Transcript Hyperthyroidism Part II

Hyperthyroidism Part II
The Return of Bill Loney
Causes
Bill asks you what happened to cause all
these crazy symptoms he is experiencing.
You explain that it is hyperthyroidism and it
is a result of one of four things:
• Graves’ Disease (autoimmune)
• Thyroid Nodule (over-secretion by tumor)
• Thyroiditis (infection)
• Overdose of thyroid hormone medication
Graves’ Disease
Fast Facts:
• Most common cause of hyperthyroidism
• 8 times more common in women
• Diagnosed via Radioactive Iodine
reuptake test and from physical exam
• Goiter, eye involvement (exopthalamos,
dryness, visual problems) and pretibial
myxedema are common findings
• Autoimmune disease known to run in
families
Now what…
Mr. Loney says, “Graves’ disease? I think
my mother had that too. Now what? How
do I get rid of it?”
You tell him that treatments include:
• Medications
• Radioactive Iodine therapy
• Surgery
• Dietary modifications
Medications
• You explain that the medications aren’t just
for treatment but are also for symptom
management and to bring thyroid levels to
a manageable level before surgery
– Anti-thyroid drugs
– Iodine
– Beta blockers
– Radioactive Iodine
Medications
• Control the symptoms, especially cardiac
– Beta-blockers: reduce sympathetic hyperreactivity
• Inhibit thyroid hormone synthesis
– Thioamides (Propylthiouracil/PTU, methimazole)
prevent hormone synthesis by inhibiting thyroidal
peroxidase (not curative)
• Destroy some of the thyroid tissue
– Radioactive iodine
• Bring thyroid levels down
– Iodine in conjunction with the Thioamides
Radioactive Iodine Therapy
• It may take 2-3 months for it to work
• Generally results in post-treatment
hypothyroidism requiring replacement
• Mr. Loney states, “You won’t be injecting
any more radioactive stuff into me!”
• You explain that the only other option is
surgery if he is not responsive to the
medications
**Contraindicated in pregnant women!
Surgery
• May involve total or sub-total removal of
thyroid tissue or nodule
• Done via endoscope or open procedure
• Usually the next option after failed
treatment with medications
• Medication regimen followed to handle
symptoms, reduce vascularity of
tissue/tumor and to ideally have the
patient in a euthyroid state (normal).
Preop Teaching:
Standard 5B: Health Teaching and
Health Promotion
• Normal post-surgical
routines/care
• May have difficulty talking
• Complications include:
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Respiratory problems from bleeding
May require emergency tracheostomy/reintubation
Blood draws to monitor calcium level
Arterial line may be used for this
Manual support of their head while changing positions
to reduce stress on suture lines
Dietary Modifications
• Made to help with deficiencies from hypermetabolism
– High protein, carbs, vitamins/minerals
– Low in fiber, caffeine
• There are also foods that naturally lower
thyroid levels
– broccoli, brussel sprouts, cabbage,
cauliflower, kale, rutabagas, spinach, turnips,
peaches, and pears
Standard 2: Diagnosis
Priority Nursing Diagnoses:
1. Activity Intolerance
2. Risk for Injury
3. Imbalanced nutrition: less than body
requirements
4. Anxiety
Carefully review the care plans in your text on
pp. 1316 and complete your hand out.