maintain extracellular fluid volume
» Promotes sodium & water reabsorption
- Cause kidneys to absorb sodium & water to bring osmolarity & blood volume back to normal
» Promotes potassium excretion   of K+
- Potassium  Dysrhythmias
» SO  aldosterone = hyponatremia & hypokalemia & vice versa
 Small amts of Androgens & Estrogens
› Usually not significant b/c the Gonads secrete sex hormones. BUT in women  adrenal is the major source of
androgens

Adrenal Medulla

 Regulates BP by effects on vascular smooth muscle of the heart

› Sympathetic / parasympathetic nervous system
› Catecholamine release (Epi/Norepi)  vasoconstriction ( HTN) & bronchodilation

3
PITUITARY GLAND
By response to hormones of the hypothalamus  Hormones secreted by the pituitary gland stimulate the functioning of
other endocrine glands.

They also promote growth & water balance in the body.

Hormones & Release of / action Target Tissue

TSH  thyroid hormones Thyroid

ACTH  cortisol & aldosterone Adrenal Cortex

LH  Progesterone & testosterone Ovary & Testes

Anterior Pituitary
FSH  estrogen & spermatogenesis

PRL  milk production Mammary glands

GH  growth r/t lipolysis, protein Bone & soft tissue

anabolism, & insulin antagonism

MSH  pigmentation Melanocytes

ADH  water reabsorption Kidney

Posterior Pituitary
Oxytocin  uterine contractions & Uterus & mammary glands
breast milk

4
THYROID GLAND
Anatomy: 2 lobes lateral to the trachea. Lobes connected by the isthmus.

Thyroid hormones:

 90% T4 & 10% T3

› T3 & T4  metabolism   oxygen use & heat production in all tissues
 Calcitonin
 Affect growth & maturation of tissues
› Healing aspect
 Cell metabolism
 Heat production
› That’s why w/ problems you’ll see a fluctuating temp
 Oxygen consumption
› Has a role carrying oxygen to the tissues
 Calcium & phosphorus balance
› Slight inversion = normal
› Problem  extreme inversion
› Normal calcium = 9.0-10.5
› Normal phosphorus = 3.0-4.5

Thyroid problems:

 Will need a supplement

 Hypothyroidism =  T4 &  TSH
 Hyperthyroidism =  T4 &  TSH

PARATHYROID GLAND
Anatomy: Small glands located behind the upper & lower poles of the thyroid gland.

Parathyroid Hormone:

 Regulates serum calcium & phosphorus

› Hormone is secreted when serum calcium levels are 
› Bone stores calcium
»  bone resorption = bone release of calcium into blood
› Activates vitamin D
» Helps with absorption of calcium & phosphorus
 Antagonist of calcitonin
› Secreted by the thyroid
› Antagonist = inhibits

5
 › Triggers the  of calcium & phosphorus

PANCREAS
Anatomy: Both an endocrine & exocrine gland.

 Islets of Langerhans perform endocrine functions

 Cells & receptors:
› Alpha  Glucagon
»  release   BG levels
- Prevent hypoglycemia
› Beta  Insulin
»  release   BG levels (b/c carried to tissues for energy) &  storage of carbs / protein / fat
- Prevent hyperglycemia
» Beta blockers (used to slow the heart) attach to beta receptors
- Take up beta receptors  insulin can’t bind  hyperglycemia
› Delta  Somatostatin & gastrin
» Somatostatin inhibits release of glucagon, insulin, & GI peptides
- Secreted in other areas of the body as well.
› F cells  pancreatic polypeptide

6
ASSESSMENT
Pt Hx

 Age?
›  age / normal s/s in an older adult r/t natural slowing
» DM
»  ovarian function
»  thyroid function
- Glandular atrophy
- Fibrosis / hardening
- Nodules formed
-  inflammatory infiltrates
» Parathyroid gland
- r/t alterations in calcium balance
 Inadequate intake
 Malabsorption
 Renal changes
» Adrenal glands
-  clearance of cortisol  HTN
 Other endocrine problems?
 PMH / other disorders?

Nutrition Hx

 Hx of N / V / abd pain?
 Increased thirst?
 Appetite change?

