Evaluating Outcomes Evaluating Outcomes for Clients with Thyroid for Clients with Thyroid

and Parathyroid and Parathyroid ProblemsProblems

Hyperthyroidism Hyperthyroidism

Thyrotoxicosis Thyrotoxicosis Graves’ disease, the most frequent Graves’ disease, the most frequent

causes: goiter, exophthalmos, causes: goiter, exophthalmos, pretibial myxedemapretibial myxedema

Laboratory assessmentLaboratory assessment Thyroid scanThyroid scan UltrasonographyUltrasonography Electrocardiography Electrocardiography

Drug TherapyDrug Therapy

Radioactive iodine therapy; not Radioactive iodine therapy; not used in pregnant womenused in pregnant women– Additional drug therapy may be Additional drug therapy may be

needed.needed.– Implement radiation precautions.Implement radiation precautions.– Monitor regularly for changes in Monitor regularly for changes in

thyroid function.thyroid function.

Surgical ManagementSurgical Management

Surgery possible in absence of Surgery possible in absence of good response to drug therapy.good response to drug therapy.

Postoperative care for:Postoperative care for:– HemorrhageHemorrhage– Respiratory distressRespiratory distress– Hypocalcemia and tetanyHypocalcemia and tetany– Laryngeal nerve damageLaryngeal nerve damage– Thyroid storm or thyroid crisisThyroid storm or thyroid crisis

Infiltrative Opthalmopathy Infiltrative Opthalmopathy

Provide symptomatic treatment.Provide symptomatic treatment. Treatment of hyperthyroidism Treatment of hyperthyroidism

does not correct eye and vision does not correct eye and vision problems of Graves’ disease.problems of Graves’ disease.

Elevate the head of bed at night.Elevate the head of bed at night. Instill artificial tears.Instill artificial tears. Treat photophobia with dark Treat photophobia with dark

glasses.glasses.(Continued)(Continued)

Infiltrative OpthalmopathyInfiltrative Opthalmopathy

(Continued)(Continued)

Give steroid therapy.Give steroid therapy. Provide diuretics. Provide diuretics.

Hypothyroidism Hypothyroidism

Decreased metabolism from low Decreased metabolism from low levels of thyroid hormoneslevels of thyroid hormones

Myxedema coma a rare, serious Myxedema coma a rare, serious complicationcomplication

Mostly a result of thyroid Mostly a result of thyroid surgery and radioactive iodine surgery and radioactive iodine treatment of hyperthyroidismtreatment of hyperthyroidism

Clinical manifestationsClinical manifestations

Decreased Cardiac OutputDecreased Cardiac Output

Interventions:Interventions:– Monitor circulatory status.Monitor circulatory status.– Monitor for signs of inadequate Monitor for signs of inadequate

tissue oxygenation.tissue oxygenation.– Monitor for changes in mental Monitor for changes in mental

status.status.– Monitor fluid status and heart rate.Monitor fluid status and heart rate.– Administer oxygen or mechanical Administer oxygen or mechanical

ventilation, as appropriate.ventilation, as appropriate.

Ineffective Breathing PatternIneffective Breathing Pattern

Interventions:Interventions:– Observe and record rate and depth Observe and record rate and depth

of respirations.of respirations.– Auscultate the lungs.Auscultate the lungs.– Assess for respiratory distress.Assess for respiratory distress.– Assess the client receiving sedation Assess the client receiving sedation

for respiratory adequacy.for respiratory adequacy.

Disturbed Thought ProcessesDisturbed Thought Processes

Interventions:Interventions:– Assess lethargy, drowsiness, Assess lethargy, drowsiness,

memory deficit, poor attention memory deficit, poor attention span, and difficulty communicating.span, and difficulty communicating.

– These problems should decrease These problems should decrease with thyroid hormone treatment.with thyroid hormone treatment.

– Provide a safe environment.Provide a safe environment.– Provide family teaching.Provide family teaching.

