Transcript Hyper and Hypothyroidism

HYPERTHYROIDISM
Shannon Galey
University of South Florida
Med Surg 1
THYROID FUNCTIONS
Hormones of the thyroid gland T3 and T4 produce and regulate adrenaline, epinephrine,
dopamine
T3 and T4 are crucial for brain development
Also regulates metabolism
Works hand in hand with pituitary gland to produce TSH ( pituitary gland controls the
amount of TSH released to the body)
Thyroid can be considered the “manager” of the body
Regulates all body organs and functions
PATHOPHYSIOLOGY
Hyperthyroidism is a disorder that
involves the excess secretions of thyroid
hormones by the thyroid gland, this can
lead to a hyper metabolic condition
called thyrotoxicosis. The most common
forms of hyperthyroidism are graves
disease, Plummer disease, (Toxic
multinodular goiter) and toxic adenoma.
GRAVES DISEASE
Diffuse enlargement of both thyroid lobes, with
uniform uptake of isotope and elevated radioactive
iodine uptake
60-80% of all cases of Hyperthyroidism in the US
Peak occurrence in people aged 20-40 years old
TOXIC MULTI NODULAR GOITER
“PLUMMER DISEASE”
Irregular areas of relatively diminished and occasionally
increased uptake; overall radioactive iodine uptake is
mildly to moderately increased
15-20% of all hyperthyroidism cases
Occurs more commonly in places with iodine
deficiencies
US adds Iodine to foods so we have less “Plummer
disease” then other countries
TOXIC ADENOMA
3-5% of all hyperthyroidism cases
growth of a thyroid nodule that produces and secretes excess
amounts of thyroid
Many times this nodule may be benign
WHO GETS HYPERTHYROID
While seen in both men and women, it is more
common in women
A persons chance increases with age presents
typically from ages 20-40 years old.
Reoccurring pregnancies can lead to thyroiditis
which puts younger women at risk for
Hyperthyroidism.
Hyperthyroidism is one of the most frequently
encountered condition in endocrinology
Out of three forms of hyperthyroidism, Graves
disease is the most common. 25 million people
Caucasians and Hispanics are more at risk then
African Americans
DANGERS OF HYPERTHYROIDISM
Preterm labor
Pregnancy induced hypertension
Eclampsia (one or more convulsions in women during
pregnancy whom suffer from high blood pressure.
Thyroid storm (is a life-threatening health condition that
is associated with untreated or undertreated
hyperthyroidism. During thyroid storm, an individual’s
heart rate, blood pressure, and body temperature can
soar to dangerously high levels. Without prompt,
aggressive treatment, thyroid storm is often FATAL
Heart Failure
TREATMENTS FOR HYPERTHYROIDSIM
Medications
Propylthiouracil
Methimazole
Anti thyroid drugs, they work by blocking
thyroids ability to produce thyroid hormone
Radioactive Iodine (RIA)
Pts whom have been on medication for at
least 6 months who have seen no
improvement
550 MBq does of radio active iodine is
administered
Majority of the time kills thyroid and pt
becomes hypothyroid, or the thyroid will
return to normal
DIETARY MODIFICATIONS
Can be used with daily medications
Broccoli
Brussel sprouts
Cabbage
Cauliflower
Kale
Mustard greens
Peaches
Pears
Rutabagas
Soybeans
Spinach
Turnips
All of these foods help suppress thyroid function
SYMPTOMS
Nervousness
Anxiety
Increased Perspiration
Heat Intolerance
Hyperactivity
Heart Palpitations
SIGNS
Tachycardia and atrial arrhythmia
Cardiac Output can be 50-300% higher in hyperthyroid
pt.
