Endocrine Disorders: Hyperthyroidism

Trach tray

What equipment/supplies should be kept in the room, at bedside, of a client with hyperthyroidism in case airway becomes completely obstructed?

Treatment & therapy for Thyrotoxicosis is aimed at what acheiving what ends:

* Decreased thyroid hormone levels & symptoms * Fever reduction * Adequate hydration (fluid replacement) * Managing stressors

Precipitating factors leading to Graves disease

* Depleted iodine supply * Infection * Stressful life events + genetic predisposition

Considerations in managing acute thyrotoxicosis:

* Ensure adequate O2 & IV fluids * Give meds * Monitor for cardiac arrhythmias * Remove blankets if diaphoretic * Assist with/encourage exercise * Restrict visitors * Establish supportive relationship * Apply artificial tears to relieve eye discomfort * Elevate HOB * Restrict salt in cases of edema * Tape eyelids for sleep if they cannot shut

Musculoskeletal symptoms of hyperthyroidism:

* Fatigue * Muscle weakness * Proximal muscle wasting * Dependent edema * Osteoporosis

Neuro symptoms of hyperthyroidism:

* Fine tremors * Insomnia * Labile mood, delirium * Hyperreflexia of tendons * Inability to concentrate

Iodine & hyperthyroidism:

* Given concurrently w/ other antithyroid drugs to prepare for thyroidectomy or crisis Tx * Large doses rapidly inhibit T3, T4 synthesis & block their circulation * Decreases vascularity of thyroid gland * Maximal effect seen w/i 1-2 weeks * Long-term use is not effective

Most obvious clinical manifestations of hyperthyroidism:

* Goiter, bruits * Exophthalmos: 20-40% with Graves

Other SxS of hyperthyroidism

* Heat intolerance * Increased sensitivity to stimulant drugs * Elevated basal temp

Nutrition needs with hyperthyroidism:

* High calorie diet: 4,000-5,000/day for hunger & prevention of tissue breakdown * Protein allowance: 1-2 g/kg ideal body weight * Avoid caffeine, highly seasoned foods, high-fiber foods * Refer to dietician

Symptoms of Thyrotoxic crisis:

* Increased HR & Temp * Restlessness * Agitation * Seizures * Abdominal pain * N/V/D * Coma

GI symptoms of hyperthyroidism:

* Increased appetite, thirst * Weight loss * Diarrhea * Splenomegaly * Hepatomegaly

What are basic physiological effects of hyperthyroidism?

* Increased metabolism * Elevated hormones increase tissue sensitivity to stimulation by SNS by increasing the # of Beta-adrenergic receptors

Teaching & radioactive iodine therapy:

* May cause dryness & irritation of mouth/throat * Teach symptoms of hypothyroidism

Diagnosing hyperthyroidism:

* Measure lab values: TSH & free thyroxine (T4) * RAI uptake indicated to differentiate Graves disease from other forms of thyroiditis

Reproductive symptoms of hyperthyroidism:

* Menstrual irregularities * Amenorrhea * Decreased libido * Impotence * Gynecomastia * Decreased fertility

Discharge teaching & thyroid surgery:

* Monitor hormone balance periodically * Reduce caloric intake to prevent weight gain * Avoid goitrogens (turnips, peanuts, soybeans) * Adequate iodine necessary for thyroid function, but excess inhibits thyroid * Exercise helps stimulate thyroid * Avoid hot temps, inhibit regeneration of thyroid

Subjective Data: nursing assessment health history: may indicate hyperthyroidism

* Preexisting goiter * Recent infection, trauma * Immigration from iodine-deficient areas * Medications * Family hx of thyroid or autoimmune disorders

Beta-adrenergic blockers & hyperthyroidism:

* Relieve symptoms of thyrotoxicosis resulting from B-adrenergic receptor stimulation * Propanolol (Inderal) is given w/ other antithyroid drugs * Tenormin preferred when client has heart disease &/or asthma

Trousseau's sign

* Sign of tetany in client's with low calcium * Wrist is contracted downward

Chvostek's sign

* Sign of tetany in hypocalcemic clients * Facial muscles contract momentarily (one side of face)

Ideal results after thyroid surgery:

* Symptom relief * No serious complications r/t dz or tx * Cooperate w/ therapeutic plan

CV system symptoms of hyperthyroidism:

* Systolic HTN * Increased cardiac output * Arrhythmias * Cardiac hypertrophy * Atrial fibrillation

Causes of hyperthyroidism:

* Thyroiditis * Nodular goiter * Exogenous iodine excess * Pituitary tumors * Thyroid cancer

Integumentary symptoms of hyperthyroidism:

* Warm, smooth, moist skin * Thin, brittle nails * Hair loss * Clubbing of fingers * Diaphoresis * Vitiligo

Nursing assessment & hyperthyroidism indications:

* Weight loss * Nausea * Diarrhea * Dyspnea on exertion * Muscle weakness * Insomnia * Heat intolerance * Decreased libido * Amenorrhea * Impotence * Irritability * Personality changes * Delirium

Nursing Diagnoses & hyperthyroidism

* Activity intolerance * Risk for injury (to the cornea) * Imbalanced nutrition: less than * Anxiety

Objective data: nursing assessment: hyperthyroidism:

* Agitaiton * Hyperthermia * Enlarged or nodular thyroid gland * Eyelid retraction * Diaphoretic skin * Brittle nails * Edema * Tachypnea * Tachycardia * Hepatosplenomegaly * Hyperreflexia * Fine tremors * Muscle wasting * Coma * Menstrual irregularity * Infertility

3 Tx options for hyperthyroidism:

* Antithyroid meds * RAI therapy * Subtotal thyroidectomy

Postoperative implementations after thyroid surgery:

* Assess for hemorrhage signs * Assess for tracheal compression signs * Semi-Fowler's & support head w/ pillows * Monitor V/S * Check for tetany (toes tingling, hands around mouth) * Monitor for Trousseau's & Chvostek's signs * Administer pain meds

Implementations before Thyroid surgery:

* Assess for iodine toxicity * Teach coughing/deep breathing/leg exercises * Suction equipment, trach tray in room * Calcium salts for tetany

Radioactive iodine therapy (RAI) & hyperthyroidism

* Damages/destroys thyroid tissue * Effects evident after 2-3 months * Treated w/ antithyroid drugs & Inderal before & during 1st 3 months of Tx * High incidence of post-tx hypothyroidism * Need for lifelong thyroid HRT

Subtotal thyroidectomy: def & when is it necessary?

90% of thyroid is removed to achieve effectiveness: If too much is removed, regeneration will not occur: hypothyroidism ensues * Used when client is unresponsive to drug therapy * Used for large goiters causin tracheal compression * Used in cases of malignancy

Graves' disease

An autoimmune disease w/ no known cause: antibodies developed to work against TSH * Hyperthyroidism/thyroid storm occur together * Diffuse thyroid enlargement, excessive TH secretion * May destroy thyroid tissue --> hypothyroidism

Exophthalmos

An impaired drainage from the orbit with increased fat & edema in the retro-orbital tissues * Causes eyeballs to protrude * Corneal surfaces become dry & irritated

30-50

Hyperthyroidism occurs with highest frequency in what age group?

What are toxic nodular goiters?

Nodules of the thyroid that secrete TH, independent of TSH Begin as follicular adenomas * Small autonomous nodules do not secrete enough to cause thyrotoxicosis, but large nodules may: > 3 cm

Thyrotoxicosis

Occurs as a result of hypermetabolism of excess T3 & T4 "Thyroid storm"

List 2 antithyroid drugs & their effects/usages

Propylthiouracil (PTU) & methimazole (Tapazole) * Inhibit synthesis of TH * Spontaneous remission occurs * Improvement begins in 1-2 weeks * Taken from 6 months to 2 years * Not curative * Shrinks thyroid before surgery to make surgery safer

Graves' disease

The most common form of hyperthyroidism, accounting for 75% of cases.

Hyperthyroidism: what is it?

This disorder involves a sustained increase in the production/release of thyroid hormones by the thyroid gland

Thyroid storm

Thyrotoxicosis * Acute rare condition: heightened symptoms of hyperthyroidism * Death rare w/ Tx, but can be deadly w/o * Caused by stressors