Products
Pre-Nursing
Nursing Student
NCLEX Prep
New Grad
Join NURSING.com to watch the full lesson now.

02.18 Thyroid Cancer

Show More

Overview

  1. A&P
    1. The thyroid gland is a butterfly-shaped gland below the Adam’s apple with two lobes
    2. It is part of the negative feedback loop to produce hormones that:
      1. Regulate Metabolism
      2. Control heart rate
      3. Control blood pressure
      4. Control body temperature
    3. The parathyroid glands are attached to the thyroid gland and they:
      1. Regulate calcium levels in the blood
    4. Find out more about the A&P in our hyper and hypothyroid lessons

Nursing Points

General

  1. Thyroid and Parathyroid Cancer

    1. Tumor forms from cells of the gland
      1. Many benign tumors form on the thyroid gland →not cancerous
      2. Malignant cells can spread to nearby tissue and organs → cancerous
    2.  Thyroid cancer is the most common endocrine cancer
    3. Cancers categorized based on the cell type
      1. Well-Differentiated → look like nearby cells → better outcomes
        1. Papillary cells → most common
        2. Follicular → Most likely to spread to blood vessels
        3. High survival if caught early- up to 99% 5-year survival
      2. Medullary→develops in cells that make calcitonin
        1. Has a genetic link → family history
        2. Often spreads before it is discovered making it difficult to treat
      3. Poorly-Differentiated → Anaplastic →only 2% of thyroid cancers
        1. Poor outcomes
      4. Parathyroid Cancer
        1. Forms on parathyroid gland → rare
        2. More difficult to treat
  1. Risk Factors
    1. Age
      1. Median age between 45-54
    2. Gender
      1. Women 3x more likely to get thyroid cancer
    3. Prior irradiation treatment to the neck
      1. Low dose radiation was previously used to treat things like tonsillitis, acne, and other skin disorders
    4. Genetics
      1. Link to medullary thyroid cancer
        1. Some with very high risk will get their thyroid gland removed

Assessment

  1. Symptoms of thyroid cancer
    1. Thyroid mass
    2. Voice changes
    3. Difficulty swallowing
  2. Symptoms of parathyroid cancer
    1. High calcium →
      1. Causes fatigue, weakness, and drowsiness

Therapeutic Management

  1. Diagnosis
    1. Imaging
      1. CT
      2. MRI
      3. PET
      4. Radioactive Iodine scans
        1. Assess for thyroid function
        2. Show activity outside the thyroid
      5. Bone-density scan → parathyroid cancer

         

    2. Labs
      1. Electrolytes
        1. Calcium and phosphorus → parathyroid
      2. TSH, T3, T4 → Assess thyroid function
  2. Treatment
    1. Surgery is the primary treatment for thyroid and parathyroid cancer
      1. Thyroidectomy → full or partial (lobectomy)
        1. Post op considerations (testable!)
          1. Assess airway for stridor or obstruction
          2. Have tracheostomy equipment nearby
          3. Minimal talking → avoid airway irritation
          4. Monitor for low calcium
            1. From removal of parathyroid glands
            2. Signs would be numbness, tingling, and muscle spasm
          5. Hormone replacement
            1. Levothyroxine
    2. Iodine-131
      1. Radioactive material attached to iodine ingested
      2. Nearly all iodine in the body absorbed by thyroid cells → radioactive material delivered directly to thyroid → targeted radiation therapy
      3. Radiation precautions
        1. ALARA → As low as reasonably achievable exposure
        2. Facility specific
    3. External Radiation Therapy
      1. For extensive disease or metastasis
    4. Chemotherapy
      1. For extensive disease and poorly differentiated tumors with metastasis
    5. Targeted therapies
      1. Used more often
      2. More are being developed
      3. Target proteins to block blood flow and nutrients to tumor

Nursing Concepts

  1. Cellular Regulation
    1. Cellular changes lead to overgrowth of metastatic cells
  2. Coping
    1. A cancer diagnosis is scary no matter how high the survival rate is
  3. Hormone regulation
    1. The thyroid gland and parathyroid gland are HUGE players in our endocrine system

Patient Education

  1. Post-op considerations
    1. Signs of complications
      1. Airway
      2. Hypocalcemia
    2. Thyroid hormone replacement
  2. Radiation safety
    1. ALARA
  3. Medullary carcinoma has genetic link
    1. Look at family history

Reference Links

Study Tools

Video Transcript

All right. Hi guys. Today, we’re going to be talking about thyroid cancer. Okay. And we’re first review a little bit about the thyroid gland. So the thyroid gland is a part of the endocrine system. It has two lobes. It’s this butterfly shaped organ, right? And behind the thyroid gland, the posterior side, we have the parathyroid glands. So that’s an important point here, because if we remove the thyroid, then we all often also remove the parathyroid gland. What are the functions of the thyroid gland? It is to release the thyroid hormones, right? It’s part of this feedback loop of the endocrine system, and it releases T3 and T four, and that impacts our body’s metabolism and impacts, um, heart rate, temperature, blood pressure, all kinds of things. Right. And then what does the parathyroid gland do? It helps us regulate our calcium in the blood. 

So if we have a disruption in this, we’ll have changes to the calcium levels. Now there’s a lot more information about the thyroid gland and you can check out the nursing.com lecture about hypo and hyper thyroidism. But it’s important to review this briefly because if we have a cancer in the thyroid gland, these functions are not going to be working appropriately. Right. Okay. Now what are the types of thyroid cancer? There’s actually several different ones and we’ll break them down briefly here. If the cancer is well differentiated, that means it looks a lot like thyroid cells. There’s two different types of well differentiated thyroid cancers. And those would be, um, of papillary papillary cells. Um, or it can be I’m sorry, you can’t type or write rather follicular. So those cells are well differentiated. They’re more like thyroid cells and they have a better outcome basically. Um, that’s the important thing about them? Modularity is another type of thyroid cancer. And the important thing about this one is it has a strong genetic link. Um, these [inaudible] cells that make calcitonin. So it’s going to have a little bit different side effect profile, um, and it does spread rapidly. 