Myxedema ComaMyxedema Coma

Coma, respiratory failure, Coma, respiratory failure, hypotension, hyponatremia, hypotension, hyponatremia, hypothermia, hypoglycemiahypothermia, hypoglycemia

Emergency careEmergency care

Thyroiditis Thyroiditis

Inflammation of the thyroid glandInflammation of the thyroid gland Three types of thyroiditis: acute, Three types of thyroiditis: acute,

subacute (granulomatous), and subacute (granulomatous), and chronic (Hashimoto’s disease)—the chronic (Hashimoto’s disease)—the most common typemost common type

Dysphagia and painless enlargement Dysphagia and painless enlargement of the glandof the gland

Nonsurgical management, drug Nonsurgical management, drug therapytherapy

Surgical managementSurgical management

Thyroid CancerThyroid Cancer

Papillary, follicular, medullary, and Papillary, follicular, medullary, and anaplasticanaplastic

Collaborative managementCollaborative management Surgery treatment of choice: Surgery treatment of choice:

thyroidectomythyroidectomy Suppressive doses of thyroid Suppressive doses of thyroid

hormone for 3 months after surgeryhormone for 3 months after surgery Study performed after drugs are Study performed after drugs are

withdrawnwithdrawn

Hyperparathyroidism Hyperparathyroidism

Parathyroid glands: calcium and Parathyroid glands: calcium and phosphate balancephosphate balance

Hypercalcemia and Hypercalcemia and hypophosphatemiahypophosphatemia

Nonsurgical management:Nonsurgical management:– Diuretic and fluid therapyDiuretic and fluid therapy– Drug therapy: phosphates, Drug therapy: phosphates,

calcitonin, calcium chelatorscalcitonin, calcium chelators

Surgical ManagementSurgical Management

Parathyroidectomy preoperative Parathyroidectomy preoperative care:care:– Client stabilized; calcium levels Client stabilized; calcium levels

normalizednormalized– Studies: bleeding and clotting times, Studies: bleeding and clotting times,

CBCCBC– Teaching: coughing, deep-breathing Teaching: coughing, deep-breathing

exercises, neck supportexercises, neck support Operative proceduresOperative procedures

(Continued)(Continued)

Surgical Management Surgical Management (Continued)(Continued)

Postoperative care includes:Postoperative care includes:– Observe for respiratory distress.Observe for respiratory distress.– Keep emergency equipment at Keep emergency equipment at

bedside.bedside.– Hypocalcemic crisis can occur.Hypocalcemic crisis can occur.– Recurrent laryngeal nerve damage Recurrent laryngeal nerve damage

can occur.can occur.

Hypoparathyroidism Hypoparathyroidism

Decreased function of the Decreased function of the parathyroid glandparathyroid gland

Iatrogenic hypoparathyroidismIatrogenic hypoparathyroidism Idiopathic hypoparathyroidismIdiopathic hypoparathyroidism HypomagnesemiaHypomagnesemia Interventions: correcting Interventions: correcting

hypocalcemia, vitamin D hypocalcemia, vitamin D deficiency, and hypomagnesemiadeficiency, and hypomagnesemia

If a manifestation is caused by hyperthyroidism, If a manifestation is caused by hyperthyroidism, indicate “HYPER”. If a manifestation is caused indicate “HYPER”. If a manifestation is caused

by hypothyroidism, indicate “HYPO.”by hypothyroidism, indicate “HYPO.”

