Hyperthyroidism
(Grave’s disease)
- High and hot (high energy and high metabolism
- Graves = Gains
- High T3 and T4 (normal = 4-12) (Look at these first)
- Cause: Graves’ disease, excess iodine
- TSH = Opposite of T3 and T4
- S/S: Amped up – lots of energy, grape eyes (exophthalmos), golf balls in throat, high BP –
180/100+ (HTN crisis),Tachycardia, palpitation, A fib, high weight loss (high energy burn),
diaphoresis – heat intolerance, High GI – Diarrhea
- Monitor for thyroid storm: agitation and confusion, restlessness, high temperatures
over 105F, high HR and BP
- Treatment: High calories, proteins and carbs. 6-8 frequent meals, low fiber, no caffeine,
no spicy food.
- Thyroidectomy: Monitor for high symptoms. A: airway (laryngeal stridor, noisy breathing,
weak voice) priority: endotracheal tube at bedside, B: Breathing that is noisy (laryngeal
stridor), C: Circulation (bleeding around pillow and insertion site) position neutral head
and neck alignment in semi-fowlers position no extending the neck. C: Hypocalcemia—
tingling and numbness around mouth and fingers, trousseaus and Chvostek
- Pharm:
- Methimazole—Not baby safe
- Propylthiouracil (PTU) “Puts Thyroid Underground”, baby safe, report fever/sore throat
- SSKI (Potassium iodine) S: Shrinks the thyroid, S: Stains teeth (use straw), K: Keep 1 hr.
apart from other meds.
- Beta blockers “-lol” specifically propranolol.
- Radioactive Iodine Uptake (RAIU): destroys they thyroid in one dose so monitor for
extreme lows. Very toxic – before giving need negative pregnancy test, no neck jewelry
or dentures, hold all thyroid meds 5-7 days before, awake (no anesthesia or sedation).
NPO 2-4 hours before and 1-2 hours after. After given avoid everyone for 1-3 days – no
restroom, utensils, nothing.
-
, Hypothyroidism
(Hashimoto’s)
- Low and slow
- Low T3 and T4(normal = 4-12) (Look here first)
- Iodine deficiency in developing countries
- Levothyroxine
- Cause: Hashimoto’s, pituitary tumor, iodine deficiency in diet, thymectomy
- S/S: fatigue, weakness, muscle pain and aches, edema in legs and under eyes, weight
gain, low digestion – constipation, alopecia, altered LOC, depression, low sex drive, dry
skin, slow skin turgor, amenorrhea or irregular periods
- Prevent Myxedema coma: Low RR rate (resp failure), Low BP and HR, Low temp – cold
intolerance – No electric blankets. Can happen post thyroidectomy or abrupt stopping of
levothyroxine.
- Treatment: Low calories, low cholesterol, low saturated fats, frequent rest periods.
Endotracheal intubation for myxedema coma. Levothyroxine (leaves T3 and T4 in the
body): Never abruptly stop medication, not a cure just hormone replacement, avoid
benzos and narcotics in general
- L: lifelong drug, long slow onset (3-4 weeks)
- E: early morning and empty stomach. 30-60 min before breakfast. Never at night
- V: very hyper. Report signs of hyperthyroidism—agitation and confusion
- O: oh the baby’s fine – pregnancy safe
(Grave’s disease)
- High and hot (high energy and high metabolism
- Graves = Gains
- High T3 and T4 (normal = 4-12) (Look at these first)
- Cause: Graves’ disease, excess iodine
- TSH = Opposite of T3 and T4
- S/S: Amped up – lots of energy, grape eyes (exophthalmos), golf balls in throat, high BP –
180/100+ (HTN crisis),Tachycardia, palpitation, A fib, high weight loss (high energy burn),
diaphoresis – heat intolerance, High GI – Diarrhea
- Monitor for thyroid storm: agitation and confusion, restlessness, high temperatures
over 105F, high HR and BP
- Treatment: High calories, proteins and carbs. 6-8 frequent meals, low fiber, no caffeine,
no spicy food.
- Thyroidectomy: Monitor for high symptoms. A: airway (laryngeal stridor, noisy breathing,
weak voice) priority: endotracheal tube at bedside, B: Breathing that is noisy (laryngeal
stridor), C: Circulation (bleeding around pillow and insertion site) position neutral head
and neck alignment in semi-fowlers position no extending the neck. C: Hypocalcemia—
tingling and numbness around mouth and fingers, trousseaus and Chvostek
- Pharm:
- Methimazole—Not baby safe
- Propylthiouracil (PTU) “Puts Thyroid Underground”, baby safe, report fever/sore throat
- SSKI (Potassium iodine) S: Shrinks the thyroid, S: Stains teeth (use straw), K: Keep 1 hr.
apart from other meds.
- Beta blockers “-lol” specifically propranolol.
- Radioactive Iodine Uptake (RAIU): destroys they thyroid in one dose so monitor for
extreme lows. Very toxic – before giving need negative pregnancy test, no neck jewelry
or dentures, hold all thyroid meds 5-7 days before, awake (no anesthesia or sedation).
NPO 2-4 hours before and 1-2 hours after. After given avoid everyone for 1-3 days – no
restroom, utensils, nothing.
-
, Hypothyroidism
(Hashimoto’s)
- Low and slow
- Low T3 and T4(normal = 4-12) (Look here first)
- Iodine deficiency in developing countries
- Levothyroxine
- Cause: Hashimoto’s, pituitary tumor, iodine deficiency in diet, thymectomy
- S/S: fatigue, weakness, muscle pain and aches, edema in legs and under eyes, weight
gain, low digestion – constipation, alopecia, altered LOC, depression, low sex drive, dry
skin, slow skin turgor, amenorrhea or irregular periods
- Prevent Myxedema coma: Low RR rate (resp failure), Low BP and HR, Low temp – cold
intolerance – No electric blankets. Can happen post thyroidectomy or abrupt stopping of
levothyroxine.
- Treatment: Low calories, low cholesterol, low saturated fats, frequent rest periods.
Endotracheal intubation for myxedema coma. Levothyroxine (leaves T3 and T4 in the
body): Never abruptly stop medication, not a cure just hormone replacement, avoid
benzos and narcotics in general
- L: lifelong drug, long slow onset (3-4 weeks)
- E: early morning and empty stomach. 30-60 min before breakfast. Never at night
- V: very hyper. Report signs of hyperthyroidism—agitation and confusion
- O: oh the baby’s fine – pregnancy safe
