GROUP 2

Victoria Chemutai – R30/6082/2021

Redemta Wangechi – R30S/11980/2022

Fauzia Bakari – R30S/11793/2022

Morris Ondede – R30S/13136/2020

Elizabeth Wambui – R30/1424/2022

Lynestacy Amukohe R30S/11425/2022

Victor Muindi R30S/11488/2022

HYPERTHYROIDISM

Hyperthyroidism is a metabolic imbalance that results from the overproduction of thyroid

hormones triiodothyronine (T3) and thyroxine (T4). The most common form is Graves’ disease,
but other forms of hyperthyroidism include toxic adenoma, TSH-secreting pituitary tumor,
subacute or silent thyroiditis, and some forms of thyroid cancer.

Functions of thyroid hormone

- Regulating your body temperature.

- Controlling your heart rate.

- Controlling your metabolism

- When your thyroid gland is working correctly, your body is in balance, and all of your
systems function properly. If your thyroid stops working the way it’s meant to —
creating too much or too little thyroid hormones — it can impact your entire body.

Risk factors

- Family history of thyroid disease

- Medical history of conditions like pernicious anemia, Type 1 diabetes and primary
adrenal insufficiency (Addison’s disease).

- Excess iodine in the diet

- Being pregnant.

Causes of hyperthyroidism

Graves’ disease: In this disorder, your immune system attacks your thyroid. This makes your
thyroid secrete too much thyroid hormone. It is a hereditary condition. It’s more common in
people assigned female at birth than people assigned male at birth. Graves’ disease is the most
common cause of hyperthyroidism, making up about 85% of cases.

Thyroid nodules: A thyroid nodule is a lump or growth of cells in your thyroid gland. They can
produce more hormones than your body needs. Thyroid nodules are rarely cancerous.

Thyroiditis: it is the inflammation of the thyroid gland, which may lead to the release of excess
thyroid hormones into the bloodstream. This can occur due to conditions like Hashimoto’s
thyroiditis and post-partum thyroiditis, where the thyroid follicular cells are damaged, and
causing stored hormones to be released. The elevated levels of hormones leads to symptoms of
hyperthyroidism.
Consuming excess iodine: If you’re at risk for hyperthyroidism and consume too much iodine
(through diet or medications), it can cause your thyroid to produce more thyroid hormone. Iodine
is a mineral that your thyroid uses to create thyroid hormone. Receiving intravenous iodinated
contrast may also cause hyperthyroidism. Amiodarone, a medication that contains a high amount
of iodine, may also cause hyperthyroidism.

PATHOPHYSIOLOGY

The pathophysiology of hyperthyroidism depends on the particular cause.

Grave’s Disease; it is an autoimmune process with antibodies against the TSH receptor. An
interplay between genetic and environmental factors influences this autoimmune process. The
antibodies stimulate the TSH receptor (TSHR), leading to increased production and release of
thyroid hormones. The trophic effects on the thyroid also lead to the growth of the thyroid gland

Toxic Multinodular Goiter; Pathogenesis of TMNG includes the initial phase of development
of the nodular disease, thereby disrupting the normal feedback mechanism that regulate
production of thyroid hormones. This phase is prolonged and present for years before the
nodules develop autonomy for thyroid hormone production. The loss of the feedback control,
coupled with hyper functioning thyroid tissue driven by cellular mutations leads to elevated
thyroid hormones.

Iodine-Induced Hyperthyroidism: it results from excessive iodine intake through diet or

administration of iodine-containing medications such as contrast media or amiodarone.
Individuals susceptible to this phenomenon include the ones residing in iodine-deficient regions,
individuals with underlying thyroid nodular disease, or underlying occult GD or previously
treated GD. Hyperthyroidism develops about 2-12 weeks after exposure to excessive iodine. As
mentioned previously, the organification of iodide residues into precursor thyroid hormone
molecules is relatively self-regulating. Excessive circulating iodide inhibits organification, a
process known as the Wolff-Chaikoff effect. This autoregulation is escaped in the Jod-Basedow
phenomenon leading to excess thyroid hormone in the presence of excess iodine/iodide.

