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Thyroid & Parathyroid Glands

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Located in middle of neck Common goal: Calcium homeostasis Calcium levels Promote effective blood coagulation Nerve function Muscle function

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Thyroid Gland three hormones

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Triiodothyronine (T3): involved with growth and development, body temp, and HR and is release as a result of TSH, has 3 iodine atoms Thyroxine (T4): 4 iodine atoms, increases metabolic rate and manages growth and development Calcitonin: works to control Ca and K uptake by the blood stream limits the osteoclasts

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structure and function

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Vascular Circular follicles (store hormones) Parafollicular cells (produce calcitonin) Affects calcium levels Effects PTH

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thyroid hormones

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Regulate metabolism Affect heat production Affect body temperature Oxygen consumption / cardiac output Blood volume Metabolism of CHO, fats, proteins Growth and development

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thyroid dysfunction

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hypothyroidism hyperthyroidism

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Synthetic T4

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levothyroxine

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synthetic t3

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liothyronine; give t4 IV until level is correct then they will be put on T3

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hypothyroidism over view

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slow metabolism heat production is low, don't handle cold always cold decrease o2 consumption HR, BP low low body temp metabolism of food is slow, leads to weight gain increase risk for atheroscholosis growth and development stunted

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hyperthyroidism

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fast metabolism excessive heat production thyroid crisis temp can be 106 super high heart works faster and harder= high BP and heart rate increase BV these patients burn up all their food, start to burn up muscles leading to muscle wasting

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thyroid gland controls

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TH production and release regulated by TSH Negative feedback loop

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hypothyroidism

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Lack of sufficient levels of thyroid hormones Absence of thyroid gland Lack of sufficient iodine Lack of sufficient functioning thyroid tissue Lack of TSH: pituitary problem Lack of TRH: hypothalamus problem Cretinism Myxedema: most severe form they can go into a coma and die from it Cause: undiagnosed hypothyroidism, virus that attacks thyroid gland, removal of the thyroid or under treating hypothyroidism or overtreating hyperthyroidism

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hyperthyroidism

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Excessive amounts of thyroid hormone Grave's disease: bugling eyes, goiter (autoimmune disease leads to over production of thyroid hormone), hyperthyroidism Overstimulation from TSH Treatment Surgical removal of thyroid gland Radiation of thyroid gland Drugs to block production of thyroxine

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thyroid agents hypothyroid

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Need hormone replacement Thyroid hormones

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thyroid agents hyperthyroidism

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Remove or destroy thyroid hormones pharmacologically Anti-thyroid drugs Thioamides Iodine solutions

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thyroid agents- thyroid hormones

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Replacement hormone products Synthetic or natural Can suppress over production of TSH Synthetic Levothyroxine (T4): synthroid: most predictable and bioavailable and relaiable drugs from treating hypothyroidism Liothyronine (T3): generally given IV and is given until they are at a stable level and can be given t4 Liotrix (T3 / T4) Natural Desiccated thyroid (Armour thyroid) (T3 / T4): this is taken from actua thyroid glands. Not as bioavailble or relianle at maintaining levels

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thyroid hormones therapeutic actions

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Increase metabolic rate of body tissues Increase oxygen consumption, respirations, heart rate Increase growth and maturation Increase metabolism: fats, CHOs, proteins Replacement therapy Treatment of myxedema Suppressions of TSH in goiters / thyroid cancer

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thyroid hormones- pharmacokinetics

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Well absorbed in GI tract / bound to serum proteins Eliminated in bile Does not cross placental barrier - May need to increase dose during pregnancy Does enter breast milk

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thyroid hormones- contraindications

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Allergies Lactation Acute MI Thyrotoxicosis Addison's disease

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thyroid hormones: adverse reactions

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things that hyperthyroid cause Skin reactions, hair loss Hyperthyroid symptoms: tachycardia, N/V, tremors CNS: insomnia, anxiety, headache Difficulty swallowing

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thyroid hormones: drug to drug interactions

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Increased risk of bleeds if taken with anticoagulants Decrease in the effectiveness of dig Decreased effect of theophyline

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thyroid hormone: example

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levothyroxine

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thyroid hormones: nursing considerations

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give them first thing in the morning before they eat. can cause anxiety and insomnia

