Thyrotoxicosis

Slides of thyrotoxicosis for Nurses. Including Definition, incidence, Etiology, clinical manifestations, Pathophysiology, Diagnostic Evaluations, Management (medical, Radioidine, Surgical and nursing management).

1. Thyrotoxicosis

2. Definition Thyrotoxicosis is the clinical syndrome that results from the exposition of tissues to an excess of circulating thyroid hormone. In most instances, thyrotoxicosis is due to an active overproduction of thyroid hormone by the thyroid follicular epithelial cells (hyperthyroidism). Thyrotoxicosis is the clinical state associated with excess thyroid hormone activity, usually due to inappropriately high-circulating thyroid hormones.

3. Incidence Thyrotoxicosis occurs in approximately 2% of women and 0.2% of men. Thyrotoxicosis due to Graves' disease most commonly develops between the second and fourth decades of life, whereas the prevalence of toxic nodular goitre increases with age. Autoimmune forms of thyrotoxicosis are more prevalent among smokers.

4. Etiology Grave's disease-Autoimmunity; stimulation of thyrocytes Toxic multinodular goiter Toxic adenoma TSH-producing adenoma or pituitary adenoma HCG-mediated hyperthyroidism Thyroiditis Drug-induced TSH secreting pituitary adenoma

5. Clinical Manifestations Weight loss Palpitations Breathlessness Tremor Tiredness Heat intolerance Excessive sweating Increased bowel action Anxiety Nervousness Muscle weakness Menstrual disturbances (oligomenorrhoea and amenorrhoea ) Loss of libido

6. Pathophysiology Due to over production of Thyroid Hormones (T3 and T4) Increase basal metabolic rate and tissue thermogenesis Activation of Sympathetic Nervous system Vasoconstriction and activation of Renin Angiotensin-aldosterone system Clinical Presentation of thyrotoxicosis

7. Diagnostic Evaluation On physical exam, patients are often cachectic, hyperthermic, diaphoretic, and anxious appearing. They may have goiter, tachycardia or atrial fibrillation, dyspnea, abdominal tenderness, hyperreflexia, proximal muscle weakness, tremor, and gynecomastia. Patients with Graves' disease present with ophthalmopathy, dermopathy, and acropachy.

8. TSH, THYROXIN, T3 and T4 evaluation Detection of Antibodies for TSH receptors ( to identify Graves' disease) ESR and CRP (elevated in Thyroiditis) Radioactive iodine uptake studies ( to identify the adenoma)

9. Medical Management There are 3 mainstays of treatment: thionamide drugs, radioiodine, and thyroid surgery. Beta-blocker therapy such as propranolol, is used to reduce adrenergic features such as sweating, anxiety, and tachycardia. Thionamide drugs include propylthiouracil (PTU) and methimazole and reduce the production of thyroid hormone.

10. 2- Radioiodine therapy Radioiodine therapy is the most common therapy used for adults with Graves’ disease. Radioactive iodine is given in one oral dose. It is absorbed by the thyroid gland inducing tissue-specific inflammation that leads to thyroid fibrosis and destruction of thyroid tissue over the next several months.

11. Surgical Management Total or partial thyroidectomy is a rapid and effective method of treating thyrotoxicosis. However, it is invasive and expensive, and causes permanent hypothyroidism, requiring levothyroxine treatment.

12. Nursing Management Nursing Diagnosis Risk for decreased cardiac output related to Changes in venous return and systemic vascular resistance & Alterations in rate, rhythm, conduction. Anxiety related to hypermetabolic state. Risk for Imbalanced Nutrition: Less Than Body Requirements related to Increased metabolism (increased appetite/intake with loss of weight)Nausea / vomiting , diarrhea. Fatigue related to hypermetabolic state.

13. Interventions Monitor vital signs, noting  pulse rate  at rest and when active. Provide for a quiet environment; cool room, decreased sensory stimuli, soothing colors, quiet music. Auscultate heart sounds, note extra heart sounds, development of gallops and systolic murmurs. Auscultate breath sounds. Note adventitious sounds. Monitor temperature; provide cool environment, limit bed linens or clothes, administer tepid sponge baths.

14. Weigh daily. Encourage chair rest or bedrest. Limit unnecessary activities. Record I&O. Consult with a dietitian to provide a diet high in calories, protein, carbohydrates, and vitamins. Avoid foods that increase peristalsis and fluids that cause diarrhea. Provide a balanced diet, with six meals per day. Encourage patient to eat and increase the number of meals and snacks. Give or suggest high-calorie foods that are easily digested.