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HYPERTHYROIDISM (THYROTOXICOSIS, GRAVES’ DISEASE

)
Hyperthyroidism is a metabolic imbalance that results from overproduction of the 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.
Thyroid storm is a rarely encountered manifestation of hyperthyroidism that can be precipitated by such events as
thyroid ablation (surgical or radioiodine), medication overdosage, and trauma. This condition constitutes a medical
emergency.

CARE SETTING
Most people with classic hyperthyroidism rarely need hospitalization. Critically ill patients, those with extreme
manifestations of thyrotoxicosis plus a significant concurrent illness, require inpatient acute care on a medical unit.

RELATED CONCERNS
Heart failure: chronic
Psychosocial aspects of care
Thyroidectomy

Patient Assessment Database
Data depend on the severity/duration of hormone imbalance and involvement of other organs.

ACTIVITY/REST
May report: Nervousness, increased irritability, insomnia
Muscle weakness, incoordination
Extreme fatigue
May exhibit: Muscle atrophy

CIRCULATION
May report: Palpitations
Chest pain (angina)
May exhibit: Dysrhythmias (atrial fibrillation); gallop rhythm, murmurs
Elevated BP with widened pulse pressure
Tachycardia at rest
Circulatory collapse, shock (thyrotoxic crisis)

ELIMINATION
May report: Urinating in large amounts
Stool changes; diarrhea

EGO INTEGRITY
May report: Recent stressful experience, e.g., emotional/physical
May exhibit: Emotional lability (mild euphoria to delirium); anxiety/depression

FOOD/FLUID
May report: Recent/sudden weight loss
Increased appetite; large meals, frequent meals; thirst
Nausea/vomiting
May exhibit: Enlarged thyroid; goiter
Nonpitting edema, especially in pretibial area

NEUROSENSORY
May exhibit: Rapid and hoarse speech

nervousness. heart enlarged with fibrosis and necrosis (late signs or in elderly with masked hyperthyroidism). ECG: Atrial fibrillations. e. tachypnea Breath sounds: Crackles. jerky movements of body parts Hyperactive DTRs Paralysis (thyrotoxic hypokalemia) PAIN/DISCOMFORT May report: Orbital pain. Plasma cortisol: Low levels (less adrenal reserve). cardiomegaly. Electrolytes: Hyponatremia may reflect adrenal response or dilutional effect in fluid replacement therapy. conjunctival irritation. recent illness (pneumonia). Thyroid-stimulating hormone (TSH): Suppressed (except when etiology is a TSH-secreting pituitary tumor or pituitary resistant to thyroid hormone). diaphoresis Skin smooth. Does not respond to thyrotropin-releasing hormone (TRH). lid retraction. disorientation. Hypokalemia occurs because of GI losses and diuresis. stupor. quick. Protein-bound iodine: Increased. homemaker/maintenance tasks Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Radioactive iodine (RAI) uptake test: High in Graves’ disease and toxic nodular goiter. recent partial thyroidectomy History of insulin-induced hypoglycemia. Thyroglobulin: Increased. . Thyroid T3 uptake: Normal to high. x-ray contrast studies Discharge plan DRG projected mean length of inpatient stay: 4. wheezes (pulmonary edema associated with thyrotoxic crisis) SAFETY May report: Heat intolerance. Normal T4 with elevated T3 indicates thyrotoxicosis. coma Fine tremor in hands. TRH stimulation: Hyperthyroidism is indicated if TSH fails to rise after administration of TRH. thyroid hormone replacement therapy or antithyroid therapy. frank psychosis. premature withdrawal of antithyroid drugs. shorter systole time. Mental status and behavior alterations. Serum T4 and T3: Increased in hyperthyroidism. low in thyroiditis.g. self-care activities. Liver function tests: Abnormal.3 days considerations: May require assistance with treatment regimen. hair fine. Alkaline phosphatase and serum calcium: Increased. Serum glucose: Elevated (related to adrenal involvement). photophobia (eye movement) RESPIRATION May report: Difficulty breathing May exhibit: Increased respiratory rate. straight Exophthalmos. warm. irritability. silky. amenorrhea Impotence TEACHING/LEARNING May report: Family history of thyroid problems History of hypothyroidism. Urine creatinine: Increased. tearing Pruritic. confusion. excessive sweating Allergy to iodine (may be used in testing) May exhibit: Elevated temperature (above 100°F). and flushed. delirium. erythematous lesions (often in pretibial area) that become brawny SEXUALITY May report: Decreased libido Hypomenorrhea. Serum catecholamines: Decreased.. trauma. cardiac disorders or surgery. purposeless.

