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s/s of hyperthyroidism

intolerance to heat

fine, straight hair

bulging eyes

facial flushing

enlarged thyroid

tachycardia (palpitations, CP, atrial fib, t and p wave changes)

increased systolic BP

breast enlargement

weight loss

muscle wasting

finger clubbing


increased diarrhea

menstrual changes(amenorrhea)

localized edema


pt reports

unplanned wt. loss

increased appetite

increase in the number of bowel movements per day


earliest problem patients notice

visual changes esp those with Graves disease (exophthalmos)


family or friends may report pt is

irritable or depressed


patients medical history may contain information about

previous thyroid surgery or radiation therapy to the neck b/c some people may remain hyperthyroid after surgey or treatment

ask about current drugs, esp use of thyroid hormone replacement or antithyroid drugs


two other eye problems

eyelid retraction (eyelid lag)-the upper eyelid fails to descend when the pt gazes slowly downward

globe (eyeball) lag-upper eyelid pulls back faster than the eyeball when the pt gazes upward.

ask pt to look down and then up, and document response



may be heard in the neck with a stethoscope from the turbulence of increased blood flow)


nursing interventions

focus on monitoring for complications

reducing stimulation

promoting comfort

teaching pt and family about therapeutic drugs and procedures


monitoring includes

patients apical pulse, BP and temp Q4h


teach pt to report immediately

any palpitations, dyspnea, vertigo or chest pain


thyroid storm

a life-threatening


what indicates thyroid storm

increases in temp indicates a rapid worsening of the pts condition and the onset of thyroid storm


conditions to consider for thyroid surgery


swelling of airway

parathyroid hormone-monitor calcium changes-tetany-trousseau's and cho

damage to laryngeal nerve


how to know if someone is having trouble with airway

stridor and salivation


treatments for thyroid

beta andergeic drugs

radioactive iodine-unsealed you need radioactive precautions (66-3)


problems with thyroid storm

even if its treated the pt can still die






restless, confused, psychotic


p. 1400



mild may able to wear sunglasses in or outside

severe may need patches with moistened material to wear to bed, eye drops and tape to sleep


Health promotion and disease prevention

take all meds as directed

check w/the provider prior to taking OTC meds

keep all follow-up appts

adjust diet to increased metabolism when needed

seek measures to reduce stress, and get rest

notify provider of fever, increased restlessness, palpitations, or chest pain


risk factors

graves disease is most common cause

toxic nodular goiter

exogenous hyperthyroidism


graves disease

autoimmune antibodies result in hypersecretion of thyroid hormones


toxic nodular goiter

a less common form of hyperthyroidism, is caused by overproduction of thyroid hormone due to the presence of thyroid nodules


exogenous hyperthyroidism

caused by excessive dosages of thyroid hormone


clinical manifestations

nervousness, irritability, hyperactivity, emotional lability, decreased attention span

weakness, easy fatigability, exercise intolerance

heat intolerance

weight change(usually loss) and increased appetite

insomnia and interrupted sleep

frequent stools and diarrhea

menstrual irregularities(amenorrhea/decreased menstrual flow)

libido increased followed by a decrease in libido as the condition progresses

warm, sweaty, flushed skin with velvety smooth texture

tremor, hyperkinesia, hyperreflexia

exophthalmos(graves only)

vision changes, retracted eyelids, global lag

hair loss


bruit over the thyroid gland

elevated SBP and widened pulse pressure

tachycardia and dysrhythmias


findings in older adults

more subtle

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