2. INTRODUCTION OF
HYPERTHYROIDISM
Excessive secretion or synthesis of thyroid hormone by thyroid
gland is known as hyperthyroidism, grave disease and
thyrotoxicosis.
Temperature, Pulse, Respiration and increases in this case.
It increase body’s metabolism casuing sudden weight and rapid or
irregular heartbeat, sweating and nervousness or irritability.
4. INCIDENCE
•In women , 4-40 times more than men.
•More common in women than in men; occurs in
about 2% of the female population.
5. Etiological Factors/ Causes
• Acute Infection
• Worry
• Anxiety
• Overwork
• Emotional Upset
• Over treatment of myxedema
• Over functioning of entire gland
• Plummber’s Disease (Multinodular Goitre)
• Graves' disease (most prevalent): diffuse hyperfunction of the thyroid
gland with autoimmune etiology and associated with ophthalmopathy.
• Hyperthyroidism is characterized by hypertrophy and hyperplasia of the
thyroid gland, which is accompanied by increased vascularity and blood
flow and enlargement of the gland.
6. Pathophysiology
Due to increased activity of SNS ( adrenergic)
Excessive amount of TH release
In response to this inc metabolic rate and alter fats, protein and CHO
metabolism
And due to Increase the beta adrenergic activity
Leading to tachy and increase CO, stroke vol.
7. Clinical Manifestations /
Signs & Symptoms
• Difficulty in sitting quietly.
• Muscle fatigability and weakness; amenorrhea.
• Nervousness, emotional lability, irritability, apprehension.
• Rapid pulse at rest and on exertion (ranges between 90 and 160); palpitations.
• Heat intolerance; profuse perspiration; flushed skin (e.g, hands may be warm,
soft, moist).
• Fine tremor of hands; change in bowel habits; constipation or diarrhea.
• Increased appetite and progressive weight loss; frequent stools.
• Atrial fibrillation possible (cardiac decompensation common in older patients).
• Bulging eyes (exophthalmos): seen only in Graves' disease.
• Thyroid gland may be palpable and a bruit may be auscultated over gland.
• Course may be mild, characterized by remissions and exacerbations.
• It may progress to emaciation, extreme nervousness, delirium, disorientation,
thyroid storm or crisis, and death.
8. SIGNS/ SYMPTOMS
CVS
• Hypertension
• Tachycardia
• Bound And Rapid Pulse
• Palpitation
RESPIRATORY SYSTEM
• Dysponea
• Increase Respiratory Rate
G.I.T
• Appetiteincrease but weight loss due to improper metabolism
• Diarrhea
• Spleenomegaly
• Hepatomegaly
MUSCULO- SKELETAL SYSTEM
• fatigue
• muscle weakness
10. Diagnostic Evaluation
• Physical Apperance
• Enlarged Neck
• History collection
• Protuding eyes
• ECG
• Thyroid Stimulating Hormone (TSH) Assay
• Elevated T3 and T4.
• 131I uptake scan may be elevated or below normal depending on the
underlying cause of the hyperthyroidism.
• Thyroid autoantibodies
• Elevated Tri-iodothyronine(T3)and radio immune assay (normal value
0.5ml-1.5ml U/L)
• Agitating expression due to basal metabolic rate (BMR).
11. Management
• Drugs that inhibit hormone formation:
• Thioamides: propylthiouracil (PTU)
• Act by depressing the synthesis of thyroid hormone
• May be given in divided daily doses (PTU) or in a single daily
dose.
• Duration of treatment is determined by clinical criteria.
• Thyroid gland becomes smaller.
• Uptakes of T4 and T3 are measured to determine
adequacy of dose.
• Treatment continued until patient becomes clinically
euthyroid; this varies from 3 months to 2 years; if
euthyroidism cannot be maintained without therapy, then
radiation or surgery is recommended.
12. PHARMACOLGICAL TREATMENT
Drugs to control peripheral manifestations of hyperthyroidism:
• Propranolol (Inderal).
• Acts as a beta-adrenergic blocking agent.
