Hyperthyroidism Study Guide

Here is my Hyperthyroidism study guide based on what Ms. Carson posted. I just added more details. If anyone finds something inaccurate, please let me know.

Hyperthyroidism

AKA Graves Disease and thyrotoxicosis
Increased production of T3 & T4
More common in women
Increased incidence with family hx

Possible Causes

• Autoantibodies


• Iodine Excess


• Stress


• Meds

Clinical Manifestations

• Restlessness/Anxiety/Psychosis - may be interfering with family, personal, and work relationships.


• Exopthalmos - bulging of the eyes ("startled look")


• Goiter - swelling of the anterior neck caused by low iodine, causing the thyroid gland to produce thyroglobulin (colloid) which accumulates in the thyroid follicles.


• Heat Intolerance/Sweating/Fever


• Tachycardia, increased cardiac output, Heart Failure


• Weight loss despite increase in appetite


• Prolinged menses


• Elderly - new onset atrial fib

Lab Values

• Low TSH - TSH is produced when thyroid hormones are low. Low TSH is present when hormones are high.


• High T3 & T4

Diagnostic Tests

• RAIU - radioactive iodine uptake test - elevated


• U/S - shows nodules

Collaborative Care

• Beta Blockers

Given to ease symptoms, esp restlessness, tachycardia, & increased bp

• Antithyroid Meds


• PTU: blocks the synthesis of T3 to T4

Safer in pregnancy

• Tapazole: Blocks syntesis of hormones

More toxic
**With ANTITHYROID MEDS watch for rash, N&V, agranulocytosis, Lupus
**Teach patient to watch for S/S of infection. MD may tell them to stop taking meds and to come in at once for blood work.
**Teach patient NOT TO USE DECONGESTANTS!

• Radioactive Iodine Therapy

Iodine taken up almost exclusively by the thyroid gland.
The radioactivity destroys thyroid cells
**WATCH FOR THYROID STORM!! (See Below)

• Subtotal Thyroidectomy

Attempts to get thyroid levels to normal first
5/6 of thyroid gland removed
Iodine prescribed beforehand to reduce blood loss
Monitor pt for S/S Iodine toxicity:
Swelling of buccal mucosa
Excessive salivation
Coryza
Skin Eruptions
Iodine Meds
No longer used as PRIMARY treatment
Decreases the release of thyroid hormones
Decreases the vascularity of thyroid (hense it's use prior to surgery)
Better given in milk or juice
GIVE MED THROUGH A STRAW! May stain teeth.

Nursing Care

• Teaching (see information given above)


• Activity Intolerance:

Group activities together
Schedule frequent rest periods.

• Anxiety:

Provide reassurance to pt and fam that mood issues are related to hyperthyroidism and should resolve once hormones are under control.
Provide treatments in a calm and unhurried approach.
Do not put patient in a room with ill or talkative patients.
Provide a calm and quiet environment.
Frequently reinforce treatment plan.

• Imbalanced Nutrition:

Well-balanced and frequent, small meals
Increase fluids to counter fluid loss from sweating and diarrhea
Avoid caffeine and alcohol.
Encourage high calorie and high protein foods.
Monitor I & O

Care of the patient after a thyroidectomy

• Risk involved


• Parathyroid Removal - Laryngeal nerve damage


• Thyroid storm


• Infection


• Hemorrhage


• Preop:


• Review hx


• Teach support of neck


• Preparing the room for postop:


• O2


• Suction


• Tracheostomy tray at bedside


• IV Calcium


• Post-Op


• Assess at least q 2 hrs for hemorrhage and breathing


• Semi-Fowlers position


• Assess for hypocalcemia


• Can pt speak?


• Home care:


• Decreased kcal


• Avoid goitrogens


• Excercise


• Monitor for hypothyroidism

Thyroid Storm
Almost always fatal if not treated

S/S:

• High fever (>101.3)


• Tachycardia (>130 bpm)


• Extreme GI Symptoms (ie diarrhea, weight loss, abd pain)


• Altered Mental Status

Management:

• Lower Core Temp (Tylenol, cooling blankets, DO NOT GIVE ASA!)


• Humidified O2 (Also monitor O2 with ABGs and Pulse Ox)


• IV Dextrose (replenishes depleted glycogen stores in the liver)


• PTU given to prevent more production of T3 & T4


• Hydrocortisone (treats shock and adrenal insufficiency)


• Iodine (decreases output of T4)


• Beta Blockers + digitalis (reduces serious cardiac symptoms