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College of Nursing
A Case Study
Hyperthyroidism
“Touch my Neck”
Presented by:
Group 1
Agcaoili, Jenalyn
Aranzaso, Christian
Columna, Liezel
Cueno, Caroline
Hierco, Rica Bianca
Legayada, Mary Jerah
Manigsaca, Melizen
Paraiso, Joanna
Romeo, Norely
Romero, Jelica
Turla, Jordina
1
CHAPTER I
INTRODUCTION
Hyperthyroidism, a term for overactive tissue within the thyroid gland, resulting in
overproduction and thus an excess of circulating free thyroid hormones: thyroxine (T4),
triiodothyronine (T3) or both. Thyroid hormone is important at a cellular level, affecting nearly
every type of tissue in the body. It functions as a stimulus to metabolism, and is critical to
from an excessive output of thyroid hormones due to abnormal stimulation of the thyroid gland
by circulating immunoglobulin. This disorder affects women eight times more frequently than
men and peaks between the second and fourth decades of life. It generally occurs between 20
intolerance: these are some of the signs and symptoms of Hyperthyroidism. Neurological
Hyperthyroidism is the most common endocrine disorder that’s why we choose this as
our case study because of its relevance to our concept about disturbance in metabolism and
endocrine. Since metabolism is all the chemical and physical processes which occur in living
organisms and that maintain life and growth, endocrine is specifically producing secretions that
are distributed in the body by the blood stream. Like with our patient with hyperthyroidism,
Stimulating Hormone) that affects his metabolism (Medical surgical Nursing; Joyce Young
Johnson).
2
BACKGROUND OF THE STUDY
One of the cases that we handled in one of the tertiary hospital in Cavite, City is
captured the interest of the researchers to further study the case (Medical Surgical Nursing;
Our patient is a 28 year old male and he is a navy. On the day of his admission, he
experienced severe palpitation or tachycardia and he felt light headedness and loss his
Major Problem: What nursing intervention can be formulated based on the identified
problem?
• Age
• Gender
• Occupation
2.) What are the different assessment parameters of a patient with Hyperthyroidism?
3.) What are the different nursing diagnoses formulated based on the client’s situation?
5.) What nursing intervention can be formulated based on the identified problem?
6.) What are the client’s responses based on the implemented nursing interventions?
3
SIGNIFICANCE OF THE STUDY
To client/his family
This study is for the family to know and understand better the importance of seeking
medical assistance. For them to understand further, the disease and be able to cope gradually
with whatever changes that the patient will go through regarding his condition.
This study will provide facts and nursing managements about this disease, which will be
a great assistance for them to provide the students to have sufficient knowledge about the
disease and how to deal with patients who are suffering from it.
To nursing education
This study will provide the information about hyperthyroidism because of the facts and
To the students
This study will serve as a reference for the nursing students about patients with
hyperthyroidism. Also, for them to gain knowledge and be aware on how to give proper nursing
This study will provide knowledge about this disease which will be helpful for the
services of the community to educate those who are suffering from this condition, the family
The result of this study will serve as a guide for future reference about future researches
4
SCOPE AND LIMITATION
The researchers had a total of five (5) interactions and/or equal to 4o hours and had a
This study covers only the information about hyperthyroidism that has relevance to our
topic; disturbances in endocrine. This study is limited only to hyperthyroidism which is results
from an excessive output of thyroid hormones such as T3 triidothyronini and T4 thyroxine, due
classified as an endocrine disorder. This study will not tackle any topic beyond the disease
(hyperthyroidism).
5
CHAPTER II
FOREIGN:
Hyperthyroidism
To be hyperthyroid, is to have an over-active thyroid gland. When the thyroid produces to much
Hyperthyroidism causes a sped-up metabolism and can cause the patient to feel hyper, edgy,
nervous and anxious. While people with any thyroid disorder have potential to experience
anxiety, those with hyperthyroidism are especially vulnerable to chronic and severe anxiety
symptoms.
Patients being treated for hypothyroidism can at times be over-treated on their thyroid hormone
medication and will cause them to experience hyperthyroidism. This is also referred to as thyro-
Hyperthyroidism is a condition of excess thyroid hormone. When hormone levels are too high,
6
the resulting sped up metabolism in the body, causes hyperthyroid symptoms. This article
further describes this over-active thyroid condition and the causes of it.
(Hashitoxicosis). When this happens, their Doctor should test them for "TSI antibodies", which
normally occur with Grave's Disease. If the antibodies are present, they may be a candidate for
Approximately 3 million Americans have Graves´ Disease and that number is greatly increased
worldwide. This article gives the basic signs and symptoms for recognizing this common cause
of hyperthyroidism.
This article looks at the different treatments for hyperthyroidism caused by Graves´ Disease,
What is hyperthyroidism?
amount of thyroid hormones that circulate in the blood. ("Hyper" means "over" in Greek).
Thyrotoxicosis is a toxic condition that is caused by an excess of thyroid hormones from any
overproduction of thyroid hormones by the thyroid gland. Because both physicians and patients
7
often use these words interchangeably, we will take some liberty by using the term
Thyroid hormones stimulate the metabolism of cells. They are produced by the thyroid gland.
