HYPERTHYROIDISM

Hyperthyroidism is the second most prevalent endocrine disorder, after diabetes mellitus. Graves’ disease, the most
common type of hyperthyroidism, results from an excessive output of thyroid hormones caused by abnormal stimulation of
the thyroid gland by circulating immunoglobulins.

CAUSES

The major causes in humans are:

 Graves' disease: An autoimmune disease
 Toxic thyroid adenoma 
 Toxic multinodular goitre
High blood levels of thyroid hormones (most accurately termed hyperthyroxinemia) can occur for a number of other reasons:
 Inflammation of the thyroid is called thyroiditis. These may be initially associated with secretion of excess thyroid
hormone, but usually progress to gland dysfunction and, thus, to hormone deficiency and hypothyroidism.
 Oral consumption of excess thyroid hormone tablets is possible,
 Amiodarone, an anti-arrhythmic drug, is structurally similar to thyroxine and may cause either under- or overactivity
of the thyroid.
 Postpartum thyroiditis (PPT) occurs in about 7% of women during the year after they give birth.
 Excess iodine consumption notably from algae such as Kelp.

PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS

 Emotional hyperexcitability  Rapid heart rate

 Irritability  Heat intolerance
 Apprehension  Flushed skin (warm, soft, moist)
 Restlessness  Increased appetite, weight loss,
 Palpitations  abnormal muscle fatigability &
 Nervousness  weakness

MANAGEMENT

 Anti-thyroid drugs
 Anti-thyroid drugs methimazole (Tapazole) or propylthioracil (PTU): 
 These drugs block the ability of the thyroid to make hormones. They offer rapid control of the thyroid.
I I
 Radioactive iodine: (123 or 131 )
 Radioactive iodine is taken by mouth and absorbed by the overactive thyroid cells. The iodine
damages these cells, and causes the thyroid to shrink and thyroid hormone levels to go down.
 This usually leads to permanent destruction of the thyroid, which will cure hyperthyroidism.
 Most patients who receive this treatment have to take thyroid hormone drugs for the rest of their lives
to maintain normal hormone levels.
 Beta blockers: Propranolol
 These drugs block the action of thyroid hormones on the body. They do not change the amount of
hormones in your blood, but they can help control the rapid heartbeat, nervousness, and shakiness caused by
hyperthyroidism.
 Thyroidectomy, 
 It involves the surgical removal of part of the thyroid gland. If only a single lump or nodule within the thyroid
is producing too much hormone, the surgeon can take out just that small part of the gland. If the entire gland
is overactive, which is more often the case, a total thyroidectomy is needed.
 It is the preferred treatment for people with a large goiter who chronically relapse after drug therapy and for
people who refuse or who are not candidates for the radioactive iodine therapy.
 Sometimes, the surgeon can leave a small portion of the thyroid intact – just enough to produce adequate
amounts of thyroid hormone. Depending on how much of the gland is left after surgery, the patient may need
subsequent thyroid replacement therapy.
 Food and diet
 Patients cannot have foods high in iodine, such as edible seaweed and kelps.
NURSING MANAGEMENT

1. Administer prescribed antithyroid medications, as ordered.

2. If iodine is part of the treatment, mix it with milk, juice, or water to prevent gastrointestinal distress, and give it
through a straw to prevent tooth discoloration.
3. Give antidiarrheal preparations as ordered.
4. Consult a dietician to ensure a nutritious diet with adequate calories and fluids.
5. Avoid excessive palpation of the thyroid, this can precipitate thyroid storm.
6. Minimize physical and emotional distress.
7. Monitor and record patient’s vital signs, weight, fluid intake, and urine output.
8. Measure neck circumference daily to check for progression of thyroid enlargement.
9. Evaluate serum electrolyte levels, and check for hyperglycemia and glycosuria.
10. Assess the patient for signs of heart failure.
11. Stress the importance of regular medical follow up after discharge because hypothyroidism may develop 2 to 4 weeks.
12. Reassure the patient and his family that mood swings and nervousness will probably subside with treatment.

ASSESSMENT
 Palpate the thyroid gland for enlargement; it is soft and may pulsate; a thrill may be felt and a bruit heard
over thyroid arteries
 Lab tests show a decrease in serum TSH, an increase in serum thyroxine (T4) level
 Obtain a health history, include family history of hyperthyroidism,
 Note reports of irritability or increased emotional reaction and the impact of these changes on patient’’s
interaction with family, friends and coworkers.
 Assess stressors and patient’s ability to cope with stress.
 Evaluate nutritional status and presence of symptoms
 Assess & monitor cardiac status periodically
 Assess emotional state and psychological status.

NURSING DIAGNOSIS WITH INTERVENTIONS

1. Imbalanced Nutrition: less than body requirements related to exaggerated metabolic rate, excessive
appetite
and increased GI activity.
Goal : Improves nutritional status

 Improving Nutritional Status

 Provide several small, well--balanced meals to satisfy patient’’s increased appetite
 Replace food/fluids lost through diarrhea & diaphoresis
 Reduce diarrhea by avoiding highly seasoned foods & stimulants such as coffee, tea, cola, and
alcohol
 Encourage high calorie, high protein foods
 Monitor I&O, daily weight

2. Impaired body temperature

Goal : Maintains normal body temperature
  Provide a cool, comfortable environment and fresh bedding and gown
 Give cool baths and provide cool fluids
 monitor body temp
 Explain to patient & family the importance of providing a cool environment

3. Low self--esteem r/t changes in appearance, excessive appetite, and weight loss
Goal : Achieves increased self-esteem

 Improving Self--Esteem:
 Convey an understanding of concerns regarding problems with appearance, appetite, and weight
 Provide eye protection if experiencing eye changes secondary to condition. Instruct in correct
instillation of eye drops/ointment to protect exposed cornea
 Arrange for pt to eat alone, if desired & if embarrassed by large meals consumed due to increased
metabolic rate.
 Avoid commenting on intake

4. Ineffective Coping r/t irritability, hyperexcitability, apprehension, emotional stability

Goal : Demonstrates effective coping methods in dealing with family, friends, and coworkers

 Enhance Coping Measures:

 Reassure family & friends that symptoms are expected to disappear with treatment
 Maintain a calm, unhurried approach, minimize stressful experiences.
 Keep environment quiet/uncluttered
 Provide information regarding all procedures
 Assist patient to take medications as prescribed, encourage adherence to therapeutic regimen