TremorsTremors Heat intoleranceHeat intolerance Weight gainWeight gain TachycardiaTachycardia InsomniaInsomnia Dry, coarse, Dry, coarse,

brittle hairbrittle hair Decreased Decreased

activity toleranceactivity tolerance

Decreased body Decreased body temperaturetemperature

PalpitationsPalpitations ApathyApathy DiaphoresisDiaphoresis Thinning of scalp Thinning of scalp

hairhair Thick, brittle nailsThick, brittle nails ConstipationConstipation

HYPO = HypothyroidismHYPO = HypothyroidismHYPER = HyperthyroidismHYPER = Hyperthyroidism

Tremors: HYPERTremors: HYPER Heat intolerance: Heat intolerance:

HYPERHYPER Weight gain: HYPOWeight gain: HYPO Tachycardia: HYPERTachycardia: HYPER Insomnia: HYPERInsomnia: HYPER Dry, coarse, brittle Dry, coarse, brittle

hair: HYPOhair: HYPO Decreased activity Decreased activity

tolerance: HYPOtolerance: HYPO

Decreased body Decreased body temperature: HYPOtemperature: HYPO

Palpitations: HYPERPalpitations: HYPER Apathy: HYPOApathy: HYPO Diaphoresis: HYPERDiaphoresis: HYPER Thinning of scalp hair: Thinning of scalp hair:

HYPERHYPER Thick, brittle nails: Thick, brittle nails:

HYPOHYPO Constipation: HYPOConstipation: HYPO

The pathology of Graves’ disease The pathology of Graves’ disease is is (select one)(select one)

A.A. increased release of TSH (thyroid increased release of TSH (thyroid stimulating hormone) by the anterior stimulating hormone) by the anterior pituitary.pituitary.

B.B. an autoimmune disorder in which an autoimmune disorder in which antibodies are made and attach to the antibodies are made and attach to the TSH receptor sites on the thyroid tissue.TSH receptor sites on the thyroid tissue.

C.C. the development of a thyroid nodule the development of a thyroid nodule which releases increased amounts of which releases increased amounts of thyroid hormones.thyroid hormones.

D.D. a lack of dietary iodine.a lack of dietary iodine.

BB

Graves’ disease is an autoimmune Graves’ disease is an autoimmune disorder in which antibodies are made and disorder in which antibodies are made and attach to the TSH receptor sites on the attach to the TSH receptor sites on the thyroid tissue. When these antibodies, thyroid tissue. When these antibodies, known as thyroid-stimulating known as thyroid-stimulating immunoglobulins (TSIs), bind to the immunoglobulins (TSIs), bind to the thyroid gland, the gland increases in size thyroid gland, the gland increases in size and overproduces thyroid hormones.and overproduces thyroid hormones.

Clients with Graves’ disease also have Clients with Graves’ disease also have exophthalmos (wide-eyed appearance) exophthalmos (wide-eyed appearance) and pretibial myxedema.and pretibial myxedema.

How can laboratory tests How can laboratory tests help differentiate help differentiate

hyperthyroidism caused hyperthyroidism caused by Graves’ disease by Graves’ disease

versus hyperthyroidism versus hyperthyroidism caused from caused from

hyperpituitarism?hyperpituitarism?

With hyperthyroidism, both the TWith hyperthyroidism, both the T33 and Tand T4 4 blood levels are elevated, blood levels are elevated, causing hypermetabolism. An causing hypermetabolism. An

elevated free thyroxine (FTelevated free thyroxine (FT44) or Free ) or Free TT44 index may be more useful as it index may be more useful as it

provides information about the provides information about the active hormone. The FTactive hormone. The FT44 is also is also elevated in hyperthyroidism. In elevated in hyperthyroidism. In

Graves’ disease, the autoantibodies Graves’ disease, the autoantibodies bind to the TSH receptor and bind to the TSH receptor and

activate it, causing an activate it, causing an overproduction of thyroid hormones. overproduction of thyroid hormones.

The increased metabolic rate The increased metabolic rate negatively feeds back and negatively feeds back and suppresses hypothalamic secretion suppresses hypothalamic secretion of thyrotropin hormone, which in turn of thyrotropin hormone, which in turn suppresses thyroid-stimulating suppresses thyroid-stimulating hormone (TSH). The TSH is hormone (TSH). The TSH is decreased in Graves’ disease. When decreased in Graves’ disease. When the TSH levels are elevated despite the TSH levels are elevated despite increased synthesis of thyroid increased synthesis of thyroid hormones, hyperpituitarism is a hormones, hyperpituitarism is a possible cause.possible cause.

