Hyperthyroidism

Question 1

What is hyperthyroidism?

Occurs 5x more in which gender
At what age range?

Answer 1

Hyperactivity of the thyroid gland with a sustained increase in production and release of thyroid hormones by thyroid gland

Women
20-40

Question 2

There is a image on page 2 where it shows the stages of hypo and hyper

Most extreme
Thyrotoxicosis
Hyperthyroidism
Euthyroid
Hypothyroidism
Myxedema coma

Question 3

What is the most common form of hyperthyroidism?

Notes
Other causes
- toxic modular goiter
- thyroditis
- excess iodine intake
- pituitary tumors
- thyroid cancer

Answer 3

Graves’ disease

Question 4

What is Graves’ disease?

Answer 4

An autoimmune disease characterized by thyroid enlargement and excess thyroid hormone secretion

Question 5

What is the pathophysiology of Graves’ disease?

Notes
- remissions and exacerbations regardless of treatment
- may progress to destruction of thyroid tissue

Answer 5

Antibodies to TSH receptor stimulate release of T3 and T4
- this leads to clinical manifestations of thyroxtocisosis

Question 6

What is thyrotoxicosis ?

Results from

Answer 6

Physiologic effects/clinical syndrome of hyper metabolism
- results from increase circulating levels of T3 and T4

Question 7

Does hyperthyroidism and thyrotoxicosis usually occur together?

Answer 7

Yes

Question 8

What are precipitating factors that interact with Graves’ disease? (5)

Answer 8

Genetic
Iodine supply decrease
Infection
Stress
Smoking

Question 9

Graves’ disease is about 80% of cases? True or false

Answer 9

True

Question 10

What are clinical manifestations of hyperthyroidism? (3)

Give two examples on what to do for the last one and hearing what

Answer 10

Increase metabolism
Increase tissue sensitivity to stimulation of SNS

Goiter
- inspection
- auscultation hearing bruits & increase blood supply

Question 11

What is the biggest manifestation for hyperthyroidism?
Which also means?

Notes
Exophthalmos - bilateral
- increase fat deposits and fluid
- eyeballs forced outward
- whites seen above iris
- eyelids do not always completely close
- diplopia possible

Answer 11

Ophthalmopathy

Abnormal eye appearance or function

Question 12

Notes
Cardiovascular system
- systolic hypertension
- bounding rapid pulse, palpitation
- increase cardiac output
- cardiac hypertrophy
- systolic murmurs
- dysrthythmias ( A fib )
- angina

Question 13

Notes
Respiratory system
- increase rr
- dyspnea on mild exertion

Question 14

Notes
Gi system
- increase appetite and thrist
- weight loss
- diarrhea
- splenomegaly & hepatomegaly

Question 15

Notes
Integumentary system
- warm, smooth moist skin
- thin brittle nails
- hair loss
- clubbing of fingers !!
- Palmer erythema
- fine, silky hair, premature graying
- diaphoresis !
- vitiligo !

Question 16

Patients may also experience something called pre-tibial myxedma & acropachy climbing of the fingers and soft tissue swelling

Notes !

Question 17

Notes
Musculoskeletal system
- fatigue
- muscle weakness
- proximal muscle wasting
- dependent edema
- osteoporosis

Question 18

Notes
Nervous system
- nervousness, anxiety, fine tremors
- insomnia
- exhaustion
- lability of mood, delirium
- hyperreflexia of tendon reflexes
- inability to concentrate
- stupor,coma

Question 19

Notes
Reproductive system
- menstrual irregularities
- amenorrhea
- decrease libido
- impotence
- gynecomastia in men
- decrease fertility

Question 20

What are the overall clinical manifestations (5)

Answer 20

Intolerance to hear
Elevated basal temperature
Lid lag, stare
Eyelid retraction
Rapid speech

Question 21

What is thyrotoxicosis?
Is it life threatening emergency?
Results from (4)

Death is rare when treatment is initiated
Thyroid storm may be the first indication of the disease

Answer 21

Excessive amounts hormones released

Yes

Stressors, infection, trauma, surgery
Espeically thyroidectomy

Question 22

What are the manifestations of thyrotoxicosis ? (12)

Answer 22

Tachycardia
Heart failure
Shock
Hyperthermia ( 105.3!)
Restless
Irritability
Seizures
Abdominal pain
Vomiting
Diarrhea
Delirium
Coma

Question 23

What’s an ancroym to help me remember the 12 manifestations for thyrotoxicosis ?

Answer 23

Tachy
Hair
Shocks
Hyper
Reality
International
Sensation
Addy
Velvet

Dies
Delirus
Coma

Question 24

How do you treat thyrotoxicsis? (4)

Answer 24

Reducing circulating hormones
- manage respiratory distress
- reduce fever
- replace fluids
- eliminate/mange stressor

Question 25

What are diagnostic studies ? TSH low or high FT4 low or high What test can you do?

Answer 25

TSH is low FT4 is high Radioactive iodine uptake (RAIU)

Question 26

What does radioactive iodine uptake (RAIU) do? Graves’ disease shows > ___% iodine uptake Thyroidits has <__% uptake

Answer 26

Differentiates Graves’ disease from other forms of thyroditis 35% 2%

Question 27

What is the goal of hyperthyroidism? Dont over think it

Answer 27

Suppress hormone over secretion Block adverse effects of thyroid hormones Prevent complications

Question 28

What are the 3 primary treatment options?

Answer 28

Anti thyroid medications Radioactive iodine therapy Surgery

Question 29

What are the 3 drugs we will use? It’s not curative btw!!

