thyroid disorder

5. Hyperthyroidism

7. What is thyroid gland?
• The thyroid gland is a butterfly-shaped
endocrine gland that is normally located in the
lower front of the neck. The thyroid’s job is to
make thyroid hormones, which are secreted
into the blood and then carried to every tissue
in the body.Thyroid hormone helps the body
use energy, stay warm and keep the brain,
heart, muscles, and other organs working as
they should.

12. Introductio
n
• Hyperthyroidism and thyrotoxicosis are used
interchangeably, however each refers to slightly
different conditions. Hyperthyroidism refers to
over activity of the thyroid gland, with resultant
excessive secretion of thyroid hormones and
accelerated metabolism in the periphery.
• Thyrotoxicosis refers to the clinical effects of an
unbound thyroid hormone, regardless of whether
or not the thyroid is the primary source. There are
a number of pathologic causes of hyperthyroidism
in children and adults.

13. CON
T..
• These include Graves disease, toxic adenoma,
toxic multinodular, goiter, and thyroiditis,
Graves disease accounts for approximately
95% of cases of hyperthyroidism, To
understand the pathophysiology of
hyperthyroidism, it is necessary to understand
the normal physiology of the thyroid gland.

15. INCIDEN
CE
• Incidence of Women 66.4% and
33.6%
in men, 15%
of
cases occur in patients older than 60 years of
age.
• In India, a large number of people suffer from
thyroid disorders. Previous studies reveal that
almost 42 million Indians suffer from thyroid
disorders. Unfortunately, awareness about the
disease is low. A recent study across 8 cities of
India (ABCDGHKM) revealed the prevalence of
thyroid disorders in around 11 % of the urban
population, with women being 3 times more
prone to the disease thanmen.

17. Hyperthyroidism is a
medical condition that
results from an excess of
thyroid hormone in the
blood.

18. Etiology
• Ectopic thyroid disease
• Grave’s disease
• Multi-nodular disease
• Thyroid adenoma
• Subacute thyroiditis
• Ingestion of thyroid hormone
• Pituitary disease
• Ingestion of food containing thyroid hormone
• High dietary iodine intake or very low dietary
intake.
• Genetic factor.

19. 1.Ectopic thyroid disease
Ectopic thyroidtissue are related to
the growth of the thyroid tissue,
causing dysphasia, dysphonia with
stomatolalia, bleeding, or dyspnea
lead to hyperparathyrodisum.

20. GRAVES' DISEASE
Graves' disease is a type of autoimmune
problem that causes the thyroid gland to
produce too much thyroid hormone, which is
called hyperthyroidism. Graves' disease
is often the underlying cause of
hyperthyroidism.

21. MULTI-NODULAR DISEASE
Sometimes, a person can have a goiter
that has multiple nodules or bumps on it,
which is
called a multinodular goiter. A toxic goiter is
one that makes too much thyroid hormone,
resulting in a condition called
hyperthyroidism. Most
thyroid nodules are harmless, but some
can be cancerous

22. THYROID ADENOMA
This occurs when a single nodule (or lump)
grows on the thyroid gland causing it to
become enlarged and produce excess thyroid
hormones. If the increased hormone
production is coming from a single nodule in
the gland, this is called
toxic adenoma.

23. SUBACUTE THYROIDITIS
Subacute thyroiditis is an acute inflammatory
disease of the thyroid probably caused by a
virus. Symptoms include fever and thyroid
tenderness. Initial hyperthyroidism is
common, sometimes followed by a transient
period of hypothyroidism. Diagnosis is clinical
and with thyroid function tests.

24. INGESTION OF THYROID HORMONE
Exogenous hyperthyroidism is the term used
to describe hyperthyroidism caused by
ingestion of excessive amounts of thyroid
hormone. It may be intentional (ie, suppressive
doses of thyroxine to treat thyroid cancer) or
inadvertent (ie, contamination of dietary
supplements).

25. PITUITARY DISEASE
TSH-secreting pituitary adenomas are benign
tumours of the pituitary gland. They produce
too much thyroid stimulating hormone (TSH),
which causes the thyroid gland to enlarge and
produce thyroid hormone in excess, leading to
an overactive thyroid (hyperthyroidism).

26. Ingestion of food containing
thyroid hormone lead to
hyperthyroidism
Due to the high iodine content,
supplements containing kelp should be
After
1 month of treatment, the thyroid
hormone levels returned to salt into foods
and nutrition to prevent hypothyroidism
and cardiovascular diseases.

