Hyperthyroidism

Compiled By: Ashish Roy

1. HYPERTHYROIDISM Compiled By - Mr. Ashish Roy (NURSING TUTOR)

2. INTRODUCTION OF HYPERTHYROIDISM Excessive secretion or synthesis of thyroid hormone by thyroid gland is known as hyperthyroidism, grave disease and thyrotoxicosis. Temperature, Pulse, Respiration and increases in this case. It increase body’s metabolism casuing sudden weight and rapid or irregular heartbeat, sweating and nervousness or irritability.

3. DEFINITION OF HYPERTHYROIDISM This hypermetabolic condition is characterized by excessive amounts of thyroid hormone in the bloodstream.

4. INCIDENCE In women , 4-40 times more than men. More common in women than in men; occurs in about 2% of the female population.

5. Etiological Factors/ Causes Acute Infection Worry Anxiety Overwork Emotional Upset Over treatment of myxedema Over functioning of entire gland Plummber’s Disease ( Multinodular Goitre) Graves' disease (most prevalent): diffuse hyperfunction of the thyroid gland with autoimmune etiology and associated with ophthalmopathy . Hyperthyroidism is characterized by hypertrophy and hyperplasia of the thyroid gland, which is accompanied by increased vascularity and blood flow and enlargement of the gland.

6. Pathophysiology Due to increased activity of SNS ( adrenergic) Excessive amount of TH release In response to this inc metabolic rate and alter fats, protein and CHO metabolism And due to Increase the beta adrenergic activity Leading to tachy and increase CO, stroke vol.

7. Clinical Manifestations / Signs & Symptoms Difficulty in sitting quietly. Muscle fatigability and weakness; amenorrhea. Nervousness, emotional lability , irritability, apprehension. Rapid pulse at rest and on exertion (ranges between 90 and 160); palpitations. Heat intolerance; profuse perspiration; flushed skin ( e.g , hands may be warm, soft, moist). Fine tremor of hands; change in bowel habits; constipation or diarrhea. Increased appetite and progressive weight loss; frequent stools. Atrial fibrillation possible (cardiac decompensation common in older patients). Bulging eyes ( exophthalmos ): seen only in Graves' disease. Thyroid gland may be palpable and a bruit may be auscultated over gland. Course may be mild, characterized by remissions and exacerbations. It may progress to emaciation, extreme nervousness, delirium, disorientation, thyroid storm or crisis, and death.

8. SIGNS/ SYMPTOMS CVS Hypertension Tachycardia Bound And Rapid Pulse Palpitation RESPIRATORY SYSTEM Dysponea Increase Respiratory Rate G.I.T Appetiteincrease but weight loss due to improper metabolism Diarrhea Spleenomegaly Hepatomegaly MUSCULO- SKELETAL SYSTEM fatigue muscle weakness

9. Continued… REPRODUCTIVE Amenorrhea Menstrual Irregularties . NERVOUS SYSTEM Difficulty in focusing of eye Nervousness Insomnia Fatigue Lack of concentration

10. Diagnostic Evaluation Physical Apperance Enlarged Neck History collection Protuding eyes ECG Thyroid Stimulating Hormone (TSH) Assay Elevated T 3 and T 4 . 131 I uptake scan may be elevated or below normal depending on the underlying cause of the hyperthyroidism. Thyroid autoantibodies Elevated Tri- iodothyronine (T3)and radio immune assay (normal value 0.5ml-1.5ml U/L) Agitating expression due to basal metabolic rate (BMR).

11. Management Drugs that inhibit hormone formation: Thioamides : propylthiouracil (PTU) Act by depressing the synthesis of thyroid hormone May be given in divided daily doses (PTU) or in a single daily dose. Duration of treatment is determined by clinical criteria. Thyroid gland becomes smaller. Uptakes of T 4 and T 3 are measured to determine adequacy of dose. Treatment continued until patient becomes clinically euthyroid ; this varies from 3 months to 2 years; if euthyroidism cannot be maintained without therapy, then radiation or surgery is recommended.

