Which symptom might the nurse identify when assessing a client with hyperthyroidism?

What is thyroid storm?

Inhaltsverzeichnis Show

Hypothyroidism
Classification
Statistics and Epidemiology
Clinical Manifestations
Complications
Assessment and Diagnostic Findings
Medical Management
Nursing Management
Practice Quiz: Hypothyroidism
What symptoms are seen in patients with hyperthyroidism?
Which signs and symptoms if noted by the nurse would indicate that the client with hyperthyroidism is experiencing thyroid crisis?
What assess with patient hyperthyroidism?
What are the common disorders associated with hyperthyroidism?

Thyroid storm is a life-threatening health condition that is associated with untreated or undertreated hyperthyroidism.

During thyroid storm, an individual’s heart rate, blood pressure, and body temperature can soar to dangerously high levels. Without prompt, aggressive treatment, thyroid storm is often fatal.

The thyroid is a small, butterfly-shaped gland located in the middle of your lower neck. The two essential thyroid hormones produced by the thyroid are triiodothyronine (T3) and thyroxine (T4). These control the rate at which every cell in your body works (your metabolism).

If you have hyperthyroidism, your thyroid is producing too much of these two hormones. This causes all of your cells to work too quickly. For example, your respiration rate and heart rate will be higher than they normally would be. You may even speak far more quickly than you usually do.

Thyroid storm is rare. It develops in people who have hyperthyroidism but aren’t receiving appropriate treatment. This condition is marked by the extreme overproduction of the two hormones produced by the thyroid gland. Not all people with hyperthyroidism will develop thyroid storm. Causes of this condition include:

severe undertreated hyperthyroidism
untreated overactive thyroid gland
infection associated with hyperthyroidism

People with hyperthyroidism may develop thyroid storm after experiencing one of the following:

trauma
surgery
severe emotional distress
stroke
diabetic ketoacidosis
congestive heart failure
pulmonary embolism

Symptoms of thyroid storm are similar to those of hyperthyroidism, but they are more sudden, severe, and extreme. This is why people with thyroid storm might not be able to seek care on their own. Common symptoms include:

racing heart rate (tachycardia) that exceeds 140 beats per minute, and atrial fibrillation
high fever
persistent sweating
shaking
agitation
restlessness
confusion
diarrhea
unconsciousness

Individuals with hyperthyroidism who experience any symptoms of thyroid storm are typically admitted to an emergency room. If you suspect you or someone else has thyroid storm symptoms, call 911 immediately. People with thyroid storm generally exhibit an increased heart rate, as well as a high top blood pressure number (systolic blood pressure).

A doctor will measure your thyroid hormone levels with a blood test. Thyroid stimulating hormone (TSH) levels tend to be low in hyperthyroidism and thyroid storm. According to the American Association for Clinical Chemistry (AACC), normal values for TSH range from 0.4 to 4 milli–international units per liter (mIU/L). T3 and T4 hormones are higher than normal in people with thyroid storm.

Thyroid storm develops abruptly and affects all the systems of your body. Treatment will begin as soon as thyroid storm is suspected — usually before lab results are ready. Antithyroid medication like propylthiouracil (also called PTU) or methimazole (Tapazole) will be given to reduce the production of these hormones by the thyroid.

Hyperthyroidism requires ongoing care. People with hyperthyroidism may be treated with radioactive iodine, which destroys the thyroid, or a course of drugs to suppress thyroid function temporarily.

Pregnant women who have hyperthyroidism can’t be treated with radioactive iodine because it would harm the unborn child. In those cases, the woman’s thyroid would be removed surgically.

People experiencing thyroid storm should avoid taking iodine in lieu of medical treatment, as this can worsen the condition. If your thyroid is destroyed by radioactive iodine treatment or removed surgically, you will need to take synthetic thyroid hormone for the rest of your life.

Thyroid storm requires immediate, aggressive emergency medical attention. When left untreated, thyroid storm can cause congestive heart failure or fluid-filled lungs.

The mortality rate for people with untreated thyroid storm is estimated to be 75 percent.

The chances of surviving thyroid storm increase if you quickly seek medical care. Related complications may be lessened once your thyroid hormone levels are returned to the normal range (known as euthyroid).

