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HYPERTHYROIDISM

This document discusses hyperthyroidism and its management. It provides information on: 1) The signs and symptoms of hyperthyroidism including increased metabolism, heat intolerance, tremors, and eye changes. 2) Graves' disease as the most common cause and its autoimmune etiology. 3) Treatment options including antithyroid medications like methimazole and propylthiouracil, beta blockers, surgery, and Lugol's solution. 4) Postoperative care focuses on monitoring for complications like hemorrhage, respiratory distress, laryngeal nerve damage, hypocalcemia, and thyroid storm.

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SJane Feria
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0% found this document useful (0 votes)
20 views6 pages

HYPERTHYROIDISM

This document discusses hyperthyroidism and its management. It provides information on: 1) The signs and symptoms of hyperthyroidism including increased metabolism, heat intolerance, tremors, and eye changes. 2) Graves' disease as the most common cause and its autoimmune etiology. 3) Treatment options including antithyroid medications like methimazole and propylthiouracil, beta blockers, surgery, and Lugol's solution. 4) Postoperative care focuses on monitoring for complications like hemorrhage, respiratory distress, laryngeal nerve damage, hypocalcemia, and thyroid storm.

Uploaded by

SJane Feria
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Nsg INCO 2

HYPERTHYROIDISM Von Graefe’s: describes an abnormal vertical


Also called: Thyrotoxicosis wideness of the palpebral fissure.
Incidence: Female (<40 yrs. old) Jeffrey’s: the forehead remains smooth when
↑ T3- metabolism (weight loss, ↑ appetite) one looks up/lack of wrinkling of the forehead
↑ T4- heat tolerance when a patient looks up with the head bent
↑ calcitonin: ↓ Ca forwards
Initial sign: tremors Proptosis: forward displacement of the eye; the
Graves’ Disease (autoimmune-makes the bulging of one or both or your eyes from their
thyroid gland activity ↑) natural position
 Most common cause of Signs:
HYPERTHYROIDISM blurred vision
 Cause is unknown but there is a diplopia (double vision) note: patch eye
hereditary link alternately
Factors: eye pain
 Autoimmune nystagmus- involuntary eye movement
 Neoplasm strabismus- "crossed eyes." (duling)
 Excessive intake of thyroid medicine lacrimation- production of tears
MANIFESTATIONS: “EVERYTHING IS HIGH AND photophobia – wear eyeglasses
WET”
BASIC CONCEPTS Lugol’s Solution
1. INCREASED METABOLIC RATE (↑ T3) SSKI
2. INCREASED BODY HEAT PRODUCTION (↑ T4) Inhibit TH synthesis and release
3. HYPOCALCEMIA (↑ Also makes the hyperplastic thyroid less
calcitonin/thyrocalcitonin) vascular prior to surgery
Used in thyroid storm
MANIFESTATIONS: “EVERYTHING IS HIGH AND Note: before sub total thyroidectomy, HCP
WET” administer Lugol’s solution to decreased
A. Due to increased metabolism vascularity to prevent bleeding.
1. Increase Appetite
2. Weight Loss NURSING RESPONSIBILITIES
3. Heat Intolerance Assess for hypersensitivity to Iodine before
giving medication (prevent anaphylactic shock)
B. Due to activation of CNS and SNS Dilute liquid iodine sources: cold water/ cold
1. Hypertension fruit juice to disguise the bitter taste
2. Diaphoresis Provide drinking straw: to prevent permanent
3. Palpitation teeth staining- FBEQ
Monitor for increased bleeding if the client is
C. Due to HYPOCALCEMIA also taking anticoagulants (warfarin, heparin,
1. Hyperactive bowel sound ASA)
2. Diarrhea
3. Restlessness MONITOR COMMON SIDE EFFECTS: (iodism)
4. Nervousness Allergic Reaction
 Metallic or Brassy taste in the mouth
Exophthalmos: the protrusion of one or both  Increase Salivation
eyes  Coryza (runny nose)
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Nsg INCO 2
 Vomiting OVER-ALL NURSING RESPONSIBILITIES
 Abdominal Pain WHEN TAKING ANTITHYROID
 Rashes MEDICATIONS
 Sore Gum  Monitor BP and PR and weight (HPN,
tachycardia)
THIOAMIDES  Weight gain indicates effectiveness of
Methimazole (TAPAZOLE) the medication
Propylthiouracil (PTU, PROPYL-THYRACIL)  Administer with meals to avoid GI
Inhibit TH production irritation
Methimazole/Tapazole can be taken in 1 daily  Avoid ASA and iodine- containing
dose medications.
Propylthiouracil must be taken in 3 doses daily  Advise client to consult physician
Methimazole/Tapazole cannot be taken during before eating iodized salt and iodine-
pregnancy rich foods

