Hyperthyroidism and Thyroid Storm

Hyperthyroidism (Graves' disease is most common) causes tachycardia, weight loss despite increased appetite, heat intolerance, diaphoresis, exophthalmos, tremors, and anxiety, with low TSH and elevated T3/T4. Treatment includes antithyroid drugs (methimazole, PTU — watch for agranulocytosis, report sore throat/fever), radioactive iodine, or thyroidectomy. Thyroid storm is a life-threatening exacerbation triggered by stress, infection, or surgery, presenting with high fever, severe tachycardia, and altered mental status; treatment includes beta blockers, antithyroid drugs, iodine, and cooling measures — a true endocrine emergency.

Hypothyroidism and Myxedema Coma

Hypothyroidism causes fatigue, weight gain, cold intolerance, bradycardia, constipation, dry skin, hair loss, and depression, with elevated TSH and low T4 in primary disease. Levothyroxine is the treatment, taken on an empty stomach in the morning, 30-60 minutes before food, separated from calcium, iron, and antacids which impair absorption. Myxedema coma is the severe, life-threatening form of hypothyroidism featuring hypothermia, bradycardia, hypotension, and decreased LOC, requiring IV levothyroxine, passive rewarming, and ventilatory support — rapid active rewarming is avoided because it can cause vasodilation and cardiovascular collapse.

Nursing Priorities and Labs

TSH and thyroid hormone move in opposite directions: elevated TSH with low T4 indicates primary hypothyroidism (the pituitary is trying to stimulate a failing thyroid), while suppressed TSH with elevated T4 indicates hyperthyroidism. For post-thyroidectomy patients, monitor for hypocalcemia from accidental parathyroid removal (Chvostek's and Trousseau's signs) and airway compromise from hematoma or laryngeal nerve damage, keeping a tracheostomy tray at bedside. Protect exophthalmos-affected eyes with lubricating drops and taping eyes closed at night to prevent corneal damage.