Planning and diagnostic nursing strategy in the clinical management of the patient with hyperthroidism

Hyperthyroidism is a common disease that affects 0.8% of the population in Europe. It occurs when the thyroid gland produces more thyroid hormones than your body needs. There are several types of treatment, such as antithyroid drugs, treatment with radioactive iodine (131I) and finally surgery, in addition to these treatments, reference is made to a good hygienic-dietary orientation. Objective: to assess from the nursing field the safest and most effective type of hyperthyroidism treatment, including the risk factors to take into account when carrying out these. Methodology: systematic searches were carried out in bibliographic sources of trials and articles published between 2015 and 2021. Including studies that contained data on risk factors for hyperthyroidism. Results: of 426 related articles found, 13 met the inclusion criteria. Total thyroidectomy surgery induced a 26% therapeutic failure rate and 95% radioactive iodine treatment compared to the 19.1% therapeutic failure in antithyroid drug treatment. Conclusion: Despite the verification of the efficacy of all existing hyperthyroidism treatments, antithyroid drugs have greater efficacy and safety than the rest of the treatments studied, in relation to the time and rate of remission. On the other hand, risk factors such as tobacco and female sex are evidenced, which are negative factors when carrying out treatment for hyperthyroidism.

Myxedema Psychosis after Levothyroxine Withdrawal in Radioactive Iodine Treatment of Differentiated Thyroid Cancer: A Case Report

Neuropsychiatric symptoms, especially acute psychosis (often referred to as myxedema madness or psychosis), are rare but possible clinical presentations of patients with hypothyroidism. A 42-year-old woman with papillary thyroid carcinoma and recent total thyroidectomy had developed flat affect, paranoid delusion, and visual and auditory hallucination during inpatient admission for elective radioactive iodine treatment. On admission, her history and physical exam did not reveal symptoms and signs of significant hypothyroidism. Other medical causes of acute psychosis were excluded, and the patient was immediately treated with thyroid hormone replacement therapy. Subsequently, her thyroid function normalized, and her psychotic symptoms gradually improved. Although there is a lack of classic signs and symptoms of hypothyroidism, myxedema madness should be recognized as one of the potentially treatable causes of acute psychosis.

Deliberate self-harm in a patient with hyperthyroidism with acute psychosis

A woman in her 30s with underlying Graves’ disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and suppressed thyroid-stimulating hormone levels. Additionally, there was a presence of antithyroid peroxidase antibodies consistent with autoimmune thyroid disease. She responded to antipsychotics and achieved biochemical euthyroidism. Subsequently, antipsychotic was tapered off during outpatient follow-up at the patient’s own request, with supplement thyroxine continuing. After 1 week, acute hallucinations and religious preoccupations re-emerged, driving her to inflict self-injuries by swallowing coins and nails and banging her head against the wall, sustaining laceration wounds. Furthermore, she hammered a roofing nail into the external genitalia, embedded in the symphysis pubis. After supplemental thyroxine was stopped and olanzapine was started, she achieved biochemical euthyroid followed by remission of psychosis within 1 week. This case illustrates the importance of elucidating organic causes of psychosis as they are easily and swiftly reversible.

EMBRYO-LARVAL TOXICITY OF ANTI-FUNGUS CHEMICALS USED AS PROPHYLACTIC AGENTS ON CLARIAS GARIEPINUS (BURCHELL, 1822)

Embryo-larval toxicity test of selected anti-fungus chemicals used as prophylactic agents on the African catfish (Clarias gariepinus) was conducted to assess the comparative efficacy as well as the toxicity of the different chemicals. Measured endpoints included hatching, embryo and larval survival, and larval growth. Iodine (100 mg L-1), hydrogen peroxide (250 mg L-1), malachite green (5 mg L-1) and formalin (250 mg L-1) were used as prophylactic agents. The eggs were spread on an incubating raft and continuously dipped in the treatment chemical for 15 minutes. After 48 hours, the mean hatch rate was highest in formalin-treated embryos (70%). Iodine treatment resulted in a hatch rate of 36.7%, which was slightly less than half that of the formalin treatment. Both hydrogen peroxide and malachite green resulted in 60.0% hatch rates. The results indicate that formalin-treated embryos performed significantly better than all the other chemicals. The highest percentage survival rate of 63.3% was observed in formalin at 72hph and 56.7% after 168hph. The lowest survival rate (10%) was observed in the iodine treatment group and closely followed by the group treated with malachite green (16.7%). Except for malachite green, which inhibited growth, the prophylactic treatments did not affect the growth performance of fry. This study presents evidence that can be used to support the use of formalin and hydrogen peroxide as prophylactic treatments in the early stages of C. gariepinus, although caution should be exercised due to the possibility of toxicity at higher concentrations and for longer periods of exposure.

Senna Tablet Increases Radiation Dose Excreted at Discharge Time in Patients Who Underwent Iodine Therapy

Introduction: Thyroid cancer is a malignancy accounting for less than 1% of human malignancies. This study aim was to investigate the effect of Senna tablets (C-Lax®) in increasing the dose of radiation excreted in patients who underwent iodine therapy in the iodine treatment center of Namazi Hospital of Shiraz University of Medical Sciences at discharge time.Methods: In this study, 180 female patients aged 30-50 years old with BMI ranges from 22 to 26 and no history of gastrointestinal diseases, especially gastrointestinal ulcers, constipation, and known intestinal diseases, were included in our study into 6 groups of 30 patients. The first three groups received 100, 150, and 200 mCi radiation respectively, and did not receive C-lax tablets. The second three groups received 100, 150, and 200 mCi radiation respectively, and additionally, received 2 C-lax tablets of Dineh Iran Pvt. Ltd. Results: In all 3 doses studied, more than 50% of reduction in radiation dose at discharge was seen. There is a statistically significant difference between the different doses of iodine intake in each of the two groups. Results show that there is a statistically significant difference between groups with consumption and without consumption of C-Lax tablets in all three doses paired groupsDiscussion and Conclusion: The radiation dose of patients at discharge time has an important effect on both patients and their families' health and thereby it should be taken into consideration. C-lax tablets can significantly reduce the radiation dose of patients at their discharge. This can result in better compliance of patients and decreased expenses for the health system and patients