Question

1. Who would benefit from SSKI, PTU, tapazole RAIU? Are there any precautions or patient teaching to be mindful of for each?

2. What is the purpose of the parathyroids? What would alert the nurse of parathyroid gland compromise?

3. Who would benefit from fludrocortisone/hydrocortisone? Are there precautions or patient teachings for the nurse to be mindful of?

Answer 1

* SSKI is super saturated potassium iodide and  is traditionally given about 10 days prior to surgery for patients with hyperthyroidism with the goal of decreasing thyroid hormone levels and gland vascularity. Potassium iodide is used to treat overactive thyroid and to protect the thyroid gland from the effects of radiation from inhaled or swallowed radioactive iodine.

PTU is propylthiouracil and PTU tablets belongs to a group of medicine called anti-thyroid agents. It is used in the treatment of hyperthyroidism. It works by reducing the production of a hormone called thyroxine by the thyroid gland.

Tapazole contains methimazole and it is used to treat hyperthyroidism. It is also taken before thyroid surgery or radioactive iodine therapy.

and

RAUI Test means Radio Active Uptake Iodine Test. The radioactive iodine uptake test is a type of scan used in the diagnosis of thyroid problems, particularly hyperthyroidism.

* Super saturated potassium iodide, propylthiouracil, methimazole are drugs used to treat HYPERTHYROIDISM. So, the patients with hyperthyroidism would benefit from these drugs.

# HYPERTHYROIDISM - The over production of hormone called thyroxine by the thyroid gland is called hyperthyroidism.

** In deciding to the use of a medicine, the risks of taking the medicine must be weighed against the good it will do. The precautions may include -

1) For SSKI -

* Patient should tell if they have any allergic problems with the medicine.

* Patient should not have high level of potassium in blood.

* Prolonged use of potassium iodide can be harmful to thyroid gland.

* Patient should know the side effects and interactions of medication. Side effects may include swelling in limbs, face, tongue, lips, lymph nodes and joint pains. These effects are less common but after prolonged use, it may cause headache, burning of mouth, confusion, numbness, irregular heartbeats, weakness of legs, etc.

2) For PTU -

* Use of this medication in pregnancy can harm to baby.

* It's use can temporarily decrease white blood cells, so patient is more prone to infections.

* It can also cause decrease in platelets no, so can cause clotting problems.

* Patient should stop taking medication if they have more symptoms than one. Symptoms may include stomach pain, clay-colored stools, dark urine, decreased appetite, fever, headache, itching, loss of appetite, nausea and vomiting, skin rash, swelling of lower legs, weakness, yellow eyes, etc.

3) For TAPAZOLE -

* This medication should not taken in pregnancy as it can harm baby.

* Agranulocytosis, leukopenia, thrombocytopenia, aplastic anaemia may occur due to this medication. In any of these cases, consumption of drug should be stop.

* Medication can cause liver toxicity and hypothyroidism.

* Side effects may include fever, sore throat, headache, skin eruptions, uneasiness or feeling of illness, etc.

## PURPOSE OF PARATHYROIDS -

The parathyroid glands manufactures the parathyroid hormone. Parathyroid hormone plays a role in regulating body's level of calcium and phosphorus in blood and bone. They increase the level of calcium when they are too low in blood. It does this through its actions on the kidneys, bones and intestine. parathyroid hormone stimulates the release of calcium from large calcium stores in the bones into the bloodstream.

** The single major disease of parathyroid glands is overactivity of one or more of the parathyroid lobes, which make too much parathyroid hormone, causing a potentially serious calcium imbalance. This is called hyperparathyroidism, it leads to hypercalcemia, kidney stones, osteoporosis, and various other symptoms. The most common symptom is fatigue and depression, memory loss, and bone aches are also very common.
SYMPTOMS OF PARATHYROID DISEASE -

• A lump in the neck.

• Difficulty speaking or swallowing.

• Muscle weakness.

• Sudden increase in blood calcium levels (hypercalcemia)

• Fatigue, drowsiness.

• Urninating more than usual, which may cause to be dehydrated and very thirsty.

• Bone pain and broken bones.

## Hydrocortisone / fludrocortisone are the corticosteroids. Corticosteroids may affect the thyroid functions. In high doses, corticosteroids reduce the conversion of active thyroxine to the more active triiodothyronine. Hence, in patients with severe hyperthyroidism, corticosteroids  may be used to reduce the levels of circulating thyroid hormones.

So, patients with hyperthyroidism would benefit from the use of hydrocortisone / fludrocortisone drug medication.

Precautions may include -

* This medicine may cause stomach bleeding. Daily use of alcohol while using this medicine may increase your risk for stomach bleeding.

* The medicine make more likely to get infections or may worsen current infections.

* The drug may cause effects like bone loss/pain, stomach bleeding, mood changes like confusion.

* Side effects may include nausea, heart burn, headache, dizziness, trouble sweating, increased sweating, acne, etc.