Endocrine and Metabolic

disorders
Metabolic hyperthyroidism
JOY JOHN DIEGO JACQIE JEFF JAYSON DOMINGO BENJO VENESSE ALVIN
MARK LOUIE

“it is when convergence meets demand

and the craving for learning is very badly
needed”
hyperthyroidism

Description:
ØAlso called Grave’s disease, Basedow’s
disease, thyrotoxicosis or exophtalmos
goiter.

ØA metabolic imbalance resulting from

excessive thyroid hormone production;
Grave’s disease is the most common form.
Etiology and incidence:
1. Autoimmune dysfunction
2. Genetic factors
3. Other possible causes:
Ø thyroid tumors
Ø pituitary tumors
Ø Hypothalmic malignancies
Ø stress or infection
Ø exposure to iodine
Ø Incidence is greatest between ages 30 and
40 and is higher in women than in men
How is hyperthyroidism diagnosed?

 If not diagnosed shortly after birth, hyperthyroidism in the

newborn can be fatal. In addition to a complete medical
history and physical examination, diagnostic procedures for
hyperthyroidism may include measurement of thyroid
hormone in the bloodstream.
 Diagnosis is based on history, physical examination, and
thyroid function tests. Serum TSH is the best test, because
TSH is suppressed in hyperthyroid patients except when the
etiology is a TSH-secreting pituitary adenoma or pituitary
resistance to thyroid hormone. Free T4 is increased. However,
T4 can be falsely normal in true hyperthyroidism in patients
with a severe systemic illness (similar to the falsely low levels
that occur in euthyroid sick syndrome) and in T3 toxicosis. If
free T4 is normal and TSH is low in a patient with subtle
symptoms and signs of hyperthyroidism, then serum T3
should be measured to detect T3 toxicosis; an elevated level
confirms that diagnosis.
Possible Lab findings
 Increased T4 and T3 levels
Non- detectable TSH

Thyroid Ultrasonography shows an

enlarged thyroid gland

A thyroid scan indicates an

increased uptake of radioactive

iodine (RAI; 131I and 123I)
Other Tests: Media file 1:  Iodine 123 nuclear scintigraphy: Iodine 123 scans of a normal thyroid
ANATOMY AND PHYSIOLOGY
why does spongebob have
claustrophobia?

Because he is
afraid of the
Santa Claus!
PATHOPHYSIOLOGY
Signs and Symptoms
Clinical manifestations
 Nervousness, irritability, hyperactivity, emotional lability, and
decreased attention span.
 Weakness, easy fatigability, exercise intolerance

 Heat intolerance

 Increased appetite, loses weight

 Insomnia, interrupted sleep

 Diarrhea, frequent stools

 Irregular or scant menses, decreased libido

 Warm, sweaty, flushed skin with velvety- smooth texture,

elevated body temperature

 Tremor, hyperkinesias, hyperreflexia

 Exopthalmos, retracted eye lids, staring gaze

 Hair loss (silky hair)

 Goiter

 Bruits over thyroid gland

 Tachycardia, moderate hypertension

Possible Nursing Diagnosis

 Activity intolerance
Hyperthermia

High risk for injury

Altered Nutrition: Less

than Body
requirements
Complications

 Graves ophthalmopathy
Graves ophthalmopathy is more common
in women than in men.
 Dermopathy

. The skin changes usually include a

nonpitting erythematous edema of the
anterior shins.
ØThyrotoxicosis/Thyroid storm
ØHemorrhage
ØHypocalcemia
Prevention

 The frequency and severity of symptoms of

thyrotoxicosis vary from person to person.
 Radiation exposure
 Recording a careful family history of
autoimmune disease, thyroid disease, and
emigration from iodine-deficient areas is
important.
 Review a complete list of medications.
HEALTH TEACHINGS
Medications:
Iodine: Potassium Iodide (Lugol’s
Solution) saturated K iodide
Propylthiouracil and
methimazole: Tapazole
β-Blockers: Propranolol (Inderal)
Radioactive sodium iodine
(131I, radioiodine): Radioiodine
Treatment

 Subtotal thyroidectomy (partial removal of the

thyroid gland)
 Total thyroidectomy (removal of the thyroid gland)

 Treatment of infiltrative dermopathy and

ophthalmopathy: In infiltrative dermopathy (in
Graves' disease), topical corticosteroids sometimes
relieve the pruritus. Dermopathy usually remits
spontaneously after months or years.
Ophthalmopathy should be treated jointly by the
endocrinologist and ophthalmologist and may
require corticosteroids, orbital radiation, and
surgery.
Diet

