hey guys nurse Mike here and welcome to simplenursing.com now before we get today's lecture started please remember to access your free quiz and preview our cool Nifty new study guides not here on YouTube click the link right up here at any time during this video all right guys let's begin all right guys let's wrap up hyper versus hypothyroidism guys the easiest way is to let the name help you so think thigh in thyroid is like a Thigh Master you guys use a lot of energy since the thyroids create high energy and high metabolism for the body so guys in hyperthyroidism think high energy and high metabolism now this is also called Graves disease so we call it gains disease high in hyper energy now on the other side for hypothyroidism guys we think low and slow energy so start moving your thighs during the exam for hyper we have high energy and for hypo we have just this low and slow all right guys now a little bit of pathophysiology that the enlex expects you guys to know but let's be honest the enlex is never going to ask you a direct question about pathophysiology so as you know just like all endocrine hormones it's a big game of telephone or dominoes if you will so the hypothalamus releases TR which then tells the anterior pituitary to release TSH the thyroid stimulating hormone and can you guess what the thyroid stimulating hormone does well yes guys it stimulates the thyroid oh how stimulating so once stimulated the thyroid pops out three most important key players guys are T3 and T4 which are basically our active thyroid hormones and also calcitonin which basically puts a ton of calcium into the bone so our memory trick is it tones down the calcium in the blood by putting a ton of calcium into the bone so calone in a ton in the bone now our thyroid hormones T3 and T4 are the main focus for our thyroid conditions hypo we have low T3 and T4 and Hyper we have high T3 and T4 and to make this your body needs dietary iodine found in salt so iodine deficiency is a major cause of that hypo low thyroidism in developing countries so what causes our high T3 and T4 in hyper thyroidism guys the number one cause is our autoimmune disease we talked about Graves disease we think gains disease in high thyroid but also too much iodine means too much thyroid hormone and even treating hypothyroid conditions guys if we give those patients too much thyroid meds like Leo thyroxine which leaves too much thyroid hormones in the body we can eventually cause a hyper condition so guys balancing these two conditions is kind of like a te Peter tutter or basically like a seesaw hyper will be the exact opposite than hypo so low T3 and T4 in our hypo comes from that autoimmune disease guys called Hashimoto that low and slow thyroid now other causes are low iodine in the diet and a big one guys big test step here pituitary tumor and even anti-thyroid treatments like a thyroidectomy where we take out that thyroid gland and now the body can't produce any thyroid hormones at all now as far as diagnostic tests guys don't let the enlex trick you here so here's a tip always focus on T3 and T4 first guys don't even look at TSH initially if T3 and T4 are high then it's hyper thigh and guys if it's low then it's hypo now you don't have to memorize any of the values the enclex will give you the ranges okay now after seeing T3 and T4 then we look at TSH so TSH will always be the opposite of T3 and T4 here guys TSH is just trying to slow the hyper and amp up the hypo so guys as far as signs and symptoms it's super simple everything in hyper will be high and hot and everything in hypo is going to be the exact opposite guys low and slow so for hyper thyroid guys that Graves disease our gains disease everything is super high we're going to be bouncing off the walls super amped up like you're on a bunch of energy drinks and again the priority is to monitor for this thyroid storm AKA thyroid toxicosis guys this will kill the patient again enlex key terms are agitation Confusion And even restlessness those are usually the first signs coupled with extremely high temperatures over 105 high heart rate and blood pressure now classic signs that will show up on select all that apply questions guys we use our two G's for Graves disease so the first G is for grape eyes now the enlex term is exop Thalamus Guys these are big eyeballs that are popping out like big grapes so think EXO and EXO Thalamus as eyes exiting the body so typically we use an eye patch or even tape down the eyelids for sleeping guys that's always on the enlex I know it's super weird but always an enlex key term and our second G is for golf ball in the throat called a goer guys this will look like a big bullfrog looking throat and now everything else will be high so we'll have high blood pressure AKA hypertension remember over 140 the heart says oh Loy we'll also see high heart rate guys known as Tac cardia over 100 heart palpitations we'll even see atrial fibrillation now we'll also see high weight loss and guys the enlex will try and trick you here no we're not talking about weight gain the bigest biggest thing is weight loss so we'll see skinny patients since we have high energy burn we burn a lot of high calories now with that will have high hot temperature hot and sweaty skin known as dieresis guys not dry skin sweaty skin now this is also called heat intolerance you will definitely see this on SATA enlex questions and the very last thing we have a high gii so we get diarrhea not constipation so guys patients in hyper mode need a hyper diet with high calories also high protein and carbohydrates now big key word here freequent meals and snacks like 6 to eight per day