Endocrine And Metabolic Disorders

Endocrine and Metabolic disorders Metabolic hyperthyroidism

JOY JOHN DIEGO JACQIE JEFF MARK LOUIE

JAYSON DOMINGO BENJO VENESSE ALVIN

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hyperthyroidism Description: ØAlso called Grave’s disease, Basedow’s disease, thyrotoxicosis or exophtalmos goiter. ØA metabolic imbalance resulting from excessive thyroid hormone production; Grave’s disease is the most common form.

Etiology and incidence: 1. 2. 3. Ø Ø Ø Ø Ø Ø

Autoimmune dysfunction Genetic factors Other possible causes: thyroid tumors pituitary tumors Hypothalmic malignancies stress or infection exposure to iodine Incidence is greatest between ages 30 and 40 and is higher in women than in men

How is hyperthyroidism diagnosed? 

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If not diagnosed shortly after birth, hyperthyroidism in the newborn can be fatal. In addition to a complete medical history and physical examination, diagnostic procedures for hyperthyroidism may include measurement of thyroid hormone in the bloodstream. Diagnosis is based on history, physical examination, and thyroid function tests. Serum TSH is the best test, because TSH is suppressed in hyperthyroid patients except when the etiology is a TSH-secreting pituitary adenoma or pituitary resistance to thyroid hormone. Free T4 is increased. However, T4 can be falsely normal in true hyperthyroidism in patients with a severe systemic illness (similar to the falsely low levels that occur in euthyroid sick syndrome) and in T3 toxicosis. If free T4 is normal and TSH is low in a patient with subtle symptoms and signs of hyperthyroidism, then serum T3 should be measured to detect T3 toxicosis; an elevated level confirms that diagnosis.

Possible Lab findings Increased T4 and T3 levels Non- detectable TSH Thyroid Ultrasonography shows an enlarged thyroid gland A thyroid scan indicates an increased uptake of radioactive iodine (RAI; 131I and 123I) 

O

ther Tests: Media file 1:  Iodine 123 nuclear scintigraphy: Iodine 123 scans of a normal thyroid

ANATOMY AND PHYSIOLOGY

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PATHOPHYSIOLOGY

Signs and Symptoms

Clinical manifestations Nervousness, irritability, hyperactivity, emotional lability, and decreased attention span.  Weakness, easy fatigability, exercise intolerance  Heat intolerance  Increased appetite, loses weight  Insomnia, interrupted sleep  Diarrhea, frequent stools  Irregular or scant menses, decreased libido  Warm, sweaty, flushed skin with velvety- smooth texture, elevated body temperature  Tremor, hyperkinesias, hyperreflexia  Exopthalmos, retracted eye lids, staring gaze  Hair loss (silky hair)  Goiter  Bruits over thyroid gland  Tachycardia, moderate hypertension 

Possible Nursing Diagnosis

Activity intolerance Hyperthermia High risk for injury Altered Nutrition: Less than Body requirements 

Complications  Graves

ophthalmopathy Graves ophthalmopathy is more common in women than in men.  Dermopathy . The skin changes usually include a nonpitting erythematous edema of the anterior shins. ØThyrotoxicosis/Thyroid storm ØHemorrhage ØHypocalcemia

Prevention  The

frequency and severity of symptoms of thyrotoxicosis vary from person to person.  Radiation exposure  Recording a careful family history of autoimmune disease, thyroid disease, and emigration from iodine-deficient areas is important.  Review a complete list of medications.

HEALTH TEACHINGS Medications: Iodine:

Potassium Iodide (Lugol’s Solution) saturated K iodide Propylthiouracil and methimazole: Tapazole β-Blockers: Propranolol (Inderal) Radioactive sodium iodine (131I, radioiodine): Radioiodine

Treatment Subtotal thyroidectomy (partial removal of the thyroid gland)  Total thyroidectomy (removal of the thyroid gland)  Treatment of infiltrative dermopathy and ophthalmopathy: In infiltrative dermopathy (in Graves' disease), topical corticosteroids sometimes relieve the pruritus. Dermopathy usually remits spontaneously after months or years. Ophthalmopathy should be treated jointly by the endocrinologist and ophthalmologist and may require corticosteroids, orbital radiation, and surgery. 

