Hyperthyroidism Flashcards
What is hyperthyroidism?
Occurs 5x more in which gender
At what age range?
Hyperactivity of the thyroid gland with a sustained increase in production and release of thyroid hormones by thyroid gland
Women
20-40
There is a image on page 2 where it shows the stages of hypo and hyper
Most extreme
Thyrotoxicosis
Hyperthyroidism
Euthyroid
Hypothyroidism
Myxedema coma
What is the most common form of hyperthyroidism?
Notes
Other causes
- toxic modular goiter
- thyroditis
- excess iodine intake
- pituitary tumors
- thyroid cancer
Graves’ disease
What is Graves’ disease?
An autoimmune disease characterized by thyroid enlargement and excess thyroid hormone secretion
What is the pathophysiology of Graves’ disease?
Notes
- remissions and exacerbations regardless of treatment
- may progress to destruction of thyroid tissue
Antibodies to TSH receptor stimulate release of T3 and T4
- this leads to clinical manifestations of thyroxtocisosis
What is thyrotoxicosis ?
Results from
Physiologic effects/clinical syndrome of hyper metabolism
- results from increase circulating levels of T3 and T4
Does hyperthyroidism and thyrotoxicosis usually occur together?
Yes
What are precipitating factors that interact with Graves’ disease? (5)
Genetic
Iodine supply decrease
Infection
Stress
Smoking
Graves’ disease is about 80% of cases? True or false
True
What are clinical manifestations of hyperthyroidism? (3)
Give two examples on what to do for the last one and hearing what
Increase metabolism
Increase tissue sensitivity to stimulation of SNS
Goiter
- inspection
- auscultation hearing bruits & increase blood supply
What is the biggest manifestation for hyperthyroidism?
Which also means?
Notes
Exophthalmos - bilateral
- increase fat deposits and fluid
- eyeballs forced outward
- whites seen above iris
- eyelids do not always completely close
- diplopia possible
Ophthalmopathy
Abnormal eye appearance or function
Notes
Cardiovascular system
- systolic hypertension
- bounding rapid pulse, palpitation
- increase cardiac output
- cardiac hypertrophy
- systolic murmurs
- dysrthythmias ( A fib )
- angina
Notes
Respiratory system
- increase rr
- dyspnea on mild exertion
Notes
Gi system
- increase appetite and thrist
- weight loss
- diarrhea
- splenomegaly & hepatomegaly
Notes
Integumentary system
- warm, smooth moist skin
- thin brittle nails
- hair loss
- clubbing of fingers !!
- Palmer erythema
- fine, silky hair, premature graying
- diaphoresis !
- vitiligo !
Patients may also experience something called pre-tibial myxedma & acropachy climbing of the fingers and soft tissue swelling
Notes !
Notes
Musculoskeletal system
- fatigue
- muscle weakness
- proximal muscle wasting
- dependent edema
- osteoporosis
Notes
Nervous system
- nervousness, anxiety, fine tremors
- insomnia
- exhaustion
- lability of mood, delirium
- hyperreflexia of tendon reflexes
- inability to concentrate
- stupor,coma
Notes
Reproductive system
- menstrual irregularities
- amenorrhea
- decrease libido
- impotence
- gynecomastia in men
- decrease fertility
What are the overall clinical manifestations (5)
Intolerance to hear
Elevated basal temperature
Lid lag, stare
Eyelid retraction
Rapid speech
What is thyrotoxicosis?
Is it life threatening emergency?
Results from (4)
Death is rare when treatment is initiated
Thyroid storm may be the first indication of the disease
Excessive amounts hormones released
Yes
Stressors, infection, trauma, surgery
Espeically thyroidectomy
What are the manifestations of thyrotoxicosis ? (12)
Tachycardia
Heart failure
Shock
Hyperthermia ( 105.3!)
Restless
Irritability
Seizures
Abdominal pain
Vomiting
Diarrhea
Delirium
Coma
What’s an ancroym to help me remember the 12 manifestations for thyrotoxicosis ?
Tachy
Hair
Shocks
Hyper
Reality
International
Sensation
Addy
Velvet
Dies
Delirus
Coma
How do you treat thyrotoxicsis? (4)
Reducing circulating hormones
- manage respiratory distress
- reduce fever
- replace fluids
- eliminate/mange stressor
What are diagnostic studies ?
TSH low or high
FT4 low or high
What test can you do?
TSH is low
FT4 is high
Radioactive iodine uptake (RAIU)
What does radioactive iodine uptake (RAIU) do?
Graves’ disease shows > ___% iodine uptake
Thyroidits has <__% uptake
Differentiates Graves’ disease from other forms of thyroditis
35%
2%
What is the goal of hyperthyroidism?
Dont over think it
Suppress hormone over secretion
Block adverse effects of thyroid hormones
Prevent complications
What are the 3 primary treatment options?
Anti thyroid medications
Radioactive iodine therapy
Surgery
What are the 3 drugs we will use?
It’s not curative btw!!
Antithyroid drugs
Iodine
B adrenergic blockers
What is the name of the anti thyroid drug?
How is it given ^?
When can it be given (3)
Another drug is ?
How often do you give it?
What is the process?
Improvment in ___ to ___ weeks
Good results in ___ to __ weeks
Therapy for ___ to ___ months
Proplythiouracil (PTU)
TID
1st trimester, young patient, thyrotoxic crisis
Methazole ( Tapazole )
Daily
Inhibits synthesis of thyroid hormone
1-2
4-8
6-15
How does iodine help?
