HYPERTHYROIDISM
HYPERTHYROIDISM
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
2
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
3
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
4
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
5
Nsg INCO 2
Monitor client’s temperature. Keep client
warm
Monitor BP. Manage hypotension
Monitor LOC
Monitor electrolytes and glucose levels