HYPOTHYROIDISM LOW & SLOW HYPERTHYROIDISM HIGH & HOT
HashimotoÕs Thyroiditis - Autoimmune T3 & T4 T3 & T4 Graves Disease - Autoimmune
Thyroidectomy, Tumors, Radioactive Iodine TSH TSH Thyrotoxicosis, Tumors,
CALCITONIN CALCITONIN
Puts ca+ back in the bone; gets it out of the blood
Exophthalmos
Decreased BP, Bradycardia, Intolerance to cold, Hair Increased BP, Tachycardia, Intolerance to heat,
Radioactive Iodine Therapy
loss, thick tongue, slow speech, brittle nails/hair, Bulging eyes, Goiter, Dyspnea on exertion, Weight Destroys thyroid hormone
constipation, muscle weakness, dry course/scaley loss, Muscle wasting, localized edema, Diarrhea, Given PO up to 3x some SIS
after
skin, menstruation irregular/heavier, weight gain Clubbing of fingers, menstruation irregular/less Up to 6-8wks for relief subside
3- 4 weeks
Outpatient w/ precautions
Anorexia
-
continue to take methima>Ole
Levothyroxine PO ÒLeaves T3 & T4 in the bodyÓ
:* RADIATION THEAPY - Radioactive for 1 week!!!
Start w/ low dose, gradually increase
Monitor BP/Pulse for s/s of HTN, CHF, MI ¥Ö:¥ Diet =
everything low
Propylthiouracil (PTU) OR a Methimazole
ÑAvoid crowds w/ methimazole
increased risk of infection
ÑWash clothes separately; no dry cleaners
Ñwash dishes in hot water & separately
Ñwash shower/sink out twice
(this is what happens when given too fast/high) ÑMonitor wt. gain w/ methimazole Ñuse Kleenex instead of handkerchief
Take as prescribed; no double doses (weight loss) women need to be med compliant ÑSit down to urinate, flush several times
Lifelong therapy** do not abruptly discontinue ÑBoth associated w/ liver failure ÑSleep separately
BEFORE: neg pregnancy test; cannot be pregnant or
Avoid fiber supplements (decrease absorption) L = life long therapy + long/slow onset (3-4wks) Jaundice/yellow sclera, dark urine, clay-color
around pregnant people after, remove jewlrey, no
E = early morning + empty stomach (1hr before)
Wait 4hrs after thyroid meds to take Antacids V = very hyper. high HR/BP/Temp (thyroid storm)
stool, elevated liver enzymes - ALT/AST/ALP) antithyroid meds 5-7 days before, NPO 2-4hrs before
Take in AM with breakfast report agitation/confusion
O = ok for baby! Pregnancy safe ( High
***no double dose, will not cure, dont stop abruptly THROID CRISIS/STORM → Hyperpyrexia + temp )
(Low RR & BP) Uncontrolled hyperthyroidism Extreme Ta c y
COMPLICATION: MYXEDEMA COMA(Emergency!!) ☆ Fever (Report any temp 1 degree higher!!)