huge enlex key term and guys we also do the three big no NOS for the enlex no high fiber we need low fiber unless the patient's constipated also no caffeine so no coffees sodas or teas and lastly no spicy food okay now on the other side in our hybo are Hashimoto guys everything is low and slow so super depressed fat and lethargic so we get the exact opposite from hyper again the extreme priority is the extreme low and slow Airway breathing and circulation now the key term is mxid MOMA guys extremely low respiratory rate so we think respiratory failure again the priority is innovation supplies at the bedside andle's key word here is endot tracheal inhibition set or tracheostomy setup so we're expecting extremely low BP AKA hypotension extremely low heart rate known as bra cardia below 60 and even low temperature called cold intolerance now the enlex tip here is no electric blankets guys this can actually harm the patient if they're not closely monitored now two more enlex tips which are the biggest risk for mixed deacom usually after a thyroid removal like a thyroidectomy or abruptly stopping thyroid replacement hormones like Leo thyroxine usually those two lead to the mix ademac coma the extreme low and slow now classic signs for our hypothyroidism guys everything's going to be low and slow now these will show up on SATA select all that appli questions so guys just think everything's going to be low and slow we have low energy known as fatigue weakness muscle pains and aches low metabolis ISM meaning we have weight gain and water gain there will be a demon in the legs and even under the eyes now the big key word here is not weight loss we have low energy which means low calories burned so guys we have weight gain here we also have low digestion called constipation not diarrhea low hair or basically hair loss called alopecia now guys this is not hear sueism huge enlex tip they're going to try and trick you he suit ism is that hairy suit we have hair loss here we also have low mental status or basically forgetfulness low mood known as depression apathy or confusion low libido with low sex drive or infertile and also slow dry skin turer huge enlex tip here guys not hot not sweaty hypo we have that dry skin now our last two enlex keywords for low and slow this is what's called irregular menstration guys so we have no periods or basically a missed period so for a No period it's called aena so just think amen No period now for low but heavy periods we call it hyper Menara so just think hyper menstration heavy bleeding now for diet and hypo guys we have low energy so we need low calories low cholesterol low saturated fats and since we have low energy we need frequent rest periods guys huge enlex tip right there now guys the most common enlex questions revolve around priority or basically who dies first and it's always the extreme conditions guys for example you will get a question about a client in Hashim moot toes with that low heart rate less than 60 or those low respirations about 10 right so we're thinking here myxedema coma guys we put that ination tray or the endot tral setup near the bedside so on the other side of things you get a question question about a client engraves disease guys with high high heart rate like over 100 beats per minute or high blood pressure over 140 SC delic and even high temperature like over 101 guys the biggest thing think thyroid storm and the priority here is to monitor for agitation and confusion now pharmacology and surgeries always enlex favorites here guys guys grab your notes grab your study guides that we provide we're going to be covering only the highly tested enlex topics here so for hypothyroidism guys we only have one main drug that you need to know for the enlex and for your nursing exams it's called Leo thyroxine which leaves T3 and T4 in the body so guys think Leo we give for hypothyroidism now our second memory trick for those SATA questions is just the acronym Leo L for lifelong drug guys we never stop taking this drug these are what's known as forever medications and L for long long slow onset usually 3 to 4 weeks till we find relief now test questions love to ask patient education on these two points so I'd write those down e is for early morning and empty stomach always 30 to 60 minutes before breakfast one time a day at the same time every day guys never at night Leo is always in the morning when you leant or basically get up now V is for very hyper guys we report signs and symptoms of hyper thyroidism basically high heart rate high BP high temperature it could lead to an extreme condition known as our thyroid storm so key words we're looking for are agitation and confusion usually the early signs of a thyroid storm and lastly O is for oh the baby's fine so guys it's pregnancy safe now the foremost tested no no to help drive them the point for the most tested points here guys no food we take an hour before breakfast key word here is empty stomach no cure this medication is a hormone replacement it will never cure it'll only treat so yes this is a forever drug and no double dosing if you ever miss a dose guys take ASAP or as soon as possible and lastly never abruptly stop taking medications key word is abrupt stop it can lead to an extreme hypo low condition with low respiratory rate low BP and guys that will kill your patient again this is called myxedema coma now some common enlex questions that will try and trick you guys it's going to give you stic questions for example additional patient teaching is needed when the patient on Leo says it doesn't work after 18 days guys teach it's a slow onset 3 to 4 weeks like 21 days now the patient 