Family Hx & Genetic risk

 Obesity?
 DM?
 Hypo / hyperthyroidism?
 Infertility?

Current health problems

 Changes in energy / fatigue?

› Could be an HPA abnormality…
 Changes in elimination?
› Amt & frequency?
 Sexual & reproductive functions?

7
  Changes in physical appearance?
› Wt gain / loss?

Physical assessment

 Prominent forehead or jaw

 Round / puffy face
 Dull / flat expression
 Exophthalmos = Bulging of the eyes
 Vitiligo = Skin discoloration
 Striae = Reddish-purple stretch marks
 Hirsutism = Excessive hair growth
 Neck  visible enlargement of thyroid?
› Goiter
 Skin / pigmentation?

Laboratory Tests

 Body fluids assessed

› Blood
» Stimulation / suppression assess measures of hormones through a trigger response
- Determines gland capability of hormone production / “provocative testing”
 Stimulation  production
 Suppression  production
- Failure of hormone level to rise = hypofunction
» Glucose checks
› Urine
› Saliva levels of hormones accurately reflect blood levels of the hormones as well
» Cortisol
» Progesterone
» Testosterone
 Assays = measure levels of hormones in body fluids
› Most common = antibody-based immunologic assays & chromatographic assays
› Detect minute quantities of a given hormone

Imaging Assessment

 MRI w/ contrast
› Most sensitive for imaging of the pituitary gland
 CT
› Pituitary
› Adrenal
› Ovaries

8
 › Pancreas
 US
› Thyroid
› Parathyroid
› Ovaries
› Testes

PITUITARY & ADRENAL PROBLEMS – CH 62

DISORDERS OF THE ANTERIOR PITUITARY GLAND

 Primary pituitary dysfunction
 Secondary pituitary dysfunction
 Pituitary hypofunction
 Pituitary hyperfunction

Hypopituitarism

 Deficiency of one or more anterior pituitary hormones  metabolic & sexual dysfunction
 Panhypopituitarism =  production of ALL anterior pituitary hormones.
› Possibly d/t a tumor
› l/t an imbalance of everything
 Most life-threating deficiency = TSH & ACTH
› Thyroid & adrenal triggering hormones
 Deficiency of gonadotropins = LH & FSH
› l/t changes in sexual function
 GH stimulates liver to produce somatomedins that enhance growth activity
› Deficiency in GH =  production of somatomedins  osteoporosis &  risk for fractures

Causes

 Tumors
 Hypotension / hypovolemic shock
 Postpartum hemorrhage
› Blood loss  infarction of pituitary tissue

Assessment

 GH  LH / FSH
›  bone density › Women
›  muscle strength » Amenorrhea

9
 » Anovulation › Hirsutism
»  libido ›  libido
› Men  ACTH
»  facial hair / body hair › Pale
»  ejaculate volume › Malaise
»  muscle mass › Anorexia
»  libido › Postural hypotension
 TSH › HA
› Wt gain
› Hypoglycemia
› Intolerance to cold
› Hyponatremia

Interventions

 Lifelong replacement of deficient hormones

 Men w/ gonadotropin deficiency
› Androgen therapy (testosterone)
» until virilization / presence of male secondary sex characteristics
-  libido
-  muscle mass
-  bone size
-  hair
» Gynecomastia can occur
 Women w/ gonadotropin deficiency
› HRT w/ estrogen & progesterone
 GH deficiency
› Receive injections of hGH (human GH)  Given @ night to mimic natural release

Hyperpituitarism

 Hormone oversecretion occurs w/ pituitary tumors / hyperplasia (overgrowth of cells)

› Typically induced by medication or cancer
› Most common cause = pituitary adenoma / benign tumor
› Common hormones produced excess (usually only one)
» PRL
» ACTH
» GH
 GH hypersecretion…
› Gigantism = GH hypersecretion before puberty
› Acromegaly = GH hypersecretion after puberty
» Thick lips /  head / lower jaw protrusion /  hands & feet / sleep apnea /  lungs, liver, heart
 Assessment
› S/s vary based on the hormone overproduction
› Ask about changes related to

