Hyperthyroidism (Grave's Disease)

  1. General information
    1. Secretion of excessive amounts of thyroid hormone in the blood causes an increase in metabolic processes
    2. Overactivity and changes in the thyroid gland may be present
    3. Most often seen in women between ages 30-50
    4. Cause unknown, but may be an autoimmune process
    5. Symptomatic hyperthyroidism may also be called thyrotoxicosis
  2. Medical management
    1. Drug therapy
      1. Antithyroid drugs (propylthiouracil and methimazole ([Tapazole]): block synthesis of thyroid hormone; toxic effects include agranulocytosis
      2. Adrenergic blocking agents (commonly propanolol [Inderal]): used to decrease sympathetic activity and alleviate symptoms such as tachycardia
    2. Radioactive iodine therapy
      1. Radioactive isotope of iodine (e.g., 131I) given to destroy the thyroid gland, thereby decreasing production of thyroid hormone
      2. Used in middle-aged or older clients who are resistant to, or develop toxicity from, drug therapy
      3. Hypothyroidism is a potential complication
    3. Surgery: thyroidectomy performed in younger clients for whom drug therapy has not been effective
  3. Assessment findings
    1. Irritability, agitation, restlessness, hyperactive movements, tremor, sweating, insomnia
    2. Increased appetite, hyperphagia, weight loss, diarrhea, intolerance to heat
    3. Exophthalmos (protrusion of the eyeballs), goiter
    4. Warm, smooth skin; fine, soft hair; pliable nails
    5. Tachycardia, increased systolic blood pressure, palpitations
    6. Diagnostic tests
      1. Serum T3 and T4 levels elevated
      2. RAIU increased
  4. Nursing interventions
    1. Monitor vital signs, daily weights.
    2. Administer antithyroid medications as ordered.
    3. Provide for periods of uninterrupted rest.
      1. Assign to a private room away from excessive activity.
      2. Administer medications to promote sleep as ordered.
    4. Provide a cool environment.
    5. Minimize stress in the environment.
    6. Encourage quiet, relaxing diversional activities.
    7. Provide a diet high in carbohydrates, protein, calories, vitamins, and minerals with supplemental feedings between meals and at bedtime; omit stimulants.
    8. Observe for and prevent complications.
      1. Exophthalmos: protect eyes with dark glasses and artificial tears as ordered.
      2. Thyroid storm: see below.
    9. Provide client teaching and discharge planning concerning
      1. Need to recognize and report signs and symptoms of agranulocytosis (fever, sore throat, skin rash) if taking antithyroid drugs
      2. Signs and symptoms of hyper/hypothyroidism