Thyroid gland hyperfunction

Hormone hypersecretion
T3 and T4 increase
Hypermetabolism
Poor nutrition – less intake nutrition
weight loss
nutritional deficit diagnosis dx

Hypermetabolism --Cardiac contractility increases

Increased pulse, increased cardiac output
cardiac compensation

Arrhythmia, tachycardia
diagnosis of decreased cardiac output

Hypermetabolism --intestinal peristaltic increase

Reabsorption decreases
frequency of defecation increased
diarrhea diagnosis

Hypermetabolism -- Heat production increases

Heat tolerance decreases
body temperature increases
The skin feels warm
diagnosis of hyperthermia

Body temperature increases – Restless

Insomnia
not enough rest
diagnosis of sleep pattern disorders
 Categories and Problem Normal
Subcategories
Physiological Respiration respiratory rate increases Normal breathing 16-20 x / minut

Circulation Arrhythmia, increased blood Blood pressure 120/80 mmHg,

pressure with heavy pulse pulse 60-100 x / minut
pressure. Tachycardia at rest
Nutrition and Increased appetite, but weight loss Normal intestinal peristalsis and
fluids over a period of several days / metabolism are not inhibite
weeks, thirst, use of diuretics
(thiazides)
Elimination weak and decreased bowel sounds, Frequency 3 times daily, soft
hyperactivity (diarrhea) texture, brownish color and odor
tend to be more pungen
Activity and Insomnia, decreased activit Sleep regularly, and move as usual
Rest without looking tire

Neurosensory - Act and think according to what is

wanted or ordered by the brain

Reproduction irregular menstruation Normal menstruation and no

and infertility
Sexuality

Psychological Pain and - Able to move the joints normally so

Comfort they don't experience any
discomfor
Ego Integrity - Feel reliable, not stressed and can
interact normally to form reality
experiences
 Growth and - Experiencing normal size increase
development and experiencing normal changes
according to the development phase
Behavior Personal - Good personal hygiene. Do not
Hygiene experience behavior that can
interfere with personal hygien

Counseling - Having knowledge about

and learning hyperthyroidism
Relational Social - Able to interact with people around
Interactions the environment without any
obstacles
Environment Safety and Excessive sweating, skin moist, Able to adapt to the environment
protection red skin, warm, heat intolerant properly

Physical Examination
The thyroid is located in the lower anterior neck. The isthmus of the
butterfly-shaped gland generally is located just below the cricoid cartilage
of the trachea, with the wings of the gland wrapping around the trachea.
Physical examination often can help the clinician to determine the etiology
of thyrotoxicosis.
Common signs of thyrotoxicosis include the following:
 Tachycardia or atrial arrhythmia
 Systolic hypertension with wide pulse pressure
 Warm, moist, smooth skin
 Lid lag
 Stare
 Hand tremor
 Muscle weakness
 Weight loss despite increased appetite (although a few patients may
gain weight, if excessive intake outstrips weight loss)
 Reduction in menstrual flow or oligomenorrhea
Pathway

Graves disease Toxic Nodular Taking over hormone TSH production Thyroiditis Excessive iodine
Goiter thyroid medicine abnormal consumption

HYPERTIROIDSM

Thyroid gland hyperfunction

Less intake nutrition
Restless
Hormone hypersecretion
Weight ↓
T3 dan T4 ↑ Hard to sleep (insomnia)
dx. Nutritional deficit
hypermetabolism Not enough rest

dx. Sleep pattern

Cardiac contractility ↑ ↑ Intestinal peristaltic Heat production ↑ disorders

pulse ↑, ↑ cardiac output Reabsorption ↓ Heat tolerance ↓

Cardiac compensation Frequency of defecation ↑ Body temperature ↑

Arrhythmia, Tachycardia Skin feels warm

dx. Diarrhea
dx. Decreased Cardiac
Output dx. Hyperthermia
 The cause of hyperthyroidism is usually graves disease, toxic nodular goiter, excessive
taking TH drugs, abnormal TSH production, thyroiditis, excessive iodine consumption can
cause hyperthyroidism due to thyroid hyperfunction resulting in hormone hypersecretion. This
condition will trigger T3 (triodotironin) and T4 (thyroxine) increase. When T3 and T4 increase,
hypermetabolism will occur. An increased metabolic rate leads to an increase in metabolic
requirements, wherein the input of nutrients is lacking, so that the patient's body weight will
decrease due to burning of available energy reserves.

Metabolic rate can also occur in cardiovascular, which can make an increase in cardiac
contractility, this condition causes increased pulse and an increase in cardiac output, eventually
the heart compensates for arrhythmias and tachycardia.

This metabolic rate can also make an increase in intestinal peristaltic, which causes
decreased reabsorption, so the frequency of bowel movements increases.

Increased metabolism causes an increase in body heat production so that the patient
expels a lot of sweat and decreased tolerance to heat, body temperature also increases and
results in warmth of the skin. Even due to this distorted metabolic process, sometimes people
with hyperthyroidism have difficulty sleeping and decreased activity.

Penyebab hipertiroidisme biasanya adalah penyakit graves, toxic nodular goiter,

minum obat TH berlebihan, produksi TSH abnormal, tiroiditis, konsumsi yodium

berlebihan dapat mengakibatkan penyakit hipertiroidisme karena terjadi hiperfungsi tiroid

sehingga terjadi hipersekresi hormone. Kondisi ini akan memicu T3 (triodotironin) dan

T4(tiroksin) meningkat. Ketika T3 dan T4 meningkat, akan terjadi hipermetabolisme. Laju

metabolisme yang meningkat menimbulkan peningkatan kebutuhan metabolik, dimana

masukan nutrisi kurang, sehingga berat badan pasien akan berkurang karena membakar

cadangan energi yang tersedia.

Laju metabolisme juga dapat terjadi pada kardiovaskular, dimana dapat membuat

peningkatan kontraktilitas jantung, kondisi ini meyebabkan nadi meningkat maupun

peningkatan pada cardiac output, akhirnya jantung berkompensasi sehingga terjadi aritmia

dan takikardi.

Laju metabolisme ini juga dapat membuat peningkatan peristaltic usus, yang

menyebabkan reabsorbsi menurun, sehingga frekuensi buang air meningkat.

Peningkatan metabolisme menyebabkan peningkatan produksi panas tubuh

sehingga pasien mengeluarkan banyak keringat dan penurunan toleransi terhadap panas,

suhu badan ikut meningkat dan mengakibatkan kulit terasa hangat. Bahkan akibat proses

metabolisme yang menyimpang ini, terkadang penderita hipertiroidisme mengalami

kesulitan tidur dan aktivitas yang menurun.