NurseSavvy Cheat SheetDisease
Hyperthyroidism & Graves' Disease
Pathophysiology & Risk Factors
Hyperthyroidism is an excess of circulating thyroid hormone, and the metabolic rate of every organ rises with it. Graves' disease causes most cases: an autoimmune antibody binds the TSH receptor and drives the gland to produce hormone continuously, ignoring the normal feedback loop that would shut it off. Because the antibody also inflames the tissue behind the eyes and over the shins, Graves' produces two findings that other causes of hyperthyroidism do not. Less common causes are a single overactive nodule, thyroiditis, and too much replacement hormone.
Signs & Symptoms
Hyperthyroid versus hypothyroid — the mirror
HyperthyroidHypothyroid
WeightLoss despite big appetiteGain despite poor appetite
TemperatureHeat intolerance, sweatingCold intolerance
BowelsDiarrheaConstipation
Heart rateFastSlow
MoodAnxious, irritableFlat, sluggish
Hyperthyroid
- Weight
- Loss despite big appetite
- Temperature
- Heat intolerance, sweating
- Bowels
- Diarrhea
- Heart rate
- Fast
- Mood
- Anxious, irritable
Hypothyroid
- Weight
- Gain despite poor appetite
- Temperature
- Cold intolerance
- Bowels
- Constipation
- Heart rate
- Slow
- Mood
- Flat, sluggish
Interventions & Priorities
monitor heart rate and rhythm Hallmark
atrial fibrillation is the complication that matterskeep the room cool and quiet
heat and stimulation both worsen the symptomshigh-calorie, high-protein diet Hallmark
the metabolic rate is burning through intakeavoid caffeine and other stimulants
weigh daily
protect the eyes with lubricating drops
exophthalmos prevents complete lid closureelevate the head of the bed
reduces periorbital swellingTreatments & Medications
methimazole Hallmark
blocks hormone production; the usual first choicepropylthiouracil Hallmark
preferred in the first trimester of pregnancybeta blocker Hallmark
controls the tachycardia and tremor but does not lower hormone levelsradioactive iodine
destroys thyroid tissue; usually leads to lifelong hypothyroidismthyroidectomy
Patient Teaching
report a sore throat or fever on an antithyroid drug Hallmark
agranulocytosis is the dangerous reactionexpect to need thyroid replacement after radioactive iodine
after radioactive iodine, keep distance from infants and pregnant people
eat more calories and protein than usual
use lubricating eye drops and sunglasses
do not stop the drug when you feel better
Report Nowescalate immediately
thyroid storm Hallmark
fever, heart rate above 140, and agitation or delirium — a crisisfever with tachycardia in a hyperthyroid client Hallmark
new irregular pulse
atrial fibrillationsore throat or fever on methimazole Hallmark
possible agranulocytosis — hold the dose and callchest pain or severe shortness of breath
Clinical Pearl
Losing weight while eating everything in sight, with a resting pulse over 100 — think thyroid, not diet.