Hard work for health student

1. 1
Thyroid disoder
By Ruach James

2. Thyroid Gland
2
 The thyroid is a gland shaped like a butterfly and
located in the front of the neck, just below the
Adam's apple.
 The thyroid is a gland responsible for production of
thyroid hormones ( T3,T4, and calcitonin).
 These hormones help to regulate the body's
metabolism and affect important processes, such as
growth and other metabolism of the body.
 The thyroid gland works like a factory that uses
iodine (mostly from the diet in seafood and salt) to
produce thyroid hormones.

3. Anatomy and physiology overview
Thyroid Gland
3

4. Anatomy and physiology overview
Thyroid Gland…
4
 The two most important thyroid hormones are thyroxine
(T4) and triiodothyronine (T3), representing 99.9% and
0.1% of thyroid hormones, respectively.
 The hormone with the most biological power is T3.
 Once released from the thyroid gland into the blood, a
large amount of T4 is converted to T3- the active
hormone that affects the metabolism of all cells.

5. Anatomy and physiology overview
Thyroid gland …
5
 The blood flow to the thyroid is very high (about 5
mL/min per gram of thyroid tissue), approximately
five times the blood flow to the liver.
 This reflects the high metabolic activity of the thyroid
gland.

6. Anatomy and physiology overview
Thyroid hormones
6
 The hypothalamus releases TRH, which sends a signal to
the pituitary gland to release TSH.
 TSH controls the rate of thyroid hormone release. In turn,
the level of thyroid hormone in the blood determines the
release of TSH.
 If over activity of any of these three glands occurs, an
excessive amount of thyroid hormones can be produced,
thereby resulting in hyperthyroidism.
 Similarly, if under activity of any of these glands occurs, a
deficiency of thyroid hormones can result, causing
hypothyroidism.

7. Anatomy and physiology overview
Thyroid hormones
7
 If the thyroid hormone concentration in the blood
decreases, the release of TSH increases, which causes
increased output of T3 and T4.
 This is an example of negative feed back.
 The term euthyroid refers to thyroid hormone
production that is within normal limits (T4= 5-13.5µg
and T3= 0.1-0.2µg).
 Thyroid gland produce another hormone called
calcitonin. Unlike T3 and T4, calcitonin is not involved in
the regulation of metabolism.
 Calcitonin regulates calcium by lowering calcium levels
in the blood.

8. Negative feed back mechanism thyroid hormone
8

9. Anatomy and physiology overview
Function of thyroid hormones
9
 The primary function of thyroid hormone is to control
cellular metabolic activity.
 The thyroid hormones influence cell replication and
are important in brain development.
 Thyroid hormone is also necessary for normal
growth.
 T4 is a relatively weak hormone, maintains body
metabolism in a steady state.
 T3 is about five times as potent as T4 and has a

10. Anatomy and physiology overview
Function of thyroid hormones…
10
 If over activity of any of these three glands
(Hypothalamus, pituitary & thyroid) occurs, an
excessive amount of thyroid hormones can be
produced, thereby resulting in hyperthyroidism.
 Similarly, if under activity of any of these glands
occurs, a deficiency of thyroid hormones can
result, causing hypothyroidism.

11. Pathophysiology
11
 Inadequate secretion of thyroid hormone during fetal and neonatal
development - stunted physical and mental growth (cretinism).
 In adults, hypothyroidism manifests as lethargy, slow mentation, and
generalized slowing of body functions.
 Over secretion of thyroid hormones (hyperthyroidism) is manifested by a
greatly increased metabolic rate.

12. Pathophysiology
12
 Many of the other characteristics of hyperthyroidism result
from the increased response to circulating catecholamines
(epinephrine and norepinephrine).
 Over secretion of thyroid hormones - associated with an
enlarged thyroid gland known as a goiter (occurs with iodine
deficiency).
 lack of iodine results in low levels of circulating thyroid
hormones, which causes release of TSH; the elevated TSH
causes overproduction of thyroglobulin (a precursor of T3 and

13. Assessment and diagnostic finding
13
Physical Examination
 Inspection for - identification of landmarks, swelling
or asymmetry.
 The patient is instructed to extend the neck slightly
and swallow.
 Thyroid tissue rises normally with swallowing.
 The thyroid is then palpated for size, shape,
consistency, symmetry, and the presence of
tenderness

14. Assessment and diagnostic finding
14
Physical Examination
 The clinician may examine the thyroid from an anterior or a
posterior position.
 In the posterior position, both hands encircle the patient’s neck.
The thumbs rest on the nape of the neck, while the index and
middle fingers palpate for the thyroid isthmus and the anterior
surfaces of the lateral lobes.
 When palpable, the isthmus is perceived as firm and of a rubber-
band consistency.

