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Hypothyroidism

– Results from suboptimal levels of thyroid hormone which can affect all body functions and can range from mild, subclinical forms or to myxedema, an advanced form.
– is the disease state in humans and in animals caused by insufficient production of thyroid hormone by the thyroid gland.
– Cretinism is a form of hypothyroidism found in infants.

Types:

Type Origin Description

Primary Thyroid gland The most common forms include Hashimoto's thyroiditis (an autoimmune disease) and radioiodine therapy for hyperthyroidism.

Secondary Pituitary Gland Occurs if the pituitary gland does not create enough thyroid stimulating hormones (TSH) to induce the thyroid gland to produce
enough thyroxine and triiodothyronine. Although not every case of secondary hypothyroidism has a clear-cut cause, it is usually
caused by damage to the pituitary gland, as by a tumor, radiation, or surgery.

Tertiary Hypothalamus Results when the hypothalamus fails to produce sufficient thyrotropin-releasing hormone (TRH). TRH prompts the pituitary gland to
produce thyrotropin (TSH). Hence may also be termed hypothalamic-pituitary-axis hypothyroidism.

Risk Factors Assessment Nursing Diagnoses Interventions

Modifiable: Subjective 1. Ineffective breathing pattern r/t Nursing


depressed ventilation.
– Therapy for hyperthyroidism – Patient may report: 2. Decreased thought process r/t
hyperthyroidism interventions like depressed metabolism and altered
radioactive iodine and – Fatigue Primary Prevention:
cardiovascular and respiratory
thyroidectomy may result to – Hair loss
status
– Brittle nails – Avoid intake of goitrogenic
rebound hypothyroidism 3. Activity intolerance r/t fatigue and
– Dry skin foods – these foods contains
– Intake of antithyroid depressed cognitive process.
– Numbness and tingling of fingers chemicals that enlarges the goiter
medications – these medications 4. Constipation r/t Depressed GI
– Husky voice and can cause hypothyroidism
suppresses the thyroid gland’s function
– Menstrual disturbances – Cessation of cigarette smoking
production of its hormones. 5. Deficient knowledge about the
– Loss of libido
– Radiation to neck as treatment therapeutic regimen for lifelong
– Increased sensitivity to cold
for head and neck cancers or thyroid replacement therapy
– Pain and swelling of joints
lymphoma – therapy would Secondary Prevention
– Constipation
damage all the cells that are
around the area, so, radiation to – Close monitoring should be taken
the neck may damage the thyroid and any signs and symptoms of
gland, thus decreasing its hypothyroidism should be
function. Objective promptly reported when taking
➢ Cigarette Smoking- Cigarettes antithyroid medications, and after
contain thiocyanate, a chemical having thyroidectomy.
that adversely affects the thyroid ➢ Hypotension
gland and acts as an antithyroid ➢ Weight gain without increase in
agent. Smoking may increase the Tertiary prevention
food intake
risk, severity and side effects of ➢ Bradycardia
hypothyroidism in patients with – Modifying activities – assist
➢ Thick skin because of the client with cane and hygiene while
Hashimoto's thyroiditis, and accumulation of
smoking worsens the effects of encouraging client to participate in
mucopolysaccharides in the activities established at level of
thyroid eye disease, a subcutaneous tissue
complication of Graves' disease. tolerance.
➢ Muscle weakness – Promoting physical comfort –
➢ Intake of Goitrogenic Foods - ➢ Elevated serum
some foods when eaten raw and patient often experiences chilling
➢ Mask-like face
in large quantities naturally and extreme intolerance to cold,
➢ Speech is slow, tongue is
contain chemicals that can even if the room feels comfortable
enlarged, hands and feet increase
promote goiter (enlarged thyroid) or hot to others. Extra clothing and
in size
and cause hypothyroidism in blankets are provided and the
➢ Pleural effusion
some people. These chemicals patient must be protected from
➢ Pericardial Effusion
are known as goitrogens. Some drafts.
➢ Respiratory muscle weakness
foods that are high in goitrogens – Enhancing coping measures –
➢ Atherosclerosis
include cabbage, Brussels the nurse should inform the client
➢ CAD
sprouts, broccoli, turnips, and the family that inability to
➢ Poor Ventricular function
rutabagas, kohlrabi, radishes, recognize them are common and
cauliflower, African cassava, part of the disorder itself.
millet, and kale. – Advice client not to take drugs
with sedative effects – sedative
effects of drugs tend to last longer
Non-modifiable: Laboratory and Diagnostic Tests: in people with hypothyroidism.

