Thyroid Gland

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Anatomy of the Thyroid Gland (Image)
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Thyroid Gland (Picmonic)
Thyroid & Parathyroid Gland (Cheatsheet)
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Outline

Overview

  1. Thyroid gland
    1. Location: bilobed “H”-shaped gland below larynx on anterior trachea
    2. Hormones
      1. Triiodothyronine (T3)
      2. Tetraiodothyronine (T4) (thyroxine)
      3. Calcitonin – NOT under control of anterior pituitary gland like T3 and T4
  2. Parathyroid glands (4)
    1. Location: in thyroid on posterior side
    2. Hormone
      1. Parathormone (parathyroid hormone)
    3. Controlled by calcium concentration in blood

Nursing Points

General

  1. T3 and T4
    1. Control of T3/T4 secretion
      1. Hypothalamus makes thyroid releasing hormones (TRH)
        1. Enters HHP system
        2. Goes to anterior pituitary gland
      2. Anterior pituitary responds and secretes TSH into blood
      3. Thyroid gland responds and secretes T3 and T4
      4. If T3 and T4 are too high:
        1. Inhibits TRH release from hypothalamus
        2. Therefore ↓ TSH
        3. Negative feedback loop
          1. Allows for tight control
      5. T3
        1. Short duration of activity
        2. Fast reactions
      6. T4
        1. Long duration
        2. Slow reactions
    2. Actions of T3 and T4
      1. Stimulate carbohydrate metabolism in most cells
      2. Stimulate production of body heat
        1. Helps maintain normal temperature
      3. Stimulate protein synthesis
  2. Calcitonin
    1. Maintain calcium concentration in blood
    2. Controlled by calcium concentration
    3. If calcium concentration in blood is increased:
      1. Stimulates osteoblasts to make bone from blood calcium
      2. Inhibits osteoclasts from adding calcium to blood by breaking down bone
      3. Inhibits calcium uptake from small intestine
        1. Excreted in stool
      4. Inhibits calcium uptake from PCT of kidney
        1. Excreted in urine
      5. Effect = decreased calcium levels in blood
  3. Parathyroid Hormone (parathormone
    1. Controlled by calcium concentration
    2. Functions
      1. Opposes activity of Calcitonin
  4. Clinical Notes:
    1. Hyperthyroidism – see individual lesson
      1. Excess secretion of T3/T4
      2. Low levels of TSH
      3. Hypermetabolic state
    2. Hypothyroidism – see individual lesson
      1. Insufficient secretion of T3/T4
      2. High levels of TSH
      3. Hypometabolic state
    3. Hyperparathyroidism
      1. Excess secretion of parathormone
      2. Increased calcium levels in blood
      3. Decreases bone density
    4. Hypoparathyroidism
      1. Insufficient secretion of parathormone
      2. Decreased calcium levels in blood
      3. Muscle twitching, convulsions, respiratory muscle failure

References:

Betts, J.G., et al. (2017). Anatomy and physiology. Houston, TX: OpenStax, Rice University. Retrieved from https://openstax.org/details/books/anatomy-and-physiology?Book%20details

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Transcript

The first thing that we have to look at is that the thyroid gland is a by load, meaning it’s got two lobes, H shaped gland that sits below the larynx. It’s just in front of or anterior to the trachea. The thyroid gland is responsible for producing several different hormones. These hormones are T3, or triiodothyronine, T4, or Tetraiodothyronine, or calcitonin. It’s important to note that calcitonin is not controlled by the anterior pituitary gland and we’ll get into that later.

The parathyroid is also part of the thyroid gland but they’re their own particular gland. There are four glands and they are located on the posterior side of the thyroid gland. The main hormone that they produce is called parathormone or the parathyroid hormone. And that’s controlled by the calcium concentration in the blood.

