Download Hyperthyroid Self

Hyperthyroid Part I
Self-Learning Module
Mr. Bill Loney
Bill is a 72 year old man who lives alone in
his small home. He reluctantly comes to
the clinic you are at but says he refuses to,
“spend all day on the pot anymore.” He
also says that his eyes have really been
bugging him and that he feels kind of
mixed up now and again.
Vital Signs
What do you expect his vital signs to be
considering that hyperthyroidism increases
metabolism and increases tissue
sensitivity to sympathetic nervous system
stimulation?
Discuss and write down what you anticipate
his vitals signs might be before
continuing…
Vital Signs at Admission
HR= 103
Heart sounds= irregular, murmur noted
Respiratory rate=30
Lungs= short of breath but clear
BP= 173/90
Temp= 38.2 C (100.7 F)
Bowel sounds= hyperactive in all 4
quadrants
Standard I: Assessment
Mr. Bill seems rather restless and maybe
even a bit agitated. You notice he is
under-dressed for this cool spring day and
is actually sweating.
You begin your head-to-toe assessment
while Mr Bill talks about some of his
symptoms.
Head to neck
His forehead is sweaty and
he says his tub has been
clogged with his hair
His eyes are bulged out from
edema and fat deposits
(exopthalmos)
“I don’t have much of an
appetite and I noticed that
I’ve lost a few pounds”**
**In the older adult client this finding is
expected. For the middle-adult client,
increased hunger and thirst is expected
due to hypermetabolism.
Head to Neck
Mr. Loney has a collared shirt on and opens
it up so you can inspect his neck and
chest. When he pulls back the color you
notice a…
Goiter
Chest and Abdomen
Bounding, rapid heart rate.
Murmurs and irregularity of
rate are noted. “I sometimes
get mild chest pains too.”
He is short of breath from
opening his shirt and
moving to the exam table.
Hyperactive bowel sounds.
He says, “I have diarrhea
three times a day.”
Hands
His palms are reddened and
his skin is quite warm. “And I
can’t work on my model
airplanes because my damn
hands shake too much!”
Clubbing of the fingernails.
The nails are brittle, thin and
some are detaching from the
nail bed (onycholysis)
Lower Extremities
Pre-tibial myxedema
(caused by deposits of
hyaluronic acid in tissues)
Dependent edema in lower
extremities. “My toes and ankles
sure have been swollen and my
muscles are just wasting away
down there.”
Labs and Diagnostics
• You tell Mr. Loney that it appears that he
may have hyperthyroidism and that further
testing is needed including lab and
diagnostic work.
• Discuss in your group what labs and
diagnostics you might anticipate before
continuing?
Labs
• Thyroid Stimulating Hormone (TSH) levels
would be?
• Elevated
• Decreased
• Free thyroxine (FT4) levels would be?
• Elevated
• Decreased
Surprised? Why aren’t TSH levels elevated
like T3 and T4 levels?
Lab Data
The body senses
that there is too
much thyroid
hormone. Via a
negative feedback
loop the body
actually oversuppress secretion
of TSH.
The feedback
loop is “broken”
because despite
lower TSH levels,
T3 and T4 levels
continue to be
high.
Diagnostics
• Radioactive Iodine Reuptake test helps
differentiate the cause
• Chest X-ray: might show enlarged heart or
compression of trachea/esophagus
• ECG: rules out cardiac involvement
• CT/MRI: to detect any tumors
Goiter compressing a
patient’s esophagus and
trachea
Good work!
• You will hear more about Mr. Loney in the
second half of class
• Make sure you complete the worksheet
• Refer to Table 48-4 pp. 1313 and Table 487 on pp. 1315 for a complete review of
clinical manifestations