The thyroid gland is located in the lower part of the neck, below the Adam's apple. The gland
wraps around the windpipe (trachea) and has a shape that is similar to a butterfly formed by
nodule") and Toxic Multinodular Goiter (TMNG) ,Excessive intake of thyroid hormones
,Abnormal secretion of TSH ,Thyroiditis (inflammation of the thyroid gland) ,Excessive iodine
intake
Graves' Disease -Graves' disease, which is caused by a generalized overactivity of the thyroid
gland, is the most common cause of hyperthyroidism. In this condition, the thyroid gland
usually is renegade, which means it has lost the ability to respond to the normal control by the
pituitary gland via TSH. Graves' disease is hereditary and is up to five times more common
among women than men. Graves' disease is thought to be an autoimmune disease, and
antibodies that are characteristic of the illness may be found in the blood. These antibodies
(TPO), and TSH receptor antibodies. The triggers for Grave's disease include:stress, smoking,
radiation to the neck, medications, and infectious organisms such as viruses. Graves' disease
can be diagnosed by a standard, nuclear medicine thyroid scan which shows diffusely increased
8
uptake of a radioactively-labeled iodine. In addition, a blood test may reveal elevated TSI
levels.Grave's disease may be associated with eye disease (Graves' ophthalmopathy) and skin
lesions (dermopathy ). Ophthalmopathy can occur before, after, or at the same time as the
hyperthyroidism. Early on, it may cause sensitivity to light and a feeling of "sand in the eyes."
The eyes may protrude and double vision can occur. The degree of ophthalmopathy is worsened
in those who smoke. The course of the eye disease is often independent of the thyroid disease,
and steroid therapy may be necessary to control the inflammation that causes the
(dermopathy) is rare and causes a painless, red , lumpy skin rash that appears on the front of the
legs.
Hyperthyroidism is a large topic so we split it into four manageable sized portions. This page
introduces hyperthyroidism. Subsequent pages are listed at the bottom which address more
In healthy people, the thyroid makes just the right amounts of two hormones, T4 and T3, which
have important actions throughout the body. These hormones regulate many aspects of our
metabolism, eventually affecting how many calories we burn, how warm we feel, and how
much we weigh. In short, the thyroid "runs" our metabolism. These hormones also have direct
effects on most organs, including the heart which beats faster and harder under the influence of
thyroid hormones. Essentially all cells in the body will respond to increases in thyroid hormone
with an increase in the rate at which they conduct their business. Hyperthyroidism is the
9
medical term to describe the signs and symptoms associated with an over production of thyroid
hormone. For an overview of how thyroid hormone is produced and how its production is
Hyperthyroidism is a condition caused by the effects of too much thyroid hormone on tissues of
the body. Although there are several different causes of hyperthyroidism, most of the symptoms
that patients experience are the same regardless of the cause (see the list of symptoms below).
Because the body's metabolism is increased, patients often feel hotter than those around them
and can slowly lose weight even though they may be eating more. The weight issue is
confusing sometimes since some patients actually gain weight because of an increase in their
appetite. Patients with hyperthyroidism usually experience fatigue at the end of the day, but
have trouble sleeping. Trembling of the hands and a hard or irregular heartbeat (called
palpitations) may develop. These individuals may become irritable and easily upset. When
hyperthyroidism is severe, patients can suffer shortness of breath, chest pain, and muscle
weakness. Usually the symptoms of hyperthyroidism are so gradual in their onset that patients
don't realize the symptoms until they become more severe. This means the symptoms may
continue for weeks or months before patients fully realize that they are sick. In older people,
some or all of the typical symptoms of hyperthyroidism may be absent, and the patient may just
Hyperthyroidism can cause a wide variety of symptoms. Most people won’t have all of the
symptoms can change over time and they can vary in severity. For many years, typical
10
symptoms of hyperthyroidism, such as excess sweating, muscle weakness, heat tolerance,
fatigue, tremor, increased heart rate, anxiety and nervousness have been recognized.IN recent
years, a number of other less typical symptoms, many of which occur outside of
symptomsof headache, vomiting, high blood calcium and low potassiumhave been found to
occur in hyperthyroidism, but sometime, because they are commonly seen in other conditions,
disorders has been linked to excess thyroid hormone, but often, this connection isn’t
considered.
potassium, which can result in temporary paralysis. This condition was originally described in
Asian men, but has since found in all races and in women although it occurs more often in men.
The sudden drop in potassium typically occurs after exercise or following ingestionof high
amounts of carbohydrates or sodium. Paralysis typically begins in the proximal muscles and is
worst in the lower legs. Patients with hypokalemic paralysis may become paralyzed after sitting
or lying down and may awaken from deep sleep unable to rise from bed. Beta-blockers improve
this condition but complete resolution doesn’t occur until the thyroid hormone levels are
lowered.
Similarly, serum calcium levels may rise in hyperthyroidism, sometimes to a significant degree.
This occurs as the hypermetabolic state causes increased withdrawal of calcium from bones.
The sudden onset of hypercalcemia may cause appetite loss, usually in contrast to the usual
increased appetite typically seen in hyperthyroidism. This can cause significant bone loss over
time, particularly in women. With treatment for hyperthyroidism, this condition improves.
11
Methimazole vs. Propylthiouracil for Hyperthyroidism
Methimazole was superior overall, and lower doses seemed sufficient for patients with mild-to-
moderate hyperthyroidism.