Systolic hypertension
Warm, moist and smooth skin
Lid lag
Fixed stare
Hand tremors
Muscle weakness
Weight loss despite increased appetite
Reduction in menstrual flow or oligomenorrhea
Diarrhea
CLINICAL PRESENTATION CAN VARY
Younger patients exhibit sympathetic activation
(anxiety, hyper activity and tremors)
Older patients exhibit cardiovascular symptoms
(dyspnea, atrial fibrillation) and weight loss
Patients with Graves disease often have more “marked”
symptoms then patients with other forms
Opthalmopathy (periorbital edema, diplopia or
proptosis) may indicate Graves disease
DIAGNOSTIC TESTS AND LABS
T h y r o i d F u n c t i o n T e st
Thyroid Function Studies
Thyroid Stimulating Hormone (TSH)
Thyrotoxicosis is marked by suppressed
TSH levels and elevated T 3 and T4 levels
Free Thyroxine (FT4)
Total Triodothyronine (T3)
Patients with milder thyrotoxicosis may
have elevation of T 3 levels only
Subclinical hyperthyroidism features
decreased TSH and normal T 3 and T4 levels
DIAGNOSTIC TEST AND LABS CONTINUED
A u t o a n t i b o d y t e st s f o r
hyperthyroidism
Autoantibody titers in
hyperthyroidism
Graves disease – Significantly elevated
anti-TPO, elevated TSI
Anti ̶ thyroid peroxidase (anti-TPO)
antibody
Toxic multinodular goiter- Low or absent
anti-TPO
Thyroid-stimulating immunoglobulin (TSI)
Toxic adenoma – Low or absent anti-TPO
Patients without active thyroid disease
may have mildly positive anti-TPO
PROGNOSIS
Stabilization of thyroid function (with meds)
Radio active Iodine is recommended(hypo is much safer!)
If thyroid ablation totally kills thyroid patient receives thyroid
replacement drugs (Synthroid)
Thyroid Hormone causes excess left ventricle thickening (heart failure
or death)
Hyperthyroidism has also been linked to dilated cardiomyopathy and
pulmonary hypertension.
Graves Disease patients should be concerned with eye disorders and
should be checked regularly
All Hyperthyroid patients should be monitored regularly and have
blood work every 3-6 months
NURSING DIAGNOSIS
Activity intolerance r/t increased oxygen need due to increased metabolic rate
Anxiety r/t increased stimulation, loss of control
Diarrhea r/t gastric mobility
Ineffective health maintenance r/t deficient knowledge regarding medications, and
coping with stress
Insomnia r/t anxiety, excessive sympathetic discharge
Imbalanced nutrition r/t less then body requirements r/t increased metabolic rate and
increased gastrointestinal activity
Risk for injury r/t eye disorders or injuries
NURSING INTERVENTIONS
Energy Management
Exercise therapy
Nutritional Management
Medication Management
Stress Reduction
Assessment of Vital Signs
Education on disorder and Medications
Reporting any changes in signs or symptoms to doctor
A PATIENT IS ADMITTED TO THE HOSPITAL IN THYROTOXIC CRISIS (THYROID
STORM). ON PHYSICAL ASSESSMENT OF THE PATIENT THE NURSE WOULD EXPECT
TO FIND?
A) Hoarseness and laryngeal stridor
B) Bulging eyeballs and arrhythmias
C) Elevated temperature and heart failure
D) Lethargy progressing suddenly to impairment of consciousness
RATIONALE
The Answer is C : Elevated temperature and signs of heart failure
A hyperthyroid crisis results in marked manifestations of hyperthyroidism, with fever
tachycardia, heart failure, shock, hyperthermia, agitation, delirium, and coma. Although
exophthalmos (abnormal bulging of eyeballs) may be present in the patient with Graves'
disease, it is not a significant factor in hyperthyroid crisis. Hoarseness and laryngeal stridor
are characteristic of hypoparathyroidism, and lethargy progressing to coma is characteristic
of myxedema coma, a complication of hypothyroidism.
SECRETION OF THYROID STIMULATING HORMONE (TSH) BY WHICH OF THE FOLLOWING
GLANDS CONTROLS THE RATE AT WHICH THE THYROID HORMONE IS RELEASED?
A) Adrenal Gland
B) Pituitary Gland
C) Parathyroid Gland
D) Thyroid Gland
RATIONALE
The Answer is B : The Pituitary Gland
By secretion of TSH the pituitary gland controls the amount of thyroid hormone released.
The adrenal gland is not involved with the thyroid gland. The parathyroid gland only
secretes parathyroid hormones and influences calcium, depending on the amount of calcium
and phosphorus in the blood. The thyroid gland secretes thyroid hormone but does not
control the mount released.
WHICH OF THE FOLLOWING GROUP OF SYMPTOMS WOULD YOU EXPECT TO FIND IN AN
ELDERLY PATIENT WITH HYPERTHYROIDISM?
A) Weight loss , Dyspnea and atrial fibrillation
B) palpitations, heat intolerance and irritability
C) Cold intolerance and weight gain
D) Numbness, cramping and tingling of extremities
RATIONALE
The Answer is A : Weight loss, dyspnea and A fib
Most elderly people present with weight loss, A fib and dyspnea. While heat intolerance,
palpations and irritability can be seen in younger patients with hyperthyroidism. Cold
intolerance, weight gain, numbness and tingling of extremities are typically associated with
Hypothyroidism.
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