Hyperthyroidism & Thyroid Storm

Question 1

What 3 hormones does the thyroid gland produce?

Answer 1

Thyroxine (T4)
Triiodothyronine (T3)
Thyrocalcitonin (calcitonin)

Question 2

What regulates the secretions of the T3 & T4 hormones?

Answer 2

Anterior pituitary gland through the negative feedback mechanism.

Question 3

What is the negative feedback mechanism?

Answer 3

When T3 & T4 levels get low the negative feedback mechanism is activated releasing TSH to stimulate the thyroid glad to secrete more hormones until normal levels are reached then it stops secreting TSH to stop the production of hormones to prevent an imbalance from occurring

Question 4

What happens when T3 & T4 levels decrease?

Answer 4

The anterior pituitary gland releases the thyroid-stimulating hormone (TSH) - this stimulates the thyroid to secrete more hormones until normal levels are reached

Question 5

What affects does T3 & T4 have on the body systems?

Answer 5

Regulates body metabolism, energy production, and fluid and electrolyte balance
Controls tissue use of fats, proteins, and carbs

Question 6

What does the body use calcitonin for?

Answer 6

Prevents calcium from leaving the bones and reduces blood calcium levels

Question 7

What is hyperthyroidism?

Answer 7

Disorder caused by an excessive amt of thyroid hormone circulating in the blood stream causing the body to be in a state of hypermetabolism.

Question 8

What causes hyperthyroidism?

Answer 8

Autoimmune antibodies mimic TSH causing a hyper-secretion of thyroid hormones.
Grave’s disease is the most common cause.

Question 9

What is Grave’s disease?

Answer 9

Auto immune disease that causes overactivity of the thyroid gland

Question 10

Labs to monitor

Answer 10

Serum TSH (decreased if disease present)
Free thyroxine index (FTI) and T3 - will be elevated if present
Thyrotropin-releasing hormone (TRH) stimulation: failure of expected rise in TSH

Question 11

Causes of False elevated levels

Answer 11

Recent use of contrast median and oral contraceptives

Question 12

Cause for false decreases in thyroid levels

Answer 12

Severe illness, malnutrition, use of aspirin, corticosteroid, and phenytoin sodium

Question 13

S/S of hyperthyroidism

Answer 13

Heat intolerance, exophthalmos, palpitations, wt. loss, excessive sweating, insomnia, HTN

Question 14

Nursing Interventions for hyperthyroidism

Answer 14

Administer antithyroid medication: (METHIMAZOLE - Tapazole)
Admin beta blocker to begin stabilization process
Admin iodine-containing meds to prevent the release of stored thyroid hormones
Monitor nutritional status, INOs, LOC and VS
Maintain a calm environment

Question 15

What is the stabilization process?

Answer 15

Stabilization process should begin ASAP: beta blockers are given to help decrease the risk of cardiac effects, such as tachycardia and atrial fibrillation

Question 16

What beta blocker should be used as part of the stabilization process with a patient with a history of asthma and why?

Answer 16

Metoprolol (Lopressor) bc it is a cardioselective and will not have any effects on the respiratory tract.

Question 17

What is a thyroid storm?

Answer 17

Also known as thyrotoxic crisis: results from a sudden surge of a large amt of thyroid hormones into the blood stream, causing an even greater increase in the body’s metabolism
MEDICAL EMERGENCY with high mortality

Question 18

Precipitating factors for a thyroid storm

Answer 18

Infection, trauma, emotional stress, and subtotal thyroidectomy

Question 19

S/S of a thyroid storm

Answer 19

Hyperthermia, hypertension, delirium, vomiting, abdominal pain, tachydysrhytmias

Question 20

Nursing Intervention for Thyroid Storm

Answer 20

Maintain airway, continuous telemetry monitoring for dysrhythmias, Tylenol for fever, cool sponge baths or ice packs, administer medications as ordered, admin IV fluids, monitor INOs and BG (admin insulin as ordered PRN), O2 PRN

Question 21

S/S of thyroid storm in an older adult are…

Answer 21

Subtle and even absent

Question 22

Older adults with hyperthyroidism normally presents with?

Answer 22

Heart Failure and Atrial Fibrillation

Question 23

What 3 types of medications need to be administered for treatment of hyperthyroidism?

Answer 23

A beta blocker (metoprolol), a antithyroid (Methimazole) and an Iodine-containing medication.

Question 24

What does an Iodine-containing medication do, when used to treat hyperthyroidism?

Answer 24

Prevents the release of stored thyroid hormones

Question 25

What does Metroprolol help treat, when used for treatment of hyperthyroidism?

Answer 25

Treats sympathetic nervous systems symptoms: Heart palpitations and tachy.

Question 26

What is Methimazole used for?

Answer 26

To block thyroid hormones from being released.

Question 27

What dietary changes should be made for a patient with hyperthyroidism?

Answer 27

Increased Calories and Increased Protein

Question 28

What patient/family education should be done regarding behavior changes in a patient with hyperthyroidism?

Answer 28

Behavior should return to normal with antithyroid treatment