thyroid and parathyroid

• thyroid: metabolism and control of calcium
• TSH: thyroid stimulating hormone (released by the pituitary)
• TSH is LOW in hyperthyroid because the thyroid is already working
• the harder the thyroid works, metabolism goes up (like a gas pedal in the car); higher BP, higher temperature, and cant sleep (dangerous and can lead to cardiac failure)
• parathyroid: 4 small glands on the thyroid; controls calcium and phosphorus
• hyperparathyroid = HIGH calcium and LOW phosphorus
• hypothyroidism: too low and low metabolism
• clinical manifestations of hypothyroidism: decreased energy, increased sleep, fatigue, weight gain, decreased appetite, susceptibility to cold temperatures, dry coarse skin
• medical management of hypothyroidism: replacement of missing hormone with levothyroxine
• complications of hypothyroidism: myxedema coma
• myxedema coma: hypoxia and CO2 retention, fluid and electrolyte imbalance, hypothermia (extreme), respiratory acidosis
• assessment for hypothyroidism: constipation (due to no GI motility), cold intolerance, goiter (due to increase in thyroid size)
• labs for hypothyroidism: elevated serum cholesterol secondary to decreased liver metabolism, elevated TSH, decreased T3 and T4
• goal for hypothyroidism: the patient will not have signs and symptoms of hypothyroidism and will have normalized TSH, T3, and T4
• interventions for hypothyroidism: monitor vital signs (especially temperature), serum calcium levels (parathyroids may be affected), daily weight, skin (turn and reposition), administer thyroid replacement (on a EMPTY stomach), use narcotics and sedative with CAUTION, and provide warming blankets
• teaching for hypothyroidism: immediately report chest pain or discomfort, take thyroid replacement as prescribed, signs of hypo and hyperthyroidism, monitor TSH levels to determine effectiveness of replacement (TSH should go back down)
• hyperthyroidism: elevated HR, cardiac dysrhythmias, increased gastric activity, increased appetite, weight loss, fatigue, nervousness, insomnia (**), light to absent menses, hair loss, goiter (Grave's disease)
• medical management of hyperthyroidism: antithyroid medications, symptom management (beta blockers), and thyroidectomy
• complications for hyperthyroidism: thyroid storm, thyrotoxicosis (when the thyroid is manipulated; really low TSH)
• thyroid storm: tachycardia (beta blocker use), fever (life threatening 103 or above due to metabolism being too high), systolic hypertension, abdominal pain, tremors, changes in LOC (very agitated), airway management and fluid resuscitation are priorities, seizure precautions
• what is the priority for a thyroid storm?

  airway management and fluid resuscitation (keep an open line, airways at bedside, and trach if needed)
• physical assessment for hyperthyroidism: vital signs, weight, cardiac/telemetry, goiter (do NOT manipulate it and educate them to not to), and exophthalmos
• what is exophthalmos?

  bulging of the eyeballs secondary to inflammation and swelling behind the eyes
• labs for hyperthyroidism: thyroid hormone levels (TSH will be VERY low and T3 & T4 will be elevated), blood glucose (hypoglycemia because metabolism is so high)
• care after thyroidectomy: monitor airway and have oxygen ready, do voice checks every 1-2 hours, monitor for bleeding for 24 hours, monitor for hypocalcemia (parathyroid may have been damaged or removed), keep emergent tracheostomy tray in room for 48 hours, and keep suctioning equipment in the room and ready
• interventions for hyperthyroidism: I&Os, eye care and lubricant (eyes won't be able to close completely with exophthalmos), seizure precautions, daily weight, administer antithyroid medications, implement cooling measures
• teaching for hyperthyroidism: take antithyroid medication at the SAME TIME everyday, consume adequate calories to keep weight up, and AVOID pregnancy (more strain on the body and most of the meds are toxic)
• hypoparathyroidism clinical manifestations: decreased calcium levels (**), numbness and tingling around mouth and in hands/feet, severe muscle cramps, spasms of hands and feet, tetany
• medical management hypoparathyroidism: supplement calcium and vitamin D
• hypoparathyroidism physical assessment: positive Chvostek and Trousseau signs, parathesias of the hands and feet, tingling of circumoral areas, hypotension, bone pain and skeletal deformities
• labs for hypoparathyroidism: decreased serum calcium levels (and albumin), ionized calcium levels, serum magnesium, acid base status (alkalosis causes increased binging of Ca to albumin), increased phosphate levels (due to low calcium)
• what does hypoparathyroidism look like?

  hypocalcemia
• interventions for hypoparathyroidism: vital signs, cardiac monitoring, neuromuscular activity, seizure precautions, administer calcium, administer vitamin D (without vitamin D calcium will just go out in the stool)
• teaching for hypoparathyroidism: medication regimen, eat foods high in calcium but low in phosphorus, and signs of hypocalcemia and hypercalcemia
• hyperparathyroidism clinical manifestations: polyuria, anorexia, constipation, abdominal pain, lethargy, confusion, muscle weakness, fatigue, and generalized bone pain (calcium is coming from the bones and breaking them down)
• medical management of hyperparathyroidism: lower calcium serum levels through diet, increase fluid intake (IV and oral), and getting them up and walking to stress the bones (get calcium back into the bones)
• physical assessment of hyperparathyroidism: muscle weakness and atrophy, lower back pain, increased incidence of pathological fractures, ventricular dysrhythmias, and renal stones (due to calcium build up in kidneys)
• labs for hyperparathyroidism: elevated ionized and serum calcium levels, decreased serum phosphorus levels
• interventions for hyperparathyroidism: cardiac monitoring, increase fluid intake (3 L/day), administer furosemide as ordered (decrease Ca), administer oral phosphates as ordered, administer calcium binders (GIVEN WITH FOOD), use lift sheet, and strain urine
• teaching for hyperparathyroidism: signs of hypocalcemia, low calcium diet, and increase fluids and fiber