Systolic Hypertension, Tachycardia, Abdominal pain
Acute illness, surgery, chemo, discontinuing Levothyroxine Maintain Airway
Leads to Respiratory Acidosis, Hypotension, Hypothermia, AVOID NARCOTICS & BENZOS Diet =
B/C IT SLOWS DOWN MORE Give PTU or Methimazole
shock, organ damage, death. Pts usually on Mech. Vent. everything high
Give Sodium Iodine
Give Hydrocortisone, Prednisone, Dexamethasone
oneay.E ?!:twN N8eToarmin 9gpO2
Maintain airway; Trach kit at bedside! (These steroids blocks conversions to T3 to T4)
Give Antipyretics, then Beta Blocker (propranolol)
Replace Fluids with NS
(Helps decrease BP/tachy/anxiety=arrhythmias)
Give IV Levothyroxine, IV Glucose, Glucocorticoids Cooling blanket/ice pack
Warming blanket, Check VS frequently, Monitor LOC
(Glucose given to replace cortisol & aldosterone)
normal Monitor VS q 30 mins
Monitor for cardiac arrhythmias
↑HYPOPARATHYROIDISM
raise
HYPERPARATHYROIDISM
***Parathyroid regulated calcium & phosphorus
Thyroidectomy, radiation, Low Mg & Ca CALCIUM CALCIUM
MAGNESIUM
Tumor of adrenal gland/hypothalamus,/pituitary
MAGNESIUM
ALL S/S of Hypocalcemia: PHOSPHORUS PHOSPHORUS High Ca & Mg
If you remove the ÒTÓ check the ÒCÓ PTH = Puts The calcium High
Ca+ High Ñ> PTH shuts off
Muscle cramps/spasms, seizures, fractures easily
Ca+ & Mg+ = Besties (same) Renal calculi, cardiac dysrhythmias, bone/ Ca+ Low Ñ> PTH turns on
Mg+ & Phos = Enemies (opposite)
Tingling hands/feet/mouth Diarrhea
Hypocalcemia = Chvostek & Trousseaus sign muscle weakness, GI problems
***Vit D helps calcium absorb
HYPER Ca+ = too much PTH/Ca+ in blood, spills out of organs
STONES Ñ kidney stones
MOANS Ñ fractured bones
GROANS Ñ constipation
Seizure precautions
Decrease Stimuli/noise What do we do? Take it out & treat hypercalcemia
: Renal
Give Calcium Gluconate, Mag Sulfate, Calcitriol complication (Hypercalcemia crisis = >14, normal 9-10.5)
Failure
(Vit D, helps Ca+ absorption) * check creatinine
Parathyroidectomy - take it out!!
( M= 0.6-1.2 )
F- = 0.5-1.2 Fluids & Diuretics (NS w/ furosemide & butanamide)
Diet: Avoid calcium
High Calcium/Low Phosphorus Give oral phosphates (will decrease Ca+)
Yes - turnips, almonds, spinach Give Calcitonin (helps put Ca+ back in bones)
No - milk, yogurt, processed cheese Give Glucocorticoids (helps calcitonin work better)
I THYROIDECTOMY W/ HYPERTHYROID PARATHYROIDECTOMY
Monitor VS q 15 mins until stable, then q 30 min Semi-Fowlers
monitor temp - thyroid storm/crisis - HTN, Tachy Position
Keep Suction, Oxygen, Trach Tray, Airway Kit/ETT tube at bedside
Check back of neck and pillow for bleeding Report if pt is
use pillows to support neck; prevent hyperextension sleepy / hard to arouse
after surgery
Check for respiratory difficulty (stridor/wheezing)
ask are you having any pain? Bandage too tight? = respiratory Distress
deep breathe q 3pm in-1hour
Hoarseness (damage to laryngeal nerve) can occur if talking too much
***Tingling of hand/feet/face/fingers/mouth = hypocalcemia (monitor Ca+)
Keep CaGluc or CaCl at bedside to administer if s/s of hypocalcemia
EDUCATTION: Life long thyroid replacement!!!
