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HYPERTHYROIDISM/GRAVE'S DISEASE - Coggle Diagram
HYPER
THYROIDISM/GRAVE'S DISEASE
Etiology and Pathophysiology
Autoimmune Disease
diffuse thyroid enlargement
excess thyroid hormone secretion
causative factors interact with genetic factors
women are five times more likely than men to develop Grave's Disease
Clinical Picture
How Diagnosed?
Subclinical Hyperthyroidism
serum TSH level below 0.4 mIU/L
Normal T4 and T3 levels
Overt Hyperthyroidism
Low or undetectable TSH
Increased T4 and T3 levels
Symptoms may or may not be present
Clinical Manifestations
related to effect of thyroid hormone excess
increased metabolism
increased tissue sensitivity to sympathetic nervous system stimulation
Goiter
Inspection
Auscultation: Bruits
Opthalmopathy
abnormal eye appearance or function
Exophthalmos
Increased fat deposits and fluid
eyeballs forced outward
cardiovascular system
systolic hypertension
bounding, rapid pulse; palpitations
increased cardiac output
cardiac hypertrophy
systolic murmurs
dysrhythmias
angina
respiratory system
dyspnea on mild exertion
increased respiratory rate
Patient Experience
GI System
increased appetite, thirst
weight loss
diarrhea
splenomegaly
hepatomegaly
Skin
warm, smooth, moist skin
thin, brittle nails
hair loss
clubbing fingers; palmar erythema
fine, silky hair; premature graying in men
diaphoresis
vitiligo
Reproductive System
menstrual irregularities
amenorrhea
decreased libido
decreased fertility
impotence and gynecomastia in men
intolerance to heat
elevated basal temperature
lid lag, stare
eyelid retraction
rapid speech
recognize and analyze
musculoskeletal system
fatigue
weakness
proximal muscle wasting
dependent edema
osteoporosis
Nervous System
hyperactive deep tendon reflexes
nervousness, fine tremors
insomnia, difficult focusing eyes
lability of mood, delirium
lack of ability to concentrate
stupor, coma
Treatment
Medical
useful in treatment of thyrotoxic states
not considered curative
antithyroid drugs
iodine
B-Adrenergic Blockers
Propylthiouracil and methimazole (Tapazole)
inhibit thyroid hormone synthesis
improvement in 1-2 weeks
results usually seen within 4-8 weeks
therapy for 6-15 months
Potassium iodine (SSKI) and Lugol's solution
inhibits synthesis of T3 and T4 and block their release into circulation
decreases vascularity of thyroid gland, making surgery safer and easier
maximal effect within 1-2 weeks
Surgical
Indications
large goiter causing tracheal compression
unresponsive to antithyroid therapy
thyroid cancer
not a candidate for RAI
Rapid reduction in T3 and T4 levels
Subtotal Thyroidectomy
preferred surgical procedure
involve removal of 90% of thyroid
can be done using minimally invasive procedures
endoscopic thyroidectomy
robotic surgery
Nutritional Therapy
High Calorie Diet (4000-5000 cal/day)
6 full meals/day with snacks in between
protein intake: 1-2 g/kg ideal body weight
increased carbohydrate intake
avoid highly seasoned and high fiber foods, caffeine
dietitian referral
Preoperative Care
give medications to achieve euthyroid state
give iodine to decrease vascularity
Patient teaching
comfort and safety measures
leg exercises, head support, neck ROM
routine postoperative care
Postoperative care
assess every frequently during first 24 hours for signs and symptoms of hemorrhage or tracheal compression
semi-fowler's position
support head with pillows
avoid tension on suture line
monitor vital signs
signs of hypocalcemia
ambulation
psychosocial support
MONITOR FOR COMPLICATIONS!!!
hypothyroidism
hypocalcemia--Chvostek's sign
hemorrhage--surgical site
laryngeal nerve damage--raspy, hoarse voice
thyrotoxicosis
infection
MAINTAIN PATENT AIRWAY
oxygen, suction equipment,
TRACHEOSTOMY TRAY in patient's room
monitor for laryngeal stridor
IV CALCIUM READILY AVAILABLE
Nursing Assessment and Dx
Objective Data
increased T3 and T4
increased T3 resin uptake
decreased or undetectable TSH
chest x ray showing enlarged heart
ECG findings of tachycardia
Nursing Dx
Activity intolerance
impaired nutritional status
lack of knowledge
overall goals
have relief of symptoms
have no serious complications related to disease or treatment
maintain nutritional balance
cooperate with therapeutic plan
Discharge Planning
Assessment & Supplies
discharge teaching
monitor hormone release periodically
decrease caloric intake
adequate but not excessive iodine intake
regular exercise
avoid high environmental temperature
Education
discharge teaching
regular follow up care
complete thyroidectomy
symptoms of hypothyroidism
need for lifelong thyroid hormone replacement
Evaluation
have relief of symptoms
no serious complications related to disease or treatment
cooperate with therapeutic plan
maintain nutritional balance