The most effective way to prevent the onset of thyroid storm is to keep up with your thyroid health plan. Take your medications as instructed. Keep all appointments with your doctor and follow through with blood work orders as needed.

Learn about the nursing care management of patients with hypothyroidism in this nursing study guide.

Hypothyroidism
Classification
Statistics and Epidemiology
Causes
Clinical Manifestations
Prevention
Complications
Assessment and Diagnostic Findings
Medical Management
Nursing Management
- Nursing Assessment
- Diagnosis
- Planning & Goals
- Nursing Interventions
- Evaluation
- Discharge and Home Care Guidelines
- Documentation Guidelines
Practice Quiz: Hypothyroidism
See Also

Hypothyroidism

Thyroid deficiency can affect all body functions and can range from mild, subclinical forms to advanced forms.

Hypothyroidismresults from suboptimal levels of thyroid hormone.
Hypothyroidism also commonly occurs in patients with previous hypothyroidism that has been treated with radioiodine or antithyroid medications or thyroidectomy.
The term myxedema refers to the accumulation of mucopolysaccharides in subcutaneous and other interstitial tissues.

Classification

The types of hypothyroidism are classified according to their causes:

Central hypothyroidism. There is a failure of the pituitary gland, the hypothalamus, or both to stimulate production of thyroid hormones.
Secondary or pituitary hypothyroidism. The cause is entirely a pituitary disorder in secondary hypothyroidism.
Tertiary or hypothalamic hypothyroidism. This refers to the cause as a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation of TRH.
The thyroid disorder is already present at birth in cretinism.

Statistics and Epidemiology

Hypothyroidism occurs in specific individuals in different instances.

Hypothyroidism occurs most frequently in older women.
There is an increased incidence of thyroid cancer in men who have undergone radiation therapy for head and neck cancer.
More than 95% of patients with hypothyroidism have primary or thyroidal hypothyroidism.

Causes

Several diseases and factors could cause hypothyroidism.

The most common cause of hypothyroidism is inflammation of the thyroid gland, which damages the gland’s cells.
Autoimmune diseases. The most common cause of hypothyroidism in adults is autoimmune thyroiditis or Hashimoto’s disease.
Atrophy of the thyroid gland. The thyroid gland shrinks in size as a result of aging.
Therapy for hyperthyroidism. Therapies such as radioactive iodine and thyroidectomy could also cause hypothyroidism.
Medications such as lithium, iodine compounds, and antithyroid medications could decrease the production of TSH.
Iodine deficiency or excess. The imbalance in the iodine levels in the body also affects the thyroid gland.
Autoimmune or Hashimoto’s thyroiditis, in which the immune system attacks the thyroid gland, is the most common example of this.
Some women develop hypothyroidism after pregnancy (often referred to as “postpartum thyroiditis”).

Clinical Manifestations

The signs and symptoms of hypothyroidism include:

Extreme fatigue. Extreme fatigue makes it difficult for the person to complete a full day’s work or participate in usual activities.
Menstrual disturbances. Menorrhagia or amenorrhea may also occur.
Increase in weight. The patient usually begins to gain weight even without an increase in food intake.
Cold intolerance. The patient often complains of being cold even in a warm environment.
Thick skin. The skin becomes thickened because of an accumulation of mucopolysaccharides in the subcutaneous tissues.

Prevention

Prevention of hypothyroidism can be achieved with the following:

Increase in iodine intake. Iodine intake is the foremost prevention strategy in hypothyroidism.
Early detection. Undergoing thyroid tests after thyroid surgery or therapy could result in early detection and prompt treatment of hypothyroidism.

Complications

Hypothyroidism can be a life-threatening disease if left unchecked.

Myxedema coma. This is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious.

Assessment and Diagnostic Findings

Hypothyroidism can be detected in many ways.

Physical examination. The thyroid gland is inspected and palpated routinely in all patients.
Serum thyroid-stimulating tests. Measurement of the serum TSH concentration is the single best screening test of thyroid function because of its high sensitivity.
Serum T3 and T4. Measurement of total T3 or T4 includes protein-bound and free hormone levels that occur in response to TSH secretion.
Thyroid antibodies. Results of testing by immunoassay techniques for antithyroid antibodies are positive in Hashimoto’s thyroiditis (100%).

