HYPERTHYROIDISM

Paulo Arwin G. Baduria, RN

 USES UP INCREASE BODY
SUGAR & HEAT
FATS INCREASE
IN
METABOLIS
M
INCREASE GI
MOTILITY
SYMPATHETIC
NERVOUS SYSTEM
“FIGHT OR FLIGHT”

-INCREASE -NEURONAL
CARDIAC DEVELOPME
OUTPUT NT
- INCREASE
RESPIRATORY
RATE
-INCREASE
MENTAL
ALERTNESS
GRAVES’ DISEASE
• MOST COMMON CAUSE
• AUTOIMMUNE

AUTOANTIBODIES -BINDS TO
AGAINST THE
THYROID- RECEPTOR
B CELLS
STIMULATING AND
HORMONE ACTIVATE THYROID
RECEPTORS FOLLICLES
FOLLICULAR
CELLS

GROW AND
PRODUCE
THYROID
HORMONES
COMPLICATIONS
GRAVES’ OPHTHALMOPATHY
- INFLAMMATION AND EDEMAIN THE TISSUE AROUND THE EYES CAUSING THE EYE
BALLS TO BE DISPLACED FORWARDS, EYELIDS RETRACT AND GIVING THE EYES A
“BULGING” APPEARANCE
SYMPTOMS
INCREASE BASAL METABOLIC RATE
- Weight loss
- Increase appetite

INCREASE PRODUCTION OF HEAT

-Heat intolerance

EFFECT OF THYROID HORMONES ON THE SYMPATHETIC

NERVOUS SYSTEM
-Tachycardia
-Sweating
-Hyperactivity
-Anxiety
-Insomnia
Untreated Hyperthyroidism

Infection or Illness

THYROID STORM
Exaggerated Symptoms
• Severe Tachyarrhytmia
• High Fever
• Delerium
• Coma
 Medications to Control HYPERTHYROIDISM

Target the THYROID Target the TISSUE

GLAND PERIPHERALLY
-Decrease the synthesis of -Decrease the
Thyroid hormones effectiveness of the thyroid
-prevent them from being hormone
releases -ONLY manages the
symptoms but doesn’t treat
the cause
RADIOACTIVE IODINE THERAPY

• DefinitiveTreatment for Hyperthyroidism

- Graves’ Disease & Multinodular Goiter
- Could worsen Graves Opthalmopathy
• Thyroid Permanently Destroyed
– Need thyroid hormone replacements to
prevent hypothyroidism
• Avoided in PREGNANCY or if
BREASTFEEDING
– Requires negative pregnancy test
Side Effects

• Infertility
• Thyroiditis
• Radiation Toxicity
– Neoplasia
– Hematopoietic Suppression
– Salivary and Lacrimal Toxicity
THIOAMIDES
• Propylthiouracil (PTU) & Methimazole
– Inhibit Thyroid Peroxidase
• STOP oxidation of Iodide ions to organic
Iodine
• STOP iodination thyrosine residue and
thyroglobulin
• STOP coupling of MIT and DIT to form T3 &
T4
– Do not inhibit release of thyroid
hormones ---- Weeks for therapeutic
Effect
Propylthiouracil
-works in peripheral tissue by inhibiting
5- deiodinase converting T4 to T3
- preferred medication during Thyroid
Storms
Side Effects

• Skin rash
• Vasculitis
• Hypothyroidism
• Lupus-Like Syndrome
• Agranulocytosis- infection
• Hypoprothrombinemia- bleeding
• Hepatotoxicity
– More common w/ propylthiouracil use
PTU & Methimazole can be used during
pregnancy
(organogenesis)- fetus most susceptible to
drug induced damage

1st- PTU (Methimazole- aplasia cutis)

2ND & 3RD – Methimazole (PTU-hepatotoxic)
 Iodine Salts & Iodine
• Saturated Potassium Iodine Solution
• Lugol’s Solution- Potassium Iodine (10%) &
Iodine (5%)
– Increase concentration
• Inhibits synthesis & release of T3 & T4
– Rapid onset of Action
» Treat Thyroid Storm
• Decrease vascularity & size od Thyroid
– Used before thyroid surgery
Side Effects

• Skin rash
• Drug fever
• Metallic taste
• Irritation of gastric mucosa (should take
with foods or diluted with fluids)
• Bleeding disorder
• Anaphylactic reaction (rare)
Medications to Treat Symptoms
of Hyperthyroidism
Beta Blockers
-Propranolol
- Used to block beta receptors in tissue innervated
by the sympathetic nervous system of
hyperthyroidism
- Rapid HR
- Sweating
- Hyperactivity
- Anxiey
- Tremors
- Decrease conversion of T4 into T3
Glucocorticoids

-Prednisone
- Decrease inflammation around the eyes
- Reduce Graves Ophthalmopathy