No special diet must be followed by

patients with thyroid disease.
Notably, excess amounts of iodide
found in some expectorants, x-ray
contrast dyes, seaweed tablets, and
health food supplements should be
avoided because the iodide interferes
with or complicates the management
of both antithyroid and radioactive
iodine therapies.
Activity

 Often, in otherwise healthy patients with

hyperthyroidism, exercise tolerance is not
affected significantly. For these people, no
reduction in physical activity is necessary.
For elderly patients or for those with
cardiopulmonary comorbidities, a decrease
in activity is prudent until hyperthyroidism is
medically controlled.
 Often with severe thyrotoxicosis, systolic
and diastolic cardiac dysfunction manifested
by dyspnea upon exertion exists.
Nursing Management

 The Nurse monitors Heart rate and Blood

pressure
 He or she records the client’s sleep pattern
and daily weights
 The nurse promotes rest and helps the client
avoid excess physical stimulation.
 Increased caloric intake can compensate for
increased metabolism.
 The nurse informs the client that effects of
anti-thyroid therapy usually are not apparent
until the thyroid gland has secreted the
excess thyroid hormone into the blood
stream. This process may take several weeks
or more.
NURSING CARE PLANS
DRUG STUDY
UPDATES!
Frequency

 United States
 Graves disease is the most common form of
hyperthyroidism. Approximately 60-80% of cases of
thyrotoxicosis are due to Graves disease. The annual
incidence of the disease is 0.5 cases per 1000 persons during
a 20-year period, with the peak occurrence in people aged
20-40 years. Toxic multinodular goiter (15-20% of
thyrotoxicosis) occurs more frequently in regions of iodine
deficiency. Most persons in the United States receive
sufficient iodine, and the incidence of toxic multinodular
goiter is less than the incidence in areas of the world with
iodine deficiency. Toxic adenoma is the cause of 3-5% of
cases of thyrotoxicosis.
 International
 The incidences of Graves disease and toxic multinodular
goiter change with iodine intake. Compared to regions of the
world with less iodine intake, the United States has more
cases of Graves disease and fewer cases of toxic
multinodular goiters.
 Race
 Autoimmune thyroid disease occurs with the same
frequency in Caucasians, Hispanics, and Asians, and it
occurs less frequently in the black population.
 Sex
 All thyroid diseases occur more frequently in women
than in men. Graves autoimmune disease occurs in a
male-to-female ratio of 1:5-10. Toxic multinodular
goiter and toxic adenomas occur more frequently in
women than in men, with a ratio of 1:2-4.
 Age
 Autoimmune thyroid diseases have a peak incidence in
people aged 20-40 years. Toxic multinodular goiters
occur in patients who usually have a long history of
nontoxic goiter and, therefore, usually present when
they are older than 50 years. Patients with toxic
adenomas present at a younger age than patients with
toxic multinodular goiter.
Other updates:
Seasonal Health News

Fatigued or Full Throttle: Is Your Thyroid to Blame?

By Debra Bruce
Reviewed by: Brunilda Nazario

 Feeling all revved up, even at bedtime? Or maybe your throttle's on idle with symptoms
of depression , fatigue, and weight gain. In both cases, the root cause may be your
thyroid.
 The thyroid -- a butterfly-shaped gland in the front of your neck -- makes hormones that
control the way your body uses energy. Your thyroid controls your metabolism, which is
how your body turns food into energy, and also affects your heart, muscles, bones, and
cholesterol.
 While thyroid disorders can range from a small, harmless goiter (enlarged gland) to life-
threatening cancer, the most common thyroid problems involve an abnormal
production of thyroid hormones. Too much of these vital body chemicals results in a
condition known as hyperthyroidism. Too little hormone production leads to
hypothyroidism.
 Although the effects of thyroid problems are unpleasant or uncomfortable, most thyroid
conditions can be managed well if properly diagnosed and treated.
What is an overactive thyroid?
 Hyperthyroidism happens when the thyroid becomes overactive and produces too
much of its hormones. Hyperthyroidism affects women five timesto 10 times more
often than men, and is most common in people younger than 40. People with
hyperthyroidism have problems that reflect overactivity of the organs of the body,
resulting in symptoms such as sweating, feeling hot, rapid heartbeats, weight loss, and
sometimes eye problems.
Kung ikaw ay
sinabihan ko na
ihanda mo ang iyong
bulsa (bago at
pagkatapos ng board
exam) para
magblow-out!,
maniwala ka at
magkakatotoo yon!

*it is already proven from the

previous batch
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FIN