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1. Secretions/Functions:
secretes parathormone, keeps calcium levels normal.
serum calcium levels ↓ = bone resorption (breakdown).
calcium levels are ↑ = stops bone resorption
Responsible for metabolism & growth.
Euthyroid – normal thyroid.
2. Etiology/Predisposing Factors
a. iaotrogenic cause – we did it to them. Surgical removal of
thyroid gland. Thyroidectomy surgical removal of thyroid.
3. S&S of Hypoparathyroidism
Hypocalcemia (irritability) –
Early sign - paresthesias – numbness & tingling of toes & hands.
Late sign – largynospasms & tetany - we have let it gone too far.
b. Hyperparathyroidism
1. Etiologies:
caused by overproduction of parathormone by parathyroid
2. S&S of Hyperparathyroidism
• Hypercalcemia (weakness) – lethargy, sluggish, constipation. Fluids – NS,
fluids (no surgery stuff b/c they will hang on to calcium). Infuse several liters
of NS over 24 hour period.
• Pulling calcium out of bones – high risk for pathologic fractures.
• Kidney stones – calcium in urine. Trying to excrete Calcium & Phosphorus in
urine. Flank pain, excruciating pain.
• Hypercalciuria –excess calcium in urine. Elevated Calcium & Phosphorus
levels in urine.
THYROID GLAND
• Responsible for growth & metabolism.
• Euthyroid – normal thyroid. Difficult growing & developing.
• Function of thyroid depends on adequate amounts of protein & iodine.
2. Secretes:
a. Calcitonin – inhibits bone resorption (breakdown). Exogenous form –
miacalcin. Nasal spray, rotate nostrils.
b. T 3 – much more potent
c. T 4 – “more 4 than 3, but 3 is more potent”. T 7 (free T 4, not bound to
protein)
Elevated T 3 & T 4, also have elevated TSH – secondary problem unless there is
more data to support tertiary problem
If have low T 3 & T 4 but high TSH – thyroid not doing what it needs to do, so
pituitary is trying to compensate
• Radioactive iodine uptake test – give patient radioactive iodine, need adequate
protein & iodine in diet to make thyroid hormone. Iodine is attracted to
thyroid – go to thyroid gland. Healthy profused tissue of thyroid will pick up
and glow. Dead, necrotic, nonfunctioning, damaged, diseased areas will not
glow – “cold spots”. Low dose radiation – flush toilet several times for
couple of days.
• Fine needle biopsy – stick needle into thyroid gland & aspirate out some
tissue.
• Cholesterol levels – cannot be used to diagnose hypo or hyperthyroidism.
Look at in relationship, if highly suspected – confirms. Hyper – cholesterol
will be low b/c they are burning everything off. Hypo – cholesterol will be
high b/c can’t metabolize fats.
2. Types of Hypothyroidism
a. Primary Hypothyroidism
thyroid’s fault
1. Congenital defects
person born with thyroid problem – cretinism – genetic defect, hypothyroid.
Important for growth & metabolism – will be morphed & retarded. Test every
baby at birth – exogenous thyroid hormones for rest of life (getting from outside)
b. Drugs
1. S&S of hypothyroidism
• hypometabolc
• gain weight – slow metabolism
• ↓HR
• ↓BP
• ↓temperature
• bowel sounds will be hypoactive: constipated
• intolerance to cold – want room warm
• fatigue
• hair loss – b/c decreased blood flow
• decreased memory
• depression
• anemia – decreased blood flow = low profusion to kidneys, make
erythropoietn – bone marrow stops making RBCs = decreased oxygenation
• cholesterol levels – go ↑ = blocked blood vessels. Someone that is
hypothyroidism, will not have s/s of chest pain or MI b/c everything is slow.
When you treat them for hypothyroidism, you speed everything up. At risk for
angina & heart attacks
• FVE – profusion if poor- kidney and renin-angiotensin system holds on to
sodium & water
• Fertility problems
• Reduced dosages of sleeping meds & pain meds – not metabolizing normally
d. Myxedema
hypothyroidism to the max – everything is slow. At risk of dying, most severe
form of hypothyroidism
1. S&S of Myxedema
• FVE - swelling of hands, feet, face, periorbital tissues. Not perfusing.
• HR slow
• BP low
• Respiration low
• Acidosis – not breathing fast leads to CNS depression – coma & death
• Anemia – kidney makes erthropoietn, stimulates bone marrow to make RBCs.
Decreased oxygenation
• Person hypothyroidism – ran out of medicine, or abruptly stopped taking
meds.
• Severe stress can cause myxedema
2. S&S of hyperthyroidism
• hypermetabolism
• ↑ HR - tachycardiac
• ↑ BP - hypertensive
• heat intolerant – ac on
• bowel sounds – hyperactive, diarrhea
• skinny – burning everything off
• can’t sleep or rest
• depressed b/c they can’t sleep
• skin is warm & moist
• greasy hair b/c increased circulation
• exophthalmos (bulging eyes) – increased retention of fluid around eyes
• May have goiter – hypo or hyper
3. DX of hyperthyroidism
• thyroid is soft & may pulsate
• thrill can often be palpated
• bruit heard over thyroid arteries
• ↓ TSH
• ↑ TSH
• ↑ free T 4
• ↑ radioactive iodine uptake