HYPERTHYROIDISM

1. MRS.ROJARANI.K, RNM,M.SC(N),
MEDICAL SURGICAL NURSING
ASSISTANT PROFESSOR
GANGA COLLEGE OF NURSING
COIMBATORE

2. MEDICAL SURGICAL
NURSING
HYPERTHYROIDISM

3. OBJECTIVES
At the end of the class the students will be able to,
• Review of anatomy and physiology of thyroid gland
• define Hyperthyroidism
• list the etiology &risk factors of hyperthyroidism
• describe the pathophysiology
• list the clinical manifestation
• enumerate the assessment and diagnostic findings
• list the complications
• explain the medical management
• describe the surgical management
• describe the nursing management
• explain the dietary management

4. INTRODUCTION
Hyperthyroidism is hyperactivity of the thyroid gland
with sustained increase in synthesis and release of
thyroid hormones. The secretion of thyroid hormone is
no longer under the regulatory control of the
hypothalamic–pituitary center.
There are a number of pathologic causes of
hyperthyroidism in children and adults. These include
Grave’s disease, toxic adenoma, toxic multinodular,
goiter, approximately 95% of cases of
hyperthyroidism.

5. REVIEW OF ANATOMY AND PHYSIOLOGY
• The thyroid gland is a butterfly-shaped gland located in the front of
the neck. The thyroid gland itself is regulated by the pituitary gland in
the brain, and the pituitary gland is regulated by the hypothalamus,
another gland in the brain.
• It consists of two lateral lobes connected by an isthmus. The gland is
about 5 cm long, 3 cm wide and weight about 30 g.
• The thyroid gland produces three hormones (T4),triiodithyroxine
(T3),and calcitonin

6. REVIEW OF ANATOMY AND PHYSIOLOGY

7. INTRODUCTION
Hyperthyroidism is hyperactivity of the thyroid gland
with sustained increase in synthesis and release of
thyroid hormones. The secretion of thyroid hormone is
no longer under the regulatory control of the
hypothalamic–pituitary center.
There are a number of pathologic causes of
hyperthyroidism in children and adults. These include
Grave’s disease, toxic adenoma, toxic multinodular,
goiter, approximately 95% of cases of
hyperthyroidism.

8. INTRODUCTION
Graves disease is the most common cause of
hyperthyroidism (60% - 80%) of all cases.
Females are affected more frequently than men 10:15
Monozygotic twins show 50% concordance rates

9. DEFINITION
Hyperthyroidism is the term for overactive tissue
within the thyroid gland, resulting in overproduction
and thus an excess of circulating free thyroid
hormones: thyroxin (T4), triiodothyronine (T3), or both.
Hyperthyroidism is hyperactivity of the thyroid gland
with sustain increase in
synthesis and release of
hormones.

10. INCIDENCE
• Hyperthyroidism is a common condition.
• It has been estimated that there are 4.7/1000 women
with active disease.
• When previously treated cases were included, the
population prevalence rose to 20/1000 in women.
• As for hypothyroidism, it is much less common in men
who have a lifetime prevalence of around 2/1000

11. CAUSES OF HYPERTHYROIDISM
CIRCULATING THYROID STIMULATORS:
• Graves disease
• Neonatal Graves disease
• Thyrotropin-secreting tumor (Pituitary adenoma)
• Choriocarcinoma
THYROIDALAUTONOMY:
• Toxic multinodular goiter
• Toxic solitary adenoma
• Congenital hyperthyroidism
• Iodine-induced hyperthyroidism(Jod-Basedow)

12. CAUSES OF HYPERTHYROIDISM CONT’
DESTRUCTION OF THYROID FOLLICLES
(THYROIDITIS)
• Sub acute thyroiditis
• Painless or postpartum thyroiditis
• Amiodarone-induced thyroiditis
• Acute (infectious) thyroiditis
EXOGENOUS THYROID HORMONE
• Iatrogenic Excess ingestion of thyroid hormone
• Factitious Excess ingestion of thyroid hormone
• Hamburger thyrotoxicosis

13. CAUSES OF HYPERTHYROIDISM CONT’
ECTOPIC THYROID TISSUE:
• Stroma ovary - Ovarian teratoma containing thyroid
tissue
• Metastatic follicular thyroid cancer
• Pituitary resistance to thyroid hormone

14. RISK FACTORS
• A previous thyroid problem, such as goiter
• A previous history of thyroids surgery
• Type 1diabetes
• Primary adrenalin sufficiency
• A family history of thyroid disease
• Pernicious anaemia.
• Over 60years

15. PATHOPHYSIOLOGY
Hyperthyroidism characterized by loss normal regulatory
control of thyroid hormone secretion
The action of thyroid hormone on the body is
stimulatory, hyper metabolism result
Increase sympathetic nervous system activity
Alteration secretion and metabolism of hypothalamic
pituitary and gonadal hormone.

