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(A Project of National Medical Centre Karachi)

Disorder of Thyroid Gland.

(Hyperthyroidism)

BY:
Shahzad Bashir
Lecturer, nmc ion.
 OBJECTIVES.
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 By the end of this lecture, the students will be able to:

 Understand the pathologic mechanism of
hyperthyroidism interm of :
 Grave’s disease.
 Goiter (Toxic).

Shahzad Bashir. 2/14/2019

 HYPERTHYROIDISM
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Hyperthyroidism is hypermetabolic state caused by elevated

circulating levels of free T3 and T4.
Over-secretion of the thyroid gland.
Also called thyrotoxicosis or graves disease, tissues are
stimulated by excessive thyroid hormone.
A recurrent syndrome, may appear after emotional stress or
infection.
Occurs mostly in women 20-50 yrs old.

Causes : Adenoma, Goiter, Viral inflammation, Auto-immune

glandular stimulation, Grave’s disease - most common cause.

Shahzad Bashir. 2/14/2019

 Cont…
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DX: > Elevated T3, T4 values in plasma.

T4= 8µg/dl(Avg:5-12µg/dl), T3=0.15µg/dl (Avg: 0.08-0.22µg/dl ,
TSH= 0.2-5.4 mU/L.
•Abnormal findings in the thyroid scan.

Goiter – Enlargement of the thyroid gland.

•Due to  stimulation of the thyroid gland by TSH.

Simple goiter – Enlarged thyroid gland.

•Due to iodine deficiency, intake of goitrogenic foods  cabbage,
turnips, soybeans.
•May be hereditary.
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 GRAVE’S DISEASE
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 R.J Graves, Irish physician reported in 1835 his observations of a
disease characterized by “violent and long continued palpitations in
females” associated with enlargement of the thyroid gland.
Disorder char. by one or more of the ff:
Hyperthyroidism due to diffuse goiter.
Localized, infiltrative dermopathy, sometimes called pretibial
myxedema.
Infiltrative opthalmopathy  Exophthalmos.
 Most common cause of endogenous hyperthyroidism.
Seen in females under age 40.
 Result from stimulation of the thyroid gland by thyroid stimulating
immunoglobulins (TSI)
 Cause is unknown, may be hereditary, gender-related,
often occurs after severe emotionalShahzad
stress or infection.
Bashir. 2/14/2019
 Cont…
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 Graves disease is characterized by a breakdown in self-

tolerance to thyroid auto-antigens, most importantly
the TSH receptor. The result is the production of
multiple autoantibodies, including:
 Thyroid-stimulating immunoglobulin.
 Thyroid growth-stimulating immunoglobulins.
 TSH-binding inhibitor immunoglobulins.

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 THYROID STORM OR CRISIS.
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Thyroid Storm or Crisis is an extreme & life threatening form of

Thyrotoxicosis.
A medical emergency  pts. develop severe manifestation of
hyperthyroidism.
 temp., tachycardia, dysrhythmias.
Worsening tremors, restlessness.
Delirious or psychotic state or coma.
Abdominal pain.
 BP and RR

Precipitated by a major stressor:

Infection.
Trauma or surgery (thyroidectomy).
Inadequate treatment. Shahzad Bashir. 2/14/2019
 Conti…
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3. Thyroid storm:
- Life-threatening.
- Sudden  release of thyroid hormone.
- Fever, tachycardia, increasing restlessness and
agitation, delirium.

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 Do you take this woman as your
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wife…. In sickness and in health…

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11 Shahzad Bashir. 2/14/2019
 Assessment
Findings: Thyroid
storm.
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 Anxiety.
 Flushed, smooth skin.
 Heat intolerance.
 Mood swings.
 Diaphoresis.
 Tachycardia.
 Palpitations.
 Dyspnea.
 Delirium, coma.
 Heart failure.

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•Medications
Propylthiouracil (PTU) – antithyroid drug.
- Blocks thyroid hormone production.
- Can cause agranulocytosis.
- Monitor pt. CBC.
Methimazole (Tapazole) – Blocks TH prod.
Iodine preparations –  the size and
vascularity of the thyroid gland; inhibit release of
thyroid hormones.
1.) Lugol’s solution
Can be given with milk or fruit juice.
Should be taken with a straw – may stain the teeth.
Complications : brassy taste in the mouth, sore teeth and
gums.
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2.) Saturated solution of potassium iodide (SSKI).
 Conti…
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•Medications
Propanolal (Inderal) and other adrenergic blockers.
• Relieve the adrenergic effects of excess thyroid
hormone (sweating, palpitations, tremors).

•Radioactive iodine (Iopanoic acid & Ipodate sodium)Limits the

secretion of the hormone by damaging or destroying thyroid tissue.

•Surgical intervention (performed only when pt. is in a

euthyroid state).
 Subtotal thyroidectomy (Large goiter).
 Total thyroidectomy (If carcinoma is present).

Shahzad Bashir. 2/14/2019

 NSG. INTERVENTIONS:
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Provide calm, restful envt.
1. Physical comfort, cool envt. temp., bathe frequently w/
cool water.
2. Provide adequate rest, avoid muscle fatigue.
3.  stressors in the envt.— noise and lights.
4. Relaxation techniques.
Provide adequate nutrients
1.  calorie,  protein, balanced diet (4,000-5,000 cal/day).
2.  fluid intake.
3. Restrict stimulants (tea, coffee, alcohol).
4. Small, frequent feedings if hypermotility is present.
5. Daily wt.

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 Conti…
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Provide emotional support:

Provide eye care

1. Eye drops, dark glasses, patch eyes if necessary.
2. Elevate head of bed for sleep.
3. Restrict dietary sodium.
4. Assess adequacy of lid closure.

Be alert for complications:

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 POST-OP CARE AFTER THYROIDECTOMY.
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 O2 therapy, suction secretions.

 Monitor for signs of bleeding and excessive edema.
 Elevate head of bed 30o, support head and neck – to
avoid tension on sutures.
Check dressing frequently, check behind the neck for
bleeding.
 Assess for signs of resp. distress, hoarseness
(laryngeal edema or damage).
 Keep tracheostomy set in patient’s room for emergency
use.

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 Post-op Complications: be alert for the
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possibility of:
1. Tetany (Due to hypocalcemia caused by accidental removal of
parathyroid glands).
Assess for numbness, tingling or muscle twitching.
 Chvostek’s sign and Trousseau’s sign.
 Ca+ gluconate IV.

2. Hemorrhage
WOF: Hypotension, tachycardia, other signs of hypovolemia.
WOF: Irregular breathing, swelling, choking---possible
hemorrhage and tracheal compression.
WOF: Early signs of hemorrhage: repeated clearing of the
throat, difficulty swallowing.
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 COMPLICATIONS :
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Cardiovascular disease (HPN, Angina, CHF).

Exophthalmos – Abnormal protrusion of the eyeballs.
- Caused by abnormal deposits of fat and fluid in
the retroocular tissue.
Corneal abrasion.
Thyroid storm or crisis  life-threatening
hypermetabolism and excessive adrenergic
response (HR, RR, BP).

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 REFERENCES
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 Porth, M. C. (2009). Pathophysiology Concepts of

altered health states (7th ed.). USA: New York,
Lippincott Williams & Wilkins.

 Robbins & Cotran, Sunders (2010). Pathologic

basis of disease (8th ed.) / Vinay Kumar… with
illustrations by James A. Perkins..

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