Hyper thyroidism

Hyper thyroidism

1. Ratheesh.R SLMGNC Hyper thyroidism or (simple and toxic goitre )

2. Introduction Hyperthyroidism occurs when the thyroid becomes over-active and produces more thyroid hormones than are needed by the body. It is sometimes called thyrotoxicosis . The most common cause of hyperthyroidism is Graves’ disease ( when the body’s immune system turns against the thyroid gland by producing antibodies ). Hyperthyroidism is also one of the phases that can occur in a condition called viral thyroiditis , although this is extremely rare in children. The hyperthyroid phase of viral thyroiditis normally settles down without treatment.

3. Definition Over activity of the thyroid gland, resulting in a rapid heartbeat and an increased rate of metabolism. Simple: It is an thyroid nontoxic goitre which may be diffuse or nodular in nature. Toxic: It is a primary or secondary thyrotoxicosis , It may be diffuse or solitory in nature and associate with excessive production of thyroid hormone.

4. Etiology Thyroiditis Excessive ingestion of thyroid hormone Over functioning of thyroid hormone Auto immune disorder Over treatment of myxedema .

5. Pathophysiology Due to any factor Secondary to excessive stimulation of adnergic nervous system – release some chemical receptors( noradrenaline ) This receptors stimulate the muscles and glands and its supply Excessive level of TH secretion Metabolic function also Increased Increased activity of sympathetic nervous system

6. Cont…. In CVS Increased TH Increased Beta adrenergic receptors in CVS Tachycardia, Increased cardiac output, Storke Volume Increased metabolic function in our body nitrogen Balance is – ve and lipid dipletion .

7. Cont…. Nutritional deficiency Before Puberty After Puberty In Women Delayed Sexual Decreased Libido Fertility decreased development Irregular Menstruation

8. Clinical manifestation Nervousness Emotional lability Difficulty in sitting quietly Heat intolerance Fine tremor of head Bulging eyes Muscles weakness Change in bowel habits Flushed Skin Rapid pulse Irritability Increased Appetite Weight loss Atrial Fibrillation .

9. Diagnostic evaluation History collection Physical examination Thyroid Scan MRI CT Thyroid function test Ultrasound Elevated T3 and T4 Elevated Serum T3 (resin) Uptake Radio active iodine uptake scan.

10. Medical management 1) Drug that inhibit hormone formation a) Thionamides => Propylthiouracil => Methimazole 2) Beta – adrenergic blockers such as propranolol and calcium antagonists. 3) Gluco -Corticoids – decrease the peripheral conversion of T4 and T3 . 4) Radio active Iodine – Limits secretion of thyroid hormone

11. Cont…. Immediate Management: Antithyroid medicine Radioactive Iodine Rx for Hyperthermia Rx for dehydration.

12. Surgical management Total Thyroidectomy : Total removal of thyroid gland ii) Subtotal or Partial Thyroidectomy :

13. complication Myxedema (swelling of the face, limbs and hands, dry and rough skin, loss of hair, slow pulse, abnormal temperature, slowed metabolism and mental dullness) Infiltrative opthalmopathy Hypo- Thyroidism Radiation thyroiditis Vocal card Paralysis

14. Nursing diagnosis Less than body requirements r/t fluid loss through diaphoresis. Risk for impaired skin integrity r/t disease process. Thought process r/t Insomnia and Irritability. Anxiety r/t condition and concern about upcoming surgery/radio active iodine treatment.