Posted: April 20th, 2022

Literature search
Hyperthyroidism review and rationale for its selection in the content of client care.
Hyperthyroidism, also known as overactive thyroid, is excessive concertation or thyroid hormone in the tissues due to excessive secretion of preformed thyroid hormones, increased synthesis of thyroid hormones, or exogenous endogenous extrathyroidal source (Mathew, Rawla & Fortes, 2021). In the USA, Graves’ Disease is the leading cause of hyperthyroidism among the young population, while in the aged population, toxic multinodular goiter is the most common cause (Doubleday & Sippel, 2020; Ross, 2021). Other causes of hyperthyroidism include thyroid adenomas, iodine-induced hyperthyroidism, factitious thyroiditis, postpartum thyroiditis, and subacute thyroiditis (Doubleday & Sippel, 2020; Ross, 2021).
In the context of client care, hyperthyroidism has a clinical significance as it occurs in 1.3% of the population but increase to 4-5% in older women; it is more predominant in the female population than in males and more common in smokers (Domino, 2020; Ross, 2021). When left untreated, hyperthyroidism can cause health complications like thinning bones, heart failure, stroke, blood clots, irregular heart, Graves’ ophthalmopathy, muscle problems, osteoporosis, fertility, and menstrual cycle issues (NIDDK, 2021). Hyperthyroidism occurred to TS due to risk of the female gender, smoking, and family history of autoimmune diseases. According to Domino (2020); NIDDK (2021), the predisposing factors include; female gender, positive family history of thyroid disease, pernicious anemia, diabetes, use of nicotine products, pregnancy (over 6 months), use of medications and foods that contain iodine, other autoimmune disorders iodide repletion after iodide deprivation.
Hyperthyroidism key concepts.
Hyperthyroidism is a condition that is marked by too much secretion of thyroid hormones by the thyroid gland. In the USA, the prevalence is 1.3% (Ross, 2021). Hyperthyroidism clinical manifestation can differ from patient to patient since the thyroid hormone can impact various systemic symptoms. The cellular effects of Triiodothyronine (T3) binding to alpha and beta receptors increase basal and thermogenesis metabolic rates. In turn, this causes constitutional symptoms like fatigue, weight loss, dysphagia, thinning hair, heat intolerance, weakness, osteoporosis, increased bone resorption, lymphadenopathy, increased hunger, increased stool frequency (over three times daily), anxiety, irritability, frequent bowel movement, tremors cardiovascular events (Doubleday & Sippel, 2020; Ross, 2021). Several studies that focus on preventing hyperthyroidism point out that the condition requires interprofessional care approach and regular monitoring.
Controversies in diagnosis and treatment and merit of evidence found on this topic
The selected articles present clear guidelines for the diagnosis and treatment of hyperthyroidism. The diagnosis can be ordered through thyroid blood tests to measure the amount of thyroid hormone and thyroid-stimulating hormone (TSH) (Ross, 2021). According to Doubleday & Sippel (2020), the thyroid-stimulating hormone test is the most sensitive test to examine thyroid function, while T4 and total serum T3 can be ordered as confirmatory tests when the thyrotoxicosis is highly suspected or to further assess abnormal TSH levels (Doubleday & Sippel, 2020). Overt hyperthyroidism will manifest high T3/T4 and low TSH levels (Doubleday & Sippel, 2020). Subclinical hyperthyroidism will present normal T3 and T4 and low TSH levels (Doubleday & Sippel, 2020). Similarly, Ross (2021) argues that hyperthyroidism is characterized by low TSH levels and high thyroid hormone levels.
In addition to blood work, imaging tests can confirm the diagnosis and rule out other diseases. For instance, a thyroid scan can help determine hyperthyroidism etiology, whether thyroiditis, toxic nodular goiter, or Graves’ disease (Ross, 2021). Thyroiditis will show higher T4 and low T3 levels, while Graves’ diseases will have positive thyrotropin receptor antibodies (Doubleday & Sippel, 2020). EKG to rule out cardiac diseases. A radioactive iodine uptake (RAIU) test is crucial for diagnosis and treatment plan since it can help differentiate between Graves’ diseases (GD), toxic adenomas (TA), and toxic multinodular goiters (TMNGs). In GD, the test will show diffuse radioactive iodine uptake in the thyroid gland. TA will show a localized area of uptake without uptake in the remaining gland, and TMNG will show irregular uptake patterns (Doubleday & Sippel, 2020). The treatment options for hyperthyroidism are dependent on the etiology severity of the symptoms to normalize the thyroid hormone levels. They include Antithyroid medication (Methimazole), surgery, and radioiodine-RAIT. The available research offers reliable and abundant evidence for accurate diagnosis, which prompts appropriate treatment.
