Hyperthyroidism

Question 1

subclinical hyperthyroidism

Answer 1

TSH under 0.4mU/L

normal T3/T4 levels

Question 2

Overt hyperthyroidism

Answer 2

Low/undetectable TSH

Inc. T4/T3

Question 3

Thyrotoxic crisis (thyroid storm) manifestations

Answer 3

Tachycardia, HF
Shock
Hyperthermia
Seizures
Abd pain, coma

Question 4

Thyrotoxic crisis (thyroid storm) drug management

Answer 4

Tapazole- 1-2 weeks improvement, take 6-15 months

Iodine: inhibits T3/4 synthesis, makes surgery easier- 1-2 weeks

Beta blockers: block SNS, relieves symptoms

Question 5

What is the treatment of choice for most adults w/ hyperthyroidism/ thyroid storm

Answer 5

Radioactive Iodine therapy (RAI)

Damages/destroys iodine tissue

can take up to 3 months

ran alongside Beta blockers/ Tapazole

Question 6

Surgical therapy for hyperthyroidism`

Answer 6

Indications:

• Large goiter compressing trachea
• Unresponsive to antithyroid drugs
• Thyroid cancer
• Can’t do RAI

Subtotal thyroidectomy:

• Preferred
• removes 90% thyroid

Question 7

Hyperthyroidism manifestations

Answer 7

Chest pain, HTN, palpitations, angina

Dyspnea, inc. RR

weight loss, diarrhea

diaphoresis

Fatigue/weakness

Hyperactive DTR

coma

Question 8

exophthalamos interventions

Answer 8

Apply artificial tears
Restrict salt
elevate head of bed
dark glasses
tape eyelids closed if needed

Question 9

Hyperthyroidism post op care

Answer 9

Watch for:

• Hypocalcemia
• Hemorrhage
• Laryngeal nerve damage (stridor)
• Thyrotoxicosis

have IV calcium readily available

Frequent assessments
Semi fowlers, give pillows for head