hey everyone it's Sarah registered nurse Orion comm and in this video I'm going to be going over hyper thyroidism what I'm going to be doing is I'm going to be giving you an in clicks review and go over the signs and symptoms the causes the nursing interventions the patho and the pharmacological aspects of dealing with this disorder in the next video I'm going to be covering hypothyroidism so be sure to check that out so you can see the differences between these two conditions now after you watch this video go to my website registered nurse Orion calm and take the free quiz to test your knowledge on hypo versus hyperthyroidism and a cart should be popping up so you can access that quiz so let's get started first let's start out by defining what hyperthyroidism is what is it it is a high secretion of thyroid hormone so the body is pumping out a lot of thyroid hormones which wreaks a lot of havoc on your body how is it diagnosed it is diagnosed with the blood test a physician orders to check your t3 t4 or TSH levels the thyroid stimulating hormone level now let's go into the pathophysiology the path of the body you will understand why you're seeing these signs and symptoms and these causes in these patients so let's go over this ok first let's go over the anatomy of the thyroid gland ok your thyroid gland sets below your Lenox your voice spots in the men they have the items Apple the laryngeal prominence will be right below them that and it's butterfly shaped and in the thyroid gland you have the parathyroid anytime the thyroid gland is manipulated like in surgery or anything like that you always got to watch out for parathyroid problems your parathyroid regulates calcium so you always want to watch monitor their calcium levels especially with like a thyroidectomy which we'll go over a little bit later and your thyroid gland produces thyroid hormones through the negative feedback loop which we'll go over a little bit later and these thyroid hormones play a huge role in how your body works and how your body metabolizes regulates its temperature and growth and development in your pediatric children they need to have good thyroid levels and for brain development these hormones are known as t3 and t4 also produces calcitonin but we're really interested in the t3 and t4 t3 in hyperthyroidism is really going to be elevated the thyroxine and t4 can also be elevated as well important part I would remember this the thyroid cannot make thyroid hormones t3 and t4 without iodine so the person has to consume enough foods with iodine Futon iodine are like your sea foods like seaweed eggs dairy things like that so you have to make sure they're getting enough of it and if they get too much of it they can go into hyperthyroidism they don't get enough iodine they will get hypothyroidism so very important ok so what exactly does t3 and t4 do what is its role okay the function is is that Bart helps you burn calories so in hyperthyroidism we're going to be burning calories I have an excessive rate and so you're going to see some weight loss it also determines how fast new cells replace dying fills how fast we digests food and stimulates the sympathetic nervous system that's why alertness we have responsiveness and quick reflexes increases our body temperature or heart rate blood pressure it's big and brain development and regulating the thyroid stimulating hormone known as TSH what is TSH so thyroid stimulating hormone and it is produced by the anterior pituitary gland and whenever it is released it's stimulate the thyroid gland to release those fibroid hormones t3 and t4 so let's look at that negative feedback loop because if you get anything messed up in this loop it will mess up how your thyroid hormones are secreted so you have the hypothalamus the hypothalamus is responsible for releasing T or H thyrotropin-releasing hormone whenever that is released the anterior pituitary gland senses that and releases TSH thyroid stimulating in horno then whenever the thyroid senses that has been released it will secrete our thyroid hormones t3 and t4 and if there's any problems like for instance say the anterior anterior pituitary gland had a tumor it wouldn't be able to secrete TSH so the thyroid just went and release t3 or t4 so if it's not going to release t3 t4 t3 or t4 you're going to have hypothyroidism even though there's nothing wrong with the thyroid there's something wrong with anterior pituitary gland and it can happen vice versa so keep that in mind now let's look at our signs and symptoms whenever you're looking at the signs and symptoms let the condition name help you we're talking about high per side ISM hyper means high elevated so everything in the body is going to be working at an accelerated high rate so let's look at the signs and symptoms okay you're going to have some weight loss going on why we just went over the function of t3 and t4 t3 t4 helps you burn calories so they're going to have an excessive amount of disk so they're going to be burning calories like crazy they're going to be losing weight they're going to have a heat intolerance literally they just feel hot and sweaty they cannot tolerate the heat and this is because their body temperature is increased next they're going to have an increase heart rate blood pressure this is due to the sympathetic nervous system being and overdrive your fight-or-flight response they're just constantly in that having diarrhea