So how does T3 and T4 work in the body? Well first there’s a signal that’s received by the hypothalamus that stimulates the release of thyrotropin-releasing hormone, or trh. That then signals to the anterior pituitary gland to secrete thyroid stimulating hormone, which travels to the thyroid gland. At that point the thyroid gland produces T3 and T4 until it’s not necessary anymore. Once that signaling stops, and negative feedback signal is sent back to the anterior pituitary gland and the hypothalamus to tell them to stop producing trh and TSH.

T3 is a short-acting hormone and has a fast reaction so if there’s a need for faster metabolism and T3 is released. T4 is just the opposite. If long-duration of metabolism or a slow reaction is needed, T4 is released. The main functions of these two hormones are to stimulate carbohydrate metabolism and the production of body heat. It also helps to maintain a normal temperature and stimulates protein synthesis.

So let’s Circle back to calcitonin. Calcitonin is produced by the thyroid gland but unlike the other thyroid hormones it is not controlled by the pituitary gland. What actually controls calcitonin production is the calcium level in the blood. So let’s look at this diagram. If calcium levels are elevated, what happens is it calcitonin is released by the thyroid gland. This vindas several things and it tells osteoblast to make new bone, which pulls calcium from the blood. More importantly it tells of osteoclasts to stop breaking down bone and releasing calcium into the bloodstream. It also inhibits calcium uptake from the small intestine and allows the calcium to be excreted in the stool, and finally it inhibits calcium uptake in the proximal convoluted tubule in the kidney. this allows the body to have the blood calcium return to normal.

Parathormone is the exact opposite and opposes the activity of calcitonin. If blood calcium is low, parathormone is released by the parathyroid glands. This in turn stimulates osteoclast production and calcium is broken down from bone and released into the bloodstream. This increases blood calcium. So they work together to help maintain balance of calcium in the blood.

Sometimes we can have access or deficient amount of a particular hormone. With the thyroid gland we can either have access thyroid hormone production, or we can have changes in the amount of parathormone produced by the parathyroid gland.

Starting with thyroidism, we are looking specifically at the production of T3 and T4. In hyperthyroidism, there is an excess production of T3 and T4, this in turn turns down the response of the pituitary gland in producing thyroid stimulating hormone. This has an increase in the metabolic state. If we look at hypothyroidism, this is a decrease production of T3 and T4, and there’s going to be this constant stimulation of thyroid stimulating hormone from the pituitary gland. But because there’s a decrease production of those hormones, that’s going to lead to a decreased metabolic State.

We talked about the parathyroid gland, and excess production of parathyroid hormone causes an increased calcium in the blood. Remember that the increase in the parathormone is going to stimulate those osteoclasts to break down the bone and that’s going to release the calcium into the bone but it also weakens the bone and causes a decrease in bone density. If we look at hypoparathyroidism, this is a decrease in parathormone. This means that there is a decreased level of calcium in the blood and that leads to muscle twitching and failure of the respiratory muscles.

Okay so let’s recap.

The thyroid gland is located just below the larynx And in front of the trachea.

The parathyroid gland are four glands located on the posterior side of the thyroid.

The thyroid hormones are produced are T3 T4 and calcitonin. Remember that calcitonin is not stimulated by the pituitary gland.

Parathormone is the hormone that is secreted by the parathyroid gland.

And finally calcitonin and parathyroid hormone are directly related to the amount of calcium in the blood and respond depending on if the calcium in the blood is too high or too low
And that’s it for our lesson on the thyroid gland. Make sure you check out all the resources attached to this lesson. Now go out, and be your best self today, and is always happy nursing.

