ENDOCRINE SUMMARY 1

CRISIS 5

WEEK 4 COMPILATION

GROUP PRESENTATION

HYPOTHYROIDISM

Exercise 1.1

What is hypothyroidism?

Answer:

Hypothyroidism is a common disorder of the endocrine system which results from suboptimal levels of thyroid hormone in the blood.

Thyroid deficiency can affect all body functions and can range from mild, subclinical forms to myxedema, an advanced form

The most common cause of hypothyroidism in adults is autoimmune thyroiditis (Hashimoto’s disease), in which the immune system attacks the thyroid gland and results in the under production of the thyroid hormones.

Hypothyroidism can also be caused by decreased production of the TSH hormone from the pituitary gland, a side effect of surgery, inflammation of the thyroid gland, and treatment for hyperthyroidism

Iodine deficiency; and iodine excess are also some common causes of hypothyroidism

Hypothyroidism also commonly occurs in patients with previous hyperthyroidism that has been treated with radioiodine or antithyroid medications or thyroidectomy.

Exercise 1.2

What are the types of hypothyroidism?

Answer:

The types of hypothyroidism include

·         Primary hypothyroidism

o   Which refers to dysfunction of the thyroid gland

·         Central hypothyroidism

o   Due to failure of the pituitary gland, hypothalamus, or both;

·         Secondary or pituitary hypothyroidism

o   Which is due entirely to a pituitary disorder

·         Hypothalamic or tertiary

o   Due to a disorder of the hypothalamus resulting in inadequate secretion of TSH from decreased stimulation by thyrotropinreleasing hormone (TRH).

Exercise 1.3

Outline few clinical manifestation of hypothyroidism.

Answer:

·         Fatigue due to slow metabolism

·         Hypothermia due to slow metabolism

·         Thick dry hair from lack of thyroid hormone

·         Dry skin from lack of thyroid hormone

·         Slow cognitive function due to slow metabolism

·         weight gain without corresponding increase in food intake

Exercise 1.4

Briefly describe the pathophysiology of hypothyroidism

Answer:

·         Under normal circumstances, the thyroid releases 100-125nmol of T4 daily and only small amounts of T3.

·         T4, a prohormone, is converted to T3, the active form of thyroid hormone in the peripheral tissues by 5’ deiodination.

·         Early in the disease process, compensatory mechanisms maintain T3 levels

·         Decreased production of T4 causes an increase in the secretion of thyroid stimulating hormone (TSH) by the pituitary gland.

·         TSH stimulates hypertrophy and hyperplasia of the thyroid gland and 5’deiodinase activity, thereby increasing T3 production.

·         The hypothyroid changes in the heart results in decreased contractility, cardiac enlargement, and pericardial effusion, decreased pulse, and decreased cardiac output

Exercise 1.5

Outline few nursing intervention related to hypothyroidism

Answer:

·         Monitor vital signs.

·         Provide a warm environment.

·         Low-calorie diet.

·         Increase fluids and fiber to prevent constipation.

·         Take thyroid replacement hormone each morning to avoid insomnia.

·         Monitor for signs of thyrotoxicosis (an increase in T3): nausea, vomiting, diarrhea, sweating, and tachycardia.

·         Explain to the patient:

o   Side effects of thyroid hormone replacement.

o   Review the signs of hyperthyroidism and hypothyroidism.

o   Have patient contact health care provider if signs change

Exercise 1.6

Outline and describe few complication of hyperthyroidism.

Answer:

·         Cretinism

o   When thyroid deficiency is present at birth, the condition is known as cretinism. However, severe form of hypothyroidism may result in physical and mental stunting in an adult accounting for cretinism as a complication.

·         Myxedema

o   The term “myxedema” refers to the accumulation of mucopolysaccharides in subcutaneous and other interstitial tissue and is used only to describe the extreme symptoms of severe hypothyroidism which is characterized by dry skin, swelling around lips and nose, hypothermia as well as mental deterioration.

HYPERTHYROIDISM

Exercise 1.1

What is hyperthyroidism?

Answer:

Hyperthyroidism is the second most prevalent endocrine disorder, after diabetes mellitus. It results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins.

The overproduction of T3 and T4 by the thyroid gland that can also be caused by an autoimmune disease where the body’s immune system attacks the thyroid gland.

Other common causes of hyperthyroidism include benign tumor (adenomas) resulting in an enlarged thyroid gland (goiter), an overproduction of TSH by the pituitary gland, caused by a pituitary tumor thyroiditis and excessive ingestion of thyroid hormone (e.g. from the treatment of hypothyroidism)

The most common type of hyperthyroidism is Graves’ disease.

Exercise 1.2

Outline few clinical manifestation of hyperthyroidism?

Answer:

Hyperthyroidism presents a characteristic group of signs and symptoms (thyrotoxicosis) such as:

o   Sweating (diaphoresis); excess thyroid hormone raises the metabolic rate

o   Increased appetite due to increased metabolism

o   Weight loss due to increased metabolism

o   Nervousness due to high levels of thyroid hormone

o   Enlarged thyroid gland (goiter) caused by tumor

o   Protrusion of the eyeballs (exophthalmos) due to lymphocytic infiltration which pushes out the eyeball

o   Menstrual changes due to elevated levels of thyroid hormone