THE CONCEPT OF HYPERTHYROIDISM AND THE NURSING PROCESS

The Concept Of Hyperthyroidism And The Nursing Process

1. HYPERTHYROIDISM Prepared by: Diane Ilao

2. Table of contents 01 02 03 04 Introduction Medical Management Thyroid Storm Nursing Intervention

3. Hyperthyroidism 01

4. HYPERTHYROIDISM -a common endocrine disorder, is a form of thyrotoxicosis resulting from an excessive synthesis and secretion of endogenous or exogenous thyroid hormones by the thyroid

5. Most Common Causes: Graves Disease Toxic Multinodular Goiter Toxic Adenoma

6. Excessive ingestion of thyroid hormone Other Causes: Thyroiditis

7. CLINICAL MANIFESTATIONS Continuous flushed skin, with a salmon color in Caucasians Warm, soft, and moist skin Dry skin and diffuse pruritus Fine tremor of the hands Ophthalmopathy, such as exophthalmos Startled facial expression due to exophthalmos Ocular changes may not always be reversible even with treatment Nervousness Emotional hyperexcitability Irritability Apprehensiveness Inability to sit quietly Palpitations Rapid pulse at rest and on exertion Poor tolerance to heat Unusual perspiration

8. DIAGNOSTIC FINDINGS ASSESSMENT - Thyroid gland is enlarged to some extent - Gland is soft and may pulsate - Thrill can often be palpated - Bruit heard over the thyroid arteries - Signs of greatly increased blood flow through the thyroid gland - Decrease in serum TSH (Thyroid Stimulating Hormone) - Increased free T4 (Thyroxine) - Increase in radioactive iodine uptake

9. Medical Management Radioactive Iodine Therapy Antithyroid Medications Beta-Adrenergic Blocking Agents Surgery

10. Thyroid Storm 02

11. (Thyrotoxic Crisis, Thyrotoxicosis) - is a form of severe hyperthyroidism, usually of abrupt onset. - untreated, it is almost always fatal - the patient is critically ill and requires astute observation and aggressive and supportive nursing care Thyroid Storm

12. CLINICAL MANIFESTATIONS High fever (hyperpyrexia) Extreme tachycardia Exaggerated symptoms of hyperthyroidism with disturbances of a major system Altered neurologic or mental state

13. Precipitating Factors: stress injury infection thyroid and non thyroid surgery tooth extraction insulin reaction diabetic ketoacidosis pregnancy digitalis intoxication abrupt withdrawal of antithyroid medications extreme emotional stress vigorous palpation of the thyroid

14. Hypothermia mattress or blanket, ice packs, cool environment Hydrocortisone and acetaminophen (Tylenol) Avoid salicylates (aspirin) Humidified oxygen Monitor respiratory status with arterial blood gas levels or pulse oximetry Management Priority: reduction of body temperature and heart rate and prevention of vascular collapse 1. Reduction of Body Temperature and Heart Rate 2. Improving Tissue Oxygenation

15. Propylthiouracil (PTU) or methimazole Iodine Hydrocortisone 4. Thyroid Hormone Management 5. Treatment for Shock or Adrenal Insufficiency 3. IV Fluids IV fluids containing dextrose 6. With Cardiac Problems Sympatholytic agents for cardiac issues like atrial fibrillation, dysrhythmias, and heart failure Propranolol, combined with digitalis, for severe cardiac symptoms

16. Medical Management 03

17. ANTITHYROID MEDICATIONS (THIONAMIDES) Objective To inhibit stages in thyroid hormone synthesis or release Mechanism of Action Block iodine utilization; preventing hormone synthesis Commonly Used Medications Methimazole (MMI, Tapazole) Propylthiouracil (PTU) Treatment Duration Until the patient is euthyroid Baseline Test CBC, liver profile Dosage Determination Based on clinical criteria: changes in PR, body weight, size of goiter, and laboratory results

18. Administration Instruct patient to take medication early in the morning on an empty stomach, 30 mins before eating Onset of Action Symptom relief may take several weeks Toxic Complications Uncommon; include medication sensitization, fever, rash, urticaria, agranulocytosis, and thrombocytopenia Stop the medication and notify physician for signs of infection or adverse reaction Use in Pregnancy PTU is recommended, but should be discontinued after 1st trimester and switch to MMI until breastfeeding Relapse Discontinuation before therapy completion results in relapse within 6 months

19. 2. ADJUNCTIVE THERAPY essential for thyroid function. potassium iodide (KI), Lugol’s solution, and saturated solution of potassium iodide (SSKI) were once main therapies. effective in the short term, especially for thyroid storm and before surgery. administered in milk or fruit juice Caution : Lugol’s solution (960 mg/day) may cause local esophageal or duodenal mucosal injury and hemorrhage. IODINE SOLUTIONS

20. Includes drugs like Propranolol, atenolol, metoprolol. Important for symptom control in hyperthyroidism. Decreases heart rate, blood pressure, muscle weakness, nervousness, tremors, anxiety, and heat intolerance. Continue until free T4 is within normal range and TSH level approaches normal. BETA-ADRENERGIC BLOCKING AGENTS

21. 3. SURGERY Type: Total Thyroidectomy; Subtotal Thyroidectomy Indication: Specific cases: pregnant women allergic to antithyroid drugs; large goiters; unable to take antithyroid meds Timing: Typically done after thyroid function return to normal (4-6 weeks) Outcomes: Relapse rates are low: nearly 0% for total thyroidectomy, 8% for subtotal thyroidectomy at 5 years

22. NURSING INTERVENTION 04

23. IMPROVING NUTRITIONAL STATUS Eat small, balanced meals (up to six a day) to satisfy increased appetite. Choose high-calorie, high-protein foods; avoid highly seasoned foods, coffee, tea, cola, and alcohol. Maintain a quiet atmosphere during meals; monitor weight and dietary intake. ENHANCING COPING MEASURES Reassure patient and family that emotional reactions are from the disorder and will improve with treatment. Keep a calm, unhurried approach; minimize stress and maintain a quiet environment. Educate about need for medication before surgery; repeat instructions due to hyperexcitability. IMPROVING SELF-ESTEEM Understand patient's concerns about appearance changes; reassure that changes are due to the disorder. Promote coping strategies; refer to counseling if needed. Educate on eye care if ocular changes occur; discourage smoking.

24. MAINTAINING NORMAL BODY TEMPERATURE Room temperature should feel warm due to increased metabolic rate. Maintain a cool environment; offer cool baths and fluids for comfort. MONITORING AND MANAGING POTENTIAL COMPLICATIONS Watch for signs of thyroid storm; assess heart and lung functions. Provide oxygen and IV fluids as needed. Medications like MMI or PTU, beta-blockers, and digitalis may be prescribed. PROMOTING HOME, COMMUNITY-BASED, AND TRANSITIONAL CARE Educate on medication usage, side effects, and when to seek help. Provide a written plan for home use. Educate on medication actions and side effects; advise on avoiding stress. Before surgery, explain expectations; repeat education as surgery nears.

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