15. Assessment and diagnostic finding
15
Physical Examination
 Having the patient swallow during the maneuver
may assist the examiner to locate the thyroid as it
ascends in the neck.
 The isthmus is the only portion of the thyroid that is
normally palpable.
 If a patient has a very thin neck, two thin, smooth,
nontender lobes may also be palpable

16. Assessment and diagnostic finding
16
Physical Examination
 If palpation discloses an enlarged thyroid gland, both
lobes are auscultated using the diaphragm of the
stethoscope.
 Auscultation identifies the localized audible vibration of
a bruit.
 This is indicative of increased blood flow through the
thyroid gland associated with hyperthyroidism and

17. Assessment and diagnostic finding
17
Physical Examination
 Other abnormal findings that require referral
for further evaluation may include
 a soft texture (Graves’ disease),
 firmness (Hashimoto’s thyroiditis or malignancy), and
 tenderness (thyroiditis)
Video

18. Laboratory and diagnostic finding
18
Assessment measures include:
 thyroid function tests - laboratory measurement of
thyroid hormones,
 biopsy,
 The most widely used tests are serum immunoassay
for TSH and free T4
 Free T4 levels - elevated in hyperthyroidism and
decreased in hypothyroidism.
 Ultrasound, CT, and MRI may be used to clarify or
confirm the results of other diagnostic studies.

19. Hypothyroidism
19
 is a state in which the thyroid gland does not
produce a sufficient amount of the thyroid hormones
T4 and T3.
 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

20. myxedema
20

21. Classification
21
 Primary or thyroidal hypothyroidism: which refers to
dysfunction of the thyroid gland itself. More than
95% of patients have primary hypothyroidism
 Central hypothyroidism: If the cause of the thyroid
dysfunction is failure of the pituitary gland, the
hypothalamus, or both.
 Secondary hypothyroidism or pituitary: If the cause
is entirely a pituitary disorder.
 Tertiary hypothyroidism or hypothalamic: If the
cause is a disorder of the hypothalamus resulting
in inadequate secretion of TSH due to decreased
stimulation by TRH.

22. Classification
22
Cretinism: If thyroid deficiency is present at birth.
 In such instances, the mother may also have thyroid
deficiency.
 Myxedema- refers to the accumulation of
mucopolysaccharides in subcutaneous and other
interstitial tissues.
 It implies presence of non-pitting mucosal edema,
 The term is used only to describe the extreme symptoms
of severe hypothyroidism.

23. Causes
23
 Autoimmune disease (Hashimoto's thyroiditis, post–
Graves' disease)
 Atrophy of thyroid gland with aging
 Therapy for hyperthyroidism
Radioactive iodine (131I)
Thyroidectomy
 Medications
Lithium, Iodine compounds
Antithyroid medications
Radiation for treatment of head and neck cancer.
 Iodine Deficiency is the most common cause of

24. Clinical features
24
Early
 Appearance: thin, brittle fingernails; dry, itchy skin;
weight gain, water retention, myxedema, hair loss
 Neurological: depression, rapid thoughts.
 Neuromuscular: depressed reflexes, hypotonia,
muscle cramps, joint pain, mood instability,
irritability, constipation
 Constitutional: fatigue, sleepiness, cold intolerance,
decreased sweating
 Cardiovascular: bradycardia, elevated serum
cholesterol.
 Endocrine: female infertility, menstrual irregularities,

25. Clinical features…
25
Late
 Appearance: thinning of the outer third of the eyebrow dry
'puffy' facial skin
 Neurological: slow speech and hoarse voice, deepening of
the voice due to Reinke's Edema
 Neuromuscular: carpal tunnel syndrome and bilateral
paresthesia
 Constitutional: low basal body temperature
 Cardiovascular: hypotension
 Endocrine: goiter, decreased libido in men due to impairment
of testicular testosterone synthesis