10
 » Hat / ring / show size
» Backache / joint pain
» HA / vision changes
» Menstrual changes
»  libido
› Imaging = MRI
› Lab tests
» Suppression testing
- BG usually suppress’ release of GH
- If GH does not fall below 5 then there is an abnormality

 Interventions
› Drug therapy
» Parlodel
» Dosinex
» Permax
» Sandostatin
» Somavert
› Radiation
› Gamma knife procedure
› Surgical: hypophysectomy
» removal of gland & tumor
» Can be transnasal or transphenoidal (picture)
» Postop:
- Monitor neurologic response
- Assess
 postnasal drip
 yellow color indicates CSF
 cardiac status
 LOC
 Neuromuscular
 Kidney function
 Increased swallowing
 Leakage of CSF?
-  HOB
- Assess for meningitis
 Inflammation of the brain / spinal cord from infection
 S/S: Fever / HA / Neck rigidity
- Hormone replacement
 Vasopressin to maintain fluid balance

11
 - Teach to avoid:
 Coughing
 Bending
 Straining
 Blowing nose
 Brushing teeth
 For 2 weeks
-  sense of smell is expected for 3-4 months

12
 DIABETES INSIPIDUS (DI)
Water metabolism problem caused by an ADH deficiency

  in ADH synthesis
or
 Inability of kidneys to respond to ADH

Classifications Assessment

 Nephrogenic  Symptoms of dehydration

› Problem w the kidneys response to ADH › Poor turgor
 Primary neurogenic › Dry membranes
› Defect in hypothalamus / pituitary gland  ›  UOP
lack of ADH production » > 4000 mL in 24 hours
 Secondary neurogenic » Dilute &  specific gravity
› Tumors near or in the hypothalamus / - < 1.005
posterior pituitary › Hypotension
› Head trauma › Tachycardia
› Brain surgery › Weak pulses
› Infectious processes ›  thirst
 Drug-related  Dx: Dehydration & hypertonic saline test
› Lithium / Demeclocycline
» Interfere w/ the response o the kidneys

Interventions  control symptoms w/ drug therapy

 Lifelong vasopressin therapy w/ permanent condition

› Maintains fluid balance
 Reverse the effect of sodium in the body
› Oral chlorpropamide
› Desmopressin acetate = most preferred (vasopressin)
» SL or metered spray (of 10 mcg)
» Signals for another dose = polyuria & polydipsia
» Induce water retention & can cause fluid overload
- Teach pts to weigh themselves to identify weight gain
 Early detection of dehydration & maintenance of adequate hydration
› Isotonic fluids
› Drink fluids  amt. of urine output
 Report / go to ER if
› Wt. gain > 1 kg + HA / confusion / N / V

13
SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH)
 “Schwartz-Bartter syndrome”
 When vasopressin (ADH) is secreted even when osmolarity is low or normal.
›  osmolarity usually inhibits ADH production & secretion
› Water is retained  hyponatremia
› S/S:
»  sodium
» Edema
» Swelling
» Wt gain
»  ADH
»  UOP
 Causes:
› Recent head trauma
› Cerebrovascular disease
› TB
» Or other pulmonary diseases
› Cancer
› Past / current drug use
» SSRI’s
›  sodium levels
 Interventions:

› Neurologic assessment  AAO x4? Assess » Vasopressin receptor antagonists 

q2hr water excretion w/out sodium loss
» Muscle twitching - Tolvaptan
»  irritability - Conivaptan
» Restlessness › Monitor for fluid overload
» Seizures / coma » Daily weights
› Fluid restriction - Wt gain  1kg/day is concerning
» 500-1000 mL/24 hr » Is & Os
› Drug therapy » BP  Hypotension
» Diuretics » Crackles in lungs
» Hypertonic saline » Edema
- 3% NaCl » Bounding pulse
» Demeclocycline › Safe environment
- Oral antibiotic; helps reach F/E » Risk for falls d/t imbalance
balance

