{ "name": "Hyperthyroidism", "slug": "hyperthyroidism", "url": "https://nursingplex.com/care-plans/hyperthyroidism", "category": "Endocrine & Metabolic", "summary": "Excess thyroid hormone causing tachycardia, weight loss and heat intolerance; storm prevention.", "nursing_diagnoses": [ "Decreased cardiac output", "Imbalanced nutrition", "Disturbed sleep pattern" ], "overview": [ "Hyperthyroidism is excess circulating thyroid hormone, most often from Graves' disease, an autoimmune condition in which antibodies stimulate the thyroid receptor continuously. Toxic nodular goiter, thyroiditis and excessive hormone replacement are other causes. Because thyroid hormone sets the metabolic rate of nearly every tissue, the presentation is a body running too fast: weight loss despite hunger, heat intolerance, tachycardia, tremor and emotional lability.", "Graves' disease adds features the other causes lack — exophthalmos from retro-orbital tissue swelling, and occasionally pretibial skin changes. Exophthalmos does not resolve when hormone levels normalize, which matters for how it is explained to patients.", "The feared complication is thyroid storm, an abrupt, life-threatening exaggeration of all symptoms usually triggered by infection, surgery, trauma or abrupt withdrawal of antithyroid drugs. Fever above 38.5 °C with severe tachycardia and altered mental status in a hyperthyroid patient is an emergency." ], "key_facts": [ { "label": "Labs", "text": "Low TSH with elevated free T4 and T3 in primary hyperthyroidism." }, { "label": "Hallmarks", "text": "Weight loss with increased appetite, heat intolerance, fine tremor, tachycardia, insomnia, diarrhea, exophthalmos in Graves'." }, { "label": "Thyroid storm", "text": "High fever, extreme tachycardia or atrial fibrillation, agitation progressing to delirium, vomiting and hypotension." }, { "label": "Drugs", "text": "Methimazole or propylthiouracil to block synthesis, beta-blockers for symptom control, iodine preparations before surgery to shrink the gland." }, { "label": "Radioactive iodine", "text": "Destroys thyroid tissue over weeks to months; most patients eventually become hypothyroid and need lifelong replacement." } ], "nursing_priorities": [ "Stabilize cardiac status and reduce the risk of arrhythmia and heart failure.", "Recognize and prevent thyroid storm.", "Meet the enormous metabolic and caloric demand and reverse weight loss.", "Provide a cool, calm, low-stimulation environment.", "Protect the eyes in exophthalmos.", "Support coping with emotional lability and body image change.", "Prepare and monitor for treatment: medication, radioactive iodine or thyroidectomy." ], "assessment": { "subjective": [ "Feeling constantly hot, sweaty and unable to tolerate warm rooms", "Nervousness, irritability, racing thoughts and difficulty sleeping", "Palpitations or a pounding heartbeat", "Increased appetite yet losing weight", "Frequent loose stools, muscle weakness especially climbing stairs", "Eye grittiness, dryness, double vision or a sense of pressure behind the eyes", "In women, lighter or absent menstrual periods" ], "objective": [ "Tachycardia at rest, widened pulse pressure, systolic hypertension, occasionally atrial fibrillation", "Warm, moist, flushed, velvety skin and fine hair", "Fine tremor of the outstretched hands and hyperactive reflexes", "Weight loss with normal or increased intake", "Exophthalmos, lid lag, incomplete eyelid closure", "Enlarged thyroid or palpable nodule, sometimes with a bruit", "Restlessness, rapid speech, emotional lability", "Low TSH with elevated free T4 and T3" ], "related_factors": [ "Autoimmune receptor stimulation in Graves' disease", "Autonomous hormone production by toxic nodules", "Inflammatory hormone release in thyroiditis", "Excessive exogenous thyroid hormone", "Increased metabolic rate raising oxygen and calorie demand", "Sympathetic overactivity affecting heart, muscle and mood" ] }, "goals": [ "The client will maintain heart rate and rhythm within an acceptable range without chest pain or signs of heart failure.", "The client will remain free of thyroid storm, and staff will recognize early warning signs.", "The client will stop losing weight and begin regaining toward baseline with adequate intake.", "The client will report improved sleep and reduced restlessness.", "The client will maintain intact corneas with no redness, ulceration or visual change.", "The client will state the purpose, schedule and side effects of prescribed therapy before discharge." ], "interventions": [ { "title": "1. Cardiac monitoring and rest", "points": [ "Measure apical pulse, rhythm and blood pressure regularly; report a resting rate above the ordered threshold, an irregular rhythm or chest pain.", "Watch for signs of heart failure — dyspnea, crackles, edema — because chronic tachycardia strains the heart, particularly in older adults.", "Give