Hyperthyroidism (Grave's disease)

An autoimmune process causes an abnormal thyroid-stimulator to affect the thyroid gland, increasing
secretion of T3 and T4. TSH secretion is inhibited.
Thyroid Gland
1. The thyroid gland is found in the anterior of the neck, in front of the trachea. The to lobes are
found on both sides of the trachea
!. Thyroid secretes T3, T4, and calcitonin
T3 and T4 are secreted by the thyroid gland. "ost T4 are con#erted into T3 in tissues. T3
and T4 ha#e an effect on metabolic rate, groth, and specific body mechanisms
$alcitonin % regulates serum $a le#els
3. Thyroid hormones are regulated hypothalamus-pituitary-thyroid a&is.
'egati#e feedback loop
Hypothalamus ( secretes T)H *thyrotropin-releasing
hormone+ ( stimulates anterior pituitary ( secretes TSH
*thyroid-stimulating hormone+ ( increases T3 and T4
production
, thyroid hormone le#els % - T)H and TSH
secretion
- thyroid hormone le#els % , T)H and TSH
secretion
Cause
1. .n hyperthyroidism, le#els of T3 and T4 increased due thyroid-
stimulating immunoglobulins *TS.s+. TS. are antibodies produced by an autoimmune process
*/ehne, !01!+. TS.s binds to the TSH receptor and stimulates the thyroid to produce T3 and T4.
!. .n hyperthyroidism, lab #alues for T3 and T4 ould be increased and TSH decreased. T3 and
T4 is increased because of TS.s, and TSH is decreased because it is trying to restore balance
and decrease thyroid hormone production.
Serum Values for Thyroid Function Tests
Serum 1alues
Thyroid Test Normal Hyperthyroid
Total T4 *mcg2d/+ 4.3-1!.3 4#er 1!.3
5ree T4 *ng2d/+ 0.6-! 4#er !
Total T3 *ng2d/+ 70-!!0 4#er !!0
5ree T3 *pg2d/+ !30-8!0 4#er 8!0
TSH *microunits2m/+ 0.3-8 9nder 0.3
Grave's disease
1. Auto-immune disease caused by e&cessi#e secretion of the thyroid hormones.
!. "ore commonly found in females than males and in omen from ages !0-40 years.
Clinical manifestations
Hyperthyroidism can be thought as an o#erheated furnace. .f production is increased then
symptoms ill result in ele#ated le#els and increased needs
thyroto&icosis % e&cess thyroid hormone secretion
Tachycardia and strong heartbeats, increase in systolic blood pressure
:ysrhythmias and angina may occur
Stimulated $'S % ner#ousness, insomnia, rapid thought flo, rapid speech
, metabolic rate % heat intolerance, ,heat production, ,bod temperature, and
arm2moist skin
sometimes e&ophthalmos
enlarged, palpable thyroid gland
hand tremors
significant eight loss despite increased appetite
Complications
1. Thyroid storm2crisis
can occur after surgery or de#elop after a se#ere illness *infection, sepsis+
hyperthermia *103 or greater+, systolic hypertension, se#ere tachycardia, restlessness, and
tremor
!. $alcium deficit
caused by trauma to parathyroid
Tests
1. ;lood dran for TSH, T3, T4, and thyroid antibodies
!. )adioacti#e iodine uptake *)A.9+ ith thyroid scan
Nursing nterventions
<oal= to decrease effects of e&cess thyroid hormone and maintain ade>uate cardiac output for tissue
needs *?erekh, !01!+
1. Assess #ital signs*?erekh, !01!+
)ationale= @ropanolol decreases heart rate and blood pressure. Aithhold medication ith heart rate is
80bpm and patient can e&perience diBBiness from hypotension. *?erekh, !013+
!. "onitor temperature and pro#ide cool en#ironment*?erekh, !01!+
)ationale= 5e#er may occur due to e&cessi#e hormone le#els. This can lead to dehydration,
hypotension, or a sign of thyroid storm. *?erekh, !01!+
<oal= @re#ent complications of thyroid storm *?erekh, !01!+
1. Assess for tachycardia, pulmonary edema, dehydration, hyperthermia, and nausea, #omiting,
diarrhea *?erekh, !01!+
Treatment
1. propanolol
beta-blocker % antagoniBe sympathetic ner#ous system and alle#iate complaints of
tachycardia, diaphoresis, ner#ousness, and tremors.
may reduce some con#ersion of T4 to T3
diBBiness should be reported due to drop in blood pressure.
!. @T9 *propylthiouracil+
antithyroid drug
methimaBole *TapaBole+ is another common antithyroid drug used
antithyroid drugs inhibits synthesis of thyroid hormones and reduce thyroid antibody le#els.
@T9 blocks the con#ersion of T4 to T3
administer for 1!-!4 months ith dose decreased as hyperthyroid state impro#es
3. )adioacti#e .odine
hypothyroidism can occur
remaining thyroid may be unable to produce enough ormone to maintain normal metabolic
state.
pregnancy and breastfeeding are contraindications
Anti-thyroid drugs are often gi#en for at least a month before radioacti#e iodine treatment
! NC"#$ %uestions
&' The nurse is caring for a client postoperative thyroidectomy' (hat )ould *e an important
nursing intervention+
1. Ha#e the client speak e#ery 3 C 10 minutes if hoarseness is present
)ationale= .t is important to check for hoarseness because it ould indicate edema. ;ut e#ery 3-10
mins is not necessary.
!. @ro#ide a lo-calcium diet to pre#ent hypercalcemia
)ationale= $alcium serum le#els are important to monitor but a lo-calcium diet is not
important at the moment.
3. $heck the dressing at the back of the neck.
)ationale= This is correct. .f bleeding occurs, it ill be seen on the posterior of the dressing or
behind the patientDs neck
4. Apply a soft cer#ical collar to restrict neck mo#ement
)ationale= This is not a proper inter#ention.
!' (hich medication )ill the nurse have availa*le fro emergency treatment of tetany in the
vlient )ho has had a thyroidectomy+
1. $alcium chloride
)ationale= This is correct. Tetany is caused by accidental remo#al of the parathyroid gland
during the surgery. $alcium chloride should be taken to restore calcium le#els.
!. @otassium chloride
)ationale= This medication is not suitable to treat tetany because it replaces electrolyte
potassium
3. "agnesium sulfate
)ationale= This medication is used to treat preeclampsia *pregnancy induced hypertension+
4. @ropylthiouracil *@T9+
)ationale= This is an anti-thyroid medication and is used to block thyroid hormone.
,eferences
?erekh, E. *!01!+. Illustrated guide for the NCLEX-RN

Exam, *7
th
ed.+. St. /ouis= "osby.
/ehne, ).A. *!01!+. Pharmacology for Nursing Care *7
th
ed+. St. /ouis, "4= Saunders