I. Pathophysiology: failure of a complex feedback mechanism
resulting in excessive secretion or release of thyroid hormone
a. Metabolic imbalance resulting from overproduction of the
thyroid hormones triiodothyronine (T3) and thyroxine (T4)
b. Thyrotoxic crisis or thyroid storm—untreated or inadequately
treated severe hyperthyroidism creating a life-threatening
c. Varied causation
1. Toxic diffuse goiter or Graves’ disease: most common
cause, accounting for 80% of hyperthyroidism diagnoses
2. Hashimoto thyroiditis
3. Subacute and “silent” thyroiditis
ii. Toxic multinodular goiter (TMG): second most common
cause of hyperthyroidism (Fisher, 2002; Schraga, 2008)
iii. Thyroid or pituitary tumors
iv. Drug-induced: iodine, excessive thyroid hormone
replacement, certain other drugs, such as amiodarone
v. Bacterial or viral infections
vi. Pregnancy: hyperemesis gravidarum, toxemia, molar
vii. Iatrogenic: manipulation of thyroid gland during
III. Statistics (Schraga, 2008)
a. Morbidity: Occurs in about 1% of U.S. population, with
more than 3 million diagnosed with Graves’ disease;
approximately 1% to 2% of individuals with hyperthyroidism
progress to thyroid storm.
b. Mortality: Adult mortality rate from thyroid storm is
approximately 10% to 20%, but may be as high as 75% in
hospitalized individuals due to comorbidities.
Most people with classic hyperthyroidism rarely need hospitalization.
Critically ill clients and those with extreme manifestations
of thyrotoxicosis, plus a significant concurrent illness,
require inpatient acute care on a medical unit.
Heart failure: chronic,
Psychosocial aspects of care,
1. Reduce metabolic demands and support cardiovascular
2. Provide psychological support.
3. Prevent complications.
4. Provide information about disease process, prognosis,
and therapy needs.
1. Homeostasis achieved.
2. Current situation being dealt with effectively.
3. Complications prevented and minimized.
4. Disease process, prognosis, and therapeutic regimen
5. Plan in place to meet needs after discharge.