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Hyperthyroidism is the overproduction of thyroid hormones by an overactive thyroid. Located in the front of the neck, the thyroid gland produces the hormones thyroxine (T4) and triiodothyronine (T3) that regulate the body's metabolic rate by helping to form protein ribonucleic acid (RNA) and increasing oxygen absorption in every cell. In turn, the productions of these hormones are controlled by thyroid-stimulating hormone (TSH) that is produced by the pituitary gland. When production of the thyroid hormones increases despite the level of TSH being produced, hyperthyroidism occurs. The excessive amount of thyroid hormones in the blood increases the body's metabolism, creating both mental and physical symptoms.
The term hyperthyroidism covers any disease which results in overabundance of thyroid hormone. Other names for hyperthyroidism, or specific diseases within the category, include Graves' disease, diffuse toxic goiter, Basedow's disease, Parry's disease, and thyrotoxicosis. The disease is 10 times more common in women than in men, and the annual incidence of hyperthyroidism in the United States is about one per 1,000 women. Although it occurs at all ages, hyperthyroidism is most likely to occur after the age of 15. There is a form of hyperthyroidism called Neonatal Grave's disease, which occurs in infants born of mothers with Graves' disease. Occult hyperthyroidism may occur in patients over 65 and is characterized by a distinct lack of typical symptoms. Diffuse toxic goiter occurs in as many as 80% of patients with hyperthyroidism.
Hyperthyroidism is often associated with the body's production of autoantibodies in the blood which cause the thyroid to grow and secrete excess thyroid hormone. This condition, as well as other forms of hyperthyroidism, may be inherited. Regardless of the cause, hyperthyroidism produces the same symptoms, including weight loss with increased appetite, shortness of breath and fatigue, intolerance to heat, heart palpitations, increased frequency of bowel movements, weak muscles, tremors, anxiety, and difficulty sleeping. Women may also notice decreased menstrual flow and irregular menstrual cycles.
The diagnosis for hyperthyroidism will be based on the Physical Examination.Patients with Hyperthyroidism often have a goiter. some of which mimic typical hyperthyroidism with the addition of fever. confusion. however this condition is easily treated with a daily administration of a single pill-thyroid replacement and therefore. Furthermore. However. and saline eye drops or high-dose glucocorticoids for ophthalmopathy. Radioactive Iodine and Thyroidectomy are almost always cures hyperthyroidism but it usually results in permanent hypothyroidism. substantial weakness. the prognosis of Hyperthyroidism is good but it all depends on the patient’s compliance to the treatment regimen. but treatment with anti-thyroid medications is usually given for at least a year and often longer. thyroid storm is a serious form of hyperthyroidism that may show up as sudden and acute symptoms. Computed Tomography (CT) Scan. . Treatment includes Anti-thyroid medications such as Propylthiouracil and Methimazole which improve Symptoms in most patients within 6 to 12 weeks. Management of hyperthyroidism includes medication for symptom relief such as Betablockers for neurologic and cardiovascular symptoms. and perhaps even coma. extreme restlessness. Routine Blood Thyroid Function Test. Ultrasonography. Magnetic Resonance Imaging (MRI) and Radioactive Iodine Uptake Test. the visible enlargement of the thyroid gland but as many as 10% doesn’t manifest the signs and these patients may also have bulging eyes. 70% may experience a relapse of symptoms in a few months to years. emotional swings or psychosis.
• Cite various drugs required for the treatment of the disease in giving a client based analysis on the said pharmacologic treatment. • To be able to help my patient. . • To accurately explain the various laboratory examinations that require for the detection of the disease and how the significant remarks or findings relate to the disease. which is aimed towards achieving optimum level of functioning.II. placing emphasis on how the complications and the disease etiology relate and sync with each other. which will be used to facilitate the client’s health status. • To evaluate the presenting clinical manifestations based on the overall condition with emphasis placed on the alterations. by giving health teachings regarding the prevention and cure of the disease. Objectives General Objectives: To be able to develop a comprehensive case study that would focus on the chosen case with regards to the pathology of the disease and it’s corresponding medical actions with the associative function of client-based interventions. Specific Objectives: • To know the patho-physiologic mechanism of the disease process of Hyperthyroidism.
