Thyroid Shit

• Hypothalamus


  Gland that links to the nervous system, so it receives signal from the brain. Can release hormones that enhance or inhibit other hormones.
• Pituitary


  "Master gland" due to its involvement in almost all hormone regulation. Connects to the hypothalamus which they transfer hormones via the bloodstream. Anterior pituitary controls thyroid and cortisol hormones.
• Adrenal gland


  Located on the top of each kidney. Releases hormones like glucocorticoids, epinephrine, and mineral corticoids.
• Endocrine nursing assessment = If there are lots of nonspecific changes, it should raise flags for a possible endocrine disorder. Health history is very important.
• Thyroid gland

  Regulates metabolic rate, growth, oxygen consumption, and brain function. Produces thyroxine (T4), triiodothyronine (T3), Calcitonin. Needs iodine to perform the synthesis of the hormones. TRH from hypothalamus -> TSH from anterior pituitary -> Thyroid hormones from gland. The increase of thyroid production turns TRH excretion from the hypothalamus.
• Effects of thyroid gland

  • Heart: HR and contractility, increases inotropy.
  • Nerves: increases SNS and brain androgen receptors.
  • Metabolism: regulated protein, carbs, and fat.
  • Bones: increases bone formation.
• Pemberton sign


  Face turning red as a result of raising hands. Palpate thyroid for inflammation.
• Hyperthyroidism effects

  • Fast HR and increased temp.
  • Increased metabolism and sensitivity.
  • Weak, nervous, weight loss, insomnia.
  • Exophthalmos = inflammation of eye, resulting in impaired drainage and increasing fat in orbital tissue. Increases eye pressure and dries corneal surfaces.
• Ways to contract hyperthyroidism

  • Primary: problem with thyroid itself resulting in high T4 and low TSH.
  • Secondary: brain cancers cause hyperactivity secreting High amounts of T4 and TSH.
  • Pregnancy or Hashimoto's can cause hyperthyroidism.
• Methimazole for hyperthyroidism

  Inhibits synthesis of thyroid hormone, blocking conversion of T4 to T3. First line of defense, not used in pregnancy.
• Beta blockers for hyperthyroidism

  Relief of symptoms due to high Beta stimulation from thyroid.
• Iodine for hyperthyroidism


  Short term and used in crisis. Inhibits T4/T3 synthesis.
• Radioactive iodide for hyperthyroidism


  Destroys thyroid tissue. Cannot have if pregnant.
• Surgical for hyperthyroidism


  Removal of a significant part of the thyroid.
• Diet for hyperthyroidism

  High calorie diet for hunger and tissue breakdown. Avoid caffeine and high fiber.
• Hashimoto's disease


  Most common form of hypothyroidism. Genetic, common In women and results from antibodies attacking the thyroid. Usually insidious for months or years.
• Hypothyroidism causes


  • Vital changes, fatigue, constipation, slow reflex, hair loss, cold intolerance.
• Goiter


  An enlarged thyroid gland due to stimulation of thyroid cells. Clue toward thyroid abnormality but not specific disorder.
• Myxedema


  Happens with longstanding hypothyroidism. Thickened, non-pitting, edematous tissue. Causes puffiness, periorbital edema and mask like effect.
• Myxedema coma

  Advancement in sluggishness, drowsiness, which progresses to impaired LOC. Iv T4 given, fluids with salts to pull fluids.
• Causes of hypothyroidism

  • Primary: autoimmune antibodies (Hashimoto's). look for thyroglobulin antibodies, ask if they have ingested iodine.
  • Secondary: TRH drops all hormones to thyroid. If there is an issue in the pituitary, everything will drop.
• May also have high cholesterol, triglycerides, anemia, and increased creatine
• Adrenal Medulla

  Secretes epinephrine
• Adrenal Cortex


  Secretes corticosteroids like glucocorticoids, mineralocorticoids, and androgens.
• Hypothalamus Corticotropin hormone

  1. -> Anterior pituitary ACTH

  2. -> adrenal produce corticosteroids
• Glucocorticoids (cortisol)


  Maintains blood glucose and has an anti-inflammatory action by suppressing the immune system.
• Mineralocorticoids (aldosterone)


  Maintains electrolyte and fluid balance.
• Androgens


  Stimulate pubic hair and sex drive in females.
• Cushing's syndrome manifestations


  • Fat deposits, weight gain, buffalo hump (neck), purple striae, moon face.
• Cushing's syndrome Causes


  Due to long term steroid use, malignancy, steroids due to asthma or cancer.
• High cortisol


  Causes fight or flight which increases HR, SVR, Vasoconstriction, and BP (Cushing's syndrome).
• Secondary hypertension

  • High risk of infections due to reduced T cells. Breakdown of tissues and depletion of muscles
• Nursing assessment for cushing's disease = Monitor for: vitals, daily weight, blood sugar, WBC's signs of infections and pneumonia. Look in mouth for thrush and provide emotional support
• Addison's disease


  Body does not produce hormones from adrenal cortex, leaving it with electrolyte imbalances, as well as diminished stress response.
• Addison's disease Causes

  • Due to autoimmune condition where body attacks adrenal cortex. Primary is adrenal insufficiency, secondary is brain issues.
• Addison's manifestations


  • Weakness, fatigue, weight loss, anorexia.
  • Hypotension, diarrhea, irritability, depression.
  • Low aldosterone leads to high K (Acidosis), low RR.
• Diagnosis of addison's

  • Lab results: hyperkalemia, hyponatremia, hypoglycemia, anemia, low urine, low cortisol, and aldosterone. Low BP for vitals.
  • EKG for arrhythmias due to high K.
  • CT and MRI.
  • ACTH stimulation: where would problem be located if high or low cortisol.
• Treatments for Addison's disease

  • Hydrocortisone which increases if more stress is present.
  • Increase salt in diet.
  • Prevent hypoglycemia and hyperkalemia.
  • Give prednisone.
  • Frequent assessments of labs with a focus on K.
• Thyroxine, cortisol, and triiodothyronine affect all body tissues.
• Levothyroxine used to treat: primary hypothyroidism, myxedema coma, simple goitre.

  
  

  Highly protein bound.