Hyperthyroidism Nursing Diagnosis and Nursing Care Plan

Hyperthyroidism Nursing Care Plans Diagnosis and Interventions

Hyperthyroidism NCLEX Review and Nursing Care Plans

The thyroid gland is the butterfly-shaped gland at the bottom of the neck, above the collarbone that produces hormone thyroxine.

Hyperthyroidism, also known as hyperactive thyroid, occurs when the thyroid gland secretes too much thyroxine. Hyperthyroidism can cause unexpected weight loss and a quick or irregular heartbeat by speeding up the body’s metabolism.

Hyperthyroidism can be treated in a variety of ways depending on the clinical judgment of the healthcare provider. Anti-thyroid medicines and radioactive iodine are used to reduce thyroid hormone production.

Surgery to remove all or part of the thyroid gland is sometimes used to treat hyperthyroidism. Although untreated hyperthyroidism can be dangerous, most people do well if it is diagnosed and treated.

Signs and Symptoms of Hyperthyroidism

Hyperthyroidism can be similar to other healthcare problems, making it harder to be diagnosed. It can also result in a wide range of signs and symptoms, such as:

  • Weight loss that is unintentional even when the appetite and food intake has increased.
  • Rapid Heartbeat that is usually more than 100 beats per minute
  • Arrhythmia
  • Palpitations or pounding of the heart
  • Anxiety, Irritability, and Nervousness
  • A fine trembling usually in the hands and fingers
  • Sweating
  • Irregular menstrual patterns
  • Increased heat sensitivity
  • More frequent bowel movements
  • Goiter or an enlarged thyroid gland that may appear at the base of the neck
  • Muscle Weakness
  • Insomnia
  • Thinning of the skin
  • Fine, brittle hair

It is more common in older adults to exhibit subtle symptoms such as a faster heart rate, sensitivity to warm temperatures, and a tendency to become more tired after performing daily activities. Hyperthyroidism symptoms might be masked by certain medications.

It’s difficult to tell if a patient has hyperthyroidism if they are taking beta-blockers for high blood pressure or another illness.

  • Thyroid eye disease –  happens when the tissues and muscles behind the eyes enlarge and the eyeballs protrude beyond their typical protective orbits.

The following are signs and symptoms of Thyroid Eye Disease:

  • Bulging of the eyes
  • A gritty sensation, discomfort, or pressure in the eyes
  • Inflammation or redness in or around the eyes
  • Puffed-up or pulled-back eyelids
  • Sensitivity to light
  • Loss of vision or double vision

Causes of Hyperthyroidism

Hyperthyroidism can be caused by a number of conditions, including Graves’ disease, Plummer’s disease, and thyroiditis. Too much thyroxine can be caused by a variety of factors, the thyroid normally generates the appropriate quantity of hormones, but it can occasionally create too much T4. This could happen for a variety of reasons, including:

1. Grave’s Disease. It is a chronic illness that affects people of all ages. Graves’ disease is an autoimmune illness in which the immune system’s antibodies cause the thyroid to produce excessive amounts of T4. Hyperthyroidism is most commonly caused by this condition.

2. Thyroid nodules. This can be toxic adenoma, toxic multinodular goiter, or Plummer’s disease. It is when one or more thyroid adenomas produce too much T4, this type of hyperthyroidism develops. An adenoma is a portion of the thyroid gland that has walled itself off from the rest of the gland, resulting in noncancerous (benign) lumps that can cause thyroid enlargement.

3. Thyroiditis. This is an infection or an immune system disorder can cause the thyroid to swell and leak hormones into the bloodstream. In this condition, the thyroid is swollen for no apparent reason. This is often followed by hypothyroidism, in which the thyroid does not make enough hormones. These conditions are usually temporary. Thyroiditis can happen:

  • Following a pregnancy
  • When there is a virus or another immune system problem
  • Too much thyroid medicine is used
  • Too much Iodine in the diet like in medication or supplement

Risk Factors for Hyperthyroidism

Risk factors for hyperthyroidism include:

  • A family history of Hyperthyroidism
  • Female gender
  • Type 1 diabetes, pernicious anemia, primary adrenal insufficiency, or history of chronic diseases.

Diagnosis for Hyperthyroidism

The following tests are used to determine if there is hyperthyroidism:

1. Medical History and Physical Assessment- the healthcare provider may look for a tiny tremor in the fingers when they’re stretched, overactive reflexes, eye changes, and warm, wet skin during the exam. The healthcare provider will also inspect the thyroid gland when swallowing to see whether it is swollen, lumpy, or sensitive, as well as check the pulse for quick or irregular beats.