26. Diagnostic evaluation
26
 History: dry skin, intolerance to cold, constipation
,fatigue
 Physical examination: B/P, HR, Skin ,hair…
 Lab investigations:
 Low serum T3
 If your free T4 levels are too low—
 the normal range for T4 is 5 to 13.5 µg/dl—it's a
possible indicator of hypothyroidism, even if previous
TSH tests came back normal.
 Serum cholesterol –elevated in hypothyroidism

27. Treatment
27
Aim:- Restore normal metabolic state by replacing the
missing hormone, synthetic levothyroxin.
 In sever hypothyroidism and myxedema
management maintain vital function.
 Avoid application of external heat because it may
increase oxygen requirement.

28. Treatment
28
Levothyroxin sodium (Levoxyl)
 T4 replacement in adults is approximately
1.6µg/kg/day.
 Circulating serum T3 and T4 levels exert a feedback
effect on both TRH and TSH secretion.
 Ideally, synthetic T4 replacement should be taken in
the morning, 30 minutes before eating.
 Other medications containing iron or antacids

29. Nursing responsibilities
29
 The patient experiences decreased energy and
moderate to sever lethargy:
 avoid complication from immobility
 help the patient exercise with his/her energy level.
 On going monitor vital signs
 Give extra blanket if feels cold
 Emotional support
 Instruct the patient not to interrupt medication even
symptoms disappear
 Follow dietary instruction

30. Major Nursing diagnosis for patients with hypothyroidism
30
Activity intolerance related to fatigue and depressed
cognitive process
 GOAL: Increased participation in activities and increased
independence
Risk for imbalanced body temperature
 GOAL: Maintenance of normal body temperature
Constipation related to depressed gastrointestinal function
 GOAL: Return of normal bowel function
Deficient knowledge about the therapeutic regimen for
lifelong thyroid replacement therapy
 GOAL: Knowledge and acceptance of the prescribed
therapeutic regimen
Disturbed thought processes related to depressed
metabolism and altered cardiovascular and respiratory
status

31. Hyperthyroidism
31
 Hyperthyroidism is a condition in which the thyroid
gland produces and secretes excessive amounts of the
free thyroid hormones(T3 and T4).
 Hyperthyroidism is the second most prevalent
endocrine disorder, after diabetes mellitus.
 If there is too much thyroid hormone, every function of
the body tends to speed up.

32. Hyperthyroidism…
32
 The thyroid gland’s production of thyroid hormones
(T3 and T4) is triggered by TSH, which is made by
the pituitary gland.
 Hyperthyroidism is a disorder that occurs when the
thyroid gland makes more thyroid hormone than the
body needs.
 It is sometimes called thyrotoxicosis, the technical
term for too much thyroid hormone in the blood.

33. Hyperthyroidism…
33
 The over stimulation of the thyroid gland leads to
hyperplasia of the gland and subsequently this
leads to an increase in the secretion of thyroid
hormones.
 The growth in the cells and its multiplication
manifest in enlargement of the gland.
 Noticeable changes occur in all parts of the body as
a result of the increased hormone secretion.
 There is elevation in metabolic rate manifesting in
elevation in metabolism of protein, fat and
carbohydrate.
 The accelerated protein and fat metabolism lead
to weight loss and muscular weakness.

34. Hyperthyroidism…
34
 The body attempts to remedy the weight loss and
so the patient's appetite is increased in the
process.
 Patient is unable to tolerate hot weather as a result
of the increase in the body metabolism.
 The superficial capillaries dilate leading to
increased peripheral blood flow and also an
increase in cardiac output as the body tries to
eliminate excess heat from the system.

35. Hyperthyroidism…
35
 The increase cardiac output in conjunction with
hormonal effects on the sympathetic nerves brings
about palpitation and tachycardia
 Increased adrenergic activity results in the retraction
of the upper eyelids which presents with increased
sclera exposure or exophthalmoses.
 Increased adrenergic activity also causes fine muscle
tremors which are noticeable when patient's hands are
outstretched.