Both methimazole and propylthiouracil (PTU) are used to treat hyperthyroidism. To compare
these drugs, Japanese researchers randomized 396 patients with Graves hyperthyroidism to
At each of three time points (4, 8, and 12 weeks), the proportion of patients with normalized
free thyroxine (T4) levels was higher in the 30-mg methimazole group than in the other two
groups. The differences were of borderline statistical significance at 4 and 8 weeks but
significant at 12 weeks (normal free T4 achieved in 97%, 86%, and 78% of patients in the 30-
mg methimazole, 15-mg methimazole, and PTU groups, respectively). In patients with mild or
moderate hyperthyroidism, normal free T4 was achieved at similar rates in the three groups.
elevations and leukopenia occurred less commonly with both doses of methimazole than with
PTU. Rash was less common with lower-dose methimazole than with higher-dose methimazole
or PTU.
Age and Gender Predict the Outcome of Treatment for Graves’ Hyperthyroidism
12
predict outcome have not generally proved clinically useful or been widely adopted in clinical
consecutively to determine whether simple clinical features predict disease presentation and
hyperthyroidism [free T4: males, 64.3 ± 3.0 pmol/L (mean ± SE); females, 61.3 ± 1.7 (P = 0.45);
free T3: males, 24.3 ± 1.5 pmol/L; females, 21.0 ± 0.6, (P = 0.04)]. Patients less than 40 yr at
diagnosis had more severe hyperthyroidism than patients more than 40 yr old [free T4: <40 yr,
64.3 ± 2.0; >40 yr, 56.7 ± 2.3 (P = 0.02); free T3: <40 yr, 22.8 ± 0.8; >40 yr, 19.0 ± 0.9 (P =
0.003)]. Males had a lower remission rate than females after a course of antithyroid medication
[19.6% vs. 40%; odds ratio, 0.37; 95% confidence interval (CI), 0.17–0.79; P < 0.01]. Similarly,
patients aged less than 40 yr had a lower remission rate than older patients (32.6% vs. 47.8%;
odds ratio, 0.53; 95% CI, 0.32–0.87; P = 0.01). One dose of radioiodine cured hyperthyroidism
in fewer males than females (47% vs. 74%; P < 0.0001). Logistic regression analysis
demonstrated male sex (odds ratio, 2.80; 95% CI, 1.31–5.98; P = 0.008), serum free T4
concentration at diagnosis (odds ratio, 1.02; 95% CI, 1.0–1.04; P = 0.01), and dose of
radioiodine administered (odds ratio, 0.99; 95% CI, 0.99–1.00; P = 0.001) were contributing
factors associated with failure to respond to a single dose of radioiodine. As males and younger
patients are more likely to fail to respond to medical treatment, and male patients are likewise
less likely to respond to a single dose of radioiodine, we suggest that those groups with low
remission rates should be offered definitive treatment with radioiodine or surgery soon after
presentation and that the value of higher initial doses of radioiodine in males be evaluated
13
LOCAL:
EXCESSIVE weight loss or weight gain may be an indication of trouble in the thyroid glands
according to Dr. Gabriel Jasul Jr., director and chairman of the Committee on Advocacy of the
Philippine Society of Endocrinology and Metabolism (PSEM). Jasul said that hyperthyroidism,
hypothyroidism and goiter are among the leading thyroid disorders. The doctor gave a primer
entitled “PSEM and the Public: Working Together to Fight Goiter,” at the press conference held
Diseases of the thyroid glands could manifest in a plethora of symptoms besides the usual lump
in the neck, related Jasul. The doctor explained that hyperthyroidism is a condition where the
thyroid glands are diffusely enlarged; its signs may include weight loss, rapid heartbeat,
muscle weakness, fatigue, increased sweating and shorter menstrual flow in women.
Hypothyroidism is the inability of the thyroid glands to produce adequate amounts of thyroid
hormones causing the body to slow down. A person with hypothyroidism may display the
following symptoms: weight gain, intolerance to cold, constipation, low infertility, depression,
sleepiness, forgetfulness, puffy face, falling hair, muscle weakness, fatigue, dry skin and longer
Jasul emphasized in his lecture that goiter is still prevalent among Filipinos. Commonly known
as bosyo, goiter is the general term for the enlargement of the thyroid gland in the neck. In the
Philippines, its frequency is high among women within the reproductive age of 13 to 20 years
old. The disease also afflicts 5 percent of the school children in the country due to iron
deficiency.
14
PSEM president Dr. Rosa Allyn Sy stressed the role of endocrinology in the management of
goiter and other thyroid diseases. Endocrinology is the study of the endocrine system and its
internist or a pediatrician who has completed two years of study in an accredited fellowship
and treatment of diabetes, thyroid disorders, obesity, dyslipidemia, osteoporosis and other
metabolic problems. The PSEM has just over 120 endocrinologists on its roster nationwide.
PSEM vice president Dr. Josephine Carlos-Raboca and director Dr. Leilani B. Mercado-Asis
said that their organization is actively involved in advocacy campaigns on the prevention and
During the recent celebration of Medicine Week, the Philippine Thyroid Association (PTA) held
its very first Thyroid Expo as part of its advocacy to educate lay people. In an effort to educate
the public and generate awareness on thyroid problems, lectures on hyperthyroidism (over-
active thyroid), hypothyroidism (under-active thyroid) and goiter were conducted through the
“That’s why we chose to hold the lectures here in a mall, where we are able to offer free thyroid
tests to the public at Clinica Manila for those who could not afford the test,” explains Dr. Roy J.
