PATHOGENESIS OF HYPERTHYROIDISM

PREDISPOSING FACTORS Sex - Female Age - 20-40yrs old

PRECIPITATING FACTORS

Diffuse toxic goiter (grave's disease) Autoimmune Condition secodary to: infection, crisis or stress

thyroid-specific suppressor T-cell lymphocytes

leads to T3 (triiodothyronine) and/or T4 (thyroxine)

result is an metabolic rate and sensitivity to catecholamines

Signs and Symptoms T, P, R, and BP; heart failure, enlargement of gland Hunger, diarrhea, weight Tremors, nervousness, bulging eyes (exophthalmos) Osteoporosis, amenorrhea Sweating, flushed skin, heat intolerance Radioactive iodine uptake, T3, T4, TSH Thyrotoxicosis: T, P >120, delirium, coma

Treatment Radioactive iodine destroys thyroid cells Propylthiouracil or methimazole to T4 Subtotal thyroidectomy (iodide before to vascularity)

Nursing Management Monitor for S&S of thyrotoxicosis Provide calm, cool environment Provide calm, cool environment Protein, calorie diet Teach S&S of hypothyroidism, which may occur with treatment Give eye care (drops, patches) prn Thyrotoxicosis: Hypothermia blanket, oxygen, propranolol, steroids, propylthiouracil, iodide

Etiology and Pathophysiology

Primary Hypothyroidism Autoimmune lymphocytic destruction (Hashimotos thyroiditis); secondary to toxic effect of hyperthyroidism thera iodides, lithium Secondary Hypothyroidism Hypothalamus and/or pituitary problems thyrotropin releasing hormone (TRH) or thyroid stimulating hormone (TSH)

Signs and Symptoms Weight, lethargy, dry pale skin, brittle hair/nails T, P, R, cold intolerance Dull expression, apathy Constipation, deafness, enlarged tongue, periorbital edema, anemia T3, T4, TSH Sensitivity to CNS depressants, cholesterol, HDL, LDL Severe hypothyroidism (myxedema) may cause coma Treatment Hormone replacement with levothyroxine TSH levels are monitored as dose is gradually to determine optimum dose Nursing Management Monitor S&S, rest, keep warm Explain that symptoms will improve with hormone replacement Teach S&S of and thyroid function Teach to fluids and fiber to constipation Monitor for toxic effects of drugs (especially CNS depressants) secondary

to metabolism

effect of hyperthyroidism therapy, atrophy with aging, genetics,

Pathwa y Diagram