 Hi, welcome to Nursing School Explained. Let's look at hypo and hyperthyroidism today. Again, I've written down here how the thyroid hormones are regulated. So remember that the hypothalamus and anterior pituitary play a big role in thyroid regulation as well. Hypothalamus releases thyroid releasing hormone, which stimulates the anterior pituitary gland to release thyroid-stimulating hormone, and then the thyroid gland will produce T3 and T4, the actual thyroid hormones that regulate our basic metabolic rate. Now, when something in this mechanism goes wrong, the thyroid can be working on overdrive, or it cannot be functioning properly resulting in hyper and hypothyroidism. Let's look at hyperthyroidism first. So that it usually happens because of thyroid follicular hyperfunction. So these thyroid cells are just extremely excited and they're just working on overdrive. It can also be caused by adenomas, which would be something like thyroid nodules or benign tumors, as well as thyroid carcinoma or cancer. And it mostly affects women in the 20s to 40s. Hyperthyroidism. And remember, because the thyroid gland regulates basic metabolic rate, if hyperthyroidism occurs, meaning that the thyroid is producing these T3 and T4 hormones on overdrive, the entire body will be hyperthyroid and will be hyper basic metabolic rate. So, which can be evidenced by restlessness and irritability, palpitations and tachycardia, maybe even tachypnea. And then heat intolerance because the temperature mechanism, the temperature control is now out of whack. They'll be feeling hot all the time and therefore be diaphoretic. And because the basic metabolic rate is affected, there will be weight loss because everything is just working on overdrive, consuming extra calories. It affects the GI system by producing diarrhea. Certainly, if the thyroid gland is overproducing, it will get enlarged, resulting in thyroid megaly or a goiter that can be visible here on exam. The thyroid gland is so big that you can actually see it with the naked eye. And then something else that happens is exopthalamus. And that basically means that the eyes will kind of be bulging out of their socket, which is a pretty telltale sign for hyperthyroidism. In hyperthyroidism, a lot of times it's also called Graves disease. As I already discussed, if the thyroid gland is working on overdrive, it's going to produce increased levels of T3 and T4. And because we have so much T3 and T4 circulating in the bloodstream, the hypothalamus is going to say, whoa, I'm going to stop producing TRH. And therefore the anterior pituitary will also not be producing thyroid stimulating hormone because it's already, there's too much in the system. Therefore, TSH will be low and T3 and T4 will be elevated. Now keep this in mind, this mechanism here because a lot of people get this confused. Do you think hyperthyroid and the thyroid stimulating hormone is increased? But no, we measure what's actually, what the thyroid gland is producing, which is T3 and T4. Now, how do we treat this? So there are certain drugs that are called anti-thyroid drugs. One of them is called PTU and then methamazole is another one. And then if the patient is given extra amounts of iodine, remember the thyroid follicles need iodine to be working, but extra iodine might inhibit T3 and T4 synthesis, therefore slowing down the level here. Then the patient might need beta blockers because everything is so working so fast they have this type of cardiac palpitations, maybe even hypertension. So we want to kind of slow things down until these anti-thyroid drugs can kind of kick in and dampen that hyperresponsiveness. Then there's also called something called radioactive iodine therapy, which basically means this radioactive material destroys the thyroid tissue and therefore it's kind of ablated and it won't be producing so much T3 and T4 anymore and therefore the levels will come down. And if all fails or if there is an adenoma or a thyroid nodule that interferes with their airway or certainly thyroid cancer, the patient will undergo thyroidectomy. And this is always something that comes up on exams as well is the post-op care for patients with thyroidectomy. And keep in mind the thyroid sits right here in the anterior neck. So when we have surgery there we always have to think about the airways. We want to have suction available, oxygen, emergency, intubation equipment at the bedside. We want to keep the patient upright so that they can handle their secretions and they're not prone to aspiration. And we want to monitor the vital signs because we know that their thyroid regulates the entire metabolic rate, heart rate, blood pressure, temperature, respiration centers. So we want to keep a close eye on the vital signs as well as their calcium level. And that is a big deal. And the reason for that is that behind the thyroid there's two extra glands or other glands on each side. So there's a total of four glands called the parathyroid glands. They sit behind the thyroid and they are involved in calcium metabolism. So now when the thyroid gland is removed inadvertently they might also remove some of those parathyroid glands which can cause an imbalance in the ability to metabolize and will produce or regulate calcium. Therefore, after a thyroidectomy we have to keep close attention of patient calcium levels. In addition after thyroidectomy because now the thyroid gland, the offender of these high levels has been removed the patient is now at risk