Management of hyperthyroidism is basically aimed at reducing the thyroid hormone secretion. A discount in the secretion helps to sacrifice the symptoms and the possible complications. Supervision includes:
1. Drugs: include the use of Anti-thyroid drugs and adrenergic antagonists.
Potassium IOdide
Anti-thyroid drugs: These include 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 reproduction and lactation because they have the capability to precipitate goitre and cretinism in the foetus.
Iodine compounds such as Potassium iodide, Lugol's solution; or saturated clarification of Potassium iodide (Sski) are also used as adjunctive therapy to sacrifice the issue 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 include Propranolol, Reserpine and Guanethidine. Adrenergic blockers are used in conjunction with iodide compounds to put in order the patient for surgical execution of the thyroid gland.
2. Irradiation: Radioactive iodine (131I) is employed to destroy the hyperactive thyroid tissue. This helps to sacrifice the secretion of thyroid hormones. Before treatment with radioactive iodine, the patient is first treated with anti-thyroid drugs for at least 6-18 months. Radioactive iodine should not be used in reproduction and lactation because it has the capability to penetrate 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 discount 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 provided for the patient. He should be given cool bath and cool fluids to help relief pain due to intolerance to heat. Bed linen should be changed oftentimes because of excess sweating. Light bed clothes should also be used for the patient.
5. Relief of anxiety: patient should be in a quiet, calm and restful environment to help sacrifice his nervousness and hyper-excitability. patient and house should be well informed about the causes of symptoms and what is to be achieved straight through treatment. Visitors likely to excite patient should be prevented from visiting him in order not to worsen the symptoms. patient 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 constantly keep him aware of his bad state. patient should be reassured that the symptoms he is experiencing which include changes in appearance, weight and appetite will gently go away as his treatment is maintained. So patient 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 prevent tissue breakdown likely to result from the increased metabolic rate. Vitamins B1 and C should be given to improve carbohydrate metabolism.
Stimulants such as coffee, tea or kola must be avoided because they increase nervousness. Extremely seasoned foods should be avoided to prevent 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. Allowable attentiveness 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 improvement in his nutritional status.
9. Skin and eye care: safe the cornea from irritation, ulceration and infection if there is exophthalmos by instilling 0.5-1% of methylcellulose into the eye. This helps to prevent drying and provides soothing result to the conjunctiva. Dark glasses should be worn to prevent dust and dirt from entering the eyes. Pressure areas should be treated to prevent pressure sore if the patient is confined to bed.
10. patient 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 result of prolong use of anti-thyroid drugs or radioactive iodide.
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