If the statement is true, place a “T” before the If the statement is true, place a “T” before the statement. If the statement is false, place a “F” statement. If the statement is false, place a “F”

before the statement.before the statement. A client is given radioactive iodine by mouth and A client is given radioactive iodine by mouth and

scanned 24 hours later during a thyroid scan.scanned 24 hours later during a thyroid scan. Drug therapy for hyperthyroidism commonly Drug therapy for hyperthyroidism commonly

includes antianxiety medications [alprazolam includes antianxiety medications [alprazolam (Xanax), lorazepam (Ativan)] to relieve (Xanax), lorazepam (Ativan)] to relieve diaphoresis, anxiety, tachycardia, and diaphoresis, anxiety, tachycardia, and palpitations.palpitations.

Results from drug therapy and from radioactive Results from drug therapy and from radioactive iodine therapy are usually seen in 48-72 hours.iodine therapy are usually seen in 48-72 hours.

A patient with hyperthyroidism has a need for A patient with hyperthyroidism has a need for increased calories, carbohydrates, and increased calories, carbohydrates, and especially proteins.especially proteins.

A client is given radioactive iodine A client is given radioactive iodine by mouth and scanned 24 hours by mouth and scanned 24 hours

later during a thyroid scan.later during a thyroid scan.

TRUETRUE The thyroid scan evaluates the position, The thyroid scan evaluates the position,

size, and functioning of the thyroid gland.size, and functioning of the thyroid gland. The uptake of the radioactive iodine is The uptake of the radioactive iodine is

measured. Normally the thyroid has an measured. Normally the thyroid has an uptake of 5 – 35% when measured at 24 uptake of 5 – 35% when measured at 24 hours.hours.

The uptake of radioactive iodine is The uptake of radioactive iodine is increased in hyperthyroidism.increased in hyperthyroidism.

Drug therapy for hyperthyroidism commonly Drug therapy for hyperthyroidism commonly includes antianxiety medications [alprazolam includes antianxiety medications [alprazolam

(Xanax), lorazepam (Ativan)] to relieve (Xanax), lorazepam (Ativan)] to relieve diaphoresis, anxiety, tachycardia, and palpitations. diaphoresis, anxiety, tachycardia, and palpitations.

– FALSEFALSE– The most commonly ordered antithyroid drugs are The most commonly ordered antithyroid drugs are

the thioamides, including propylthiouracil (PTU) the thioamides, including propylthiouracil (PTU) and methimazole (Tapazole), which block thyroid and methimazole (Tapazole), which block thyroid hormone production.hormone production.

– Iodine preparations decrease blood flow through Iodine preparations decrease blood flow through the thyroid gland. This reduces the production the thyroid gland. This reduces the production and release of thyroid hormone.and release of thyroid hormone.

– Lithium carbonate also inhibits thyroid hormone Lithium carbonate also inhibits thyroid hormone release.release.

– Beta-adrenergic blocking drugs, such as Beta-adrenergic blocking drugs, such as propranolol (Inderal) and atenolol (Tenormin), propranolol (Inderal) and atenolol (Tenormin), relieve diaphoresis, anxiety, tachycardia, and relieve diaphoresis, anxiety, tachycardia, and palpitations.palpitations.

Results from drug therapy and from radioactive Results from drug therapy and from radioactive iodine therapy are usually seen in 48-72 hours.iodine therapy are usually seen in 48-72 hours.

FALSEFALSE The response to thioamides is delayed The response to thioamides is delayed

because the client may have large because the client may have large amounts of thyroid hormone stored that amounts of thyroid hormone stored that continues to be released.continues to be released.

With the use of iodine preparations, With the use of iodine preparations, improvement usually occurs within 2 improvement usually occurs within 2 weeks, but weeks may be needed before weeks, but weeks may be needed before metabolism returns to normal.metabolism returns to normal.

