Thyroid & Parathyroid (HLC Spring 2026)

Thyroid & Parathyroid Disorders

Monica DeSantiago, MSN, RN, CNE ACC ADN Level II Program HLC

By the end of the lecture, students will be able to:

• Explain how thyroid hormone is regulated in the body.

• Describe the clinical manifestations, diagnostics, treatment, and nursing care of a patient with a thyroid problem.

• Explain complications of hyperthyroidism and hypothyroidism and how to manage these complications.

• Describe the clinical manifestations, diagnostics, treatment, and nursing care of a patient with a parathyroid problem.

Objectives

• Consists of several organs and glands that secrete

hormones

Thyroid Gland

The thyroid gland secretes 3 main hormones:

• triiodothyronine - _____

• thyroxine - _____

• calcitonin
• Helps lower the blood’s calcium level

T3

T4

Thyroid hormone = T3 + T4

Iodine is needed to produce T3 and T4.

T3

T4

• triiodothyronine
• 3 iodine atoms
• active form
• 20% of thyroid hormone production

• thyroxine
• 4 iodine atoms
• inactive form
• 80% of thyroid hormone production
• T4 is converted to T3

Why is thyroid hormone important?

T3 & T4 affect every cell and organ:

• Metabolic rate
• Heart rate
• Body temperature
• Digestion
• Growth & development
• Muscle contraction
• Skin & bone maintenance

What stimulates the release of T3 and T4 from the thyroid gland?

It’s a negative feedback loop!

Continuum of Thyroid Dysfunction

Normal

Hyperthyroidism

Hyperthyroidism

Definition: Hyperactivity of the thyroid gland with sustained increase in the creation and release of thyroid hormones Cause: Graves’ disease accounts for 75% of cases

• Autoimmune disease that results in thyroid hyperactivity

Think: Increased metabolism

• Cardiovascular
• Respiratory
• Gastrointestinal
• Integumentary
• Musculoskeletal
• Nervous
• Reproductive

Hyperthyroidism – Diagnostics

Ophthalmologic examination

History & physical exam; EKG

RAIU, thyroid scan

Lab tests

goiter

exophthalmos

RAIU Test

Used to differentiate Graves' disease from other causes of hyperthyroidism RAIU will be elevated. What must be assessed prior to the test?

Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.

Radioactive iodine uptake

• Used to differentiate Graves’ disease from other causes of hyperthyroidism

• RAIU will be elevated

What must be assessed prior to the test?

Radioactive Iodine Uptake Test (RAIU Test)

Title

Write a brief description here

Goals of Care

Get in euthyroid state.

• Block adverse effects of thyroid hormone
• Suppress hormone oversecretion
• Prevent complications

Treatment Options

DRUG THERAPY

RADIOACTIVE IODINE THERAPY (RAI)

SURGERY

• Useful in treating hyperthyroidism

• NOT considered curative

• Antithyroid drugs
• Iodine
• Beta blockers

Drug Therapy

Drug Therapy – Antithyroid Drugs

Action: Inhibit the production of thyroid hormone

• Methimazole (Tapazole)
• Usually preferred except in pregnancy
• Fewer side effects
• Taken once a day

• Propylthiouracil (PTU)
• First line therapy for thyrotoxicosis
• Can cause liver damage
• Taken TID
• Can be taken during 1st trimester of pregnancy

Drug Therapy – Iodine

Action: Inhibits the creation of T3 and T4 Decreases the vascularity of the thyroid gland, which decreases the risk of bleeding and makes surgery safer Examples:

• Saturated solution of potassium iodide (SSKI)
• Lugol’s solution

Drug Therapy – Beta Blockers

Action: Decreases the workload of the heart by ↓ heart rate, ↓ BP, ↓ cardiac output

• Used for symptomatic relief of thyrotoxicosis; blocks the effects of sympathetic nervous stimulation, thereby decreasing tachycardia, nervousness, irritability, and tremors

Examples:

• Propranolol (Inderal) – usually given with other antithyroid meds
• Atenolol – preferred for patients with asthma or heart disease

Do these medications cure the problem?

Radioactive Iodine Therapy (RAI)

Used to destroy excess thyroid tissue, thereby limiting thyroid hormone secretion

• Response is DELAYED – up to 3 months
• Treat with antithyroid meds and a beta blocker until effects are seen

Complication:

• High incidence of post-treatment hypothyroidism (80%)
• Teach symptoms of hypothyroidism

RAI is not an option during pregnancy.