2. Blood Tests – Thyroid-stimulating hormone (TSH) and thyroxine blood tests can be used to confirm the diagnosis. An overactive thyroid is indicated by high thyroxine levels and low or nonexistent TSH values. Because TSH is the hormone that tells the thyroid gland to generate more thyroxine, the amount of TSH is crucial. These tests are especially important for older adults who may not have classic hyperthyroidism symptoms.

  • Normal TSH level: 0.4 to 4.0 mIU/L
  • Normal T3 level: 100 to 200 ng/dL
  • Normal T4 level: 5.0 to 12.0 μg/dL
  • Normal Free T4 level: 0.8 to 1.8 ng/dL.

If blood tests reveal hyperthyroidism, it is advised to undergo one of the tests below to identify why the thyroid is overactive:

3. Radioiodine uptake test – For this test, a modest amount of radioactive iodine (radioiodine) will be orally ingested to see how much collects in the thyroid gland. To discover how much iodine the thyroid has absorbed, an assessment will be performed after four, six, or 24 hours — and sometimes all three.

A high radioiodine uptake implies that the thyroid gland is overproducing thyroxine. Graves’ illness or hyperfunctioning thyroid nodules are the most likely causes. If hyperthyroidism is present and the patient has a low radioiodine absorption, it means that the thyroxine stored in the thyroid gland is leaking into the bloodstream.

4. Thyroid scan – A radioactive isotope will be injected into a vein on the inside of the elbow or, in some cases, in the vein of the hand. After that, the patient will lie down on a table with the head stretched backward while a unique camera displays an image of the thyroid gland on a computer screen. This test demonstrates how iodine accumulates in the thyroid.

5. Thyroid ultrasound – The thyroid is imaged using high-frequency sound waves in this test. Ultrasound may be more effective than other tests at detecting thyroid nodules, and there is no radiation involved.

Treatment for Hyperthyroidism

Hyperthyroidism can be treated in a variety of ways. The optimal treatment depends on the patient’s age, physical condition, underlying cause, personal preference, and the severity of the disorder. Treatment options include:

1. Radioactive iodine– it is taken by mouth and absorbed by the thyroid gland, causing it to shrink. Symptoms normally go away after a few months. Excess radioactive iodine is excreted from the body in weeks to months.

2. Anti-thyroid medications– These drugs work by preventing the thyroid gland from generating too many hormones and thereby reducing hyperthyroidism symptoms. Symptoms usually improve within a few weeks to months, although anti-thyroid medication treatment often lasts at least a year or longer.

3. Beta-blockers– these are types of medications that are often used to treat high blood pressure and have no effect on thyroid levels, However, they can help with hyperthyroidism symptoms like tremors, rapid heart rate, and palpitations.

4. Surgical procedures (thyroidectomy)– Thyroid surgery may be an option if the patient is pregnant or otherwise unable to tolerate anti-thyroid medications or radioactive iodine therapy. In a thyroidectomy, the surgeon removes the majority of the thyroid gland. The vocal cords and parathyroid glands, damage to the vocal cords and parathyroid glands are at risk from this procedure.

Lifestyle Modification

1. Low-iodine Diet– Once treatment for Hyperthyroidism has begun, the symptoms should start to subside. However, it is recommended to manage Hyperthyroidism with a healthy diet avoid the following:

  • Seafood
  • high amounts of poultry or beef
  • dairy products
  • high amounts of grain products (such as bread, pasta, and pastries)
  • egg yolks
  • iodized salt

2. Exercise- Exercise in general will boost the mood and improve muscle tone, as well as the cardiovascular system. Graves’ disease patients should engage in weight-bearing exercise to help maintain bone density. Exercising can also help reduce appetite and regain energy.

3. Relaxation Techniques– Many relaxation techniques, especially when dealing with illness, can help retain a positive outlook. Stress is known to be a risk factor in Graves’ disease, so learning to relax and create balance will help to preserve physical and emotional health.

Nursing Diagnosis for Hyperthyroidism

Hyperthyroidism Nursing Care Plan 1

Risk for Decreased Cardiac Output

Nursing Diagnosis: Risk for Decreased Cardiac Output related to increased cardiac workload, changes in venous return and systemic vascular resistance and alterations in rate, rhythm, conduction, secondary to hyperthyroidism.

Desired Outcome: The patient will be able to maintain an adequate cardiac output, as evidenced by stable vital signs, normal capillary refill, palpable peripheral pulses, good mentation, and absence of dysrhythmias.

