1. Thyroid And Parathyroid

2. Learning outcomes
Describe the definition, etiology. Clinical manifestations , management, nursing care for client with:
Hyperthyroidism.
Hypothyroidism.
MINTS

3. Hyperthyroidism Hyperthyroidism
Thyroid hormone thyroxin (T4) and triode thyroxine (T3) more active form, regulate energy metabolism, and growth and development.
Hyperthyroidism
It is sustained, increased synthesis and release of thyroid hormone by the thyroid gland.

4. Hyperthyroidism- Aetiology
The incidence is 4 to 10 times greater in women, and highest frequency is in the years age
Toxic diffuse goiter (Grave’s disease):
Is an autoimmune disorder(develops antibodies against various antigens within the thyroid gland , by insufficient iodine supply, infection, stress.

5. Hyperthyroidism- Aetiology
2. Toxic multinodular goiter(plummer’s disease) common in iodine deficient area.
3. Toxic adenoma
4. Thyroiditis: Is an inflammatory process in the thyroid by bacterial or fungal infection,
5. T3 thypotoxicism: T3 level elevated but cause is unknown.
MINTS

6. Hyperthyroidism- Aetiology Cont.
6. Hyperthyroidism caused by metastatic thyroid cancer. 7. Pituitary hyperthyroidism: Rare pituitary adenomas. 8. Iodine induced hyperthyroid over production by administration of supplemental iodine to a person with endemic goiter.

7. Hyperthyroidism- Clinical Manifestation
Cardiovascular:
Hypertension; increased rate and force of cardiac contractions; rapid pulse; increased cardiac output; arrhythmias; palpitations; angina.
Respiratory:
Increased respiratory rate; dyspnoea on mild exertion.
Musculoskeletal:
Fatigue, muscle weakness, dependent oedemas, osteoporosis.

8. Hyperthyroidism- Clinical Manifestation
Gastrointestinal:
Increased appetite, thirst, weight loss, increased peristalsis, diarrhoea, increased bowel sound, splenomegaly, hepatomegaly.
Integumentary:
Warm, smooth, moist skin; thin brittle nails, hair loss, palmer erythema; fine silky hair .

9. Hyperthyroidism- Clinical Manifestation
Nervous System
Difficulty in focussing eyes. Nervousness; fine tremor(of fingers and tongue); insomnia; liability of mood, restlessness, personality changes, depression, fatigue, apathy, lack of ability to concentrate, stupor, coma.
Reproductive:
Menstrual irregularities; oligomenorrhea, amenorrhoea; libido
Others:
Intolerance to heat; Temp., exophthalmoses.

10. Hyperthyroidism- management
Three classes of medications:
1. Ant thyroids of thiomide, which inhibit the synthesis of thyroid hormone.
2. Iodine, which inhibits the release of thyroid hormone Eg- Radioactive iodine.
It is administered orally in one dose, per/g. Of thyroid tissue.
3. Beta- adrenergic blockers, such as Inderal
Surgical Treatment
One lobe (subtotal). Removal gland (total thyroidectomy

11. Hyperthyroidism- Ng. management
Placing the client in calm, cool room.
Encouraging and assisting with exercise.
Restricting visitors who upset the client.
Establishing a supportive, trusting relationship

12. Hyperthyroidism- Ng. management
Applying artificial tears to soothe and moisten
conjunctival membrane & wearing dark-colored
glasses.
Using light bed covering and change it.
Salt restriction and elevate client’s head to
reduce pre- orbital oedema.

13. Hyperthyroidism- Ng. management
If the client receiving radiation therapy:
Flush the toilet two or three times after each use.
Increase intake of fluids to aid excretion.
Sleep alone for few days and avoid kissing .
Do not breast feed, delay pregnancy after 6 m.
RAI should not be used in pregnant women because of the teratogenic effects on foetus

14. Hyperthyroidism- Ng. management
As recovery ensure the nurse should:
Promote adequate rest (back rubs, hot milk)
Maintain increase activity tolerance
encourage short walk, rest between activity
Maintain adequate nutrition intake
monitor I&O, weight daily, protein & cal.
Promote good eye care (dark glass)
Facilitate improved coping.
Enhance client knowledge.

