Management of hyperthyroidism is basically aimed at reducing the thyroid hormone secretion. A allowance in the secretion helps to reduce the symptoms and the potential complications. Supervision includes:
1. Drugs: comprise the use of Anti-thyroid drugs and adrenergic antagonists.
Potassium IOdide
Anti-thyroid drugs: These comprise Propylthiouracil (Ptu), or Methimazole (Tapazole). They are used to depress the synthesis of thyroid hormone thereby reducing the symptoms of hyperthyroidism. They should not be used in fertilization and lactation because they have the ability to precipitate goitre and cretinism in the foetus.
Iodine compounds such as Potassium iodide, Lugol's solution; or saturated solution of Potassium iodide (Sski) are also used as adjunctive therapy to reduce the publish of thyroid hormones from the thyroid gland.
Adrenergic blockers: These drugs are used as adjunctive drugs to control the nervous symptoms of hyperthyroidism. They help in controlling anxiety, tachycardia and heat intolerance as well. They comprise Propranolol, Reserpine and Guanethidine. Adrenergic blockers are used in conjunction with iodide compounds to get ready the outpatient for surgical execution of the thyroid gland.
2. Irradiation: Radioactive iodine (131I) is employed to destroy the hyperactive thyroid tissue. This helps to reduce the secretion of thyroid hormones. Before treatment with radioactive iodine, the outpatient is first treated with anti-thyroid drugs for at least 6-18 months. Radioactive iodine should not be used in fertilization and lactation because it has the ability to lanch the placenta and it is also secreted in breast milk.
3. Surgery: Subtotal thyroidectomy which is the surgical discharge of about 5/6th of the thyroid gland tissues helps to bring about a allowance In the signs and symptoms of hyperthyroidism in some patients for a long period of time.
4. Relief of discomfort: A comfortable environment should be in case,granted for the patient. He should be given cool bath and cool fluids to help relief ache due to intolerance to heat. Bed linen should be changed often because of excess sweating. Light bed clothes should also be used for the patient.
5. Relief of anxiety: outpatient should be in a quiet, calm and restful environment to help reduce his nervousness and hyper-excitability. outpatient and family should be well informed about the causes of symptoms and what is to be achieved straight through treatment. Visitors likely to excite outpatient should be prevented from visiting him in order not to worsen the symptoms. outpatient should be reassured that his emotional disturbances will abate as treatment progresses.
6. Self esteem: If patient's condition is very bad, mirrors should not be allowed into his room so as not to enduringly keep him aware of his bad state. outpatient should be reassured that the symptoms he is experiencing which comprise changes in appearance, weight and appetite will gradually go away as his treatment is maintained. So outpatient needs not over burden himself with his disturbing image.
7. Fluids and nutrition: Fluids should be increased to replace the fluid lost straight through sweating, polyuria and diarrhoea. Foods high in protein, carbohydrate and calorie should be given to forestall tissue breakdown likely to effect from the increased metabolic rate. Vitamins B1 and C should be given to heighten carbohydrate metabolism.
Stimulants such as coffee, tea or kola must be avoided because they increase nervousness. Extremely seasoned foods should be avoided to forestall the diarrhea from worsening straight through increased peristalsis.
8. Observation: The vital signs should be checked at least 4 hourly, with emphasis on pulse and blood pressure. Adrenergic drugs have the tendency to worsen the cardiac failure. Proper concentration to the blood pressure will enable you know when the condition gets worse. Patient's weight should also be checked and recorded daily to monitor revising in his nutritional status.
9. Skin and eye care: protect the cornea from irritation, ulceration and infection if there is exophthalmos by instilling 0.5-1% of methylcellulose into the eye. This helps to forestall drying and provides soothing effect to the conjunctiva. Dark glasses should be worn to forestall dust and dirt from entering the eyes. Pressure areas should be treated to forestall pressure sore if the outpatient is confined to bed.
10. outpatient education: The dosage, side effects and complications of prescribed drugs should be explained to the patient. He should be made to understand the signs of thyroid storm and the conditions that can trigger off a thyroid storm or crisis. Emphasis should be laid on the point of long-term treatment because of the possibility of developing hypothyroidism as a effect of prolong use of anti-thyroid drugs or radioactive iodide.
10 Ways to manage Hyperthyroidism
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