Describe the anatomy of the thyroid gland:

Mrs. Duarte is a 40 year old woman who has scheduled an appointment with her primary HCP to assess a lump that has developed on the left side of her neck.  Mrs. Duarte explains to her HCP that she has noticed a swollen area on the left side of her neck that has been increasing in size. She states, "I am really afraid I have cancer. I eat plenty but seem to be losing weight. I have lost 10 lbs in 2 months.  I have been very agitated and irritable.  Perhaps I am nervous about the possibility that this lump is cancer."

The HCP notes that Mrs. Duarte's hands have a fine tremor and she has mild periorbital edema indicative of exophthalmos.  On physical assessment, the HCP palpates a smooth, soft, enlarged left lobe of the thyroid gland.  The HCP places the bell of the stethoscope over the swollen area and auscultates a bruit. Further discussion reveals that Mrs. Duarte has been having difficulty sleeping, thinning hair, and loose bowel movements.  Concerned that Mrs. Duarte has a thyroid disorder, the HCP orders serum lab testing to assess the client's levels of TSH (thyroid stimulating hormone), FT4 (free tetraiodothyronine/ thyroxine), and schedules the client for a radioactive iodine uptake test. 

1.  Describe the anatomy of the thyroid gland, its hormone production, and briefly describe its function.

2.  Does the HCP suspect that Mrs. Duarte has hypothyroidism or hyperthyroidism?  Identify the clinical manifestations that support your answer.

3.   Identify 3 nursing diagnoses appropriate for Mrs. Duarte.

4.   The HCP heard a bruit over the thyroid gland.  Is this a normal or abnormal finding?  Explain what a bruit is and what it means.

5.  Mrs. Duarte is noted to have mild periorbital edema.  What causes this edema?  What are the potential complications that can arise?  What suggestions can the nurse offer for minimizing the potential complications and discomfort if the edema worsens?

6. Briefly explain what the TSH and FT4 tests measure and provide the normal range for each.  What TSH and FT4 test results will confirm the suspected thyroid disease identified in question 2?

7. Explain to Mrs. Duarte how the radioactive uptake test is conducted and how the results will help the HCP confirm Mrs. Duarte's diagnosis.

Mrs. Duarte undergoes RAI therapy and develops hypothyroidism following the therapy.  She is prescribed Levothyroxine.  She asks the nurse what the medicine is for, and how long she will have to take it.  Provide the client with teaching regarding the rationale for the prescribed Levothyroxine and her question regarding the length of treatment.