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Endocrine

Concepts Covered:

  • Endocrine System
  • Tissues and Glands
  • Disorders of Pancreas
  • Disorders of the Adrenal Gland
  • Disorders of the Thyroid & Parathyroid Glands
  • Oncology Disorders
  • Pregnancy Risks
  • Respiratory Disorders
  • Terminology
  • Disorders of the Posterior Pituitary Gland
  • Eating Disorders
  • Medication Administration
  • Statistics
  • Female Reproductive Disorders
  • Renal Disorders
  • Substance Abuse Disorders
  • Renal and Urinary Disorders
  • Newborn Care
  • Studying
  • Urinary System
  • Noninfectious Respiratory Disorder

Study Plan Lessons

Pituitary Gland
Pancreas
Glands
Metabolic & Endocrine Module Intro
Metabolic/Endocrine Course Introduction
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Hyperparathyroidism
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Pituitary Adenoma
Thyroid Cancer
Glucose Tolerance Test (GTT) Lab Values
Thyroid Gland
Pituitary Gland
Free T4 (Thyroxine) Lab Values
Glucose Lab Values
Iodine Nursing Considerations
Levothyroxine (Synthroid)
Hypoparathyroidism
Hyperthyroidism Case Study (75 min)
Metabolic & Endocrine Module Intro
Metabolic & Endocrine Terminology
Metabolic/Endocrine Course Introduction
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care Plan (NCP) for Hyperparathyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Thyroid Cancer
Pituitary Adenoma
Pituitary Gland
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Thyroid Cancer
Thyroid Gland
Thyroid Stimulating Hormone (TSH) Lab Values
Thyroxine (T4) Lab Values
Triiodothyronine (T3) Lab Values
Metabolic & Endocrine Terminology
Antidiabetic Agents
Hypoparathyroidism
Iodine Nursing Considerations
Hyperthyroidism Case Study (75 min)
Free T4 (Thyroxine) Lab Values
Levothyroxine (Synthroid)
Metabolic & Endocrine Module Intro
Metabolic/Endocrine Course Introduction
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care Plan (NCP) for Hyperparathyroidism
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Thyroid Cancer
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Thyroid Cancer
Triiodothyronine (T3) Lab Values
Thyroxine (T4) Lab Values
Thyroid Stimulating Hormone (TSH) Lab Values
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Hypothyroidism
Pituitary Adenoma
Pituitary Gland
Thyroid Gland
Hypoparathyroidism
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Metabolic & Endocrine Terminology
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care Plan (NCP) for Hyperparathyroidism
Nursing Care Plan (NCP) for Hypoparathyroidism
Thyroid Gland
Thyroid Cancer
Diabetes Mellitus Case Study (45 min)
Glucose Lab Values
Hypoglycemia
Glucagon Lab Values
Glipizide (Glucotrol) Nursing Considerations
Glands
Metabolic & Endocrine Terminology
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Hypoglycemia
Pancreas
Adrenal Gland
Adrenal Gland Hormones Nursing Mnemonic (The 3 S’s)
Cortisol Lab Vales
Cortisone (Cortone) Nursing Considerations
Corticosteroids
Cushing’s Syndrome Case Study (60 min)
Metabolic & Endocrine Terminology
Metabolic/Endocrine Course Introduction
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Cushing’s Disease
Pituitary Gland
Diabetes Insipidus Case Study (60 min)
Free T4 (Thyroxine) Lab Values
Growth Hormone (GH) Lab Values
Metabolic & Endocrine Terminology
Metabolic/Endocrine Course Introduction
Cortisol Lab Vales
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Pituitary Adenoma
Pituitary Gland
Thyroid Stimulating Hormone (TSH) Lab Values
Thyroid Gland
Growth Hormone (GH) Lab Values
Pituitary Adenoma
Pituitary Gland
Cushing’s Syndrome Case Study (60 min)
Diabetes Insipidus Case Study (60 min)
Diabetes Insipidus Nursing Mnemonic (DDD)
Diabetes Management
Diabetes Mellitus (DM) Module Intro
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Glipizide (Glucotrol) Nursing Considerations
Glucose Lab Values
Glucose Tolerance Test (GTT) Lab Values
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Insulin
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Metabolic & Endocrine Module Intro