15. Hypothyroidism Definition
Is a metabolic state resulting from a deficiency
of thyroid hormone that may occur at any age Congenital hypothyroidism results in a condition called Cretinism.
Aetiology
Loss or atrophy of thyroid tissue
Autoimmune thyroiditis, ablative, therapy for hyperthyroidism, thyrotoxic drugs, maldevelopment, radiation for head.

16. Hypothyroidism-Aetiology Cont.
Loss of trophic stimulation
Pituitary or hypothalamus dysfunction.
Miscellaneous alteration
Deficit in hormone biosynthesis, peripheral
resistance to thyroid hormone, iodine deficit
The most frequent causes
1. Haiter any enlargement of the thyroid gland, cancer or inflammation (simple goiter),

17. Hypothyroidism-Aetiology Cont.
2. Thyroiditis
Acute thyroiditis : results from infection of thyroid by pyogenic organisms.
Subacute nonsuppurative thyroiditis: may follow an upper respiratory infection.
Chronic thyroiditis.
Ablative therapy.
Total thyroidectomy, radiation therapy of pituitary or thyroid gland.

18. Hypothyroidism- Clinical Manifestations
Defective physical development and mental
retardation in infant and children.
Infant Large posterior fontanels, squinting excessive sleeping, thickened skin and lips, enlarged tongue, abdominal distention, vomiting, feeding and respiratory difficulty.

19. Hypothyroidism- Clinical Manifestations
Adult
Cardiovascular: decreased pulse rate, change in
BP, cardiac hypertrophy, weak contractility,
anaemia, CHF, angina and MI.
Respiratory: Dyspnea, decreased breathing capacity.
Gastrointestinal: decreased appetite, nausea, vomiting, weight gain, constipation, abd. distention.
Musculoskeletal : Fatigue; weakness; muscular aches;
and pain; slow movement.

20. Hypothyroidism- Clinical Manifestations
Integumentary: dry, cold skin; brittle nails; coarse hair, poor turgor of mucosa; oedema; puffy face, decreased, sweating; pallor.
Nervous: Apathy; lethargy; slowed mental process; hoarseness, slow speech; stupor; coma; anxiety, depression.
Reproductive: Prolonged menstrual periods or amenorrhoea; decreased libido, infertility.
Others: increased susceptability to infection, intolerance to cold, decreased hearing.

21. Hypothyroidism- Management
Low-caloric diet to promote weight loss.
Synthetic oral thyroxine synthroid, levothyroid is the drug of (sodium- levo- thyroxine) of choice.
Client with compromised cardiac status, a small initial dose (12.5 to 25mg.l)
If chest pain occur with treatment, ECG and cardiac enzyme tests are performed.

22. Hypothyroidism- Nursing Management
Assessment through history taking.
If the client has any oedema, coma, mechanical respiratory support necessary &. Cardiac monitoring.
All medication will be administering IV because unreliable absorption of oral medications due to paralytic ileus.
The nurse should monitor hypothermia, vital signs, body weight, fluid intake and output.

23. Hypothyroidism- Nursing Management
Promote activity to the level of client tolerance (monitor cardiovascular response, BP, pulse, respiration before, during, after activities.
Promote positive body image.
Promote normal bowel elimination.
Treat hypothermia.
Facilitates intake of a nutritional diet

24. Hypothyroidism- Nursing Management
Provide for self- care needs (hygiene, toilet)
Maintain skin integrity.
Facilitate safe environment and orientation to environment:
Monitor neurological status every shift.
Reorient client frequently.
Maintain safe environment.
Involve client in decision about care.