Hyperthyroidism (Diffuse Toxic Goiter or Graves Disease)

Hyperthyroidism is the term for overactive tissue within the thyroid gland, resulting in overproduction and thus an excess of circulating free thyroid hormones: thyroxine (T4), triiodothyronine(T3), or both.

Etiology and Pathophysiology

■ Diffuse toxic goiter (Graves’ disease) or autoimmune condition secondary to infection, crisis or stress. This leads to ↓thyroid-specific suppressor T-cell lymphocytes, which leads to ↑T3 (triiodothyronine) and/or ↑T4 (thyroxine). The result is an ↑metabolic rate and sensitivity to
catecholamines

■ Sudden severe hyperthyroidism is called thyrotoxicosis or thyroid storm

■ Hyperthyroidism generally occurs between 20 and 40yr old and is more
common in females

Signs and Symptoms

■ ↑T, ↑P, ↑R, and ↑BP; heart failure, enlargement of gland

■ Hunger, diarrhea, ↓weight

■ Tremors, nervousness, bulging eyes (exophthalmos)

■ Osteoporosis, amenorrhea

■ ↑Sweating, flushed skin, heat intolerance

■ ↑Radioactive iodine uptake, ↑T3, ↑T4, ↓TSH

■ Thyrotoxicosis: ↑T, P >120, delirium, coma

Treatment

■ Radioactive iodine destroys thyroid cells

■ Propylthiouracil or methimazole to ↓T4

■ Subtotal thyroidectomy (iodide before to ↓vascularity)

Nursing Management

■ Monitor for S&S of thyrotoxicosis

■ Provide calm, cool environment

■ ↑Protein, ↑calorie diet

■ Teach S&S of hypothyroidism, which may occur with treatment

■ Give eye care (drops, patches) prn

■ Thyrotoxicosis: Hypothermia blanket, oxygen, propranolol, steroids,
propylthiouracil, iodide
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