Hyperthyroidism Nursing InterventionsRationale
Monitor the patient’s blood pressure while lying, sitting, or standing if possible. Take note of the increased pulse pressure.    Excessive peripheral vasodilation and decreased circulation volume might cause general or orthostatic hypotension. The compensatory increase in stroke volume and decreased systemic vascular resistance are reflected in widened pulse pressure.
Monitor the patient’s central venous pressure (CVP).To measure circulation volume and heart function in a more direct manner.
Assess the patient for any complaints of chest pain or angina.Increased myocardial oxygen needs or ischemia could be the cause.
Ask the patient if there is any presence of the following symptoms: Severe thirst, dry mucous membranes, a weak or thready pulse, poor capillary refill, decreased urine output, and hypotension.Rapid dehydration can occur, lowering circulation volume and putting cardiac output at risk.  
Maintain a cool environment in the patient’s room and, limit the use of bed linens or clothing, and give the patient tepid sponge baths.Excessive hormone levels can produce fever (up to 104°F), which can aggravate diuresis and/or dehydration, as well as enhanced peripheral vasodilation, venous pooling, and hypotension.
Monitor the weight of the patient daily, Encourage bed rest. Limit the patient’s time spent on activities that aren’t vital.Physical activity raises metabolic and circulatory demands, potentially worsening heart failure.
Assess the patient for history of asthma or broncho constrictive illness, sinus bradycardia and heart blockages, severe heart failure, or a current pregnancy.The presence or possibility for recurrence of these disorders has an impact on the treatment options. The use of beta-adrenergic blocking medications, for example, is not recommended.

Hyperthyroidism Nursing Care Plan 2

Fatigue

Nursing Diagnosis: Fatigue related to hypermetabolic state with increased energy requirements and irritability of central nervous system with altered body chemistry, secondary to hyperthyroidism, as evidenced by reduced performance due to an excessive lack of energy to keep up with the daily routine, nervousness, tension, and irritability, and impaired ability to concentrate.

Desired Outcomes:

  • The patient will be able to verbalize increased energy level
  • The patient will show improved participation in desired activities.
Hyperthyroidism Nursing InterventionsRationale
Monitor the patient’s vital signs and take note of the pulse rate when at rest and when the patient is not active.The pulse is usually high, and tachycardia (up to 160 beats per minute) may be present even when the patient is at rest.
Assess the patient for the development of Tachypnea, dyspnea, pallor, and cyanosis.In a hypermetabolic state, Oxygen demand and consumption rise, increasing the risk of hypoxia with activity.
Provide the patient with a calm environment, room with preferred temperature, reduced sensory stimuli, calm colors, and soft music.Reduces stimuli that can make agitation, hyperactivity, and insomnia worse.
Encourage the patient to limit the activities and spend as much time as possible in bed.To aid to counteract effects of increased metabolism.  
Provide comfort measures such as massage or touch therapy, as well as cold showers. Ensure a high Fowler’s position to patients with dyspnea.These methods will help in decreasing nervous energy and promote relaxation.  
Provide relaxing diversional activities to the patient, such as reading, listening to the radio, or watching television.To allow for the constructive utilization of nervous energy and may help to lessen anxiety.  
Encourage the patient to verbalize feelings but avoid topics that irritate or upset the patient and discuss with the patient how to deal with these emotions.Increased CNS irritability can make a patient easily agitated, aroused, and prone to emotional outbursts.  
Discuss the causes of fatigue and emotional lability with the patient’s significant other.  Understanding that the behavior is physical in nature will help the significant other cope with the current situation and urge them to behave positively and assist the patient.

Hyperthyroidism Nursing Care Plan 3

Anxiety

Nursing Diagnosis: Anxiety related to central nervous system overstimulation secondary to hyperthyroidism, as evidenced by increased feelings of apprehension, loss of control, panic, changes in cognition, extraneous movements, tremor, and restlessness.

Desired Outcomes:

  • The patient will verbalize feeling more relaxed.
  • The patient will report decreased anxiety to a manageable level.
  • The patient will be able to identify healthy coping mechanisms for dealing with emotions.
Hyperthyroidism Nursing InterventionsRationale
Stay with the patient. Maintain a calm manner while caring for the patient. Recognize the patient’s fear and give the patient control over behavior.    To assure the patient or significant other that the situation is safe, even if the patient feels out of control. Conflicts or overreactions to stressful circumstances can be avoided by avoiding personal responses to incorrect statements or acts.
Describe and explain procedures to the patient, the surrounding environment, and any sounds that the patient may hear.To provide factual information, reducing the distortions and ambiguity that might lead to anxiety and fear reactions.  
Speak with the patient in short statements and make use of simple terms.The ability to process information may be hampered by a reduction in attention span and concentration.
Provide a conducive environment for the patient. Reduce external stimuli and place the patient in a quiet room, play soft and calming music, dim the lights, and limit the number of people who come into contact with the patient.To create a therapeutic environment by acknowledging that unit activity or staff may be contributing to the patient’s anxiety.  
Discuss with the patient the reasons for emotional lability or psychotic reaction.Understanding that behavior is based on physical factors makes it easier to accept the circumstance and encourages new responses and methods.
Observe the patient’s behavior that may indicate a high level of anxiety.      Irritability and insomnia are two symptoms of mild anxiety. Feelings of impending doom, terror, inability to talk or move, shouting, or swearing may accompany severe anxiety that progresses to panic.