• Inhibits peripheral conversion of T4 to T3.
• Abolishes tachycardia, tremor, excess sweating, nervousness.
• Controls hyperthyroid symptoms until antithyroid drugs or radioiodine
can take effect.
• Glucocorticoids: decrease the peripheral conversion of T4 to T3, a more
potent thyroid hormone severe hyperactivity known as thyrotoxicosis,
thyroid storm or thyroid crisis.(Thyroid storm or crisis, an extreme form of
hyperthyroidism, is characterized by hyperpyrexia, diarrhea, dehydration,
tachycardia, arrhythmias, extreme irritation, delirium, coma, shock, and
death if not adequately treated.
• Thyroid storm may be precipitated by stress (surgery, infection) or
inadequate preparation for surgery in a patient with known
hyperthyroidism).
• Radioactive Iodine
Action: limits secretion of thyroid hormone by destroying thyroid tissue
13. SURGICAL MANAGEMENT
• Surgery
• SUBTOTAL THROIDECTOMY (REMOVAL OF ONE LOBE ).
• TOTAL THOIDECTOMY (REMOVAL OF GLAND )
• Used for those with large goiters, or for those for whom the use of
radioiodine or thioamides is contraindicated.
• Subtotal thyroidectomy involves removal of most of the thyroid gland
14. Complications
• Thioamide toxicity: agranulocytosis may occur suddenly.
• Hypothyroidism if over treated with ant thyroid medication or if
radiation treatment is used.
• Graves' disease.
• Features include exophthalmos, weakness of extraocular muscles, lid
edema, lid lag.
15. Nursing Diagnoses
• Imbalanced Nutrition: Less Than Body
Requirements related to hypermetabolic state and
fluid loss through diaphoresis.
• Providing Adequate Nutrition
• Determine the patient's food and fluid
preferences.
• Provide high-calorie foods and fluids consistent
with the patient's requirements.
• Provide a quiet, calm environment at meals.
• Restrict stimulants (tea, coffee, alcohol); explain
rationale of requirements and restrictions to
patient.
16. Nursing Management / Nursing Interventions
• Encourage and permit the patient to eat alone if embarrassed or if
otherwise disturbed by voracious appetite.
• Monitor I.V. infusion when prescribed to maintain fluid and
electrolyte balance.
• Monitor fluid and nutritional status by weighing the patient daily and
by keeping accurate intake and output records.
• Monitor vital signs to detect changes in fluid volume status.
17. Disturbed Thought Processes related to insomnia, decreased attention
span, and irritability
• Promoting Normal Thought Processes
• Explain procedures to patient in an unhurried, calm manner.
• Limit visitors; avoid stimulating conversations or television programs.
• Reduce stressors in the environment; reduce noise and lights.
• Promote sleep and relaxation through use of prescribed medications,
massage, and relaxation exercises.
• Minimize disruption of the patient's sleep or rest by clustering nursing
activities.
• Use safety measures to reduce risk of trauma or falls (padded side rails,
bed in low position).
18. Risk for Impaired Skin Integrity related to diaphoresis, hyperpyrexia,
restlessness, and rapid weight loss.
• Maintaining Skin Integrity
• Assess skin turgor, mucous membranes, and neck veins for signs of
increased or decreased fluid volume.
• skin frequently to detect diaphoresis.
• Bathe frequently with cool water; change linens when damp.
• Avoid soap to prevent drying and use lubricant skin lotions to pressure
points.
• Protect and relieve pressure from bony prominences while immobilized
or while hypothermia blanket is used.
19. Anxiety related to condition and concern about upcoming
surgery/radioiodine treatment
• Relieving Anxiety
• Encourage the patient to verbalize concerns and fears about illness and
treatment.
• Support the patient who is undergoing various diagnostic tests.
• Explain the purpose and requirements of each prescribed test.
• Explain results of tests if unclear to the patient or if questions arise.
• Clear up misconceptions about treatment options.
20. THANKYOU FOR YOUR ACTIVE
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IF ANY QUERY REGARDING THE TOPIC
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The End.