this is because your GI system is an overdrive it's shooting through food through those intestines and again that will attribute to the weight loss because whenever you have food flying through the intestines it's not giving it enough time to absorb nutrients so that can lead to that they're also going to have smooth hair and soft skin that's due to that increased blood flow they're at risk for cardiac dysrhythmias like atrial fibrillation and personality changes because they are just really wired they're going to be moody restless irritable and have problems sleeping at night insomnia so what causes hyperthyroidism the most common cause is great Eve's disease and this is an autoimmune condition the body is causing it on itself and what's happening is that the body is producing an antibody / immunoglobulin called TS i thyroid-stimulating immunoglobulin and this acts like TSH our thyroid stimulating hormone so because we have this invader TSI working in the body because the autoimmune response is causing it to secrete it the tsa the body looks at it as TSH so whenever TSH is released remember from the anterior pituitary gland it causes the thyroid to release t3 and t4 so you're going to have excessive amounts of this being released and this tends to be genetic runs in families Graves disease now with this the patient will have unique symptoms they'll have these symptoms that we talked about just a minute ago but they'll also have keep this in mind commit this to memory they will have protruding eyeballs that's where the eyes are opened up really big it's like a shocked look on the face and they just stay like that um they could have AG order in the neck myxedema pretibial type this is where you have a waxy orange peel appearance on the skin that is found on like the feet or legs so they will have those types of symptoms okay next let's look at the toxic nodular Gorder known as TNG this is also another cause this is not autoimmune like Graves disease so the body isn't causing it what it's caused by our nodular growth and like gore ders on the neck that are independently working to hyper secrete the thyroid hormone so you have these knowledge alerts on the neck you're going to see the border and they are secreting your t3 and t4 and causing lots of problems on the body you will see the typical signs and symptoms that we talked about but you will not see the eye changes like the 'but reading eyeballs like how you doing great disease so you do not have that another cause of hyperthyroidism is thyroid thyroid itis this is insulin nation of the thyroid gland and what happens is that the thyroid gland becomes inflamed and whenever it comes inflamed it causes it to release the thyroid hormones into the blood so you'll have excessive production of that and another cause is just consuming too much iodine we talked about that earlier and remember what does iodine do thyroid loves iodine when you take in a lot of iodine you're going to produce lots of thyroid hormones so that can cause it as well and treatment for these conditions which were fixed and go in-depth here in a second we're going to go over the pharmacological aspects of the treatment patient education but treatments for these conditions are anti thyroid medications radioactive iodine beta blockers and thyroid ectomy so let's go over that first let's look at the nursing interventions what are you going to do for this patient as the nurse taking care of someone with hyperthyroidism you want to keep them comfortable because remember they are having issues with heat intolerance they're very stimulated or restless so you want to keep the environment cool and quiet and administer sedatives if the doctors order them as needed to keep them calm and collective you're going to obtain weights you want to monitor their weight make sure they're getting proper nutrition because they're burning calories so fast your monitor that heart rate blood pressure or EKG for any changes make sure they're part rate is not tacky or their blood pressure is too high educate the patient about medications they're going to be taking or any possible treatments to treat this condition and you're going to monitor them for thyroid storm what is a thyroid storm it is a life-threatening condition where there is maybe untreated hyperthyroidism or the patients had a thyroidectomy so they've had they're getting way too much thyroid hormone maybe the treatments not helping or they just had their thyroid gland removed so they're definitely at risk for that and how does this present this presents with those exaggerated symptoms already of the hyperthyroidism so instead of having just he intolerance they're going to have a fever a raging fever they'll be very hot they'll have very fast heart rate hypertension be really Restless so everything is going to an accelerated rate but exaggerated so let's look at the medication treatment how are these treat how is hyperthyroidism treated with medications okay one type of medication are called anti thyroid medications what do they do they stop the thyroid from synthesizing t3 and t4 so you're not going to be synthesizing all that thyroid hormone and these medications don't damage the thyroid gland like radioactive iodine which is a treatment we'll be talking about here in a second and some medications that are popular that people use one is called tapas all also called methimazole and this is the most common