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Nurs 561 Exam 2 Thyroid Ag Acnp
Practical 1 Exam 2025 Questions With
Right Answers.
Thyroid Hormones and where they are produced
oThyroid hormones are T4 (L-thyronine/thyoxine) and T3 (L-triiodothyronine). T4 is produced only by the thyroid. Whereas with T3, 20% is produced by the thyroid and 80% is produced by peripheral conversion of T4 to T
oThyroid stimulating Hormone (TSH) from anterior pituitary regulates secretion of thyroid hormones
Thyroid Function and Aging
o T4 probably doesn't change with age
o T3 decreases with age and possibly stress
o TSH may be more elevated with age
o Thyroid binding globulin (TBG) and albumin may decrease with age
TSH test and normal range
measures pituitary's response to peripheral levels of thyroid hormone; measures serum TSH; if H-P axis is intact the TSH will be suppressed in hyperthyroidism and elevated in hypothyroidism. Single best indicator for hypothyroidism, manage patient off of their TSH level. Can do reflex T
Free T
serum T4, this is a direct measure of serum free T4; likewise with T3, free T4 lets us know what is metabolically active
Total T
free T4 plus bound T4 (T4 RIA); likewise with T
Labs and Hypothyroidism
Decreased Free T4, Increased TSH, Decreased T4 and T
Labs and Hyperthyroidism
Increased Free T 4, decreased TSH, Increased T4, and increased T
Thyroglobulin (TBG) Increased with?
: pregnancy, oral contraceptives, chronic liver disease, acute hepatitis
TBG decreased with
steroids, chronic liver disease, severe systemic disease, nephrosis
Primary Hypothyroidism
Thyroid Scan
isotopes used can detect size and function of gland; "cold" (non functioning) nodules increased chance of malignancy; can use Technetium or Radioactive Iodine- used to measure thyroid function (uptake) and diagnose certain causes of hyperthyroidism. Hot nodules can be indicative of inflammation or thyroiditis
Grave's Disease
Hyperthyroidism. most common cause, it is often associated with a goiter and exophthalmos and sometimes dermopathy of the lower extremities, it is autoimmune in origin and 1/3 of patients will go into spontaneous remission in 1-2 years
Thyroid storm
Hyperthyroidism. extreme of the hyperthyroid state- tachycardia, fever, confusion, delirium- medical emergency, can lead to afib, CHF, and stroke
Thyroiditis
Hyperthyroidism. idiopathic inflammation of the thyroid gland, 3 types, s/s may include tender thyroid (because it is inflamed), can be firm, nodular, and when a patient has thyroiditis they may have flu like symptoms due to the inflammation
o Hashiomotos- enlargement of the thyroid, can cause either hyper or hypo
o Post Partum Thyroiditis- can happen on occasion
o Sub acute- caused by a viral infection
Toxic Multi-Nodular Goiter
non-neoplastic enlargement of the thyroid
Hyperthyroidism S/S
goiter, tremor, tachy, systolic murmur, lidlag (idictative of hyperthyroidism and nothing else, sclera seen between iris and the lid when you ask them to look up and down), brisk deep tendon reflexes, nervousness, weight loss, heat intolerance, sweating, fatigue, stroke, osteoporosis
Hyperthyroidism Treatment Medicine
•Propanolol- give in the mean time to treat symptoms until endocrine sees them, beta blocker, decrease HR and increase contraction, prevent sequale from hyperthyroidism (just a protective measure) 20-40mg 2 - 4x a day, can use sustained release metoprolol once a day (more expensive). Decreases HR, tremor, and restlessness
•Meds- anti-thyroid medications usually in children and young adults only 6months to a 2 years, 60% remission rate, reassess 12-24 months, cats get hyperthyroid
- Methimazole
- Propylthiouracil
Hyperthyroid treatment other than medicine
•Radioactive Iodine- Grave's Disease is usually treated with RAI, calculate the dose which is high to kill thyroid gland, become hypothyroid and be on replacement for life
•Surgery- generally people who fail medication, children or adults with large goiters, subtotal or total thyroidectomy
Hypothyroidism Epidemiology
more common with advancing age; affects 7% of folks >55; 8-10 times more common in women, most of the time autoimmune, idiopathic or iatrogenic, drug induced
Solitary Thyroid Nodules
o Usually nodules are benign- less than 10% are malignant
o Worrisome findings: Rapid growth, complex nodule, voice changes (endo or ENT can biopsy)
o If mobile, tender, and smooth, they are probably benign (still investigate though)
o Hard, fixed, irregular- more likely to be malignant
o CT scans and MRIs play NO role with the thyroid gland
Thyroid Cancer
o Major factor is childhood or adolescent exposure to head and neck radiation
