Responses to Altered endocrine function

• Endocrine glands

  • THYROID GLAND
  • PARATHYROID GLAND
  • ADRENAL GLAND
  • PITUITARY GLAND
  • PANCREAS
• Hormones produced by thyroid gland

  • T3- triiodothyronine
  • T4- tetraiodothyroxine
  • Calcitonin- promotes calcium reabsorption to the bone
• Uptake of iodine is required in the production of thyroid hormones
• Function of T3 and T4

  Regulate the body's metabolic activity
• Cretinism


  Caused by hyposecretion of thyroid hormones during fetal life, leading to stunted growth and development
• Goiter


  Thyroid gland enlargement caused by oversecretion of thyroid hormones or inadequate iodine intake, leading to overstimulation of TSH and consequently, oversecretion of thyroid hormones
• Assessment of the thyroid

  • Inspection: Swelling, Asymmetry
  • Palpation: Size, shape, consistency, symmetry, tenderness (ask the patient to swallow during assessment)
  • Auscultation: Bruit
• Thyroid function tests

  • Serum TSH (high sensitivity; routine at 35 years old, every 5 years)
  • Serum free T4 (test of choice to patients undergoing treatment for hyperthyroidism)
  • Serum T3 (most accurate indicator for hyperthyroidism) and T4
  • T3 resin uptake (test for patients receiving therapeutic or diagnostic doses of iodine; inverse relationship with thyroid hormone level)
  • Thyroid antibodies (for autoimmune thyroid problems)
  • Radioactive iodine uptake (direct relationship with thyroid hormone levels)
  • Fine needle aspiration biopsy
  • Thyroid scan
  • Serum thyroglobulin
• Nursing Considerations: Assess if patient took medications containing iodine because they may alter results
• Hyperthyroidism

  • A common endocrine disorder
  • A form of thyrotoxicosis resulting from an excessive synthesis and secretion of endogenous and exogenous thyroid hormones by the thyroid
• Causes of hyperthyroidism

  • Immune related (Grave's)
  • Thyroiditis
  • Excessive thyroid hormone intake
  • overactive thyroid nodules
  • too much iodine
  • too much thyroid hormone medicine
  • noncancerous tumor of pituitary gland
• Signs and symptoms of hyperthyroidism: thyrotoxicosis

  • Nervousness (presenting symptom)
  • Agitation, emotional hyperactivity
  • Increase HR, BP, Palpitations
  • Heat intolerance
  • Flushed, warm, soft skin
  • Fine tremors of the hand
  • Exophthalmos (bulging eyes)
  • Weight loss even with increase appetite
  • Thrill or pulsations upon thyroid palpation
  • Bruit upon thyroid auscultation
• Medical management of hyperthyroidism

  • Radioactive therapy
  • Thyroidectomy- must be in euthyroid state prior to surgery, anti-thyroid drugs given to decrease TH levels, Lugol's solution given to decrease blood loss
  • Beta-blockers
  • Anti-thyroid medications- propylthiouracil (DOC for pregnant women), Methimazole, WOF agranulocytosis
• Nursing management of hyperthyroidism

  • Improve nutritional intake (small, frequent meals, increase calorie and CHON diet, environment conducive for meals, weight and dietary intake monitoring)
  • Thermoregulation
  • Addressing psychosocial issues
  • Monitoring for complications
• Hypothyroidismor underactive thyroid


  Results from sub-optimal levels of thyroid hormone
• Causes of hypothyroidism


  • Autoimmune disease (Hashimoto's)
  • Aging
  • Radiation therapy
  • Medications
  • Iodine imbalance
  • As secondary disorder
  • thyroidectomy
  • congenital hypothyroidism
  • thyroiditis
• Signs and symptoms of hypothyroidism

  • Extreme fatigue
  • Hair loss
  • Brittle nails
  • Dry nails
  • Numbness and tingling of fingers
  • Husky/ hoarse voice
  • Menstrual disturbances
  • Cold intolerant
  • Weight gain even with lack of appetite
  • Masklike face
  • Myxedema
  • puffy or swollen face
  • droopy eyelids
  • constipation
• Medical management of hypothyroidism

  • Levothyroxine
  • Monitoring for cardiac dysfunction and medication interactions (as needed)
  • Addressing symptoms as manifested
  • Severe forms: Life support measures
  • lifestyle modification
• Pre-operative care for thyroidectomy

  • Instruct on high caloric, high protein diet
  • Instruct to take supplementary vitamins, as prescribed
  • Instruct to avoid stimulants prior to surgery
  • Discuss pre-operative tests to be taken and their indications
  • Address psychosocial concerns
  • Instruct and demonstrate how to support the neck post-operatively to avoid strain on operative site
• Post-operative care for thyroidectomy

