__________ is an autoimmune disorder that results from an
excessive output of thyroid hormones caused by abnormal
stimulation of the thyroid gland by circulating immunoglobulins.
This disease affects women eight times more frequently than
men, with onset usually between the second and fourth decades.
The disorder may appear after an emotional shock, stress, or an
infection, but the exact significance of these relationships is not
understood.
Graves disease
Patients with hyperthyroidism exhibit a characteristic group of
signs and symptoms. Clinical manifestations are related to the
__________ and __________. The patient may appear anxious,
seem restless and irritable, and exhibit fine tremors of the hands.
The patient will be tachycardic and complain of palpitations.
Heat intolerance will be noted with increased perspiration.
Additional clinical manifestations include an increase in
appetite, diarrhea, weight loss, and thin skin.
Increase in metabolic rate and increased oxygen consumption
Cardiac effects of hyperthyroidism may include sinus
tachycardia or arrhythmias, decreased cardiac output, increased
pulse pressure, and palpitations; these changes may be related to
__________ or to __________. Myocardial hypertrophy and
heart failure may occur if the hyperthyroidism is severe and
untreated.
,Increased sensitivity to catecholamines or to changes in
neurotransmitter turnover
In hyperthyroidism, the thyroid gland is enlarged to some extent.
It is soft and may pulsate; a thrill often can be palpated, and a
bruit is heard over the thyroid arteries. These are signs of
__________.
Greatly increased blood flow through the thyroid gland
Appropriate treatment of hyperthyroidism depends on the
underlying cause and often consists of a combination of
therapies, including antithyroid agents, radioactive iodine, and
surgery. Treatment of hyperthyroidism is directed toward
reducing __________ to relieve symptoms and prevent
complications.
Thyroid hyperactivity
The use of __________ is the most common form of treatment
for Graves disease.
Radioactive iodine
The three treatments (radioactive iodine therapy, antithyroid
medications (eg thionamides) and surgery) share the same
complications. What are they?
Relapse or recurrent hyperthyroidism and permanent
hypothyroidism
Two forms of pharmacotherapy are available for treating
hyperthyroidism and controlling excessive thyroid activity.
What are they?
,(1) the use of irradiation by administration of the radioisotope
131I for destructive effects on the thyroid gland and (2)
antithyroid medications that interfere with the synthesis of
thyroid hormones and other agents that control manifestations of
hyperthyroidism
Why is radioactive iodine contraindicated in pregnancy?
It crosses the placenta
What is the goal of radioactive iodine therapy (131I)?
To eliminate the hyperthyroid state with the administration of
sufficient radiation in a single dose
How does radioactive iodine therapy treat hyperthyroidism?
Almost all of the iodine that enters and is retained in the body
becomes concentrated in the thyroid gland. Therefore, the
radioactive isotope of iodine is concentrated in the thyroid
gland, where it destroys cells without jeopardizing other
radiosensitive tissues. Over a period of several weeks, thyroid
cells exposed to the radioactive iodine are destroyed, resulting in
reduction of the hyperthyroid state and inevitably
hypothyroidism
The use of an ablative dose of radioactive iodine initially causes
an acute release of thyroid hormone from the thyroid gland and
may cause increased symptoms. The patient is observed for
signs of __________, a life-threatening condition manifested by
cardiac arrhythmias, fever, and neurologic impairment which
may lead to heart failure, circulatory collapse, and dangerous
, elevation of body temperature, all related to the increase in
metabolism. Beta-blockers are used to control these symptoms
Thyroid storm
What is a major advantage of treatment with radioactive iodine?
It avoids many of the side effects associated with antithyroid
medications.
True or false: patients who receive radioactive iodine can
contaminate their household and other people through saliva,
urine, or radiation emitting from their body. They should avoid
sexual contact, sleeping in the same bed with other people,
having close contact with children and pregnant women, and
sharing utensils and cups
True
What is the objective of pharmacotherapy of hyperthyroidism?
p. 1463
To inhibit one or more stages in thyroid hormone synthesis or
hormone release
Because antithyroid medications do not interfere with release or
activity of previously formed thyroid hormones, it may take
several __________ until symptom relief occurs. At that time,
the maintenance dose is established, and the medication is
gradually tapered over several months
Weeks
True or false: discontinuation of antithyroid medications before
therapy is complete usually results in relapse within 6 months