Medical Management

The primary objective in the management of hypothyroidism is to restore a normal metabolic state by replacing the missing hormone.

Pharmacologic therapy. Synthetic levothyroxine is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters.
Prevention of cardiac dysfunction. As long as metabolism is subnormal and the tissues require relatively little oxygen, a reduction in the blood supply is tolerated without overt symptoms of coronary artery disease.
Supportive therapy. Oxygen saturation levels should be monitored; fluids should be administered cautiously; application of external heat must be avoided, and oral thyroid hormone therapy should be continued.

Nursing Management

Nursing care for a patient with hypothyroidism includes the following:

Nursing Assessment

Assessment of the patient with hypothyroidism should include:

Assessment of the thyroid from an anterior or posterior position.
Auscultation of the lobes of the thyroid gland using the diaphragm of the stethoscope if there are abnormalities palpated.
Assess thyroid gland for firmness (Hashimoto’s) or tenderness (thyroiditis).

Diagnosis

Based on the assessment data, the nursing diagnoses appropriate for a patient with hypothyroidism are:

Activity intolerance related to fatigue and depressed cognitive process.
Risk for imbalanced body temperature related to cold intolerance.
Constipation related to depressed gastrointestinal function.
Ineffective breathing pattern related to depressed ventilation.
Disturbed thought processes related to depressed metabolism and altered cardiovascular and respiratory status.

Planning & Goals

To achieve a successful nursing care plan, the following goals should be realized:

Increase in participation in activities.
Increase in independence.
Maintenance of normal body temperature.
Return of normal bowel function.
Improve respiratory status.
Maintenance of normal breathing pattern.
Improve thought processes.

Nursing Interventions

Nursing interventions for a patient with hypothyroidism include the following:

Promote rest. Space activities to promote rest and exercise as tolerated.
Protect against coldness. Provide extra layer of clothing or extra blanket.
Avoid external heat exposure. Discourage and avoid the use of external heat source.
Mind the temperature. Monitor patient’s body temperature.
Increase fluid intake. Encourage increased fluid intake within the limits of fluid restriction.
Provide foods high in fiber.
Manage respiratory symptoms. Monitor respiratory depth, rate, pattern, pulse oximetry, and ABG.
Pulmonary exercises. Encourage deep breathing, coughing, and use of incentive spirometry.
Orient to present surroundings. Orient patient to time, place, date, and events around him or her.

Evaluation

A successful nursing care plan has achieved the following goals:

Increased participation in activities.
Increased independence.
Maintained normal body temperature.
Return of normal bowel function.
Improved respiratory status.
Maintained normal breathing pattern.
Improved thought processes.

Discharge and Home Care Guidelines

At the completion of the home care instruction, the patient or caregiver will be able to:

Medication compliance. State that compliance to medical regimen is life-long.
Cold intolerance. State the need to avoid extreme cold temperature until condition is stable.
Follow-up visits. State the importance of regular follow-up visits with health care provider.
Weight reduction. Identify strategies for weight reduction and prevention of constipation such as high-fiber, low-calorie intake and adequate fluid intake.

Documentation Guidelines

The focus of documentation should include:

Level of activity.
Vital signs before, during, and after activity.
Record of core temperature, initially and prn.
Results of laboratory and diagnostic studies.
Usual and current bowel pattern, duration of the problem, and individual contributing factors.
Characteristics of stool.
Respiratory pattern, breath sounds, and use of accessory muscles.
Plan of care.
Teaching plan.
Response to interventions, teaching, and actions performed.
Attainment or progress toward desired outcomes.
Modifications to plan of care.
Long term needs.

Practice Quiz: Hypothyroidism

Here’s a 5-item quiz about the study guide. Please visit our nursing test bank for more NCLEX practice questions.

1. The preferred medication for treating hypothyroidism is:

A. Lithium.
B. Propranolol.
C. Propylthiouracil.
D. Synthroid.

2. A clinical manifestation usually associated with hypothyroidism is:

A. A pulse rate lower than 95 bpm but greater than 60 bpm.
B. An elevated systolic blood pressure.
C. Muscular fatigability.
D. Weight loss.