Thyroiditis: results in the transient increase in circulating thyroid hormone resulting from
inflammation or destruction of the thyroid follicular cells. The inflammation or destruction of the
thyroid follicular cells can result from autoimmunity or the result of external factors such as
infections.

Signs and symptoms

Rapid heartbeat (palpitations).

Weight loss.

Increased appetite.
Diarrhea and more frequent bowel movements.

Vision changes.

Thin, warm and moist skin.

Menstrual changes.

Intolerance to heat and excessive sweating.

Sleep issues.

Swelling and enlargement of the neck from an enlarged thyroid gland (goiter).

Hair loss and change in hair texture (brittle).

Bulging of the eyes (seen with Graves’ disease).

Muscle weakness.

Diagnosis for hyperthyroidism

History taking: focus on the signs and symptoms, family history on the condition

Physical exam:

- Inspection- the neck appearance, look for swelling and enlargement of the thyroid gland
known as goiter. A diffuse or nodular enlargement may suggest hyperthyroidism.

Eye changes: observe for signs of thyroid eye disease (grave’s ophthalmology), including
lid retraction, lid lag and proptosis (bulging eyes)

Skin changes: check for warm, moist skin and note any sweating or flushing, which may
be indicative of increased metabolic rates.

- Palpation: palpate the thyroid for size, tenderness and consistency. A firm, smooth, or
nodular texture maybe present in hyperthyroidism.

Blood tests for diagnosing hyperthyroidism: blood test is for identification of high levels of
thyroid hormones in the body. This is called thyroid function testing. When you have
hyperthyroidism, levels of the thyroid hormones T3 and T4 are above normal and thyroid-
stimulating hormone (TSH) is lower than normal

Imaging Tests: Taking a closer look at your thyroid can help in diagnosis of hyperthyroidism
and the possible cause of it. Imaging tests that can be used include:

1. Radioactive iodine uptake (RAIU) test: For this test, you’ll take a small, safe dose of
radioactive iodine by mouth to see how much of it your thyroid absorbs. After a certain
 amount of time a scan on the neck is done with a device called a gamma probe to see how
much of the radioactive iodine the thyroid has absorbed. If it thyroid has absorbed a lot of
the radioactive iodine, it means that your thyroid gland is producing too much thyroxine
(T4). If this is the case, you most likely have Graves' disease or thyroid nodules.

2. Thyroid scan: This procedure is an extension of the RAIU, where in addition to

measuring the absorbed amount of radioactivity by your thyroid, a patient lie on a table
with the head tilted back while a special camera (gamma camera) takes several images of
your thyroid. Thyroid scan is used to look for lumps or nodules on your thyroid,
inflammation, swelling, and goiter or thyroid cancer.

3. Thyroid ultrasound: An ultrasound uses high-frequency sound waves to create images of

your thyroid. It’s a non-invasive procedure that allows your provider to look at your
thyroid on a screen. Your provider may use this test to look for nodules on your thyroid.

Treatment of hyperthyroidism

Treatment depends on the cause. Treatment options may include:

Antithyroid drugs eg. Methimazole or propylthiouracil: These drugs block the ability of your
thyroid to make hormones. They offer rapid control of your thyroid.

Radioactive iodine: Radioactive iodine is an oral medication that your overactive thyroid cells
absorb. The radioactive iodine damages these cells and causes your thyroid to shrink and thyroid
hormone levels to go down over a few weeks. This usually leads to permanent destruction of the
thyroid, which will cure hyperthyroidism. The amount of radiation delivered by this medication
is different from the amount used for the radioactive iodine uptake (RAIU) test and scan for
diagnosis. Most people who receive this treatment have to take thyroid hormone drugs for the
rest of their lives to maintain normal hormone levels.

