Medical conditions

1. NMTT06207: Care of Patients
with Medical Conditions
Session 30: Nursing Care Of A
Patient With Hyperthyroidism

2. Learning Tasks
At the end of this session each learner is
expected to be able to:-
• Define hyperthyroidism
• Explain the causes and risk factors
hyperthyroidism
• Explain the pathophysiology of hyperthyroidism
• Identify signs and symptoms of hyperthyroidism
• Identify diagnostic measure of hyperthyroidism
• Identify complication of hyperthyroidism
• Give care to the patient with hyperthyroidism

3. Definition of Hyperthyroidism
• Hyperthyroidism is a condition in which an
overactive thyroid gland is producing an
excessive amount of thyroid hormones
that circulate in the blood.
• Is a condition in which the thyroid gland
produces too much of the thyroxine
hormone

4. Causes and Risk Factors
Hyperthyroidism
• Graves' Disease
• Functioning adenoma ("hot nodule") and toxic
multinodular goiter (TMNG)
• Excessive intake of thyroid hormones
• Abnormal secretion of Thyroid Releasing
Hormone (TSH)
• Thyroiditis (inflammation of the thyroid gland)
• Excessive iodine intake
• Noncancerous growths of the thyroid gland or
pituitary gland

5. Causes and Risk Factors
Hyperthyroidism cont.
Risk factors
• Positive family history of hyperthyroid
condition
• Gender: females predisposed to
hyperthyroid condition
• Other autoimmune disorders
• Iodide repletion after deprivation

6. Pathophysiology of
Hyperthyroidism
• The thyroid hormone controls metabolism of the body.
• The hypothalamus and the pituitary gland control the
secretion of TSH which stimulates the secretion of the thyroid
hormones, triiodothyronine, or T3 and thyroxine, or T4.
• Over production of T3, T4 or both from the thyroid gland
increases metabolic rate, responses to circulating
catecholamine (epinephrine and norepinephrine)
• Hyperthyroidism occurs when the thyroid gland releases too
much of its hormones over a short (acute) or long (chronic)
period of time
• Over secretion of thyroid hormones is usually associated with
enlarged gland (goiter

7. Signs and Symptoms of
Hyperthyroidism
• Patients with mild disease usually experience no symptoms.
• In patients older than 70 years, the typical signs and
symptoms also may be absent.
• Common symptoms include:
• Excessive sweating
• Increased bowel movements
• Tremor (usually fine shaking)
• Nervousness/ agitation, trembling hands
• Weight loss
• Fatigue
• Decreased concentration
• Goiter (visibly enlarged thyroid gland) or thyroid nodules

8. Signs and Symptoms of
Hyperthyroidism cont.
• Irregular and scant menstrual flow
• Mental changes, such as confusion, delirium,
and Insomnia
• Palpitations, fast heart rate.
• Heat intolerances
• Breathlessness
• Warm moist skin
• Hair loss
• Staring gaze

9. Diagnostic Measures of
Hyperthyroidism
• Medical history and physical exam.
• Blood test for TSH level
• Radioactive iodine uptake (thyroid scan)
• Thyroid ultrasonography – shows enlarged
thyroid gland

10. Complications of
Hyperthyroidism
• Heart problems.
• Brittle bones.
• Eye problems

11. Care of a Patient with
Hyperthyroidism
General nursing care of a patient with hyperthyroidism
• Monitor patient’s vital signs, daily weights
• Administer antithyroid medications as ordered
• Provide for periods of uninterrupted rest, assign to a private
room away from excessive activity and administer
medications to promote sleep as ordered.
• Provide a cool environment
• Minimize stress in the environment
• Encourage quiet, relaxing diversional activities
• Provide a diet high in carbohydrates, protein, calories,
vitamins, and minerals with supplemental feedings between
meals and at bedtime; omit stimulants

12. General nursing care of a patient
with hyperthyroidism cont.
• Observe for and prevent complications, exophthalmos,
protect eyes thyroid storm.
• Provide client teaching and discharge planning on:
• Recognition and reporting of signs and symptoms of
agranulocytosis (fever, sore throat, skin rash) and
hyper/hypothyroidism if taking ant thyroid drugs
• Depends on the cause and the severity of symptoms
• Hyperthyroidism is usually treated with one or more of
the following drug Therapy
• Antithyroid drugs (propylthrouracil and methimazole
([Tapazole
• Adrenergic blocking agents (commonly propanolol
[Inderal]):

13. General nursing care of a patient
with hyperthyroidism cont.
• Iodine (as strong Iodine solutions)
• Radioactive iodine therapy
• Radioactive isotope of iodine (e.g., 131I) given to
destroy the thyroid gland, thereby decreasing
production of thyroid hormone
• Used in middle-aged or older clients who are
resistant to, or develop toxicity from, drug therapy
Surgery, subtotal or total thyroidectomy.
Thyroidectomy is performed in younger clients for
whom drug therapy has not been effective
• Provide thyroid hormone replacement pills for the
rest of life following thyroidectomy.

14. Specific Nursing Care of Patient
Undergoing Thyroidectomy
• Pre-operative preparation
• Give pre-operative prescribed drugs
• Observe the sleeping pulse rate
• Immediate preoperative care:
• Obtain vital signs
• Check hemoglobin
• Cross-matching 2 units of blood
• chest x-ray

15. Specific Nursing Care of Patient
Undergoing Thyroidectomy cont.
 Post-operative care
• Be alert to post anesthetic priorities, carefully monitoring the
patient's cardiopulmonary status, neurological status, comfort
level, surgical wound condition, and metabolic state.
• Monitor the patient's level of consciousness, vital signs, and
pulse oximetry.
• The nurse should assess the patient's pain level and provide
individualized management as required.
• Airway obstruction in the thyroidectomy patient immediately
following surgery may be the result of several conditions.
These include laryngospasm, laryngeal edema due to surgical
manipulation, continually assess and document the patient's
airway patency, oxygen saturation levels, and respiratory
status.

16. Specific Nursing Care of Patient
Undergoing Thyroidectomy cont.
• Document the presence of drains, the amount and
consistency of drainage, and the functioning status
of the equipment, patient's dressing for changes in
drainage and tightness
• Note the presence of neck swelling (edema)
around the edge of the neck dressing.
• Assess the patient for any numbness or tingling
around the lips or hands. Neuromuscular
irritability, indicating hypocalcaemia and potential
tetany
• Keep the patient in high Fowler's position to
promote venous return from the head

17. Key Points
• Hyperthyroidism is over secretion of thyroxine
hormone which results in increased metabolism,
Heat intolerances, Breathlessness, Warm moist
skin and Hair loss.
• Graves’s disease is a common cause of
hyperthyroidism.
• Increased thyroid hormone leads to goiter.
• Proper treatment of hyperthyroidism is required in
order to overcome all the life threatening
complications such as heart problems, eye
problem and osteoporosis

18. Self Evaluation
• What are the signs and symptoms of
hyperthyroidism?
• What are the complications of
hyperthyroidism?

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21. References cont.
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