Hyperthyroidism Nursing Care Plan 4

Risk for Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis: Risk for Imbalanced Nutrition: Less Than Body Requirements related to metabolic imbalance secondary to hyperthyroidism as evidenced by weight loss, nausea, vomiting, diarrhea, and hyperglycemia .

Desired Outcome: The patient will be free for signs of malnutrition as evidenced by stable weight gain, increased appetite, and normal laboratory values.

Hyperthyroidism Nursing InterventionsRationale
Monitor the patient’s daily food intake. Weigh the patient every day and keep track of the losses.Continued weight loss despite adequate calorie intake could suggest antithyroid medication failure.
Encourage the patient to eat by increasing the number of meals and snacks per day and give or advise the patient some high-calorie, easily digestible foods.To aid in maintaining a high enough caloric intake to keep up with the hypermetabolic state’s rapid calorie expenditure.  
Discuss with the patient about the foods that can cause increased peristalsis and fluids that can cause diarrhea and advise the patient to avoid taking them.Increased GI tract motility can cause diarrhea and make it difficult to absorb essential nutrients.  
Ensure that the patient has a well-balanced diet, provide six meals per day for the patient as recommended.To aid with weight gain. Note: If the patient has edema, a low-sodium diet should be recommended.
Set an appointment for the patient with a dietitian to provide a diet that is high in calories, vitamins, proteins, and carbohydrates.Assistance in ensuring proper nutrient intake and identifying appropriate supplements may be required.  
Administer the advised medications to the patient that will help in maintaining the blood sugar level.To provide energy needs and prevent or treat hypoglycemia.
Assess the patient’s nutritional history with the help of significant others.Family members may be able to provide more accurate information on the patient’s eating habits, especially if the patient’s perception is impaired.
Examine the laboratory results of the patient and determine if they indicate well-being or deterioration. Include the serum albumin, transferrin, RBC and WBC count, and the serum electrolyte values.Laboratory tests are significant in establishing the nutritional condition of a patient. An abnormal result in a single diagnostic test may indicate several possible causes.

Hyperthyroidism Nursing Care Plan 5

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of awareness or recall, misinterpretation of the given information, and unawareness of available information sources secondary to hyperthyroidism, as evidenced by questions and requests for additional information, assertions of misunderstanding, and development of avoidable complications.

Desired Outcomes:

  • The patient will verbally express understanding of the disease process and possible complications.
  • The patient will be able to link indications and symptoms to the disease process and correlate symptoms to causative factors.
  • The patient will express knowledge of the therapeutic needs.
  • The patient will make the necessary lifestyle modifications and follow the treatment plan.
Hyperthyroidism Nursing InterventionsRationale
Discuss with the patient and family the disease process and what to expect in terms of its management.Provides a knowledge base from which patients can make informed decisions.
Provide information that is relevant to the patient’s situation.To determine the course of treatment, this information comprises the severity of the condition, the cause, age, and any associated problems.
Identify the patient’s stressors and discuss with the patient about the thyroid crisis precipitators, such as personal or social issues, career concerns, infection, and pregnancy.Psychogenic variables play a significant role in the onset and or development of this condition.  
Discuss with the patient the indications and symptoms of hypothyroidism, as well as the importance of ongoing follow-up care.  A patient who has been treated for hyperthyroidism should be informed of the possibility of hypothyroidism developing, which can happen right after therapy or up to 5 years later.
Discuss and Emphasize to the patient the importance of pharmacological therapy, including the need of sticking to the schedule and the therapeutic and adverse effects that can be expected.To suppress hormone production, antithyroid medicine necessitates long-term adherence to a medical regimen. Agranulocytosis is the most serious side effect that might occur, and if problems arise, different medications may be prescribed.
Allow the patient to have scheduled relaxation breaks.  Reduces metabolic needs and prevents excessive fatigue. Stamina and activity levels will also increase.
Review the patient’s need for a nutritious diet and nutrient demands on a regular basis. Advise the patient to avoid caffeine, red/yellow food dyes, and artificial preservatives.Provides enough nutrition to keep the body in a hypermetabolic state. When a hormonal imbalance is resolved, the diet must be re-adjusted to avoid excessive weight gain. To minimize cumulative systemic effects, irritants and stimulants should be limited.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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