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Hyperthyroidism NCLEX Review

Hyperthyroidism NCLEX review notes for students who are prepping to take the NCLEX exam. The endocrine system is made-up of many disorders, such as hypothyroidism and hyperthyroidism.

As a student prepping for NCLEX, it is very important you know the differences between the two conditions.

As the nurse taking care of the patient with hyperthyroidism it is important you understand the signs and symptoms, pathophysiology, causes, nursing interventions, and medical treatments.

Don’t forget to take the quiz on hypothyroidism vs hyperthyroidism.

In this NCLEX review, you will learn the following:

  • Pathophysiology of the thyroid gland
  • Negative feedback loop of the thyroid gland
  • Signs and symptoms of hyperthyroidism
  • Causes of Hyperthyroidism
  • Nursing Interventions
  • Medications for Hyperthyroidism
  • Treatments

Lecture on Hyperthyroidism

Hyperthyroidism

Definition: High secretion of thyroid hormone

Key Players:

Thyroid: produces thyroid hormones that play a big role in body metabolism, regulation of body temperature, and growth/development.

  • These hormones are known as: T3 Triiodothyronine, T4 Thyroxine (most important when talking about hypo/hyper thyroidism), and Calcitonin.
  • Thyroid can NOT make thyroid hormones without iodine which comes from foods (if you don’t have enough iodine in your diet…low t3 and t4…this leads to hypothyroidism and if you have too much hyperthyroidism)

T3 & T4: plays a huge role in:

  • burning calories
  • how new cells replace dying cells
  • how fast we digest food
  • stimulate sympathetic nervous system (alertness, quick responsiveness/reflexes)
  • increases body temperature and heart rate
  • brain development
  • muscle contraction
  • fertility
  • regulates TSH (thyroid-stimulating hormones through the negative feedback loop)

TSH: produced from the anterior pituitary gland that stimulates T3 and T4 production

Negative Feedback Loop of Thyroid Hormone Production

Hypothalamus produces -> TRH (Thyrotropin-releasing hormone)…this causes the Anterior Pituitary Gland to produce ->TSH (thyroid-stimulating hormone)….this cause the thyroid gland to produce-> T3 & T4

  • There can be problems with the feedback system where the pituitary gland is not stimulating the thyroid gland enough so hormones are not produced or the thyroid is not receptive to the TSH from the pituitary gland.

Thyroid problems diagnosed with blood tests that look at T3, T4 (free) levels, and TSH to make a conclusive diagnosis.

Signs & Symptoms Hyperthyroidism

Let the word of the condition help you: HYPERthyroidism…everything is going to be working at an accelerated or high of a rate.

Depending on how high the levels are and what is causing the condition signs and symptoms can vary:

  • Weight loss (burning calories increased)
  • Heat intolerance (feel extremely hot…sweaty)
  • Tachycardia (sympathetic system in overdrive)
  • Hypertension (sympathetic system in overdrive)
  • Diarrhea (GI system working harder and faster)
  • Skin smooth (from increased blood flow)
  • Soft hair
  • Cardiac dysrhythmias: A-fib
  • Personality changes: irritable, moody, insomnia
  • Irregular menstruation in women

Causes of Hyperthyroidism

Grave’s Disease (most common cause): autoimmune disorder due to the production of an antibody/immunoglobulin TSI (thyroid stimulating immunoglobulin) that has the same effect as TSH…this stimulates the body to produce high amounts of thyroid hormones (genetic).

  • NOTE UNIQUE  S & S: Protruding eyeballs, goiter, pretibial myxedema: waxy orange peel appearance of the skin found in the feet and legs
  • TX: antithyroid meds, beta blockers (block the effect of the high thyroid hormones on the body…slows heart, decrease sweating) radioactive iodine therapy, or thyroidectomy

Toxic Nodular Goiter (TNG): not autoimmune…growths of nodular goiters that are independently functioning to cause hypersecretion of thyroid hormones

  • S & S: won’t see ophthalmic signs like the protruding eye balls but the classic signs and symptoms of hyperthyroidism
  • TX: antithyroid meds, beta blockers (block the effect of the high thyroid hormones on the body…slows heart, decrease sweating) radioactive iodine therapy, or thyroidectomy

Thyroiditis: inflammation of the thyroid gland and this can cause T3 and T4 leak into the body

Too much iodine: remember iodine helps make T3 and T4

Nursing Interventions for Hyperthyroidism

  • Keep the patient comfortable: cool, quiet environment, calm (administer prescribed sedatives as needed)
  • Obtain daily weights (need to watch weigh due to weight loss from the increased metabolic rate)
  • Monitor EKG, heart rate, blood pressure
  • Educate about medications and treatment (radioactive iodine therapy and thyroidectomy)
  • Monitor for Thyroid Storm: life-threatening that presents with exaggerated signs/symptoms of hyperthyroidism, such as fever, fast heart rate, HTN
    • Cause of thyroid storm: complication from uncontrolled hyperthyroidism or due to thyroidectomy (caused from excessive thyroid hormones leaking into the bloodstream after removal)

Medications for Hyperthyroidism

Antithyroid medication: stops the thyroid from synthesizing T3 and T4, doesn’t damaged thyroid gland like radioactive iodine therapy

  • Methimazole “Tapazole” (most common…fewer side effect)…common treatment for Grave’s Disease
  • PTU “Propylthiouracil” (safer during first trimester of pregnancy)….liver failure
    • Other side effects of both medications: agranulocytosis and aplastic anemia

Education for Antithyroid medications:

  • Never stop taking abruptly (takes a while before the patients start seeing results)
  • Take at same time every day
  • Signs and symptoms of thyroid storm
  • Avoid iodine rich foods (sea foods like seaweed, dairy eggs) or supplements
  • No aspirin (increases thyroid hormone)
  • Signs and symptoms of hypothyroidism (toxicity)

Beta Blockers:” Inderal” to treat patient signs and symptoms (help decrease heart rate, blood pressure, and decrease heat intolerance)

Treatment for Hyperthyroidism

Radioactive iodine: destroys the thyroid gland overtime and is a permanent cure compared to medications….not for pregnant or nursing women

  •  Side Effects: Iodism: taste changes “metal taste”, nausea, and swollen saliva glands

Surgical Treatment:

Thyroidectomy: Removal of the thyroid gland

Watch for thyroid storm due to the manipulation of the gland causing extra T3 and T4 to leak into the body….prevent by prepping with medications of: antithyroid meds, sodium iodide solution, beta blockers, glucocorticoids

  • Educate about post-opt care: coughing and deep breathing and splinting neck when coughing
  • Monitor for parathyroid destruction problems (common when a thyroid procedure is performed due to the close proximity of the parathyroid to the thyroid gland)…watch calcium levels “hypocalcemia”…parathyroid responsible for calcium regulation)
  • Watch for respiratory distress due to the nature of the surgical site…keep patient in semi-fowler’s to help with swelling and drainage at the site (keep at bedside trach kit and supplies)

You may be interested in Cushing’s and Addison’s

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