12. PHARMACOLGICAL TREATMENT Drugs to control peripheral manifestations of hyperthyroidism: Propranolol ( Inderal ) . Acts as a beta-adrenergic blocking agent. Inhibits peripheral conversion of T 4 to T 3 . Abolishes tachycardia, tremor, excess sweating, nervousness. Controls hyperthyroid symptoms until antithyroid drugs or radioiodine can take effect. Glucocorticoids : decrease the peripheral conversion of T 4 to T 3 , a more potent thyroid hormone severe hyperactivity known as thyrotoxicosis , thyroid storm or thyroid crisis.(Thyroid storm or crisis, an extreme form of hyperthyroidism, is characterized by hyperpyrexia, diarrhea , dehydration, tachycardia, arrhythmias, extreme irritation, delirium, coma, shock, and death if not adequately treated. Thyroid storm may be precipitated by stress (surgery, infection) or inadequate preparation for surgery in a patient with known hyperthyroidism). Radioactive Iodine Action : limits secretion of thyroid hormone by destroying thyroid tissue

13. SURGICAL MANAGEMENT Surgery SUBTOTAL THROIDECTOMY (REMOVAL OF ONE LOBE ). TOTAL THOIDECTOMY (REMOVAL OF GLAND ) Used for those with large goiters, or for those for whom the use of radioiodine or thioamides is contraindicated. Subtotal thyroidectomy involves removal of most of the thyroid gland

14. Complications Thioamide toxicity: agranulocytosis may occur suddenly. Hypothyroidism if over treated with ant thyroid medication or if radiation treatment is used. Graves' disease. Features include exophthalmos, weakness of extraocular muscles, lid edema , lid lag.

15. Nursing Diagnoses Imbalanced Nutrition: Less Than Body Requirements related to hypermetabolic state and fluid loss through diaphoresis. Providing Adequate Nutrition Determine the patient's food and fluid preferences. Provide high-calorie foods and fluids consistent with the patient's requirements. Provide a quiet, calm environment at meals. Restrict stimulants (tea, coffee, alcohol); explain rationale of requirements and restrictions to patient.

16. Nursing Management / N ursing I nterventions Encourage and permit the patient to eat alone if embarrassed or if otherwise disturbed by voracious appetite. Monitor I.V. infusion when prescribed to maintain fluid and electrolyte balance. Monitor fluid and nutritional status by weighing the patient daily and by keeping accurate intake and output records. Monitor vital signs to detect changes in fluid volume status.

17. Disturbed Thought Processes related to insomnia, decreased attention span, and irritability Promoting Normal Thought Processes Explain procedures to patient in an unhurried, calm manner. Limit visitors; avoid stimulating conversations or television programs. Reduce stressors in the environment; reduce noise and lights. Promote sleep and relaxation through use of prescribed medications, massage, and relaxation exercises. Minimize disruption of the patient's sleep or rest by clustering nursing activities. Use safety measures to reduce risk of trauma or falls (padded side rails, bed in low position).

18. Risk for Impaired Skin Integrity related to diaphoresis, hyperpyrexia, restlessness, and rapid weight loss. Maintaining Skin Integrity Assess skin turgor, mucous membranes, and neck veins for signs of increased or decreased fluid volume. skin frequently to detect diaphoresis. Bathe frequently with cool water; change linens when damp. Avoid soap to prevent drying and use lubricant skin lotions to pressure points. Protect and relieve pressure from bony prominences while immobilized or while hypothermia blanket is used.

19. Anxiety related to condition and concern about upcoming surgery/radioiodine treatment Relieving Anxiety Encourage the patient to verbalize concerns and fears about illness and treatment. Support the patient who is undergoing various diagnostic tests. Explain the purpose and requirements of each prescribed test. Explain results of tests if unclear to the patient or if questions arise. Clear up misconceptions about treatment options.

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