CHITWAN MEDICAL COLLEGE

SCHOOL OF NURSING
Affiliated to T.U
Bharatpur-5, Chitwan

LESSON PLAN
ON

HYPERTHYROIDISM

Submitted To: Submitted By:

Ms. Pratima koirala Sristi Lamsal

Lecturer Roll no: 24

School of Nursing School of Nursing

Chitwan Medical College Chitwan Medical college

LESSON PLAN

Programme : PCL Nursing

Subject : Adult nursing

Topic : Hyperthyroidism

Date: 2077/ 6/ 6

Time : 12md-1pm

Venue : PCL Nursing 2nd year class

Number of Students : 39

Level of students: PCL 2nd year students

Name of Supervisor: Ms. Pratima koirala, Lecturer

Name of student teacher: Sristi Lamsal

General objective
At the end of the session, PCL Nursing 2nd year students will be able to explain
about hyperthyroidism.
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Hyperthyroidism
 Introduction
• Hyperthyroidism refers to over activity of the thyroid gland leading gland leading to
sustained increase and excessive synthesis of thyroid hormones and accelerated
metabolism in the peripheral tissues.

Etiology and Risk factors

 Graves disease: most common cause of hyperthyroidism (75%). Graves disease is an

autoimmune disorder mediated by immunoglobulin G antibody that bind to and activate
TSH receptors on the surface of the thyroid cells to release T3 and T4.

 Toxic Nodular Goiter: thyroid hormone secreting nodules that function independent of
TSH stimulation. If these nodule are associated with hyperthyroidism, called toxic
nodular goiter. Nodules may be multiple or single nodules and are usually benign.

 Thyroiditis : inflammation of thyroid gland can lead to the release of excess amount of
thyroid hormones thyroid hormones that are normally stored in gland.

Pathophysiology
Clinical features

 Nervousness (emotionally hyper-excitable), irritable, apprehensiveness, inability to sit

quietly, palpitations, rapid pulse on rest and exertion.

 Poor tolerance of heat; excessive perspiration; skin that is flushed and likely to be warm
,soft and moist.

 Fine tremor of hands.

 Exophthalmos(bulging eyes)seen only in Grave’s disease.

 Increased appetite and dietary intake.

 Progressive loss of weight ,abnormal muscle fatigability ,weakness.

 Changes in bowel function.

 Pulse ranges between 90and 160beats/min with sinus tachycardia or dysrhythmias;

increase Systolic(but not diastolic) Blood pressure.

 Osteoporosis and fracture

 Deterioration in handwriting.
 Menstrual irregularities usually amenorrhea.

Diagnostic procedure
• History and physical examination

 Neck examination-Thyroid gland is enlarged and soft.

 Laboratory test includes an increase in serum T4 and T3 and decrease TSH

 Ophthalmic examination

 Measurement of pituitary production of TSH

 Thyroid scan

 Thyroid antibodies

 Thyroid biopsy

Management
 Pharmacological management

Antithyroid drugs, radiation, surgery may be used for hyperthyroidism.

 Nodular toxic goiter : surgery or use of radio active iodine.

 Thyroid carcinoma : surgery or radiation is used.

 Antithyroid medicine

 I). Drug that inhibit hormone formation

Thioamides: Propylthiouracil, Methimazole

 Drugs to control peripheral manifestation of hyperthyroidism.

i). Propranolol: inhibit conversion of T3 to T4

ii). Glucocorticoids

Radioactive iodine
  The goal of radio active iodine is to destroy overactive thyroid cells.
 Almost all the iodine that enters in the body is concentrated in the thyroid
gland. Therefore, a radioactive isotope of iodine is concentrated in the
thyroid gland where it destroys thyroid cells

Surgical management
Used for those with large goiter or for those for whom the use of radioiodine or thioamides
is contraindicated.

 Thyroidectomy (removal of thyroid gland) is performed. It may be total or

partial.
 Total thyroidectomy is performed to remove thyroid cancer.
 Subtotal thyroidectomy : Is performed to correct hyperthyroidism and
extreme cases of simple goiter. Approximately one sixth of the functioning
gland is left. Intact hormonal replacement may not be necessary.

Diet therapy
• The patient with hyperthyroidism needs a high calorie, high protein diet to
compensate for hypermetabolic state.

Nursing management
• Obtain a health history, including family history of hyperthyroidism and symptoms
medications etc.

• History of weight loss, diarrhoea, insomnia, emotional liablity, palpitation, photophobia.

• Neck palpation for enlarged thyroid gland

• Vital signs to establish baseline data

• Evaluate nutritional status, emotional state and psychological status

• Eyes for exophthalmos, photophobia.

