Hyperthyroidism

• Hyperthyroidism 


  Hypersecretion of thyroid hormone
• Grave's Disease is an autoimmune condition that causes hyperactivity of thyroid gland increasing thyroid hormone which causes hyperthyroidism
• Hyperthyroidism Clinical Findings:

  • Appearance: Exophtalmus - due to inflammation fat pads in the back of the eye
  • T3 & T4: High
  • TSH: Low
  • Metabolism: High
  • Weight: Low
  • Appetite: High
  • GIT: Diarrhea
  • Heat production: High temp. leading to heat intolerance
  • Skin: Diaphoresis
  • SNS: Hyperactive
  • Vital Signs: High HR
  • Complication: Thyroid Storm
  • Calcium: Decreased due to high calcitonin
• Hyperthyroidism: Signs and Symptoms

  "Everything is high, fast, and wet"

  • ex: high and fast: hypertension, tachycardia, high body temperature; wet: diaphoresis (wet skin), diarrhea (wet stool)
• Hyperthyroidism: Signs and Symptoms

  "All High except weight and TSH"
• Hyperthyroidism Management:

  • Calorie: High
  • Fiber: Low
  • Fluids: High
  • Activity: Bed rest
  • Environment: Cool & Non-stimulating
  • Sedatives: Yes
  • Stimulants: NO
• Pharmacotherapy in Hyperthyroidism:

  Thioamides: Decreases thyroid hormone

  1. PTU (Propylthiouracil) - DOC
  2. Methimazole - not baby safe

  Side effect:

  Monitor

  • Agranulocytosis (low WBC)
  • Sore throat - stop!
  • VS and weight
  • With meals
• Pharmacotherapy in Hyperthyroidism:

  Iodides: Lugol's Solution and Saturated Solution of Potassium Iodide (SSKI)

  • increases permeability of thyroid gland which inhibits release of thyroid hormone

  NI:

  • mix with fluids to improve palatability (metallic taste)
  • drinking straw to prevent staining
• Pharmacotherapy in Hyperthyroidism:

  Calcium Gluconate

  • to increase calcium
  • at bedside: MagSul (antidote)
• Pharmacotherapy in Hyperthyroidism:

  Beta-blocker: Propanolol

  • to control tachycardia and hypertension
  • check pulse before administration
• Pharmacotherapy in Hyperthyroidism:

  Radiation therapy: Radioiodine or radioisotope

  • to destroy overactive thyroid gland

  NC:

  • isolate 48 hours (radioactive)
  • 2 days isolation: double gloving, double flushing
• Surgery in Hyperthyroidism:

  Thyroidectomy

  Postoperative Interventions:

  • Position: Semi-fowler's
  • Sign of bleeding: check at the back of the neck
  • Have tracheostomy set, oxygen and suction available at bedside. Inadvertent parathyroid damage leads to hypocalcemia which may cause laryngospasm that results to airway obstruction.
  • Ask client to speak every hour. Severe hoasness = laryngeal damage
  • Complication: Thyroid Storm
• Hyperthyroidism: Thyroidectomy

  Complication: Thyroid Storm

  • can occur from release of thyroid hormone into the bloodstream during surgery; it can also follow severe infection and stress

  First sign: Fever