Hyperthyroidism

Subject: Medical and Surgical Nursing I (Theory)

Overview

The thyroid glands' continuous rise in thyroid hormone production and relaxation is known as hyperthyroidism. It is an endocrine condition that is very preventable. Its causes include Greaves disease, toxic, diffuse goiter, thyroid cancer, etc. Heat intolerance, exophthalmos, occasional loose stools, etc. are some of its symptoms. For its diagnosis, lab tests including serum T3, T4, free T3, TSH levels, TRH stimulation, and a Thyroid scan can be carried out. Iodine and other anti-thyroid medications are used to treat it. It is removed surgically using total and partial thyroidectomies. Every 15 minutes after surgery, check your vital signs. Utilize suction to stop the pooling of respiratory secretions.

Hyperthyroidism

It is described as a steady rise in the thyroid glands' production and relaxation of thyroid hormone. It is an endocrine condition that is highly preventable. Thyroxin hormone overproduction has led to a problem of thyroid secretion. Less than 5% of all patients with hyperthyroidism are children. The presence of thyroid-stimulating autobodies (TSAB), which bind to the TSH receptor and then activate cyclic Amp, is what causes this condition.

Etiology

  • Greaves Disease,
  • Toxic, Diffuse Goiter,
  • Thyroid Carcinoma,
  • Toxic Adenoma.

Pathophysiology

The normal function of PTH is to increase bone resorption, thereby maintaining the proper balance of calcium and phosphorus ions in the blood. Excessive circulating PTH leads to bone damage, hypercalcemia, and kidney damage.

Clinical Manifestation

  • Heat intolerance,
  • Exophthalmos,
  • Loose bowel moments,
  • Profuse diaphoresis,
  • Tachycardia,
  • Hypertrophy of thyroid cells.

Diagnostic Evaluation

  • History and physical examination,
  • Ophthalmologic examination,
  • Laboratory tests such as serum T3, T4, free T3, TSH levels and TRH stimulation,
  • Thyroid scan.

Management

Medical Management

  • Antithyroid drugs which inhibit synthesis of thyroid hormone, eg propylthiouracil, and methimazole.
  • Iodine eg. Radioactive iodine.
  • Beta-adrenergic blockers.

Surgical Management

  • Subtotal thyroidectomy- removal of one lobe of the thyroid gland.
  • Total thyroidectomy – removal of the thyroid gland.

Care of the Thyroidectomy

  • A thyroidectomy may be total or partial. Total thyroidectomy is performed to remove thyroid cancer.
  • A client who undergoes this surgery must take thyroid hormone permanently.
  • Subtotal thyroidectomy is performed to correct hyperthyroidism or simple goiter. About 5/6th of the gland is removed and one sixth of the functioning gland is left intact. Hormone replacement may not be necessary.

Complication of Thyroidectomy

  • Hemorrhage or infection.
  • A risk of thyroidectomy tetany.
  • Respiratory obstruction.
  • Vocal cord death.

Nursing Management

  • A restful, calm and quite an environment provide because of increased metabolism can cause of sleep disturbance.
  • Use light bed cover and change line frequently if the patient is diaphoretic.
  • Encourage exercise to allow the release of the nervous tension and restless.
  • Avoid visitors.
  • Provides the patient well-balanced high- calorie diet.

Pre- operative Management

  • Radioactive iodine in large dose may also be given in combination or with surgery.
  • The usual preparation for any of the thyroid gland surgery is undertaken.

Post- operative Management

  • Provide semi-positions fowler's to guard against strain line to prevent the sense that the neck is slipping off.
  • Planing a hand either side of the neck provides supportive care, particularly while getting out of bed.
  • Encourage the patient to move their neck fully once the sutures are removed to prevent a persistent restriction of their ability to move their head.
  • Keep an eye on the side effects, such as respiratory distress, calcium insufficiency, and laryngeal nerve injury bleeding.
  • The tissue and suture clips were removed 2-4 days after surgery.

Immediate Post- operative Care

  • Check vital signs every 15muintes.
  • Prevent pooling of respiration secretion by suctioning.
  • Avoid straining of suture.
  • Maintain potential airway.
  • Relive tracheal irritation.

Reference

  • HealthLine. 2005. 2017. http://www.healthline.com/health/hyperthyroidism
  • Mayo Clinic. 1998 28 October 2015 http://www.mayoclinic.org/diseases-conditions/hyperthyroidism/basics/symptoms/con-20020986
  • MedicineNet. 1996. 2017 http://www.mayoclinic.org/diseases-conditions/hyperthyroidism/basics/symptoms/con-20020986
  • Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/000356.htm
  • Medscape. 1994. 2017 http://emedicine.medscape.com/article/121865-overview
Things to remember
  • Endocrine disease can be very effectively avoided.
  • Laboratory tests including serum T3, T4, free T3, TSH levels, and TRH stimulation show that PTH's natural role is to stimulate bone resorption.
  • An whole or partial thyroidectomy is possible. To eliminate thyroid cancer, a total thyroidectomy is performed.
  • If a patient is experiencing diaphoresis, use a light bed cover and change the linen frequently.
  • Every 15 minutes, check your vital signs.
  • Utilize suction to stop the pooling of respiratory secretions.
Questions and Answers

It is described as a steady increase in the thyroid glands' production and relaxation of thyroid hormone. Endocrine disorder can be very effectively avoided.

