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Hypothyroidism

By: Michelle Russell

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Objectiveso 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 causesoHashimoto’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 causeso 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- causeo 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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Epidemiologyo Most common in women

between 30-50 years of ageo 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 SymptomsMost 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

Severeo Dryness and thickening of

skino 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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Complicationso Goiter

Enlargement of the thyroid glando 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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Myxedemao 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 testingo 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 Relevanceo 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 informationo “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/ Assessmento 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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Prognosiso 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 Diagnosiso 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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Conclusiono 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 Citedo 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?