36. Hyperthyroidism…
36
 Graves' disease-An autoimmune disease (the
most common etiology hyperthyroidism) with 50-
80% worldwide.
 Graves' disease, results from an excessive output of
thyroid hormones caused by abnormal stimulation
of the thyroid gland by circulating Immunoglobulin.
 Frequently causing it to enlarge to twice its size or
more (goiter), with related hyperthyroid symptoms
such as increased heartbeat, muscle weakness,
disturbed sleep, and irritability.

37. Hyperthyroidism…
37
 It can also affect the eyes, causing bulging eyes
(exophthalmia).
 It affects other systems of the body, including the
skin, heart, circulation and nervous system.

38. Causes
38
 It is usually associated with hyperplasia of the
thyroid gland and multinodular goiter.
 Adenoma of thyroid
 Thyrioditis
 Excessive ingestion of thyroid hormone
 Eradiation of thyroid hormone

39. Clinical features
39
 Nervousness, Goiter or Hand tremor
 Emotionally hyperexitability, irritable, they can not
sit quietly.
 Tachycardia and palpitation,
 excessive sweating
 Wt loss despite large appetite
 Patient exhibits exophthalmoses (bulging of eyes)
 diarrhea
 Tremor
 Heat intolerance ,

40. Assessment and Diagnostic Findings…
40
Physical Examination
 High systolic blood pressure, increased heart rate
 Shaking of the hands
 Swelling or inflammation around the eyes
 soft and pulsate enlarged glands
 A thrill often can be palpated
 a bruit is heard over the thyroid arteries. These are
signs of greatly increased blood flow through the thyroid
gland.

41. Assessment and Diagnostic Findings…
41
Blood tests:
 Thyroid hormones TSH, T3, and T4.
 Cholesterol levels
 Glucose
 Radioactive iodine uptake

42. Possible Complications
42
 Thyroid crisis (storm), also called thyrotoxicosis, is a
sudden worsening of hyperthyroidism symptoms
that may occur with infection or stress.
 Fever, decreased alertness, and abdominal pain
may occur. Patients need to be treated in the
hospital.
 Other complications of hyperthyroidism include:
 fast heart rate,
 abnormal heart rhythm,
 heart failure
 Osteoporosis

43. Possible Complications…
43
 Surgery-related complications:
 Scarring of the neck
 Hoarseness due to nerve damage to the voice box
 Low calcium level due to damage to the parathyroid
glands (located near the thyroid gland)
 Hypothyroidism (underactive thyroid)

44. Management
44
No specific treatment directed toward the causes of
hyperthyroid is available.
but 3 form of treatment available for Rx
hyperthyroidism and control excessive thyroid
activity.
 Pharmacological
 Irradiation
 surgery

45. Management
45
Pharmacological….
Inhibit one /more stage of hormone synthesis
Anti-thyroid agent
 Propthyluarcil (methimasole): prevent the thyroid gland
from converting iodine to its organic (hormonal) form in
the thyroid and block conversation of T4 to T3 in the
tissue.
 Beta blocking adregenic drug propanolol is often given
to control nervousness, tachycardia, tremor by blocking

46. Pharmacology …
46
Radioactive iodine (131 I) to destroy over active
thyroid cells and stops the excess production of
hormones.
Surgical removal: Part or all the thyroid gland.
 Lugol’s solution (iodine) may be given to depress
the thyroid gland in preparation for surgery.
 If thyroid is removed with surgery or destroyed with
radiation, it is must take thyroid hormone
replacement pills for the rest of the life.

47. Complications
47
Potential complications may include the
following:
 Thyrotoxicosis or thyroid storm
 Hypothyroidism

48. The major nursing diagnoses of the patient with
hyperthyroidism may include the following:
48
 Imbalanced nutrition, less than body requirements, related to
exaggerated metabolic rate, excessive appetite, and
increased GI activity
 Ineffective coping related to irritability, hyperexcitability,
apprehension, and emotional instability
 Low self-esteem related to changes in appearance, excessive
appetite, and weight loss
 Altered body temperature

49. Goiter
49
Goiter is an increase in size of the thyroid gland which
can occur in hypothyroid, euthyroid, hyperthyroid
state.

50. Type of goiter
50
Simple goiters:
 develop when the thyroid gland does not make enough
hormones to meet the body's needs.
 The thyroid gland tries to make up for this shortage by
growing larger.
Endemic goiters :
 occur in people who do not get enough iodine in their diet
(iodine is necessary to make thyroid hormone).
 because iodine is added to table salt in the United States
and other countries, this type of goiter usually does not occur
in these countries.

