Med-Surg Endocrine System, part 15: Hyperthyroidism & Thyroid Storm (Thyrotoxicosis)

by Cathy Parkes August 01, 2020

Full Transcript

Alright. In this video, we are going to talk about hyperthyroidism as well as thyrotoxicosis. If you are following along with cards, I'm on card 37. So with hyperthyroidism, we have excess secretion of T3 and T4 from the thyroid gland, and just like we saw with hypothyroidism, we have primary, secondary, and tertiary causes of this disorder. And if you recall, the hypothalamus produces TRH, thyroid-releasing hormone which causes the pituitary gland to produce TSH, thyroid-stimulating hormone and that allows for secretion of T3 and T4 from the thyroid gland. So if we have an issue with the thyroid gland itself - so that would be primary hyperthyroidism - the most common cause is Grave's Disease which is an autoimmune issue, but we can also have some kind of thyroid nodule. Due to one of these causes, we have hypersecretion of T3 and T4. So that's primary hyperthyroidism. With secondary hyperthyroidism, this is where we have some kind of pituitary disorder such as a tumor, which is causing excess secretion of TSH. So with all this extra TSH, the thyroid gland is getting the message to produce more and more thyroid gland hormones even though it doesn't really need to, but that's the order it's getting from the pituitary gland. And then with tertiary hyperthyroidism, that means we have an issue in the hypothalamus. So due to some kind of hypothalamus dysfunction, the hypothalamus is producing too much TRH, which is causing the production of too much TSH, which is causing the thyroid gland to go into overdrive, producing all that T3 and T4 even though it really isn't supposed to just because it's getting that order from above. So those are the three causes of hyperthyroidism. So with all that T3 and T4 being produced by the thyroid gland, it really puts the body into a hypermetabolic state. So signs and symptoms of hyperthyroidism include tachycardia, hypertension, heat intolerance, bulging eyeballs, which is something called exophthalmos, weight loss without trying, insomnia, diarrhea, and warm, sweaty skin. In terms of the labs we'll see with hyperthyroidism, T3 and T4 levels will be elevated. TSH levels will depend on whether we're talking about primary or secondary hyperthyroidism. So with primary hyperthyroidism, that's where we have Graves' disease or a thyroid nodule, that thyroid gland is just cranking out the T3 and T4 regardless of how much TSH it's getting. The pituitary gland's over here really concerned, like, "Wow, you're putting out a lot of T3 and T4. Can you please chill out?" And the thyroid gland's like, "I can't chill out. I got to keep making my T3 and T4." So the pituitary gland is scaling back how much TSH it gives the thyroid gland, but the thyroid gland doesn't care. Doesn't care and is going to keep cranking that stuff out as fast as it can. So with primary hyperthyroidism, elevated T3 and T4 but decreased TSH because that pituitary gland is trying to rein that thyroid gland in. When we have secondary or tertiary hyperthyroidism, then our levels of TSH will be increased, right, because there's some kind of tumor or malfunction which is causing increased TSH, which is causing the thyroid gland to produce more T3 and T4. So the thyroid gland is functioning fine. He's like, "I think I'm making enough T3, T4 here." But the pituitary gland's going crazy and is like, "No. Here's some more TSH. Make more. Make more." And the thyroid gland's like, "Okay, I'll do that." And that's secondary hyperthyroidism. So with that, we'll have elevated TSH and elevated T3 and T4.

Alright. Let's move to treatment. So if a patient has primary hyperthyroidism, they may need a thyroidectomy, which is removal of the thyroid gland. And in my next video, we will talk about nursing care of patients who have to undergo a thyroidectomy. Medications that could be used include PTU, iodine solutions, as well as beta-blockers to help bring those vital signs down. In terms of nursing care, we're going to want to increase our patient's calorie and protein intake because of that weight loss and the fact that they're in this hypermetabolic state. We're going to want to monitor their I's and O's as well as their weight and their vital signs. And then for exophthalmos, which is the bulging eyes, we're going to want to tape their eyelids closed for sleep and provide eye lubricant to really protect those eyes.

Alright. So let's briefly talk about a life-threatening complication of hyperthyroidism which is thyrotoxicosis, or a thyroid storm. This is where we have excessively high levels of thyroid hormones. And this could be brought on due to infection, stress, diabetic ketoacidosis, which is DKA, or possibly due to a thyroidectomy. In terms of signs and symptoms of this disorder, we're going to have severe hypertension as well as chest pain, dysrhythmias, dyspnea, which is difficulty breathing, delirium, fever, and nausea and vomiting. So in terms of treatment, we can give this patient beta-blockers to try to get those vital signs in control, antithyroid medications, as well as antipyretics for treating the fever. And in terms of nursing care, we're definitely going to want to maintain a patent airway, which is always your number-one priority, and then also monitor the patient for dysrhythmias.

So that is it for hyperthyroidism. In my next video, we will talk about care of a patient who requires a thyroidectomy. Thanks so much for watching!

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