16. PATHOPHYSIOLOGY CONT’
Excessive amount of thyroid hormone stimulate the
cardiac system and increase the adrenergic receptors
Tachycardia and increase cardiac output, stroke
volume and peripheral blood flow
Negative nitrogenous balance, lipid depletion and
the resultant state of nutritional deficiency
HYPERTHYROIDISM

17. PATHOPHYSIOLOGY CONT’

18. CLINICAL MANIFESTATION
Symptoms and their severity depend on duration and extent of
thyroid hormone excess, and the age of the individual.
Individuals may experience:
 Nervousness and irritability
 Palpitations and tachycardia
 Heat intolerance or increased sweating
 Tremor
 Weight loss or gain
 Increase in appetite
 The skin is flushed continiously,with a characteristic salmon
colour in Caucasians and is likely to be warm, soft and moist

19. CLINICAL MANIFESTATION CONT’

20. CLINICAL MANIFESTATION CONT’
Frequent bowel movements or diarrhea
Lower leg swelling
Sudden paralysis
Shortness of breath with exertion
Decreased menstrual flow
Impaired fertility
Sleep disturbances (including insomnia)

21. CLINICAL MANIFESTATION CONT’
Changes in vision
 Photophobia, or light sensitivity
 Eye irritation with excess tears
 Diplopia, or double vision
 Exophthalmos, or forward protrusion of the eyeball
 Fatigue and muscle weakness
 Thyroid enlargement
 Pretibial myxedema (fluid buildup
in the tissues about the shin bone;
may be seen with Grave's disease)

22. INVESTIGATION
 History and physical examination
 Ophthalmic examination
 ECG- atrial tachycardia
 Thyroid function test: T3 andT4
 Thyroid releasing hormone
stimulation test
 Radioactive iodine uptake(RAIU)
 Thyroid ultrasound
 Thyroid scinti scan
 Cholesterol test
 Glucose test

23. INVESTIGATION

24. INVESTIGATION

25. LABORATORY ASSESSMENT
TEST NORMAL
VALUE
HYPERTHYROIDISM
Serum T3 70-205 ng/dl Increased
Serum T4 4-12 ng/dl Increased
Free T4 index 0.8-2.4 ng/dl Increased
T3 renin uptake 24-34% increased
TRH stimulation
test
Double the value Little or no TSH
response
Thyroid
suppressiontest
N / A Fails to suppress
RAIU or levels.

26. LABORATORY ASSESSMENT CONT’
TSH stimulation
test
>10% in RAIU Fails to suppress
RAIU
Thyroid antibodies Titre < 1:100 High titre
Thyrotrophine
receptor antibodies
Titre < 130% of
basal activity .
High titre indicate
grave’s disease
TSH 2-10 Μu /ml Low in grave’s disease ;
high in secondary or
tertiary hyperthyroidism
.
Thyroid-stimulating immunoglobulin (TSI) test. This test,
also called a thyroid-stimulating antibody test, measures the
level of TSI in your blood. Most people with Graves' disease
have this antibody, but people whose hyperthyroidism is
caused by something else do not.

27. COMPLICATION
• Heart problems - These include a rapid heart rate , atrial
fibrillation, congestive heart failure,
• Brittle bones - Untreated hyperthyroidism can also lead to
weak, brittle bones(osteoporosis).
• Eye problems - People with Graves' ophthalmopathy
develop eye problems, including bulging, red or swollen
eyes, sensitivity to light, and blurring or double vision.
Untreated, severe eye problems can lead to vision loss.

28. COMPLICATION
• Red, swollen skin - In rare cases, people with Graves'
disease develop Graves' dermopathy. This affects the skin,
causing redness and swelling, often on the shins and feet.
• Thyroid crisis
• Hypothyroidism

29. MANAGEMENT
Anti thyroid drugs
Beta blockers
Radio active therapy
Surgical management-Sub total thyroidectomy

30. MEDICAL & NUTRITIONAL MANAGEMENT
Anti-thyroid medications
 These –medications gradually reduce
symptoms of hyperthyroidism by preventing
your thyroid gland from producing excess
amounts of hormones.
 They include propylthiouracil
and methimazole(Tapazole).
• Symptoms usually begin to improve in 6 to 12
weeks, but treatment with anti-thyroid
medications typically continues at least a year
and often longer.

31. MEDICAL & NUTRITIONAL MANAGEMENT
CONT’Propylthiouracil (PTU)
One of the advantages of PTU is that it has a lower risk of
birth defects and therefore it is the first line treatment for
pregnant women. A disadvantage is that PTU is only
available in 50-milligram units
Methimazole (Tapazole)
The main benefit of Tapazole is that it can be taken one,
two, or three times a day (depending on your dosage). Pills
are available in 5 or 10 milligrams. It also has fewer side
effects and often reverses hyperthyroidism quickly.