, ATCH BP
↓ sugar
a :¥¥ e→ ADDISONS
K+
Na+
BP
SUGAR
WEIGHT
CORTISOL
CUSHINGS WBC
Risk for Infection
Autoimmune, Infection (TB), **All about the missing hormones: Cortisol & Aldosterone Corticosteroid Excess giucocofrticoid
Cortisol = controls glucose + fight/flight inflammatory process Corticosteroid Therapy #1 cause
Hypothalamus or Pituitary Tumor Aldosterone = controls Na+, K+, water balance which controls BP Hypothalamus/Pituitary Tumor
Moon face
ACTH elevated Buffalo hump
Hyperkalemia K+ Truncal obesity
Hyponatremia Na+ d/t aldosterone Weight gain
C
Hypotension BP Muscle atrophy
Hypoglycemia d/t cortisol Thinning skin
Shock Osteoporosis
Tachycardia Increased risk of Infection
Bronze pigmented skin GI Ulcer
FVO
Replace hydrocortisone Ñ Solumedrol, solu-cortef, hydrocortisone
Replace aldosterone Ñ fludrocorisone - balance Na+ and K+ 1. Always ask what meds theyÕre on
Replace fluid loss Ñ Hypertonic 3% NS COPD, Autoimmune, RA, Asthma, MS, Lupus take steroids
2. Decrease amount of corticosteroids
medication may need to be
During stress/ infection
=
***Must taper off!! Too quick = adrenal insufficiency
increased to prevent
(If too quick adrenal gland cant rebound quickly enough, so
adrenal insufficiency
you throw them in Addisons Crisis)
3. Teach Low Sodium Diet (2-4g/day)
Eat baked/grilled chicken, fish, pork tenderloin
Monitor canned good b/c theyÕre high in sodium Na+
PHEOCHROMOCYTOMA 1
"
Catecholamine (epinephrine and norepinephrine)
" Adrenalcrisis producing benign tumor in adrenal medulla
ADDISONÕS CRISIS **life threatening emergency
When the need for cortisol or aldosterone is greater than the
available supply HTN **Hallmark sign Headache
Profuse sweating
FIX ALDOSTERONE Apprehension, sense of impending doom
Hormone Replacement Ñ D5 1/2NS rapid infusion dexamethasone Palpitations
IV bolus and drip (drip over 8hr for 12hr) will also give H2 Blocker Flushing Monitor Vitals
to prevent risk of ulcers b/c steroids cause GI issues N/V, Anxiety, Abdominal pain Manage BP
Monitor heart rhythm
FIX HYPERKALEMIA Strict I/OÕs
Kayexalate Ñ takes longer; to remove K+ TREATMENT Pain mgmt
Loop Diuretics (Furosemide) Ñ avoid K+ sparing (Aldactone) Surgery to remove tumors & adrenal gland BG testing
Insulin, Dextrose and NS to drive K+ back into cells Do not palpate abdomen!!! Causes severe HTN
Risk for dysrhythmias/VFib!! Cardiac Monitor. Tall peaked T waves Take BP in same arm for accurate reading
FIX CORTISOL
EDUCATE
IV glucose Ñ monitor blood sugars every hour
Do not smoke, drink caffeine, or change positions suddenly
Avoid eating foods high in Thymine (red wine, chocolate, cheese)
HashimotoÕs Thyroiditis - Autoimmune T3 & T4 T3 & T4 Graves Disease - Autoimmune
Thyroidectomy, Tumors, Radioactive Iodine TSH TSH Thyrotoxicosis, Tumors,
CALCITONIN CALCITONIN
Puts ca+ back in the bone; gets it out of the blood
Exophthalmos
Decreased BP, Bradycardia, Intolerance to cold, Hair Increased BP, Tachycardia, Intolerance to heat,
Radioactive Iodine Therapy
loss, thick tongue, slow speech, brittle nails/hair, Bulging eyes, Goiter, Dyspnea on exertion, Weight Destroys thyroid hormone
constipation, muscle weakness, dry course/scaley loss, Muscle wasting, localized edema, Diarrhea, Given PO up to 3x some SIS
after
skin, menstruation irregular/heavier, weight gain Clubbing of fingers, menstruation irregular/less Up to 6-8wks for relief subside
3- 4 weeks
Outpatient w/ precautions
Anorexia
-
continue to take methima>Ole
Levothyroxine PO ÒLeaves T3 & T4 in the bodyÓ
:* RADIATION THEAPY - Radioactive for 1 week!!!
