Hyperthyroidism is a metabolic imbalance that results from overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). The most common form is Graves’ disease, but other forms of hyperthyroidism include toxic adenoma, TSH-secreting pituitary tumor, subacute or silent thyroiditis, and some forms of thyroid cancer.
Thyroid storm is a rarely encountered manifestation of hyperthyroidism that can be precipitated by such events as thyroid ablation (surgical or radioiodine), medication overdosage, and trauma. This condition constitutes a medical emergency.
- Decreased Cardiac Output — Hyperthyroidism Nursing Care Plan (NCP)
- Fatigue — Hyperthyroidism Nursing Care Plan (NCP)
- Disturbed Thought Processes — Hyperthyroidism Nursing Care Plan (NCP)
- Imbalanced Nutrition — Hyperthyroidism Nursing Care Plan (NCP)
- Anxiety — Hyperthyroidism Nursing Care Plan (NCP)
- Impaired Tissue Integrity — Hyperthyroidism Nursing Care Plan (NCP)
- Knowledge Deficit — Hyperthyroidism Nursing Care Plan (NCP)
Nursing Priorities for Hyperthyroidism Nursing Care Plan (NCP)
- Reduce metabolic demands and support cardiovascular function.
- Provide psychological support.
- Prevent complications.
- Provide information about disease process/prognosis and therapy needs.
Discharge Goals for Hyperthyroidism
- Homeostasis achieved.
- Patient effectively dealing with current situation.
- Complications prevented/minimized.
- Disease process/prognosis and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
Hyperthyroidism Diagnostic Studies
- Radioactive iodine (RAI) uptake test: High in Graves’ disease and toxic nodular goiter; low in thyroiditis.
- Serum T4 and T3: Increased in hyperthyroidism. Normal T4 with elevated T3 indicates thyrotoxicosis.
- Thyroid-stimulating hormone (TSH): Suppressed (except when etiology is a TSH-secreting pituitary tumor or pituitary resistant to thyroid hormone). Does not respond to thyrotropin-releasing hormone (TRH).
- Thyroglobulin: Increased.
- TRH stimulation: Hyperthyroidism is indicated if TSH fails to rise after administration of TRH.
- Thyroid T3 uptake: Normal to high.
- Protein-bound iodine: Increased.
- Serum glucose: Elevated (related to adrenal involvement).
- Plasma cortisol: Low levels (less adrenal reserve).
- Alkaline phosphatase and serum calcium: Increased.
- Liver function tests: Abnormal.
- Electrolytes: Hyponatremia may reflect adrenal response or dilutional effect in fluid replacement therapy. Hypokalemia occurs because of GI losses and diuresis.
- Serum catecholamines: Decreased.
- Urine creatinine: Increased.
- ECG: Atrial fibrillations; shorter systole time; cardiomegaly, heart enlarged with fibrosis and necrosis (late signs or in elderly with masked hyperthyroidism).
- Needle or open biopsy: May be done to determine cause of hyperthyroidism, differentiate cysts or tumors, diagnose enlargement of thyroid gland.
- Thyroid scan: Differentiates between Graves’ disease and Plummer’s disease, both of which result in hyperthyroidism.