A 35-year-old woman is admitted to the community clinic with a complaint of incr

Question

A 35-year-old woman is admitted to the community clinic with a complaint of increased warmth, palpitations, and weight loss. She has noted these symptoms for the past 2 months. She has lost 5 pounds over the past 3 weeks even though she has been hungry and eating frequently.

She states she is healthy and takes no medications.

On the nursing assessment, the following physical findings were noted:

BP 130/60, P 110, R 22

Skin: moist and soft

HEENT: slight protrusion of both eyes

Heart: rate 110, regular, without murmur or gallop

Lungs: clear to auscultation

EXT: fine tremors noted in both hands

1. Reviewing the clinical manifestations above, is the patient displaying signs and symptoms of hyper or hypothyroidism. Explain the rationale for your answer.

2. How can you explain the increased sensation of palpitations and increased heart rate in this patient? How does it relate to the sympathetic nervous system response?

3. When the nurse noted the protrusion of both eyes above, what complication of thyroid disease is most likely? What is the underlying pathophysiology of this condition?

Explanation / Answer

1. The patient is displaying the symptoms of hyperthyroidism, because increased warmth, palpitations, and weight loss are the symptoms of hyperthyroidism along with racing heartbeat, shakiness and sweating spells, however in Hypothyroidism patient gains the weight, slow heart rate and dry skin.

Secondly slight protrusion of both eyes (proptosis or exophthalmos) is usually used when describing bulging eyes caused by Graves disease, a disorder causing hyperthyroidism.

2. Hyperthyroidism. may directly effect the heart. This may produce symptoms of palpitations, increased heart rate and heart pain. Similar symptoms may occur in hypothyroidism if it is treated too often with thyroid replacement therapy.

Many of the common symptoms of hyperthyroidism such as palpitations, trembling, and anxiety are mediated by increase in beta-adrenergic receptors on cell surfaces. Beta blockers, which are used to treat high blood pressure, are a class of drugs that offset this effect, reducing rapid pulse associated with the sensation of palpitations, decreasing tremor and anxiety.

3. As stated above, exophthalmos describes a condition where the eyeball appears to bulge. Exophthalmos can also cause eye problems such as corneal dryness and conjunctivitis. There is a possibility that the eyes may continue to bulge if treatment is not received.

Exophthalmos is not a condition, but the sign of a disorder. Commonly, it can signal a problem with the thyroid gland. Graves' disease is the most common cause of exophthalmos.

Graves' disease is an autoimmune disease which causes hyperthyroidism. A person with hyperthyroidism has an overactive thyroid gland that produces excess hormones and causes it to grow. It is a condition where the soft tissues and muscles around the eyes become swollen and inflamed. The autoimmune antibodies can attack the muscles and soft tissue surrounding the eyes, which can cause them to protrude from the sockets leading to dryness and redness of eyes, puffy eyes, inflammation, swelling, and vision problems.

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