Endocrine

• Hypothyroidism signs and symptoms

  • Intolerance to cold
  • Extreme Fatigue
  • Thick tongue
  • Brittle nails and hair
  • Hair loss
  • Constipation
• Hyperthyroidism signs and symptoms

  • Intolerance to heat
  • Bulging eyes
  • Facial flushing
  • Enlarged thyroid
  • Tachycardia
  • Weight loss
  • Finger clubbing
  • Diarrhea
• Hypothyroid treatments


  Replacement of thyroid hormone
• Levothyroxine (Synthroid)


  Synthetic T4, drug of choice for hypothyroidism treatment
• Levothyroxine


  • Given PO and well absorbed in empty stomach (30-60 min, prior to breakfast)
  • Take the same time, every day
  • Safe for pregnancy
  • Monitor height and development in infants and children
• Side effects of Levothyroxine


  • CNS: insomnia, irritation, nervousness
  • GI: N/V/D, weight loss
  • Endocrine: no menstrual cycle
• Adverse effects of Levothyroxine

  • CV: Hypotension, Palpitation, A-fib
  • Bone: Osteoporosis
  • CNS: Seizures
• Thyroid crisis/storm


  Extreme tachycardia, widen diastolic/systolic, high temperature
• Methimazole


  Drug of choice for hyperthyroidism treatment, inhibits thyroid hormone, blocks thyroid action but does not destroy
• Uses of Methimazole


  • Graves disease
  • Adjunct to radiation therapy
  • Suppressed thyroid synthesis in preparation for thyroidectomy
• Side effects of Methimazole

  • CNS: HA, Dizziness, drowsiness, weakness, tiredness
  • GI: stomach pain, loss of taste, vomiting, heartburn
  • Hematologic: Agranulocytosis (decrease WBC)
• Patient education for Methimazole


  • Safer than PTU (except in 1st trimester)
  • Avoid in 1st trimester of pregnancy
  • Agranulocytosis most serious and dangerous toxicity
  • Report sore throat, fever immediately
• Propylthiouracil (PTU)


  Inhibits thyroid production AND prevents conversion of T4 to T3 in the periphery, second line drug generally not preferred over methimazole
• Uses of PTU


  • Pregnancy
  • Preferred during thyroid storm/thyrotoxic crisis
  • Pt's intolerant of Methimazole
• Side effects of PTU

  • CNS: Dizziness, sleepiness, HA, vertigo, tingling
  • GI: vomiting, loss of taste, heartburn, stomach pain
  • CV: chest pain, increase risk of bleeding, SOB, edema
  • Can also cause agranulocytosis
  • Risk for liver injury
• Patient teaching for PTU

  Shorter half life requiring multiple doses
• PTU is safer in pregnancy and in breast milk, does not cross placenta as easily as methimazole
• Radioactive Iodine 131I and 123I

  131I: Thyroid Cancer - high dose, Hyperthyroidism - lower dose

  123I: Diagnostic testing for hypo/hyper
• Contraindications for radioactive iodine: Pregnancy/Lactation, Pediatric patients
• Growth hormone releasing hormone (GH-RH) Somatropin


  Used for growth hormone deficiency
• Nursing assessment for Somatropin

  • Obtain baseline vital signs for future comparison - Report abnormal results
  • Assess fluid, hydration, and electrolyte statuses - Report abnormal findings
  • Assess patients for an infectious process. Corticotropin can suppress signs and symptoms of infection
  • Note the patient's physical growth. If a child, compare growth with reported standards. Report findings.
• Recommended uses of Somatropin


  Used in patients experiencing growth failure
• Side effects of Somatropin

  • CV: peripheral edema, weakness
  • CNS: headache
  • MUSCULOSKELETAL: paresthesia, arthralgia, myalgia
• Adverse effects of Somatropin


  • Seizures
  • Secondary malignancy (leukemia)
  • Intracranial HTN
• Athletes should not take GH to build muscle because of its serious side effect as well as it effect on insulin
• Somatropin should be administered to child before the epiphyses are fused
• Long term therapy with Somatropin can eventually cause diabetes
• Somatropin cannot be taken with corticosteroids as they inhibit the effects of somatropin
• Growth hormone inhibiting hormone (GH-IH) Somatostatin


  Used for growth hormone excess
• Drugs for growth hormone excess- gigantism and acromegaly


  Pegvisomant, Lanreotide, Octreodite, Bromocriptine
• Mechanism of action of these drugs

  GI receptor antagonist so they block GI receptor sites or inhibit the secretion of GH
• Adverse effects of these drugs


  Pegvisomant - CV: chest pain, HTN, Lab: elevated hepatic transaminases

  Octreodtide - CV: cardiac toxicity (bradycardia and arrhythmias)

  Bromocriptine - CV: cardiac toxicity (HTN, MI, Angina), cerebrovascular toxicity (CVA and seizure)