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Hypothyroidism
By: Michelle Russell
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Objectives
o To understand hypothyroidism and how it effects the body• Causes• Signs/ symptoms
o Become familiar with current treatment and nursing interventions
o Develop appropriate nursing diagnoses
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What is Hypothyroidism?
o Occurs when the thyroid gland doesn’t produce enough thyroid hormone (T-3, T-4)
o State of metabolic slow down
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PathophysiologyoThyroxine (T-4) &Ttriiodothyronine(T-3)oT-4 converts into T-3
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Primary causes
oHashimoto’s disease• Autoimmune disorder usually with a genetic component
• Antibodies are attacking the thyroid gland• 80% of all cases- most common cause
oOther- cancer, nodules, infection, pregnancy, congenital disease (1 in 3,000 babies), thyroidectomy
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Other causes
o secondary (5% of cases) Failure of the Pituitary gland to produce enough TSH
o Tertiary Failure of the Hypothalamus to make TRH
o BOTH are usually caused by tumors and are rare
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Iodine deficiency- cause
o Iodine is needed to synthesize T4 and T3
o Iodine deficiency is most common cause in developing countries Its not a problem in the U.S. because it is included in our
salt! But stay aware…
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A visual recap OVERVIEW: Pathophysiology and Causes
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Epidemiology
o Most common in women between 30-50 years of age
o Approximately 10% of ALL adults have evidence of Hashimoto’s disease Hashimoto’s is more prevalent in white females 20% of cases are inherited with a autosomal recessive
pattern
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Signs and Symptoms
Most common
o Tiredness and weakness-feeling "run down"
o Weight gain or difficulty losing weight o Constipation o Depressiono Thinning or brittleness of the hair or
nails o Cold intolerance o Sleepiness o Memory losso Decreased libido o Muscle aches and pains o Hoarse voice
Severe
o Dryness and thickening of skin
o Slowed speecho Altered menstrual cycleo Puffiness in face, hands,
feeto Decrease capacity to taste
or smello Jaundiceo Increase in tongue size
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Complications
o Goiter Enlargement of the thyroid gland
o Thyroid cancer and noduleso Heart disorders
Higher risk for developing heart disease, atherosclerosis, heart attack, and stroke
o Infertility Affect ovulation and decrease chances of conceiving
o Mental status Depression- usually when left untreated May lead to dementia
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Example Goiter
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Myxedema
o Rare and life threatening (50% mortality rate)o May cause a coma
Not enough thyroid hormone, your body cannot utilize glucose
o Symptoms Similar to hypothyroidism but EXTREME Edema- swelling around the eyes, body and thickening of
the tongue (heavy mushy skin)o Triggors- infections, stroke, trauma, heart failure,
GI bleeding, hypothermia
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Example Myxedema
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Diagnostic testing
o Blood test: TSH, T3, T4
o Thyroid antibody test to detect Hashimoto’s: TgAB
o Ultrasound: Detect nodules, tumors, heterogeneous appearance
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Patient Relevance
o 51 years oldo Presenting problems:
Stress- new job, different state, cultural differences, newly-wed, small income
Started developing symptoms which she contributed to stress Life gradually settled, but symptoms did not disappear
o Symptoms: Cognitive- concentration, memory, focusing difficulties,
tiredness, fatigue Goiter
o Diagnosis: Hashimoto’s Thyroiditis o Treatment: Armour Thyroid
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Subjective information
o “I am usually very tired even after getting up in the morning”.
o “Trying to stay awake during lectures, meetings, and movies is very difficult”.
o “I am very busy/active while teaching, and I have no problem staying awake. But once my kids go to bed I have difficulty concentrating, staying awake, and getting paperwork done”.
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Nursing Interventions/ Assessment
o Give Synthroid (Levothyroxine) at least 30 min. before breakfast! Typically done on night shift as a 6am med.
o Physical examo Palpate thyroid glando Assess for paleness, puffiness or lack of facial expressiono Skin & hair may be dry
o Monitor vitals/ Labso Slowed HR and RR; EKG may eventually be done
o Patient education
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Outpatient thyroid surgery: Should patients bedischarged on the day of their procedures?
o Yes, with appropriate Interventions…o Nursing Interventions
o Patient educationo Verbal and written instructionso Signs and symptoms of complicationso Counseling with pamphlet
o Follow up telephone call the next day from the Nurseo Thyroidectomies- prescription for calcium replacement to prevent
Hypocalcemiao Follow up visit two weeks after surgery
o 99.6% of patients were discharged as planned with only 1.7% readmitted
Article 1
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Assessment and Management of Patients With Hypothyroidism
oNursing Interventions:oStart with comprehensive history- SymptomsoBe aware of Hypothyroid symptoms in order to
formulate questionsoUnderactive Thyroid-Dependent Quality of Life
Questionnaire (ThyDQoL)oPregnancy- *** Need to have an increase in
medication doseoMyxedema- IV bolus T3 Q8H
Article 2
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Are there gaps between research and practice?
o Absolutely!o Not enough patient educationo Never a thorough assessmento Synthroid is sometimes not given enough time
before breakfast
o CAUSES- Nurse shortage and too many patients for one Nurse to care for
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Prognosis
o Generally pretty well if continue to have follow up visits, frequent monitoring, and medication compliance
o Patient from the article:o She continues to experience symptomsoBut they have gotten better since she started supplementation
o But has learned to manage/ cope with them
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Nursing Diagnosis
o Activity intolerance R/T disease status AEB Verbalization of lack of energy, tiredness, and weakness
o Others:o Constipationo Low self esteemo Fatigue
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Conclusion
o This is a common conditiono Understand the signs/ symptoms of
hypothyroidism o Such as cold intolerance, weight gain, tiredness, memory
loss and depressiono Slowed HR and RR
o Causes: Hashimoto Thyroiditis is most commono Patient education about the illness is needed/
importance of medication compliance
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Works Cited
o Berber, E., & Rehan, K. (2011, January 18). endocrineweb. Retrieved from http://www.endocrineweb.com/conditions/hypothyr oidism/complications- hypothyroidism
o Carson, M. (2009). Assessment and management of patients with hypothyroidism. Learning Zone, 28(18), 51-55. Retrieved from http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=21&hid=122&sid=8584a050-a8ed-4ac9-b7a7-a1f8e0e5960f%40sessionmgr13
o Living with hashimoto's disease. (2009, January 12). Retrieved from http://vitamvas.tripod.com/thyroid.html
o Mathur, R. (2011). Medicine.net. Retrieved from http://www.medicinenet.com/myxedema_coma /article.htm
o Mayo Clinic Staff. (2010, June 12). Hypothyroidism underactive thyroid. Retrieved from http://www.mayoclinic.com/health/hypothyroidi sm/DS00353/DSECTION=symptoms
o Medicine.net. (n.d.). medicinenet.com. Retrieved from http://www.medicinenet.com/hashimotos_thyroiditis/article.htm
o Trottier, D. C., Barron, P., Moonje, V., & Tadros, S. (2009). Outpatient thyroid surgery: Should patients be discharged on the day of their procedures?. Research, 52(3), 21-25. Retrieved from
http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=18&hid=122&sid=8584a050-a8ed-4ac9-b7a7-a1f8e0e5960f@sessionmgr13
o WebMD. (2010, June). Webmd. Retrieved from http://www.webmd.com/a-to-z-guides/thyroid- hormone-tests
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Questions?
