Alternative names

Thyrotoxicosis; Overactive thyroid; Graves disease - hyperthyroidism; Thyroiditis -

hyperthyroidism; Toxic goiter - hyperthyroidism; Thyroid nodules - hyperthyroidism;
Thyroid hormone - hyperthyroidism

The thyroid gland is an important organ in the endocrine system, located at the front of
the neck and on top of where your collarbones meet. It creates hormones that control
the way every cell in the body uses energy which is called “metabolism”.

Diseases and conditions that causes hyperthyroidism:

Hyperthyroidism is diagnosed with a medical history, physical exam and blood tests.
Depending on the results of the blood tests, you may need other tests too.

● Medical history and physical exam. During the exam, your health care
provider may check for:
 ○ Slight tremor in your fingers and hands.
○ Overactive reflexes.
○ Rapid or irregular pulse.
○ Eye changes.
○ Warm, moist skin.
● Your provider also examines your thyroid gland as you swallow to see if it's larger
than usual, bumpy or tender.
● Blood tests. Blood tests that measure the hormones T-4 and T-3 and
thyroid-stimulating hormone (TSH) can confirm a diagnosis of hyperthyroidism. A
high level of T-4 and a low level of TSH is common in people with
hyperthyroidism.
Blood tests are particularly important for older adults because they may not have
classic symptoms of hyperthyroidism.
Thyroid blood tests may give false results if you take biotin. Biotin is a B vitamin
supplement that also may be found in multivitamins. Tell your health care
provider if you are taking biotin or a multivitamin with biotin. To make sure your
blood test is accurate, your health care provider may ask you to stop taking biotin
3 to 5 days before the test.

If blood test results show hyperthyroidism, your health care provider may suggest one of
the following tests. They can help find out why your thyroid is overactive.

● Radioiodine scan and uptake test. For this test, you take a small, dose of
radioactive iodine, called radioiodine, to see how much of it collects in your
thyroid gland and where it collects in the gland.
If your thyroid gland takes in a high amount of radioiodine, that means your
thyroid gland is making too much thyroid hormone. The most likely cause is
either Graves' disease or overactive thyroid nodules.
If your thyroid gland takes in a low amount of radioiodine, that means
hormones stored in the thyroid gland are leaking into the bloodstream. In
that case, it's likely that you have thyroiditis.
● Thyroid ultrasound. This test uses high-frequency sound waves to make
images of the thyroid. Ultrasound may be better at finding thyroid nodules
than are other tests. There's no exposure to radiation with this test, so it can
be used for people who are pregnant or breastfeeding, or others who can't
take radioiodine.
Treatment

There are several treatments available for hyperthyroidism. The best approach for you
depends on your age and health. The underlying cause of hyperthyroidism and how
severe it is make a difference too. Your personal preference also should be considered
as you and your health care provider decide on a treatment plan. Treatment may
include:

