Thyroid enlargement
Thyroid enlargement: Excerpt from Nursing: Interpreting Signs and Symptoms
An enlarged thyroid can result from inflammation, physiologic changes, iodine deficiency, thyroid tumors, and drugs. Depending on the medical cause, hyperfunction or hypofunction may occur with resulting excess or deficiency, respectively, of the hormone thyroxine. If no infection is present, enlargement is usually slow and progressive. An enlarged thyroid that causes visible swelling in the front of the neck is called a goiter.
History and physical examination
The patient's history commonly reveals the cause of thyroid enlargement. Important data includes a family history of thyroid disease, onset of thyroid enlargement, any previous irradiation of the thyroid or the neck, recent infections, and the use of thyroid replacement drugs.
Begin the physical examination by inspecting the patient's trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. To palpate the thyroid gland, you'll need to stand behind the patient. Give the patient a cup of water, and have him extend his neck slightly. Place the fingers of both hands on the patient's neck, just below the cricoid cartilage and just lateral to the trachea. Tell the patient to take a sip of water and swallow. The thyroid gland should rise as he swallows. Use your fingers to palpate laterally and downward to feel the whole thyroid gland. Palpate over the midline to feel the isthmus of the thyroid.
During palpation, be sure to note the size, shape, and consistency of the gland, and the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit. The bruit is often continuous.
Medical causes
Hypothyroidism.Hypothyroidism causes an enlarged thyroid. Additional signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.
Iodine deficiency.A deficiency of iodine in the food or water of a particular area may cause an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.
Thyroiditis.Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.
Thyrotoxicosis.Signs and symptoms of thyrotoxicosis include an enlarged thyroid, nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.
Tumors.An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.
Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.
Other causes
Goitrogens.Goitrogens are drugs—such as lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid—and substances in foods that decrease thyroxine production. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.
Nursing considerations
▪ Prepare the patient for diagnostic tests, which may include needle aspiration, ultrasound, and radioactive thyroid scanning.
▪ Prepare the patient for surgery or radiation therapy, if necessary.
▪ Provide specific interventions, depending on whether the patient is hypothyroid or has thyroiditis.
▪ Provide postoperative care for the patient who has undergone thyroidectomy.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Explain the signs and symptoms of hypothyroidism to report.
▪ Explain posttreatment precautions to the patient undergoing radioactive iodine therapy.
▪ Teach thyroid hormone replacement therapy and signs of thyroid hormone overdose to report.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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