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Thyroid hormones are essential for the body to function normally. To achieve
this purpose, the thyroid hormones must be present in the body in the correct
amount -- not too little and not too much.
Hyperthyroidism is the term for overactive tissue within the thyroid gland,
resulting in overproduction and thus an excess of circulating free thyroid hormones:
thyroxine (T4), triiodothyronine (T3), or both. Thyroid hormone is important at a
cellular level, affecting nearly every type of tissue in the body. It is the second
common endocrine disorder, and Grave’s disease is the most common type. Long-
acting thyroid stimulator (LATS) is found in significant concentrations in the serum
of many of these patient’s.
The disorder affects women eight times more frequently than men and peaks
between the second and fourth decades of life. It may appear after an emotional
shock, stress, or infection, but the exact significance of these relationships is not
understood. Other common causes include thyroiditis and excessive ingestion of
thyroid hormone.
ASSESSMENT
CAUSES
LABORATORY EXAMS
1. radioactive iodine (rai) uptake test: high in graves’ disease and toxic
nodular goiter; low in thyroiditis.
2. serum t4 and t3: increased in hyperthyroidism. normal t4 with elevated
t3 indicates thyrotoxicosis.
3. thyroid-stimulating hormone (tsh): suppressed (except when etiology is
a tsh-secreting pituitary tumor or pituitary
resistant to thyroid hormone). does not respond to thyrotropin-
releasing hormone (trh).
4. thyroglobulin: increased.
5. trh stimulation: hyperthyroidism is indicated if tsh fails to rise after
administration of trh.
6. thyroid t3 uptake: normal to high.
7. protein-bound iodine: increased.
8. serum glucose: elevated (related to adrenal involvement).
9. plasma cortisol: low levels (less adrenal reserve).
10. alkaline phosphatase and serum calcium: increased.
11. liver function tests: abnormal.
12. electrolytes: hyponatremia may reflect adrenal response or dilutional
effect in fluid replacement therapy. Hypokalemia occurs because of gi
losses and diuresis.
13. serum catecholamines: decreased.
14. urine creatinine: increased.
15. ecg: atrial fibrillations; shorter systole time; cardiomegaly, heart
enlarged with fibrosis and necrosis (late signs or in elderly with masked
hyperthyroidism).
PATHOPHYSIOLOGY
NURSING MANAGEMENT
– NURSING DIAGNOSIS
NURSING INTERVENTION
Actions/Intervention Rationale
continued weight loss in face of
adequate caloric intake
independent
may indicate failure of antithyroid
monitor daily food intake. weigh daily
therapy.
and report losses.
dependent
hypoglycemia.
Actions/Intervention Rationale
independent
review disease process and future expectations. provides knowledge base from which patient can
make
informed choices.
identify stressors and discuss precipitators to psychogenic factors are often of prime
thyroid importance in the
pregnancy.
discuss drug therapy, including need for adhering preparation for thyroidectomy) requires
to adherence to a
regimen, and expected therapeutic and side medical regimen over an extended period to
effects. inhibit
e.g., fever, sore throat, and skin eruptions. and prompt intervention are important in
preventing
development of agranulocytosis.
Independent
monitor vital signs, noting pulse rate at rest and pulse is typically elevated and, even at rest,
when tachycardia
note development of tachypnea, dyspnea, pallor, o2 demand and consumption are increased in
and
hypermetabolic state, potentiating risk of hypoxia
cyanosis. with
activity.
provide for quiet environment; cool room, reduces stimuli that may aggravate agitation,
decreased
hyperactivity, and insomnia.
sensory stimuli, soothing colors, quiet music.
encourage patient to restrict activity and rest in helps counteract effects of increased metabolism.
bed as
much as possible.