HYPERTHYROIDISM
A common endocrine disorder is a form of
THYROTOXICOSIS resulting from an excessive
synthesis and secretion of endogenous or
exogenous thyroid hormones by the thyroid (Norris,
2019).
Diagnosis & Treatment for Hyperthyroidism Problem |
Livofy
The most common causes are:
Graves' Disease
Toxic Multinodular Goiter
Toxic Adenoma
Other causes:
THYROIDITIS (inflammation of the thyroid gland)
Excessive Ingestion of Thyroid Hormone
GRAVE’S DISEASE
an autoimmune disorder that results from an
excessive output of thyroid hormones caused by
abnormal stimulation of the thyroid gland by
circulating immunoglobulins.
This disease affects women 8x more than men, w/
onset usually between the 2nd and 4th decades.
Precipitated by:
o Emotional Shock
o Stress
o Infection
but the exact significance of these relationships is
not understood (Norris, 2019
PATHOPHYSIOLOGY
T3 vs T4: What Iis
the Difference? | NursingCenter
ASSESSMENT FINDINGS
Soft and may Pulsate
Thrill often can be palpated
Bruit is heard over the thyroid arteries
LABORATORIES AND DIAGNOSTIC FINDINGS
1. Thyroid Function Tests:
A. Thyroid Stimulating Hormone (TSH) Level:
DECREASED
B. Triiodothyronine (T3) and Thyroxine (T4) Levels:
ELEVATED
Exophthalmos
also known as proptosis, is a medical term for a 2. Thyroid Antibody Tests:
bulging or protruding eyeball or eyeballs A. Thyroid Stimulating Immunoglobulin (TSI) Assay:
ELEVATED
B. Thyroid Peroxidase Antibodies (TPOAb) and 5. Fine Needle Aspiration (FNA) Biopsy:
Thyroglobulin Antibodies (TgAb): ELEVATED Result: Differentiate between benign and
malignant nodules
3. Radioactive Iodine Uptake (RAIU) Test:
This test involves administering a small amount of
radioactive iodine orally or intravenously
followed by measurement of the uptake of
radioactive iodine by the thyroid gland using a
gamma probe or imaging
Colloid nodule. Sheath of normal thyroid epithelium
Result: INCREASED UPTAKE
shows uniform nuclei and pale cytoplasm
(Papanicolaou, ×100).
Papillary thyroid carcinoma. A) Follicular cells with large
irregular nuclei, nuclear grooving, and pale chromatin
4. Thyroid Ultrasound (Papanicolaou, ×400). B) Histologic preparation
showing typical papillary configurations (hematoxylin-
Result: ENLARGED size, shape, and structure of the eosin, ×50).
thyroid gland, and/or presence of nodules or other
abnormalities
6. Serum Calcium Levels:
Normal:
8.5 to 10.5 mg/dL or
2.1 to 2.6 mmol/L
Result: HYPOCALCEMIA
NURSING DIAGNOSES
ACTUAL PHYSIOLOGIC
1. Impaired Nutritional Status related to
exaggerated metabolic rate, excessive appetite,
and increased GI activity
2. Disturbed Sleep Pattern related to increased
metabolic rate, anxiety, and hormonal
imbalances
Clinical and ultrasound findings of thyroid
involvement in FD/MAS.... | Download Scientific 3. Fatigue related to increased metabolic rate and
Diagram altered sleep patterns
4. Impaired Thermoregulation related to
increased metabolic rate, and hormonal
imbalances
POTENTIAL PHYSIOLOGIC
1. Risk For Impaired Skin Integrity related to
increased sweating and potential heat
intolerance
2. Risk For Impaired Cardiac Function related to
alteration in heart rate and rhythm
ACTUAL BEHAVIORAL
1. Ineffective Coping related to irritability, and
emotional instability
2. Situational Low Self-esteem related to changes PREGNANT WOMEN:
in appearance, excessive appetite, and weight o 1ST Trimester: propylthiouracil given
loss rather than methimazole due to the
teratogenic effects of methimazole
o 2ND & 3RD Trimester: shifted to
POTENTIAL BEHAVIORAL
methimazole, due to risk of hepatotoxicity
1. Risk For Severe Anxiety related to uncertainty
about the future
2. Risk For Impaired Decision-Making related to
cognitive changes, and emotional instability
PLANNING & IMPLEMENTATION
OBJECTIVES:
1. To achieve and maintain euthyroid state.
2. To maintain adequate cardiac function.
3. To maintain adequate nutritional status.
4. To maintain normal body temperature.
5. To prevent or minimize complications.
6. To address psychological symptoms such as
anxiety, depression, or mood changes.
MEDICAL MANAGEMENT
I. Antithyroid Agents (thionamides)
II. Adjunctive Therapy
III. Radioactive Iodine
IV. Surgery
Goal: Reduce thyroid hyperactivity to relieve
symptoms and prevent complications.
Radioactive Iodine : treatment for Graves’ disease.
Remission for up to 12 to 18 months but often
experience recurrence within 12 months of
II. RADIOACTIVE THERAPY
treatment happens to patients with Graves’ disease
Treatment of choice.
(Lee & Khardori, 2018).
Radioactive isotope of iodine is concentrated in the
thyroid gland, where it destroys (after several
I. ANTITHYROID THERAPY
weeks) thyroid cells without jeopardizing other
NURSING CONSIDERATIONS: radiosensitive tissues.