51. Types of goiter
51
Sporadic goiters:
 most cases, have no known cause.
 In some cases, certain drugs can cause this type of goiter.
 For example, the drug lithium, which is used to treat certain
mental health conditions, as well as other medical conditions,
can cause this type of goiter.

52. Risk factors for goiter
52
 Hereditary (inherited from family)
 Female gender
 Age over 40
 Exposure to radiation :
 person who has had medical radiation
treatments to the head and neck has a greater
risk of developing goiter.

53. What are the symptoms of goiter?
53
 A swelling in the front of the neck, just below
the Adam's apple
 A feeling of tightness in the throat area
 Hoarseness
 Neck vein swelling
 Dizziness when the arms are raised above the
head

54. Other, less common symptoms :
54
 Difficulty breathing (shortness of breath)
 Coughing
 Wheezing (due to squeezing of the windpipe)
 Difficulty swallowing (due to squeezing of the esophagus, or “food
tube”)

55. How is goiter diagnosed?
55
• Physical exam: if the thyroid gland has grown by feeling the
neck area for nodules and signs of tenderness.
• Hormone test: measures thyroid hormone levels,
• Antibody test: An antibody is a protein made by WBC.
Antibodies help defend against invaders (for example,
viruses) that cause disease or infection in the body.
• Ultrasound of the thyroid: Ultrasound of the thyroid reveals
the gland's size and finds nodules.

56. How is goiter diagnosed?
56
Thyroid scan: imaging test provides information on the size and
function of the gland.
 In this test, a small amount of radioactive material is injected into a
vein to produce an image of the thyroid on a computer screen.
CT scan or MRI of the thyroid:
 If the goiter is very large or spreads into the chest, a CT
scan or MRI is used to measure the size and spread of the goiter.

57. Management and treatment
57
No treatment/"watchful waiting."
 If the goiter is small and is not bothering you, it
to be treated.
 However, the goiter will be closely watched for any
Medications.
 Levothyroxine (Levothroid®, Synthroid®) is a thyroid
hormone replacement therapy.
 It is prescribed if the cause of the goiter is an underactive
(hypothyroidism).
 if the cause of the goiter is an overactive thyroid
(hyperthyroidism) drugs
used

58. Management and treatment
58
Radioactive iodine treatment.
 used in cases of an overactive thyroid gland (orally).
 the patient usually has to take thyroid hormone replacement
the rest of his or her life after radioactive iodine treatment
Biopsy :
 a biopsy is the removal of a sample of tissue or cells from
organisms to be studied in a laboratory.
 A biopsy is taken to rule out cancer.
Surgery:
 is performed to remove all or part of the thyroid gland.
 if the goiter is large and causes problems with breathing and
 the patient may need to take thyroid hormone replacement
the rest of his or her life.

59. Endemic(iodine deficient) goiter
59
 Endemic goiter is a type of goiter that is associated
with dietary iodine deficiency.
 Some inland areas where soil and water lacks in
iodine compounds and consumption of marine
foods is low are known for higher incidence of
goiter. In such areas goiter is said to be "endemic".
 Simple goiter represents a compensatory
hypertrophy of thyroid gland presumable caused by
stimulation of the pituitary gland.

60. Endemic Goiter….
60
 The pituitary Gland produce TSH hormone that
controls the level of thyroid hormone from the
thyroid Gland.
 Its production increases , if there is subnormal
thyroid activity as when insufficient iodine is
available for production of the thyroid hormone.
 Such goiters usually cause no symptoms, except for
the swelling in the neck, which may result in

61. Clinical Manifestation
61
 Increased size of the thyroid gland;
 Difficulty swallowing;
 Shortness of breath;
 Pain in the neck
Nonspecific symptoms:
 Pain in the eyes;
 Turbidity visible objects;
 Depression;
 Blurry vision;
 Chills;
 Dryness of the skin;

62. Diagnosis
62
 Family history and examination of the patient.
 Physical Examination: palpation or Inspection.
 Blood test: to pinpoint the exact cause of thyroid
enlargement (determine the levels T3 ,T4 and TSH
as well ESR
 CT scans, MRIs, and a biopsy of the thyroid gland.
The latter is necessary for a suspected thyroid
cancer.

