Page 341 - Critical Care Nursing Demystified

326 CRITICAL CARE NURSING DeMYSTIFIED

Intravenous thyroid hormone replacement and critical care management is nec-
essary for patient survival.

Prognosis
Intravenous thyroid hormone replacement and critical care management is nec-
essary for patient survival. The mortality rate is 20–25% even with vigorous
treatment and early intervention.

Hyperthyroidism (Graves’ Disease, Thyrotoxicosis)

What Went Wrong?
An excessive amount of thyroid hormone is produced and released beyond the
needs of the body. There is an increased metabolism level that can be caused
by tumors, inflammation, or autoimmune disorders of the thyroid gland.

Hallmark Signs and Symptoms
These include exophthalmus or large, bulging eyes; goiter; weight loss; extreme
irritability; nervousness; restlessness; and insomnia. The goal of care is to prevent
the oversecretion and adverse effects of thyroid hormones. Surgical intervention Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
such as a subtotal thyroidectomy, treatment with radioactive iodine, and anti-
thyroid medications are considered.
Examples of antithyroid medications are provided in Table 7–5.

TABLE 7–5 Examples of Antithyroid Medications
Medication Purpose
PTU (propylthiouracil) Blocks the conversion of T4 to T3
Tapazole (methimazole) Slower acting but more potent than PTU
SSKI (saturated solution of Rapid-acting and short-term duration
potassium and Lugolʼs solution) preparations of iodine used to control
hyperthyroidism by reducing thyroid
hormone release into the circulation
Lithium carbonate Given to individuals who cannot take
iodine preparations due to allergies
Prevents the release of thyroid hormone
Decadron (dexamethasone) A glucocorticoid medication that can be
given 2 mg q 6 hours intravenously
It suppresses thyroid hormone release
Propranolol (Inderal) and atenolol B-adrenergic blockers to provide
(Tenormin) symptomatic relief of hyperthyroidism