THYROID GLAND

By : Iman Qasem Kteo

THE THYROID GLAND

The thyroid gland is a butterfly-shaped organ located in the Lower neck, anterior to the trachea.

***It consists of Two lateral lobes connected by an isthmus. 5

cm long and 3 cm wide and weighs about 30 g .

***The blood Flow to the thyroid is very high approximately

five times the blood flow to the Liver .

***This reflects the high metabolic activity of the thyroid

Gland

Functions

*** Stimulates & maintains metabolic processes

* Produces thyroid hormones T3-triiodothyronine and T4-thyroxine

* These hormones regulate metabolism & affect the growth and

function of other systems in the body

*** Secretes calcitonin to lower serum calcium levels

*** Parathyroid gland secretes PTH to raise serum calcium levels

HYPOTHYROIDISM - TESTS

•SERUM THYROID-STIMULATING HORMONE

the best way to initially test thyroid function is to measure the TSH level in a

blood sample.

**A high TSH level indicates that the thyroid gland is failing (primary

hypothyroidism) .

**the TSH level is low, usually indicates that the person has an overactive

thyroid that is producing too much thyroid hormone (hyperthyroidism

T4 TESTS

T4 circulates in the blood in two forms:

1 )T4 bound to proteins that prevent the T4 from entering the various tissues

that need thyroid hormone.

2 )free t4, which does enter the various target tissues to exert its effects .

T3 TESTS

Patients who are hyperthyroid will have an elevated T3 level. In some

individuals with a low TSH, only the T3 is elevated and the FT4 is

normal. T3 testing rarely is helpful in the hypothyroid patient, since it is

the last test to become abnormal .

Normal Value

T.S.H : 0.4 to 4.5 mU/L (milliunites per litre)

T3 : (1.15 to 3.10 nmol/L).

T4 : (58.5 to 150 nmol/L).

•THYROID ANTIBODIES

In many patients with hypothyroidism or hyperthyroidism, lymphocytes make

antibodies against their thyroid that either stimulate or damage the gland.. also

in diagnose the thyroid problems .

**positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies in a

patient with hypothyroidism make a diagnosis of hashimoto’s thyroiditis .

**+ev antibodies in a hyperthyroid patient,

the most likely diagnosis is autoimmune

thyroid disease

•RADIOACTIVE IODINE UPTAKE

The patient is Administered a tracer dose of iodine 123 (123I) or

another Radionuclide, With a scintillation counter, detects the

Gamma rays released from the breakdown of 123I in the thyroid .

**Patients with hyperthyroidism

exhibit a high uptake Of the 123I

** Patients with hypothyroidism

exhibit a very low uptake.

•THYROID SCAN, RADIOSCAN, OR SCINTISCAN

**determining the location, size, Shape, and anatomic

function of the thyroid gland

**Identifying Areas of increased function (“hot” areas) or

decreased function (“Cold” areas) can assist in diagnosis .

Normal thyroid Hot nodule Cold nodule

•FINE-NEEDLE ASPIRATION BIOPSY

Use of a small-gauge needle to sample the thyroid tissue for

Biopsy is a safe and accurate method of detecting malignancy..

Results are reported as

( 1 )negative (benign), (2) Positive (malignant) ,

(3 )indeterminate (suspicious), and (4) inadequate

(nondiagnostic).

FINE-NEEDLE ASPIRATION BIOPSY

•SERUM THYROGLOBULIN

Thyroglobulin (tg) can be measured reliably in the serum

By radioimmunoassay. Clinically, it is used to detect

persistence Or recurrence of thyroid carcinoma.

HYPERTHYROIDISM

◊ Hyperthyroidism is the second most prevalent endocrine Disorder, after

diabetes mellitus .

◊ Graves’ disease, the most Common type of hyperthyroidism, results

from an excessive Output of thyroid hormones

◊ It affects women eight times more frequently Than men

◊ The disorder may Appear after an

emotional shock,

stress ,

infection ,

◊ but The exact significance of these relationships is not understood.