Start w/ low dose, gradually increase
Monitor BP/Pulse for s/s of HTN, CHF, MI ¥Ö:¥ Diet =
everything low
Propylthiouracil (PTU) OR a Methimazole
ÑAvoid crowds w/ methimazole
increased risk of infection
ÑWash clothes separately; no dry cleaners
Ñwash dishes in hot water & separately
Ñwash shower/sink out twice
(this is what happens when given too fast/high) ÑMonitor wt. gain w/ methimazole Ñuse Kleenex instead of handkerchief
Take as prescribed; no double doses (weight loss) women need to be med compliant ÑSit down to urinate, flush several times
Lifelong therapy** do not abruptly discontinue ÑBoth associated w/ liver failure ÑSleep separately
BEFORE: neg pregnancy test; cannot be pregnant or
Avoid fiber supplements (decrease absorption) L = life long therapy + long/slow onset (3-4wks) Jaundice/yellow sclera, dark urine, clay-color
around pregnant people after, remove jewlrey, no
E = early morning + empty stomach (1hr before)
Wait 4hrs after thyroid meds to take Antacids V = very hyper. high HR/BP/Temp (thyroid storm)
stool, elevated liver enzymes - ALT/AST/ALP) antithyroid meds 5-7 days before, NPO 2-4hrs before
Take in AM with breakfast report agitation/confusion
O = ok for baby! Pregnancy safe ( High
***no double dose, will not cure, dont stop abruptly THROID CRISIS/STORM → Hyperpyrexia + temp )
(Low RR & BP) Uncontrolled hyperthyroidism Extreme Ta c y
COMPLICATION: MYXEDEMA COMA(Emergency!!) ☆ Fever (Report any temp 1 degree higher!!)
Systolic Hypertension, Tachycardia, Abdominal pain
Acute illness, surgery, chemo, discontinuing Levothyroxine Maintain Airway
Leads to Respiratory Acidosis, Hypotension, Hypothermia, AVOID NARCOTICS & BENZOS Diet =
B/C IT SLOWS DOWN MORE Give PTU or Methimazole
shock, organ damage, death. Pts usually on Mech. Vent. everything high
Give Sodium Iodine
Give Hydrocortisone, Prednisone, Dexamethasone
oneay.E ?!:twN N8eToarmin 9gpO2
Maintain airway; Trach kit at bedside! (These steroids blocks conversions to T3 to T4)
Give Antipyretics, then Beta Blocker (propranolol)
Replace Fluids with NS
(Helps decrease BP/tachy/anxiety=arrhythmias)
Give IV Levothyroxine, IV Glucose, Glucocorticoids Cooling blanket/ice pack
Warming blanket, Check VS frequently, Monitor LOC
(Glucose given to replace cortisol & aldosterone)
normal Monitor VS q 30 mins
Monitor for cardiac arrhythmias
↑HYPOPARATHYROIDISM
raise
HYPERPARATHYROIDISM
***Parathyroid regulated calcium & phosphorus
Thyroidectomy, radiation, Low Mg & Ca CALCIUM CALCIUM
MAGNESIUM
Tumor of adrenal gland/hypothalamus,/pituitary
MAGNESIUM
ALL S/S of Hypocalcemia: PHOSPHORUS PHOSPHORUS High Ca & Mg
If you remove the ÒTÓ check the ÒCÓ PTH = Puts The calcium High
Ca+ High Ñ> PTH shuts off
Muscle cramps/spasms, seizures, fractures easily
Ca+ & Mg+ = Besties (same) Renal calculi, cardiac dysrhythmias, bone/ Ca+ Low Ñ> PTH turns on
Mg+ & Phos = Enemies (opposite)
Tingling hands/feet/mouth Diarrhea
Hypocalcemia = Chvostek & Trousseaus sign muscle weakness, GI problems
***Vit D helps calcium absorb
HYPER Ca+ = too much PTH/Ca+ in blood, spills out of organs
STONES Ñ kidney stones
MOANS Ñ fractured bones
GROANS Ñ constipation
Seizure precautions
Decrease Stimuli/noise What do we do? Take it out & treat hypercalcemia
: Renal
Give Calcium Gluconate, Mag Sulfate, Calcitriol complication (Hypercalcemia crisis = >14, normal 9-10.5)
Failure
(Vit D, helps Ca+ absorption) * check creatinine
Parathyroidectomy - take it out!!