27. High dietary iodine intake or
very low dietary intake. lead to
hyperthyroidism
However, too high iodine intake, for example
due to overdosage of iodine supplements, can
have toxic side effects. It can lead to
hyperthyroidism and consequently high blood
levels of thyroid hormones (hyperthyroxinemia).

28. GENETIC FACTOR
hereditary toxic thyroid hyperplasia or
autosomal dominant autoimmune
hyperthyroidism. It
is hereditary through dominant activating
mutation of the TSH receptor (TSHR) affecting
all thyroid cells.

29. Pathophysiolo
gy
Hyperthyroidisms characterized by loss normal regulatory control of thyroid
hormone secretion.
The action of thyroid hormone on the body is stimulatory, hyper
metabolism result
Increase sympathetic nervous system activity
Alteration secretion and metabolism of hypothalamic pituitary and
gonadal hormone.
Excessive amount of thyroid hormone stimulate the cardiac system and
increase the adrenergic receptors.
Tachycardia and increase cardiac –output, stroke volume and
peripheralblood flow.
Negative nitrogenous balance, lipid depletion and the resultant state
ofnutritional deficiency.

30. Clinical
manifestation
• Symptoms and their severity depend on duration
and extent of thyroid hormone excess, and the age
of the individual. Individuals may experience:
• Nervousness and irritability
• Palpitations and tachycardia
• Heat intolerance or increased sweating
• Tremor
• Weight loss or gain
• Increase in appetite
• Frequent bowel movements or diarrhea
• Lower leg swelling
• Sudden paralysis
• Shortness of breath with exertion
• Decreased menstrual flow
• Impaired fertility
• Sleep disturbances (including insomnia)

32. Cont..
• Changes in vision
– Photophobia, or light sensitivity
– Eye irritation with excess tears
– Diplopia, or double vision
– Exophthalmos, or forward protrusion of the eyeball
– Fatigue and muscle weakness Thyroid enlargement
Pretibial myxedema (fluid buildup in the tissues
about the shin bone; may be seen with Grave's
disease)

34. Investigation
• History and physical examination
• Ophthalmic examination
• ECG- atrial tachycardia
• Thyroid function test: T3 andT4
• Thyroid releasing hormone stimulation test
• Radioactive iodine uptake (RAIU)
• Thyroid scan

35. Cholesterol test
Your doctor may need to check your
cholesterol levels. Low cholesterol can be a
sign of an elevated metabolic rate, in which
your body is burning through cholesterol
quickly.
T4, free T4, T3
These tests measure how much thyroid
hormone (T4 and T3) is in your blood.

36. Thyroid stimulating hormone level test
Thyroid stimulating hormone (TSH) is a
pituitary gland hormone that stimulates the
thyroid gland to produce hormones. When
thyroid hormone levels are normal or high, your
TSH should be lower. An abnormally low TSH
can be the first sign of hyperthyroidism.
Triglyceride test
Your triglyceride level may also be tested.
Similar
to low cholesterol, low triglycerides can be a
sign of an elevated metabolic rate.

37. Thyroid scan and uptake
This allows your doctor to see if your thyroid
is overactive. In particular, it can reveal
whether the entire thyroid or just a single area
of the gland is causing the overactivity.
Ultrasound
Ultrasounds can measure the size of the
entire thyroid gland, as well as any masses
within it.
Doctors can also use ultrasounds to
determine if a mass is solid or cystic.
CT or MRI scans
A CT or MRI can show if a pituitary tumor is

38. Treatme
nt
1. Radioactive iodine
Takenby mouth, radioactive iodine is
absorbed by your thyroid gland, where it
causes the gland to shrink and symptoms to
subside, usually within three to six months.

40. 2. Anti-thyroid
medications
• These medications
gradually reduce symptoms
of hyperthyroidism by
preventing your thyroid
gland from producing
excess amounts of
hormones. They include
propylthiouracil and
methimazole (Tapazole).
• Symptoms usually begin to
improve in 6 to 12 weeks,
but treatment with anti-
thyroid medications typically
continues at least a year

41. 3. Beta
blockers
• These drugs are
commonly used to treat
high blood pressure.
They won't reduce your
thyroid levels, but they
can reduce a rapid heart
rate and help prevent
palpitations. Side effects
may include fatigue,
headache, upset
stomach, constipation,
diarrhea or dizziness.

