Thyroid Disease Hyperthyroidism And Hypothyroidism Full Details
- Hyperthyroidism means excessive secretion of Thyroid Disease hormone (T3 & T4).
- 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’S 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
- 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.)
- 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.
- 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
- Thyroid storm – It is an acute life-threatening condition in an uncontrollable hyperthyroidism
- Causes are manipulation of thyroids gland during surgery, infecting & stress.
- 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).
- 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
- Decreased T3 & T4 hormone level.
- Increased TSH hormone level.
- Increase lipid & cholesterol level in blood.
- Decreased radioactive iodine (I131 )uptake.
- 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.
Myxedema coma -it is a rare but serious disorder caused by constantly very low production of thyroids
Hormone cauSe coma.