Hyperthyroidism is a condition caused by excessive production of thyroid hormones. Graves' disease is the most common cause. Common symptoms include palpitations, weight loss, nervousness, and eye problems. Treatment options include antithyroid medications to suppress hormone production, radioactive iodine therapy to damage the thyroid gland, and surgery to remove part or all of the thyroid. Nursing care focuses on monitoring for side effects of medications and complications related to thyroid hormone imbalance or surgery.

1. HYPERTHYROIDISM
PRESENTED BY – SAKSHI DUMKA

3. DEFINITIO
N• HYPERTHYROIDISM IS HYPERACTIVITY OF
THYROID GLAND WITH SUSTAINED INCREASE IN
SYNTHESIS AND RELEASE OF THYROID
HORMONES.
- Lewis medical and surgical textbook

4. CLINICAL STATISTICS
GRAVES DISEASE IS THE MOST COMMON CAUSE OF
HYPERTHYROIDISM (60-70%) OF ALL CASES
 FEMALES ARE AFFECTED MORE FREQUENTLY THAN MEN-
10:1
 MONOZYGOTIC TWINS SHOWS 50% CONCORDANCE RATES
 INCIDENCE PEAKS FROM AGE 20-40 YEAR
 42 MILLION PEOPLE IN INDIA SUFFER FROM THYROID
DISEASES.

5. CLINICAL MANIFESTATION

6. CARDIOVASCULAR SYSTEM
SYSTOLIC
HYPERTENSION
PALPITATIONS
ANGINA
CARDIAC
HYPERTROPHY
DYSRHYYTHMIAS
BOUNDING/RAPID
PULSE

7. GASTROINTESTINAL SYSTEM
• INCREASED APPETITE
• INCREASED THIRST
• WEIGHT LOSS
• HEPATOMEGALY AND SPLEENOMEGALY
• DIARRHEA

8. NERVOUS SYSTEM
DIFFICULTY FOCUSSING EYES
NERVOUSNESS
FATIGUE
INSOMNIA
STUPOR
TREMORS
COMA

9. MUSCULOSKELETAL SYSTEM
FATIGUE
PROXIMAL
MUSCLE
WASTING
WEAKNESS
OSTEOPOROSIS
DEPENDENT
EDEMA

10. INTEGUMENTARY SYSTEM
WARM, SMOOTH,MOIST SKIN
ONYCHOLYSIS
CLUBBING OF FINGERS
PALMAR ERYTHEMA
DIAPHORESIS

11. REPRODUCTIVE SYSTEM
MENSTRUAL
IRREGULARITY
AMENORRHEADECREASED
FERTLITY

12. OTHERS
INTOLERANCE TO HEAT
 EXOPTHALMOS
 EYELID RETRACTION
 LID LAG
 ELEVATED TEMPERATURE

13. TOXIC NODULAR GOITRE
THYROID
ACROPACHY
LID LAG AND EYE
RETRACTION

15. COMPLICATIONS
 THYROTOXIOSIS
 SEVERE ACROPACHY
 CARDIAC HYPERTROPHY
 OPTHALMOPATHY ( Thyroid eye disease)
 SARCOPENIA

17. MANAGEMENT

18. MEDICAL MANAGEMENT
• Goal: Block the adverse effect of excessive thyroid
hormone, suppress oversecretion of thyroid
hormone and prevent complication
• Diagnostic assessment –
History and physical examination
Ophthalmologic examination
ECG
Lab tests( T3, T4, TSH )

19. 1. RADIOACTIVE IODINE THERAPY (RAI)
• USED TO TREAT TOXIC ADENOMA / MULTINODULAR GOITRE AND
THYROTOXICOSIS.
• ACTION: DESTROY/ DAMAGE THYROID TISSUE . BLOCKS RELEASE
OF THESE HORMONES INTO CIRCULATION.
• CONTRAINDICATED IN PREGNANCY
TEACH PATIENT/ FAMILY ( LIMIT EXPOSURE)
 USING PRIVATE TOILET FACILITIES
 SEPARATE LAUNDERY
 AVOID CLOSE CONTACT WITH PREGNANT WOMEN AND
CHILDREN

20. 2. BETA- ADRENERGIC BLOCKING AGENT
• USED TO RELIEF SYMPTOMS OF THYROTOXICOSIS.
• BLOCK EFFECTS OF SYMPATHETIC NERVOUS
STIMULATION THEREBY DECREASING: TACHYCARDIA,
NERVOUSNESS, IRRITABILITY AND TREMORS.
• Eg : PROPRANOLOL , ATENOLOL

21. 3. ANTITHYROID DRUGS
• FIRST LINE DRUG : PROPYLTHIOURACIL AND METHIMAZOLE. THEY INHIBIT SYNTHESIS OF
THYROID HORMONES.
• INDICATIONS :
 GRAVES DISEASE
 HYPERTHYROIDISM IN PREGNANCY
 BEFORE SURGERY( FOR EUTHYROID STATE)
DOSE:
METHIMAZOLE – SINGLE DOSE DAILY
PROPYLTHIOURACIL- 3 TIMES A DAY .
IMPROVEMENT SEEN WITHIN 1-2 WEEKS AFTER START DOSE.

22. 4. ADJUNCTIVE THERAPY
• IODINE SOLUTION IS USED WHICH BLOCKS CONVERSION OF
T4 TO T3. LIKE:- lugol’s solution, potassium iodide
• INDICATION :
• PREGNANCY WHEN ANTITHYROID NOT USE
• PREOPERATIVELY WHEN OTHERS ARE INEFFECTIVE.
• REDUCE GLAND VASCULARITY BEFORE SURGERY FOR
GRAVES DISEASE .

23. S.N AGENT ACTION NURSING RESPONSIBILTY
1. PROPYLTHIOURACIL
(PTU)
Blocks synthesis of
hormone
Monitor cardiac parameter.
Observe for conversion to
hypothyroidism.
Watch for rash, nausea,
vomiting.
2. METHIMAZOLE Inhibit synthesis of
thyroid hormone.
More toxic than PTU
Watch for rash, vomiting and
other symptoms.
3. SODIUM IODIDE Suppress release of
thyroid hormone.
Give 1 hr after PTU or
methimazole.
4. DEXAMETHASONE Suppress release of
thyroid hormone.
Monitor intake output
Monitor blood glucose
5. BETA- BLOCKER Beta adrenergic blocking
agent.
Monitor cardiac status
use with caution for cardiac

24. SURGICAL MANAGEMENT
• TOTAL THYROIDECTOMY
• SUBTOTAL THYROIDECTOMY
• THYROID LOBECTOMY
• HEMITHYROIDECTOMY