14
ADRENAL GLAND HYPOFUNCTION
 Adrenocortical steroids may  b/c inadequate secretion of ACTH
› Not enough cortisol & aldosterone
»  aldosterone  hyperkalemia & hypernatremia
- Monitor HR / rhythm / ECG
»  cortisol  hypoglycemia
- Monitor BG hourly
› Dysfunction of hypothalamic-pituitary control mechanism
› Direct dysfunction of adrenal tissue
› Addisonian crisis vs. Addison’s disease
» Addisonian crisis = acute adrenal insufficiency
- Usually response to stress or trauma
 Limit stress
 Monitor:
 BG / Tele / VS / Fluid balance
- Life-threatening
 Need for cortisol & aldosterone is > available supply
» Addison’s disease = adrenal insufficiency (d/t primary or secondary factors)

- Primary: - Secondary:
 TB  Pituitary tumors
 Hemorrhage  PP pituitary necrosis
 AIDS  Hypophysectomy
 Adrenalectomy  High-dose brain radiation
 Drugs & toxins  Cessation LT steroids

ADRENAL GLAND HYPERFUNCTION

Hypersecretion by adrenal cortex 

 Cushing’s syndrome
› When resulting from drug therapy or another health problem
 Hypercortisolism (Cushing’s disease)
› R/I hyperglycemia &  immunity ( WBC)
 Excessive androgen production

Hypercortisolism (Cushing’s disease)

Causes:

 Bilateral adrenal hyperplasia

 Pituitary adenoma  the production of ACTH
 Malignancies

15
 › Carcinomas of the lung
› GI tract
› Pancreas

Assessment:

 Clinical manifestations: › Cardiac changes

› General appearance » HTN
» Moon face » Edema
» Buffalo hump » Petechiae
» Truncal obesity › Musculoskeletal changes  think safety!!!
› Skin changes » Muscle atrophy
» Thinning skin » Osteoporosis
» Striae › Glucose metabolism
» Pigmentation › Immune changes
»  risk for infection
»  inflammatory response

 Psychosocial assessment
 Lab tests: cortisol levels
› Blood
› Saliva  normal = < 2.0
› Urine

Interventions:

 Priority issues:
› Fluid overload r/t hormone-induced water & sodium retention
› Safety
› Risk for infection
› Potential for Addisonian crisis
 Nonsurgical:
› Patient safety
» Prevent worsening of fluid overload
» Pulmonary edema & HF can occur very quickly
› Drug therapy
» Drugs that interfere w/ ACTH production
» Monitor for F/E balance problems during drug therapy
› Nutrition therapy
» Sodium & fluid restrictions
› Monitoring
» S/S of fluid overload Q2hrs
» F/E balance

16
 » Is & Os
» Daily weights
 Surgical: (may hypofunction, requiring supplements)
› Hypophysectomy (removal of pituitary)
» Used when hypersecretion r/t  pituitary secretion of ACTH
› Adrenalectomy
› Preop / intraop: Glucocorticoids are given to prevent Addisonian crisis postop.
› Postop: Need for LT drug therapy

Hyperaldosteronism

 Increased secretion of aldosterone w/ mineralocorticoid excess

 Primary aldosteronism = Conn’s syndrome
› Result of excess secretion from one or both adrenal glands
› Usually caused by adrenal adenoma
 Causes:
› F/E imbalances
» Hypokalemia
» Hypernatremia
- Leads to  blood volume  HTN
 Assessment:
› Hypokalemia
› HTN
› HA / Fatigue
› Weakness
› Polydipsia
› Polyuria
› paresthesia (tingling / numbness)
› DX:  potassium,  sodium,  aldosterone
 Interventions:
› Surgery is common tx
» Adrenalectomy
- 1 removed: temp glucocorticoid replacement
- Both removed: Lifelong replacement
» Potassium must be corrected before surgery
› Spironolactone therapy continued if surgery cannot be performed
» Potassium sparing diuretic
» Controls K+ & HTN

17
PHEOCHROMOCYTOMA
Catecholamine-producing tumors arising in the adrenal medulla.

Tumors produce / store / release epinephrine & norepinephrine

› Worry about vasoconstriction

» Pt often has episodes of HTN lasting minutes-hours
- HTN is main sign!!
- Dx: increased catecholamine, and UA.
» Stabilize BP w/ adrenergic blocking agents
- Phenoxybenzamine
› Also causes bronchoconstriction

Do not give ______  hypertensive crisis

 TCA drugs  Droperidol

 Glucagon  Naloxone

Interventions:

 Hydration prior to surgery

 Surgery: removal of 1 or both adrenal glands
 Postop:
› Promote tissue perfusion
› Comfort
› Nutritional measures
› Monitor BP – sitting & standing
› Teach to avoid:
» Smoking
» Caffeine
» Sudden changes in position

18
THYROID / PARATHYROID PROBLEMS – CH 63

HYPERTHYROIDISM
Excessive thyroid hormone secretion. “Thyrotoxicosis”

Most common form of the disease = Grave’s disease: autoimmune disorder.

