7 Hyperthyroidism Nursing Care Plans


Learn about nursing care plans and nursing diagnosis for hyperthyroidism, a condition where the thyroid gland produces too much thyroid hormone. Discover interventions and goals to improve patient outcomes.

What is Hyperthyroidism?

Hyperthyroidism, also known as Grave’s disease, Basedow’s disease, or thyrotoxicosis is a metabolic imbalance that results from the overproduction of 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.

A 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.

Nursing Care Plans

Nursing care management for patients with hyperthyroidism requires vigilant care to prevent acute exacerbations and complications.

Here are seven (7) nursing care plans (NCP) and nursing diagnoses for patients with hyperthyroidism:

  1. Risk for Decreased Cardiac Output
  2. Fatigue
  3. Risk for Disturbed Thought Processes
  4. Risk for Imbalanced Nutrition: Less Than Body Requirements
  5. Anxiety
  6. Risk for Impaired Tissue Integrity
  7. Deficient Knowledge
  8. Other Possible Nursing Care Plans

Risk for Decreased Cardiac Output

Hyperthyroidism can cause a hypermetabolic state which leads to an increased demand for oxygen and nutrients by the body, including the heart. This increased demand can lead to an increase in cardiac load and a decrease in cardiac output, which can be further exacerbated by alterations in heart rate, rhythm, and conduction, as well as changes in venous return and vascular resistance. If left uncontrolled, these factors can contribute to a higher risk of decreased cardiac output and potentially even heart failure in patients with hyperthyroidism.

Nursing Diagnosis

  • Risk for Decreased Cardiac Output

Risk factors may include

  • Uncontrolled hyperthyroidism, hypermetabolic state
  • Increasing cardiac workload
  • Changes in venous return and systemic vascular resistance
  • Alterations in rate, rhythm, conduction

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • The client will maintain adequate cardiac output for tissue needs as evidenced by stable vital signs, palpable peripheral pulses, good capillary refill, usual mentation, and absence of dysrhythmias.

Nursing Assessment and Rationales

1. Observe signs and symptoms of severe thirst, dry mucous membranes, weak or thready pulse, poor capillary refill, decreased urinary output, and hypotension.
Rapid dehydration can occur, which reduces the circulating volume and compromises cardiac output.

2. Note history of asthma and bronchoconstrictive disease, sinus bradycardia and heart blocks, advanced HF, or current pregnancy.
The presence or potential recurrence of these conditions affects the choice of therapy. For example use of [beta]-adrenergic blocking agents are contraindicated.

3. Observe for adverse side effects of adrenergic antagonists: severe decrease in pulse, BP; signs of vascular congestion/HF; cardiac arrest.
Indicates the need for reduction or discontinuation of therapy.

4. Investigate reports of chest pain or angina.
This may reflect increased myocardial oxygen demands or ischemia.

5. Assess pulse and heart rate while the patient is sleeping.
Provides a more accurate assessment of tachycardia.

6. Auscultate heart sounds, note extra heart sounds, development of gallops, and systolic murmurs.
Prominent S1 and murmurs are associated with a forceful cardiac output of a hypermetabolic state; the development of S3 may warn of impending cardiac failure.

7. Auscultate breath sounds. Note adventitious sounds.
An early sign of pulmonary congestion, reflecting developing cardiac failure.

8. Monitor BP lying, sitting, and standing, if able. Note widened pulse pressure.
General or orthostatic hypotension may occur as a result of excessive peripheral vasodilation and decreased circulating volume. Widened pulse pressure reflects a compensatory increase in stroke volume and decreased systemic vascular resistance (SVR).

9. Monitor temperature; provide a cool environment, limit bed linens or clothes, and administer tepid sponge baths.
Fever (may exceed 104°F) may occur as a result of excessive hormone levels and can aggravate diuresis and/or dehydration and cause increased peripheral vasodilation, venous pooling, and hypotension.

10. Record I&O. Note urine specific gravity.
Significant fluid losses through vomiting, diarrhea, diuresis, and diaphoresis can lead to profound dehydration, concentrated urine, and weight loss.

11. Weigh daily. Encourage chair rest or bed rest. Limit unnecessary activities.
Activity increases metabolic and circulatory demands, which may potentiate cardiac failure.

12. Monitor ECG, noting rate and rhythm. Document dysrhythmias.
Tachycardia (greater than normally expected with fever and/or increased circulatory demand) may reflect direct myocardial stimulation by thyroid hormone. Dysrhythmias often occur and may compromise cardiac output.

13. Monitor central venous pressure (CVP), if available.
Provides a more direct measure of circulating volume and cardiac function.

