OM VERMA ASSISTANT PROFESSOR RELIANCE INSTITUTE OF NURSING

5. Hyperthyroidism

7. What is thyroid gland?
• The thyroid gland is a butterfly-shaped
endocrine gland that is normally located in the
lower front of the neck. The thyroid’s job is to
make thyroid hormones, which are secreted
into the blood and then carried to every tissue
in the body. Thyroid hormone helps the body
use energy, stay warm and keep the brain,
heart, muscles, and other organs working as
they should.

12. Introduction
• Hyperthyroidism and thyrotoxicosis are used
interchangeably, however each refers to slightly
different conditions. Hyperthyroidism refers to
over activity of the thyroid gland, with resultant
excessive secretion of thyroid hormones and
accelerated metabolism in the periphery.
• Thyrotoxicosis refers to the clinical effects of an
unbound thyroid hormone, regardless of whether
or not the thyroid is the primary source. There are
a number of pathologic causes of hyperthyroidism
in children and adults.

13. CONT..
• These include Graves disease, toxic adenoma,
toxic multinodular, goiter, and thyroiditis,
Graves disease accounts for approximately
95% of cases of hyperthyroidism, To
understand the pathophysiology of
hyperthyroidism, it is necessary to understand
the normal physiology of the thyroid gland.

15. INCIDENCE
• Incidence of Women 66.4% and 33.6% in men, 15% of
cases occur in patients older than 60 years of age.
• In India, a large number of people suffer from thyroid
disorders. Previous studies reveal that almost 42
million Indians suffer from thyroid disorders.
Unfortunately, awareness about the disease is low. A
recent study across 8 cities of India (ABCDGHKM)
revealed the prevalence of thyroid disorders in around
11 % of the urban population, with women being 3
times more prone to the disease than men.

17. Hyperthyroidism is a medical
condition that results from
an excess of thyroid
hormone in the blood.

18. Etiology
• Ectopic thyroid disease
• Grave’s disease
• Multi-nodular disease
• Thyroid adenoma
• Subacute thyroiditis
• Ingestion of thyroid hormone
• Pituitary disease
• Ingestion of food containing thyroid hormone
• High dietary iodine intake or very low dietary
intake.
• Genetic factor.

19. 1.Ectopic thyroid disease
Ectopic thyroid tissue are related to the
growth of the thyroid tissue, causing
dysphasia, dysphonia with stomatolalia,
bleeding, or dyspnea lead to
hyperparathyrodisum.

20. GRAVES' DISEASE
Graves' disease is a type of autoimmune problem
that causes the thyroid gland to produce too
much thyroid hormone, which is
called hyperthyroidism. Graves' disease is often
the underlying cause of hyperthyroidism.

21. MULTI-NODULAR DISEASE
Sometimes, a person can have a goiter that
has multiple nodules or bumps on it, which is
called a multinodular goiter. A toxic goiter is one
that makes too much thyroid hormone, resulting in
a condition called hyperthyroidism. Most
thyroid nodules are harmless, but some can be
cancerous

22. THYROID ADENOMA
This occurs when a single nodule (or lump) grows
on the thyroid gland causing it to become enlarged
and produce excess thyroid hormones. If the
increased hormone production is coming from a
single nodule in the gland, this is called
toxic adenoma.

23. SUBACUTE THYROIDITIS
Subacute thyroiditis is an acute inflammatory
disease of the thyroid probably caused by a virus.
Symptoms include fever and thyroid tenderness.
Initial hyperthyroidism is common, sometimes
followed by a transient period of hypothyroidism.
Diagnosis is clinical and with thyroid function tests.

24. INGESTION OF THYROID HORMONE
Exogenous hyperthyroidism is the term used to
describe hyperthyroidism caused by ingestion of
excessive amounts of thyroid hormone. It may be
intentional (ie, suppressive doses of thyroxine to
treat thyroid cancer) or inadvertent (ie,
contamination of dietary supplements).

25. PITUITARY DISEASE
TSH-secreting pituitary adenomas are benign
tumours of the pituitary gland. They produce too
much thyroid stimulating hormone (TSH),
which causes the thyroid gland to enlarge and
produce thyroid hormone in excess, leading to an
overactive thyroid (hyperthyroidism).

26. Ingestion of food containing thyroid
hormone lead to hyperthyroidism
Due to the high iodine content,
supplements containing kelp should be After 1
month of treatment, the thyroid
hormone levels returned to salt into foods and
nutrition to prevent hypothyroidism and
cardiovascular diseases.