A patient with hyperthyroidism has a need A patient with hyperthyroidism has a need for increased calories, carbohydrates, and for increased calories, carbohydrates, and

especially proteins.especially proteins. TRUETRUE The client is hypermetabolic and has The client is hypermetabolic and has

an increased need for calories, an increased need for calories, carbohydrates, and proteins. carbohydrates, and proteins. Proteins are especially important Proteins are especially important because the client is at risk for a because the client is at risk for a negative nitrogen balance.negative nitrogen balance.

More questionsMore questions

What should be What should be assessed to determine if assessed to determine if antithyroid agents (such antithyroid agents (such as propylthiouracil) are as propylthiouracil) are

effective? What are effective? What are common side effects common side effects

associated associated with these drugs?with these drugs?

Effectiveness of therapy can be Effectiveness of therapy can be demonstrated by a decrease in the severity demonstrated by a decrease in the severity of symptoms of hyperthyroidism.of symptoms of hyperthyroidism.

Of particular concern is the effect of the Of particular concern is the effect of the thyroid hormone activity on cardiac thyroid hormone activity on cardiac function. The drugs should lower the function. The drugs should lower the systolic BP, narrow the pulse pressure, systolic BP, narrow the pulse pressure, lower the heart rate, and eliminate lower the heart rate, and eliminate dysrhythmias if effective.dysrhythmias if effective.

Weight gain is another sign of effective Weight gain is another sign of effective therapy.therapy.

The most common side effects are nausea, The most common side effects are nausea, vomiting, and rash. Hypothyroidism is a vomiting, and rash. Hypothyroidism is a possible side effect for which dose possible side effect for which dose adjustment may be indicated.adjustment may be indicated.

Indicate if the statement regarding Indicate if the statement regarding thyroidectomy is true (T) of false (F).thyroidectomy is true (T) of false (F).

A client should avoid coughing following A client should avoid coughing following surgery.surgery.

Clients are at risk for hypocalcemia Clients are at risk for hypocalcemia following a thyroidectomy.following a thyroidectomy.

Permanent hoarseness occurs if laryngeal Permanent hoarseness occurs if laryngeal nerve damage occurs.nerve damage occurs.

In acute respiratory obstruction, a In acute respiratory obstruction, a laryngeal stridor will be heard.laryngeal stridor will be heard.

Neck extension should be avoided to Neck extension should be avoided to decrease tension on the suture line.decrease tension on the suture line.

A client should avoid coughing following surgery. A client should avoid coughing following surgery. FALSE,FALSE, BUT IT IS IMPORTANT BUT IT IS IMPORTANT TO SUPPORT THE NECK WHEN COUGHING OR MOVING. PLACING BOTH TO SUPPORT THE NECK WHEN COUGHING OR MOVING. PLACING BOTH HANDS BEHIND THE NECK WHEN MOVING REDUCES THE STRAIN ON THE HANDS BEHIND THE NECK WHEN MOVING REDUCES THE STRAIN ON THE SUTURE LINE.SUTURE LINE.

Clients are at risk for hypocalcemia following a thyroidectomy. Clients are at risk for hypocalcemia following a thyroidectomy. TRUE.TRUE. THE THE PARATHYROID GLANDS CAN BE DAMAGED OR THEIR BLOOD SUPPLY PARATHYROID GLANDS CAN BE DAMAGED OR THEIR BLOOD SUPPLY IMPAIRED. HYPOCALCEMIA AND TETANY RESULT IF PARATHYROID HORMONE IMPAIRED. HYPOCALCEMIA AND TETANY RESULT IF PARATHYROID HORMONE IS DECREASED. EARLY SIGNS OF HYPOCALCEMIA ARE NUMBNESS AND IS DECREASED. EARLY SIGNS OF HYPOCALCEMIA ARE NUMBNESS AND TINGLING AROUND THE MOUTH OR FINGERS AND TOES.TINGLING AROUND THE MOUTH OR FINGERS AND TOES.

