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How Hyperthyroidism and Hypothyroidism
Oyid: Tipping the scales: Understanding thyroid imbalances. 1
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< Back to Search Results Hide Cover [Featu re] Nursing Critical Care Issue: Volume 8(1 ). january 2013 p 23-28 Copyright: 2013 lippincott Will iams & Wilkins Inc. Publication Type: [Feature] DOl: 10.1 097/01.CCN .0000418818.21604.22 ISSN: 1558447X Accession: 01244666201301 000-00006 < Previous Article Table of Contents Tipping the scales: Understanding thyroid imbalances Crawford Ann PhD RN; Harris Helene MSN RN Author Information Next Article >
Ann Crawford is a professor in the College of Nursing at the University of Mary Hardin-Baylor in Belton Tex.
Helene Harris is a clinical educator at Central Texas Veterans Health care System in Temple Tex.
Find out how to recognize and respond to potentially life-threatening metabolic imbalances.
The authors have disclosed that they have no financial relationships related to this article.
Thyroid hormones affect overall metabolism and electrolyte balance. Alterations in
thyroid hormone function can cause widespread and potentially life-threatening
effects. This article reviews hyperthyroidism and hypothyroidism and what you need
to know about each condition. For details on this endocrine gland see About the
Figure. No
caption a
Hyperthyroidism is the clinical syndrome that results when tissues are exposed to high levels of circulating
thyroid hormone. In most cases hyperthyroidism is due to hyperactivity of the thyroid gland.1 This common
endocrine disorder can occur at any age although patients typically are diagnosed between ages 20 and 40.
Women are much more likely to be diagnosed with a form of hyperthyroidism than men.23 The increased
levels of circulating thyroid hormones increase sympathetic nervous system activity and increase metabolic
rate causing many of the clinical manifestations of hyperthyroidism.1
Thyroid hormone overstimulation on the cardiovascular system causes fight-or-flight types of responses
including an increase in heart rate stroke volume myocardial contractility and BP.1 2 No matter what the
cause manifestations of overproduction of thyroid hormones are termed thyrotoxicosis. However
thyrotoxicosis isnt synonymous with hyperthyroidism and thyrotoxicosis can occur without hyperthyroidism.
For a list of the manifestations of hyperthyroidism see Clinical manifestations of hyperthyroidism and
Elevated thyroid hormone levels increase the bodys metabolic rate and affect the metabolism of proteins fat s
and carbohydrates. Because of th is although the patient has an increased appetite and food intake energy
needs exceed the supply and the person loses weight. With the high metabolic rate protein degradation
exceeds protein synthesis causing a negative nitrogen balance. Fat metabolism is increased reducing fat
stores. Sustained hyperthyroidism leads to more chronic nutritional deficits.1 2 Hypersecretion of thyroid
hormones can also affect the secretion of other endocrine hormones within the hypothalamus and anterior
pituitary gland including sex hormone production.2
Thyrotoxicosis may also be caused by radiation exposure ingestion of excess thyroid hormone thyroiditis
(usually temporary) interferon-alpha therapy pituitary tumors and metastatic thyroid cancer. Patients taking
the antiarrhythmic drug amiodarone a heavily iodinated compound can develop hyperthyroidism or
hypothyroidism.3 Hyperthyroidism may be acute or chronic depending on its underlying etiology.
Graves disease is an autoimmune disease characterized by abnormal stimulation of the thyroid gland in which
the body makes antibodies that bind to the thyro id-stimulation hormone (TSH) receptor sites in the thyroid.
Thyroid-stimulating immunoglobulins (TS is) attach to the thyroid tissue causing gland hypertrophy and thyroid
hormone overproduction. Patients with Graves disease will demonstrate the key features of thyrotoxicosis.1 3

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Diagnostic testing and
Nursing considerations and
patient teaching
Diagnostic testing and
Nursing interventions
Patient education
Staying in balance
About the thyroid ..
Serious trouble
Ovid: Tipping the scales: Understanding thyroid imbalances.
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Toxic multinodulor goiter is hyperthyroidism caused by multiple thyroid nodules. usually composed of enlarged
thyroid tissue or benign tumors. The overproduction of thyroid hormones is usually less severe than in Graves
disease and the clinical presentation wilt be similar though without the manifestation of exophthalmos or
pretibial edema.2
Diagnostic testing and management Table Clinical man if
Hyperthyroidism is diagnosed based on patient history clinical presentation and thyroid hormone lab studies
and including T3 T4 TSH and T3 resin uptake (T3RU). In addition measurement ofTSH receptor antibodies
(TSH-RAb) may be used to diagnose Graves disease.2
A radioiodine uptake and thyroid scan may be performed to evaluate the thyroid glands size position and
function. A thyroid ultrasound may also be used to determine the size of the thyroid gland and presence of
masses or nodules.24
Treatment for hyperthyroidism includes antithyroid drug therapy radioiodine and surgery (subtotal or neartotal
thyroidectomy).S Medications such as methimazole and propylthiouracil (PTU) inhibit the synthesis of
thyroid hormones but dont inactivate circulating thyroid hormones or those stored in the thyroid. These
medications are used for long-term management. Potassium iodide and iodine solutions inhibit the synthesis
and the release of the thyroid hormone and generally are used for short-term therapy such as before thyroid
surgery.6 Beta-blockers can be used to help control adrenergic signs and symptoms especially in the early
stages of treatment before the antithyroid drugs take effect. Beta-blockers block the effects of the thyroid
hormone on the sympathetic receptors of the heart decreasing myocardial oxygen demands.6
Radioiodine (radioactive iodine) causes progressive destruction of thyroid cells . Potential adverse effects
include pharyngitis or neck tenderness for a few days and complications include hypothyroidism.6 Radioiodine
may exacerbate the ophthalmopathy for patients with Graves disease (more on this later).6 Because fewer
than 50% of patients treated with antithyroid medications remain in long-term remission radioactive iodine is


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