Cuison, endocrinologist and current PTA president. “Just like diabetes, many people with
thyroid problems are unaware of their condition until it becomes serious and entrenched. But
15
unlike diabetes, there is still a very low awareness for thyroid diseases. That’s why the
declaration of the third week of January as Goiter Awareness Week is very important to us,”
says Cuison.
For hypothyroidism, common symptoms are fatigue, weight gain, constipation, fuzzy thinking,
low blood pressure, fluid retention, depression, body pain, slow reflexes, among others. For
hyperthyroidism, symptoms include anxiety, insomnia, rapid weight loss, diarrhea, fast heart
rate, high blood pressure, eye sensitivity/bulging and vision disturbances, and many other
concerns.
For certain thyroid problems, more women are afflicted than men. At greater risk are women
who have family members (mothers, sisters, or cousins) who have had thyroid problems. It also
“If you are a woman and thyroid problems have been found in your family, it would be best to
have your thyroid checked,” recommends Dr. Cuison. “Thyroid hormones are partly responsible
for brain development, that’s why pregnant women should have a thyroid test while newborns
approach. Most thyroid problem cases can be managed medically, which means they can be
given tablets. However, for problems discovered much later, there is another modality —
surgical intervention. Another modality that can be used is called radioactive iodine,” explains
Cuison.
To improve the awareness and treatment of thyroid problems, Dr. Cuison urges all physicians to
cooperate with the PTA by disseminating information to their patients about thyroid problems
16
Goiter still rampant among Filipinos
Goiter prevalence in the Philippines is still high compared to other Asian countries, with the
This was revealed by officials of the Philippine Society of Endocrinology and Metabolism
during a press conference dubbed PSEM and the Public: Working Together to Fight Goiter held
Goiter or the enlargement of the thyroid gland just below the Adam’s apple – is also prevalent
in five percent of the schoolchildren. The disease is most commonly caused by iodine
deficiency.
PSEM director and committee on advocacy chair Dr. Gabriel Jasul, Jr. also provided an
overview of the diseases of the thyroid gland which include goiter, hypothyroidism and
hyperthyroidism. PSEM president Dr. Rosa Allyn Sy, on the other hand, stressed the role of
PSEM vice-president Dr. Josephine Carlos-Raboca and director Dr. Leilani B. Mercado-Asis,
also presented their advocacy campaigns on the awareness, prevention and treatment of goiter.
17
Goiter Awareness Week brings to fore importance of ASIN Law implementation
TACLOBAN CITY, Jan. 7 (PNA) -- The Goiter Awareness Week is celebrated on the
fourth week of January, thanks to President Gloria Macapagal Arroyo who, through
Proclamation No. 1188 in 2007, declared the fourth week of January as Goiter Awareness
Week.
In signing the Proclamation, President Arroyo stressed the need to promote a sustained
information and education of the population on the prevention of goiter and other thyroid
disorders.
The Department of Health (DOH) has been designated as the lead agency in conducting
information dissemination, education and training, research and preventive measures like
There is a need for the various stakeholders to work together to fight goiter through
concerted efforts in raising awareness against goiter and to stress the importance of
preventing this formidable disease which affects women under reproductive age and
It has always been said that a goiter maybe a temporary problem that will remedy itself
Goiter or the enlargement of the thyroid gland is considered prevalent in the Philippines.
Based on the studies on urinary iodine levels conducted by the Department of Health,
most goiter cases are found in the mountainous provinces and other remote areas of the
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Synthesis
thyroid gland, an excessesive amount of thyroid hormones that circulate in the blood.
the most common cause of hyperthyroidism and it is thought to be a autoimmune disease and
antibodies that are characteristics of the illness may found in the blood,and what triggers for
intake. Various symptoms manifest in this disease such as excessive sweating, heat tolerance,
increase bowel movement, tremor, nervouseness, agitation, rapid heart rate, weight loss,
fatigue, decrease concentration, irregular and scant menstrual flow for female.
19
There are various ways to diagnosed hyperthyroidism some of this diagnostic test is
blood test to test the level of thyroid-stimulating hormone, because decrease TSH means that
Hyperthyroidism is treated in many ways such as treating the symptoms itself using
medication like beta- blockers, using antithyroid drugs, radioactive iodine theraphy which give
orally on a one-time basis to ablate a hyperactive gland, and surgery which is the partial
Thyroid Gland
The thyroid is one of the largest endocrine glands in the body. This gland is found in
the neck inferior to (below) the thyroid cartilage (also known as the Adam's apple in men) and
at approximately the same level as the cricoid cartilage. The thyroid controls how quickly the
body burns energy, makes proteins, and how sensitive the body should be to other hormones.
thyroxine (T4) and triiodothyronine (T3). These hormones regulate the rate of metabolism and
affect the growth and rate of function of many other systems in the body. Iodine is an essential
component of both T3 and T4. The thyroid also produces the hormone calcitonin, which plays a
The thyroid is controlled by the hypothalamus and pituitary. The gland gets its name
from the Greek word for "shield", after the shape of the related thyroid cartilage.
20
Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) are the most
Anatomy
The thyroid gland is butterfly-shaped organ and is composed of two cone-like lobes or
wings: lobus dexter (right lobe) and lobus sinister (left lobe), connected with the isthmus. The
organ is situated on the anterior side of the neck, lying against and around the larynx and
trachea, reaching posteriorly the oesophagus and carotid sheath. It starts cranially at the oblique
line on the thyroid cartilage (just below the laryngeal prominence or Adam's apple) and extends
inferiorly to the fourth to sixth tracheal ring. It is difficult to demarcate the gland's upper and
lower border with vertebral levels as it moves position in relation to these during swallowing.
