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Thyroid disorder (Hyperthyroidism (S/S (weight loss, tachycardia,…

- - - - Thiamine Derivatives
        
        Propylthiouracil (PTU)
        
        carbimazole; methimazole
        
        Restore euthyroidism; promote remission of Grave's disease; treating simple goiter
      - adverse effct
        
        bone marrow suppression
        
        hepatitis
        
        Arthralgia; rash (Urticaria: severe allergy)
      - management
        
        review current drug regimen by assessing baseline lab data on WBC & differential count, LFT
        
        euthyroid state is achieved -> only keep maintenance dose
        
        after therapy withdrawal -> FU for 1 yr
        
        relapse? s/s of hyperthyroidism
        
        Monitoring
        
        pulmonary function
        
        cardiac function
        
        CBC & bleeding tendency
    - - Gold standard
      - Oral radioactive iodine is administered
        
        destroying overactive thyroid cells
        
        Dosage: depending on clinical signs
        
        pretreatment of PTU can bring radioprotective effect
      - takes few mth
      - indication
        
        hyperthyroidism
        
        postoperative residual cancer
      - Contraindication
        
        allergy to iodine
        
        pregnancy
      - Side effects
        
        Nausea & vomiting
        
        loss of taste
        
        complication
        
        permanent hypothyroidism
        
        transient hypothyroidism (<6 mth)
      - Nursing care
        
        Anxiety and knowledge deficit
        
        pt's bodily secretions are radioactive -> wear water-proof gloves when handling, use disposable items and leave them in room
        
        nurse in isolation room, with lead wall, clear adjacent room, radioactive precaution label, should stay <30 min in 24 hours
        
        encourage fluid intake (2.5-3L/ day)-> reduce unnecessary radiation
        
        double flush after use
        
        when vomit -> use non-disposable radio-resistant gloves when cleaning floor
        
        take precaution even after the 1st week post treatment
        
        Female: avoid pregnancy in 6 mth to 1 yr
        
        safety principles:
        
        direct care limited to 30 min/ 8 hr shift; Lead shield
      - Client education
        
        report any hyper/ hypo thyroidism & thyroid function
        
        whole body scan after 7-10 days
    - - Total thyroidectomy
        
        indiction: thyroid cancer
        
        Potential complications
        
        Hemorrhage on neck-> may compress the trachea -> difficult in breathing
        
        Airway obstruction & resp. distress
        
        irregular breathing pattern?; arrange pt in semi-fowler position
        
        Hypoparathyroidism
        
        parathyroid gland injury
        
        Tetany (due to hypocalcaemia)
        
        monitor calcium level
        
        thyrotoxic storm
        
        acute & fatal -> stored thyroid hormone is relaesed
        
        Laryngeal nerve palsy
        
        alert for hoarseness of voice
        
        resp. problem/ disphagia
      - Sub-total (Unilateral/ Bilateral/ Isthmus) thyroidectomy
        
        potential complication
        
        recurrence of thyrotoxicosis
        
        late hypothyroidism
      - post-ot care
        
        vital sign Q1H till stable
        
        Warning signs: HAEMORRHAGE(e.g. bleeding on the anterior, sides and the back of neck)
        
        any tachycardia & hypotension
        
        need reinforce dressing?
        
        report: clearing of throat, smothering, choking & disphagia
        
        stridor (abnormal breathing sound) -> may indicate swelling of neck & compression on trachea
        
        drainage: observe the characteristic & amount (sudden increase: possible hemorrhage; sudden decrease: blockage of drain & hematoma formation & compression of trachea
    - - exophthalmos (眼球突出）
        
        corticosteroids (reduce inflammation)
        
        methylcellulose eye drop (relieving dry eyes)
      - Swelling
        
        elevate head during sleeping
        
        Avoid smoking
      - Nutrition deficit
        
        frequent meals with snacks
        
        High calories
- - - - Lethargy
      - hypothermia
  - - - Levothyroxine (Special consideration of dosage )
    - - medication
        
        take at same time each day
        
        on empty stomach; morning
      - Alert of s/s of hypothyroidism
        
        e.g. SOB, abdominal bleeding/ bruising
        
        or hyperthyroidism
        
        Chest pain, palpitation, sweating, nervousness
      - regular follow up (monitoring s/s, serum TSH & T4)
- - - - High uptake (35%)
        
        too much thyroxine (T4)
        
        possibly Graves' disease
      - Low uptake
        
        other forms