A case study on hyperthyroidism
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   Davao Doctor College Gen. Malvar St. Davao City  A Book Base Case Study Of Hyperthyroidism Operative Review of Thyroidectomy In Partial Fulfillment Of NCM 103 Presented to: Rufino M. Dayrit Jr. RN, MN Of Davao Doctors College Presented by: Ken Alfred Pedreso July 2014  TABLE OF CONTENTS I. INTRODUCTION II. ANATOMY III. PATHOPHYSIOLOGY IV. MEDICAL MANAGEMENT V. DIAGNOSIS VI. PROCEDURE PROPER (with Instrumentation) VII. Roles of Circulating and Scrub nurse VIII. Nursing Management a. Nursing Care Plan IX. Pharmacology X. Bibliography  CHAPTER I INTRODUCTION Hyperthyroidism, or overactive thyroid, is due to the overproduction of the thyroid hormones T3 and T4, which is most commonly caused by the development of Graves' disease, an autoimmune disease in which antibodies are produced which stimulate the thyroid to secrete excessive quantities of thyroid hormones. The disease can result in the formation of a toxic goiter as a result of thyroid growth in response to a lack of negative feedback mechanisms.  About 1 in 500 women have hyperthyroidism during pregnancy. In some, it is a preexisting condition; in others, the condition will develop during the course of the pregnancy. It can be difficult to diagnose because the pregnancy often masks it; that is, some of the symptoms may be attributed to the pregnancy itself rather than to hyperthyroidism. Hyperthyroidism may affect a woman's ability to become pregnant. The most common cause of hyperthyroidism in pregnancy is Graves' disease. Symptoms generally will be worse in the first half of the pregnancy, will lessen during the second half, and most likely will recur after the baby is born. The mother should continue with her normal anti-thyroid medication during her pregnancy as prescribed by her doctor. Most pregnant women and their babies will not experience significant problems if the hyperthyroidism is mild to moderate. If properly treated, the pregnancy can be expected to progress normally. Women with severe or uncontrolled hyperthyroidism have an increased risk of infection, iron deficiency (anemia), and high blood pressure accompanied by too much protein in the urine (a potentially dangerous condition called pre-eclampsia). If a woman has severe hyperthyroidism, her baby has a chance of having hyperthyroidism as well. There is a risk to the outcome of the pregnancy, having a small baby or a premature birth.  Fortunately, most women who have hyperthyroidism in pregnancy can be successfully treated with medication. The anti-thyroid drug which is Propylthiouracil is commonly prescribed and can be safely used during pregnancy. It may take up to a month on medication for the symptoms to resolve. Radioactive iodine cannot be used during pregnancy. Rarely, if the symptoms and thyroid hormone levels cannot be controlled, surgery needs to be considered to remove the thyroid gland. Hyperthyroidism does not affect labor and delivery. However, thyroid storm can develop which can be life threatening. The symptoms are an exaggeration of the normal hyperthyroid symptoms with a very fast heart rate, tremors, nervousness, altered consciousness, nausea, vomiting, diarrhea, and an extremely high fever. This will require intensive care treatment to try normalizing the very high thyroid hormone levels and keeping the patient cool. Grave’s disease which is the most common form of hyperthyroidism in the US is approximately 60-80% of cases of thryotoxicosis due to this disease. The annual incidence of the disease is 0.5 cases per 1000 persons during a 20 year period, with the peak occurrence in people aged 20-40 years. Hyperthyroidism occurs in 2/1000 pregnancies in the United Kingdom. Graves’ hyperthyroidism is the commonest cause of hyperthyroidism in young women (about 85% of cases) in the United Kingdom. The prevalence of undiagnosed hyperthyroidism in women is about 4.7/1000, and 0.2% of UK women have been previously diagnosed and treated. In areas of mild iodine deficiency the prevalence is higher. In addition to true hyperthyroidism, the more common clinical entity of transient gestational hyperthyroidism may be seen particularly in the first trimester, with prevalence in Europeans of 2-3% but a much higher prevalence in South Asian populations. Hyperthyroidism does not often arise for the first time in early pregnancy, but clinicians need to be aware of the symptoms and signs.
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