4. diagnose enlargement of thyroid gland.Needle or open biopsy: May be done to determine cause of hyperthyroidism. Prevent complications. NURSING PRIORITIES 1. if available. Note General/orthostatic hypotension may occur as a result of widened pulse pressure. Investigate reports of chest pain/angina. 5. Reduce metabolic demands and support cardiovascular function. NURSING DIAGNOSIS: Cardiac Output. risk for decreased Risk factors may include Uncontrolled hyperthyroidism. . good capillary refill. Provide information about disease process/prognosis and therapy needs. Provide psychological support. Thyroid scan: Differentiates between Graves’ disease and Plummer’s disease. Widened pulse pressure reflects compensatory increase in stroke volume and decreased systemic vascular resistance (SVR). hypermetabolic state Increasing cardiac workload Changes in venous return and systemic vascular resistance Alterations in rate. usual mentation. 3. Provides more direct measure of circulating volume and cardiac function. rhythm. Complications prevented/minimized. excessive peripheral vasodilation and decreased circulating volume. Plan in place to meet needs after discharge. palpable peripheral pulses. May reflect increased myocardial oxygen demands/ischemia. presence of signs and symptoms establishes an actual diagnosis. Disease process/prognosis and therapeutic regimen understood. ACTIONS/INTERVENTIONS RATIONALE Hemodynamic Regulation (NIC) Independent Monitor BP lying. 2. 2. Patient effectively dealing with current situation. 3. Monitor central venous pressure (CVP). and absence of dysrhythmias. Provides a more accurate assessment of tachycardia. sitting. differentiate cysts or tumors. Homeostasis achieved. if able. 4. conduction Possibly evidenced by [Not applicable. DISCHARGE GOALS 1. and standing. Assess pulse/heart rate while patient is sleeping. both of which result in hyperthyroidism.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Circulatory Status (NOC) Maintain adequate cardiac output for tissue needs as evidenced by stable vital signs.

limit Activity increases metabolic/circulatory demands. advanced HF.g. Weigh daily. atropine may be required. . and weight loss. noting rate/rhythm. may potentiate cardiac failure. volume and compromises cardiac output. reflecting (e. and nervousness and is first drug of choice for acute storm. antagonists. diarrhea.. Auscultate breath sounds. signs of vascular congestion/HF. Prominent S1 and murmurs are associated with forceful development of gallops and systolic murmurs.g.. nadolol (Corgard). Monitor ECG. fever/increased circulatory demand) may reflect direct myocardialstimulation by thyroid hormone. diaphoresis) can lead to profound dehydration. development of S3 may warn of impending cardiac failure. Note history of asthma/bronchoconstrictive disease. pindolol (Visken). sinus Presence/potential recurrence of these conditions affects bradycardia/heart blocks. developing cardiac failure. agents is contraindicated. e. Rapid fluid replacement may be necessary to improve circulating volume but must be balanced against signs of cardiac failure/need for inotropic support. cardiac output of hypermetabolic state. which nonessential activity. venous pooling.. Record I&O. Document Tachycardia (greater than normally expected with dysrhythmias. crackles). excessive hormone levels and can aggravate diuresis/dehydration and cause increased peripheral vasodilation. e.. Significant fluid losses (through vomiting. BP. Monitor temperature. noting extra heart sounds.g. cardiac arrest. concentrated urine. Observe signs/symptoms of severe thirst. diuresis. decreased urinary output. noting adventitious sounds Early sign of pulmonary congestion. provide cool environment. and hypotension. atenolol Given to control thyrotoxic effects of tachycardia. (Tenormin). Observe for adverse side effects of adrenergic Indicates need for reduction/discontinuation of therapy. Decreases heart rate/cardiac work by blocking [beta]-adrenergic receptor sites and blocking conversion of T4 to T3.g. dry mucous Rapid dehydration can occur. use of [beta]-adrenergic blocking pregnancy. Collaborative Administer IV fluids as indicated. e. which reduces circulating membranes. administer tepid sponge baths. and hypotension. propranolol (Inderal). Administer medications as indicated: [beta]-blockers. weak/thready pulse. Encourage chair rest/bedrest. tremors. or current choice of therapy. limit bed Fever (may exceed 104°F) may occur as a result of linens/clothes. Note urine specific gravity. Dysrhythmias often occur and may compromise cardiac function/output.ACTIONS/INTERVENTIONS RATIONALE Hemodynamic Regulation (NIC) Independent Auscultate heart sounds. Note: If severe bradycardia develops. poor capillary refill. severe decrease in pulse.

