Hyperthyroid

• HEAT INTOLERANCE
• tachycardia
• full bounding pulse
• tachydysthythmias (A-fib)
• > stroke volume
• > CO and blood flow
• Dyspnea
• Tachypnea
• > appetite and thirst
• Weight loss
• Hyperactive bowel sounds
• > peristaltic activity (N/V/D)
• Splenomegaly
• Hepatomegaly
• Muscle weakness & fatigue
• Muscle wasting
• dependent edema
• osteoporosis
• Difficulty concentrating
• Tremors
• Nervousness
• Restlessness
• Emotional lability
• Insomnia
• Depression/Fatigue
• Hyperreflexia
• Stupor
• Profuse perspiration
• >basal temperature
• Rapid speech
• Goiter
• Exopthalamus
• Menstrual irregularities/ammenorrhea
• <libido
• gynecomastia in men
• impotence
• < fertility
• Hair loss (patchy)
• fine-silky hair
• warm smooth moist skin
• thin brittle nails
• clubbing of fingers or thyroid acropachy
• palmer erythema
• diaphoresis
• bitilago
• pretibial myxedema
• elelid retraction
• lid Lag (stare)
• >tearing

• Grave's Disease
• Thyrotoxicosis
• Thyrotoxic Crisis (Thyroid Storm)

• Autoimmune disorder
• Diffuse thyroid enlargement
• Excessive TSH secretion
• 75% of cases of hyperthyroidism
• Most common in Women 20-40 yo
• Too much T3 & T4 production
• Remission & Exacerbation with or without tx
• May progress to destruction of Thyroid tissue i.e. causing HYPOthyroidism
• Both Hyperthyroidism & Thyrotoxicosis found
• S/S
• Directly related to hyperthyroidism
• Goiter possible
• Exophthalmus
• Bruit possible
• A-Fib in older adults

• Physiological effects or clinical syndrome of hyper metabolism resulting fron excess circulating levels of T3, T4 or both
• Causes: Stress, Infection, Surgery or trauma, MI, CVA, texemia in preg., DKA
• Complication: Thyrotoxic Crisis (Thyroid Storm)

• SEVERE tachycardia (230-280)
• SEVERE Hyperthermia (up to 105.3)
• Restlessness
• Heart failure
• Shock
• Agitation
• Seizures
• Abd pain with N/V
• Dehydration
• Delirium
• Coma
• Severy HTN

Centers on reducing circulating thyroid hormone levels and reducing clinical minifestations.

We want to block adverse effexcts and stop oversecretion.

• Antithyroid drugs (PTU)
• Beta blocker (Inderol, Tenormin)
• Iodine
• Radio active Iodine
• Surgical therapy
• Manage respiratory distress
• Fever reduction
• Fluid replacement
• Eliminate stressors

• Antithyroid drugs
• Beta blockers
• Iodine
• Radioactive Iodine (RAI)

• Propylrthioeruacil (PTU)
• Methimazole (Tapazole)

• Must continue for 6-16 months
• NOT curative
• High rate of NONcompliance
• High rate of reoccurrence when drugs d/c

• Lowers hormone levels quickly
• Must be taken TID

Administered qd

• Grave's in young pt
• Hyperthyroidism during pregnancy
• May be admin to achieve euthroid state prior to surgery or radiation therapy

• Propranolol (Inderal)
• Atenolol (Tenormin)

• Rapidly provides symptomatic relief
• Usually admin with other antithyroid meds
• SE: arrhythmias; bradycardia; chf; pulmonary edema; fatigue; weakness; erictile dysfunction

• Preferred for pt with asthma or heart disease
• SE: Bradycardia; chf; pulmonary edema' fatigue; weakness; erectile dysfunction

• Decreases vascularity of thyroid gland
• Used with other antithyroid drugs to prep for thyroidectomy or tx of thyrotoxic crisis
• Lg dose rapidly inhibits synthesis of T3 & T4
• blocks te release of these hormones into circulation
• Max effects seen within 1-2 wks
• NOT effective in controlling hyperthyroidism long term

• Sip through straw
• Mix with juice or water d/t GI irritatation
• Assess for Toxicity: swelling of mucus membranes & buccal mucosa; excessive salivation; N/V; Skin reactions

• Tx choice for NON pregnant adults
• Pt is NOT radioactive
• Destroys thyroid tissue resulting in limited thyroid hormone secretion
• Delayed response: may not see results for 2-3 months
• Treat with antithyroid drgs & beta blocker until effects become apparent (3 mo)
• Necessitates need for life long thyroid hormone replacement!
• Usually effecxtive but with high incidence of post tx hypothyroidism.

• Thyroidectomy
• Subtotal thyroidectomy

• Used for:
• pt unresponsive to antithyroid therapy
• Barg goiters causing tracheal compression
• possible malignancy
• not good candidate for RAI
• Advantages:
• Rapid reduction in T3 & T4 levels than RAI alone

• Indications:
• Minimally invasive
• Appropriate for pt with sm nodules (<3cm)
• No evidence of malignancy
• Advantages:
• Less scaring
• Less pain
• Faster return to normal activity

• Preferred surg. proceedure
• Remove 90% of thyroid tissue
• Too much tissue removal results in hypothyroidism
• Complication:
• parathyroid gland removed or damaged-this leads to hypocalcemia and tetany. Can cause laryngeal stridor and need trach tube.

Euthyroid state by admin Iodine, Antithyroid med, beta blocker

• Deep breathing/cough/leg exercises
• post op positioninbg & turning
• Practice neck ROM exercises
• Inform talking may be difficult for short time post op
• expect hoarseness d/t edema
• Avoid caffeine
• scar will fade over time
• High calorie diet (4000-5000 Kcal/day); 6 sm meal/day; high protein, carb mineral & vitamin snacks
• AVOID spicy & high fiber foods

• O2
• suction equipment
• trach tube
• ***If tetany r/t parathyoid damage and hypocalcemia: IV calcium gluconate or IV gluceptate
• Assess q2h for 24hr
• hemorrhage
• trach compression (irregular breathing)
• Neck swelling
• frequent swallowing
• sensations of fullness @ incisiuon line
• choking
• Blood on anterior or posterior dressing
• support in semi-fowlers position
• support head with pillows
• avoid flexion of neck & any tension on suture lines
• monitor & assess VS per protocol
• Check for tetany (tingling around mth, toes, fingers; muscular twitching) for @ least 72 hrs
• Pain/admin meds to control
• Ambulate within hrs of surg
• fluids asatolerated
• soft diet day after surgery