63. Treatment
63
 Supplementary iodine, such as SSKI, is prescribed
to suppress the pituitary's thyroid-stimulating
activity.
 Consuming more foods rich in this substance
(especially seafood).
 To compensate for low levels of thyroid hormones a
sufferer can also be prescribed a medication, such
as levothyroxine – a synthetic form of a thyroid

64. Endemic Goiter…
64
 If the mean iodine intake is less than 40 fg/day,(˷4.0g)
the thyroid gland hypertrophies.
 The WHO recommends that salt be iodized to a
concentration of 1 part in 100,000, which is adequate
for the prevention of endemic goiter.
 In the United States, salt is iodized to 1 part in 10,000.
 The introduction of iodized salt has been the single
most effective means of preventing goiter in at-risk

65. Endemic Goiter…
65
 Surgical procedures are used in a significant increase in thyroid
gland, malignant neoplasm of the thyroid gland, as well as in those
cases when all other treatments proved to be ineffective
 When surgery is recommended, the risk of postoperative
complications is minimized by ensuring a preoperative euthyroid
state through treatment with ant thyroid medications and iodide to
reduce the size and vascularity of the goiter.
 Providing children in iodine-poor regions with iodine compounds
can prevent simple or endemic goiter.

66. Thyroiditis…
66
Thyroiditis, inflammation of the thyroid gland, can be
acute, sub-acute, or chronic.
 Each type of thyroiditis is characterized by
inflammation, fibrosis, or lymphocytic infiltration of
the thyroid gland.
Acute thyroiditis
 Acute thyroiditis is a rare disorder caused by
infection of the thyroid gland by bacteria, fungi,
mycobacterium, or parasites.
 Staphylococcus aureus and other staphylococci are the
most common causes.

67. Thyroiditis…
67
Acute thyroiditis….
 Infection typically causes anterior neck pain and
swelling, fever, dysphagia, and dysphonia.
 Pharyngitis or pharyngeal pain is often present.
Examination may reveal warmth, erythema (redness),
and tenderness of the thyroid gland.
Treatment:
 antimicrobial agents and fluid replacement.
 Surgical incision and drainage may be needed if an
abscess is present.

68. Sub acute thyroiditis
68
 Sub acute thyroiditis may be sub acute
granulomatous thyroiditis or painless thyroiditis
(silent thyroiditis or sub acute lymphocytic
thyroiditis).
 Sub acute granulomatous thyroiditis is an
inflammatory disorder of the thyroid gland that
predominantly affects women between 40 and 50

69. Sub acute thyroiditis…
69
 painful swelling in the anterior neck that lasts 1 to 2
months and then disappears spontaneously without
residual effect.
 It often follows a respiratory infection.
 enlarged thyroid glands symmetrically and painful.
 reddened and warm overlying skin .
 Swallowing may be difficult and uncomfortable.
 Irritability, nervousness, insomnia, and weight loss—
manifestations of hyperthyroidism.
 chills and fever as well

70. Management
70
Treatment aims to control the inflammation.
 NSAIDs are used to relieve neck pain.
 Beta-blocking agents (propranolol)may be used to
control symptoms of hyperthyroidism.

71. Management…
71
 Anti thyroid agents, which block the synthesis of T3
and T4, are not effective in thyroiditis because the
associated thyrotoxicosis results from the release of
stored thyroid hormones rather than from their
increased synthesis.
 In more severe cases, oral corticosteroids may be
prescribed to reduce swelling and relieve pain

72. Chronic thyroiditis (hashimoto’s disease)
72
 Chronic thyroiditis, which occurs most frequently in
women between 30 and 50 years old, has been
termed Hashimoto’s disease, or chronic lymphocytic
thyroiditis;
 Its diagnosis is based on the histological
appearance of the inflamed gland.
 In contrast to acute thyroiditis, the chronic forms are
usually:
 not accompanied by pain, pressure symptoms, or
fever, and thyroid activity is usually normal or low
rather than increased.

73. Chronic thyroiditis…
73
 If untreated, the disease runs a slow, progressive
course, leading eventually to hypothyroidism.