– Autoimmune disease
(Hashimoto’s thyroiditis) - is an
Thyroid Tests Medical Management:
autoimmune disease where the
body's own T-cells attack the cells
of the thyroid impairing it’s
function.
– Postpartum thyroiditis - is a
phenomenon observed following ➢ Serum TSH – increased – Synthetic Levothyroxine (synthroid
pregnancy and may involve ➢ Serum T3 and T4 – decreased or Levothroid) is the preferred
hyperthyroidism, hypothyroidism ➢ Radioactive iodine uptake – very preparation for treating
or the two sequentially. low uptake hypothyroidism and nontoxic
– Atrophy of thyroid gland with ➢ Fine-needle aspiration biopsy – to goiter. In order to determine the
rule out cancer right dosage initially, the physician
aging – the thyroid gland function
➢ Thyroid scan – determine the would measure TSH level after 2-
degenerates with aging
location, size and shape of the 3 months. Presence of excessive
– Iodine deficiency - iodine
gland. amounts of these hormones can
provides substrate for functionally
➢ Scintiscan – scan using a cause symptoms similar to that of
autonomous (ie, not under TSH
scintillation detector or gamma hyperthyroidism.
regulation) areas of the thyroid to
camera moves back and forth – Effectiveness of thyroid hormones
produce hormone, if iodine is
across the area to be studied in a may be increased by phenytoin
deficient, these areas will not be
series of parallel tracks, and a (Dilantin)
able to produce thyroid hormones,
visual image of the distribution of – Place client on high fiber, high
thus decreasing its availability.
the radioactivity in the area is protein low calorie diet.
being scanned. – Give stool softeners

Surgical Management – no surgical


management for hypothyroidism which is
caused by the removal of the thyroid gland
itself.

• Thyroidectomy
Complications:

• Goiter – constant stimulation of the thyroid to release more hormones may cause the gland to become larger.
• Heart problems – hypothyroidism may also be associated with an increase in risk of heart disease, primarily because of high levels of LDL can occur in people with an
underactive thyroid.
• Mental health issues – depression may occur early in hypothyroidism and may become severe over time. Hypothyroidism can also cause slowed mental functioning.
• Myxedema – this rare life threatening condition is the result of long-term undiagnosed hypothyroidism. Its symptoms include intense cold intolerance and drowsiness
followed by profound lethargy and unconsciousness. A myxedema can be triggered by sedatives, infection or other stress in the body.
• Infertility – low levels of thyroid hormones interferes with ovulation, thus impairing fertility.
Pathophysiology of Hypothyroidism
Non-modifiable Risk Factors: Modifiable Risk Factors

• Age • Intake of antithyroid


○ >50 in women drugs
○ >60 in men • Intake of goitrogenic
• Gender foods
• Heridofamilial • Cigarette smoking
predisposition • Exposure to radiation
• Autoimmune disease
• Postpartum thyroiditis

Unknown Etiology

Decrease Thyroid ability to


produce thyroid hormones

Low circulating
thyroid hormone TSH is released by Constant stimulation of the
levels TRH is released by the APG in an effort thyroid to release more
the hypothalamus to increase the hormones may cause the gland
T3and T4 output of to become larger --GOITER
the thyroid gland

Lack of thyroid hormones result to


deteriorating body processes, eventually
progressing to coma
 Respiratory System
 GI System
S/Sx include:  Dyspnea
 Decreased
 Decreased breathing appetite
capacity
 Cardiovascular System  Nausea and
vomiting
 Increased capillary fragility
 Weight gain
 Decreased rate and force of
contraction  Musculoskeletal System
 Distended
 Fatigue abdomen
 Cardiac hypertrophy

 Distant heart sounds  Weakness

 Muscular aches  Nervous System


 Anemia
and pains
 Apathy
 Tendency to develop CHF,
angina, and MI  Slow movements
 Lethargy
 Arthralgia
 Fatigue

 Integumentary System  Forgetfulness

 Dry, thick, elastic,  Hoarseness


cold skin OTHER
 Slowed mental
 Thick, brittle nails  Increases susceptibility status
 Reproductive System to infection
 Dry, sparse, course  Slow, slurred
hair  Prolonged  Sensitivity to narcotics, speech
menstrual barbiturates, anesthesia
 Pallor  Stupor, coma
periods or
amenorrhea  Cold intolerance
 Puffy face  Paresthesias
 Decreased libido  Goiter
 Anxiety and
depression
References:

Books:

– Richard Lehne: Pharmacology for Nursing Care


– Heuther; mcCance: understanding Pathphysiology
– Smeltzer, et. Al.: Textbook of medical-surgical nursing

Internet:

– http://www.healthscout.com/ency/68/34/main.html#CausesandRiskFactorsofHypothyroidism
– http://www.scribd.com/doc/6685888/Endocrine-Diseases
– http://www.scribd.com/doc/6685900/Endocrine-Disorders
– http://www.nlm.nih.gov/medlineplus/ency/article/000356.htm
– http://www.medicinenet.com/script/main/art.asp?articlekey=19366
– http://www.healthscout.com/ency/68/46/main.html#CausesandRiskFactorsofHyperthyroidism
– http://thyroid.about.com/od/thyroidbasicsthyroid101/a/riskfactors.htm
– http://www.merck.com/mmpe/sec12/ch152/ch152e.html