Hyperthyroidism

Thyroid Gland

Thyroid Hormone
a. T4 - Thyroxine – body heat production
b. T3 – Triiodothyronine – Metabolism & growth
c. Calcitonin – Thyrocalcitonin – decrease level of
calcium in blood.
 Hyperthyroidism “Grave’s Disease”
>Toxic Diffuse Goiter/ Parry’s Disorder

*Increased Metabolic Rate ( due to hyper secretion of T3 )

*Increased Heat Production (due to hyper secretion of T4 )
*Hypocalcemia ( due to hyper secretion of calcitonin )

Risk Factors:
•Females, Below 40yrs old
•Severe Emotional Stress
•Autoimmune Disorders
 PATHOPHYSIOLOGY
HYPERTHYROIDISM

Increase TSH stimulation to the

Pituitary Gland

Stimulation of Thyroid Hormone

Increase in T3 and T4

Hormonal Imbalance

Multi-system Changes

Physical Neuro-
CV Nutrition Musculo- Psycho- Integu-
logical
skeletal logical mentary
System
Enlarge HR
Weight
Thyroid Irritability
BP Loss Anxiety Sweating
gland Restless
Appetite Insomnia Heat
Fine Intolerance
Respira-
Eyes Tremors
tory
System
Exopthalmos
RR
Assessment:
>Thyroidal Disturbances
*Restlessness, nervousness, irritability, agitation
*Fine tremors
*Tachycardia
*HPN
*increase appetite
*Weight loss
*Diaphoresis
*Diarrhea
*Heat intolerance
*Amenorrhea
*Fine silky skin
*Pliable nails

>Ophthalmopathy
*Exophthalmos
*Accumulation of Fluids at the fat pads behind eyeballs,
pushing the eyes forward
 Graves’
Ophthalmpathy

Management of Graves’ Ophthalmophaty

1.Apply cool compress to eyes.
2.Wearing sunglasses.
3.Use lubricating drops.
4.Elevate the head of bed.
Diagnostic Procedure:

1.Serum Thyroid-Stimulating Hormone Test

2.Serum Free T4
3.Radioactive Iodide Uptake (RAIU)
4.Thyroid Scan
5.Fine Needle Biopsy (FNB)
> To asses for malignant cells

6.Basal Metabolic Rate

>Measure Oxygen Consumption at the lowest
cellular activity

Preparation:
*NPO 10-12hrs

7.Reflex Testing
>Hyperactive Tendon of Achilles Reflex (TAR)
indicate
Hyperthyroidism
Treatment:

A. General management
Sedatives for restlessness/insomnia
B. Management
A. Medical
1. Propylthiouracil (PTU), Methimazole (MM)
> Inhibits synthesis of thyroid hormones
Side effects:
*agranulocytosis, fever, sore throat, skin rashes

2. Iodides: Lugol’s Solution

SSKI – Saturated Solution of Potassium Iodide
> Inhibits release of thyroid hormone
Side effects:
*Allergic reaction, Increased salivation, Coryza
 3. Dexamethasone
>Inhibits the action of thyroid hormones

4. Beta – Blockers
>To control tachycardia, HPN
B. Radiation Therapy (131I)
a. More commonly used than before
b. Contraindications
*pregnant
*young people (<20yrs)
*severe exophthalmos
*thyrotoxic crisis
*failed to uptake I

D. Thyroidectomy
> a surgical procedure done to removed thyroid gland
when there is malignancy.
Pre-operative care:
>Promote Euthyroid state.
>Administer Iodides as ordered.
*To reduce the size & vascularity of thyroid gland, thereby to
prevent postop hemorrhage.
>ECG
*Heart failure/ cardiac damage results from HPN/ tachycardia.

Post – operative care:

>Position : Semi-fowler’s with head, neck & shoulder erect.
>Prevent hemorrhage
>Keep tracheostomy set available for first 48hr.
>Ask the patient to speak every hour , to assess laryngeal nerve damage.
>Keep Ca gluconate readily available
*Tetany is occurs if hypoCa is present.
>Monitor Body temperature
*Hyperthermia is an initial sign of thyroid crisis.
>Monitor BP
*To assess for Trousseau’s sign (hypocalcemia)
>Advise to support neck with interlaced fingers when getting up from
bed.
>Observe for signs and symptoms of potential complications.
*Hemorrhage
*Airway obstruction
*Tetany
*Recurrent laryngeal nerve damage
*Thyrpoid crisis
*Myxedema
Prepared by:

Group 4
BSN 3B2-4

Reyes, Gracebel B.
Siman. Bernadette C.
Tamondong, Mary Robin F.
Nebres, Aileene B.
Nieto, Edison
Ramos, Zarina Mae P.
Torres, Alfred O.
Blaza, Myra Belle C.
Illustrisimo, Ronald L.
Chavez, Tyrone A.
Dominguez, John Vic B.