Permanent hoarseness occurs if laryngeal nerve damage occurs. Permanent hoarseness occurs if laryngeal nerve damage occurs. FALSE.FALSE. THE THE NURSES ASSESSES THE CLIENT’S VOICE AT 2-HOUR INTERVALS AND NURSES ASSESSES THE CLIENT’S VOICE AT 2-HOUR INTERVALS AND DOCUMENTS CHANGES. THE CLIENT IS REASSURED THAT HOARSENESS IS DOCUMENTS CHANGES. THE CLIENT IS REASSURED THAT HOARSENESS IS USUALLY TEMPORARY.USUALLY TEMPORARY.

In acute respiratory obstruction, a laryngeal stridor will be heard. In acute respiratory obstruction, a laryngeal stridor will be heard. TRUE.TRUE. EMERGENCY TRACHEOSTOMY EQUIPMENT IS KEPT IN THE CLIENT’S ROOM.EMERGENCY TRACHEOSTOMY EQUIPMENT IS KEPT IN THE CLIENT’S ROOM.

Neck extension should be avoided to decrease tension on the suture line. Neck extension should be avoided to decrease tension on the suture line. TRUE.TRUE. SANDBAGS AND PILLOWS ARE USED TO SUPPORT THE HEAD AND SANDBAGS AND PILLOWS ARE USED TO SUPPORT THE HEAD AND NECK.NECK.

Thyroid StormThyroid Storm

What interventions are implemented What interventions are implemented prior to a thyroidectomy to prevent prior to a thyroidectomy to prevent the risk of a thyroid storm?the risk of a thyroid storm?

What signs and symptoms are What signs and symptoms are common during a thyroid storm?common during a thyroid storm?

What are the primary concerns What are the primary concerns during a thyroid storm?during a thyroid storm?

Thyroid StormThyroid Storm Prior to surgery a clients receive antithyroid Prior to surgery a clients receive antithyroid

drugs, beta blockers, steroids, and iodides drugs, beta blockers, steroids, and iodides before to prevent thyroid crisis.before to prevent thyroid crisis.

Signs and symptoms of a thyroid storm are related to Signs and symptoms of a thyroid storm are related to the increase in metabolic rate. They include fever, the increase in metabolic rate. They include fever, tachycardia, systolic hypertension, abdominal pain, tachycardia, systolic hypertension, abdominal pain, N&V, diarrhea, agitation, tremors, restlessness, N&V, diarrhea, agitation, tremors, restlessness, confusion, psychosis, and seizures, It has a mortality confusion, psychosis, and seizures, It has a mortality rate of 25%.rate of 25%.

It is important to identify the causative event. The It is important to identify the causative event. The primary concerns will be maintaining airway patency, primary concerns will be maintaining airway patency, providing adequate ventilation, and stabilizing the providing adequate ventilation, and stabilizing the hemodynamic status.hemodynamic status.

MyxedemaMyxedema

During hypothyroidism, cellular energy During hypothyroidism, cellular energy production is decreased and metabolites production is decreased and metabolites build up.build up.

The metabolites are compounds of proteins The metabolites are compounds of proteins and sugars called glycosaminoglycans.and sugars called glycosaminoglycans.

These compounds build up inside cells, These compounds build up inside cells, which increases mucous and water, forms which increases mucous and water, forms cellular edema, and changes organ texture.cellular edema, and changes organ texture.

The edema is mucinous edema (called The edema is mucinous edema (called myxedema) rather than edema caused by myxedema) rather than edema caused by water alone.water alone.

Myxedema ComaMyxedema Coma

A rare, serious complication of untreated A rare, serious complication of untreated or inadequately treated hypothyroidism.or inadequately treated hypothyroidism.

Decreased metabolism leads to a flabby Decreased metabolism leads to a flabby heart increased chamber sizeheart increased chamber size

Cardiac output decreasesCardiac output decreases Perfusion to the brain and other organs Perfusion to the brain and other organs

decreasesdecreases Decreased perfusion makes slowed Decreased perfusion makes slowed

cellular metabolism worse.cellular metabolism worse. Tissue and organ failure occurs.Tissue and organ failure occurs.