 Grave’s specific S/S:

› Goiter
› Exophthalmos
› Pretibial myxedema
» Dry, waxy swelling of the lower legs
» Resembles benign tumors
 Dx lab: TRAbs (Antibodies to TSH receptor) measured in blood
›

Assessment

 History
› Age / Gender / Usual weight / PMH
 Lab tests:
› Measure blood levels
» T3
- Norm = 70-205
» T4 ()
- Norm = 4-12
» TSH ()
- Norm = 2-10
 Clinical manifestations

› Skin symptoms › Other

» Diaphoresis » Goiter
» Thinning of the scalp hair » Enlarged spleen
› Cardiopulmonary » Muscle weakness / wasting
» Palpitations › Neurologic
» CP » Blurred / double vision  earliest!
» Tachy » Red conjunctiva
» Rapid / shallow respirations » Exophthalmos
› GI » Hyperactive DTR
» Wt. loss » Photophobia = sensitivity to light
»  stools » Insomnia
»  appetite › Metabolic symptoms

19
 »  metabolic rate » Fatigue
» Heat intolerance
» Low-grade fever

 Psychosocial assessment
› Often has:
» Wide mood swings
» Irritability
»  attn span
» Manic behavior

 Other Dx:
› Thyroid scan
» Evaluates position, size, & function of thyroid
› US
» Determines size & any nodules / masses
› ECG  includes change from baseline
» Usually shows SVT
» A. Fib
» Dysrhythmias
» PVC’s

Interventions

 Nonsurgical
› Monitoring
» May complain of palpitations
» VS q4hrs
› Reduce stimulation
» Encourage rest
› Promote comfort
» Reduce stress
»  room temp
» Change linens b/c diaphoresis
» Prevent eye dryness
› Drug therapy
» Antithyroid drugs  block thyroid hormone production
- Preferred drugs = thionamides
 Methimazole  birth defects
 Propylthiouracil  report yellowing of skin or dark urine
 Immunosuppressant drugs
 Watch for S/S of hypothyroidism
- Cold intolerance
- Weight gain

20
 - Brady
» Iodine preparations  for ST therapy before surgery
- Improvement usually in 2 weeks
» Beta-adrenergic blocking drugs
- Propranolol
- Relieve diaphoresis, tachy, anxiety, & palpitations
- DO NOT inhibit thyroid hormone production.
» Lithium

 Surgical
› Total / subtotal thyroidectomy
» IF doesn’t respond to other therapies
» After total = MUST TAKE lifelong thyroid hormone replacement
› Postop complications
» Hemorrhage – suture line integrity
- Avoid straining & coughing
- Positioning:  HOB, don’t extend neck
» Respiratory distress
» Hypocalcemia & tetany
» Laryngeal nerve damage
- Hoarseness & stridor
 Stridor = harsh, high pitched
- Swelling postop  this
» Thyroid storm / crisis = rapid worsening of condition  LIFE-THREATENING
- High fever & HTN
» Eye & vision problems of graves’ disease

21
HYPOTHYROIDISM
Low levels of thyroid hormone.

Thyroid cells produce Thyroid Hormones

 When they are damaged OR when not enough iodine & tyrosine are ingested then the cells fail to produce thyroid
hormone
› Iodine & tyrosine needed to make thyroid hormone
 As a response to  thyroid hormone levels in the blood, the pituitary gland secretes TSH which binds to thyroid cells
& causes the thyroid to enlarge  Goiter.
› BUT thyroid hormone doesn’t increase b/c cells are still damaged or missing product.
›  thyroid hormone   metabolism
 Myxedema = edema produced by mucus & water, that changes organ texture
› Myxedema coma, or “hypothyroid crisis” = poorly treated hypothyroidism 
»  cardiac output (d/t weak heart)
»  perfusion
» Tx:
- ABC’s
- Fluid resuscitation
- Meds as prescribed
 Levothyroxine
 Glucose
 Corticosteroids