Current EBM guidelines and Standardized Procedure for diagnosis.
The American Thyroid Association provides guidelines and standardized procedures for diagnosing and managing hyperthyroidism. The ATA guidelines recommend that for the diagnosis of hyperthyroidism, the diagnostic workup entails measuring thyroid-stimulating hormone (TSH), free thyroxine (T4), and total triiodothyronine (T3) levels to assess the presence and severity of the disease. Also, the guidelines assert that radioactive iodine uptake and thyroid gland can be performed to evaluate or determine the etiology (Ross et al., 2016). Accordingly, the American Society for Clinical Pathology discourages ordering multiple tests during the initial tests in patients suspected of thyroid complications. Instead, it recommends a TSH test and if results are abnormal, proceed with additional tests and treatment based on the results. Also, the American Association of Clinical Endocrinologists discourages ordering thyroid ultrasound in persons with abnormal thyroid function tests if there is no palpable thyroid gland abnormality.
According to the ATA guidelines, Methimazole is the first-line and preferred antithyroid medication to treat hyperthyroidism except in patients allergic to the medication or women in the first trimester of pregnancy (Ross et al., 2016). These guidelines and procedures for diagnosing and managing hyperthyroidism are backed with grade B and C evidence implying that the healthcare provider should order the service to the eligible.
Impact on practice and what should be done differently based on the knowledge gained
Following the ATA guidelines, the treatment for patient TS will be positively impacted. The guidelines will help the clinician appropriately diagnose and treat hyperthyroidism without contraindication. The treatment for TS will include administering Methimazole because the research reveals that antithyroid medications inhibit thyroid peroxidase, blocking T3 and T4 synthesis. As a result, this helps normalize thyroid function, prevent hyperthyroidism exacerbation, and avoid surgical risks due to untreated hyperthyroidism. The research proves that the patient can benefit from the therapy. Based on the evidence, TS requires collaborative and interprofessional care approach and follow-up appointments. Lastly, patient education is key to the management and treatment of any diseases; thus, the patient should be educated about medication compliance. In addition, the patient should be educated to avoid caffeine, smoking cessation, stress management therapy, avoid foods/substances rich in iodine.
• Consider cultural, spiritual, and socioeconomic issues as applicable.
Planning for patient care with hyperthyroidism should consider cultural, spiritual, and socioeconomic factors. This was not pertinent for TS. However, patient education concerns could impact the care. TS admits she is a smoker; she should be educated to cease smoking. Secondly, she verbalizes stress hence the need for stress management. These factors could have increased the patient’s risk for the condition hence need to be addressed. Lastly, the physician must understand that the patient may have financial constraints or reliable transport (does not have a vehicle), which are essential for increased visitation compliance; thus, accommodation should be made or suggested. TS is of Caucasian dialect and Christin but admits religion does not play a role in healthcare decisions.
Conclusion
Hyperthyroidism is a medical term used to describe the thyroid gland’s inappropriate high production of thyroid hormones (Mathew, Rawla & Fortes, 2021; Ross, 2021). When this occurs, it results in thyrotoxicosis (a condition where there is excess thyroid hormone on the tissues causing systemic clinical manifestations) and increases the body’s metabolism. Based on the information coved above, hyperthyroidism is life-threatening and can pose a significant burden to one’s daily routine. The condition can present with an array of symptoms, and if not properly managed, it can result in poor quality of life. Since there exist various causes of hyperthyroidism, it can best be managed through a collaborative approach by an interprofessional team along with the prescription of medication. The team must use current evidence clinical practice guidelines to ensure the patient gets the appropriate standard of care.