NURSING RESPONSIBILITIES BETA-BLOCKER: Propanolol (Inderal)


Monitor for SIDE EFFECTS: To control hypertension and tachycardia
(agranulocytosis/neutropenia with leukopenia) CALCIUM- CHANNEL BLOCKERS,
 Fever DEXAMETHASONE (glucocorticoid)
 Sore Throat  It inhibits the action of thyroid
 Rashes hormones
 Sore Gums
 Diarrhea SURGEY
 Subtotal Thyroidectomy: 5/6 of the
NURSING RESPONSIBILITIES gland is removed
Other side effects:  leaves enough of the gland in place to
 Hypothyroidism produce an adequate amount of TH.
 Pruritus  Total Thyroidectomy: treats cancer of
 Protrusion of Eye the thyroid and the client requires
 Anorexia lifelong hormone replacement
 Loss of taste
 Menstrual changes
Administer at same time each day with meals
(to prevent thyroid storm)

NURSING RESPONSIBILITIES
 If taking warfarin: bleeding PERIOPERATIVE CARE
 If taking lithium: Hypothyroidism Before surgery, the client should be in as nearly
 Full effects experienced in 12 weeks euthyroid state as possible: ASSESS
 Take medication regularly and exactly.  Vital signs
Do not discontinue abruptly (it will  Weight
cause thyroid storm)  Electrolyte level
 Hyperglycemia
 Glucosuria

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Nsg INCO 2
 Teach client to support the neck when  Have suction equipment, oxygen and a
sitting up in bed, while moving about tracheostomy set available for
and while immediate use.
performing DBCT: to avoid 3. LARYNGEAL NERVE DAMAGE
hyperextension of the neck  Assess for ability to speak aloud every
 Teach to expect hoarseness; (mild hour, noting quality and tone of voice
hoarseness is due to anesthesia, while  Limit talking and assess for level of
severe hoarseness indicates laryngeal hoarseness.
nerve damage. Note: report to HCP  Mild hoarseness is normal:
because during surgery they might  Severe hoarseness indicates Laryngeal
remove parathyroid gland) severe damage Notify physician.
 Place on ECG: prone to cardiac arrest
 Administer the ff. medications as LARYNGEAL NERVE DAMAGE
prescribed to prevent thyroid storm Observe for other signs of recurrent laryngeal
 Lugol’s Solution reduce vascularity of nerve damage:
the thyroid gland  Respiratory obstruction
 Propanolol control hypertension and  High Pitch Voice
tachycardia  Stridor
 Glucocorticoid(dexamethasone) inhibit  Dysphagia (diff. swallowing)
action of thyroid hormones  Restlessness

POSTOPERATIVE CARE TETANY- Involuntary contraction of muscles


 Provide comfort measures. Administer that usually results from low calcium levels in
analgesic pain medications.  the blood due to Hypocalcemia
 Position in Semi fowler’s (with head, deficiency:
neck and shoulders erect) after  Paresthesia (numbness, spasms)
recovery and support head and neck  Muscle Twitching
with pillows.  Convulsion/ Seizure
 POSITIVE Chvostek sign
COMPLICATIONS  POSITIVE Trousseaus sign
1. HEMORRHAGE
 Assess dressing if present and the area TETANY
under/back of the neck and shoulders Tetany occurs in 1-7 days after surgery.
(indicates bleeding) Keep calcium gluconate PER IV available
 Monitor BP and pulse (bleeding) Monitor BP: hypocalcemia leads to
 Assess tightness of dressing if present Hypotension

2. RESPIRATORY DISTRESS (Due to THYROID STORM


Hypocalcemia there is laryngeal spasms that An extreme state of hyperthyroidism
could lead to respiratory distress) Factors:
 Assess RR, rhythm, depth and effort. a) people with DKA, Untreated
 Assist with DCE (deep breathing Hyperthyroidism, Infection, Trauma
exercises) b) people with hyperthyroidism that have
experienced - I, T, U