RAI Patient Teaching

For 7 days after therapy:

• Use private ____________________

• Separate _______________________

• Don’t prepare ___________________

• Avoid being close to ____________________________

• FORCE _______________!

Match characteristics with medication

1. Treatment of choice in nonpregnant adults
2. Inhibits the creation of thyroid hormone
3. High incidence of post-treatment hypothyroidism
4. Used to decrease vascularity
5. Used to control sympathetic nervous symptoms
6. Destroys thyroid tissue, limiting thyroid hormone secretion

1. Methimazole (Tapazole)
2. Potassium iodine
3. Propranolol
4. Radioactive iodine 131

Surgery – Thyroidectomy

Indications:

• Unresponsive to antithyroid drug therapy
• Goiters causing tracheal compression
• Thyroid cancer
• Not a candidate for RAI

• Teach patient how to support head manually when turning in bed and ROM exercises of the neck
• Review the importance of leg exercises
• Teach that talking will likely be difficult for a few days afterwards

Thyroidectomy – Preoperative Care

Thyroidectomy – Postoperative Care

• Every 2 hours for 24 hours
• Assess for signs of hemorrhage
• Assess for tracheal compression

• Keep ice pack on neck – Why?

• Semi-Fowler position
• Support head & neck with pillows
• Avoid flexion of neck

• Provide comfort measures/analgesics as prescribed.

Thyroidectomy – Postoperative Care

• Monitor ______________
• Control ______________
• Have ____________________ at bedside
• Monitor for hypo_______________
• Treat with IV calcium gluconate
• Trousseau and Chvostek signs
• Muscle cramps/tetany/twitching
• Evaluate difficulty in speaking/hoarseness
• Some hoarseness for 3 to 4 days is expected

Trousseau sign

Chvostek sign

Why might a patient who had a partial thyroidectomy have tetany?

Hyperthyroidism – Eye Care

____________ – protrusion of eyeballs from orbits Eye Care

• Apply artificial tears to soothe and prevent corneal ulceration
• Tape eyelids shut for sleep, as needed; wear sleep mask
• Elevate HOB and salt restriction for periorbital edema
• Dark glasses to reduce glare and prevent irritation
• Teach exercise eye muscles to maintain flexibility/complete eye ROM

Hyperthyroidism – Nursing Care

Assess for signs of heart failure - WHY?

Calm, quiet room

Cool room

Light bed coverings

Change linens frequently (diaphoresis)

NCLEX Practice

Hyperthyroidism Complications

Definition: Acute, rare condition where all manifestations of hyperthyroidism are more severe

Life-threatening emergency, but death is rare when treatment is started early

Acute Thyrotoxicosis (Thyroid Storm)

Patient is critically ill and requires accurate assessment and aggressive nursing care, often in an intensive care unit (ICU).

Acute Thyrotoxicosis (Thyroid Storm)

Symptoms include:

• Respiratory distress
• Severe hyperthermia – up to 106o
• Severe tachycardia – pulse > 130 BPM
• Heart failure
• Shock
• Abdominal pain, vomiting, diarrhea
• Agitation, delirium
• Seizures
• Coma

Acute Thyrotoxicosis (Thyroid Storm)

Goal of Treatment: Decrease thyroid hormone levels and clinical manifestations with drug therapy. Support vital functions. Interventions:

• Manage respiratory distress – humidified oxygen, pulse oximetry, intubation (if severe)
• Administer medications – PTU, methimazole, beta blockers, iodine
• Continuous EKG monitoring
• Fever reduction – antipyretics, cooling blankets, ice packs
• Treatment of heart failure
• IV fluid and electrolyte replacement

Hypothyroidism

Hypothyroidism

Definition: Hypoactivity of the thyroid gland with sustained decrease in the creation and release of thyroid hormones Causes:

• Hashimoto’s disease – an autoimmune disorder
• Iodine deficiency
• Thyroidectomy

Think: Decreased metabolism

• Cardiovascular
• Respiratory
• Gastrointestinal
• Integumentary
• Musculoskeletal
• Nervous
• Reproductive

Hypothyroidism – Diagnostics

History & physical exam

Lab tests

Serum TSH determines cause

• Increased TSH with a thyroid defect
• Decreased TSH with a pituitary defect

Hypothyroidism – Drug Therapy

Levothyroxine (Synthroid)

• Must take regularly
• Lifelong therapy
• Take 30-60 minutes before food intake
• Monitor for tachycardia, angina, and cardiac dysrhythmias
• Monitor thyroid hormone levels and adjust as needed.
• Because of impaired memory, be sure to provide the patient with written instructions and teach family as well as patient