The thyroid gland is covered by a fibrous sheath, the capsula glandulae thyroidea,
composed of an internal and external layer. The external layer is anteriorly continuous with the
lamina pretrachealis fasciae cervicalis and posteriorolaterally continuous with the carotid
sheath. The gland is covered anteriorly with infrahyoid muscles and laterally with the
sternocleidomastoid muscle. Posteriorly, the gland is fixed to the cricoid and tracheal cartilage
and cricopharyngeus muscle by a thickening of the fascia to form the posterior suspensory
thyroid lobe, is present at the most posterior side of the lobe. In this region the recurrent
laryngeal nerve and the inferior thyroid artery pass next to or in the ligament and tubercle.
Between the two layers of the capsule and on the posterior side of the lobes there are on each
21
The thyroid isthmus is variable in presence and size, and can encompass a cranially
thyroglossal duct. The thyroid is one of the larger endocrine glands, weighing 2-3 grams in
The thyroid is supplied with arterial blood from the superior thyroid artery, a branch of
the external carotid artery, and the inferior thyroid artery, a branch of the thyrocervical trunk,
and sometimes by the thyroid ima artery, branching directly from the aortic arch. The venous
blood is drained via superior thyroid veins, draining in the internal jugular vein, and via inferior
thyroid veins, draining via the plexus thyroideus impar in the left brachiocephalic vein.
Lymphatic drainage passes frequently the lateral deep cervical lymph nodes and the pre- and
parathracheal lymph nodes. The gland is supplied by sympathetic nerve input from the superior
cervical ganglion and the cervicothoracic ganglion of the sympathetic trunk, and by
parasympathetic nerve input from the superior laryngeal nerve and the recurrent laryngeal
nerve..
22
Physiology
The primary function of the thyroid is production of the hormones thyroxine (T4),
organs such as the liver, kidney and spleen. T3 is about ten times more active than T4. T3 and
Thyroxine (T4) is synthesised by the follicular cells from free tyrosine and on the
tyrosine residues of the protein called thyroglobulin (TG). Iodine is captured with the "iodine
trap" by the hydrogen peroxide generated by the enzyme thyroid peroxidase (TPO) and linked
to the 3' and 5' sites of the benzene ring of the tyrosine residues on TG, and on free tyrosine.
Upon stimulation by the thyroid-stimulating hormone (TSH), the follicular cells reabsorb TG
and proteolytically cleave the iodinated tyrosines from TG, forming T4 and T3 (in T3, one
iodine is absent compared to T4), and releasing them into the blood. Deiodinase enzymes
convert T4 to T3. Thyroid hormone that is secreted from the gland is about 90% T4 and about
10% T3.
Cells of the brain are a major target for the thyroid hormones T3 and T4. Thyroid
hormones play a particularly crucial role in brain maturation during fetal development. A
transport protein (OATP1C1) has been identified that seems to be important for T4 transport
across the blood brain barrier. A second transport protein (MCT8) is important for T3 transport
and albumin. Only a very small fraction of the circulating hormone is free (unbound) - T4
0.03% and T3 0.3%. Only the free fraction has hormonal activity. As with the steroid hormones
and retinoic acid, thyroid hormones cross the cell membrane and bind to intracellular receptors
23
(α1, α2, β1 and β2), which act alone, in pairs or together with the retinoid X-receptor as
T3 and T4 regulation
hormone (TSH), released by the anterior pituitary (that is in turn released as a result of TRH
release by the hypothalamus). The thyroid and thyrotropes form a negative feedback loop: TSH
production is suppressed when the T4 levels are high, and vice versa. The TSH production
hypothalamus and secreted at an increased rate in situations such as cold (in which an
accelerated metabolism would generate more heat). TSH production is blunted by somatostatin
(SRIH), rising levels of glucocorticoids and sex hormones (estrogen and testosterone), and
Calcitonin
stimulates movement of calcium into bone, in opposition to the effects of parathyroid hormone
(PTH). However, calcitonin seems far less essential than PTH, as calcium metabolism remains
clinically normal after removal of the thyroid, but not the parathyroids.
24
PATHOPHYSIOLOGY
HYPERTHYROIDISM
Modifiable
Non-modifiable
Diet Age
• Heavy drinker
Lifestyle Gender
• Navy
Stimulation of Thyroid
Hormone
Increase in T3 and T4
Weight
Loss Restless Sweating
Enlarge Respira- Musculo- Anxiety 25
HR Appetite Hormonal Imbalance Heat
Thyroid tory skeletal
Fine Psycho- Integu- Neuro-
Exopthalmos
Physical
gland
Eyes System
RR Nutrition Multi-system
System Insomnia
Tremors Changes logical Intolerance
mentary Irritability
logical
CV
BP
CHAPTER III
RESEARCH METHODOLOGY
Research Design
The descriptive method of research was utilized in this study, because it is concerned
with the existing condition, it’s meaning, significance and then making adequate and accurate
interpretations of the data gathered. This study contains only the facts about the disease of
Hyperthyroidism and the important information about the patient. The researchers use this kind
Research Environment
The researchers conducted this study at the medical ward on one of the Tertiary Hospital
in Cavite City. The institution has a 100-bed capacity catering various services like;
Rehabilitation Medicine, Physical Therapy, ICU, Delivery Room, Operating Room and
Emergency Room.