3. Nursing care for a patient with hypothyroidism includes assessing for clinical manifestations associated with hypothyroidism. A manifestation not consistent with her diagnosis is a:

A. Change in her menstrual pattern.
B. Pulse rate of 58 bpm.
C. Temperature of 95.88 ºF.
D. Weight loss of 10 lbs over a 2-week period.

4. The principle objective of medical management is to:

A. Irradiate the gland in an attempt to stimulate hormonal secretion.
B. Replace the missing hormone.
C. Remove the diseased gland.
D. Withhold exogenous iodine to create a negative feedback response, which will force the gland to secrete hormones.

5. Nursing comfort measures for a patient with hypothyroidism should include:

A. Encouraging frequent periods of rest throughout the day.
B. Offering the patient additional blankets to help prevent chilling.
C. Using a cleansing lotion instead of soap for the skin.
D. All of the above.

Answers and Rationale

1. Answer: D. Synthroid.

D: Synthetic levothyroxine is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters.
A: Lithium is not recommended for patients with hypothyroidism.
B: Propranolol is not recommended for patients with hypothyroidism.
C: Propylthiouracil is not recommended for patients with hypothyroidism.

2. Answer: C. Muscular fatigability.

C: Extreme fatigue makes it difficult for the person to complete a full day’s work or participate in usual activities.
A: A pulse rate lower than 95 bpm but greater than 60 bpm is considered normal.
B: An elevated systolic blood pressure is not a sign of hypothyroidism.
D: Weight loss is not a sign of hypothyroidism.

3. Answer: D. Weight loss of 10 lbs over a 2-week period.

D: Weight gain occurs in hypothyroidism.
A: A change in her menstrual pattern is a sign of hyperthyroidism.
B: A pulse rate of 58 bpm is a sign of hyperthyroidism.
C: A temperature of 95.88⁰F is a sign of hyperthyroidism.

4. Answer: B. Replace the missing hormone.

B: To balance the level of thyroid hormones, the principal objective of medical management should be to replace the missing hormone.
A: Irradiating the gland could worsen the disorder.
C: Removing the diseased gland could worsen the disorder.
D: Withholding exogenous iodine could worsen the disorder.

5. Answer: D. All of the above.

D: All of the interventions listed above are appropriate for a patient with hypothyroidism.
A: Promoting rest could avoid extreme fatigue.
B: Additional blankets could prevent chilling for the cold-intolerant patient.
C: Using a cleansing lotion could moisturize the dry skin instead of soap.

What symptoms are seen in patients with hyperthyroidism?

Symptoms.

Unintentional weight loss, even when your appetite and food intake stay the same or increase..

Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute..

Irregular heartbeat (arrhythmia).

Pounding of your heart (palpitations).

Increased appetite..

Nervousness, anxiety and irritability..

Which signs and symptoms if noted by the nurse would indicate that the client with hyperthyroidism is experiencing thyroid crisis?

Have the patient report any signs and symptoms of thyrotoxicosis immediately: rapid heart rate, palpitations, perspiration, shakiness, tremors, difficulty breathing, nausea, vomiting. Teach the patient to report increased neck swelling, difficulty swallowing, or weight loss.

What assess with patient hyperthyroidism?

Hyperthyroidism can be diagnosed with blood tests that measure the amount of thyroid hormone and thyroid-stimulating hormone (TSH). Typically, the thyroid hormone level is high, and the TSH level is low.

What are the common disorders associated with hyperthyroidism?

What are the complications of hyperthyroidism?.

an irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related problems..

an eye disease called Graves' ophthalmopathy..

thinning bones, osteoporosis link, and muscle problems..

menstrual cycle and fertility issues..

Which symptom might the nurse identify when assessing a client with hyperthyroidism?

Hypothyroidism

Classification

Statistics and Epidemiology

Causes

Clinical Manifestations

Prevention

Complications

Assessment and Diagnostic Findings

Medical Management

Nursing Management

Nursing Assessment

Diagnosis

Planning & Goals

Nursing Interventions

Evaluation

Discharge and Home Care Guidelines

Documentation Guidelines

Practice Quiz: Hypothyroidism

See Also

What symptoms are seen in patients with hyperthyroidism?

Which signs and symptoms if noted by the nurse would indicate that the client with hyperthyroidism is experiencing thyroid crisis?

What assess with patient hyperthyroidism?

What are the common disorders associated with hyperthyroidism?

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