Nursing Care Plan for Hyperthyroidism

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Pathophysiology

Hyperthyroidism is the overproduction of hormone thyroxine by the thyroid gland. This hormone speeds up the body’s metabolism, causing sudden weight loss, and can result in a fast or irregular heart rate.  Often, inflammation and edema can result in exophthalmos (protrusion of the eyes). Treatment is medications and/or surgery to remove all or part of the thyroid gland. The symptoms of hyperthyroidism are similar to other health problems and may go undetected for some time.

Etiology

The most common cause of hyperthyroidism is an autoimmune disease called Grave’s disease, where the body makes an antibody (TSI) that stimulates the thyroid gland to produce too much thyroid hormone (TSH). This disorder is considered somewhat hereditary as it is often found running in families. Other causes include nodules (goiter) or inflammation of the thyroid that cause it to produce excess TSH. A less common cause is excessive intake or medications that contain iodine.

Desired Outcome

Maintain adequate cardiac output, decreased fatigue and optimal skin integrity

Hyperthyroidism Nursing Care Plan

Subjective Data:

  • Increased appetite
  • Nervousness
  • Nausea
  • Changes in menstrual patterns
  • Increased sensitivity to heat
  • Fatigue
  • Difficulty sleeping
  • Sudden weight loss
  • More frequent bowel movements

Objective Data:

  • Enlarged thyroid gland (goiter)
  • Tachycardia
  • Vomiting
  • Diarrhea
  • Sweating
  • Tremor
  • Thinning skin
  • Fine, brittle hair
  • Low TSH level with elevated Free T4 level

Nursing Interventions and Rationales

  • Monitor vitals, including orthostatic BP assessment and pulse / heart rate during sleep

 

  • Orthostatic hypotension can occur as a result of increased metabolism and excessive peripheral vasodilation.
  • Assessing the pulse during sleep can give a more accurate measure of tachycardia.

 

  • Perform 12-lead ECG and monitor

 

Tachycardia can indicate stimulation by the thyroid hormone and result in dysrhythmias.

 

  • Assess respiratory status and auscultate lungs for adventitious breath sounds; take note of any history of asthma

 

Signs of pulmonary congestion can indicate early cardiac involvement.

A history of asthma can affect treatment (no beta-blockers).

 

  • Encourage eye protection and eye drops.

 

Exophthalmos (protruding eyes)  is a hallmark symptom and often results in dry eyes and risk of damage to the cornea. Encourage dark sunglasses and isotonic eye drops for lubrication.

 

  • Monitor daily food intake; incorporate daily weights

 

Even though patient may have increased metabolism and food intake, weight is often lost. Continued weight loss with therapy can indicate ineffective treatment.

 

  • Avoid foods that cause loose stools or increased peristalsis; incorporate extra calories, protein, carbs and vitamins into 6 small meals throughout the day

 

Increased metabolism also increases intestinal motility which can lead to diarrhea and impair nutrient absorption. Consider consulting with dietitian for optimal diet choices.

 

  • Prepare patient for surgery and monitor patient after surgery for swallowing and excessive bleeding.

 

Surgical intervention to remove part or all of the thyroid may be necessary in cases where the patient is unable to tolerate antithyroid medications or the cause is a toxic nodule on the thyroid. Surgery is the quickest cure for hyperthyroidism and has a relatively short recovery period.

 


References

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