Thyroid Disease Hyperthyroidism And Hypothyroidism Full Details

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Thyroid Disease Hyperthyroidism And Hypothyroidism Full Details

Thyroid Disease
Thyroid Disease

Hyperthyroidism/Thyrotoxicosis

  • Hyperthyroidism means excessive secretion of Thyroid Disease hormone (T3 & T4).

Etiology

  • Malignancy of Thyroid Disease gland and TSH producing cells of the anterior pituitary gland.

Graves Disease (also known diffuse toxic goiter)

  • It is the most common cause of hyperthyroidism.
  • It occurs due to abnormal formation of thyroid stimulating Immunoglobulin’s (TST).
  • TSI like TSH, stimulate enlargement of thyroids gland and cause diffuse toxic goiter.

Sign (objective physical evidence)/ symptoms (subjective evidence) –

  • Goiter & exophthalmos (proptosis, protruding eyeball due to edema behind the eye) It appears only in grave‚ÄôS disease.
  • Increase heart rate, hypertension & palpitation.
  • Heat intolerance, weight loss, overeating (hyperphagia), diaphoresis, smooth, soft skin & hair (all are due to increase BMR).
  • Diarrhea (due to increase peristalsis).
  • Nervousness, Tremors in hands, Agitation (reslesness & anxiety) & Mood swing

Diagnosis

  • Based on C/M & laboratory finding.
  • Increased level of T3 & T4 in blood.
  • Decreased level of TSH in blood.

(Normal level of T,-5-12 ug/dl, T3 – 70-220 ng/di, TSH-0.5-5.4mlu/litre (milli international unit per it.)

Management

  • Provide adequate rest to decrease BMR.
  • Provide cool, non-stimulating & quiet environment.
  • Provide a high-calorie diet.
  • Administer anti-thyroid medication such as propylthiouracil (PTU), it blocks synthesis of thyroid hormone.
  • Administer propranolol for palpitation & anxiety.
  • Administer radioactive iodine I131 I to destroy thyroid gland cells into toxic goiter (Graves’s disease) and thyroid carcinoma.

Surgery

  • Thyroidectomy (excision of the thyroid gland, used mainly to treat thyroid cancers, goiters or Grave’s disease).
  • Monitor for a sign of hypocalcemia & tetany caused by trauma to parathyroid gland during Surgery of thyroid gland
  • Maintain semi-Fowler’s position after surgery.
  • Administer calcium gluconate to prevent tetany

Complication

  • Thyroid storm – It is an acute life-threatening condition in an uncontrollable hyperthyroidism
  • Causes are manipulation of thyroids gland during surgery, infecting & stress.

 

Hypothyroidism/ Myxedema

  • Deficiency of thyroid hormone (T3, T4) called hypothyroidism which causes decrease BMR in the body.
  • Hypothyroidism in childhood due to congenital absence or atrophy of gland cause stunted mental and physical growth which called creationism or congenital hypothyroidism.
  • Hypothyroids in adulthood called myxedema which occurs five times more in a female.

Etiology– there are three types of hypothyroidism based on etiology

1 Primary hypothyroidism – CauSes are

  • Congenital defect of thyroid gland (cretinism).
  • lodine deficiency (hypothyroidism due to iodine deficiency cause simple goiter).
  • Excessive anti-thyroid drugs like propylthiouracil (PTU).
  • Surgery & radiation of thyroid gland.
  • Hashimoto’s thyroiditis (autoimm illness that causes destruction and fibrosis of the thyroid gland).

2 Secondary hypothyroidism– Caused by malfunction of the pituitary gland.

3 tertiary/central hypothyroidism -Cause if hypothalamus fails to produce thyroid releasing hormone (TRH).

C/M

  • myxedema (generalized puffiness and edema of the skin due to deposition of muce-polysaccharides. Giving it a waxy appearance).
  • latolerance to cold (hypothermia), weight gain, dry skin & hair, anorexia, weakness fatigue (all are due to decrease BMR).
  • Loss of hair.
  • Bradycardia and hypotension.
  • Constipation (due to decrease peristalsis).
  • Loss of memory and apathy.
  • Loss of libido (in male & female).
  • Irregular menses (in women).
  • Impotence (in male).
  • Goiter may or may not be present.
  • It may cause CHF

Diagnosis

  • Decreased T3 & T4 hormone level.
  • Increased TSH hormone level.
  • Increase lipid & cholesterol level in blood.
  • Decreased radioactive iodine (I131 )uptake.

Management

  • Administer thyroid hormone preparation-
  • Levothyroxine sodium (the sodium salt of the natural isomer of thyroxine used to treat thyroid deficiency, it is most commonly prescribed).
  • Liothyronine sodium (sodium salt of triiodothyronine, used in treating hypothyroidism).
  • Administer these medications with caution in MI,
  • hypertension, diabetes & renal failure patient.
  • Advise the patients for low calorie, cholesterol & saturated fat.
  • Provide high iodine, roughage (fiber diet) & fluid diet to prevent constipation.
  • Provide warm environment to prevent cold intolerance.

Complication

Myxedema coma -it is a rare but serious disorder caused by constantly very low production of thyroids

Hormone cauSe coma.