Hyperthyroidism

Hyperthyroidism

1. Risk Factors

   • family history
   • female: 40-60 (Lewis et al., 2014)
   • previous autoimmune disease (Leonard, G., Leonard, S. L., 2008)
   • iodine repletion after iodine depletion (Leonard, G., Leonard, S. L., 2008)
   • sex steroids
   • smoking

2. diagnosis

   • physical examination and clinical presentation
     • weight loss/gain with or without increased appetite (Johnstone, Hendry, Farley & McLafferty, 2014)
     • goitre (Johnson, Hendry, Farley & Mclafferty, 2014)
     • heat intolerance and increased perspiration (Johnstone, Hendry, Farley & McLafferty, 2014)
     • insomnia and irritability (Lewis et al, 2014)
     • tachycardia or palpitations (Johnstone, Hendry, Farley & McLafferty, 2014)
     • reduced menstrual flow (Johnstone, Hendry, Farley & McLafferty, 2014)
     • muscle weakness, fatigue, tremors (Johnstone, Hendry, Farley & McLafferty, 2014)
   • lab studies
     • decreased TSH, increased T3 and T4 (Lewis et al., 2014)
   • radioactive iodine reuptake test (Lewis et al., 2014)

3. patient teaching

   • decrease anxiety
     • calm environment (Lewis et al., 2014)
       • privacy
       • soothing music
       • decrease noise
   • nutrition
     • increase protein and calories (Lewis et al., 2014)
       • lentils
       • chicken
       • nuts
       • salmon
       • eggs
     • increase calcium and vitamin D to prevent osteoporosis (Mayo Clinic, 2015)
     • encourage fluids
   • hyperthermia due to increased metabolism (Lewis et al., 2014)
     • reduce physical activity
     • stay in cool environment
     • encourage fluids to prevent dehydration
   • potential for cardiac problems (Lewis et al, 2014)
     • teach symptoms of CHF and hypertension, dysrhythmias (Lewis et al., 2014)
   • graves
     • avoid wind and bright lights
     • dark sunglasses
     • artificial tears and lubricating gel

4. treatment

   • medication
     • radioactive iodine (Mayo Clinic, 2015)
       • do not give to pregnant women (Mayo Clinic, 2015)
     • anti-thyoid medication
       • methimazole (Felicilda-Reynaldo, 2016)
       • propylthiouracil when patient cannot tolerate methimazole or for palliation (Felicilda-Reynaldo, 2016)
     • beta-blockers as adjunct therapy to control cardiac symptoms (Felicilda-Reynaldo, 2016)
     • corticosteroids to decrease eye swelling in graves ophthalmology
   • nutritional (Mayo Clinic, 2015)
     • extra nutrition especially protein
   • surgery
     • thyroidectomy
     • orbital decompression surgery and eye muscle surgery for graves (Mayo Clinic, 2015)

5. pathophysiology

   • excess thyroid hormone secretion (Mayo Clinic, 2015)
   • autoimmune disease (Mayo Clinic, 2015)
     • thyroid stimulating immunoglobulin s produced and targets TSH receptors on thyroid receptors (Mayo Clinic, 2015)

6. complications

   • thyroid storm (Lewis et al, 2014)
   • Graves disease (Lewis et al, 2014)
   • cardiac abnormalities
     • dysrhythmias (Lewis et al, 2014)
     • CHF (Lewis et al, 2014)
     • HTN (Lewis et al, 2014)