Diet No

special diet must be followed by patients with thyroid disease. Notably, excess amounts of iodide found in some expectorants, x-ray contrast dyes, seaweed tablets, and health food supplements should be avoided because the iodide interferes with or complicates the management of both antithyroid and radioactive iodine therapies.

Activity  Often,

in otherwise healthy patients with hyperthyroidism, exercise tolerance is not affected significantly. For these people, no reduction in physical activity is necessary. For elderly patients or for those with cardiopulmonary comorbidities, a decrease in activity is prudent until hyperthyroidism is medically controlled.  Often with severe thyrotoxicosis, systolic and diastolic cardiac dysfunction manifested by dyspnea upon exertion exists.

Nursing Management  The

Nurse monitors Heart rate and Blood pressure  He or she records the client’s sleep pattern and daily weights  The nurse promotes rest and helps the client avoid excess physical stimulation.  Increased caloric intake can compensate for increased metabolism.  The nurse informs the client that effects of anti-thyroid therapy usually are not apparent until the thyroid gland has secreted the excess thyroid hormone into the blood stream. This process may take several weeks or more.

NURSING CARE PLANS

DRUG STUDY

UPDATES!

Frequency  

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United States Graves disease is the most common form of hyperthyroidism. Approximately 60-80% of cases of thyrotoxicosis are due to Graves disease. The annual incidence of the disease is 0.5 cases per 1000 persons during a 20-year period, with the peak occurrence in people aged 20-40 years. Toxic multinodular goiter (15-20% of thyrotoxicosis) occurs more frequently in regions of iodine deficiency. Most persons in the United States receive sufficient iodine, and the incidence of toxic multinodular goiter is less than the incidence in areas of the world with iodine deficiency. Toxic adenoma is the cause of 3-5% of cases of thyrotoxicosis. International The incidences of Graves disease and toxic multinodular goiter change with iodine intake. Compared to regions of the world with less iodine intake, the United States has more cases of Graves disease and fewer cases of toxic multinodular goiters.

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Race Autoimmune thyroid disease occurs with the same frequency in Caucasians, Hispanics, and Asians, and it occurs less frequently in the black population. Sex All thyroid diseases occur more frequently in women than in men. Graves autoimmune disease occurs in a male-to-female ratio of 1:5-10. Toxic multinodular goiter and toxic adenomas occur more frequently in women than in men, with a ratio of 1:2-4. Age Autoimmune thyroid diseases have a peak incidence in people aged 20-40 years. Toxic multinodular goiters occur in patients who usually have a long history of nontoxic goiter and, therefore, usually present when they are older than 50 years. Patients with toxic adenomas present at a younger age than patients with toxic multinodular goiter.

Other updates: Seasonal Health News Fatigued or Full Throttle: Is Your Thyroid to Blame? By Debra Bruce Reviewed by: Brunilda Nazario Feeling all revved up, even at bedtime? Or maybe your throttle's on idle with symptoms of depression , fatigue, and weight gain. In both cases, the root cause may be your thyroid.  The thyroid -- a butterfly-shaped gland in the front of your neck -- makes hormones that control the way your body uses energy. Your thyroid controls your metabolism, which is how your body turns food into energy, and also affects your heart, muscles, bones, and cholesterol.  While thyroid disorders can range from a small, harmless goiter (enlarged gland) to lifethreatening cancer, the most common thyroid problems involve an abnormal production of thyroid hormones. Too much of these vital body chemicals results in a condition known as hyperthyroidism. Too little hormone production leads to hypothyroidism.  Although the effects of thyroid problems are unpleasant or uncomfortable, most thyroid conditions can be managed well if properly diagnosed and treated. What is an overactive thyroid?  Hyperthyroidism happens when the thyroid becomes overactive and produces too much of its hormones. Hyperthyroidism affects women five timesto 10 times more often than men, and is most common in people younger than 40. People with hyperthyroidism have problems that reflect overactivity of the organs of the body, resulting in symptoms such as sweating, feeling hot, rapid heartbeats, weight loss, and sometimes eye problems. 

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