To maintain good body mechanics and prevent and correct deformities. feelings. and sleep. 11. 14. To promote optimal activity. To facilitate the maintenance of a supply of oxygen to all body cells. 13. 4. She defined nursing as a service to individuals. Abdellah’s Typology of 21 Nursing Problems: 1. and reactions. emotional. The said Hyperthyroidism could lead to different problems that the patient can experience and it is the responsibility of the nurse to meet the different needs of the client to achieve the optimum level of functioning. 15. To recognize the physiologic responses of the body to disease conditions. To promote safety through prevention of accidents. 3. 9. Theoretical Framework PATIENT CENTERED APPROACHES by Faye Glenn Abdellah The Faye Glenn Abdellah’s Nursing Theory would be best adapted on this kind of case. 8. rest. .III. To facilitate the maintenance of sensory function. To facilitate the maintenance of regulatory mechanisms and functions. To promote the development of productive interpersonal relationships. To facilitate the maintenance of fluid and electrolyte balance. On her theory it consists of a broadly grouped 21 nursing problems to guide in the nursing intervention that will be rendered to the patient and promote the use of nursing judgment. To facilitate the maintenance of nutrition of all body cells. to families and therefore to society with a goal of giving a holistic care that pertains to physical. 7. 2. or other trauma and through the prevention of the spread of infection. social and spiritual functioning of the client. 10. 6. 5. To facilitate the maintenance of effective verbal and nonverbal communication. 12. injury. To promote good hygiene and physical comfort. She also said that nursing is a service that is based on the art and science which aims to help the sick or healthy people and cope with their health needs. To identify and accept positive and negative expressions. intellectual. exercise. To identify and accept the interrelatedness of emotions and organic illness. To facilitate the maintenance of elimination.
and developmental needs. 18. 17. emotional. To create and maintain a therapeutic environment. To use community resources as an aid in resolving problems arising from illness. 20. 21. To understand the role of social problems as influencing factors in the cause of illness. To accept the optimum possible goals in light of physical and emotional limitations. 19. To facilitate progress toward achievement of personal spiritual goals. To facilitate awareness of self as an individual with varying physical.16. .
VII. Anatomy and Physiology .
It starts cranially at the oblique line on the thyroid cartilage (just below the laryngeal prominence or Adam's apple) and extends inferiorly to the fourth to sixth tracheal ring. a pyramidal extension of the thyroid lobe. These hormones regulate the rate of metabolism and affect the growth and rate of function of many other systems in the body. The organ is situated on the anterior side of the neck. connected with the isthmus. The thyroid is controlled by the hypothalamus and pituitary. The external layer is anteriorly continuous with the lamina pretrachealis fasciae cervicalis and posteriorolaterally continuous with the carotid sheath. The thyroid participates in these processes by producing thyroid hormones.Thyroid Gland The thyroid is one of the largest endocrine glands in the body. reaching posteriorly the oesophagus and carotid sheath. The thyroid controls how quickly the body burns energy. The thyroid also produces the hormone calcitonin. The thyroid gland is covered by a fibrous sheath. Iodine is an essential component of both T3 and T4. is present at the most posterior side of the lobe. In variable extent. which plays a role in calcium homeostasis. This gland is found in the neck inferior to (below) the thyroid cartilage (also known as the Adam's apple in men) and at approximately the same level as the cricoid cartilage. Zuckerkandl's tubercle. the capsula glandulae thyroidea. after the shape of the related thyroid cartilage. and how sensitive the body should be to other hormones. lying against and around the larynx and trachea. Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) are the most common problems of the thyroid gland. The gland is covered anteriorly with infrahyoid muscles and laterally with the sternocleidomastoid muscle. principally thyroxine (T4) and triiodothyronine (T3). The gland gets its name from the Greek word for "shield". Posteriorly. In this region the recurrent . the gland is fixed to the cricoid and tracheal cartilage and cricopharyngeus muscle by a thickening of the fascia to form the posterior suspensory ligament of Berry. composed of an internal and external layer. It is difficult to demarcate the gland's upper and lower border with vertebral levels as it moves position in relation to these during swallowing. Anatomy The thyroid gland is butterfly-shaped organ and is composed of two cone-like lobes or wings: lobus dexter (right lobe) and lobus sinister (left lobe). makes proteins.
