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Bryna Curandell

on 5 December 2011

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Transcript of Hyperthyroidism

Hyperthyroidism Presented by Bryna Curandell Ashley Pinarija Lidia Mercado Erin Morgan Case Study Mrs. Jones, age 30 years old, presented herself at the ED. She has a swollen left area of her neck and she states that the swelling has increased over the past week. She is nervous about her weight because she has been eating a lot but losing weight. She has also been stressed out about her mother’s recent death. Mrs. Jones also states that she has a light menstrual period, diarrhea, restlessness, and she complains of severe back problems. She has to roll off the bed because her pain is so severe. She also has bulging eyes. Physical Assessment Differential Diagnoses Diagnostic Test Results BP: 148/72
Pulse: 120 w/ palpitations
Respiratory Rate: 24 breaths/min
Temp: 103ºF
Thyroid firm and dense
Family thyroid abnormalities Swollen Lymph nodes
Thyroid Cancer or Tumor
1. TSH
2. Thyroid antibody
3. Serum T4 Test
4. Serum T3 Test
5. Urine Analysis
6. Radioacitve Iodine Uptake (RAIU)
7. Thyroid scan
8. CBC
9. Throat Culture
10. Glucose, Electrolyte Test
Blood Glucose: 4.2 mmol/L (3.9-5.5)
TSH: Low (0.4-6)
Thyroid Stim Immunoglobin: 333 (0-139)
Thyrotopin Receptor Ab: 1.79 (0-1.75)
T3 total Serum: elevated (80-220)
Radioactive Iodine Test: High
Thyroid scan: enlarged thyroid
Total T4: High (4.5-12.5)
Free T4: High (0.7-2.0)
Urine Analysis: normal
CBC: normal
Throat Culture: negative
Glucose Test: normal
Electrolyte Test: Low Also referred as “overactive thyroid”.

Hyperthyroidism is a condition where thyroid hormone levels are elevated in the blood. Prevalence of overt thyrotoxicosis is about 0.5%.
However, 1% to 2% of patients have a below-normal TSH level.
Occurs in 1% of women and .02% in men
85% of cases are in people younger than 60

Prevalence Sympathetic NS stimulations: (Tachycardia, tremor, increased systolic blood pressure, and hyperreflexia)
Eyelid lag (lagophthalmos)
Weight loss
Psychological disturbances Symptoms Graves Disease
Toxic Multinodular Goiter
Toxic Adenoma
Thyroid Cancer
TSH Secreting Pituatary Adenomas
Iodine- Induced Thyrotoxicosis
Amiodarone-Induced Hyperthyroidism
Subacute thyroiditis

