Hyperthyroidism and Thyrotoxicosis

Overview

• Excess secretion of T3 and T4 from the thyroid gland.
• Causes: Primary, Secondary, and Tertiary.

Hormonal Pathway

• Hypothalamus: Produces TRH (Thyroid-Releasing Hormone)
• Pituitary Gland: Produces TSH (Thyroid-Stimulating Hormone)
• Thyroid Gland: Produces T3 and T4

Types of Hyperthyroidism

Primary Hyperthyroidism

• Cause: Issue with the thyroid gland itself
• Common Cause: Graves' disease (autoimmune), thyroid nodule
• Lab Results: Elevated T3 and T4, decreased TSH

Secondary Hyperthyroidism

• Cause: Pituitary disorder (e.g., tumor)
• Effect: Excess secretion of TSH
• Lab Results: Elevated T3 and T4, elevated TSH

Tertiary Hyperthyroidism

• Cause: Hypothalamus dysfunction
• Effect: Excess TRH leading to excess TSH

Signs and Symptoms

• Tachycardia
• Hypertension
• Heat intolerance
• Exophthalmos (bulging eyeballs)
• Weight loss without trying
• Insomnia
• Diarrhea
• Warm sweaty skin

Labs Interpretation

• Primary Hyperthyroidism: Elevated T3 and T4, decreased TSH
• Secondary/Tertiary Hyperthyroidism: Elevated T3, T4, and TSH

Treatment

Primary Hyperthyroidism

• Surgical: Thyroidectomy
• Medications: PTU, iodine solutions, beta blockers

Nursing Care

• Increase calorie and protein intake
• Monitor eyes, weight, and vital signs
• For exophthalmos: tape eyelids closed for sleep, provide eye lubricant

Thyrotoxicosis (Thyroid Storm)

• Description: Life-threatening, excessively high levels of thyroid hormones
• Triggers: Infection, stress, diabetic ketoacidosis (DKA), thyroidectomy

Symptoms

• Severe hypertension
• Chest pain
• Dysrhythmias
• Dyspnea (difficulty breathing)
• Delirium
• Fever
• Nausea and vomiting

Treatment

• Beta blockers
• Antithyroid medications
• Antipyretics (for fever)

Nursing Care

• Maintain a patent airway
• Monitor for dysrhythmias

Upcoming Topic: Care of patients requiring thyroidectomy.