Thyroid Gland
-small saddle-shaped gland that wraps around the anterior portion of the trachea
Thyroid gland primarily affects…
- metabolism
- cardiovascular
- GI
- neuromuscular
Hyperthyroidism
- caused by excessive delivery of TH
- increases metabolic rate
- heightens sympathetic nervous systems’ response
Etiology of Hyperthyroidism
- autoimmune stimulation
- excess secretion of thyroid-stimulating hormone
- excessive intake of thyroid meds
Risk factors for hyperthyroidism
- women (10x more likely)
- genetics
- fam hx of graves
- increased iodine intake
- 20-40 yrs in age
Clinical Manifestations of Hyperthyroidism
- Hypermetabolism
- increased appetite with wt loss
- hypermotile bowels
- heat intolerance, insomnia
- palpitations
- increased sweating
- hair changes
General S/S of Graves
- fatigue
- goiter
- heat intolerance
- increased GI motility
- wt loss with increased appetite
Psych S/S of Graves
- anxiety
- depression
- irritability
- nervousness
Cardio S/S of Graves
- A fib
- Palpitations
- Systolic ejection murmur
Opthalmic S/S of Graves
- eyelid retraction
- lid lag
- stare
Derm S/S of Graves
- pruritus
- smooth skin
- sweating
- warm, moist skin
Neuromuscular S/S of Graves
- hyperactive deep tendon reflex
- tremor
Reproductive S/S of Graves
- ED
- gynecomastia
- irregular menses
Graves Dz
-type of autoimmune problem that causes the thyroid gland to produce too much thyroid hormone, which is called hyperthyroidism.
Thyroiditis
- T4 and T3 levels initially elevated, but depress over time
- recovery may be complete in weeks or months
- bacterial, tx with antibiotics or surgical drain
- NSAIDs progressing to corticosteroids if needed
- Propranolol/Atenolol may be used to tx cardiovascular symptoms r/t hyperthyroid state
Thyroid Storm
- Thyrotoxic crisis
- extreme state of hyperthyroidism
- considered life threatening emergency, death rare when tx started early
Clinical manifestations of Thyroid Storm
- severe tachycardia
- HF
- shock
- hyperthermia
- restlessness
- agitation
- seizures
- abdominal pain
- N/V/D
- delirium
- coma
Thyroid Storm Tx
- decrease circulating hormone levels with drug therapy
- managing resp. distress
- fever reduction
- fluid replacement
- elimination or management of the initiating stressor(s)
Excess TSH Stimulation
- secondary form of hyperthyroidism (rare)
- caused by overproduction of TSH by the pituitary gland and usually stimulates the thyroid gland to produce excess of thyroid hormone
Antithyroid Drugs
- Pylithioruacil (PTU)
- Methimazole (Tapazole)
Radioactive Iodine Therapy
- damages or destroys thyroid tissue
- outpatient tx, given orally
- Radioactive iodine is low, no radiation precautions needed
- dryness and irritation of mouth and throat during tx
- high incident of post-tx hypothyroidism in 80 percent of cases
Thyroidectomy (Subtotal)
-Subtotal: leaves about 10 percent of thyroid gland and the reminder of gland will produce adequate TH
Thyroidectomy (Total)
Thyroid gland removal and patients will require lifelong hormone replacement
Post op complications
- hypothyroidism
- hemorrhage
- damage to parathyroid glands - hypocalcemia
- injury laryngeal nerve - vocal cord paralysis
- infection
- resp distress