42. Surgical
management
• Surgical Treatment of Thyroid Disease
General Several surgical options exist for
treating thyroid disease and the choice of
procedure depends on two main factors.
• The first is the type and extent of thyroid
disease present.
• The second is the anatomy of the thyroid
gland itself. The most commonly performed
procedures include: lobectomy, lobectomy
with isthmectomy, subtotal thyroidectomy, and
total thyroidectomy.

45. Nursing management
1. Imbalancednutrition less than body
requirement related to anorexia and
increase metabolic demand is
inappropriate.
Intervention:
- High calorie diet (4000-5000 kcal/day)
- High protein diet (1-2 g/kg of ideal body
weight)
- Frequent meals

46. 2. Activity intolerance related to exhaustion
secondary to accelerated metabolic rate
resulting in inability to perform activity
without shortness of breath and significant
increased in heart rate
Intervention:
- Assist with regular physical activity.
- Assist in activities of daily living
- Assist the patient to schedule rest
periods.

47. Cont.
.
3. Risk for injury: corneal ulceration,
infection and not possible blindness
related inability to close the eye lids
secondary to exophthalmos.
4. Hyperthermia related to accelerated
metabolic rate resulting in fever,diaphoresis
and reported heat intolerance.
5. Impaired social interaction related to
extreme agitation, hyperactivity, and mood
swings resulting in inability to relate
effectively with others

48. Hypothyroidism
• Abnormally low activity of the thyroid
gland, resulting in retardation of growth
and mental development in children and
adults.

50. A condition in which the thyroid gland
doesn't produce enough thyroid
hormone.
Hypothyroidism's deficiency of thyroid
hormones can disrupt such things as heart
rate, body temperature and all aspects of
metabolism.
Hypothyroidism is most prevalent in older
women. Major symptoms include fatigue,
cold sensitivity, constipation, dry skin and
unexplained weight gain.

52. INCIDEN
CE
• Worldwide about one billion people are
estimated to be iodine deficient; however,
it is unknown how often this results in
hypothyroidism.
• In large population-based studies in
Western countries with sufficient dietary
iodine, 0.3– 0.4% of the population have
overt hypothyroidism.
• A larger proportion, 4.3–8.5%,
have subclinical hypothyroidism.
• Women are more likely to
develop hypothyroidism than
men.

53. Risk
factors
• Although anyone can develop hypothyroidism,
you're at an increased risk if you:
• Are a woman older than age60
• Have an autoimmune disease
• Have a family history of thyroid disease
• Have other autoimmune diseases, such
asrheumatoid arthritis or lupus, a chronic
inflammatorycondition
• Have been treated with radioactive iodine
oranti- thyroid medications
• Received radiation to your neck or upper chest
• Have had thyroid surgery (partial thyroidectomy)
• Have been pregnant or delivered a baby
within the past six months

54. Causes of hypothyroidism
• Medication: A number of medications can
cause Hypothyroidism. Lithium, which is
used to treat certain psychiatric disorders,
can also affect the thyroid gland.
• Genetic dysfunction: The thyroid gland may
be dysfunctional at birth, or may fail at some
phase in adult life.
• Previous thyroid surgery: Removal of a
large portion or the entire thyroid gland may
reduce or stop the process of thyroid
hormone production.
• Treatment for Hyperthyroidism:
Treatmentfor Hyperthyroidism may
sometimes result in Hypothyroidism.

55. Causes of hypothyroidism
• Radiation therapy: Exposure of the thyroid
gland to radiation therapy for the treatment of
cancers of the head and neck region may
result in Hypothyroidism.
• Damage to the Pituitary Gland: The
pituitary gland may be damaged due to
disease orsurgery which may result in
decreased level of thyroid hormones.
• Autoimmune Thyroid Disease: This is the
most common cause of Hypothyroidism.
This happens when the body's immune
system produces certain antibodies that
attack its own thyroid gland leading to a
reduced thyroid hormone production.

58. Sign and
symptoms
• Hypothyroidism signs and symptom may
include:
• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual
periods
• Thinning hair
• Slowed heart rate
• Depression

60. Investigation
• History and physical examination
• Serum T3,T4
• Serum TSH.
• Serum cholesterol
• TRH stimulation test

61. Treatme
nt
• Thyroid hormone replacement
e.g: levothyroxine
• Monitor thyroid hormone level and
adjusted dosages
• Nutritional therapy to promote weight
loss