Causes:

 Thyroid surgery
 Radioactive iodine
 Treatment of hyperthyroidism
  thyroid tissue
 Cancer
 Drugs: Lithium / Propylthiouracil

22
Assessment

 History
› Often reports  in sleep time
› May report  libido
 Psychosocial: apathy / depression / paranoia

 Physical assessment & S/S

› Skin › GI
» Cool / pale / yellow » Wt gain
» Thick / brittle nails & hair » Constipation
» Poor wound healing » Abd distension
› Pulmonary › Neuromuscular
» Dyspnea » Confusion
› Cardiovascular » Paresthesia
» Brady »  DTR
» Enlarged heart » Muscle aches / pain
»  activity tolerance › Other
» Hypotension » Facial puffiness
› Metabolic » Hoarseness
»  metabolic rate » Goiter
»  body temp » Thick tongue
» Cold intolerance » Easy bruising

Interventions = LIFELONG Hormone replacement therapy

 Levothyroxine (Synthroid)
› Start low dose & gradually increase
» Starting too high  HTN, MI, HF

23
THYROIDITIS
Inflammation of the thyroid.

Types:

 Acute
› Bacterial invasion
› S/S: pain / neck tenderness / fever / dysphagia
 Subacute (Granulomatous)
› Viral infection
› S/S: fever / chills / dysphagia / muscle & joint pain
» Pain can radiate to ears & jaw
 Chronic (Hashimoto’s disease – most common!)
› Common type of hypothyroidism
› Autoimmune disorder
› Triggered by bacterial / viral infection  thyroid destruction
»  TH
»  TSH
› S/S: Dysphagia / painless enlargement

Interventions

 Nonsurgical
› Give thyroid hormone to prevent hypothyroidism & suppress TSH
» As a result,  size of gland
 Surgical – IF goiter doesn’t respond to thyroid hormone
› Subtotal thyroidectomy
» Nursing interventions:
- Promote comfort
- Teach about…
 Hypothyroidism
 Drugs
 Surgery

24
THYROID CANCER
Types:

 Papillary
› Young women
 Follicular
› Older adults
› Met  lung & bone
› Dysphagia & Dyspnea
 Medullary
› Common > 50 yr/old
 Anaplastic
› Rapid & aggressive
› Stridor / Hoarseness / Dysphagia
› Tx: Radiation (ablative amts)
» No improvement?  chemotherapy

Initial sign of thyroid cancer = painless lump / nodule in thyroid &  Thyroglobulin (Tg). Normal Tg = 0.5-53 men & 0.5-
43 women.

Management

 Surgery for other 3 types.

› Total thyroidectomy
» Thyroid hormone therapy
» Monitor Tg postop
» Teach abt mgmt. of hypothyroidism!

25
HYPERPARATHYROIDISM
Parathyroid glands  serum calcium & phosphorus regulation.

Acts directly on the kidney!  reabsorption of calcium & excretion of phosphorus.

Hypercalcemia & Hypophosphatemia

 Excessive PTH levels  Bone resorption

  bone density
 Ask about Hx of falls or fractures

Nonsurgical management

 Diuretic & hydration therapies

› Furosemide & fluids to promote calcium excretion
 Drug therapy: for more severe
› Cinacalcet – FIRST
» Reduce PTH production & release
› Oral phosphates
» Inhibit bone resorption
 MONITOR: cardiac function & intake / output q2hrs
 Prevent injury

Surgical management

 Parathyroidectomy

HYPOTHYROIDECTOMY
 function of parathyroid gland.

Causes:

 Iatrogenic = environment caused

 Idiopathic = body caused
 Hypomagnesemia
›  mag suppressed PTH secretion

Interventions:

 Correct hypocalcemia
 Vitamin D deficiency

26
 Hypomagnesemia

27