A hyperthyroid state resulting from hypersecretion of the thyroid hormones (triiodothyronine and thyroxine). It may be caused by:

Graves’ Disease: autoimmune derivation; circulating anti-TSH autoantibodies that displace TSH from and activate the thyroid receptors.
- Associated with Hashimoto’s Disease a state of chronic inflammation of the thyroid gland that usually causes hypothyroidism.
Thyrotoxicosis (excessive thyroid hormones) may result from autoimmune diseases, functional thyroid adenomas, and infection.

Complications

Thyrotoxicosis, or a Thyroid Crisis/Thyroid Storm is a sudden exacerbation of symptoms of hyperthyroidism that often occur with infection or stress. Immediate hospitalization is required.
- Fever
- Decreased Mental Alertness
- Abdominal Pain
Heart-related Complications: tachycardia, congestive heart failure, atrial fibrillation
Increased risk for osteoporosis in long-lasting hyperthyroidism.
Complications secondary to surgical management:
- Scarring of the neck
- Vocal hoarseness due to nerve damage to the voice box.
- Hypocalcemia due to parathyroid damage.
Complications secondary to other managements: radioactive iodine, and hormone replacement therapy also have other potential complications.

Assessment Findings

Enlarged Thyroid Gland (Goiter) e.g. in Graves’ disease, autoimmune disorders
Palpitations, Cardiac Dysrhythmias (tachycardia or even atrial fibrillation in severe cases), Hypertension, increased cardiac output: increased thyroid hormones stimulate the heart.
Exophthalmos (bulging eyes) may be present, particularly in those with Graves’ disease. This results from swelling of the tissues around the eyes.
Heat Intolerance: increased body heat results in being less tolerance even to warm environments.
Diaphoresis: heightened metabolic activity and body temperature.
Weight Loss: heightened metabolic activity results in increased energy expenditure despite an increase in appetite.
Diarrhea: gastrointestinal motility may be enhanced by hyperthyroidism.
Smooth and soft skin and hair: thyroid hormones stimulate skin cell regeneration and hair keratin production (integumentary effects).
Nervousness, Fine Tremors of the Hands: nervous system stimulation by the thyroid hormones.
Personality Changes, Mood Swings, Irritability, and Agitation: neurotransmitters in the brain and the nervous interact with thyroid hormones.
Oligomenorrhea (irregular menstrual periods) as thyroid hormones are involved in the regulation of the menstrual cycle.

Primary Nursing Diagnosis: Activity intolerance related to exhaustion and fatigue.
TSH Assay reveals decreased levels (normally 0.5 to 1.5 mU/L) of TSH as the body attempts to regulate elevated thyroid hormones.
T₃ and T₄ radioimmunoassay show elevations reflecting overproduction. These values are also used to monitor effect of therapy.
- Triiodothyronine levels are normally 80 to 230 ng/dL. These levels are lower than T₄ as T₃ has a greater effect on the body.
- Thyroxine levels are normally 5.0 to 12.0 μg/dL.
24 hour Radioactive Iodine Uptake
Thyroid Autoantibody Testing
Antithyroglobulin
Electrocardiogram

(a) Reduction of thyroid hyperactivity for symptomatic relief and (b) removing the cause of complications

Irradiation via radioactive Iodine (¹³¹I or ¹²³I) of overactive thyroid cells. This is the most common form of treatment for the elderly, but is contraindicated in pregnancy and nursing mothers. Iodine may cross the placenta and is secreted in breast milk.
Pharmacotherapy: Antithyroid medications that inhibit hormone synthesis/release or reduce the amount of thyroid tissue.
- Propylthiouracil; PTU (Propacil) and Methimazole (Tapazole) are the most common, used until thyroid hormones are normal. Both of these drugs inhibits the ability of the thyroid to utilize iodine. A maintenance dose is established followed by a gradual withdrawal for several months. Antithyroid medications are contraindicated in late pregnancy due to risk for goiter and cretinism in the fetus.
- Propylthiouracil is recommended during the first trimester of pregnancy as methimazole may result in teratogenesis.
Surgery: removal of most of the thyroid gland; no longer the preferred choice of therapy for Graves’ disease, but is still used for patients who cannot tolerate antithyroid drugs, have significant ophthalmopathy, have large goiters, or cannot undergo radioiodine therapy.

Potassium Iodide, Lugol’s Solution, and Saturated Solution of Potassium Iodide (SSKI) may also be added to induce the Wolff-Chaikoff Effect, a protective mechanism as a result of elevated iodine levels, where thyroid peroxidase (used for synthesis of hormones) downregulation occurs to prevent excessive production from iodine saturation.
Beta-Adrenergic Agents (Propanolol) may be used to reduce effects of hyperthyroidism on the sympathetic nervous system e.g. nervousness, tachycardia, tremors, anxiety, and heat intolerance.

Provide adequate rest (activity intolerance)
Administer sedatives as prescribed.
Provide a cool and quiet environment
Obtain daily weight.
Provide a high-calorie diet (increased metabolism)
Administer antithyroid medications, iodine preparations, or propanolol as prescribed.
Prepare for radioactive iodine therapy as ordered.
Prepare for thyroidectomy as ordered.
Artificial Tears are given to prevent corneal ulceration due to exophthalmos.

Physical Findings: cardiovascular status (resting pulse, blood pressure, presence of angina or palpitations), bowel activity, edema, condition of skin, activity tolerance, hypermetabolism, eye status, heat intolerance.
Medication Response, skin care regimen, nutrition, body weight, comfort level
Psychosocial Response to changes in bodily function, mental acuity, behavioral patterns, emotional stability.

Disease Process: the role of the thyroid gland, disease, treatment plan, and its side effects.
Medications: thorough explanation of all medications (dosage, route, action, adverse effects, monitoring).
- Take PTU or Methimazole with meals to limit gastric irritation.
- Mix iodine solutions with milk or juice to limit gastric irritation. Use a straw to minimize risk for teeth discoloration.
Complications: have the patient report any manifestations of thyrotoxicosis (tachycardia, palpitations, shakiness, tremors, DOB, N&V), neck swelling, dysphagia, or weight loss immediately.