◊ Other common causes of hyperthyroidism include Thyroiditis and

excessive ingestion of thyroid hormone

Signs and Symptoms – Exophthalmos – Weight loss despite excellent appetite – hypermetabolic state– Insomnia– Fatigue– Palpitations– Heat intolerance– Sweating– Diarrhea– Deterioration in handwriting– Menstrual irregularities– Muscle weakness/– Nervousness– Tachycardia– Goiter– Elevated plasma levels of thyroxin and/or triiodothyronine

Exophthalmos

Exophthalmos is a disease affecting the eyes. it is a

condition of altered thyroid metabolism that causes protein depositions

within the extra ocular muscles and causes the eyeballs to

protrude, forcing the eyelids open. This disease is more

common

in middle aged women and people who smoke.

CausesExophthalmos is most often caused by thyroid problems,

particularly Grave’s Disease. Less often, it can be caused by something in the eye socket such as:

Cancerous tumor Mucocoele (mucus-filled cyst) Blood clots Eye injury Sinus infection Bacterial infection

Symptoms include One or both eyes bulging out of the socket (more

commonly both eyes) Dry, red, & itchy eyes Puffy or swollen eyes Irritation Photophobia (sensitivity to light) Limited eye movement Blurred/double visionSymptoms will continue to worsen if not treated and can

lead to blindness.

THYROID STORM

THYROID STORM

Thyroid storm (thyrotoxic crisis) is a form of severe

hyperthyroidism, Usually of abrupt onset. Untreated, it is

almost always Fatal, but with proper treatment the mortality

rate is reduced Substantially. The patient with thyroid storm or

crisis is critically Ill and requires astute observation and

supportive Nursing care during.

CLINICAL MANIFESTATIONS

Thyroid storm is characterized by:

•High fever

•Extreme tachycardia

•Exaggerated symptoms of hyperthyroidism

,gastrointestinal (Weight loss, diarrhea, abdominal pain) or cardiovascular (Edema, chest pain, dyspnea, palpitations)

•Altered neurologic or mental state, which frequently Appears as delirium psychosis, somnolence, or coma

THYROID CANCER

Cancer of the thyroid is much less prevalent than other Forms

of cancer. There are several types of Cancer of the thyroid

gland . External radiation of the head, neck, or chest in infancy

And childhood increases the risk of thyroid carcinoma .

SIGNS AND SYMPTOMS

• Common

– Asymptomatic

mass

– Cough

– Dyspnea

– Dysphagia

• Common

– Asymptomatic

mass

– Cough

– Dyspnea

– Dysphagia

• Rare

– Pain

– Stridor

– Vocal cord paralysis

– Rapid enlargement

• Rare

– Pain

– Stridor

– Vocal cord paralysis

– Rapid enlargement

CAUSES AND RISK FACTORS Genetics: Family History: Radiation Exposure:

Radiation therapy to Head or Neck. Exposure to Radioactive Iodine during childhood, or other radioactive

substances Chronic Iodine deficiency ↑ risk for Follicular carcinoma.

Gender: Female > Males.

Age: More common at young adults.

Race: White race > Black race.

TYPE OF THYROID CANCER

•Papillary adenocarcinoma• Incidence 50%

Most common and least aggressive

Asymptomatic nodule in a normal gland

Starts in childhood or early adult life, remains localized

Metastasizes along the lymphatics if untreated

More aggressive in the elderly

•Follicular adenocarcinoma

• Incidence 15%

• Appears after 40 y of age

• Encapsulated; feels elastic or rubbery on palpation

• Spreads through the bloodstream to bone, liver, and lung

• Prognosis is not as favorable as for papillary

adenocarcinoma

•Medullary• Incidence 5%

Appears after 50 y of age

Occurs as part of multiple endocrine neoplasia (MEN)

Hormone-producing tumor causing endocrine dysfunction

symptoms

Metastasizes by lymphatics and bloodstream

Moderate survival rate

• ANAPLASTIC

• 5%

50% in patients older than 60 y

Hard, irregular mass that grows quickly and

spreads by direct invasion to adjacent tissues

May be painful and tender

Survival for patients with anaplastic cancer

is usually less than 6 months

THYROIDECTOMY

Thyroidectomy• Thyroidectomy, although rare, may be performed for patients

with:

• thyroid cancer

• hyperthyroidism

• pregnant women

• patients who do not want radiation therapy

• patients with large goiters who do not respond to anti-thyroid

drugs.

