HYPERTHYROIDISM

DISEASE: HYPERTHYROIDISM- is a hyperthyroid state resulting from hypersecretion of thyroid hormones(T3 and T4), characterized by an increased rate of body metabolism, common cause is Grave’s disease also known as toxic diffuse goiter, clinical manifestations are referred to as thyrotoxicosis.

SIGNS & SYMPTOMS: Enlarged thyroid gland(goiter), palpitations, cardiac dysrhythmias, such as tachycardia or atrial fibrillation, protruding eyeballs(exophthalmos), hypertension, heat intolerance, diaphoresis, weight loss, diarrhea, smooth, soft skin and hair, pliable nails, nervousness and fine tremors of hands, personality changes, irritability and agitation, mood swings.

PATIENT TEACHINGS: Provide adequate rest. Provide cool and quiet environment. Obtain weight daily. Avoid administration of stimulants.

 TREATMENTS: Administer sedatives as prescribed. Administer antithyroid medications(propylthiouracil(PTU) and methimazole(Tapazole)) that block thyroid synthesis, as prescribed. Administer iodine preparations that inhibit the release of thyroid hormone as prescribed. Administer propranolol(Inderal) for tachycardia as prescribed. Prepare the client for radioactive iodine therapy as prescribed to destroy thyroid cells. Prepare the client for thyroidectomy if prescribed.

DIET: Provide a high-calorie diet.

HYPOTHYROIDISM

DISEASE: HYPOTHYROIDISM(myxedema) is a hypothyroid state resulting from a hyposecretion of the thyroid hormones T4 and T3, characterized by a decreased rate of body metabolism.

SIGNS & SYMPTOMS: Lethargy and fatigue, weakness, muscle aches, paresthesia, Intolerance to cold, weight gain, dry skin and hair, loss of body hair, bradycardia, anorexia, constipation, generalized puffiness and edema around the eyes and face, forgetfulness and loss of memory, menstrual disturbances, cardiac enlargement, tendency to develop congestive heart failure.

PATIENT TEACHINGS: Instruct the client about thyroid replacement therapy.

 TREATMENTS: Monitor VS, including heart rate and rhythm. Administer thyroid replacement; levothyroxine sodium(Synthroid) is most commonly prescribed. Assess the client for constipation; provide roughage and fluids to prevent constipation. Provide a warm environment. Avoid sedatives and narcotics because of increased sensitivity to these medications.

DIETS AND DRUGS: Instruct client in low-calorie, low cholesterol, low saturated fat diet. Levothyroxine(Synthroid), Thyroglobulin(Proloid), Dessicated thyroid, Liothyronine(Cytomel) Thyroid hormone replacements are taken daily in the morning to prevent insomnia.

ADDISON DISEASE

ADDISON DISEASE – hyposecretion of adrenal cortex hormones (glucocorticoids & mineralocorticoids). Fatal if left untreated.

SIGNS & SYMPTOMS: Lethargy, fatigue & muscle weakness, GI disturbances, wt. loss, menstrual changes in women, impotence in men, hypoglycemia, hyperkalemia, postural hypotension, dehydration, emotional disturbances

PATIENT TEACHINGS: Avoid individuals with infection, strenuous exercise & stressful situations. Need for lifelong glucocorticoid therapy. Avoid OTC meds. Wear medic-alert bracelet.

 TREATMENTS: Monitor VS, BP, wt. and I & O. Monitor blood glucose, and potassium. Administer glucocorticoid or mineralocorticoid medications as prescribed.

DIETS AND DRUGS: High protein, carbohydrate, & sodium intake. Dexamethasone, Hydrocortisone and Fludrocortisone.