Beta-blockers: these drugs blocks the activity of the thyroid hormones in the body. They do not
change the levels of the hormones in the blood, but they help manage symptoms such as rapid
heartbeat, nervousness and shakiness that are cause by hyperthyroidism. These treatment option
is usually paired with another option to treat hyperthyroidism over a long term.

Surgery: thyroidectomy which involves the removal of the thyroid gland may be done. This will
correct your hyperthyroidism, but it will usually cause hypothyroidism which requires lifelong
thyroid supplements to keep hormone levels normal.

Nursing management.

Nursing diagnosis
 1. Imbalanced Nutrition less Than Body Requirements related to increased metabolic
demands associated with hyperthyroidism as evidenced by weight loss, reduced food
intake, and low serum protein levels.
2. Impaired Skin Integrity related to skin dryness and vulnerability secondary to excessive
sweating and increased metabolic activity in hyperthyroidism as evidenced by warm,
moist skin, and susceptibility to skin breakdown.

3. Disturbed Sleep Pattern related to increased metabolic rates and heightened sympathetic
nervous system activity secondary to elevated thyroid hormone levels affecting the sleep-
wake cycle as evidenced by insomnia, fragmented sleep, and fatigue.
4. Anxiety related to increased excitability and heightened sensitivity of the nervous system
as evidenced by restlessness, palpitations, and increased heart rate.
5. Risk for Imbalanced Fluid Volume related to hypermetabolic state causing increased
fluid loss in hyperthyroidism as evidenced by increased thirst, polyuria, and potential
dehydration.

Nursing goals
The client will:

- Maintain adequate cardiac output for tissue needs as evidenced by stable vital signs, palpable
peripheral pulses, good capillary refill, usual mentation, and absence of dysrhythmias.

- Verbalize an increase in the level of energy.

- Display an improved ability to participate in desired activities.

- maintain the usual reality orientation.

- recognize changes in thinking/behavior and causative factors.

- demonstrate stable weight with normal laboratory values and be free of signs of malnutrition.

- Report reduced anxiety to a manageable level.

- maintain moist eye membranes, free of ulcerations.

- identify measures to provide protection for the eyes and prevent complications.

- express understanding of the disease process, therapeutic needs, and potential complications.

Nursing interventions

Monitor vital signs, especially heart rate and blood pressure (both increase in hyperthyroidism)

Ask if the patient has chest pain (Due to increased heart work)
Listen to the heart for murmurs

Obtain ECG (atrial arrhythmias may occur in hyperthyroidism)

Teach the patient to relax

Administer medications as prescribed (beta-blockers)

Check intake and output (diarrhea is a common feature in hyperthyroidism)

Weigh patient daily

Administer anti-thyroid medications as prescribed

Educate the patient about thyroid surgery

Educate the patient on radioactive iodine and how it can destroy the thyroid gland

Provide oxygen if the saturation is less than 94%

Complications

Thyroid storm (thyroid crisis/ thyroitoxic crisis): It happens when your thyroid makes and
releases a large amount of thyroid hormone in a short amount of time. Reflecting the
hypermetabolic state of hyperthyroidism, the patient experiencing thyroid storm will present with
tachycardia, increased GI motility, diaphoresis, anxiety, fever, and manifestations of multiple
organ dysfunction. Thyroid storm is a potentially life-threatening complication of
hyperthyroidism, thus requiring immediate attention. The mortality rate is high in individuals
more than 60 years of age, of about 16%.

Other complications include: increased risk of acute cardiovascular events, atrial fibrillation,
ischemic stroke, osteoporosis, infertility, abnormalities of menstrual cycles, and mortality.
Subclinical hyperthyroidism has been associated with an increased risk of arrhythmias such as
atrial fibrillation, osteoporosis, hip fractures, and mortality.

A complication of Graves’ disease, one of the causes of hyperthyroidism, is called Graves’ eye
disease (Graves’ ophthalmopathy). This condition can usually not be prevented. Graves’ eye
disease can cause the following complications:

Bulging eyes.

Vision loss.

Double vision.
Light sensitivity.