Causes Pathophysiology Caused by an autoimmune destruction of the thyroid gland.
When T3 and T4 are overproduced, systemic adrenergic activity increase.
Epinephrine overproduction
Severe hypermetabolism
Leading rapidly to cardiac, GI, and sympathetic NS decomposition
1. Stimulation of energy use:
elevates basal metabolic rate→ increases oxygen consumption and increase heat production
2. Stimulation of the heart:
increase cardiac output and increase oxygen demand
3. Promotion of growth and development:
essential for normal development of the brain and significant impact on maturation of skeletal muscle
Thyrotropin- releasing hormone (TRH) is secreted by the hypothalamus acts on the anterior pituitary gland to secret thyrotropin (thyroid-stimulating hormone, TSH)
TSH acts on the thyroid to stimulate the 3 aspects of thyroid functionNegative Feedback Loop: A rise in plasma levels of T3 and T4
TSH is suppressed inhibitory effect of thyroid hormones on the anterior pituitary Regulatory Thyroid Action Thyroid Hormone Action http://video.about.com/thyroid/Thyroglobulin-Protein.htm Pharmacological Management Non Pharmacological
Management Antihyperthyroid
Propylthioracil Methimazole
MOA: Inhibits transformation of iodine so iodotyrosine (T4) cannot be formed
Drug Interactions: Anticoagulants (Vit K), Digitalis glycosides, theophylline
Adverse Effects: rash, hyperplastic thyroid, damages thyroid of fetus, temporary hypothyroidism, glucopenia (makes sure to obtain WBC count)
Nursing Assessment: GI upset, fever, CBC, monitor glucose, skin rash, and large lymph nodes Propylthioracil
MOA: inhibits transformation of iodine so iodotyrosine (T4) cannot be formed, and blocks conversion of T4 to T3 in peripheral tissues
Drug Interactions: Anticoagulants (Vit K), Digitalis glycosides, theophylline
Adverse Effects: rash, hyperplastic thyroid, damages thyroid of fetus, temporary hypothyroidism, glucopenia (makes sure to obtain WBC count)
Nursing Assessment: GI upset, fever, CBC, monitor glucose, skin rash, and large lymph nodes
Beta Blockers
(propranolol, metoprolol)
MOA (beta 1 antagonist):
1. Blockade of cardiac beta 1 receptors decreases contraction of the heart and lowers BP
2. Blockade of beta1 receptors on the kidneys to stop RAAS
Drug Interactions: Antipsychotics, Antihypertensives, Antiarrhythmics, Mefloquine
Adverse Effects: Fluid retention or worsening of HF, Fatigue, Hypotension, Bradycardia or heart block
Nursing Assessment: Check BP and HR Iodine/Iodide
(Radioactive Iodine)
MOA: Inhibits T4 from thyroid gland. Effects are weaker than methimazole or PTU
Drug Interactions: Antithyroid Drug, Lithium, Anticoagulants
Adverse Effects: Folliculitis and fever
Nursing Assessment: increase fluid intake and monitor for hypothyroidism Sunglasses
Elevate head during sleep
Artificial tears
High fiber diet with bland foods
Ice pack or cooling blanket Corticosteroid
MOA: decrease body inflammation
Drug Interactions: Aspirin can increase side effects, prescribe low-dose aspirin if needed for heart attack or stroke prevention; Warfarin, NSAIDs, Antiplatelet drugs can cause bleeding and bruising
Adverse Effects: Blurred vision, eye pain, swelling, rapid weight gain, convulsions, high BP, uneven heartbeats, seizure
Nurse Assessment: Check CBC (see if WBCs have increased), monitor vital signs, symptoms of infections, and monitor BP Patient Education Disease and related systems
How to take medication
Importance of follow up appointments
Good sleep patterns
Music and relaxation
Nutrition and monitoring weight
Eye care
Do not touch the thyroid gland Nursing Diagnoses References
Drugs.com. (2010). Methimazole. Drugs.com. Retrieved from http://www.drugs.com/mtm/methimazole.html
Key thyroid function tests. (n.d.). Retrieved from http://thyroid.about.com/newsinfo/1/bltestvalues.htm
Lab Results...help..!. [Web log message]. (2011, March 24). Retrieved from http://www.livingwithgravesdisease.com/forums/index.php?/topic/3887-lab-resultshelp
LD Online. (2006). Speech and language milestone chart. Retrieved April 11, 2006, from: http://www.ldonline.org/ld_indepth/speech-language/lda_milestones.html
Lehne, R. A. (2010). Pharmacology for nursing care (7th ed.). Philadelphia, PA: Saunders Elsevier.
Lippincott Williams & Wilkins. (2009). Pathophysiology made incredibly easy! (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Milas, K. & Rehan, K. (2010). Radioactive iodine for hyperthyroidism. Endocrine Web. Retrieved from http://www.endocrineweb.com/conditions/hyperthyroidism/radioactive-iodine-hyperthyroidism.
NHS Choices. (2010). Exophthalmos treatment. Retrieved from http://www.nhs.uk/Conditions/Exophthalmos/Pages/Treatment.aspx
Olson, J. (2011). Clinical pharmacology made ridiculously simple (4 ed.). Miami, FL: MedMaster, Inc.
Skugor, M., & Fleseriu, M. (n.d.). Hypothyroidism and hyperthyroidism. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypothyroidism-and-hyperthyroidism/
Williams, L., & Hopper, P. (2007). Understanding medical surgical nursing. (3rd ed., pp. 837-839). Philadelphia, PA: F.A. Davis Company.
Women Health Tips. (2011). How to diet with graves. Women Health Tips. Retrieved from: http://www.womenhealthtips.net/how-to-diet-with-graves-disease.html

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