use treatment for Graves disease because mainly because it has fewer side effects however this medication cannot be used in the first trimester of pregnancy so if you have a patient a female who's pregnant or first trimester they're usually started on PTU which is profile uracil and this is safe to use in the first trimester however studies have shown that there is an increased risk of liver failure with this medication so you want to watch those liver enzymes over all other side effects that you can get from these anti thyroid medications are a granulocyte OSIS where this is where you have a decrease white blood count so they can be at risk for infections or aplastic anemia meaning that those red blood cells are diminished now some patient education that you want to remember when teaching your patient great test questions on how to take these meds and things to watch out for okay number one educate the patient to never just stop taking these medications abruptly a lot of times these medications take a while for the patient to start seeing symptoms relieved so they think hey the medications not working I'm not going to take it anymore let them know it takes a while take the medication at the same time every day monitor the have the patient monitor themselves for thyroid storm that can mean that they're it's not being treated properly they need more thyroid hormone than what they're getting so they need to watch out for that extreme fever rapid heartbeat high blood pressure and they also need to avoid foods rich and iodine because remember iodine makes thyroid hormone so they need to restrict what they're eating again that's like your seafoods like seaweed eggs dairy things like that and no aspirin aspirin actually increases thyroid hormone so they want to avoid taking aspirin and to watch out for toxicity symptoms which would be hypothyroid signs and symptoms so slow heart rate I'm feeling exhausted tired hypothermia things like that so how'd the patient be aware of those now let's look at the treatment that a patient can have for this condition one treatment is the radioactive iodine how this works is a patient will tell you capsule with iodine iodine will be radioactive they'll swallow that pill the iodine will go to the thyroid because the thyroid loves iodine but this iodine special iodine it's radioactive so what it's going to do is it's going to destroy the thyroid gland over time the thing with this is that it's a permanent cure compared to the thought to the anti thyroid medications it's not typically a permanent cure and it doesn't destroy the thyroid gland like this does however this is not for women who are pregnant or nursing because the radioactive material one thing that a patient can get from this is signs and symptoms of IOT ism which is just taste changes where they can get like this metal taste in their mouth nausea or swollen slobber glands so watch out for that another treatment is thyroidectomy this is where they just go and completely remove this thyroid gland all together however there are some issues whenever this happens you want to watch out for the thyroid storm what happens is whenever they remove the thyroid gland they manipulated it some t3 and t4 could have leaked into the system during removal and it shot the levels up so the patient's going to experience hyperthyroidism and so to help combat that a lot of times they like to put them on anti thought medications sodium iodine solution a beta blocker and glucocorticoids and beta blockers let me just touch on this for a second a lot of times patients with hyperthyroidism may be site started on beta blockers like in Doral why this helps the patient cope with some of the symptoms that they're getting especially that fast heart rate increased blood flow the blood pressure and the heat intolerance because those beta blockers is going to bring that heart rate down bring that blood pressure down I'm just hopefully going to make them feel more comfortable and bring that heat and tolerance down so that's one thing and glucocorticoids also for the thyroidectomy that's to suppress the immune system another thing you want to watch out for the thyroidectomy if you can't remember anything else about thyroidectomy remember this you can need to watch out for pair of thyroid gland problems remember the parathyroid regulates calcium so if you remove this gland you're going to have possible issues with parathyroid where the calcium levels are going to drop to a really bad level and they might have hypocalcemia so watch your calcium levels with that post-op you want to make sure the patients coughing and deep breathing preventing pneumonia and when ever and they are coughing that they are splinting the wound they don't want to bust that wound open watch out for respiratory distress in these patients because the wound is going to be on their neck they're definitely at risk for excessive swelling bleeding which can cause respiratory distress so watch that make sure you have a trach kit emergency trach kit at the bedside oxygen or suction just in case you how to intervene and the best position to keep these patients in who've had a thyroidectomy is semi fowlers so that is about hyperthyroidism now watch the next video on hypothyroidism and don't forget to take that free quiz on my website register nurse orion calm and thank you so much for watching and please consider subscribing to this YouTube channel