NARRATIVE:

Hyperthyroidism includes diseases that are a subset of thyrotoxicosis that are caused by excess synthesis and secretion of thyroid hormone by the

thyroid. Thyrotoxicosis is the hypermetabolic condition associated with elevated levels of free thyroxine (T4) and/or free triiodothyronine (T3). The over stimulation of the thyroid gland leads to hyperplasia of the gland and subsequently this leads to an increase in the secretion of thyroid hormones. The growth in the cells and its multiplication manifest in enlargement of the gland. Noticeable changes occur in all parts of the body as a result of the increased hormone secretion. There is elevation in metabolic rate manifesting in elevation in metabolism of protein, fat and carbohydrate. The accelerated protein and fat metabolism lead to weight loss and muscular weakness. The body attempts to remedy the weight loss and so the patient's appetite is increased in the process.

Patient is unable to tolerate hot weather as a result of the increase in the body metabolism. The superficial capillaries dilate leading to increased peripheral blood flow and also an increase in cardiac output as the body tries to eliminate excess heat from the system. This accounts for warm and moist skin and also for the perspiration.

The increase cardiac output in conjunction with hormonal effects on the sympathetic nerves brings about palpitation and tachycardia. There may be ectopic beats or atrial fibrillation in the elderly. There is increase in systolic blood pressure and the pulse pressure. The heart tries to compensate for these increases and may eventually become overwhelmed and fail.The hemodynamic features of hyperthyroidism are due to functional alterations in both the peripheral circulation and the myocardium. There is an increase in total blood volume and a decrease in systemic vascular resistance . These effects increase preload and decrease afterload and are accompanied by an increase in heart rate and myocardial contractility . The result is a high output cardiac state.

Patients with CHF usually present to the hospital with signs of fluid overload. They become short of breath due to the buildup of excess fluid in the lung. The fluid excess interferes with the transfer of oxygen from air to blood. Classically this has been attributed to abnormal heart muscle function where the heart muscle is weakened (by heart attack, hypertension, or other causes) and can no longer pump blood efficiently. The heart is stiff and requires higher pressure to fill it between heartbeats. The period between heartbeats when the heart fills is called diastole, and this form of heart muscle disease is called diastolic heart failure. Much less is known about this form of CHF in spite of the fact that up to half of the heart failure treated in hospital in diastolic CHF. The most common identifiable cause of diastolic heart failure by far is hypertension. There will be a condition called Pleural Effusion caused by Left sided heart failuerevthe accumulation of fluid in the pleural cavity that is caused by the backflow of blood from the left ventricle. Symptoms such as crackles, dyspnea, and blood tinged secretions will occur.

Portal Hypertension happens when unoxygenated and detoxified blood goes to the right atrium. For patients with Right Sided Heart Failure there will be ineffective pumping of blood therefore accumulation of blood in the right ventricle causes congestion. There will be a backflow of accumulated blood back to the hepatic vein down to the liver and the portal vein. Increase accumulation of blood in the portal vein causes Portal Hypertension.

With proper management such as Management such as: oxygen therapy, intubation, use of mechanical ventilator, cardiac monitoring, suctioning, OF feeding via NGT, semi-fowlers position, nebulization. The patient will be able to improve his/her cardiac output, have effective tissue perfusion, restored oxygenation of tissue and cells leading to cell recovery, therefore multi- organ system failure is PREVENTED leading to good prognosis.

Without proper management, Patient will deteriorate, less oxygenated blood in the circulation and in the cells, therefore there will be cell death and multi-organ system failure leading to poor prognosis and eventually death.