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antithyroid agents

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Used to block the production of thyroid hormone & treat hyperthyroidism Thioamides Iodide solutions

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antithyroid agents therapeutic actions: thioamides

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Prevent formation of thyroid hormones in thyroid cells Inhibit conversion of T4 to T3 Protpylthiouracil (PTU): safer for pregnant women** Methimazole: much more toxic

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antithyroid agents thioamides pharmacokinetics

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absorbed in GI tract, concentrated in thyroid gland→ excreted in urine Crosses placental barrier and milk (PTU is safest for pregnancy)

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antithyroid agents thioamides: adverse effects

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Drowsiness, lethargy, bradycardia, nausea, skin rash GI: N/V, liver toxicity Agrandulosytosis Bone marrow suppression: would see fatigue, increased risk of bleeding, increased risk of infection

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antithyroid agents: drug to drug interactions: thioamides

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Thioamides: increased risk of bleeding with anticoagulants, with dig or t drug (thyroid) increased risk for toxicity

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thioamides drugs

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Methimazole (this one is more toxic) PTU can be used with pregnancy (p.599) increased risk for weakness, neuritis, skin rashes, bone marrow suppression

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antithyroid agents therapeutic actions: Iodide solutions

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decrease the size and vascularity of the thyroid gland to prepare them for surgery High doses block thyroid function: this is done in cancers Cause thyroid cells to be oversaturated / Stop producing thyroid hormone Radioactive iodine (sodium iodide(I131): used in braky therapy (seeds they put in the thyroid) For 8-10 days they are radioactive. Can't be in the same area as someone that's pregnant or close to babies. This is used in patients that are not surgical candidates, elderly with severe disease, or women who can't get pregnant

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antithyroid agents iodine solutions pharmacokinetics

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Absorbed in GI tract → excreted in urine Crosses placental barrier and milk Na+I131

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antithyroid agents contraindications

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Allergies to iodine Pregnancy / lactation Liver dysfunction: they build up in the liver Pulmonary edema / Pulmonary TB Women who can get pregnant

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antithyroid agents iodine solutions: adverse effects

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Hypothyroidism Metallic taste burning in mouth, sore gums/teeth, diarrhea, staining of teeth, skin rash, goiter Can cause destruction of the gums and teeth

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iodine solution drugs

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Strong Iodine products (p.599): increased risk of rash, goiter, swelling of the salivary glands, head cold symptoms, congestion, can have an allergic reaction to the iodine, need to watch for a shell fish allergy

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parathyroid gland

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controls Ca 4-12 Small glands located on back of thyroid gland Produce parathormone (PTH) Regulate calcium levels

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parathyroid gland: structure and function

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Parafollicular cells of thyroid gland → produce calcitonin in response to lower serum calcium levels → balances effects of PTH PTH stimulates osteoclasts (bone breakdown) to release calcium from bones Increases intestinal absorption of calcium Increases calcium resorption from kidneys in the proximal tubules Stimulates kidney cells to produce calcitriol which stimulates intestinal transport of calcium into blood

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calcium is used for

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Membrane transport system Conduction of nerve impulses Muscle contraction: need to be concerned about the heart Blood clotting

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serum Ca

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9-11 mg/dL Too low: numbness and tingling around mouth and fingers and toes. Extremely low: heart and respiratory failure because of the tenty of the bronchioles and seizures

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calcitonin

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Release of calcitonin regulated at cellular level Released when serum Ca++ levels rise Reduces Ca++ levels by blocking bone resorption / enhancing bone formation PTH released when Ca++ levels are low / Blocked when Ca++ is high Mg+ will normally be low if Ca is low / PO4 is normally high when Ca is low

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hypoparathyroidism

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Absence of PTH Low calcium level Occurs with accidental removal or disease of gland Treatment Calcium Vitamin D

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hyperparathyroidism

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Excess PTH Elevated calcium level Result of tumor or genetic disorder Primary: actually parathyroid gland is not working Secondary: renal patients, will have a high PTH but a low serum Ca: one of the jobs of the kidneys is to regulate Ca. IF they are not working they don't use vit D and hold on to Ca as they should. Brain senses this and tells parathyroid to release PTH but the kidneys aren't responding giving them a low serum Ca Another type is post menopausal women. Low Ca level is sensed by the brain tells body to pull from the bones leading to osteoporosis Paget's disease (genetic Post menopausal osteoporosis

