An autoimmune disorder.   Pts develop antibodies to the TSH receptor. These antibodies attach to receptors and stimulate the thyroid gland to secrete T4, T3 or both.

decreased TSH levels and elevated (free T4) levels. T3 T4 freeT4, thyroid antibodies, T3 uptake test, Thyroid scan/ RAIU (Radioactive Iodine Uptake)

Graves disease: RAUI test used to differentiate between Graves disease and other thyroiditis. With show an uptake of 35-95%.

TSH

T3, T4, and free T4

Thryoid antibodies

T3 uptake test

Thyroid scan

RAIU

hyermetabolism

heat intolerance

weight loss

increased appetite

increased beta activity

palpitations

tachycardia

A-fib

diarrhea insomnia anxiety

goiter

enlarged thyroid with excessive hormone secretion

exophthalmos

changes in menstruation

most common in women ages 20-40

1. antithyroid medications

2. radioactive iodine therapy

3. subtotal thyroidectomy

STOP THYROID HORMONE SECRETION AND MANAGE THE SYMPTOMS

1. Medications
2. thyroid ablation
3. thyroidectomy
4. nutrition

1. Beta blockers inhibit adrenergic effects for palpitations, tachycardia, A-fib, symptomatic relief of thyrotoxicosis: Propronalol. Atenolol for asthama and heart disease

2. Antithyroid medications: inhibits synthesis of thyroid hormone and interferes with iodine utilization. May be used before surgery. (PTU) Propylthiouracil. Methimazole.

3. Iodine (SSKI- saturated solution of Potassium Iodine, Lugols solution): Large doses inhibit synthesis of T3 and T4 and block thier release into circulation.

Saturated solution of potassium iodine-SSKI, Lugols solution

Large amounts rapidly inhibit they synthesis of T4 and T3 and block thier release into circulation

Used with antithyroid medications before subtotal thyroidectomy or tx of thyroidtoxic crisis

Decreases vascularization so makes surgery easier and safer.

Short term use because therapeutic effects are decreased over time.

PTU- propylthiouracil. Methimazole.

Inhibits the synthesis of thyroid hormones and interferes with iodine utilization.

May be used before surgery

• Thyroid ablation.Damages or shrinks thyroid tissue, limiting thyroid hormone secretion
• Treatment of choice for most nonpregnant adult pts.
• Can cause hypothyroidism.

• Surgical remivol of 90% of thyroid.
• Indicated for pts with large goiter that causes tracheal compression, pts unresponsive to antithyrod therapy, thyroid cancer or pts not candidate for RAI.
• Assess pt q2hrs for 24 hrs Semi-fowlers position. Monitor vital signs, check for Ca deficeincy-tetnay,Trousserous and Chvokes sign.
• Post op: decrease calorie intake to promore weight loss. Adequate iodine intake- but not too much. Avoid high temp because it inhibits thyroid regeneration. Watch out for hematoma, swelling and airway restriction.

Total thyroidectomy can cause damage to parathyroid glan, laryngeal nerve damage- horse voice

Describe the post care of thyroidectomy

• hemorrhage.
• Key Assessment!   Monitor for airway obstruction; inflammation, swelling, Ca:  have tracheostomy tray at bedside.
• hypocalemia-tetany
• hypothyroidism
• hoarsness- may go away 

• diet-  frequent meals
• activity- scheduled rest time
• monitor pt for comlications: A-fib, tachycardia, airway obstruction
• pre/post surgical care
• prevent corneal injury
• medicaion and self care teaching

• excess thyroid hormone and increased sensitivity to symptoms
• triggered by: Infection, trauma, manipuation during OP
• S/S: death due to cadiac complications-if untreated. abrupt onset, hyperthermia 102-106, metabolic acidosis, dehydration

Start antithyroid medications ASAP. colling blanket, tylenol, cardiac monitoring, dexamethasom-steriod med that suppresses T3 and T4 release.

Do not use aspirin because it increases T3 and T4.

• altered nutrition
• activity intolerance
• risk for injury (corneal ulceration)
• disturbed body image

Amiodarone (Cordarone)- contains iodine

Lithium- blocks hormone production

Iodine deficiency.