What is the most common reason a person What is the most common reason a person seeks medical help prior to being diagnosed seeks medical help prior to being diagnosed

with hypothyroidismwith hypothyroidism? ? (select one)(select one)

A.A. Weight gainWeight gain

B.B. DyspneaDyspnea

C.C. DepressionDepression

D.D. HoarsenessHoarseness

C. DepressionC. Depression

Depression is the most common reason for Depression is the most common reason for seeking medial attention. Family seeking medial attention. Family members often bring the client for the members often bring the client for the initial evaluation. The client may be too initial evaluation. The client may be too lethargic, apathetic, or drowsy to lethargic, apathetic, or drowsy to recognize changes in his or her condition.recognize changes in his or her condition.

Other psychosocial changes include Other psychosocial changes include paranoia, agitation, disturbed thought paranoia, agitation, disturbed thought process, and impaired memory.process, and impaired memory.

Indicate “T” for a true statement Indicate “T” for a true statement and “F” for a false statement.and “F” for a false statement.

The client with more severe symptoms of The client with more severe symptoms of hypothyroidism is started on the lowest dose of hypothyroidism is started on the lowest dose of thyroid hormone replacement.thyroid hormone replacement.

A client is placed on thyroid hormone A client is placed on thyroid hormone replacement until Treplacement until T33 and T and T44 level become level become normal, and is then gradually tapered off the normal, and is then gradually tapered off the medication.medication.

Increased mental awareness is a sign of Increased mental awareness is a sign of effective thyroid hormone replacement therapy.effective thyroid hormone replacement therapy.

Emergency care of the client during myxedema Emergency care of the client during myxedema coma includes levothyroxine sodium IV.coma includes levothyroxine sodium IV.

True or FalseTrue or False The client with more severe symptoms of The client with more severe symptoms of

hypothyroidism is started on the lowest dose of hypothyroidism is started on the lowest dose of thyroid hormone replacement. thyroid hormone replacement. TRUETRUE. . This caution This caution is especially important when the client has known is especially important when the client has known cardiac problems. Severe hypertension, heart cardiac problems. Severe hypertension, heart failure, and myocardial infarction can occur if the failure, and myocardial infarction can occur if the initial dose is too high or if the dose is increased initial dose is too high or if the dose is increased too rapidly.too rapidly.

A client is placed on thyroid hormone replacement A client is placed on thyroid hormone replacement until Tuntil T33 and T and T44 level become normal, and is then level become normal, and is then gradually tapered of the medication. gradually tapered of the medication. FALSEFALSE The The client with hypothyroidism requires lifelong thyroid client with hypothyroidism requires lifelong thyroid hormone replacement.hormone replacement.

True or FalseTrue or False Increased mental awareness is a sign of Increased mental awareness is a sign of

effective thyroid hormone replacement therapy. effective thyroid hormone replacement therapy. TRUE TRUE Other signs of resolving hypothyroidism Other signs of resolving hypothyroidism will also demonstrate effective therapy. will also demonstrate effective therapy.

Emergency care of the client during myxedema Emergency care of the client during myxedema coma includes levothyroxine sodium IV. coma includes levothyroxine sodium IV. TRUETRUE Other interventions include maintain a patent Other interventions include maintain a patent airway, replacing fluids, administering glucose airway, replacing fluids, administering glucose IV, administering corticosteroids, checking IV, administering corticosteroids, checking temperature frequently, monitoring BP, temperature frequently, monitoring BP, covering client with warm blankets, and covering client with warm blankets, and monitoring mental status.monitoring mental status.