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Nsg INCO 2
DKA membrane permeability and decreased
neuromuscular irritability
MANIFESTATIONS
 Hyperthermia  Hypocalcemia
 Tachycardia, Dysrhythmia  Cold intolerance
 Hypertension  Hypotension
 Nausea and vomiting, Diarrhea  Constipation
 Restlessness, Confusion, Agitation,  Weak & diminished pulse
Irritability  Weakness
 Tremors/Seizure  Paralytic ileus
 Delirium and Coma  ↓ oxygen consumption
 ↓ metabolism
COLLABORATIVE MANAGEMENT
 maintain patent airway and adequate Decreased TH levels decrease:
ventilation  Common in women between 40-60;
 administer antithyroid medications as incidence rises after age 50
prescribed (lugol’s solution) Causes
 monitor VS, I and O, neurologic status, a. autoimmune disorders
cardiovascular status every hour b. thyroidectomy
 implement measures to lower fever c. radioactive iodine
(hyperthermia) d. antithyroid drugs
 use cooling blanket (hyperthermia)
 maintain quiet, calm, cool, private  Myxedema hypothyroidism in adults
environment until crisis is over ----nonpitting edema in the connective
(convulsion/seizure) tissue throughout the body
 SIGNS:
PATIENT TEACHING AFTER THYRODECTOMY a. Puffy Face
 Support neck with interlaced fingers b. Enlarge toes
when getting up from bed to prevent? c. Hoarse Voice
hyperextension
 Start ROM exercises of the neck 3-4  Cretinism: hypothyroidism in children
days after discharge This is the result of water retention in
 Massage incision with cocoa butter muco-protein deposits in the interstitial
lotion once healing occurs (minimize spaces known as Hydrophilic
scarring) proteoglycans
 Have regular follow-up care.
HYPOTHYROIDISM---May either be:
HYPOTHYROIDISM a. Primary hypothyroidism----- caused by
THREE BASIC CONCEPTS congenital defects in the gland, loss of
Decreased metabolic rate: ↓ T3 thyroid tissue following surgery or
Decreased body heat production: ↓ T4 radiation, antithyroid medications,
Hypercalcemia: thyroiditis,
Another cause: Amiodarone
SIGNS AND SYMPTOMS: “EVERYTHING IS LOW, (Codarone)------ contains 75 mg of
SLOW AND DRY”- results to decreased cell iodine per 200 mg tablet
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Nsg INCO 2
b. Secondary hypothyroidism: results  Potentiate the effect of anticoagulant
from anterior pituitary TSH deficiency drugs: bleeding
 Potentiate the effects of digitalis: hallow
MANIFESTATIONS green like vision, diarrhea, NV,
INITIAL SIGN: fatigue dysrhythmia, impotence
 Goiter  Monitor for symptoms of coronary
 Anorexia insufficiency: Chest
 Edema Pain,Dyspnea,Tachycardia
 Weight Gain, Constipation  Must be taken for the rest of one’s life
 Dry Skin, Pruritus
 dyspnea, hoarseness and muscle Myxedema Coma
stiffness Life threatening complication of longstanding
 decreased sense of taste and smell, untreated hypothyroidism usually triggered by
menstrual disorders, anemias, cardiac an acute illness or trauma, infection
enlargement
MANIFESTATION
MANIFESTATIONS  Characterized by severe metabolic
 Abnormalities in lipid metabolism with disorders
elevated serum cholesterol and  Hypoglycemia
triglyceride levels:  Hypotension
 Hypernatremia- due to decreased renal  Hyponatremia
blood flow and glomerular filtration  Hypothermia
rate that reduces the kidney’s ability to  Lactic Acidosis
excrete water  Bradycardia
 Respiratory Failure
THYROID PREPARATIONS  Coma
LEVOTHYROXINE SODIUM(T4) LEVOXYL,  ALL VITAL SIGNS ARE PROFUNDLY
LEVOTHROID, SYNTHROID LIOTHYRONINE DEPRESSED.
SODIUM(T3), CYTOMEL
THYROLAR, THYCAR(THYROID) MYXEDEMA COMA
 Occurrence and Incidence: Rare, winter
LEVOTHYROXINE: months, older women with chronic
 treatment of choice hypothyroidism
 Increase blood levels of TH  PRECIPITATING FACTORS:
 Increases CO, BT and oxygen T
consumption I
Failure to take thyroid replacement
NURSING RESPONSIBILITIES medications.
 Give 1 hour before meals or 2 hours after
meals MANAGEMENT
 Take apical rate before administering  Maintain patent airway
drug. Report less than 60 AHR (normal  Administer IV fluids and Synthorid/IV as
60 HR, <60,>120 indicates rebound prescribed
tachycardia)  Administer glucose/IV as ordered

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Nsg INCO 2
 Monitor client’s temperature. Keep client
warm
 Monitor BP. Manage hypotension
 Monitor LOC
 Monitor electrolytes and glucose levels

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