Up to 80% of the T4 is converted to T3 by peripheral organs such as the liver. draining via the plexus thyroideus impar in the left brachiocephalic vein. kidney and spleen. Lymphatic drainage passes frequently the lateral deep cervical lymph nodes and the pre. Iodine is captured with the "iodine trap" by the hydrogen peroxide generated by the enzyme thyroid peroxidase (TPO) and linked to the 3' and 5' sites of the benzene ring of the tyrosine residues on TG.laryngeal nerve and the inferior thyroid artery pass next to or in the ligament and tubercle. and calcitonin. The thyroid isthmus is variable in presence and size. triiodothyronine (T3). T3 is about ten times more active than T4. and releasing them into the blood. a branch of the external carotid artery. The venous blood is drained via superior thyroid veins.and parathracheal lymph nodes. . forming T4 and T3 (in T3. the follicular cells reabsorb TG and proteolytically cleave the iodinated tyrosines from TG.. The gland is supplied by sympathetic nerve input from the superior cervical ganglion and the cervicothoracic ganglion of the sympathetic trunk. Deiodinase enzymes convert T4 to T3. and on free tyrosine. a branch of the thyrocervical trunk. Physiology The primary function of the thyroid is production of the hormones thyroxine (T4). remnant of the thyroglossal duct. Thyroid hormone that is secreted from the gland is about 90% T4 and about 10% T3. and via inferior thyroid veins. draining in the internal jugular vein. one iodine is absent compared to T4). and the inferior thyroid artery. T3 and T4 production and action Thyroxine (T4) is synthesised by the follicular cells from free tyrosine and on the tyrosine residues of the protein called thyroglobulin (TG). The thyroid is one of the larger endocrine glands. and sometimes by the thyroid ima artery. and can encompass a cranially extending pyramid lobe (lobus pyramidalis or processus pyramidalis). Between the two layers of the capsule and on the posterior side of the lobes there are on each side two parathyroid glands. weighing 2-3 grams in neonates and 18-60 grams in adults. Upon stimulation by the thyroid-stimulating hormone (TSH). branching directly from the aortic arch. and by parasympathetic nerve input from the superior laryngeal nerve and the recurrent laryngeal nerve. and is increased in pregnancy The thyroid is supplied with arterial blood from the superior thyroid artery.
Thyroid hormones play a particularly crucial role in brain maturation during fetal development. The thyroid and thyrotropes form a negative feedback loop: TSH production is suppressed when the T4 levels are high. calcitonin seems far less essential than PTH. thyroid hormones cross the cell membrane and bind to intracellular receptors (α1. As with the steroid hormones and retinoic acid. The TSH production itself is modulated by thyrotropin-releasing hormone (TRH). A transport protein (OATP1C1) has been identified that seems to be important for T4 transport across the blood brain barrier. in pairs or together with the retinoid X-receptor as transcription factors to modulate DNA transcription. transthyretin and albumin. TSH production is blunted by somatostatin (SRIH). which is produced by the hypothalamus and secreted at an increased rate in situations such as cold (in which an accelerated metabolism would generate more heat). Calcitonin stimulates movement of calcium into bone. but not the parathyroids. . β1 and β2). However. released by the anterior pituitary (that is in turn released as a result of TRH release by the hypothalamus). A second transport protein (MCT8) is important for T3 transport across brain cell membranes. as calcium metabolism remains clinically normal after removal of the thyroid. In the blood. rising levels of glucocorticoids and sex hormones (estrogen and testosterone). which act alone. Only a very small fraction of the circulating hormone is free (unbound) .3%. Only the free fraction has hormonal activity. and excessively high blood iodide concentration. α2.Cells of the brain are a major target for the thyroid hormones T3 and T4. T3 and T4 regulation The production of thyroxine and triiodothyronine is regulated by thyroidstimulating hormone (TSH). T4 and T3 are partially bound to thyroxine-binding globulin.03% and T3 0. and vice versa. Parafollicular cells produce calcitonin in response to hypercalcemia.T4 0. in opposition to the effects of parathyroid hormone (PTH). Calcitonin An additional hormone produced by the thyroid contributes to the regulation of blood calcium levels.
Age: 45 .Gender: Female Precipitating Factor / Modifiable: Occupation (Street-sweeper) Smoker Stress - Excess hypothalamic secretion of Thyroid Releasing Hormone (TRH) Increase the Thyroid Stimulating Hormone (TSH) of Pituitary Gland Stimulation of Thyroid Hormone that Increase the triiodothyronine (T3) and thyroxine (T4) Hormonal Imbalance Multi-system Changes CardioPhysical Respiratory System MusculoSkeletal system Nutrition NeuroPsychological Integumentary .VIII. Pathophysiology Predisposing Factor / Non-Modifiable: .