Metabolic/Endocrine Course Introduction
Metformin (Glucophage) Nursing Considerations
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Case Study for Diabetic Foot Ulcer
Nursing Case Study for Type 1 Diabetes
Pituitary Gland
Protein in Urine Lab Values
Urinalysis (UA)
Addisons Assessment Nursing Mnemonic (STEROID)
Addisons Disease
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Cushing’s Syndrome Case Study (60 min)
Cushings Assessment Nursing Mnemonic (STRESSED)
Nursing Care Plan (NCP) for Cushing’s Disease
Diabetes Insipidus Case Study (60 min)
Diabetes Insipidus Nursing Mnemonic (DDD)
Enuresis
Metabolic/Endocrine Course Introduction
Metabolic & Endocrine Module Intro
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Urinalysis (UA)
Nursing Care Plan (NCP) for Diabetes Insipidus
Diabetes Insipidus Case Study (60 min)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Diabetes Management
Diabetes Mellitus (DM) Module Intro
Diabetic Ketoacidosis (DKA) Case Study (45 min)
DKA Treatment Nursing Mnemonic (KING UFC)
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Case Study for Type 1 Diabetes
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Diabetes Management
Diabetes Mellitus (DM) Module Intro
Glucose Lab Values
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Adrenal Gland
Antidiabetic Agents
Blood Glucose Monitoring
Diabetes Management
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Glipizide (Glucotrol) Nursing Considerations
Glucose Lab Values
Glucose Tolerance Test (GTT) Lab Values
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypoglycemia
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin
Insulin Mixing
Insulin Drips
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin Mnemonic (Ready, Set, Inject, Love)
Metformin (Glucophage) Nursing Considerations
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Care Plan (NCP) for Hypoglycemia
Nursing Case Study for Type 1 Diabetes
Pancreas
Corticosteroids
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care and Pathophysiology for Cushings Syndrome
Cushings Assessment Nursing Mnemonic (STRESSED)
Cushing’s Syndrome Case Study (60 min)
Adrenal Gland
Addisons Disease
Addisons Assessment Nursing Mnemonic (STEROID)
Cortisol Lab Vales
Cortisone (Cortone) Nursing Considerations
Corticosteroids
Adrenal Gland
Addisons Disease
Cushing’s Syndrome Case Study (60 min)
Cushings Assessment Nursing Mnemonic (STRESSED)
Glucose Lab Values
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Pituitary Adenoma
Pancreas
Glucagon (GlucaGen) Nursing Considerations
Glucagon Lab Values
Hypoglycemia
Nursing Care Plan (NCP) for Hypoglycemia
Pancreas
Adrenal Gland
Antidiabetic Agents
Blood Glucose Monitoring
Diabetes Management
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Corticosteroids
Disease Specific Medications
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Glipizide (Glucotrol) Nursing Considerations
Glucose Tolerance Test (GTT) Lab Values
Glucose Lab Values
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypoglycemia
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin Mnemonic (Ready, Set, Inject, Love)
Insulin Mixing
Insulin Drips
Insulin – Short Acting (Regular) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Hypoglycemia
Nursing Case Study for Type 1 Diabetes
Pancreas
Pituitary Gland
Growth Hormone (GH) Lab Values
Thyroid Stimulating Hormone (TSH) Lab Values
Thyroid Gland
Pituitary Gland
Nursing Care Plan (NCP) for Hyperthyroidism
Free T4 (Thyroxine) Lab Values
Triiodothyronine (T3) Lab Values
Thyroxine (T4) Lab Values
Thyroid Stimulating Hormone (TSH) Lab Values
Thyroid Gland
Thyroid Cancer
Pituitary Gland
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Free T4 (Thyroxine) Lab Values
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Pituitary Gland
Thyroid Gland
Thyroid Cancer
Triiodothyronine (T3) Lab Values
Thyroxine (T4) Lab Values
Thyroid Stimulating Hormone (TSH) Lab Values
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hyperparathyroidism