Conditions that could lead to Conditions that could lead to hyperparathyroidism include which of the hyperparathyroidism include which of the

following? Indicate all that apply.following? Indicate all that apply. Congenital thyroid dysgenesisCongenital thyroid dysgenesis Parathyroid carcinomaParathyroid carcinoma Vitamin D deficiencyVitamin D deficiency HypomagnesemiaHypomagnesemia Chronic renal failure with Chronic renal failure with

hypocalcemia.hypocalcemia. Neck traumaNeck trauma

Causes of hyperparathyroidism include the Causes of hyperparathyroidism include the BOLDBOLD items:items:

Congenital dysgenesisCongenital dysgenesis Parathyroid carcinomaParathyroid carcinoma Vitamin D deficiencyVitamin D deficiency HypomagnesemiaHypomagnesemia Chronic renal failure with Chronic renal failure with

hypocalcemia.hypocalcemia. Neck traumaNeck trauma Other causes are parathyroid Other causes are parathyroid

adenoma, congenital hyperplasia, adenoma, congenital hyperplasia, neck radiation, parathyroid neck radiation, parathyroid hormone-secreting carcinomas of hormone-secreting carcinomas of lung, kidney , or GI tract.lung, kidney , or GI tract.

Indicate “T” for a true statement Indicate “T” for a true statement and “F” for a false statement.and “F” for a false statement.

A client with hyperparathyroidism is at risk for A client with hyperparathyroidism is at risk for pathologic fractures.pathologic fractures.

Hypercalcemia associated with Hypercalcemia associated with hyperparathyroidism is treated with dietary hyperparathyroidism is treated with dietary restriction of calcium.restriction of calcium.

A positive Chvostek’s sign and Trousseau’s A positive Chvostek’s sign and Trousseau’s sign indicate hypercalcemia.sign indicate hypercalcemia.

Serum PTH, calcium, and phosphate levels Serum PTH, calcium, and phosphate levels and urine cyclic adenosine monophosphate and urine cyclic adenosine monophosphate (cAMP) are the most commonly used (cAMP) are the most commonly used laboratory tests to detect laboratory tests to detect hyperparathyroidism.hyperparathyroidism.

True or FalseTrue or False A client with hyperparathyroidism is at risk for A client with hyperparathyroidism is at risk for

pathologic fractures. pathologic fractures. TRUETRUE An increased rate An increased rate of bone destruction occurs when the levels of of bone destruction occurs when the levels of PTH are high, resulting in pathologic fractures, PTH are high, resulting in pathologic fractures, bone cysts, and osteoporosis.bone cysts, and osteoporosis.

Hypercalcemia associated with Hypercalcemia associated with hyperparathyroidism is treated with dietary hyperparathyroidism is treated with dietary restriction of calcium. restriction of calcium. FALSEFALSE A diuretic and A diuretic and fluid therapy is the most common method used fluid therapy is the most common method used to lower calcium. Other drug therapy includes to lower calcium. Other drug therapy includes oral phosphates, calcitonin, and calcium oral phosphates, calcitonin, and calcium chelators such as Mithramycin.chelators such as Mithramycin.

True or FalseTrue or False A positive Chvostek’s sign and Trousseau’s A positive Chvostek’s sign and Trousseau’s

sign indicate hypercalcemia. sign indicate hypercalcemia. FALSEFALSE Low Low calcium levels are associated with increased calcium levels are associated with increased neuromuscular activity. Chvostek’s and neuromuscular activity. Chvostek’s and Trousseau’s are found in hypocalcemia.Trousseau’s are found in hypocalcemia.

Serum PTH, calcium, and phosphate levels and Serum PTH, calcium, and phosphate levels and urine cyclic adenosine monophosphate (cAMP) urine cyclic adenosine monophosphate (cAMP) are the most commonly used laboratory tests are the most commonly used laboratory tests to detect hyperparathyroidism. to detect hyperparathyroidism. TRUETRUE In In hyperparathyroidism, serum PTH is increased, hyperparathyroidism, serum PTH is increased, calcium is increased, phosphate is decreased, calcium is increased, phosphate is decreased, and urinary cAMP is increased.and urinary cAMP is increased.