74. Management
74
 The objective of treatment is to reduce the size of
the thyroid gland and prevent hypothyroidism.
 Thyroid hormone therapy is prescribed to reduce
thyroid activity and the production of thyroglobulin.
 If hypothyroid symptoms are present, thyroid
hormone
therapy is prescribed.

75. Thyroid cancer
75
 Cancer of the thyroid is much less prevalent than other forms
of cancer;
 however, it accounts for 90% of endocrine malignancies.
 There are several types of cancer of the thyroid gland;
 the type determines the course and prognosis
 External radiation of the head, neck, or chest in infancy and
childhood increases the risk of thyroid carcinoma.

76. Type of thyroid cancer
76
Classified based on the type of cell from which they develop.
Papillary carcinoma :
 the most common type of thyroid cancer, accounting for approximately 80 percent
of cases.
 slow-growing, differentiated cancers that develop from follicular cells and can
develop in one or both lobes of the thyroid gland.
 may spread to nearby lymph nodes in the neck, but it is generally treatable with a
good prognosis
.

77. Types of thyroid cancer
77
Follicular carcinoma :
 the second most common type of thyroid cancer,
 more frequent in environment where an inadequate dietary
intake of iodine.
 In most cases, it is associated with a good prognosis,
although it is somewhat more aggressive than papillary
cancer.
 Follicular carcinomas do not usually spread to nearby lymph
nodes, but they are more likely than papillary cancers to
spread to other organs, like the lungs or the bones

78. Type of thyroid cancer
78
Anaplastic carcinoma :
 the most undifferentiated type of thyroid cancer, meaning
that it looks the least like normal cells of the thyroid
gland.

 As a result, it is a very aggressive form of cancer that
quickly spreads to other parts of the neck and body.
 It occurs in approximately 2 percent of thyroid cancer
cases.

79. Type of thyroid cancer
79
Medullary thyroid carcinoma :
 develops from C cells in the thyroid gland,
 more aggressive and less differentiated than papillary or follicular
cancers.
 Approximately 4% of all thyroid cancers will be of the medullary
subtype.
 These cancers are more likely to spread to lymph nodes and other
organs, compared with the more differentiated thyroid cancers.
 They also frequently release high levels calcitonin and
carcinoembryonic antigen (CEA), which can be detected by blood
tests.

80. Thyroid cancer
80
Assessment and Diagnostic Findings
 Lesions that are ;
 single, hard, and fixed on palpation or associated with
cervical lymphadenopathy suggest malignancy,
 thyroid function tests
 biopsy
 ultrasound, MRI, CT, thyroid scans, and
 thyroid suppression tests.

81. Cervical nodes
81

82. Cervical lymphadenopathy
82

83. Cervical lymphadenopathy
83

84. Biopsy
84

85. Thyroid cancer
85
Medical Management
The treatment of choice for thyroid carcinoma is surgical
removal.
 Efforts are made to spare parathyroid tissue to reduce the
risk of postoperative hypocalcemia and tetany.
 Chemotherapy is infrequently (rarely) used to treat thyroid
cancer.

86. Nursing Management
86
Important preoperative goals are to gain the
patient’s confidence and reduce anxiety.
Providing Preoperative Care
 The nurse instructs the patient about the
importance of eating a diet high in carbohydrates
and proteins.
 A high daily caloric intake is necessary because
of the increased metabolic activity and rapid
depletion of glycogen reserves.
 Supplementary vitamins, particularly thiamine
and ascorbic acid, may be prescribed.
 The patient is reminded to avoid tea, coffee,
cola, and other stimulants

87. Nursing management
87
 During postoperative period, the most comfortable position is
the semi-Fowler’s position, with the head elevated and
supported by pillows
 IV fluids are administered during the immediate postoperative
period.
 Water may be given by mouth as soon as nausea subsides.
 Usually, there is a little difficulty in swallowing; initially, cold
fluids and ice may be taken better than other fluids.

 Often, patients prefer a soft diet to a liquid diet in the
immediate postoperative period..

88. Nursing management
88
 The patient is advised to talk as little as possible to reduce
edema to the vocal cords; however, any voice changes are
noted, which might indicate injury to the recurrent laryngeal
nerve, which lies just behind the thyroid next to the trachea.

89. The End
89