Diagnostic / Laboratory Examinations Thyroid Function Tests (March 5.Respiratory Rate Tremors -Muscle Weakness & Fatigability -Heat Intolerance Sweating -Anxiety -Insomnia IX.Palpitation .Blood Pressure .50 – 23.79 pmol/L Normal Values 2..00 Interpretation Increased.80 pmol/L 11. 2013) (Radioimmuno Assay / Immunoradiometric Assay) Examination Triiodothyronine / FT3 (RIA) Thyroxine Findings / Results 65. indicates Hyperthyroidism Increased. indicates .Increase -Enlarged Thyroid Gland -Exophthalmia General Metabolic Rate ( BMR) -Weight Loss -Restless -Fine Heart Rate .50 – 5.94 pmol/L 48.
hemorrhage and fluid retention which can cause hemodilution Decreased.40 – 0.6 – 6.75 uIU/ml Hyperthyroidism Decreased.54 Interpretation Within Normal Range Decreased. may indicates anemia./ FT4 (RIA) Thyroid Stimulating Hormone / TSH (IRMA) - 0.44 x10^12/L 4.3 x10^9/L 5 – 10 x10^9/L Within Normal Range . indicates Hyperthyroidism Hematology Tests (January 30. hemorrhage and fluid retention which can cause hemodilution Within Normal Range Within Normal Range Within Normal Range Examination Hemoglobin Hematocrit Red Blood Cell (RBC) Count 4.39 Normal Values 120 – 180 g/L 0. may indicates anemia.06 uIU/ml pmol/L 0. 2013) Findings / Results 134.0 g/L 0.27 – 3.2 x10^12/L Mean Corpuscular Volume (MCV) Mean Corpuscular Hemoglobin (MCH) Mean Corpuscular Hemoglobin Concentration (MCHC) White Blood Cell (WBC) count 88 fL 30 g/L 34 g/dL 80 – 96 fL 27 – 31 g/L 33 – 36 g/dL 6.
8 % 39.2 % 40 – 60 % 20 – 40 % 0–1% 4–8% Within Normal Range Within Normal Range Within Normal Range Increased.9 % 0.6 % 1–3% autoimmune disorders Increased.Differential Count: Neutrophils Lymphocytes Basophils Monocytes 43. Drug Study Name of Drug Mechanism of Action Indications Contraindications Adverse Effects Nursing Interventions . may indicates allergic reaction. may indicates chronic infections or chronic inflammation and Eosinophils 5.5 % 10. skin diseases and parasitic infections X.
Generic Name: Methimazole Brand Name: Tapazole Drug Class: Anti-thyroid Drug Dose: 20 mg Route: P. urticaria. granulocytopenia. myalgia. Used for treating hyperthyroidism. hypoprothrombinemia. beta blockers.Instruct patient to take this drug as prescribed with meals to decrease the gastrointestinal symptoms . (twice a day) Pregnancy Category: D Inhibits the synthesis of thyroid hormones. vomiting. epigastric distress. drowsiness. hepatitis and nephritis Name of Drug Generic Name: Propranolol hydrochloride Mechanism of Action Competitively blocks betaadrenergic receptors in Indications Indicated for the management of Contraindications Contraindicated with allergy to betablocking Adverse Effects Side Effects: Bradycardia. paresthesia. it increased the therapeutic effects of all said drugs and may requires to stop or decrease the dosage of the said drugs. Since T3 is more potent than T4.Educate patient to consult the physician immediately if the signs and symptoms of agranulocytosis occurs. such as fever.Monitor vital signs especially blood pressure and heart rate . skin pigmentation.Emphasize the importance of drug compliance and need to be taken for a prolonged period to achieve the desired effects. a lupus-like syndrome. lactation and severe renal disease Pharmacokinetics: Onset – 30 to 40 mins. (by mouth) Frequency: B. Duration – 2 to 4 hours Metabolism – T ½ is 6 to 13 hours Excretion – Urine Interactions: Methimazole have a Drug to Drug effects with anticoagulants. jaundice. abnormal loss of hair. headache. thrombocytopenia. thrombo- Nursing Interventions . Contraindicated with allergy to antithyroid products. sialadenopathy. This action decreases thyroid hormone production. pregnancy.O. It also used for decreasing symptoms of hyperthyroidism in preparation for surgical removal of the thyroid gland or before inactivating the thyroid gland with radioactive iodine. Peak – 60 mins. digitalis glycosides and theophylline. Methimazole also interferes with the conversion of T4 to T3. pruritus. Side Effects: skin rash. and lymphadenopathy . neuritis.I.D.Inform patient the expected side effects of the medication . and abruptly stopping the antithyroid drug could bring on a thyroid crisis . edema. loss of taste. sore throat and unusual bleeding Adverse Effects: agranulocytosis. drug fever. this also reduces the activity of thyroid hormones. vertigo. arthralgia. nausea. Thus prevents iodine and peroxidase from their normal interactions with thyroglobulin to form T4 and T3.
