1. THYROTOXICOSIS

2. DEFINITION
•Thyrotoxicosis is the clinical syndrome that
results from the exposition of tissues to an
excess of circulating thyroid hormone. In most
instances, thyrotoxicosis is due to an active
overproduction of thyroid hormone by the
thyroid follicular epithelial cells
(hyperthyroidism).
•Thyrotoxicosis is the clinical state associated
with excess thyroid hormone activity, usually
due to inappropriately high-circulating thyroid
hormones.

3. INCIDENCE
•Thyrotoxicosis occurs in approximately 2% of women
and 0.2% of men.
•Thyrotoxicosis due to Graves' disease most commonly
develops between the second and fourth decades of
life, whereas the prevalence of toxic nodular goitre
increases with age.
•Autoimmune forms of thyrotoxicosis are more
prevalent among smokers.

4. ETIOLOGY
1. Grave's disease-Autoimmunity; stimulation of thyrocytes
2. Toxic multinodular goiter
3. Toxic adenoma
4. TSH-producing adenoma or pituitary adenoma
5. HCG-mediated hyperthyroidism
6. Thyroiditis
7. Drug-induced
8. TSH secreting pituitary adenoma

5. CLINICAL MANIFESTATIONS
•Weight loss
•Palpitations
•Breathlessness
•Tremor
•Tiredness
•Heat intolerance
•Excessive sweating
•Increased bowel action
•Anxiety
•Nervousness
•Muscle weakness
•Menstrual disturbances
(oligomenorrhoea and
amenorrhoea)
•Loss of libido

6. PATHOPHYSIOLOGY
Due to over production of Thyroid Hormones (T3 and T4)
Increase basal metabolic rate and tissue thermogenesis
Activation of Sympathetic Nervous system
Vasoconstriction and activation of Renin Angiotensin-
aldosterone system
Clinical Presentation of thyrotoxicosis

7. DIAGNOSTIC EVALUATION
On physical exam, patients are often
cachectic, hyperthermic, diaphoretic,
and anxious appearing.
They may have goiter, tachycardia or
atrial fibrillation, dyspnea, abdominal
tenderness, hyperreflexia, proximal
muscle weakness, tremor, and
gynecomastia.
Patients with Graves' disease present
with ophthalmopathy, dermopathy,
and acropachy.

8. •TSH, THYROXIN, T3 and T4 evaluation
•Detection of Antibodies for TSH receptors ( to identify
Graves' disease)
•ESR and CRP (elevated in Thyroiditis)
•Radioactive iodine uptake studies ( to identify the adenoma)

9. MEDICAL MANAGEMENT
•There are 3 mainstays of treatment: thionamide
drugs, radioiodine, and thyroid surgery.
•Beta-blocker therapy such as propranolol, is
used to reduce adrenergic features such as
sweating, anxiety, and tachycardia.
•Thionamide drugs include propylthiouracil
(PTU) and methimazole and reduce the
production of thyroid hormone.

10. 2- RADIOIODINE THERAPY
•Radioiodine therapy is the most common
therapy used for adults with Graves’ disease.
•Radioactive iodine is given in one oral dose. It
is absorbed by the thyroid gland inducing
tissue-specific inflammation that leads to
thyroid fibrosis and destruction of thyroid
tissue over the next several months.

11. SURGICAL MANAGEMENT
Total or partial thyroidectomy is a rapid and effective
method of treating thyrotoxicosis.
However, it is invasive and expensive, and causes
permanent hypothyroidism, requiring levothyroxine
treatment.

12. NURSING MANAGEMENT
Nursing Diagnosis
•Risk for decreased cardiac output related to Changes
in venous return and systemic vascular resistance &
Alterations in rate, rhythm, conduction.
•Anxiety related to hypermetabolic state.
•Risk for Imbalanced Nutrition: Less Than Body
Requirements related to Increased metabolism
(increased appetite/intake with loss of weight)Nausea
/ vomiting , diarrhea.
•Fatigue related to hypermetabolic state.

13. INTERVENTIONS
•Monitor vital signs, noting pulse rate at rest and
when active.
•Provide for a quiet environment; cool room,
decreased sensory stimuli, soothing colors, quiet
music.
•Auscultate heart sounds, note extra heart sounds,
development of gallops and systolic murmurs.
•Auscultate breath sounds. Note adventitious
sounds.
•Monitor temperature; provide cool environment,

14. •Weigh daily. Encourage chair rest or bedrest. Limit
unnecessary activities.
•Record I&O.
•Consult with a dietitian to provide a diet high in
calories, protein, carbohydrates, and vitamins.
•Avoid foods that increase peristalsis and fluids
that cause diarrhea.
•Provide a balanced diet, with six meals per day.
•Encourage patient to eat and increase the number
of meals and snacks. Give or suggest high-calorie
foods that are easily digested.