Single dose is effective in treating 80% to 90% of
Take Baseline & Monitor:
cases to treat toxic adenomas, toxic multinodular
o CBC esp. WBC w/ Differential Count, and
Goiter, and most varieties of thyrotoxicosis
Platelet
(Bauerle & Clutter, 2019).
o Liver Profile (Transaminases and Bilirubin)
Contraindicated during pregnancy
Therapeutic Dose basis: pulse rate, pulse pressure,
Pregnancy test 48 hours prior to treatment
body weight, size of the goiter, and results of
Do not conceive for at least 6 months following the
laboratory studies
treatment
Administer: morning on an empty stomach 30
Breast-feeding for up to 6 weeks is contraindicated
minutes before eating
It can contaminate saliva , urine ,, or radiation are
Avoid food that decrease absorptions: walnuts,
emitted from their body:
soybean flour, cottonseed meal, and dietary fiber
Avoid the following:
It takes several weeks until symptom relief occurs
Sexual contact
Maintenance dose is established, then gradually
Sleeping in the same bed with other people
tapered over several months
Having close contact with children and
Common Medication Side Effects/Adverse
pregnant women
Reactions: Fever, Rash, Urticaria, Agranulocytosis,
Sharing utensils and cups
and Thrombocytopenia (S/Sx of Bleeding)
The patient should follow the innstructions
STOP if: signs of infection, especially pharyngitis
provided regarding the time restrictions for
and fever or the occurrence of mouth ulcers
these cautions because they are dose related.
Notify the primary provider immediately if w/ s/sx
The patient is observed for signs Thyroid Storm ***
of infections, and undergo hematologic studies
Thyroid Hormone Replacement (levothyroxine)
Do NOT Discontinue medications abruptly, or
is started 4 to 18 weeks after the antithyroid
w/out physician's order
medications have been stopped based on the
results of thyroid function tests
example: nag radio active therapy then ga inom
Altered neurologic or mental state:
kapa anti hyroid medications such as PTU then ma
o Delirium Psychosis
stop. After 4 weeks ma start levothyroxine but
o Somnolence
depends on the result of t3 and t4.
o Coma
Monitor serum free T4 (principal test):
o 3 to 6 weeks post administration of PRECIPITATING FACTORS:
radioactive iodine
o then Q 1 to 2 months until normal thyroid Stress: Injury, Infection, Thyroid and Non-thyroid
function is established Surgery, Tooth Extraction
TSH monitored Q 6 to 12 months for life once a Insulin Reaction
normal thyroid state has been established Diabetic Ketoacidosis
Pregnancy
IV.SURGERY Digitalis Intoxication
SUBTOTAL OR TOTAL THYROIDECTOMY Abrupt Withdrawal of Antithyroid Medications
Done only if euthyroid state is reach (4 to 6 Extreme Emotional Stress Vigorous Palpation of the
weeks). Thyroid
Stop medications that prolongs clotting (e.g., MANAGEMENT
aspirin, anticoagulant) several weeks before
surgery (↓ risk of post-op bleeding) FEVER:
Monitor evidence of Iodine Toxicity (Fischbach hypothermia mattress or blanket
& Fischbach, 2018) ice packs
o Brown-stained Mucosa
cool environment
o Burning Pain in the Mouth &
hydrocortisone
Esophagus
acetaminophen
o Laryngeal Edema
o Shock NOTE:
NURSING CONSIDERATIONS: Salicylates (e.g., aspirin) are not used because they
displace thyroid hormone from binding proteins
Pre-op : Potassium iodide (SSKI) + antithyroid
and worsen the hypermetabolism
agents or beta-adrenergic blockers (to reduce
the effects of hyperthyroidism quickly and help OXYGENATION:
to prevent the onset of thyroid storm).
Humidified Oxygen
o SSKI : 5 gtts. Q6H Arterial Blood Gas levels monitoring
o propylthiouracil : 200 mg Q6H Oxygen Saturation level monitoring
o propranolol : 60 - 80 mg PO Q6H (↓
tachycardia) FLUID BALANCE:
Continue to take the propylthiouracil and any IV fluids containing dextrose are given to replace
cardiac medication until the free T4 and T3 liver glycogen stores that have been decreased in
levels are near normal (Bauerle & Clutter, 2019) the patient who is hyperthyroid
MEDICATIONS:
THYROID STORM (THYROTOXIC CRISIS , THYROXICOSIS) PROPYLTHIOURACIL OR METHIMAZOLE
It is a form of severe hyperthyroidism, usually of is given to impede formation of thyroid hormone
abrupt onset; if untreated, it is almost always and block conversion of T4 to T3, the more active
fatal. form of thyroid hormone.
Patients are critically ill and requires astute
observation , aggressive and supportive nursing
care during and after the acute stage of illness.
Clinical Manifestations
Hyperpyrexia (high fever) : >38.5°C (>101.3°F)
Extreme Tachycardia: >130 bpm
Exaggerated symptoms of hyperthyroidism with
disturbances of a major system
o GIT: weight loss, diarrhea, & abdominal
pain
o CARDIOVASCULAR: edema, chest pain,
dyspnea, & palpitations
Hydrocortisone is prescribed to treat shock or
adrenal insufficiency.
Iodine is given to decrease output of T4 from the
thyroid gland.
propranolol, combined with digitalis (Lanoxin) for
cardiac problems such as atrial fibrillation,
arrhythmias, and heart failure
