Complications

By Mayo Clinic Staf

Hyperthyroidism can lead to a number of complications:

Heart problems. Some of the most serious complications of hyperthyroidism

involve the heart. These include a rapid heart rate, a heart rhythm disorder called
atrial fibrillation and congestive heart failure a condition in which your heart can't
circulate enough blood to meet your body's needs. These complications generally
are reversible with appropriate treatment.

Brittle bones. Untreated hyperthyroidism can also lead to weak, brittle bones
(osteoporosis). The strength of your bones depends, in part, on the amount of
calcium and other minerals they contain. Too much thyroid hormone interferes with
your body's ability to incorporate calcium into your bones.

Eye problems. People with Graves' ophthalmopathy develop eye problems,

including bulging, red or swollen eyes, sensitivity to light, and blurring or double
vision. Untreated, severe eye problems can lead to vision loss.

Red, swollen skin. In rare cases, people with Graves' disease develop Graves'
dermopathy, which afects the skin, causing redness and swelling, often on the shins
and feet.

Thyrotoxic crisis. Hyperthyroidism also places you at risk of thyrotoxic crisis

a sudden intensification of your symptoms, leading to a fever, a rapid pulse and even
delirium. If this occurs, seek immediate medical care.

Hyperthyroidism Nursing
Management

Hyperthyroidism is a metabolic imbalance that causes overproduction of thyroid

hormones. The thyroid gland is this little butterfly-shaped organ behind the larynx that
produces thyroid hormones; thyroxine (T4) and triiodothyronine (T3), responsible
for certain metabolic processes such as energy metabolism, temperature regulation,
and other sympathetic activities in the human body. It is the second most
prevalent endocrine disorder, after diabetes mellitus, affecting more women than men.
Graves disease is the most common form of hyperthyroidism caused by abnormal
stimulation of the thyroid gland by circulating immunoglobulins.
Thyrotoxicosis; also known as thyroid storm, is caused by hyperthyroidism but has
more excessive concentration of thyroid hormones due to overstimulation of the
thyroid gland. This is caused by stress that occurs more often after a subtotal
thyroidectomy. This is a life-threatening situation that requires urgent medical
response.

Causes

Autoimmune disease (Graves disease)

Genetics

Neoplasms in the thyroid gland

Increased thyroid-stimulating hormone (TSH) secretion negative feedback

mechanism

Clinical Manifestations
Tremors
-Intolerance to heat
-Irritable
-Diaphoretic
-Tachycardia (palpitations)
-Hypertension
-Increase gastrointestinal peristalsis (diarrhea)
-Weight loss
-Muscle wasting
-Enlarged thyroid (goiter)

-Bulging eyes (exopthalmos)

-Amenorrhea
-Breast enlargement
-Soft skin
-Fine soft hair
-Finger clubbing
-Pliable nails (very hard nails)

Assessment of the thyroid gland

Inspection and palpation- Instruct patient to extend neck slightly and swallow.
-thyroid tissue should rise normally with swallowing.
-palpate to note size, shape, symmetry, & tenderness.

Diagnostic Finding

Elevated thyroxine (T4) level-

Elevated triiodothyronine (T3) level- > 1.15 to 3.10 nmol/L

High Radioactive Iodine Uptake (RAIU) through thyroid scanning.

Elevated thyroid-stimulating hormone (TSH or thyrotropin) level using

> 58.5 to 150 nmol/L

serum immunoassay

Elevated free thyroxine (FT4) level through serum immunoassay.

Negative(benign) or positive(malignant) result after aspiration biopsy

Medical Management

Propylthiouracil (PTU)

block synthesis of thyroid hormones to

decrease output of T3 & T4. Methimazole Their life-threatening adverse effect

isAgranulocytosis.

Sodium Iodide- lyse thyroid gland cells to bring thyroid glands activity
down.

Saturated solution of potassium iodide (SSKI) reserved for severe

thyrotoxicosis by blocking synthesis of thyroid hormones to decrease output
of T3 & T4.

Propanolol- a beta-adrenergic blocker to relieve signs and symptoms of

hyperthyroidism e.g. hypertension, tremors, tachycardia, irritability, & other
hypersympathetic activities.

Thyroidectomy surgical removal of the thyroid gland. Subtotal

thyroidectomyis usually done to patients with hyperthyroidism wherein 5/6
of the total thyroid tissue is removed. Patients need to be evaluated for
hypothyroidism, which can develop years after surgery.

Hyperthyroidism Nursing Management

Provide cool environment.

Minimize stress by providing privacy and placing patient in a private room.

Teach patient to avoid stimulants such as coffee, sweets, tea, soft drinks,
energy bar and cigarette smoking.

Watch out for signs of Agranulocytosis (decrease in WBC) such as sudden

onset of fever and sore throat when patient has medications such as PTU or
Methimazole.

Monitor for other unusualities such as allergic reactions to drugs, and others.

Patient care post-thyroidectomy

Assessment
Assess airway obstruction due to inflammation
Assess vital signs- helps detect bleeding or hemorrhage
Assess bleeding- look at patients dressing at the back of the neck.
Observe if patient always swallows- sign of bleeding
Monitor for signs of Hypocalcelmia
Monitor voice quality

Complications
Airway Obstruction
Laryngeal Nerve Damage- Normal to have hoarse voice within the first 3 days to
weeks.
No improvement of the voice for 6 weeks to 12 months is considered to have
permanent damage.

(Hermann et al2004).
Hemorrhage
Hypocalcemia- < 4.5 5 mEq/L
Signs & symptoms:

or

8.5-10.5 mg/dL

tetany, paresthesia, bronchospasm,

(+) Trosseaus sign,(+) Chvosteks sign, prolonged Q-T interval on cardiac monitor.

At bedside : prepare
Tracheostomy set
Oxygen
Suctioning machine
Calcium gluconate

Eye care for patients with exopthalmos

eye shades- for patients with photosensitivity

eye drops- helps keep eyeballs moist

cover with clean gauze- usually at bedtime to promote sleep

raise head of bed- to relieve eye swelling

Question and clarify medication orders for aspirin. Make sure aspirin is
avoided as this can increase free thyroid hormones in the system.

Diet should be high in calories and high in protein.