Hypothyroidism

Reported By: Hermae Angelic E. Guleng

Hypothyroidism results from suboptimal levels of thyroid hormone thyroid deficiency can affect all the body function and can range from mild, subclinical forms to myxedema and advance form

Thyroid Gland

CAUSES OF HYPOTHYROIDISM

AUTOIMMUNE DISEASE (hashimotos thyroiditis), graves disease ATROPY OF THYROID GLAND WITH AGING THERAPY FOR HYPERTHYROIDISM Radioactive iodine Thyroidectomy MEDICATIONS Lithium Iodine compounds
.

Thyroidectomy

CAUSES OF HYPOTHYROIDISM
ANTITHYROID MEDICATIONS. RADIATION TO HEAD AND NECK. For treatment of head and neck cancers, lymphoma infiltrative disease of the thyroid iodine deficiency / iodine excess.

Pathophysiology

Pathophysiology
PRIMARY OR THYROIDAL HYPOTHYROIDISM- dysfunction of the thyroid gland itself .(95 percent of pt. with thyroidism ). CENTRAL HYPOTHYROIDISMfailure of the pituitary gland, hypothalamus or both. PITUITARY/SECONDARY HYPOTHYROIDISM- entirely pituitary disorder.

Pathophysiology
HYPOTHALAMIC/TERTIARY HYPOTHYROIDISM- Disorder of the hypothalamus resulting in adequate secretions of TSH due to decreased stimulation by TRH. CRETINISM- hypothyroidism present at birth.

Diagnostic Findings
1. THYROID FUNCTION TESTLaboratory measurement of thyroid hormones, thyroid scanning, biopsy and ultrasonography 2. THYROID STIMULATING HORMONE- measurement of serum TSH concentration is the single best screening test for thyroid function, values above the normal range (0.4- 6.15 U/ml) indicates hypothyroidism.

Diagnostic Findings
OTHER DIAGNOSTIC TESTS Ultrasound, CT scans, and MRI may be used to clarify or confirm the results of other diagnostic studies. Thyroglobulin (Tg), a precursor for T3 and T4, can be measured reliably in the serum by radioimmunoassay. Clinically, it is used to detect persistence or recurrence of thyroid carcinoma.

Signs and Symptoms

A. EARLY SYMPTOMS- nonspecific Fatigue, hair loss, brittle nails, dry skin numbness and tingling of the fingers may occur. husky voice, hoarseness menstrual disturbances (menorrhagia or amenorrhea, loss of libido) It affects woman 5 times more between 30-60 years.

Signs and Symptoms

B. SEVERE SYMPTOMS

Subnormal temperature and pulse rate Patient gains weight without increase food intake Skin becomes thickened (Myxedema) Hair thins and falls out, face becomes expressionless and masklike Complains of cold even in warm environment

Severe symptoms
Speech is slow, hand enlarges, hands and feet increases in size deafness may also occur Associated with increase serum cholesterol level, Atherosclerosis, coronary artery disease

Signs and Symptoms

C. ADVANCED SYMPTOMS

-personality and cognitive changes (dementia) -Inadequate ventilation and sleep apnea Pleural effusion, pericardial effusion and respiratory muscle weakness. Hypothermic, sensitive to sedatives opiods anesthetic agents

Signs and Symptoms

D. MYXEDEMA COMA- most extreme

severe stage of hypothyroidism in which pt. is hypothermic and unconscious increase lethargy may progress to stupor/coma. may develop with undiagnosed hypothyroidism or use of sedatives, opiods analgesic agents. RR drive is depressed resulting in alveolar hypoventilation, carbon dioxide retention narcosis, coma.

Medical Management.
(Restore normal metabolic state by replacing missing hormone) A. PHARMACOLOGIC THERAPY -synthetic levothyroxine (Synthroid or levothroid) is the preferred preparation for hypothyroidism and suppressing nontoxic goiters. The dosage is based on pt. serum TSH concentration. Desiccated thyroid is used infrequently.

A. Pharmacologic Theraphy

PREVENTION OF CARDIAC DYSFUNCTION - when thyroid hormone is administered, oxygen demand increases but oxygen supply decreases.

-Angina or dysrhythmias can occur on thyroid replacement medications

B. Prevention of Medication Interaction

TH may increase blood glucose levels. Effects of TH maybe increse by dilantin and tricyclic anti-depressant agents. Hypnotic and sedative agents may include profound somnolence, and can cause respiratory depression. If use of these medication is necessary monitor for narcosis and respiratory failure

C. Supportive Theraphy
Maintain vital functions in severe hypothyroidism and myxedema coma. Measuring arterial blood gasses to determine carbon dioxide retention and combat hypoventilation. Pulse oximeter for oxygen saturation. Fluids should be administered cautiously. Heat pad is avoided. TH is administered if myxedema has progressed to myxedema coma

Nursing Management
1. MODIFYING ACTIVITY

assist with care and hygiene while encouraging pt. to participate in activities.
-provide independence in self care activities.

Nursing Management
2. MONITORING PHYSICAL STATUS Monitor V/S and cognitive level. Deterioration of physical mental status Signs symptoms indicating that treatment has resulted in metabolic rate exceeding the ability of cardiovascular / pulmonary systems to respond. Continued limitations or complications of myxedema.

Nursing Management
3. PROMOTING PHYSICAL COMFORT

extra clothing or blanket is provided and pt. protected from drafts. Heating pads/electric blanket is avoided, because of peripheral vasodilation, further loss of body heat, vascular collapse.

Nursing Management
4. ENHANCING COPING MEASURES nurse informs the pt. and family that the symptoms and inability to recognize them are common. pt. and family may require assistance and counseling to deal with emotional concerns.

Nursing Management
5. PROMOTING HOME AND COMMUNITY BASED CARE

Teaching patients self care. Instruct patience about actions /side effects of medication, and on how and when to take prescribed meds. Nurse provides written information for family and Pt. Dietary instruction is provided to promote weight loss once medication has been initiated to promote return normal bowel patterns.

Nursing Management
5. CONTINUING CARE.

Nurse reinforce the importance of continued thyroid hormone replacement and periodic follow up testing and instruct family and friends about signs of overmedication and undermedication.