Final Hyper

Hyperthyroidism

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a.k.a Thyrotoxicosis; Overactive thyroid is the term for overactive tissue within the thyroid gland, resulting in overproduction and thus an excess of circulating free thyroid hormones: thyroxine (T 4), triiodothyronine (T3), or both. Thyroid hormone is important at a cellular level, affecting nearly every type of tissue in the body. Is a metabolic imbalance that results from overproduction of the thyroid hormones triiodothyronine(T3) and thyroxin(T4).

Risk Factors

Non-modifiable:

➢ Age(>50) – degeneration that happens with aging increases one’s risk for hyperthyroidism.

➢ Gender -- Graves' disease and hyperthyroidism affect women 8 times more often than men.

➢ Heredity – family history of hyperthyroidism increases one’s risk of acquiring the disorder.

➢ Grave's disease - the most common cause of hyperthyroidism, is characterized by hyperthyroidism and one or more of the following: ○

Goiter

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Exophthalmos

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Infiltrative dermopathy

Graves' disease is caused by an autoantibody against the thyroid receptor for thyroidstimulating hormone (TSH); unlike most autoantibodies, which are inhibitory, this autoantibody is stimulatory, thus producing continuous synthesis and secretion of excess T4 and T3.

Assessment

ACTIVITY/REST: May report: Nervousness, increased irritability, insomnia, muscle weakness, incoordination, extreme fatigue. May exhibit: Muscle Atrophy

CIRCULATION: May report: palpitations, chest pain(angina) May exhibit: dysrhythmias(atrial fibrillation); gallop rhythm, murmurs, elevated BP with widened pulse pressure, tachycardia at rest, circulatory collapse, thyrotoxic crisis

ELIMINATION: May report: urinating in large amounts, diarrhea

EGO INTEGRITY: May report: recent stressful experience, e.g., emotional/physical May exhibit: emotional lability (mild euphoria to delirium); anxiety/depression

Nursing Diagnoses

1. Hyperthermia r/t hypermatabolic state. 2. Decreased cardiac output May be related to: ➢ Hypermetabolic rate ➢ increased cardiac workload ➢ changes in venous return and systemic vascular resistance. 1. Fatigue May be related to: ➢ Hypermetabolic state with increased energy requirements. ➢ Altered body chemistry 1. Anxiety May be related to: ➢ Physiologic factors: Hypermetabolic state (CNS stimulation), pseudocatecholamine effect of thyroid hormones 1. Disturbed thought process May be related to: ➢ Physiological changes: increased CNS stimulation/ accelerated mental activity. ➢ Altered sleep patterns

Interventions

Nursing:

Primary:

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Advice patients to take caution on taking medications that are thyrotoxic e.g. amiodarone and interferon-α – these drugs are thyrotoxic and can induce thyroiditis, patients should be cautious in taking such medications esp. if they have genetic predisposition to hyperthyroidism. Avoid excessive intake of foods high in iodine e.g. seafoods. Instruct the client to minimize exposure to stress

Secondary:

➢ Improve nutritional status – hyperthyroidism affects all body systems including the GI system. The appetite is increased but may be satisfied by several wellbalanced meals of small size, even up to 6 meals a day.

➢ Maintain normal body