# Hyperthyroidism --- **Hyperthyroidism** is a condition where there is an excess production and secretion of [[thyroid hormone]]. Since TH determines our [[basal metabolic rate]], this condition is associated with the systems of the body being ramped up, including emotional and mental state. ## Causes There are several causes to hyperthyroidism: - the most common cause is an [[autoimmune disorder]] called **Graves disease** - toxic multinodular goiter - toxic adenoma - thyroiditis - overdose of [[levothyroxine]] (i.e. iatrogenic) ## Risk Factors - sex - more common for those AFAB - age - 20s-40s - high [[stress]] ## Signs & Symptoms The first signs of hyperthyroidism are nervousness, emotional hyperexcitability, irritableness, apprehension, palpitations, rapid pulse. Older patients sometimes get [[atrial fibrillation|afib]]. - flushed, hot, itchy skin - light skinned people will turn sort of salmon colored - exophthalmos, also known as **thyroid eye disease** - a bulging of the eye - fatty tissue behind the eye push out the eyes - nervousness - startled expression - weight loss despite increased appetite - amenorrhea - myocardial hypertrophy/[[heart failure]] - late sign, if left untreated. ## Diagnostic Tests - blood draw (thyroid panel) - reduced [[thyroid hormone|TSH]] but increased [[thyroid|T4]] - increase in radioactive iodine uptake - possibly an enlarged thyroid ## Treatment The goal of hyperthyroidism treatment is to reduce hyperactivity of thyroid and relieve the symptoms. If it's transient they might use a [[beta blockers]], but often treatment involves removing the thyroid and starting someone on thyroid replacement hormones (which will last the rest of their lives). - Radioactive iodine with I$_{131}$ - This is used to eradicate the thyroid gland. It is a one time therapy given over one to two doses. - contraindicated for pregnancy/breastfeeding - After 4-18 weeks start on thyroid replacement therapy ([[levothyroxine]]) - timing depends on blood tests - Side Effects: - radioactive for the first two days - loss of taste - dry mouth - risk for a [[#Thyroid Storm|thyroid storm]] initially - Anti-thyroid medication (**Propylthiouracil**) - Blocks hormone conversion T4 to T3 - T3 is much more biologically active. Most T4 converts to T3, so preventing that will pull the punch. - Oral, empty stomach, 30 min prior to meal - Monitor for [[hypothyroidism]] - Used as a chemotherapy agent with immunosuppression side effect risk. - **Monitor and report immediately for infection, especially throat or fever; rash, N/V, agranulocytosis** - **Monitor WBC before and after starting** - Surgery is an option, but it's not typically done - usually only done if the goiter is obstructive or if someone was pregnant and can't have the other ones ## Thyroid Storm A **thyroid storm** or a **thyrotoxic crisis** is a extreme spike in TH production. It's rare but very dangerous. It can be caused by too much [[stress]], or starting thyroid replacements too soon after a thyroidectomy. High fever > 101.3F HR > 130 Altered neuro/mental status-psychosis, somnolence or coma Management of a thyroid storm are: - Prevent CV collapse - Beta blockers to get HR down - Ice packs/Cooling blanket - Humidified oxygen - IVF with dextrose - PTU - monitor - Hydrocortisone to treat shock or adrenal insufficiency ## Nursing Considerations Impaired nutrition- less than body requirements d/t hypermetabolic state Ineffective coping r/t irritability, hyper excitable state, apprehension Impaired thermoregulation- excessive body temperature, feel too warm altered body image- exophthalmos, muscle wasting Risk for Thyroid Storm; Risk for hypothyroidism after treatment ___