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UT - Hyperthyroidism
Adult Med-surg
| Question | Answer |
|---|---|
| What is hyperthyroidism? | Sustained increase in synthesis and release of thyroid hormones by thyroid gland. |
| Who is affected more? | Women |
| What age has the highest frequency? | 20-40 year olds |
| What is euthyroid/? | Non-production of THS |
| What is the most common cause of hyperthyroidism? | Grave's disease |
| What are other causes? | Thyroiditis, toxic nodular goiter, exogenous iodine excess, pituitary tumors, thyroid cancer. |
| What is thyroidtoxicosis? | Increased release of T3 & T4. |
| What is Grave's disease? | Autoimmune disease of unknown etiology with diffuse thyroid enlargement and excessive thyroid hormone secretion. |
| What are some precipitating factors of Grave's disease? | Insufficient iodine supply, infection, stressful life events interacting with genetic factors. |
| How is Grave's an autoimmune disorder? | Antibodies are developed to TSH receptors leading to thyrotoxicosis and progressing to destruction of thyroid tissue causing hypothyroidism. |
| What are some physiological manifestations of hyperthyroidism? | Increased metabolism, Increased tissue sensitivity to the sympathetic nervous system (Fight of fight or flight) |
| What is a Grave's specific clinical manifestation of hyperthyroidism? | Exophthalmos |
| What is exophthalmos? | Protrusion of eyeballs from the orbits. This is seen in 20 - 40 % of patients. There is increased fat and edema in retro-orbital tissues and impaired drainage from the orbit.. |
| What are some cardiovascular manifestations of hyperthyroidism? | Bruit over thyroid gland, systolic hypertension, increased cardiac output, Dysrhythmias, cardiac hypertrophy, Atrial fibrillation. |
| What are some GI Tract manifestations? | Increased appetite and thirst, Weightloss, Diarrhea, hepato and spleno megaly |
| What are some manifestations in the integumentary organ? | Warm, smooth, moist skin. Thin brittle nails, Hair loss, clubbing of fingers, Diaphoresis, vitiligo. |
| What are some manifestations of the musculoskeletal system. | Fatigue, muscle weakness, proximal muscle wasting, dependent edema, osteoporosis. |
| What are some reproductive system manifestations? | Menstrual irregularities, amenorrhea, Decreased libido, impotence, gynecomastia, in men, decreased fertility. |
| What are some nervous system manifestations? | Fine tremors, insomnia, delirium, hyperactive tendon reflexes, inability to concentrate. |
| How are stimulant drugs reacted to with hyperthyroidism? | Increased sensitivity to and compounded effect. |
| How does a person with hyperthyroidism react to heat? | Intolerant to heat. |
| What types of diagnostic studies will be done on a hyperthyroid patient? | H&P, ophthalmologic exam, ECG, Radioactive iodine uptake (RAIU) (to separate Grave's from other types of hypothyroid sufferers. |
| What are some expected lab values specific to the functioning of the thyroid? | Decreased TSH, Increased free thyroxine (Free T4), Increased total T3 & T4 |
| What are the goals of collaborative care? | Block adverse effects of thyroid hormones and stop hormone oversecretion |
| How are beta-Adrenergic blockers of assistance? | Symptomatic relief of thyrotoxicosis due to beta-Adrenergic receptor stimulation. |
| What is RAI? | Radioactive Iodine Therapy. It is the treatment of choice for hyperthyroidism |
| Who is NOT a candidate of RAI? | Pregnant adults. |
| What does RAI do? | Damages or destroys thyroid tissue. It has a 2-3 month delayed response. |
| What are some drawbacks to RAI? | There is a high incidence of hypothyroidism posttreatment due to the fact that doses are not able to be calibrated enough to not cause too much damage. It is very hit or miss with amount of damage done. May be a need for lifelong thyroid hormone replace |
| When would surgery be preferred over RAI? | Unresponsiveness to drug therapy, large goiters compressing the trachea (2-3 months too long), possible malignancy, individual not a good candidate for RAI. |
| What is a subtotal thyroidectomy? | removal of significant portion of thyroid (90% needs to be removed to be effective). It is the preferred surgical method. |
| What are some drawbacks to subtotal thyroidectomy? | Too much may be removed leading to hypothyroidism. |
| What meds may be administered prior to surgery, and why? | antithyroid drugs, iodine, beta-Adrenergic blockers. These are used to achieve a euthyroid state and to control symptoms. |
| What are some complications of surgery? | hypothyroidism, damage/removal of parathyroid glands, hemorrhage, laryngeal nerve damage, thyrotoxic crisis (Storm), infection. |
| What nutritional modifications are required? | High calorie, protein of 1-2 g/kg. Avoid caffiene, highly seasoned foods, high fiber foods as SNS problems may develop. |
| What are some nursing diagnoses relating to hyperthyroidism? | Activity intolerance, Risk for injury, imbalanced nutrition: less than body requirements, anxiety, insomnia. |
| What type of overall goals for nursing? | Relief of symptoms, Have no serious complications related to disease or treatment, maintain nutritional balance, cooperate with therapeutic plan. |
| Acute thyrotoxicosis | Hospitalization, aggressive treatment, thyroid blocking medications, IV fluids, ensure oxygenation, monitor for cardiac dysrhythmias, calm quiet room, cool room, light bed coverings, artificial tears, tape eyelids shut if they can't close them for sleep, |
| What is the biggest post op problems with thyroid surgery? | Airway problems. |
| What type of preoperative care? | alleviate signs/symptoms of thyrotoxicosis, control cardiac problems, Assess for signs of iodine toxicity, Oxygen, suction, tracheostomy tray in room. |
| Preoperative teaching? | Coughing, deep breathing, and leg exercises, supporting head while turning in bed, Range of motion exercises of neck, Speaking difficulty for a short time after surgery, Routine postop care. |
| Postop nursing care? | Assess (q 2 hrs X 24 hrs) for signs of hemorrhage and tracheal compression (irregualr breathing, neck swelling, frequent swallowing, choking), place in semi-fowlers postition, support head with pillow, avoid flexion of neck and tension on the suture lines |
| What if stridor is present? | Call for help!!! |
| What is stridor? | Intense wheezing trying to get air through a restricted airway. |
Created by:
mpabner
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