and the release of renin and lowering BP. broncho-spasm. syncope. tachyarrhythmias. agina pectoris. renal or thyroid dysfunction. dizziness. orthostatic hypotension. T ½ is 8 to 11 hours Excretion – Urine agents. (three times a day) Pregnancy Category: C the heart and juxtoglomerular apparatus. bronchospasm. palpitations. Pharmacokinetics: Onset – 20 to 30 mins. myocardial infarction. cardiac workload and oxygen consumption. drowsiness.or third degree heart block. Peak – 60 to 90 mins.Instruct patient to comply with drug regimen and abrupt discontinuation of anti-hypertensive drug may cause rebound hypertension . second. acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone. decreased serum levels and therapeutic effects with methimazole cytopenia. nausea and vomiting . stress-induced angina. agranulocytosis.D.Educate patient to report immediately in the hospital if there is difficulty of breathing. diabetes mellitus and hypoglycemia Interactions: Increased serum levels and toxic effects with lidocaine and cimetidine. COPD. thyrotoxicosis and control of tachycardia or tremors associated with hyperthyroidism. sinus bradycardia. depression. Decreased antihypertensive effects with NSAIDs. fatigue.O. peripheral vascular disease. slow pulse. pregnancy and lactation. cardiogenic shock. night cough. decreased libido. hypertension. decreasing the influence of the sympathetic nervous system on these tissues. (by mouth) Frequency: T.Brand Name: Inderal Drug Class: Antihypertensive and betaadrenergic blocker (nonselective) Dose: 10 mg Route: P. has membranestabilizing (local anesthetic) effects that contribute to its antiarrhythmic action. Discharge Plan .I.Encourage patient to increase fluid intake and take this drug as prescribed with meals . bronchial asthma. swelling of extremities. heart failure. fever and sore throat Adverse Effects: Complete heart block. unexplained itching and skin rash XII. confusion. Duration – 6 to 12 hours Metabolism – Hepatic.Advise patient that anti-hypertensive drug may cause dizziness resulting from orthostatic hypotension. Cautions: Hepatic. rash. and for that reason instruct patient to remain in a sitting position for several minutes before standing up . dry mouth. the excitability of the heart.
and follow-up visits.. lunch and dinner. Provide clean and safe environment. Advised the patient to comply with the entire treatment course and explained the benefits of her compliance.Environment and Exercise • • Advised the Patient’s family to maintain a quiet and pleasant environment to promote relaxation for the patient. Encouraged the patient and her family to initiate an active or passive Range of Motion to all the extremities of the patient and do it every 8 hours for 15-30 minutes. diet recommendations. medications. And also take 10mg of Propranolol by mouth every after her breakfast. • • . Provide written and oral instructions about the activity.Out Patient follow-up .Treatment • Instructed the patient and her family to accomplish the entire laboratory test that was ordered by the physician and so that her doctor can determine on what course of treatment is best suitable for the patient. .Medication • • • Described the importance of her compliance on taking the prescribed medications including the potential unpleasant effects of non-compliance. .Health Teachings • Instructed the patient to avoid strenuous activities and advice the patient’s family to assist her on some activities of daily living. where the patient is having a difficulty to do it by herself. . Advised the patient’s family to help and support the patient on acquiring the medications prescribed by the physician Instructed the patient to take 20mg of Methimazole by mouth every morning and evening with meals.
Spirituality • • Encouraged the patient to always pray and have Faith whatever happens to her life. . lunch and dinner with a snack in between her meal-time. .Diet • • Advised the patient to always eat her breakfast. Instructed the patient to drink 8 or more glasses of water a day and avoid any caffeinated drinks. . Instructed the patient and her family to immediately consult the Physician for any problems or complications encountered. Always eat foods that are high in calorie.• • Advised the patient and her family to go back in the hospital after 6 weeks and bring along with them the new laboratory test. Advised the patient’s family to assist the patient on her way to attend the Sunday mass.
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