Answer 29

Antithyroid drugs Iodine B adrenergic blockers

Question 30

What is the name of the anti thyroid drug? How is it given ^? When can it be given (3) Another drug is ? How often do you give it? What is the process? Improvment in ___ to ___ weeks Good results in ___ to __ weeks Therapy for ___ to ___ months

Answer 30

Proplythiouracil (PTU) TID 1st trimester, young patient, thyrotoxic crisis Methazole ( Tapazole ) Daily Inhibits synthesis of thyroid hormone 1-2 4-8 6-15

Question 31

How does iodine help? Decreases their what and makes what safer? Maximal effect within __to __ weeks ( not effective long term ) This is used before surgery and to treat crisis

Answer 31

Inhibit synthesis of T3 and T4 and block their release into circulation Decrease vascularity of thyroid gland - makes surgery safer 1-2

Question 32

What is B adrenergic blockers do? Decrease what (4) Name a medication Atenolol (Tenormin) - best with CAD pt

Answer 32

Symptoms relief of thyrotoxicosis Decrease tachycardia, nervousness, irritability and tremors Propranolol (inderal)

Question 33

To who is radioactive iodine therapy usually given to? This is dangerous why? And causes It has a delayed response of how many months? Treated with antithyroid drugs and b block before and during first 3 months of RAI

Answer 33

Non pregnant adults Damages your thyroid tissue 80% of hypothyroid 2-3minrha

Question 34

What should be done first before doing radioactive iodine therapy for women?

Answer 34

Pregnancy test

Question 35

What are we going to teach patients who are doing radioactive iodine therapy to do?

Answer 35

Oral care - salt water gargles, ice chips, magic mouthwash And symptoms of hypothyroidism

Question 36

Notes Radiation precautions - use seperate bathrooms - flush 2-3 times - wash towels,sheets, clothes seperate and every day - do not prepare food for others that requires prolonged handling with bare hands - avoid being close to pregnant woman and children for 7 days

Question 37

What is the 4 indicators for surgery ? This helps with what,?

Answer 37

Large goiter - causing tracheal compression - unresponsive to antithyroid therapy - thyroid cancer - not a candidate for RAI Rapid reduction if T3/T4

Question 38

Notes Subtotal thyroidecomty - preferred surgical procedure - involves removal of 90% of thyroid - can be done endoscopically

Question 39

What is the nutritional therapy? (4) Avoiding what? (2) - caffeine Dietitian referral!

Answer 39

High calorie diet (4-5K daily) Six full meals with snacks Protein intake 1-2g ideal body weight Increase carbodhyrate intake Highly seasoned High fiber foods

Question 40

Notes Nursing assessment Subjective data - past health history - goitered recent infection, trauma, immigration from iodine deficient area, autoimmune disease Medications - thyroid hormones - herbal therapies Family history Iodine intake Weight loss Increase appetite thirst Nausea vomitting Diarrhea Polyuria Sweating Dyspnea on exertion Palpitations Muscle weakness Fatigue Insomnia Chest pain Nervousness Heart intolerance Pruritus Decreased libido Impotence Gynecosmastia Amenorrhea Emotional lability Personality changes Delirum

Question 41

Notes Nursing assessment objective Agitation Rapid speech Anxiety Restless Hyperthermia Enlarged or nodular thyroid gland Exophthlamos Eyelid retraction, infrequent blinking Warm diaphoretic velvety skin Thin loose nails Fine silky hair Palmar erythema Clubbing Vitiligo Edema Tachypena Dyspnea Tachycardia Bounding pulse Murmurs HTN Bruit Increase bowel sounds Increase appetite Diarrhea Weight loss Hepatosplenomegaly Hyperreflexia Fine tremors Muscle wasting Infertility Increase T3/T4 Increase T3 resin uptake Decrease OR undetectable TSH Chest x ray enlarged heart ECG of tachy

Question 42

Notes Nursing diagnosis - activity intolerance - imbalanced nutrition

Question 43

Notes Nursing planning - experience relief - have no serious complication related to disease or treatment - maintain nutritional balance - cooperate with theraputeic plan

Question 44

Nursing implementation Acute thyrotoxicosis - agresstive treatment - medications block SNS - monitor dysthymias - oxygenation - fluid & electrolye replacement - be calm quiet and cool

Question 45

If exophthalmos is present ( large eyes ) what should you do ? (6)

Answer 45

Apply tear drops Salt restriction Elevate head of bed Dark glasses Tape eyelids closed if needed to sleep ROM of intraocular muscular

Question 46

Notes Nursing implementation Preoperative care - administer medications to achieve euthryoidism - administer iodine to decrease vascularity - asses for signs of toxicity - comfort and Stafety - leg exercise

Question 47

What are the 4 signs of iodine toxicity?

Answer 47

Swelling of buccal muscosa Excessive salivation Nausea/vomiting Skin reactions

Question 48

Notes Nursing implementation Monitor for complications - hypocalcemia - hemorrhage - laryngeal nerve damage - thyrotoxic crisis - infection Maintain patent airway - oxygen, suction equipment, tracheostomy tray in patient room - monitor for laryngeal stridor ( edema or hypocalcemia ) - IV calcium readily viable Asses every 2 hours first 24 hours Hemorrhage or tracheal compression Semi flowers position Support head with pillows Avoid neck Flexion Monitor vital signs and calcium levels Analgesics Ambulating Psychosocial support

Question 49

What are the 3 signs of hypocalcemia?

Answer 49

Difficulty speaking/hoarseness Trousseaus and Chvostek sign

Question 50

Notes Nursing implementation Discharge teaching - monitor hormone balance - decrease caloric intake - regular exercise - no excessive iodine - avoid hot environments Regular follow up Symptoms of surgery Evaluations - relief of symptoms - no complications - cooperate with therapeutic plan