30 weeks pregnant guys is that okay yes it's baby safe and my personal favorite patient states I'm glad this med will finally cure me guys no there's no cure here and a little side note for hypo since everything is low and slow we avoid narcotics or basically opioids like vicadin and other painkillers and guys we avoid benzos which are sedatives these drugs can actually add to the low and slow dropping us into low condition that my exid maoma okay so now the pharmacology for hyper thyroidism that grave disease or our gains disease guys think here the thyroid is super amped up and super high so we need to slow down that thyroid right or basically we need to kill it so the four drugs you need to know methol guys is not baby safe but its friend PTU propath urasil memory trick for PTU is puts the thyroid underground this guy is Babys safe but we report fever and sore throat guys these dudes stop the thyroid from making T3 and T4 basically slow it down now sski are potassium iodide guys the memory trick is ssk S4 shrinks the thyroid before thyroid removal or basically thyroidectomy this is done to reduce the bleeding AKA reduce the vascularity s is for stains the teeth so guys drink it through a straw with some juice and K is to keep it one 1 hour apart from other anti-thyroid medications lastly since hyper thyroid we have a hyper heart we use beta blockers which puts the brakes on the heart slowing it down now these guys end an LOL like propanolol so think the double L's and LOL lowers the double heart vitals so low blood pressure and low heart rate now next up guys the most dangerous and consequently the most tested here R AIU Radioactive iodine uptake Guys these are the big guns it destroys the thyroid in like one dose so we expect hypo low signs and symptoms basically we're monitoring for extreme lows like respiratory failure now again guys it's very toxic making the patient like radioactive so some common enclex select that apply questions always come from this section guys write these down before giving we always ensure a pregnancy test is negative we always remove neck jewelry and dentures that one came up a lot in the enlex here and 5 to 7 days before giving this drug we hold any antithyroid meds and guys yes you're awake there's no anesthesia there's no Conscious Sedation so we're just NPO 2 to 4 hours before and 1 to two hours after guys it's not 12 hours and this is not surgery this is just a radioactive pill one dose one andone lasts about 24 to 72 hours and speaking of after we give it guys we avoid everyone up to 7 days now most quiz Banks say about 1 to 3 days so just avoid everyone so no going around pregnant people guys no crowds not even the same restroom we're flushing it three times not even the same food utensils guys and no not the same laundry as your family separate laundry baskets and lastly no cuddling and not even kissing now lastly guys if all else fails we can do a good oldfashioned surgery known as a thyroid ectomy now a lot of enlex tips come from this section so please write this down since thyroid ectomy are usually done for hyperthyroidism it's kind of like removing a big glass of milk surgeons can accidentally like squeeze out a lot of thyroid hormones into the body so guys we're monitoring for high extreme conditions after surgery known as a thyroid storm okay now for the big enlex priorities we have the ABCs of thyroidectomy A is for Airway since surgery is done near the neck guys we think Airway huge enlex key terms here write these down Len gel Strider noisy breathing and even horseness or weak voice huge big enlex key terms there these usually indicate an airway problem so the number one priority is endot tral tube at bedside now the enlex will call it different things like Innovation supplies and even tracheostomy setup so anything with the word tra in it guys keep it at the bed side huge on the enlex now B is for breathing that is noisy like covered before laryng Strider so guys we always monitor voice strength and quality now next C is for circulation obviously we just had the surgery so guys we're looking for bleeding but specifically bleeding around the pillow and insertion site now big enlex key terms for positioning to prevent the bleeding guys write these down we want a neutral head and neck alignment this means not supine big no no guys head of the bed 30 to 45° AKA semi fowers and lastly guys big no for flexing this a no flex zone for sure no extending the neck huge and always on the enlex now our last C which is another enlex favorite guys calcium that is low below 8.6 known as hypocalcemia now Guys these numbers are based on N click standards so your textbook in your school might differ so memory trick is if you remove the T then you check the c or basically if you remove the thyroid then guys check the calcium now the first sign of low calcium write this down tingling and numbness or circum oral tingling around the mouth and even the fingers and the two other keyw are T and C for low calcium so truso which is basically that arm torque with the blood pressure cuff on and chiastic that cheeky smile with facial numbness so guys I call these the two dance moves of low calcium so remember if you remove the tea then check the see all right guys that wraps it up for hyper and hypothyroidism guys don't forget to take your quiz to test your comprehension thanks for watching for our full video and new quiz Bank click right up here to access your free trial and please consider subscribing to our YouTube channel last but not least a big thanks to our team of experts helping us make these great videos all right guys see you next time [Music] [Music]