Nursing diagnosis
 Imbalance nutrition more than body requirement related to hypermetabolic
state and fluid loss through diaphoresis.
  Activity intolerance related to exhaustion secondary to increased metabolic rate.
 Altered body temperature related to hypermetabolic status.
 Risk for impaired skin integrity related to diaphoresis, hyperpyrexia, restlessness
and rapid weight loss.

Maintaining nutritional status

• Provide high calorie , high protein diet and fluids consistent to patient requirements

• Provide several small well balanced meals ( up to 6 meals a day) to satisfy patient
increased appetite.

• Monitor fluid and nutritional status by weighing patient daily and keeping intake output
records and records of dietary intake.

• Monitor vital sign, skin turgor, mucous membrane to assess level of fluid volume.

Reducing activity intolerance

• Provide the client with environment that is restful both mentally and physically.

• Provide private room and peaceful environment to promote rest.

• Prevent client from disturbing others through hyperactivity and restlessness.

Maintaining normal body temperature

• Assess temperature regularly.

• Provide cool environment and maintain proper ventilation.

• Encourage patient to use loose clothes.

• Provide cold sponging.

• Administer antipyretics as pescribed.

 Maintaining skin integrity

• Assess the skin frequently to detect diaphoresis.

• Encourage patient to bath frequently with cool water, change linen when damp.

• Avoid soap to prevent drying and apply lubricant skin lotion to pressure points.

• Protect and relieve pressure from bony prominences when immobilized.

Care of client before thyroidectomy

• Teach importance of taking prescribed antithyroid medications.

• Teach deep breathing exercise and use of hands to support neck to avoid strain on
suture line after surgery.

Care of client after thyroidectomy

• Observe for clinical findings of respiratory distress and laryngeal stridor caused by
tracheal edema( keep tracheostomy set available) a sore throat when swallowing.

• Maintain semi followers position to reduce edema.

• Observe dressings at operative site and back of neck and shoulders for clinical findings
of hemorrhage.

• Observe for clinical findings of thyrotoxicosis such as high temperature, tachycardia,

irritability delirium, coma resulting from manipulation of gland.

• Notify physician immediately, if clinical findings of thyrotoxicosis occur.

• Observe for clinical finding of tetany such as numbness or twitching of extremities,

spasm of glottis etc. If tetany occurs give calcium gluconate or calcium chloride (IV) as
prescribed.

• Assess for hoarseness of voice.

Client teaching regarding radioactive iodine
• Client is mildly radioactive and should follow radiation precaution for 7 days.

• Avoid prolonged contact with children and sleeping with another person, flush toilet
after use, through handwashing.

• Hospitalization in isolation may be required for several days, if large dose is required.

Patient education

• Instruct patient as follows

• Importance of taking antithyroid medications regularly and to observe for adverse

effect.

• Necessity of having period serum studies to monitor hormone level.

Complications
• Exophthalmos

• Thyroid storm ( thyroid crisis, thyrotoxicosis)

• Heart disease

Summary
 • Hyperthyroidism refers to over activity of the thyroid gland leading gland leading to
sustained increase and excessive synthesis of thyroid hormones and accelerated
metabolism in the peripheral tissues.
• Etiology and risk factors are graves disease, toxic nodular goiter and thyroiditis.
• Nervousness, Poor tolerance of heat, Exophthalmos, Increased appetite and dietary
intake, Progressive loss of weight ,abnormal muscle fatigability ,weakness, Changes in
bowel function, tachycardia and mensuration irregularities are some of its clinical
features.
• Medical management includes Antithyroid drugs, radiation, surgery for hyperthyroidism.
• Nursing management includes maintenance of nutritional status, body temperature
and skin integrity, health education and care of patient before and after thyroidectomy.
• Complications includes Exophthalmos, Thyroid storm and Heart disease

Assignments

 Define hyperthyroidism and list down its signs and symptoms.

References

• Janice, L.H.,& Kerry, H.C.(2015). BRUNNER AND SIDDHARTH’S TEXTBOOK OF

th
MEDICAL SURGICAL NURSING-II(13 ed.). New Delhi, India: Wolters Kluwer(India)
PVT LTD ; 1470-1479

• Shrestha, S., Paudyal,P., & Giri,s.(2019). A Textbook of Medical Surgical Nursing I

th
and II(4 ed.). Bhotahity, kathmandu, Nepal: HERITAGE PUBLISHERS AND
DISTRUBUTORS PVT.LTD; 449-454
• Sharma, M., Poudel, K.,& Gautam,R.(2017). Essential Textbook of Medical Surgical
Nursing(2nd ed.).Kathmandu, Nepal: Samikshya Publications PVT LTD; 397-399
• Internet: Wikipedia