Aspirin is contraindicated because it actually increases level of circulating thyroid hormones by blocking binding of T3 and T4 with thyroid-binding proteins. . e.g. Peak results take 6–12 wk (several treatments may be necessary). a single dose controls hyperthyroidism in about 90% of patients. Diuresis may be necessary if HF occurs. May be definitive treatment or used to prepare patient for surgery. Potassium (KCl. Acetaminophen (Tylenol). dexamethasone (Decadron). K-Lyte). almost all patients with Graves’ disease because it destroys abnormally functioning gland tissue. inhibits calcium absorption. methimazole (Tapazole). Also people preparing or administering the dose must have their own thyroid burden measured. Blocks thyroid hormone synthesis and inhibits peripheral propylthiouracil(PTU). Note: It also may be effective in reducing calcium level if neuromuscular function is impaired. and reduces peripheral conversion of T3 from T4. Strong iodine solution (Lugol’s solution) or Acts to prevent release of thyroid hormone into supersaturated potassium iodide (SSKI) PO. Digoxin (Lanoxin).g. however. Note: Once PTU therapy is begun. Increased losses of K+ through intestinal/renal routes may result in dysrhythmias if not corrected.. e. Decreases hyperthermia. RAI (Na131I or Na125I) following NRC regulations Radioactive iodine therapy is the treatment of choice for for radiopharmaceutical. Provides glucocorticol support. circulation by increasing the amount of thyroid hormone stored within the gland. May interfere with RAI treatment and may exacerbate the disease in some people. Digitalization may be required in patients with HF before [beta]-adrenergic blocking therapy can be considered/safely intiated. Note: This therapy is contraindicated during pregnancy. but effect is slow and so may not relieve thyroid storm. Furosemide (Lasix). relieves relative adrenal insufficiency. May be used as surgical preparation to decrease size and vascularity of the gland or to treat thyroid storm. Note: Should be started 1–3 hr after initiation of antithyroid drug therapy to minimize hormone formation from the iodine. Corticosteroids. conversion of T4 to T3. Drug of choice to reduce temperature and associated metabolic demands.ACTIONS/INTERVENTIONS RATIONALE Hemodynamic Regulation (NIC) Collaborative Thyroid hormone antagonists.. and contaminated supplies and equipment must be monitored and stored until decayed. abrupt withdrawal may precipitate thyroid crisis. Note: May be given before thyroidectomy and discontinued after surgery.

thereby reducing metabolic demands/cardiac workload. or diuretic therapy may cause dysrhythmias and compromise cardiac function/output. May be necessary to support increased metabolic demands/O2 consumption. Promotes rest.g. . Reduces shivering associated with hyperthermia. dialysis. Administer transfusions. Provide supplemental O2 as indicated. Note: In the presence of thyrotoxic paralysis (primarily occurring in Asian men). close monitoring and cautious replacement are indicated because rebound hyperkalemia can occur as condition abates releasing potassium from the cells. Pulmonary congestion may be noted with cardiac decompensation. altered intake. Muscle relaxants. Elevation may alter cardiac contractility. Pulmonary infection is most frequent precipitating factor of crisis. as indicated. Serum calcium. Occasionally used to lower uncontrolled hyperthermia (104°F and higher) to reduce metabolic demands/O2 consumption and cardiac workload. Chest x-rays. Sputum culture. Cardiac enlargement may occur in response to increased circulatory demands. May be done to achieve rapid depletion of extrathyroidal hemoperfusion. e. which can further increase metabolic demands.: Serum potassium. assist with plasmapheresis. Hypokalemia resulting from intestinal losses. Subtotal thyroidectomy (removal of five-sixths of the gland) may be treatment of choice for hyperthyroidism once euthyroid state is achieved. Prepare for surgery. barbiturates. Monitor laboratory/diagnostic studies. Provide hypothermia blanket as indicated. May demonstrate effects of electrolyte imbalance or ischemic changes reflecting inadequate myocardial oxygen supply in presence of increased metabolic demands. hormone pool in desperately ill/comatose patient.ACTIONS/INTERVENTIONS RATIONALE Hemodynamic Regulation (NIC) Collaborative Sedative. Serial ECGs.

