Editing Medical-Surgical Nursing (section)

=== Thyroid Disorders ===

Hyperthyroidism, most often Graves disease, produces weight loss despite increased appetite, heat intolerance, diaphoresis, tachycardia and palpitations, tremor, anxiety and insomnia, diarrhea, goiter, and exophthalmos. Treatment includes antithyroid drugs such as methimazole or propylthiouracil, beta blockers for symptom control, radioactive iodine, or thyroidectomy. Provide a cool, quiet environment and a high-calorie high-protein diet.

Thyroid storm is a life-threatening exacerbation with high fever, severe tachycardia or dysrhythmia, hypertension, agitation, and delirium, often triggered by infection, surgery, or stress. It requires immediate cooling, beta blockade, antithyroid medication, and intensive monitoring.

Hypothyroidism produces fatigue, cold intolerance, weight gain, bradycardia, dry coarse skin and hair loss, constipation, depression, and slowed mentation. Levothyroxine is taken in the morning on an empty stomach, at least thirty minutes to an hour before food, and separated from calcium and iron supplements, which impair absorption. It is a lifelong therapy. Myxedema coma is the severe decompensated form with hypothermia, hypoventilation, hypotension, hyponatremia, and stupor.

Nursing application: after thyroidectomy the priorities are airway and hemorrhage. Keep a tracheostomy tray and suction at the bedside, check for bleeding behind the neck and on the pillow, support the head and neck when moving, and monitor voice quality for laryngeal nerve injury. Watch for hypocalcemia from inadvertent parathyroid injury, which presents with tingling around the mouth and in the fingertips and positive Chvostek and Trousseau signs.