Etiology

  • Greaves disease
  • Toxic, diffuse goiter
  • Thyroid carcinoma
  • Toxic adenoma

Medical management:

  • Antithyroid medications include propylthiouracil and methimazole that prevent the production of thyroid hormone.
  • Iodine, for instance. Iodine that is radioactive
  • Anti-beta-adrenergic drugs.

Surgical management:

  • One thyroid lobe is removed during a partial thyroidectomy.
  • The thyroid gland is removed through a total thyroidectomy.

Care of the thyroidectomy:

  • An entire or partial thyroidectomy is possible. To eliminate thyroid cancer, a total thyroidectomy is performed.
  • After this procedure, the patient will always need to take thyroid hormone.
  • To treat hyperthyroidism or a straightforward goiter, a subtotal thyroidectomy is carried out. One sixth of the working gland is left intact and about one-half of the gland is removed. There may be no need for hormone replacement.

Complication of thyroidectomy:

  • Bleeding or an infection.
  • Tetany risk after thyroid surgery.
  • Barrier to breathing.
  • Voice cord demise.

Nursing management:

  • A tranquil, calm, and quiet environment can interrupt sleep because of an elevated metabolism.
  • If a patient is experiencing diaphoresis, use a light bed cover and change the linen frequently.
  • Encourage people to exercise so that they can let off their anxiety and restlessness.
  • Avoid guests.
  • gives the patient a high-calorie, well-balanced meal.

Pre operative management:

  • Large doses of radioactive iodine can also be administered in conjunction with or during surgery.
  • To prepare for any thyroid surgery, the customary steps are done.

Post operative management:

  • Provide semi-positions fowler's to guard against strain line to prevent the sense that the neck is slipping off.
  • Planing a hand either side of the neck provides supportive care, particularly while getting out of bed.
  • Encourage the patient to move their neck fully once the sutures are removed to prevent a persistent restriction of their ability to move their head.
  • Keep an eye on the side effects, such as respiratory distress, calcium insufficiency, and laryngeal nerve injury bleeding.
  • The tissue and suture clips were removed 2-4 days after surgery.

Immediate pos operative care:

  • Every 15 minutes, check your vital signs.
  • Utilize suction to stop the collecting of respiratory secretions.
  • Do not pull on the suture.
  • Keep open any potential airways
  • Relive tracheal irritation

It is described as a steady increase in the thyroid glands' production and relaxation of thyroid hormone. It is an endocrine condition that is highly preventable.

Etiology:

  • Greaves disease
  • Toxic, diffuse goiter
  • Thyroid carcinoma
  • Toxic adenoma

Pathophysiology:

Increased bone resorption helps maintain the proper balance of calcium and phosphorus ions in the blood, which is the normal function of PTH. Increased levels of PTH in the bloodstream cause kidney damage, hypercalcemia, and bone loss.

Clinical manifestation:

  • Heat sensitivity
  • Exophthalmos
  • Moments of loose bowels
  • Excessive sweating
  • Tachycardia
  • The enlargement of thyroid cells

Diagnostic evaluation:

  • A background check and physical assessment
  • A medical eye examination
  • Tests in the lab include measurements of serum T3, T4, free T3, TSH levels, and stimulation of TRH.
  • Thyroid exam

Medical management:

  • Antithyroid medications include propylthiouracil and methimazole that prevent the production of thyroid hormone.
  • Lodine, for instance. Iodine that is radioactive
  • Anti-beta-adrenergic drugs.

Surgical management:

  • One thyroid lobe is removed during a partial thyroidectomy.
  • The thyroid gland is removed through a total thyroidectomy.

Care of the thyroidectomy:

  • An entire or partial thyroidectomy is possible. To eliminate thyroid cancer, a total thyroidectomy is performed.
  • After this procedure, the patient will always need to take thyroid hormone.
  • To treat hyperthyroidism or a straightforward goiter, a subtotal thyroidectomy is carried out. One sixth of the functioning gland is left intact and about one-half of the gland is removed. There may be no need for hormone replacement.

Complication of thyroidectomy:

  • Bleeding or an infection.
  • Tetany risk after thyroid surgery.
  • Obstruction to breathing.
  • Voice cord demise.

Nursing management:

  • A tranquil, calm, and quiet environment can interrupt sleep because of an elevated metabolism.
  • If a patient is experiencing diaphoresis, use a light bed cover and change the linen frequently.
  • Encourage people to exercise so that they can let off their anxiety and restlessness.
  • Avoid guests.
  • Gives the patient a high-calorie, well-balanced meal.

Pre operative management:

  • Large doses of radioactive iodine can also be administered in conjunction with or during surgery.
  • To prepare for any thyroid surgery, the customary steps are done.

Post operative management:

  • Provide semi-positions fowler's to guard against strain line to prevent the sense that the neck is slipping off.
  • Planing a hand either side of the neck provides supportive care, particularly while getting out of bed.
  • Encourage the patient to move their neck fully once the sutures are removed to prevent a persistent restriction of their ability to move their head.
  • Keep an eye on the side effects, such as respiratory distress, calcium insufficiency, and laryngeal nerve injury bleeding.
  • The tissue and suture clips were removed 2-4 days after surgery.

Immediate pos operative care

  • Every 15 minutes, check your vital signs.
  • Utilize suction to stop the pooling of respiratory secretions.
  • Do not pull on the suture.
  • Keep open any potential airways
  • Relive tracheal irritation

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