-
hyperthyroidism
- excessive TH secretion
- - hyperactivity of gland
- risk:
- more in woman than man esp 20-40
- genetic, autoimmune
-
Graves disease
- most common form of hyperthyroidism
- toxic, diffuse goiter
- autoimmune disorder
- - abnormal stimulation of thyroid by immunoglobins
- hallmarks: hyperthyroidism, goiter, exopthalmus
-
hyperthyroidism
manifestations
- opposite of hypothyroidism
- incre appetite
- wt loss
- irritable, nervousness, hyperexcitablity
- loose stools
- tachycardia, palpitations
- chaotic emotions - up and down
- heat intolerance, skin flushed
- - hot
-
hyperthyroidism
manifestations
- amenorrhea- wt loss, chx in estrogen
- fatigue, weakness
- goiter- incr release of TH
- exopthalmus
- - not able blinking
- - injury
-
Dx
- elev T4, t3, t3u
- dec TSH
- dec chol
-
complications of hyperthyroidism
- exopthalmos
- heart disease- d/t incr demands
- thyroid storm
- more TH incr effects of catecholamines (this is release during stress)
-
Thyroid storm
- potentially fatal
- - early id and tc are essential
- various causes-
- - hyperthyroidism, infection, surgery, med OD, trauma, labor, MI, PE, after thyroidectomy
- ** high fever, > 103 severe tachycardia > 130, delerium (chx in mentation), dehydration (incr glome rate, diuresis), extreme irritability, HTN
-
management thyroid storm
- cooling blanket, tylenol
- oxygen therapy- inc O2 demand
- IVF
- Po/IV antithyroid drg
- glucocorticoids
- beta- blocker
-
management of graves disease
- meds
- radiodine
- surgery
- choice is based on age, goiter size, coexisting medical problems
- goal decre TH
-
Antithyroid meds
- to inhibit stages of TH development and release
- PTU- most commonly used
- - impairs TH synthesis
- - se- agranulcytosis, profound neutropenia (incr risk infection- mouth, respitory infectuib
- NI: effects in 1-2 months, compliance
- f/u
- take 3 x day
-
antithyroid meds 2
- Methimazole (tapazole)
- - blocks TH action in body
- - SE agranulocytosis- incr risk infection
- Iodine therapy
- - decr vascularity
- - dec circulating TH
- se- stains teeth- use straw, n/v, angioedema- airway
-
adjunct med
- beta blocker- propanalol
- glucocticoids- dec some TH
-
pt teaching
- maybe a delay of weeks to months between the start of therapy and improvement of symptoms
- not overnight
-
radioiodine therapy
- for middle age- elderly pt
- contraindicated in pregnancy
- local irradiation destroys cells
- **may go to far and cause myxedema
- symptoms should subside in 3-4 weeks
- f/u for hyperthyroidism
- cause u may loss too much
-
managment of alt in nutrition
- diet-
- high protein and cal
- - 6-8 meals a day 4000-5000 al
- incre fluids
- supplements
- monitor protein/albumin- at risk for underwt
- check wt q day- call md if loss > or = 2kg
-
Activity intolerance
- restful environment
- assess activity, pulse, o2 stat- may have difficulty sleeping
- assist and promote mobility
-
risk of injury
exothalmus
- artifical tears
- eye patches taping, PRN, dark glasses
- protect from irritants- dusk and smoke
- elev HOB a night
- NA restriction- dec edema
- glucocticoids
- surgery- last resort
-
Hyperthermia
- cool environemnt
- cooling blanket PRNchange beddings freg
-
surgical management of hyperthyroidism
total
- total thyroidectomy:
- - to remove thyroid CA
- - permanant TH replacement
- - parathyroid is also removed
- ---- risk for hypocalcemia
-
surgical management of hyperthyrodism
subtotal
- subtotal thyroidectomy- preferred 5/6 removed
- - may not need TH after
- - parathyroid maybe inadvertenly removed- risk for hypocal
- - need to be euthyroid preop- normal TSH- take antithyroid meds- prevent thyroid storm
- - effective in most peeps with graves disease
-
complications of thyroidectomy
- vocal cords paralysis- norm after surg should return in 3-4 days
- hypoparathyroidism
- hemorrhage
- throtoxicosis
- respiratory obstruction- edema of vocal cords
-
nursing management for thyroidectomy
- VS q 15 mins then q 30 min x 12 hr
- semi fowler's
- fluids then diet as tolerated
- pain management
- careful cough, deep breathing q 30 mins
- trachostomy set at the bedside
- humidified o2 via mask
-
nursing management thyroidectomy
more
- assess for dec in ca- tetany, muscle spasm, weakness, trosseau, chovect
- monitor Ca. Mg, Po4
- assess bleeding
- education
- - support head, ROM no flexion
- meds- may need synthyroid
- lanolin?
- f/u
|
|