Research Respondent
The research respondent’s were the patient with hyperthyroidism and her mother as
Research Instrument
The researchers made use of the following sources of information to gather all the
26
• Interview
The researchers made an initial interview with the patient and his mother to
provide additional information about the past health and family history. It was done on one
• Physical Assessment
manifestation or any abnormalities on the patient that can be used as a baseline data in
• Review of Records
The researchers reviewed the secondary sources of data such as the patient’s
chart to further add some details about the patient and his condition, and helped the
27
CHAPTER IV
DEMOGRAPHIC PROFILE
Gender: Male
Employment: Navy
Few months PTA the pt increased his appetite but he didn’t gain weight instead he lost
some weight. He usually had an insomnia and restless on the rest of the day. He also
Few days PTA the pt vomits all the foods he ate and experiencing fine tremors in his
extremities.
On the day of his admission he experience severe palpitation/ tachycardia and he felt
lightheadedness and loss his consciousness that’s prompted his admission in one of the Tertiary
The patient was a fully immunized child except measles and chickenpox and no allergy
in any medicines.
28
Patient had a primary KOCH’s during his childhood years but treated at 7 years old. The
patient had different diseases during his childhood he had measles and chickenpox which
Family History of
He usually had sedentary lifestyle. He likes to eat cabbage very often and he did’t
He is an heavy alcohol drinker since he was in high school. He can drink up to 2 long
AFTER 52 kg
29
General survey
Dec. 3, 2008
Temp: 36.5 ˚C
RR: 27 cpm
Physical Assessment
SKIN
HAIR
SCALP
mumps
Deformities No trauma deformities
SKULL
30
Areas to assess Findings
EYES
NECK
Nails
LUNGS
31
Musculoskeletal
Neurologic
ABDOMEN
After physical assessment there was no abnormalities expect for resilient and silky hair,
bilateral exopthalmus of his eyes, excessive sweating of his skin, enlarged and palpable mass
on the anterior portion of the neck, fine tremors, irritable and restless.
32
Examination/s Requested Results Normal Values Interpretation
T3 7.7 2.2-6.8 pmol/L Increased
T4 29.8 10.3-25.74 pmol/L Increased
TSH 0.1 0.3-5.0Uiu/ML Decreased
Interpretation
The diagnostic result was increased T3 AND T4 this result indicate that the patient has a
CHAPTER V
CONCLUSION
Hyperthyroidism. How it will affect the normal process of the endocrine system to individual
and what are several changes it can bring to all people’s having this disease? Based on the case
presented, with the support of literatures and research study on Hyperthyroidism, the
implemented in both clinical and home setting; in order to provide an optimum care for the
people with Hyperthyroidism. A proper health teaching is an important tool for nurse’s and its
33
primary responsibility should always be prioritize and should be given an emphasis for its
management.
There are treatments for Hypertyroidism the Antithyroid medication and radioactive
iodine are the ones doctors use most often. In rare cases, surgery may be done. Even if your
symptoms are not bothering you, you still need treatment, because hyperthyroidism can lead to
RECOMMENDATION
The research study brought about a great deal, gives some additional information in
enhancing nursing care practice and deep responsibility with regards to our nursing practice.
For this reasons, this case study recommend the following concepts which may be consider
vital in the care management of Hyperthyroidism in general for all aspects of people’s.
For client and family, to be able for them to understand the disease and to know what
are the factors they need to consider for seeking some medical assistance for the patient
For nursing service department, this study will provide them to have idea and sufficient
knowledge about this kind of disease that the patient was suffering.
For nursing education and students, this study will provide some important information
about Hyperthyroidism and this research study will serve as references for the nursing student
to be guided and to have an idea on how to provide a proper nursing care management for the
34
For the community health center and city health office, which will benefit to this study to
provide some information and idea about this disease and will serves as a references that will
For the future researchers, it will be beneficial to have knowledge regarding to the
thyroid gland, causing the levels of thyroid hormone in the blood to be too high. It is also
necessary to have a background regarding to this kind of disease which is very difficult to have
and we should familiarize ourselves on the signs and symptoms of this kind of disease.
We should support our nursing management with vital health teaching by spreading basic
necessary information regarding predisposing factors that can lead of having Hyperthyroidism.
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CONCEPT MAP
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Interpretation of Concept Map
1.) The first priority nursing diagnosis is cardiac output; risk for decrease. Because of the
heart inadequately pump blood to meet metabolic demands of the body. It should be
prioritized based on the ABC principle (Airway, Breathing and Circulation). The heart
manifest the patient to restlessness, irritability, fatigue and with vital signs of BP 140/90
Appropriate nursing interventions should be done for the patient to have adequate
cardiac output (Blood pressure, pulse rate and respiratory rate) within normal parameters.
2.) The second priority nursing is imbalanced nutrition: less than body requirements.
Because the patients body is having intake of nutrients insufficient to meet the metabolic
needs of the body; which is cause by hyper metabolic state secondary to excessive
thyroid hormone secretion. Nursing interventions needs to be formulated for the patient,
to be able to consume adequate nourishment needed by the body based to patient’s weight
3.) The third priority nursing diagnosis is anxiety. Patient is irritable, has insomnia,
intolerance to heat, restless, fatigue, has fine tremors, increased sweating, and has a
respiratory rate of 27 cpm. Anxiety is an alerting signal that warns of impending danger
and because of the formulated nursing interventions the patient will be able to take the
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4.) The fourth priority nursing diagnosis is fatigue. Based on the assessment done the
patient is manifesting fine tremors, anxiety, increased sweating and verbalizing lack of
energy with vital signs of pulse rate 129 bpm, blood pressure 140/90 mmHg and
sustained sense of exhaustion and decreased capacity for physical and mental work at
usual level.