14. Monitor laboratory and diagnostic studies: 

  • 14.1. Serum potassium
    Hypokalemia resulting from intestinal losses, altered intake, or diuretic therapy may cause dysrhythmias and compromise cardiac function/output. In the presence of thyrotoxic paralysis (primarily occurring in Asian men), close monitoring and cautious replacement are indicated because rebound hyperkalemia can occur as the condition abates releasing potassium from the cells.
  • 14.2. Serum calcium
    Elevation may alter cardiac contractility.
  • 14.3. Sputum culture
    Pulmonary infection is the most frequent precipitating factor of crisis.
  • 14.4. Serial ECGs
    May demonstrate the effects of electrolyte imbalance or ischemic changes reflecting inadequate myocardial oxygen supply in the presence of increased metabolic demands.
  • 14.5. Chest x-rays
    Cardiac enlargement may occur in response to increased circulatory demands. Pulmonary congestion may be noted with cardiac decompensation.

Nursing Interventions and Rationales

1. Provide supplemental O2 as indicated.
May be necessary to support increased metabolic demands and/or O2 consumption.

2. Provide a hypothermia blanket as indicated.
Occasionally used to lower uncontrolled hyperthermia (104°F and higher) to reduce metabolic demands/O2  consumption and cardiac workload.

3. Administer IV fluids as indicated.
Rapid fluid replacement may be necessary to improve circulating volume but must be balanced against signs of cardiac failure and the need for inotropic support.

4. Administer medications as indicated:

  • 4.1. Thyroid hormone antagonists: propylthiouracil (PTU), methimazole (Tapazole)
    May be a definitive treatment or used to prepare the patient for surgery, but the effect is slow and so may not relieve thyroid storm. Once PTU therapy is begun, abrupt withdrawal may precipitate a thyroid crisis. Acts to prevent the release of thyroid hormone into circulation by increasing the amount of thyroid hormone stored within the gland. May interfere with RAI treatment and may exacerbate the disease in some people.
  • 4.2. [beta]-blockers: propranolol (Inderal), atenolol (Tenormin), nadolol (Corgard), pindolol (Visken)
    Given to control the thyrotoxic effects of tachycardia, tremors, and nervousness, and is the first drug of choice for an acute storm. Decreases heart rate or cardiac work by blocking [beta]-adrenergic receptor sites and blocking the conversion of T4 to T3. If severe bradycardia develops, atropine may be required. Blocks thyroid hormone synthesis and inhibits the peripheral conversion of T4 to T3.
  • 4.3. Strong iodine solution (Lugol’s solution) or supersaturated potassium iodide (SSKI) PO
    May be used as surgical preparation to decrease the size and vascularity of the gland or to treat thyroid storm. Should be started 1–3 hr after initiation of antithyroid drug therapy to minimize hormone formation from the iodine. If iodide is part of the treatment, mix it with milk juice, or water to prevent GI distress and administer it through a straw to prevent tooth discoloration.
  • 4.4. RAI (Na131I or Na125I) following NRC regulations for radiopharmaceutical
    Radioactive iodine therapy is the treatment of choice for almost all patients with Graves’ disease because it destroys abnormally functioning gland tissue. Peak results take 6–12 wk (several treatments may be necessary); however, a single dose controls hyperthyroidism in about 90% of patients. This therapy is contraindicated during pregnancy. Also, people preparing or administering the dose must have their own thyroid burden measured, and contaminated supplies and equipment must be monitored and stored until decayed.
  • 4.5. Corticosteroids: dexamethasone (Decadron)
    Provides glucocorticoid support. Decreases hyperthermia; relieves relative adrenal insufficiency; inhibits calcium absorption; and reduces the peripheral conversion of Tfrom T4. May be given before thyroidectomy and discontinued after surgery.
  • 4.6. Digoxin (Lanoxin)
    Digitalization may be required in patients with HF before [beta]-adrenergic blocking therapy can be considered or safely initiated.
  • 4.7. Potassium (KCl, K-Lyte)
    Increased losses of K+ through intestinal and/or renal routes may result in dysrhythmias if not corrected.
  • 4.8. Acetaminophen (Tylenol)
    Drug of choice to reduce temperature and associated metabolic demands. Aspirin is contraindicated because it actually increases the level of circulating thyroid hormones by blocking the binding of T3 and T4 with thyroid-binding proteins.
  • 4.9. Sedative, barbiturates
    Promotes rest, thereby reducing metabolic demands and cardiac workload.
  • 4.10. Furosemide (Lasix)
    Diuresis may be necessary if HF occurs. It also may be effective in reducing calcium level if the neuromuscular function is impaired.
  • 4.11. Muscle relaxants
    Reduces shivering associated with hyperthermia, which can further increase metabolic demands.

5. Administer transfusions; assist with plasmapheresis, hemoperfusion, and dialysis.
May be done to achieve rapid depletion of the extrathyroidal hormone pool in a desperately ill or comatose patient.

6. Prepare for possible surgery.
Subtotal thyroidectomy (removal of five-sixths of the gland) may be the treatment of choice for hyperthyroidism once a euthyroid state is achieved.


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to endocrine system and metabolism disorders:


Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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