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Antihypocalcemic Agents

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Vitamin D supplements Calcium supplements Calcitriol teriparatide

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Vitamin D supplement

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helps digestive tract absorption, it is fat soluble, helps with immune system especially in the gut, helps with cardiac function, helps with Ca absorption

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Calcium supplements

answer

generally taken every day up to a couple times a day, taken for osteoporosis or for prevention of osteoporosis, elderly tend to take it Take with food so it will bind to the porphorus in the food lowering phosphorus raising Ca in renal patients

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calcitrol

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most common form of Vitamin D

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teriparatide

answer

PTH genetically engineered from E. coli Increases bone mass

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Antihypocalcemic Agents therapeutic action

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Regulates absorption of calcium and phosphate from small intestine, mineral resorption in bone, and reabsorption of phosphate from renal tubules Works with PTH / calcitonin Increases skeletal mass Used for management of hypcalcemia

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Antihypocalcemic Agents pharmacokinetics

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Absorbed in GI tract Stored in liver, fat, muscle, skin, and bones Excreted in bile

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Antihypocalcemic Agents contraindications

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Allergies Hypercalcemia / vitamin D toxicity (people who have high Ca will tend to have cancer) Pregnancy / lactation

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Antihypocalcemic Agents adverse effects

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GI: metallic taste, N/V, dry mouth, constipation, anorexia CNS: weakness, headache, somnolence, irritability Liver / renal impairment: Increased toxic effects

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Antihypocalcemic Agents drug to drug interactions

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Increase risk of hyperMg with meds that contain Mg: antacids, milk of magnesia, pantoprol that contains Mg Decrease of Ca is taking cholesthyromine (cholestrol med) or mineral oil (laxative): can take them together but have to separate them by 2 hours

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Antihypocalcemic Agents prototypes

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Calcitriol (p. 605): can cause weakness HA, N/V, dry mouth, constipation, muscle pain, bone pain, and a metallic taste

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Antihypercalcemic Agents

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Bisphosphonates (prevents them from losing all the Ca from bones take before breakfast need to sit up for a half hour to an hour after can only take with h20) / Calcitonin salmon Act on serum calcium levels Do not suppress PTH

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Antihypercalcemic Agents therapeutic action: Bisphosphonates

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Slow or block bone resorption Do not inhibit normal bone formation Examples: edidronate, alendronate, risedronate (actonel) ALL END IN DRONATE Treat Paget's disease / post menopausal osteoporosis

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Antihypercalcemic Agents therapeutic action: calcitonins

answer

Hormones secreted by thyroid gland Balances effects of PTH Calcitonin salmon Can be given as a nasal spray daily alternating nares can cause irritation, need to refrigerate after Can also be given by injection Inhibits bone resorption, lowers serum calcium in children / Paget's disease Increases release of phosphate, calcium, and sodium from kidney

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Antihypercalcemic Agents pharmacokinetics

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Bisphosphonates Well absorbed in small intestine → excreted in urine Calcitonins Metabolized in tissues → excreted in urine Given by injection or nasal spray

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Antihypercalcemic Agents contraindications: bisphosphonates

answer

Hypocalcemia Allergies Pregnancy / lactation Renal dysfunction GI disease Anyone not able to remain upright for 30 minutes**

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Antihypercalcemic Agents contrindications calcitonins

answer

do not have to sit up for 30 minutes for this one this is what you give to someone who cannot sit up for 30 minutes Pregnancy / lactation Allergy to salmon or fish products Renal dysfunction

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Antihypercalcemic Agents adverse effects of bisphosphonates

answer

Headaches, nausea, diarrhea Increase in bone pain in Paget's disease Esophageal erosion**: this is why they have to sit up for 30 minutes!! >5 year use increases risk for femoral fracture

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Antihypercalcemic Agents adverse effects calcitonins

answer

Flushing of face and hands, rash, N/V, urinary frequency, Local irritation in the nose this is why you alternate nares

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Antihypercalcemic Agents drug to drug interactions

answer

Antacids, calcium, iron, and multivitamins: these should be separated by 30 minutes

question

anti-hypercalcemia agents prototype

answer

alendronate (p. 607) calcitonin salmon (p. 607)

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