5.) The fifth priority nursing diagnosis is disturbed sleep pattern. Patient is verbally
complaining of difficulty falling asleep and based on the assessment done he is irritable,
have fine tremors and unilateral exopthalmos. Time- limited disruption of sleep this is
what the patient experiencing. Which can affect the recovery of the patient that is, why
6.) The last priority nursing diagnosis disturbed body image. Disturbed body image
means confusion in mental picture of one’s physical self. The patient is manifesting
weight loss, unilateral exopthalmos, silky resilient hair and he is shy at first. That’s why
necessary nursing interventions should be done for the patient to accept the change or
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Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
39
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Independent:
Subjective: Imbalanced At 4 hours of After 4 hours
nutrition: less nursing • Provided • To enhance of rendering
“Pumayat talaga ako, maski than body intervention good oral client’s appetite nursing
malakas ako kumain, ganito requirements the patient hygiene and ability to eat intervention the
siguro talaga pag may related to hyper will be able to before and patient was
goiter” as verbalized by the metabolic state consume after meals able to
patient secondary to adequate • Monitor food • Continued weight consume
excessive nourishment. intake loss in face of adequate
Objective: thyroid adequate caloric nourishment.
hormone intake may
- Increased appetite secretion as indicate failure of
- Weight loss evidenced by anti- thyroid
weight loss, therapy.
(Weight before: 60 kg) restlessness and • Encourage • Keeping enough
(Weight now: 52 kg) irritability. patient to eat caloric intake
and increase aids in
- Restless meals and hypermetabolic
- Irritability snaks with state
high calorie
that are easily
digested
• Instruct the • It is increased GI
patient to motility may
avoid foods result in diarrhea
that increased and impair
peristalsis (eg. absorption of
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Tea. Coffee, needed nutrients
fibrous and
highly
seasoned
foods) and
fluids that
causes
diarrhea (eg.
Apple/ prune
juice).
• Provide • To enhance the
relaxing and intake ability
pleasant
environment
Dependent:
Collaborative:
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Nursing Planning Intervention Rationale Evaluation
Assessment Diagnosis
42
Independent:
Subjective: Anxiety (mild) At 8hours of After 8 hours of
“ naiinip na ako dito”
related to nursing • Observe behavior • Mild anxiety rendering nursing
as verbalized by theincreased intervention indicative of is manifested intervention the patient
patient stimulation the patient will level of anxiety by irritability was able to verbalized
secondary to be able to and insomnia feelings of anxiety
Objective: excessive thyroid verbalize
hormone feelings of • Establish • To have an open
- Irritability secretion as anxiety therapeutic communication
- Restless evidenced by relationship
- Fatigue irritability, • To establish
- Tremors (fine) insomnia, • Stay with patient, rapport.
- Increased restlessness, maintaining calm
sweating tremors( fine), manner.
- Increased increased
• Attention span
respiration sweating, and
may be
(RR 27 cpm) increased • Speak in brief shortened,
respiration statements, using concentration
simple words. reduced, limiting
ability to
assimilate
information.
• To promote
• Provide comfort clients safety.
measures (putting
up the bed
siderails and
don’t leave the
client alone at • To know the
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bedside) coping strategy
of the client
• Encourage client
to express • Helps the patient
feelings to know the
reality
• Provide accurate
information about
the situation
• To determine
those that might
Dependent: be helpful to the
current situation
• Review coping of the patient
strategies or
mechanism
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Nursing Planning Intervention Rationale Evaluation
Assessment Diagnosis
45
• Assist with self
care needs; keep • For easy access
bed in low and to avoid
position and accidents
travel ways
clear of
furniture
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Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Long Term: Independent: Long Term:
Subjective: Disturbed sleep After 24 hours After 24 hours of
pattern related to of nursing • Provided quiet • To enhance rendering nursing
“Hindi ako daytime activity intervention environment and client ability intervention the patient
masyado nakatulog pattern as the patient comfort measures to fall asleep. was be able to obtained
kagabi, kumakabog evidenced by will be able to (e.g backrub, the different measures of
yung dibdib ko” as irritability identify the washing hands and an 8 hours normal
verbalized by the tremors (fine) different face, cleaning and sleeping pattern as
patient Presence of eye measures how straitening sheets) evidenced by (-)
bags. to obtain a in preparation to irritability, relax, and
Objective: Frequent normal sleep. minimal yawning.
yawning. sleeping
- Irritability pattern • Recommended • Caffeine
- fatigue evidenced by limiting intake of increases
- tremors non- irritable, chocolate and awaking time
(fine) relax, and caffeine/alcoholic during the
- Presence of absence of beverages esp. prior night. A full
eyebags on. eye bags, and to bedtime stomach
- Frequent no frequent interferes
yawning. yawning. with sleep
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watching television
Dependent:
• To monitor
• Obtain history clients
including bed time sleeping
routines pattern.