for hypothyroidism. So we'll have to watch out about these kind of opposite symptoms and see if the patient has any of those. And a lot of times not the entire thyroid gland is removed or ablated by this radioactive therapy or completely shrunk down by these anti-thyroid drugs. But many times the patients will need to go for continued laboratory testing at regular intervals to see how their thyroid hormones are. And many times they will need supplemental thyroid hormone after they've experienced hypothyroid because now the gland is kind of switching over to the opposite function. So let's look at this here in terms of hypothyroidism. We have to distinguish between primary and secondary hypothyroidism. So primary would be destruction of thyroid tissue or iodine deficiency that is needed for T3 and T4 production. Or the patient can be suffering from Hashimoto's disease or Hashimoto's thyroiditis which is an autoimmune disease meaning the patient's body will attack the thyroid gland and therefore it won't be functioning properly. Secondary causes of hypothyroidism are any kind of disorders of the hypothalamus or pituitary gland. So if we look at this back here, this mechanism, so if something is going on with the pituitary or hypothalamus, let's say a tumor, a stroke, a bleed, a traumatic head injury, any of those mechanisms can have an effect on either the hypothalamus and the anterior pituitary and therefore the whole mechanism sequence of events here can be interrupted causing thyroid disorders but it's not really anything that has to do with the thyroid function itself as in primary hypothyroidism here but it's secondary causes by damaging these structures of the brain. Now remember, as in hypothyroidism, everything is sped up and extra active. In hypothyroidism it's the exact opposite. So there will be decreased metabolic rate. The patient will therefore be fatigued, lethargic, they'll have bradycardia, maybe hypotension, low body temperature resulting in cold intolerance. They might be anemic, they might be constipated because again, everything is slowing down. In women they might have menstrual irregularities, they might have increased levels of cholesterol and triglycerides making them prone to other consequential problems because of these issues. There might be impaired memory and certainly weight gain because everything is just slowed down and their metabolic rate is just not working sufficiently. And in terms of lab tests, because now the thyroid gland is not producing T3 and T4, T3 and T4 here will be low but the anterior pituitary, if it's working properly, will say, hello thyroid gland, you need to be producing T3, T4, we are not sensing any of that in the bloodstream so the thyroid stimulating hormone will be elevated. Elevated TSH, low levels of T3, T4 in hypothyroidism. Treatment is basically artificial thyroid hormone and the most common medication here would be level thyroxine. And again, this is a drug that often comes up on NCLEX and exam questions, any kind of thyroid medication is best to take on an empty stomach with a full glass of water one to two hours before any other medications, preferably first thing in the morning. So a lot of providers will tell their patients when you wake up in the morning at three o'clock, for example, to use the restroom, you will make sure that you have your thyroid medicine at your nightstand. And when you use the restroom, you take that pill, therefore they take it with a full glass of water on an empty stomach and they're gonna go back to sleep so they won't be taking any other medications. This is something that's usually recommended. And then the thyroid hormones, this is not something that gets regulated very quickly. So patients will need to go get their labs drawn every four to six weeks and then their dose will be adjusted. If they're suffering from hypothyroidism, most likely their dosage will be adjusted up until they've reached you thyroid conditions where everything will be back in balance. Now, complication of hypothyroidism is something called mixed edema colna. And the cause can be infection, trauma, drug such as opiates or benzodiazepines and cold exposure. So this might be somebody who already has hypothyroidism. Now they're, let's say they're exposed to cold air or cold temperatures for prolonged period of time and they maybe get hospitalized for frostbite, then they're at risk for suffering big edema colna. And signs and symptoms of this would be altered level of consciousness. Patients might have facial or periorbital edema. And then all these basic metabolic rate indicators such as heart rate, blood pressure, temperature might be completely low. And therefore the patient will have hypothermia, great cardio and hypotension. And this can lead to cardiovascular collapse and death. Now, if the patient is experiencing mixed edema colna, the treatment then is rather than PO and waiting for the six weeks, the treatment is IV thyroid hormone to replenish the hormone that the patient is missing and then get them back to a uteroid normally balanced thyroid state. So thank you for watching this video on thyroid disorders, hyper and hypothyroidism. I hope this has helped you gain a better understanding of how it happens and why. And I always find it beneficial writing the hypo and hyper conditions out next to each other because then we can compare and contrast and a lot of times it makes more sense. Thanks for watching Nursing School Explained. See you next time.