Thyroidectomy• Types

• The two types of thyroidectomy include:

1.Total thyroidectomy:

2.Subtotal thyroidectomy: up to five-sixths of the

gland is removed

Post-operative Thyroid hormone.

Replacement therapy.

Suppression of TSH release.

NURSING CARE PLANS

• Nursing priorities

1.Reverse/manage hyperthyroid state preoperatively.

2.Prevent complications.

3.Relieve pain.

4.Provide information about surgical procedure, prognosis, and

treatment needs.

NURSING DIAGNOSIS

• acute Pain, May be related to Surgical

interruption/manipulation of tissues/muscles

• Possibly evidenced by guarding behavior; restlessness

•Planning

• Report pain is relieved/controlled

Nursing Interventions

Assess verbal and nonverbal reports of pain Place in semi-Fowler’s position and support head and neck

with sandbags or small pillows. Maintain head and neck in neutral position and support

during position changes. Instruct patient to use hands to support neck during movement and to avoid hyperextension of neck.

Give cool liquids or soft foods, such as ice cream or popsicles. Encourage patient to use relaxation techniques: guided

imagery, soft music, progressive relaxation. Administer analgesics and/or analgesic throat sprays and

lozenges as necessary.

• 2. Ineffective airway clearance

• Nursing diagnosis

• Risk for ineffective airway clearance Risk factors may

include Tracheal obstruction; swelling, bleeding,

laryngeal spasms

•Planning

• Maintain patent airway, with aspiration prevented.

Nursing Interventions

Monitor respiratory rate, depth, and work of breathing.

Auscultate breath sounds

. Assess for dyspnea, and cyanosis. Note quality of voice.

Caution patient to avoid bending neck; support head with pillows

Assist with repositioning, deep breathing exercises, and/or coughing as indicated.

Suction mouth and trachea as indicated, noting color and characteristics of sputum

Investigate reports of difficulty swallowing.

Provide steam inhalation; humidify room air.

• Nursing diagnosis• Knowledge, deficient [learning need] regarding condition, prognosis,

treatment, self-care, and discharge needs, May be related to recall, misinterpretation ,Unfamiliarity with information resources

• Possibly evidenced by development of preventable complications

• Planning.

• Participate in treatment regimen.

• Initiate necessary lifestyle changes.

Nursing Interventions

Review surgical procedure and future expectations. Discuss need for well-balanced, nutritious diet Recommend avoidance of goitrogenic foods, e.G., Excessive

ingestion of seafood, soybeans, turnips. Identify foods high in calcium and vitamin d.

Review importance of rest and relaxation, avoiding stressful

situations and emotional outbursts.

Instruct in incisional care: cleansing, dressing application.

Recommend the use of loose-fitting scarves to cover scar,

avoiding the use of jewelry.

Apply cold cream after sutures have been removed.

Discuss possibility of change in voice.

Identify signs and symptoms requiring medical evaluation.

• Nursing diagnosis

• impaired verbal Communication, May be related to ,

• Vocal cord injury/laryngeal nerve damage ,Tissue edema; pain/discomfort

• Possibly evidenced by

• Impaired articulation, does not/cannot speak

•Planning• Establish method of communication in which needs can be

understood

•Nursing interventions

Assess speech periodically. Encourage voice rest.

Keep communication simple. Ask yes or no questions.

Provide alternative methods of communication as appropriate:

slate board, picture board.

Anticipate needs as possible. Visit patient frequently.

Maintain quiet environment

Thank You

By : Iman Qasem

Kteo