Hyperthyrodism
- 4. 4 -Prepared By Binita Bhattarai Bsc Nsg 4th yr 6th batch
- 5. Introduction Hyperthyroidism is the second most common endocrine disorder. It results from an excessive output of thyroid hormones due to abnormal stimulation of the thyroid gland by circulating immunoglobulins. Binita Bhattarai5
- 6. Definition Binita Bhattarai6 Hyperthyroidism is an over production of thyroid hormone which creates far reaching metabolic effects. A high level of thyroid hormone increases the metabolic rate. It enhances the activity of norepinephrine due to increase in number of beta adrenergic receptors sites in the body.
- 7. Incidence Binita Bhattarai7 It affects women eight times more frequently than men. It is peak between second and fourth decades of life.
- 9. Causes Binita Bhattarai9 Most common causes Rarer causes Graves disease Abnormal secretion of TSH Functioning adenoma Thyroiditis Toxic multinodular Goiter Excessive iodine intake Excessive intake of thyroid hormone Certain medications like amiodarone
- 14. Pathophysiology Binita Bhattarai14 Hyperthyroidism results from an excessive amount of circulating thyroid hormone. Primary hyperthyroidism occurs when a problem is within thyroid gland. Secondary hyperthyroidism occurs when a problem is in other than thyroid gland.(pituitary and hypothalamus).
- 15. Clinical manifestation Binita Bhattarai15 Nervousness,irritability,inability to sit quietly,palpitation Rapid pulse on rest and exertion. Poor intolerence of heat;excessive perspiration;skin that is flushed with a characteristic salmon color and likely to be warm,soft and moist.
- 16. Contd.. Binita Bhattarai16 Dry skin and diffuse pruritus. Fine tremors of the hands. Exophthalmos(bulging eyes). Increased appetite and dietary intake
- 17. Contd.. Binita Bhattarai17 Progressive weight loss Abnormal muscle fatigability, Weakness, Amenorrhea ,changes in bowel pattern. Blood pressure elevation,
- 18. Contd.. Binita Bhattarai18 Cardiac effects may include sinus tachycardia , increased pulse pressure and palpitation,myocardial hypertrophy and heart failure may occur if hyperthyroidism is severe and untreated. Osteoporosis and fracture,
- 22. Medical Management Binita Bhattarai22 Drug therapy a) Antithyroid drug(propylthiouracil) and Methimazole (Tapazole):block synthesis of thyroid hormone b) Adrenergic blocking agents(commonly propranolol) Radioactive iodine It is given to destroy the overactive thyroid cells. It is most commonly used in elderly patients. It is contraindicated in pregnancy and lactating mothers.
- 23. Contd Binita Bhattarai23 Adjunctive therapy Potassium iodide,Lugols solution and saturated solution of potassium iodide (SSKI)may be added. Beta-adrenergic agents may be used to control the sympathetic nervous system effects that occurs in hyperthyroidism. For eg:propanolol is used in nervousness,tachycardia,tremor,anxiety and heat intolerance.
- 24. Surgical intervention Binita Bhattarai24 Before surgery , propylthiouracil is given for until signs of hyperthyroidism disappeared. Thyroidectomy is performed after thyroid function has returned to normal (4 to 6 weeks)
- 25. Nursing Intervention Binita Bhattarai25 Maintaining normal body temperature Provide a cool, comfortable environment and fresh bedding and gown as needed. Give cool baths and provide cool fruits; monitor body temperature.
- 26. Contd.. Binita Bhattarai26 Improving Nutritional Status Provide several small and well balanced meals (up to 6 times) to satisfy patients increased appetite. Replaced food and fluids lost through diarrhea and diaphoresis and control diarrhea that results from increased peristalsis. Reduce diarrhea by avoiding highly seasoned foods and stimulate such as coffee ,tea, cola and alcohol; encourage high calorie, high protein food. Provide quiet environment during meal time to aid digestion.
- 27. Contd Binita Bhattarai27 Enhanching coping measures Reassure the patient that the emotional reactions being experienced are a result of the disorder and that with effective treatment those symptoms will be controlled. Reassure family and friends that symptoms are expected to disappear with treatment . Maintain a calm,unhurried approach and minimize stressful experiences. Provide information regarding thyroidectomy and preparatory pharmacotherapy to alleviate anxiety.
- 28. Contd Binita Bhattarai28 Improving Self-Esteem Convey to patient an understanding of concerns regarding problems with appearance ,appetite and weight and assist in developing coping strategies. Provide eye protection if patients experience eye changes secondary to hyperthyroidism. Discourage smoking. Arrange for patient to eat alone, if desired and if embarrassed by the large meals consumed due to increased metabolic rate. Avoid commenting on intake.
- 29. MCQs Binita Bhattarai29 Exophthalmos refers to: Redness of eyes Bulging of eyes Edema of hands Swelling of feet Major cause of hyperthyroidism is: Thyroiditis Excessive iodine Graves diseases Amiodarone
- 30. Answers Binita Bhattarai30 Exophthalmos refers to: Redness of eyes Bulging of eyes Edema of hands Swelling of feet Major cause of hyperthyroidism is: Thyroiditis Excessive iodine Graves diseases Amiodarone
- 31. Assigenment Binita Bhattarai31 Write the prevention of hyperthyroidism?