altered body chemistry Possibly evidenced by Verbalization of overwhelming lack of energy to maintain usual routine. and O2 demand and consumption are increased in cyanosis. hypermetabolic state.g. Avoid topics that irritate or upset patient. judicious touch/massage. dyspnea. easily excited. soothing colors. decreased performance Emotional lability/irritability. e.. Display improved ability to participate in desired activities. e. much as possible. Discuss with SO reasons for fatigue and emotional Understanding that the behavior is physically based may lability. television. promoting relaxation. tachycardia active. Allows for use of nervous energy in a constructive reading. manner and may reduce anxiety. Provide for diversional activities that are calming. agitated. and prone to emotional outbursts. May decrease nervous energy. tension Jittery behavior Impaired ability to concentrate DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Endurance (NOC) Verbalize increase in level of energy. potentiating risk of hypoxia with activity. cool room. pallor. noting pulse rate at rest and when Pulse is typically elevated and. enhance coping with current situation and encourage SO to respond positively and provide support for patient. cool showers. Discuss ways to Increased irritability of the CNS may cause patient to be respond to these feelings. radio. decreased Reduces stimuli that may aggravate agitation. quiet music. and insomnia. hyperactivity. Note development of tachypnea. (up to 160 beats/min) may be noted.g. Encourage patient to restrict activity and rest in bed as Helps counteract effects of increased metabolism. Provide comfort measures. Provide for quiet environment.. nervousness. NURSING DIAGNOSIS: Fatigue May be related to Hypermetabolic state with increased energy requirements Irritability of central nervous system (CNS). sensory stimuli. ACTIONS/INTERVENTIONS RATIONALE Energy Management (NIC) Independent Monitor vital signs. . even at rest.

ACTIONS/INTERVENTIONS RATIONALE Energy Management (NIC) Independent Monitor daily food intake.. antianxiety Combats nervousness. apple/prune juice).. Aids in controlling serum glucose if elevated. and vitamins. identify appropriate supplements. Insulin (small doses). tea.g. coffee. nutrients. Increased motility of GI tract may result in diarrhea and fibrous and highly seasoned foods) and fluids that cause impair absorption of needed nutrients. Collaborative Consult with dietitian to provide diet high in calories. .. using high-calorie foods that are easily with rapid expenditure of calories caused by digested. Continued weight loss in face of adequate caloric intake may indicate failure of antithyroid therapy.. Encourage patient to eat and increase number of meals Aids in keeping caloric intake high enough to keep up and snacks. diarrhea (e. May need assistance to ensure adequate intake of protein. NURSING DIAGNOSIS: Nutrition imbalanced.g. e.g. vitamin B complex. Administer medications as indicated: Glucose. chlordiazepoxide (Librium). diarrhea Relative insulin insufficiency. risk for less than body requirements Risk factors may include Increased metabolism (increased appetite/intake with loss of weight) Nausea/vomiting. Given to meet energy requirements and prevent or correct hypoglycemia.g. presence of signs and symptoms establishes an actual diagnosis. hyperglycemia Possibly evidenced by [Not applicable. hypermetabolic state. e. hyperactivity.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Nutritional Status (NOC) Demonstrate stable weight with normal laboratory values and be free of signs of malnutrition. agents. and insomnia.ACTIONS/INTERVENTIONS RATIONALE Energy Management (NIC) Collaborative Administer medications as indicated: Sedatives. phenobarbital (Luminal). Weigh daily and report losses. Avoid foods that increase peristalsis (e. carbohydrates.

