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Hyperthyroidism vs. Hypothyroidism

Adult Nursing NCLEX Review Thyroid Disorders Hyperthyroidism vs. Hypothyroidism

Hyperthyroidism

Causes

Graves Disease
Too much Iodine, ⇑ T3 and T4
Throid medication excess (Levothyroxine)

Labs

⇓ TSH (thyroid-stimulating hormone)
⇑ T3 & T4
Memorize it!
Pituitary produces TSH
If the pituitary sees that the thyroid is hyperactive (producing too much T3 & T4), it will slow down. Thus, TSH is low.

Symptoms of Hyperthyroidism

When you think about signs and symptoms think fast and high. High vital signs. Fast Metabolism.

↑ Temp

↑ BP

↑ Pulse

Palpitations

Heat Intolerance

↑ Metabolism

Hot & sweaty

Exophthalmos

Irritable

Nervousness

Insomnia

Tremors

↑ Appetite

Losing weight

Diarrhea

Exophthalmos

Big protruding

Eyes

Patch eyes

to protect them

Treatment of Hyperthyroidism

Agranulocytosis and aplastic anemia are side effects of Methimazole and PTU. PTU can be used in pregnancy. Avoid aspirin because it increases thyroid hormone. NCLEX Alert!

Cannot be used in first trimester. Use only in second trimester. Take at the same time every day. Avoid foods high in iodine. Avoid aspirin because it increases thyroid hormone. Side effects: Agranulocytosis and aplastic anemia

Propylthiauracil: Only anti-thyroid medication that can be used in first trimester of pregnancy. Take at the same time. Avoid food high in iodine. Avoid Aspirin. Side effects: Agranulocytosis and aplastic anemia.

To decrease heart rate and blood pressure

Side effects: taste changes and swollen salivary glands

Agranulocytosis is a serious condition where the body has a very low level of certain white blood cells called granulocytes. These cells are important for fighting off infections. When someone has agranulocytosis, their immune system is weakened, and they are at a higher risk of developing severe infections.

In aplastic anemia, all three types of blood cells—red blood cells, white blood cells, and platelets—are affected. The bone marrow fails to produce enough of these cells, leading to low levels in the bloodstream. Low platelets= bleeding. Low WBC= infection. Low RBCs= fatigue and SOB.

Complications of Hyperthyroidism

Thyroid Storm/Thyrotoxic crisis
Severe symptoms of hyperthyroidism. It is a medical emergency
High temperature, tachycardia, systolic HTN, diarrhea, tremors, agitation, seizures, and coma.
Treatment: PTU, beta blockers, thyroidectomy.
NCLEX alert: Priority is to give beta blockers. Think: What will work the fastest! Anti-thyroid medications (PTU & Methimazole) take a while to work.

Thyroidectomy with life-long thyroid replacement

Thyroidectomy = Surgical Treatment

Thyroidectomy

Watch for thyroid storm after thyroidectomy because excessive T3 & T4 enters the bloodstream, causing severe hypertension, tachycardia, and elevated temperature

Hypocalcemia

Parathyroid is close to thyroid. It may have been damaged during surgery.

Laryngeal Nerve

Ask client to speak to check for laryngeal nerve damage after thyroidectomy

Respiratory Status

Swelling and hemorrhage can obstruct airway. Listen for stridor and have the tracheostomy tray at the bedside after thyroidectomy (PRIORITY)

Hypothyroidism

Slow and Low

Hypothyroidism

Causes

Hashimoto’s Disease
Low Iodine ⇓T3 and T4
Thyroidectomy
Pituitary Tumor
Anti-thyroid medication
Mostly Women

Labs

⇑ TSH (thyroid-stimulating hormone)
⇓ T3 & T4
The pituitary produces TSH, if it sees that the thyroid is hypoactive (producig low T3 & T 4), the pituitary gland will make more TSH