27. High dietary iodine intake or very low
dietary intake. lead to
hyperthyroidism
However, too high iodine intake, for example due to
overdosage of iodine supplements, can have toxic
side effects. It can lead to hyperthyroidism and
consequently high blood levels of thyroid hormones
(hyperthyroxinemia).

28. GENETIC FACTOR
hereditary toxic thyroid hyperplasia or autosomal
dominant autoimmune hyperthyroidism. It
is hereditary through dominant activating mutation
of the TSH receptor (TSHR) affecting all thyroid
cells.

29. Pathophysiology
Hyperthyroidisms characterized by loss normal regulatory control of thyroid
hormone secretion.
The action of thyroid hormone on the body is stimulatory, hyper metabolism
result
Increase sympathetic nervous system activity
Alteration secretion and metabolism of hypothalamic pituitary andgonadal
hormone.
Excessive amount of thyroid hormone stimulate the cardiac system andincrease
the adrenergic receptors.
Tachycardia and increase cardiac –output, stroke volume and peripheralblood
flow.
Negative nitrogenous balance, lipid depletion and the resultant state ofnutritional
deficiency.
Hyperthyroidism result

30. Clinical manifestation
• Symptoms and their severity depend on duration and
extent of thyroid hormone excess, and the age of the
individual. Individuals may experience:
• Nervousness and irritability
• Palpitations and tachycardia
• Heat intolerance or increased sweating
• Tremor
• Weight loss or gain
• Increase in appetite
• Frequent bowel movements or diarrhea
• Lower leg swelling
• Sudden paralysis
• Shortness of breath with exertion
• Decreased menstrual flow
• Impaired fertility
• Sleep disturbances (including insomnia)

32. Cont..
• Changes in vision
– Photophobia, or light sensitivity
– Eye irritation with excess tears
– Diplopia, or double vision
– Exophthalmos, or forward protrusion of the eyeball
– Fatigue and muscle weakness Thyroid enlargement
Pretibial myxedema (fluid buildup in the tissues about
the shin bone; may be seen with Grave's disease)

34. Investigation
• History and physical examination
• Ophthalmic examination
• ECG- atrial tachycardia
• Thyroid function test: T3 and T4
• Thyroid releasing hormone stimulation test
• Radioactive iodine uptake (RAIU)
• Thyroid scan

35. Cholesterol test
Your doctor may need to check your cholesterol
levels. Low cholesterol can be a sign of an elevated
metabolic rate, in which your body is burning
through cholesterol quickly.
T4, free T4, T3
These tests measure how much thyroid hormone
(T4 and T3) is in your blood.

36. Thyroid stimulating hormone level test
Thyroid stimulating hormone (TSH) is a pituitary
gland hormone that stimulates the thyroid gland to
produce hormones. When thyroid hormone levels
are normal or high, your TSH should be lower. An
abnormally low TSH can be the first sign of
hyperthyroidism.
Triglyceride test
Your triglyceride level may also be tested. Similar
to low cholesterol, low triglycerides can be a sign of
an elevated metabolic rate.

37. Thyroid scan and uptake
This allows your doctor to see if your thyroid is
overactive. In particular, it can reveal whether the
entire thyroid or just a single area of the gland is
causing the overactivity.
Ultrasound
Ultrasounds can measure the size of the entire
thyroid gland, as well as any masses within it.
Doctors can also use ultrasounds to determine if a
mass is solid or cystic.
CT or MRI scans
A CT or MRI can show if a pituitary tumor is present
that’s causing the condition.

38. Treatment
1. Radioactive iodine
Taken by mouth, radioactive iodine is absorbed
by your thyroid gland, where it causes the gland
to shrink and symptoms to subside, usually
within three to six months.

40. 2. Anti-thyroid medications
• These medications gradually
reduce symptoms of
hyperthyroidism by preventing
your thyroid gland from
producing excess amounts of
hormones. They include
propylthiouracil and
methimazole (Tapazole).
• Symptoms usually begin to
improve in 6 to 12 weeks, but
treatment with anti-thyroid
medications typically continues
at least a year and often longer.

41. 3. Beta blockers
• These drugs are commonly
used to treat high blood
pressure. They won't
reduce your thyroid levels,
but they can reduce a rapid
heart rate and help prevent
palpitations. Side effects
may include fatigue,
headache, upset stomach,
constipation, diarrhea or
dizziness.