coupled with effects of excess thyroid hormones. restlessness. NURSING DIAGNOSIS: Anxiety [specify level] May be related to Physiological factors: hypermetabolic state (CNS stimulation). maintaining calm manner. using simple words. Report anxiety reduced to a manageable level. soothing music. surrounding environment. Stay with patient. ACTIONS/INTERVENTIONS RATIONALE Anxiety Reduction (NIC) Independent Observe behavior indicative of level of anxiety. insomnia. concentration reduced. situation is temporary and will improve with treatment. Attention span may be shortened. distortion of environmental stimuli Extraneous movements. hyperventilation. which reduces or sounds that may be heard by patient. Mild anxiety may be displayed by irritability and insomnia. reduce number unit activity/personnel may increase patient’s anxiety. Provides accurate information. Severe anxiety progressing to panic state may produce feelings of impending doom. of persons contacting patient. produces clinical manifestations of catecholamine excess even when normal levels of norepinephrine/epinephrine exist. to inappropriate remarks or actions prevents conflicts/overreaction to stressful situation. Identify healthy ways to deal with feelings. reduce bright lights. Describe/explain procedures. Discuss with patient/SO reasons for emotional Understanding that behavior is physically based enhances lability/psychotic reaction. . movements. provide Creates a therapeutic environment. inability to speak or move. Speak in brief statements. shakiness. repetitive Increased number of [beta]-adrenergic receptor sites. Monitor physical responses. tremors DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Anxiety Control (NOC) Appear relaxed. limiting ability to assimilate information. following. (Refer to ND: Thought acceptance of situation and encourages different Processes. risk for disturbed. Reinforce expectation that emotional control should Provides information and reassures patient that the return as drug therapy progresses. Avoiding personal responses to patient.) responses/approaches. environment is safe. panic Changes in cognition. loss of control. Reduce external stimuli: Place in quiet room. pseudocatecholamine effect of thyroid hormones Possibly evidenced by Increased feelings of apprehension. terror. Affirms to patient/SO that although patient feels out of Acknowledge fear and allow patient’s behavior to belong control. noting palpitations. shouting/swearing. shows recognition that soft. distortions/misinterpretations that can contribute to anxiety/fear reactions.

CNS irritability.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Distorted Thought Control (NOC) Maintain usual reality orientation. cool room. May be hypervigilant. Determines extent of interference with sensory orientation to person/place/time. patient/SO if crisis precipitates lifestyle alterations. memory. illogical thinking. extremely sensitive. ACTIONS/INTERVENTIONS RATIONALE Delirium Management (NIC) Independent Assess thinking processes. Assess level of anxiety. attention span. restless. auditory/visual hallucinations. Reorient to person/place/time as indicated. risk for disturbed Risk factors may include Physiological changes: increased CNS stimulation/accelerated mental activity Altered sleep patterns Possibly evidenced by [Not applicable. reduce effects of hyperthyroid secretion.g.ACTIONS/INTERVENTIONS RATIONALE Anxiety Reduction (NIC) Collaborative Administer antianxiety agents or sedatives and monitor May be used in conjuction with medical regimen to effects. Reduction of external stimuli may decrease dim lights. presence of signs and symptoms establishes an actual diagnosis. Recognize changes in thinking/behavior and causative factors. (Refer to ND: Anxiety) Anxiety may alter thought processes. processing. Provide quiet environment. Limit procedures/personnel. NURSING DIAGNOSIS: Thought Processes.. e. counseling. decreased stimuli.. . or crying or may develop frank psychosis. hyperactivity/reflexia. pastoral care. Note changes in behavior. Refer to support systems as needed. Helps establish and maintain awareness of reality/environment. Ongoing therapy support may be desired/required by social services. e.g. Present reality concisely and briefly without challenging Limits defensive reaction.

NURSING DIAGNOSIS: Tissue Integrity..g. free of ulcerations. which indicated. Collaborative Administer medication as indicated. Elevate the head of the bed and restrict salt intake if Decreases tissue edema when appropriate. e. padded side rails. Patient’s agitation/psychotic behavior may precipitate family quarrels/conflicts. Provide safety measures. room with outside window. Risk Control (NOC) Identify measures to provide protection for eyes and prevent complications. hallucinating/disoriented. alter Promotes continual orientation cues to assist patient in level of lighting to simulate day/night. eyelids. eyelids completely because of edema/fibrosis of fat pads. to enhance thinking ability. risk for impaired Risk factors may include Alterations of protective mechanisms of eye: impaired closure of eyelid/exophthalmos Possibly evidenced by [Not applicable. HF.. or soft restraints as last resort as necessary.g. e.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Tissue Integrity: Skin & Mucous Membranes (NOC) Maintain moist eye membranes.ACTIONS/INTERVENTIONS RATIONALE Delirium Management (NIC) Independent Provide clock. can aggravate existing exophthalmos. Note: needed. Instruct patient in extraocular muscle exercises if Improves circulation and maintains mobility of the appropriate. presence of signs and symptoms establishes an actual diagnosis. ACTIONS/INTERVENTIONS RATIONALE Surveillance (NIC) Independent Encourage use of dark glasses when awake and taping the Protects exposed cornea if patient is unable to close eyelids shut during sleep as needed. .g.. Encourage visits by family/SO. Provide support as Aids in maintaining socialization and orientation. maintaining sense of normalcy. Promotes relaxation. reduces CNS hyperactivity/agitation sedatives/antianxiety agents/antipsychotic drugs. calendar. close Prevents injury to patient who may be supervision. e.