● Anti-thyroid medicine. These medications slowly ease symptoms of

hyperthyroidism by preventing the thyroid gland from making too many
hormones. Anti-thyroid medications include methimazole and
propylthiouracil. Symptoms usually begin to improve within several weeks to
months.
Treatment with anti-thyroid medicine typically lasts 12 to 18 months. After
that, the dose may be slowly decreased or stopped if symptoms go away
and if blood test results show that thyroid hormone levels have returned to
the standard range. For some people, anti-thyroid medicine puts
hyperthyroidism into long-term remission. But other people may find that
hyperthyroidism comes back after this treatment.
Although rare, serious liver damage can happen with both anti-thyroid
medications. But because propylthiouracil has caused many more cases of
liver damage, it's generally used only when people can't take methimazole.
A small number of people who are allergic to these medicines may develop
skin rashes, hives, fever or joint pain. They also can raise the risk of
infection.
● Beta blockers. These medicines don't affect thyroid hormone levels. But
they can lessen symptoms of hyperthyroidism, such as a tremor, rapid heart
rate and heart palpitations. Sometimes, health care providers prescribe
them to ease symptoms until thyroid hormones are closer to a standard
level. These medicines generally aren't recommended for people who have
asthma. Side effects may include fatigue and sexual problems.
● Radioiodine therapy. The thyroid gland takes up radioiodine. This
treatment causes the gland to shrink. This medicine is taken by mouth. With
this treatment, symptoms typically lessen within several months. This
treatment usually causes thyroid activity to slow enough to make the thyroid
gland underactive. That condition is hypothyroidism. Because of that, over
time, you may need to take medicine to replace thyroid hormones.
● Thyroidectomy. This is surgery to remove part of or all of the thyroid gland.
It is not used often to treat hyperthyroidism. But it may be an option for
people who are pregnant. It also may be a choice for those who can't take
 anti-thyroid medicine and don't want to or can't take radioiodine therapy.
Risks of this surgery include damage to the vocal cords and parathyroid
glands. The parathyroid glands are four tiny glands on the back of the
thyroid. They help control the level of calcium in the blood.
People who have a thyroidectomy or radioiodine therapy need lifelong
treatment with the medicine levothyroxine (Levoxyl, Synthroid, others). It
supplies the body with thyroid hormones. If the parathyroid glands are
removed during surgery, medicine also is needed to keep blood calcium in a
healthy range.

Thyroid eye disease

If you have thyroid eye disease, you may be able to manage mild symptoms with
self-care steps, such as artificial tear drops and lubricating eye gels. Avoiding wind and
bright lights can help too.

More-severe symptoms may need treatment with medicine called corticosteroids, such
as methylprednisolone or prednisone. They can lessen swelling behind the eyeballs.
The medicine teprotumumab (Tepezza) also may be used to control moderate to severe
symptoms. If those medicines don't ease symptoms, other medicines are sometimes
used to treat thyroid eye disease. They include, tocilizumab (Actemra), rituximab
(Rituxan) and mycophenolate mofetil (Cellcept).

In some cases, surgery may be needed to treat thyroid eye disease, including:

● Orbital decompression surgery. In this surgery, the bone between the eye
socket and the sinuses is removed. This surgery can improve vision. It also
gives the eyes more room, so they can go back to their usual position.
There is a risk of complications with this surgery. If you have double vision
before the surgery, it may not go away afterward. Some people develop
double vision after the surgery.
● Eye muscle surgery. Sometimes scar tissue from thyroid eye disease can
cause one or more eye muscles to be too short. This pulls the eyes out of
alignment, causing double vision. Eye muscle surgery may correct double
vision by cutting the muscle from the eyeball and attaching it again farther
back.
Graves Disease (most common cause of hypothyroidism)- an abnormal immune system
response that causes the thyroid gland to produce too much hormone. It is common in
women over 20 years of age but also occur at any age and can also affect men. Recent
study also shows that a deficiency in Vitamin D can

Thyroiditis - The cause of thyroiditis depends on the type of disease you have. Most types
occur when your immune system attacks the thyroid gland. This causes inflammation (the
body’s response to injury) and damages the thyroid cells. The reason for the attack often is an
autoimmune disease, such as Hashimoto’s.
Other types of thyroiditis occur from use of radiation or certain medicines. Viral or bacterial

infections also may cause thyroiditis.

NURSING MANAGEMENT

● Monitor vital signs, especially heart rate and blood pressure (both increase in

hyperthyroidism)

● Ask if the patient has chest pain (Due to increased heart work)

● Listen to the heart for murmurs

● Obtain ECG (atrial arrhythmias may occur in hyperthyroidism)

● Teach the patient to relax

● Administer medications as prescribed (beta-blockers)

● Check intake and output (diarrhea is a common feature in hyperthyroidism)

● Weigh patient daily

● Administer antithyroid medications as prescribed

● Educate the patient about thyroid surgery

● Educate the patient on radioactive iodine and how it can destroy the thyroid gland

● Provide oxygen if the saturation is less than 94%

● If the patient has a fever, provide a cooling blanket

● Check thyroid function labs