1. Hyperthyroidism Part II The Return of Bill Loney

2. Causes Bill asks you what happened to cause all these crazy symptoms he is experiencing. You explain that it is hyperthyroidism and it is a result of one of four things: Graves’ Disease (autoimmune) Thyroid Nodule (over-secretion by tumor) Thyroiditis (infection) Overdose of thyroid hormone medication

3. Graves’ Disease Fast Facts: Most common cause of hyperthyroidism 8 times more common in women Diagnosed via Radioactive Iodine reuptake test and from physical exam Goiter, eye involvement (exopthalamos, dryness, visual problems) and pretibial myxedema are common findings Autoimmune disease known to run in families

4. Now what… Mr. Loney says, “Graves’ disease? I think my mother had that too. Now what? How do I get rid of it?” You tell him that treatments include: Medications Radioactive Iodine therapy Surgery Dietary modifications

5. Medications You explain that the medications aren’t just for treatment but are also for symptom management and to bring thyroid levels to a manageable level before surgery –Anti-thyroid drugs –Iodine –Beta blockers –Radioactive Iodine

6. Medications Control the symptoms, especially cardiac –Beta-blockers: reduce sympathetic hyper- reactivity Inhibit thyroid hormone synthesis –Thioamides (Propylthiouracil/PTU, methimazole) prevent hormone synthesis by inhibiting thyroidal peroxidase (not curative) Destroy some of the thyroid tissue –Radioactive iodine Bring thyroid levels down –Iodine in conjunction with the Thioamides

7. Radioactive Iodine Therapy It may take 2-3 months for it to work Generally results in post-treatment hypothyroidism requiring replacement Mr. Loney states, “You won’t be injecting any more radioactive stuff into me!” You explain that the only other option is surgery if he is not responsive to the medications **Contraindicated in pregnant women!

8. Surgery May involve total or sub-total removal of thyroid tissue or nodule Done via endoscope or open procedure Usually the next option after failed treatment with medications Medication regimen followed to handle symptoms, reduce vascularity of tissue/tumor and to ideally have the patient in a euthyroid state (normal).

9. Preop Teaching: Standard 5B: Health Teaching and Health Promotion Normal post-surgical routines/care May have difficulty talking Complications include: –Respiratory problems from bleeding –May require emergency tracheostomy/reintubation –Blood draws to monitor calcium level –Arterial line may be used for this –Manual support of their head while changing positions to reduce stress on suture lines

10. Dietary Modifications Made to help with deficiencies from hyper- metabolism –High protein, carbs, vitamins/minerals –Low in fiber, caffeine There are also foods that naturally lower thyroid levels –broccoli, brussel sprouts, cabbage, cauliflower, kale, rutabagas, spinach, turnips, peaches, and pears

11. Standard 2: Diagnosis Priority Nursing Diagnoses: 1.Activity Intolerance 2.Risk for Injury 3.Imbalanced nutrition: less than body requirements 4.Anxiety Carefully review the care plans in your text on pp. 1316 and complete your hand out.