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Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Subjective: Long Term: Independent: Long Term:
Disturbed body After 2 days of After 2 days of
“Para nga ko si image related to nursing • Encourage • For support to rendering nursing
Garfield yung dalawa disease process intervention the client to make patient about his intervention the
kong mata, ang laki.” (hyperthyroidis patient will be own decisions illness patient was able
As verbalized by the m) as evidence able to and accept both to accept self
patient by, bilateral demonstrate inadequacies image as
exopthalmos. acceptance of and strengths evidenced by
Objective: self image as interaction with
evidence by • Assess for and • Good nutrition the student
- Bilateral interact with the promote good and sleep patters nurses
exopthalmos nurse on duty, nutrition and promote faster
- Silky resilient and student sleep patterns healing and better
hair nurses coping
- Shy at first
- Weight loss • Acknowledge • Assist the client
coping to coping to
(Weight before: 60 kg) mechanisms as renewed sense of
(Weight now: 52 kg) a normal well-being &
feelings when increases trust
adjusting to between the nurse
changes in body and patient.
and lifestyle
• Encourage • To enhance
client to coping or
verbalize handling his
feelings situation
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Dependent:
• Social support
• Encourage enhances both
significant other emotional and
to offer support physical health
• To have
• Alert staff or acceptance and
significant not embarrassed
others to the patient when
monitor facial his appearance is
expressions and affected
nonverbal
behaviors
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DRUG STUDY
Generic Name: Increases For treating Thyrotoxicosis, Side effects: Instruct patient to
methimazole metabolic rate, Hyperthyroidism myocardial Nausea and take the drug with
cardiac output and infarction and vomiting, meals to decrease
Brand Name: protein synthesis. severe renal disease diarrhea, cramps, gastrointestinal
Tapazole 10 mg Useful for treating tremors, symptoms
thyrotoxic crisis nervousness,
Dose: 10 mg and in preparation insomnia, Advise patient about
for subtotal headache and the effects of iodine
Route: PO thyroidectomy. weight loss and its presence in
iodized salt, shellfish
Frequency: q6 Adverse Effects: and OTC cough
Tachycardia, medicines
hypertension and
palpitations
Emphasize the
importance of drug
compliance; abruptly
stopping the
antithyroid drug
could bring on a
thyroid crisis
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signs and symptoms
of hypothyroidism:
lethargy, puffy
eyelids and face,
thick tongue, slow
speech with
hoarseness, lack of
perspiration and slow
pulse.
Hypothyroidism may
result to treatment of
Hyperthyroidism
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Name Mode of Indications Contraindications Adverse Effects Nursing
Action Interventions
Generic Name: Selectively To control Second and Third Side Effects: Monitor vital signs
propanolol Hcl blocks beta - hypertension and degree heart block, Bradycardia, especially blood
adrenergic management for cardiogenic shock, thrombocytopenia, pressure and pulse
Brand Name: receptor sites, thyrotoxicosis CHF, sinus drowsiness, dry
Inderal 20 mg decreases bradycardia mouth and Instruct patient to
sympathetic dizziness comply with drug
Dose: 20 mg outflow to the Caution: regimen: abrupt
periphery, Hepatic, renal or Adverse Effects: discontinuation of
Route: PO suppresses thyroid dysfunction; Complete heart antihypertensive
rennin- asthma; peripheral block, drug may cause
Frequency: OD angiotensin- vascular disease; bronchospasm, rebound
aldosterone type 1 diabetes agranulocytosis hypertension
system mellitus
Advise patient that
antihypertensives
may cause dizziness
resulting from
orthostatic
hypotension. Instruct
patient to remain in a
sitting position for
several minutes
before standing
Encourage patient to
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increase fluid intake
Instruct client to avoid
excessive intake of alcoholic
beverages. Alcohol can
cause vitamin B complex
deficiencies
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Name Mode of Indications Contraindications Adverse Nursing
Action Effects Interventions
Generic Name: Water- soluble To treat Patient with liver GI irritation and Instruct client to take
Vitamin B vitamins are not peripheral dysfunction vasodilation, the prescribed amount
Complex stored in the neuritis, essential resulting in of drug.
body and are for building flushing sensation
Brand Name: readily excreted block of nucleic Advise client to check
Nevramin in the urine. acids, red blood the expiration dates
Protein binding cell formation on vitamin containers
Route: PO of water – and synthesis of before purchasing and
soluble vitamins hemoglobin taking them. Potency
Frequency: OD is minimal. of the vitamin is
reduced after the
expiration date.
Encourage patient to
eat foods high in
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Vitamin B such as
grains, cereal, bread
and meats
56
57
BIBLIOGRAPHY
Book:
Nurse’s Pocket Guide (10th edition) by Marilyn E. Doenges and Alice C. Murr
Davis’s Drug Guide for Nurses (10th edition) by Judith Hopfer Deglin
Web/internet:
http://dine.racoma.com.ph/health/take-charge-of-your-health/
http://www.medicinenet.com/hyperthyroidism/index.htm
http://general-medicine.jwatch.org/cgi/content/full/2007/619/1
http://jcem.endojournals.org/cgi/content/abstract/85/3/1038
http://www.tribune.net.ph/life/20081117lif5.html
http://www.malaya.com.ph/feb17/livi1.htm
http://positivenewsmedia.net/am2/publish/Health_21/Goiter_Awareness_Week_brings_to_fore
_importance_of_ASIN_Law_implementation.shtml
http://www.manilastandardtoday.com/?page=goodLife02_sept19_2006