So that’s an important thing about med jewelry and then not differentiated or poorly differentiated, also anaplastic thyroid cancer. And that would be much harder to treat much poorer prognosis. Parathyroid carcinoma also is possible. It’s rare, but it does happen. And that’s cancer that occurs primarily in those parathyroid cells. Okay. Risk factor of thyroid cancer prior radiation treatment mint to the neck. nd this actually used to be done, used to do radiation treatments for things like tonsillitis, acne, other skin disorders, not done so much any more, but older generations might have had low dose radiation for things like that. And then age, the primary age for diagnosis or the median age is between 45 and 54. Gender females are actually three times as likely as males to get the thyroid cancer. And we don’t actually know the reason of that, that, it has, um, obviously something to do with hormones because versus part of our endocrine system, right. 

Genetic mutations, I mentioned that there’s a link to the med Larry cancer, and that one is one that spreads rapidly. So there’s actually some patients who will get their thyroid gland removed. If they are at a very high risk of getting thyroid cancer before they have the cancer there, they’ll get it removed. Symptoms of thyroid cancer would be if we feel a mass on the thyroid, right, a palpable mass and that growing mass can lead to voice changes and difficulty swallowing. And then if the cancer is in the parathyroid gland, we can have this high calcium overactive right high calcium can cause fatigue, weakness, and drowsiness diagnostics for thyroid cancer. We’ll do imaging, a CT MRI or pet scan. And then they also have specific imaging, That actually use iodine or radioactive iodine because the thyroid gland processes almost all of the iodine that the body receives go straight to the thyroid gland. 

So they attach different radioactive materials to iodine. And that allows a study of the function of the thyroid gland. Okay. A biopsy will be done of course, to assess the cells. Once a section has been removed and then labs, we want to look at, of course that  thyroid hormones, right? T thyroid stimulating hormone T three and T four, that then also we want to look at calcium. Um, and then working with that would be phosphorus. Okay. The primary treatment for thyroid cancer is to remove it. And that would be with a thyroidectomy or removal of the thyroid. It can be a partial or a full removal, and there are some really important nursing considerations that the thyroid ectomy that you need to remember, this is testable material guys. If you have a thyroidectomy, you need to be monitoring closely their airway. And that would be because imagine here we remove this section, right? 

Our body’s natural response to any trauma is to activate our immune system, which can, can cause inflammation. And as it swells, we can be at risk of impeding the trachea, right, impeding the airway. So we need to have a trake kit, any emergency trake kit at the bedside. So we could do an emergency track if needed. If you have a thyroidectomy, you need to make sure you have a trache kit at the bedside. I learned that the hard way from a surgeon as a new nurse, and then also when you study monitoring calcium levels in these patients and looking for signs of low calcium. So we need to look for signs of low calcium. And that would mean our muscles are hyper excitable. 

Okay. So that would be numbness, tingling, or muscle spasms would be things that we’re looking for. Other treatments for thyroid cancer would be iodine one 31. And this is similar to the, um, imaging centers. We do. So almost all of the iodine that our body receives goes directly to the thyroid, right? So we attach this radioactive material to that iodine and the iodine delivers this radiation directly to the thyroid gland. Also, we can do external radiation and both of these, um, we talk about this a little bit more in more detail in the radiation lecture, but they are radiation treatments. Chemotherapy can also be used. It’s really more for extensive disease and that poorly differentiated tumors and then targeted therapies, um, target proteins to block blood flow to these tumors. It’s important with iodine to talk about, um, reducing exposure to family members and staff to the iodine because they will be producing this radiation after the take these substances. We’ll talk more about that in patient education. 

Okay. So postop considerations, that big thing to educate our patients about, we need to talk about, um, making sure they’re informing us for any signs of hypocalcemia, low calcium or issues with their airway. And then they’re also gonna need a thyroid replacement hormone, because if we remove the thyroid gland, we’re going to need to replace the hormones that it makes. Right. Um, and then radiation safety. This is what I was talking about before. So we need to educate our patients and our staff caring for these patients to get as low as reasonable, achievable, as low as reasonably achievable exposure to radiation. So to do that, we need to limit the time where with these patients as much as possible. And then there is a genetic link. So making sure patients are aware of that, to that med jewelry, thyroid cancer, nursing concepts, we’re talking about cancer here. 

Something went wrong with cellular regulation, right? It’s growing out of control coping. I’ve had a patient once. This is big with thyroid cancer, who told me she felt guilty because she had an easy cancer. For some reason. I don’t know why she felt that way, but I just thought it was worth mentioning any cancer diagnosis is very scary and difficult to deal with no matter how early your stage is. And then hormone regulation, this is part of our endocrine system, right? So we are going to have to replace the hormones that we’ve lost. Okay. So some key points about thyroid cancer. Primary treatment is surgery with that surgery re monitoring airway and signs of hypocalcemia. We need that trake at the bedside, right? There are different types of cells and they act in different ways, more differentiated. So they look more like normal cells have better outcomes. Thyroid hormones need to be replaced after surgery and iodine. One 31 is a specific treatment for thyroid cancer, and we need to teach our patients about radiation safety. All right, guys, that’s all I have for you. We love you. Go out and be your best self today. And as always happy nursing.

 

 

[FREE]
[FREE]