HYPERTHYROIDISM 4.

DALYRIMPLE’S SIGN: forward displacement of

o Also called THYROTOXICOSIS the eye; the bulging of one or both of your eyes
o Incidence: female, ↓40 years old from their natural position.
Signs:
GRAVE’S DISEASE  Blurred vision
o Makes thyroid overactive.  Diplopia
o Most common cause of Hyperthyroidism  Eye pain
o Cause is unknown, but there is a hereditary link  Lacrimation
 Photophobia
FACTORS:
 Autoimmune
 Neoplasm (tumor)
 Excessive intake of Thyroid medications

MANIFESTATIONS:
“Everything is high and wet”

Basic Concepts ANTI-THYROID MEDICATION

 Increased metabolic rate (High T3) IODIDES
 Increased body heat production (High T4) 1. Lugol’s solution
 Hypocalcemia (High thyrocalcitonin) 2. Saturated Solution of Potassium Iodide
(SSKI)
A. Due to increased metabolism  Inhibit TH synthesis and release.
 Increased appetite  Also makes the hyperplastic thyroid less
 Weight loss vascular prior to surgery.
 Heat intolerance  Used in thyroid storm.

B. Due to activation of CNS and SNS NURSING RESPONSIBILITIES

 Hypertension 1. Assess hypersensitivity to iodine before giving
 Diaphoresis medication
 Palpitation 2. Dilute iodine sources:
 Cold water
C. Due to Hypocalcemia  Cold fruit juice
 Hyperactive bowel sounds  Provide drinking straws it causes permanent
 Diarrhea teeth staining
 Restlessness  Monitor for increased bleeding tendency if
 Nervousness the client is also taking anticoagulants
3. Monitor common side effects
EYE MANIFESTATION 1. Allergic reaction
1. EXOPHTALMOS: the protrusion of one or both 2. Metallic or brassy taste in the mouth
eyes 3. Increased salivation
4. Coryza
5. Vomiting
6. Abdominal pain
7. Rashes
8. Sore gums

2. VON GRAEFE’S SIGN: describes an abnormal THIOAMIDES

vertical wideness of the palpebral fissure. 1. Methimazole (Tapazole)
2. Propylthiouracil (PTU, Propyl-thyracil)

 Inhibit TH production
 Methimazole/Tapazole can be taken in 1 daily
dose
3. JEFFREY’S SIGN: the forehead remains smooth  Propylthiouracil must be taken in 3 doses
when one looks up/ lack of wrinkling of the daily
forehead when patient looks up with the forehead  Methimazole/Tapazole cannot be taken during
bent forewards. pregnancy

NURSING RESPONSIBILITIES
1. Monitor for side effects:
(Agranulocytosis/neutropenia with leukopenia)
 Fever
 Sore throat
 Rashes
 Sore gums
 Diarrhea

Other Side effects:

 Hypothyroidism
 Pruritis
 Periorbital edema
  Anorexia  Assess dressing if present and the area
 Loss of taste under/back of the neck and shoulders.
 Menstrual changes R: accumulation of blood in the neck may
2. Administer at same time each day with meals compress airways
3. If taking warfarin: bleeding  Monitor BP and pulse
4. If taking lithium hypothyroidism  Assess tightness of dressing if present
5. Full effects experienced in 12 weeks R: respiratory distress may indicate bleeding
6. Take medication regularly and exactly. Do not
discontinue abruptly to prevent thyroid storm. RESPIRATORY DISTRESS
 Assess RR, rhythm, depth, and effort
OVERALL NURSING RESPONSIBILITIES WHEN  Assist with DCE
TAKING ANTI-THYROID MEDICATIONS  Have suction equipment, oxygen, and a
 Monitor BP, PR and weight tracheostomy set available for immediate use.
 Weight gain indicates effectiveness. R: Inadvertent Parathyroid damage leads to
 Administer with meals to prevent GI irritation. hypocalcemia (laryngospasm that result to
 Avoid ASA and iodine-containing medications. airway obstruction)
 Advise the client to consult a physician before
eating iodized salt and iodine-rich foods. LARYNGEAL NERVE DAMAGE
 Assess for ability to speak aloud every hour,
BETA-BLOCKER noting quality and tone of voice.
1. Propranolol/Inderal  Limit talking and assess for level of
 To control hypertension and tachycardia hoarseness.
 Mild hoarseness is normal: d/t intubation.
CALCIUM CHANNEL BLOCKERS  Severe hoarseness indicates laryngeal nerve
1. Dexamethasone damage. Notify physician.
 It inhibits the action of thyroid hormones.  Observe for other signs of recurrent laryngeal
nerve damage:
SURGERY a. Respiratory obstruction
SUB-TOTAL THYROIDECTOMY b. High pitch voice
 5/6 of the gland is removed c. Stridor
 Leaves enough of the gland in place to produce d. Dysphagia
an adequate amount of TH e. Restlessness

TOTAL THYROIDECTOMY TETANY

 Treats cancer of the thyroid and the client  Involuntary contraction of the muscles
requires lifelong hormone replacement.  Due to calcium deficiency:
 Paresthesia: numbling and tingling
PERIOPERATIVE CARE:  Muscle twitching
o Before surgery, the client should be in as nearly  Convulsions and seizures
euthyroid state as possible:  Positive Chvostek’s Sign
o Assess:  Positive Trousseau Sign
 Vital signs  Occurs in 1-7 days after surgery.
 Weight  Keep calcium gluconate per IV available
 Electrolyte level  Monitor BP
 Hyperglycemia R: Hypocalcemia leads to hypotension
 Glucosuria
o Teach the client to support the neck when sitting THYROID STORM
up in bed, while moving about, and while
performing DBCT: hold the back of the neck to
prevent hyperextension of the neck.
o Teach to expect hoarseness: due to intubation
during anesthesia induction.
o Place on ECG: : (HF or cardiac damage
results from HPN and tachycardia)
o Administer the following medications as
prescribed to prevent thyroid storm.
a. Lugol’s Solution to reduce the vascularity
of the thyroid gland.
b. Beta-blocker to control hypertension and
tachycardia.
c. Glucocorticoid to inhibit the action of
thyroid hormones.

POSTOPERATIVE CARE
o Provide comfort measures. Administer analgesic
pain medications.
o Position in semi-fowler’s (with head , neck, and
shoulders erect) after recovery and support head
and neck with pillows

HEMORRHAGE