  • Assess for hemodynamic stability and bleeding on site by checking the nape for pooling of blood
  • Monitor respiratory status and prepare tracheostomy set at bedside
  • Position in semi-fowler's position, supporting the head with pillows
  • WOF inability to speak or voice changes; possibly laryngeal nerve damage
  • Provide high caloric diet
• Adrenal medulla


  • Hormone- Epinephrine, Norepinephrine
  • Function- Fight or Flight response
• Adrenal cortex layers and hormones

  • Glomerulosa: Glucocorticoid (Hydrocortisone) - Increase blood glucose levels, anti-inflammatory effect, suppression of allergic response
  • Fasciculata: Mineralocorticoid (Aldosterone) - Sodium retention, potassium/hydrogen excretion
  • Reticularis: Androgens - Secondary sex characteristics
• Addison's disease / Adrenocortical insufficiency

  Caused by inadequate formation of hormones originating from the adrenal cortex due to idiopathic, autoimmune, drug-mediated, and other factors
• Clinical manifestations of Addison's disease

  • Muscle weakness
  • Anorexia
  • GI symptoms
  • Emaciation
  • Bronzing of the skin and mucous membranes
  • Fatigue
  • Hypotension
  • Decrease glucose, sodium
  • Increase potassium
  • Mental status changes
  • Addisonian Crisis - Cyanosis + Signs of Circulatory Shock
• Diagnostics for Addison's disease

  • Decrease blood/ urine ACTH, serum cortisol
• Medical management of Addison's disease

  • Control circulatory shock
• Nursing management of Addison's disease

  • Close monitoring (WOF signs of circulatory shock)
  • Improving fluid balance (High sodium diet as tolerated)
  • Maintaining stress-free environment
• Cushing's syndrome


  Caused by excessive adrenocortical activity, leading to hypersecretion of hormones originating from the adrenal cortex
• Clinical manifestations of Cushing's syndrome

  • Central-type obesity
  • "Buffalo hump" (shoulders)
  • Heavy trunk
  • Thin extremities
  • Muscle wasting
  • Thin, fragile skin
  • Weakness and lassitude
  • Altered sleep patterns
  • immunosuppression
  • Moon-faced appearance
  • Virilization
  • Weight gain
  • Possible: HPN, heart failure
  • Hirsutism
  • Breast atrophy
  • Amenorrhea
  • Enlarged clitoris
  • Deep Voice
• Diagnostics for Cushing's syndrome

  • Dexamethasone suppression test - Dexamethasone is given orally at 11PM, then plasma cortisol is checked at 8am the next morning
• Medical management of Cushing's syndrome

  • Depends on the cause of syndrome- hypothalamic/ pituitary or adrenal
• Nursing management of Cushing's syndrome

  • Patient safety (protective environment)
  • Monitoring for infection
  • Pre- and post- operative care for adrenalectomy or transsphenoidal hypophysectomy
  • Promoting balance between rest and activity
  • Maintaining skin integrity
  • Nutritional support for improving body image and safety (Low Carb, Sodium, high protein, calcium and vitamin D diet)
  • Addressing psychosocial issues
• thyroid gland

  A) mood

  B) heart rate

  C) energy

  D) growth

  E) nerves

  F) breathing

  G) liver

  H) functioning

  
• overactive thyroid

  A) hyperthyroidism

  
• symptoms of hyperthyroidism

  A) bulging eyes

  B) goiter

  C) swelling

  D) increased palpitations

  E) hunger

  F) mood swings

  G) weight loss

  H) hand tremors

  I) breathing problems

  J) hair loss

  
• risk factors of hyperthyroidism

  • have a family history of thyroid disease
  • have other health problems, including
  • Pernicious anemia (vitamin B12 deficiency)
  • Type 1 or type 2 diabetes
  • Primary adrenal insufficiency, a disorder of hormones
  • eat large amounts of food containing iodine such as kelp
  • use medicines that contain iodine
  • use nicotine products
  • pregnant within the past 6 months
• complications of hyperthyroidism

  • stroke, heart failure
  • Graves’ ophthalmopathy
  • osteoporosis
  • menstrual cycle and fertility issues
• hyperthyroidism pathophysiology

  1. hypothalamus releases thyrotropin releasing hormone
  2. anterior pituitary releases TSH
  3. production of T3, T4, calcitonin

  A) predisposing/ precipitating

  B) excessive stimulation

  C) TSH

  D) T3/T4

  
• thyrotoxicosis - hormone levels are elevated with or without increase thyroid hormone synthesis
• enlarged thyroid- goiter

  1. toxic goiter- large with excessive thyroid hormone levels
  2. non-toxic- goiter- large with normal TSH levels (probably due to lack of iodine)