beta-blockers as ordered to control heart rate, tremor and anxiety, and explain they treat symptoms rather than the underlying disease.", "Enforce rest periods and limit stimulating activity; the patient often feels energetic while the heart is being overworked." ] }, { "title": "2. Preventing and recognizing thyroid storm", "points": [ "Treat any infection promptly and reduce physiologic stress; infection is the most common trigger.", "Recognize warning signs: temperature climbing rapidly, heart rate above 130, agitation or confusion, vomiting and abdominal pain.", "For suspected storm, notify the provider immediately, apply cooling measures without aspirin (which displaces thyroid hormone from binding proteins), give oxygen and IV fluids, and anticipate antithyroid drugs, iodine, beta-blockers and corticosteroids.", "Stress that antithyroid medication must never be stopped abruptly." ] }, { "title": "3. Nutrition and weight restoration", "points": [ "Provide a high-calorie, high-protein diet with four to six meals plus snacks; calorie needs may reach 4,000–5,000 per day.", "Add carbohydrates, vitamins and adequate calcium; avoid caffeine and other stimulants that increase heart rate and diarrhea.", "Weigh daily on the same scale and record intake to judge whether feeding matches metabolic demand.", "Encourage fluids to replace losses from sweating and loose stools, monitoring for dehydration.", "Avoid high-fiber irritants during active diarrhea and reassess stool pattern each shift." ] }, { "title": "4. Environment, rest and emotional support", "points": [ "Keep the room cool, quiet and dimly lit; use light bedding and permit frequent linen changes for diaphoresis.", "Cluster care to protect sleep and limit visitors when the patient is agitated.", "Explain to family that irritability, crying and mood swings are hormonal and will improve with treatment — this alone relieves substantial conflict.", "Use short, calm, concrete communication and avoid confrontation." ] }, { "title": "5. Eye protection in exophthalmos", "points": [ "Instill artificial tears or lubricating ointment as ordered; incomplete lid closure dries and ulcerates the cornea.", "Tape lids gently closed at night or use eye shields if the lids do not meet.", "Elevate the head of the bed and restrict salt to reduce periorbital edema.", "Provide dark glasses for photophobia and inspect for redness, pain or visual change daily.", "Explain that eye changes may persist after hormone levels normalize; refer to ophthalmology for progressive disease." ] }, { "title": "6. Medication management", "points": [ "Give methimazole or propylthiouracil at consistent times and teach that clinical improvement takes several weeks because stored hormone must be depleted.", "Warn the patient to report sore throat, fever or mouth ulcers immediately — these suggest agranulocytosis; monitor CBC and liver function.", "Administer iodine preparations diluted in juice through a straw to protect teeth, and give them after the antithyroid drug when both are ordered.", "Teach that abrupt discontinuation can precipitate thyroid storm." ] }, { "title": "7. Radioactive iodine and surgical care", "points": [ "For radioactive iodine, explain outpatient dosing, the need to avoid close prolonged contact with children and pregnant women for the prescribed days, separate toileting hygiene, and that pregnancy must be excluded first.", "Teach that hypothyroidism is the expected long-term outcome and requires lifelong replacement with periodic TSH checks.", "Before thyroidectomy, ensure the patient is euthyroid and has received iodine to reduce gland vascularity.", "After thyroidectomy, keep the patient semi-Fowler's with the neck supported, keep suction, oxygen and a tracheostomy tray at the bedside, and check behind the neck for pooling blood.", "Assess for hoarseness or weak voice (laryngeal nerve injury), stridor (airway compromise), and tingling around the mouth or fingers with positive Chvostek or Trousseau signs (hypocalcemia from parathyroid injury); keep calcium gluconate available." ] } ], "patient_teaching": [ "Take antithyroid medication exactly as scheduled and never stop it suddenly.", "Report fever, sore throat, mouth sores, yellowing of skin or eyes, or unusual bruising right away.", "Eat a high-calorie, high-protein diet with frequent meals until weight stabilizes; avoid caffeine and stimulants.", "Keep the environment cool and plan rest periods; fatigue is real even when you feel wired.", "Use eye lubricant, wear dark glasses outdoors and report any change in vision.", "Recognize thyroid storm warning signs — high fever, racing heart, confusion — and seek emergency care.", "After radioactive iodine, follow the radiation precautions exactly for the days specified.", "Attend all follow-up appointments for thyroid function tests; treatment often swings toward hypothyroidism over time." ] }