32. MEDICAL & NUTRITIONAL MANAGEMENT
CONT’
• Inhibitor of hormone synthesis
– Carbimazole
– Methimazole
– Propylthiouracil
• Inhibitor of hormone release
– Iodine
– Iodides of Na,k
– Organic iodides
• Radioactive iodine
– 131 I (Radioactive iodine)
• Ionic inhibitors
– Thiocynate(-SCN)
– Perchlorates(-ClO4)
– Nitrates(NO3)
CLASSIFICATION OF ANTITHYROID DRUGS

33. MEDICAL & NUTRITIONAL MANAGEMENT
CONT’
Beta blockers
• These drugs are
commonly used to treat
high blood pressure.
• They are used to reduce a
rapid heart rate and help
prevent palpitations.
• Side effects may include
fatigue, headache, upset
stomach, constipation,
Diarrhea or dizziness.

34. MEDICAL & NUTRITIONAL MANAGEMENT
CONT’
Radio active iodine:
• Taken by mouth, radioactive iodine is
absorbed by your thyroid gland, where it causes the
gland to shrink and symptoms to subside, usually within
three to six months.

35. MEDICAL & NUTRITIONAL MANAGEMENT
CONT’
Radio active iodine cont’:
It is used to treat toxic adenoma, toxic multi nodular goitre .
It is contraindicated during pregnancy because it crosses the
placenta. They should also be instructed to not conceive
for at least 6 months following treatment.
Radioactive iodine should not be given until at least 6
weeks after lactation stops.
Over a period of several weeks, thyroid cells exposed to the
radioactive iodine are destroyed, resulting in reduction of
the hyper thyroid state and inevitably hypothyroidism.

36. MEDICAL & NUTRITIONAL MANAGEMENT
CONT’
Eat a heart-healthy diet. This diet should include foods
such as: Fruits, vegetables, grains, and fat-free or low-
fat milk and milk products, Lean meats, poultry, fish,
beans, eggs, and nuts.
Limit foods with saturated fats, trans fats, cholesterol,
sodium (salt), and added sugars.
Get regular physical activity for at least 30 minutes a day
on most days of the week.
Limit your intake of alcohol.

37. MEDICAL & NUTRITIONAL MANAGEMENT
CONT’

38. SURGICAL MANAGEMENT
Surgical Treatment of Thyroid Disease General Several
surgical options exist for treating thyroid disease and the
choice of procedure depends on two main factors.
• The first is the type and extent of thyroid disease present.
• The second is the anatomy of the thyroid gland itself. The
most commonly performed procedures include: lobectomy,
lobectomy with isthmectomy,Subtotal thyroidectomy,
and total thyroidectomy.

40. NURSING MANAGEMENT
• Improving nutritional status
• Enhancing coping measures
• Improve self esteem
• Maintaining body temperature

41. NURSING MANAGEMENT
Imbalanced nutrition less than body requirement
related to anorexia and increase metabolic demand is
inappropriate.
Intervention:
• High calorie diet (4000-5000kcal/day)
• High protein diet (1-2 g/kg of ideal bodyweight)
• Frequent meals

42. NURSING MANAGEMENT
Activity intolerance related to exhaustion secondary to
accelerated metabolic rate resulting in inability to
perform activity without shortness of breath and
significant increased in heart rate
Intervention:
• Assist with regular physical activity.
• Assist in activities of daily living

43. NURSING MANAGEMENT
Ineffective coping related to irritability, hyper
excitability, apprehension, and emotional instability
Low self esteem related to changes in appearance,
excessive appetite, and weight loss
Risk for injury: corneal ulceration, infection and not
possible blindness related inability to close the eye lids
secondary to exophthalmos.

44. NURSING MANAGEMENT
Hyperthermia related to accelerated metabolic rate
resulting in fever, diaphoresis and reported heat
intolerance.
Impaired social interaction related to extreme
agitation, hyperactivity, and mood swings resulting in
inability to relate effectively with others

45. PREVENTION
• Hyperthyroidism is not preventable. You may avoid the symptoms
of hyperthyroidism by being diagnosed and treated early.
• Lifestyle changes may help reduce your symptoms.
• Avoiding caffeine and reducing stress may help relieve symptoms of
anxiety, nervousness, poor concentration, and fast heartbeat.
• Quitting smoking can reduce your risk of developing Grave’s
Ophthalmopathy
• Attend all of your doctor appointments.
• Advice to take anti thyroid medication at the same time each day.
• Continue to monitor dose of medicine to make sure
receive the correct amount.

46. REFERENCE
 Smeltzer.Suzanne co et al, “Text book of Medical
Surgical Nursing” Published by Elsevier,12th Edition
 Black, J.M., et.al.,
1997.MedicalSurgicalNursing.5thedi. Philadelphia:
Saunders publication.
 Bliley, D.M., 1987.Medical Surgical Nursing. ST
Louis: Mosby Company.
 Brunner and Suddarth, 1995. Text Book of Medical
Surgical Nursing. Philadelphia: Mosby Company.

47. REFERENCE
 Lewis, “Medical Surgical Nursing” Published by
Elsevier, 11th Edition: Year-1996
 Pamela .L. Swearingen, Malavizhi.S, “Nursing care
Planning Resources”2017, Published by Elsevier,
First south Asia Edition: Page no-287.Volume-1.
WEB SOURCES
www.wikipedia.com
www.mayoclinic.org/diseases-
conditions/hyperthyroidism/