Decreases their what and makes what safer?
Maximal effect within __to __ weeks
( not effective long term )
This is used before surgery and to treat crisis
Inhibit synthesis of T3 and T4 and block their release into circulation
Decrease vascularity of thyroid gland
- makes surgery safer
1-2
What is B adrenergic blockers do?
Decrease what (4)
Name a medication
Atenolol (Tenormin) - best with CAD pt
Symptoms relief of thyrotoxicosis
Decrease tachycardia, nervousness, irritability and tremors
Propranolol (inderal)
To who is radioactive iodine therapy usually given to?
This is dangerous why?
And causes
It has a delayed response of how many months?
Treated with antithyroid drugs and b block before and during first 3 months of RAI
Non pregnant adults
Damages your thyroid tissue
80% of hypothyroid
2-3minrha
What should be done first before doing radioactive iodine therapy for women?
Pregnancy test
What are we going to teach patients who are doing radioactive iodine therapy to do?
Oral care
- salt water gargles, ice chips, magic mouthwash
And symptoms of hypothyroidism
Notes
Radiation precautions
- use seperate bathrooms
- flush 2-3 times
- wash towels,sheets, clothes seperate and every day
- do not prepare food for others that requires prolonged handling with bare hands
- avoid being close to pregnant woman and children for 7 days
What is the 4 indicators for surgery ?
This helps with what,?
Large goiter - causing tracheal compression
- unresponsive to antithyroid therapy
- thyroid cancer
- not a candidate for RAI
Rapid reduction if T3/T4
Notes
Subtotal thyroidecomty
- preferred surgical procedure
- involves removal of 90% of thyroid
- can be done endoscopically
What is the nutritional therapy? (4)
Avoiding what? (2)
- caffeine
Dietitian referral!
High calorie diet (4-5K daily)
Six full meals with snacks
Protein intake 1-2g ideal body weight
Increase carbodhyrate intake
Highly seasoned
High fiber foods
Notes
Nursing assessment
Subjective data
- past health history
- goitered recent infection, trauma, immigration from iodine deficient area, autoimmune disease
Medications
- thyroid hormones
- herbal therapies
Family history
Iodine intake
Weight loss
Increase appetite thirst
Nausea vomitting
Diarrhea
Polyuria
Sweating
Dyspnea on exertion
Palpitations
Muscle weakness
Fatigue
Insomnia
Chest pain
Nervousness
Heart intolerance
Pruritus
Decreased libido
Impotence
Gynecosmastia
Amenorrhea
Emotional lability
Personality changes
Delirum
Notes
Nursing assessment objective
Agitation
Rapid speech
Anxiety
Restless
Hyperthermia
Enlarged or nodular thyroid gland
Exophthlamos
Eyelid retraction, infrequent blinking
Warm diaphoretic velvety skin
Thin loose nails
Fine silky hair
Palmar erythema
Clubbing
Vitiligo
Edema
Tachypena
Dyspnea
Tachycardia
Bounding pulse
Murmurs
HTN
Bruit
Increase bowel sounds
Increase appetite
Diarrhea
Weight loss
Hepatosplenomegaly
Hyperreflexia
Fine tremors
Muscle wasting
Infertility
Increase T3/T4
Increase T3 resin uptake
Decrease OR undetectable TSH
Chest x ray enlarged heart
ECG of tachy
Notes
Nursing diagnosis
- activity intolerance
- imbalanced nutrition
Notes
Nursing planning
- experience relief
- have no serious complication related to disease or treatment
- maintain nutritional balance
- cooperate with theraputeic plan
Nursing implementation
Acute thyrotoxicosis
- agresstive treatment
- medications block SNS
- monitor dysthymias
- oxygenation
- fluid & electrolye replacement
- be calm quiet and cool
If exophthalmos is present ( large eyes ) what should you do ? (6)
Apply tear drops
Salt restriction
Elevate head of bed
Dark glasses
Tape eyelids closed if needed to sleep
ROM of intraocular muscular
Notes
Nursing implementation
Preoperative care
- administer medications to achieve euthryoidism
- administer iodine to decrease vascularity
- asses for signs of toxicity
- comfort and Stafety
- leg exercise
What are the 4 signs of iodine toxicity?
Swelling of buccal muscosa
Excessive salivation
Nausea/vomiting
Skin reactions
Notes
Nursing implementation
Monitor for complications
- hypocalcemia
- hemorrhage
- laryngeal nerve damage
- thyrotoxic crisis
- infection
Maintain patent airway
- oxygen, suction equipment, tracheostomy tray in patient room
- monitor for laryngeal stridor ( edema or hypocalcemia )
- IV calcium readily viable
Asses every 2 hours first 24 hours
Hemorrhage or tracheal compression
Semi flowers position
Support head with pillows
Avoid neck Flexion
Monitor vital signs and calcium levels
Analgesics
Ambulating
Psychosocial support
What are the 3 signs of hypocalcemia?
Difficulty speaking/hoarseness
Trousseaus and Chvostek sign
Notes
Nursing implementation
Discharge teaching
- monitor hormone balance
- decrease caloric intake
- regular exercise
- no excessive iodine
- avoid hot environments
Regular follow up
Symptoms of surgery
Evaluations
- relief of symptoms
- no complications
- cooperate with therapeutic plan
