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Causes
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Graves Disease, Toxic Modular Goiter, Exogenous Hyperthyroidism (taking to much thyroid med), Thyroiditis, Excessive Iodine consumption
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S/S
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Anxiety, increased HR, weight loss, restlessness, jittery, heat intolerance, palpitations, insomnia, increased systolic BP, hands tremor, hyperactive reflexes, possible goiter
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Graves Disease
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Autoimmune, genetic component, production of TSI, TSI mimics TSH = increased thyroid hormone production
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S/S: Exophthalmos, pretibial myxedema
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Treatments
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Anti-thyroid Medications (Stop T3 & T4 production)- Methimazole, PTU
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Supportive- Beta Blockers
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Glucocorticoids- inflammation/swelling
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RAI- destroys thyroid tissue
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Thyroidectomy- total or partial
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Potassium Iodine- blocks uptake of iodine
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Nursing Interventions
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Monitor heart, VS, I&O. Improve nutritional status, enhanced coped measures (quiet cool room), regulate temperature, monitor for thyroid storm
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Must have tracheostomy tray/oxygen/suction/calcium gluconate after thyroidectomy!
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Life-Threatening
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Causes:
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Excessive thyroid hormone release. Often with infection, trauma, DKA, pregnancy, surgery, or deep palpitation
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S/S:
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fever, tachycardia, HTN, abdominal pain, sweating, anxiety, seizures, coma, death
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Treatment:
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Maintain ventilation, temp, safety, seizure precautions, bed in low position, cool room, suction
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Causes:
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Hashimotos Thyroiditis, glucocorticoids, thyroid cancer, pituitary tumors, decreased ingestion of iodine, treatment of hyperthyroidism
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Increased TSH= Decreased T3 & T4
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Decreased TSH = Increased T3 & T4
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S/S:
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Slow, fatigue, weakness, constipation, cold intolerance, fertility issues, low HR/RR/T, weight gain, depression
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Treatment:
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Lifelong meds (ex.synthroid) on an empty stomach, don't take w/in 4 hours of GI meds (specifically calcium)
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Causes:
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Abrupt stopping of thyroid replacement medication
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Post thyroidectomy
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S/S:
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Early signs- depression, diminished cognitive status, lethargy, somnolence
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Advancing signs: respiratory depression, coma, narcosis, hyponatremia, hypoglycemia, hypotension, bradycardia, and hypothermia
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Treatment:
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REPLACE THYROID HORMONE
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Avoid sedatives and opioids
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