Endocrine · Topic 5 of 17

Hyperthyroidism & Graves' Disease

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Endocrine · thyroid

Hyperthyroidism & Graves' Disease

The thyroid makes too much hormone, so everything speeds up. The danger is thyroid storm.

01 · Thyroid stormFever, HR above 140, delirium: report now

02 · The hallmarkBulging eyes (exophthalmos) = Graves'

03 · The drug dangerSore throat on methimazole or PTU: hold the drug

Why it happens

Too much thyroid hormone speeds up every system

Graves' antibody stimulates the TSH receptor → gland overproduces

The gland ignores feedback → keeps making hormone

What causes it

Graves' disease (autoimmune) is the most common cause

Most common

Graves' disease

Other causes

Toxic nodular goiterThyroiditisToo much thyroid replacement

Higher risk

WomenFamily history of autoimmune thyroid disease

What you'll see

Everything speeds up — weight loss, fast pulse, heat intolerance

Weight loss despite increased appetite

Tachycardia and palpitations

Heat intolerance with sweating

Diarrhea, fine hand tremor

Anxiety, irritability, insomnia

Goiter (enlarged thyroid)

Exophthalmos (bulging eyes) — Graves' disease only

Also unique to Graves': pretibial myxedema (thickened skin over the shins).

Labs & diagnostics

Low TSH · high free T4

TSH low (suppressed)

Free T4 high

The opposite of primary hypothyroidism

Red flags

Thyroid storm: high fever, HR above 140, delirium report now

Sore throat, fever or mouth sores on methimazole or PTU hold drug

Fast, irregular pulse (atrial fibrillation) report now

Neck swelling, hematoma or stridor after thyroidectomy act now

Tingling, Chvostek or Trousseau sign after thyroidectomy low calcium

Hoarse or weak voice after thyroidectomy report now

Treatment

Antithyroid drugfirst-line

methimazole

Blocks new thyroid hormone production

Takes weeks to work

PTUfirst trimester of pregnancy

propylthiouracil

Preferred early in pregnancy — methimazole can cause birth defects

Boxed warning: severe liver injury

Beta blockercontrols symptoms

propranolol

Controls tachycardia, tremor and anxiety

Does not lower hormone levels

Radioactive iodinedestroys thyroid tissue

Usually causes permanent hypothyroidism — lifelong levothyroxine

Never in pregnancy or breastfeeding

Thyroidectomyremoves the gland

Lugol's SSKI

Iodine solution before surgery shrinks the gland and its blood supply

Airway, calcium and voice checks after

Nursing priorities

Report thyroid storm signs at once: fever, HR above 140, delirium

Monitor heart rate and rhythm for atrial fibrillation

After thyroidectomy, airway first — trach set at bedside, HOB up

Give a high-calorie, high-protein diet; weigh daily

Keep the room cool and quiet; no caffeine or stimulants

Protect the eyes: lubricating drops, sunglasses, HOB raised

Hyper or hypo?

Mirror images: everything fast vs everything slow

	Hyperthyroidism	Hypothyroidism
Weight	Loss	Gain
Temperature	Heat intolerance	Cold intolerance
Bowels	Diarrhea	Constipation
Pulse	Fast	Slow
TSH	Low	High
Free T4	High	Low

Teach your patient

Keep taking antithyroid drugs — they take weeks to work

Report sore throat, fever or mouth sores at once

After radioactive iodine, expect lifelong levothyroxine

Delay pregnancy at least 6–12 months after radioactive iodine

After radioactive iodine, stay 6 feet from infants, children, pregnant people

Sleep alone for the days the provider specifies

Avoid caffeine and other stimulants

Use eye drops and sunglasses for bulging eyes

Pearl

Hyperthyroidism speeds everything up: weight loss despite a big appetite, fast pulse, heat intolerance. Bulging eyes mean Graves'.

Sources · Hyperthyroidism, Nursing (StatPearls) · Medical-Surgical Nursing 21.3 Thyroid and Parathyroid Disorders (OpenStax) · Pharmacology for Nurses 27.2 Thyroid and Antithyroid Drugs (OpenStax) · Methimazole tablets label (DailyMed) · Propylthiouracil tablets label (DailyMed) · Radioactive Iodine (American Thyroid Association) · Graves Disease (American Thyroid Association) · Radiation Safety with Radioiodine I-131 (American Thyroid Association) · Follow your facility's protocol for radioactive iodine precautions.

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