Lubricates the eyes. prognosis. May decrease signs/symptoms or prevent worsening of the condition. self-care. Initiate necessary lifestyle changes and participate in treatment regimen. Appearance can be enhanced with proper use of makeup. request for information. NURSING DIAGNOSIS: Knowledge. Identify relationship of signs/symptoms to the disease process and correlate symptoms with causative factors. Adrenocorticotropic hormone (ACTH). and discharge needs May be related to Lack of exposure/recall Information misinterpretation Unfamiliarity with information resources Possibly evidenced by Questions. prednisone. deficient [Learning Need] regarding condition. and use of shaded glasses. treatment. statement of misconception Inaccurate follow-through of instructions/development of preventable complications DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Knowledge: Illness Care (NOC) Verbalize understanding of disease process and potential complications. reducing risk of lesion formation. Antithyroid drugs. Prepare for surgery as indicated. . Can decrease edema in mild involvement. Eyelids may need to be sutured shut temporarily to protect the corneas until edema resolves (rare) or increasing space within sinus cavity and adjusting musculature may return eye to a more normal position. Given to decrease rapidly progressive and marked inflammation. Verbalize understanding of therapeutic needs. altered appearance and measures to enhance self-image. Diuretics. overall grooming. Collaborative Administer medications as indicated: Methylcellulose drops.ACTIONS/INTERVENTIONS RATIONALE Surveillance (NIC) Independent Provide opportunity for patient to discuss feelings about Protruding eyes may be viewed as unattractive.

to be readjusted to prevent excessive weight gain. and expected therapeutic and side effects. stamina and activity level will increase. which can occur immediately after treatment or as long as 5 yr later. Severity of condition. and interactions. cause. Provide information about signs/symptoms of Patient who has been treated for hyperthyroidism needs to hypothyroidism and the need for continuing follow-up be aware of possible development of hypothyroidism.. pregnancy. red/yellow food dyes.g. and prompt intervention are important in preventing development of agranulocytosis. and concurrent complications determine course of treatment. physical condition/presence of complications. Identify signs/symptoms requiring medical evaluation.. infection. including need for adhering to Antithyroid medication (either as primary therapy or in regimen. Explain need to check with physician/pharmacist before Antithyroid medications can affect or be affected by taking other prescribed or OTC drugs. Provides knowledge base from which patient can make informed choices. fever. . e. age. Early identification of toxic reactions (thiourea therapy) e. and alternative drugs may be given if problems arise. A hormonal imbalance is corrected. occurrence/exacerbation of this disease. POTENTIAL CONSIDERATIONS following acute hospitalization (dependent on patient’s age. personal/social and job concerns. side effects. diet will need artificial preservatives. care. Identify stressors and discuss precipitators to thyroid Psychogenic factors are often of prime importance in the crises. Provide information appropriate to individual situation. Emphasize importance of planned rest periods. and life responsibilities) Fatigue—hypermetabolic state diminishing body energy reserves. reduces metabolic demands. avoid caffeine.g. risk for more than body requirements—change in BMR and metabolic needs. Review need for nutritious diet and periodic review of Provides adequate nutrients to support hypermetabolic nutrient needs.ACTIONS/INTERVENTIONS RATIONALE Teaching: Disease Process (NIC) Independent Review disease process and future expectations. state. prolonged recovery. As euthyroid state is achieved. Prevents undue fatigue. preparation for thyroidectomy) requires adherence to a medical regimen over an extended period to inhibit hormone production. Agranulocytosis is the most serious side effect that can occur. personal resources. Nutrition: imbalanced. Necessary for monitoring effectiveness of therapy and prevention of potentially fatal complications. requiring monitoring of medication levels. and skin eruptions. Discuss drug therapy. numerous other medications. Stress necessity of continued medical follow-up. Irritants and stimulants should be limited to avoid cumulative systemic effects. sore throat.