42. Surgical management
• Surgical Treatment of Thyroid Disease General
Several surgical options exist for treating thyroid
disease and the choice of procedure depends on
two main factors.
• The first is the type and extent of thyroid disease
present.
• The second is the anatomy of the thyroid gland
itself. The most commonly performed procedures
include: lobectomy, lobectomy with isthmectomy,
subtotal thyroidectomy, and total thyroidectomy.

45. Nursing management
1. Imbalanced nutrition less than body
requirement related to anorexia and increase
metabolic demand is inappropriate.
Intervention:
- High calorie diet (4000-5000 kcal/day)
- High protein diet (1-2 g/kg of ideal body weight)
- Frequent meals

46. 2. Activity intolerance related to exhaustion
secondary to accelerated metabolic rate
resulting in inability to perform activity without
shortness of breath and significant increased in
heart rate
Intervention:
- Assist with regular physical activity.
- Assist in activities of daily living
- Assist the patient to schedule rest periods.

47. Cont..
3.Risk for injury: corneal ulceration, infection
and not possible blindness related inability to
close the eye lids secondary to exophthalmos.
4.Hyperthermia related to accelerated
metabolic rate resulting in fever, diaphoresis and
reported heat intolerance.
5.Impaired social interaction related to extreme
agitation, hyperactivity, and mood swings
resulting in inability to relate effectively with
others

48. Hypothyroidism
• Abnormally low activity of the thyroid gland,
resulting in retardation of growth and mental
development in children and adults.

50. A condition in which the thyroid gland doesn't
produce enough thyroid hormone.
Hypothyroidism's deficiency of thyroid hormones
can disrupt such things as heart rate, body
temperature and all aspects of metabolism.
Hypothyroidism is most prevalent in older women.
Major symptoms include fatigue, cold sensitivity,
constipation, dry skin and unexplained weight gain.

52. INCIDENCE
• Worldwide about one billion people are
estimated to be iodine deficient; however, it is
unknown how often this results in
hypothyroidism.
• In large population-based studies in Western
countries with sufficient dietary iodine, 0.3–
0.4% of the population have overt
hypothyroidism.
• A larger proportion, 4.3–8.5%, have
subclinical hypothyroidism.
• Women are more likely to develop
hypothyroidism than men.

53. Risk factors
• Although anyone can develop hypothyroidism, you're
at an increased risk if you:
• Are a woman older than age 60
• Have an autoimmune disease
• Have a family history of thyroid disease
• Have other autoimmune diseases, such as rheumatoid
arthritis or lupus, a chronic inflammatory condition
• Have been treated with radioactive iodine or anti-
thyroid medications
• Received radiation to your neck or upper chest
• Have had thyroid surgery (partial thyroidectomy)
• Have been pregnant or delivered a baby within the
past six months

54. Causes of hypothyroidism
• Medication: A number of medications can cause
Hypothyroidism. Lithium, which is used to treat
certain psychiatric disorders, can also affect the
thyroid gland.
• Genetic dysfunction: The thyroid gland may be
dysfunctional at birth, or may fail at some phase in
adult life.
• Previous thyroid surgery: Removal of a large
portion or the entire thyroid gland may reduce or
stop the process of thyroid hormone production.
• Treatment for Hyperthyroidism: Treatment for
Hyperthyroidism may sometimes result in
Hypothyroidism.

55. Causes of hypothyroidism
• Radiation therapy: Exposure of the thyroid gland
to radiation therapy for the treatment of cancers
of the head and neck region may result in
Hypothyroidism.
• Damage to the Pituitary Gland: The pituitary
gland may be damaged due to disease or surgery
which may result in decreased level of thyroid
hormones.
• Autoimmune Thyroid Disease: This is the most
common cause of Hypothyroidism. This happens
when the body's immune system produces
certain antibodies that attack its own thyroid
gland leading to a reduced thyroid hormone
production.

58. Sign and symptoms
• Hypothyroidism signs and symptom may include:
• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory

60. Investigation
• History and physical examination
• Serum T3, T4
• Serum TSH.
• Serum cholesterol
• TRH stimulation test

61. Treatment
• Thyroid hormone replacement e.g:
levothyroxine
• Monitor thyroid hormone level and adjusted
dosages
• Nutritional therapy to promote weight loss