( M= 0.6-1.2 )
F- = 0.5-1.2 Fluids & Diuretics (NS w/ furosemide & butanamide)
Diet: Avoid calcium
High Calcium/Low Phosphorus Give oral phosphates (will decrease Ca+)
Yes - turnips, almonds, spinach Give Calcitonin (helps put Ca+ back in bones)
No - milk, yogurt, processed cheese Give Glucocorticoids (helps calcitonin work better)
I THYROIDECTOMY W/ HYPERTHYROID PARATHYROIDECTOMY
Monitor VS q 15 mins until stable, then q 30 min Semi-Fowlers
monitor temp - thyroid storm/crisis - HTN, Tachy Position
Keep Suction, Oxygen, Trach Tray, Airway Kit/ETT tube at bedside
Check back of neck and pillow for bleeding Report if pt is
use pillows to support neck; prevent hyperextension sleepy / hard to arouse
after surgery
Check for respiratory difficulty (stridor/wheezing)
ask are you having any pain? Bandage too tight? = respiratory Distress
deep breathe q 3pm in-1hour
Hoarseness (damage to laryngeal nerve) can occur if talking too much
***Tingling of hand/feet/face/fingers/mouth = hypocalcemia (monitor Ca+)
Keep CaGluc or CaCl at bedside to administer if s/s of hypocalcemia
EDUCATTION: Life long thyroid replacement!!!
, ATCH BP
↓ sugar
a :¥¥ e→ ADDISONS
K+
Na+
BP
SUGAR
WEIGHT
CORTISOL
CUSHINGS WBC
Risk for Infection
Autoimmune, Infection (TB), **All about the missing hormones: Cortisol & Aldosterone Corticosteroid Excess giucocofrticoid
Cortisol = controls glucose + fight/flight inflammatory process Corticosteroid Therapy #1 cause
Hypothalamus or Pituitary Tumor Aldosterone = controls Na+, K+, water balance which controls BP Hypothalamus/Pituitary Tumor
Moon face
ACTH elevated Buffalo hump
Hyperkalemia K+ Truncal obesity
Hyponatremia Na+ d/t aldosterone Weight gain
C
Hypotension BP Muscle atrophy
Hypoglycemia d/t cortisol Thinning skin
Shock Osteoporosis
Tachycardia Increased risk of Infection
Bronze pigmented skin GI Ulcer
FVO
Replace hydrocortisone Ñ Solumedrol, solu-cortef, hydrocortisone
Replace aldosterone Ñ fludrocorisone - balance Na+ and K+ 1. Always ask what meds theyÕre on
Replace fluid loss Ñ Hypertonic 3% NS COPD, Autoimmune, RA, Asthma, MS, Lupus take steroids
2. Decrease amount of corticosteroids
medication may need to be
During stress/ infection
=
***Must taper off!! Too quick = adrenal insufficiency
increased to prevent
(If too quick adrenal gland cant rebound quickly enough, so
adrenal insufficiency
you throw them in Addisons Crisis)
3. Teach Low Sodium Diet (2-4g/day)
Eat baked/grilled chicken, fish, pork tenderloin
Monitor canned good b/c theyÕre high in sodium Na+
PHEOCHROMOCYTOMA 1
"
Catecholamine (epinephrine and norepinephrine)
" Adrenalcrisis producing benign tumor in adrenal medulla
ADDISONÕS CRISIS **life threatening emergency
When the need for cortisol or aldosterone is greater than the
available supply HTN **Hallmark sign Headache
Profuse sweating
FIX ALDOSTERONE Apprehension, sense of impending doom
Hormone Replacement Ñ D5 1/2NS rapid infusion dexamethasone Palpitations
IV bolus and drip (drip over 8hr for 12hr) will also give H2 Blocker Flushing Monitor Vitals
to prevent risk of ulcers b/c steroids cause GI issues N/V, Anxiety, Abdominal pain Manage BP
Monitor heart rhythm
FIX HYPERKALEMIA Strict I/OÕs
Kayexalate Ñ takes longer; to remove K+ TREATMENT Pain mgmt
Loop Diuretics (Furosemide) Ñ avoid K+ sparing (Aldactone) Surgery to remove tumors & adrenal gland BG testing
Insulin, Dextrose and NS to drive K+ back into cells Do not palpate abdomen!!! Causes severe HTN
Risk for dysrhythmias/VFib!! Cardiac Monitor. Tall peaked T waves Take BP in same arm for accurate reading
FIX CORTISOL
EDUCATE
IV glucose Ñ monitor blood sugars every hour
Do not smoke, drink caffeine, or change positions suddenly
Avoid eating foods high in Thymine (red wine, chocolate, cheese)