Hypothyroidism – Nursing Care

• Use mild soap. Moisturize to prevent skin breakdown.
• Maintain a warm environment.
• Avoid sedatives.
• Prevent constipation: use stool softeners & increase fiber intake
• Notify HCP if signs of hyperthyroidism appear:
• Dyspnea, rapid pulse, chest pain, nervousness, insomnia, weight loss

NCLEX Practice

Hypothyroidism Complications

Myxedema

Impaired lymphatic drainage and fluid retention causes:

• puffy skin
• periorbital edema
• waxy consistency

Definition: Rare condition where severe hypothyroidism leads to the body being unable to maintain homeostasis

Life-threatening emergency, with a high mortality rate

Myxedema Coma

Patient is critically ill and requires accurate assessment and aggressive nursing care, often in an intensive care unit (ICU).

Myxedema Coma

Symptoms include:

• Subnormal temperature
• Hypoventilation – respiratory drive is suppressed
• Hypotension – decreased cardiac contractility leads to decreased cardiac output and bradycardia

Myxedema Coma

Treatment:

• Administer IV thyroid hormone replacement
• Vital functions must be supported
• Mechanical respiratory support
• Cardiac monitoring

• Fluid & electrolyte replacement as needed
• Frequent VS monitoring
• Monitor core temperature

NCLEX Practice

Think of these two when comparing Hyper- vs. Hypo- thyroidism

VS.

Hypothyroidism

Hyperthyroidism

Parathyroid Glands

Hyperparathyroidism

• high levels of ____________
• high serum _________ levels

Hyperparathyroidism

Overproduction of parathyroid hormone (PTH) causes bones to constantly release Ca into the bloodstream

• What are complications associated with calcium loss in the bones?

Increase in blood/serum calcium

• What are complications associated with increased calcium in the blood?

Hyperparathyroidism – S/S Hint: They mimic those of hypercalcemia.

• Lethargy, fatigue, memory impairment
• Decreased muscle tone/atrophy/impaired coordination
• Hypercalciuria → kidney stones (nephrolithiasis)
• Osteoporosis, fractures
• Constipation
• Anorexia, weight loss
• Hypertension

Hyperparathyroidism – Diagnostics

• Lab tests
• Parathyroid hormone
• Serum calcium
• Serum phosphorus

• Dual energy X-ray absorptiometry (DEXA) scan

• MRI/CT/Ultrasound
• Detect adenomas

TREATMENT

Most effective treatment is ____________________. What are the criteria for this treatment?

Hyperparathyroidism – Surgery

• Can involve partial or complete removal of parathyroid glands

• Leads to rapid reduction of calcium levels. Monitor for low calcium.

• Usually done via endoscopy as an outpatient procedure

• If multiple glands are removed, might have autotransplantation of parathyroid tissue in forearm or near sternocleidomastoid muscle so that PTH secretion can continue

• If autotransplantation is not possible (or fails) will need to take calcium and vitamin D supplements for life

Hyperparathyroidism – Nonsurgical/Drug Therapy

• Conservative approach often used in patients who are asymptomatic or have mild symptoms

• Ongoing care: monitor labs; annual X-rays & DEXA scans

• Medications:
• Diuretics
• Bisphosphonates: alendronate (Fosamax)
• Calcimimetics

Hyperparathyroidism – Treatment & Nursing Care

• IV and PO hydration
• Force fluids. Why?
• Encourage mobility/weight-bearing exercises
• Promotes bone calcification
• Diet therapy:
• Limit calcium intake

NCLEX Practice

Hypoparathyroidism

• _______ levels of PTH
• _______ serum calcium levels

Hypoparathyroidism – S/S Hint: They mimic those of hypocalcemia.

• Tingling of lips, hands, feet
• Hypotension
• Decreased cardiac output
• Painful muscle cramps, tremors, tetany, seizures
• Dysphagia/laryngospasms (can compromise breathing)
• Abdominal cramps/malabsorption
• Personality changes
• Dry, scaly skin

Hypoparathyroidism – Treatment & Nursing Care

• Monitor calcium levels
• EKG monitoring
• Medications:
• IV calcium (calcium gluconate)
• Infuse slowly to prevent hypotension and cardiac dysrhythmias
• Oral calcium
• Vitamin D
• Promotes intestinal calcium absorption

Hypoparathyroidism – Treatment & Nursing Care

Diet therapy:

• Encourage high-calcium foods

Goals of Care

• Treat acute complications
• Maintain normal serum calcium levels
• Prevent long-term complications

NCLEX Practice

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