Hyperthyroidism vs. Hypothyroidism

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HYPERthyroidism

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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.

Signs and Symptoms

Hyperthyroidism: Everything is HYPER
HIGH Metabolism (skinny)
HIGH BP and HR (Palpitations)
HIGH GI- diarrhea)
HIGH Temperature
HOT and SWEATY
Heat Intolerance
Hyper-excitable/Irritable
Nervous/tremors
Weight loss and hair loss
High appetite but losing weight
Goiter (enlarged Thyroid)
EXOPHTHALMOS

Bulging eyes Use tape or patch eyes to protect them

Treatment

Anti-thyroid medications

Methimazole (cannot be used in 1st trimester of pregnancy. Only 2nd and 3rd).
PTU (Propylthiauracil)
PTU only anti-thyroid medication that can be used during 1st trimeter of pregnancy.
Important anti-thyroid side effects to remember: Agranulocytosis and aplastic anemia

Beta blockers to decrease BP & HR
Iodine compounds
Radioactive Iodine therapy (client may have taste changes and swollen salivary glands)
Thyroidectomy (watch for thyroid storm after thyroidectomy because excessive T3 & T4 enters the bloodstream, causing severe hypertension, tachycardia, and elevated temperature)
Monitor for hypocalcemia: parathyroid is close to the thyroid
Monitor for laryngeal nerve damage during thyroidectomy. Ask client to speak.
Monitor respiratory status. swelling and hemorrhage can obstruct airway. Listen to stridor and have the tracheostomy tray at the bedside
If due to excess thyroid hormone intake, reduce dosage.

Complications

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, glucocorticoids, thyroidectomy

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

Signs and Symptoms

Hypothyroidism: Everything is HYPO
Low energy
Low Metabolism (weight gain)
Low HR, BP, RR, and Temp
Slow GI (constipation)
Low mood/sex drive
Low mind/memory
Low interest/Apathy
Slow menstruation
Hair loss/Brittle nails
Puffy face
Myxedema (swealling)
Low appetite but gaining weight
Intolerance to Cold

Treatment

Levothyroxcine (hormone replacement)
Life-long treatment
Must take in the morning and in an empty stomach to increase absorption.
Do not give narcotics to these patients due to hypersensitivity

Complications

Myxedema Coma

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Important to know about Anti-thyroid medications (PTU and methimazole)
The client must take them at the same time every day. Avoid foods high in idione. They take a while to work. Avoid aspirin because it increases thyroid hormone levels. Also, side effects are agranulocytosis and aplastic anemia.