NUTRITIONAL MANAGEMENT

OF HYPOTHYROIDISM
YAEL AKILOV, QUEENS COLLEGE DIETETIC INTERNSHIP, 2017
 HYPOTHYROIDISM
Thyroid disorder which is when the thyroid gland is underactive
Body is not producing enough thyroid specific hormones
Functions related to the thyroid gland:
Fat and carbohydrate metabolism,
Respiration,
Body temperature
Brain development
Cholesterol levels
Nervous system
Blood calcium levels
Menstrual cycles
Skin integrity
 TREATMENT/TESTING
Commonly thyroid problems are corrected with the use of synthetic
version of thyroxine pills
Used to replenish hormonal imbalances that are associated with
hypothyroidism
Diagnostic blood testing called TSH (thyroid stimulating hormone) measures how
much of the thyroid hormone thyroxine (T4) the thyroid gland makes
If levels of TSH are high than this indicates the thyroid gland is being pushed to
make more T4 because there isnt enough T4 in the blood
This indicates positive for hypothyroidism.
 EVIDENCE-BASED NUTRITION
RECOMMENDATIONS: SELENIUM & ZINC
Selenium is a micronutrient that has an important role in thyroid hormone
metabolism.
The thyroid gland has the highest concentration of selenium throughout the body.
Selenium is important in the metabolism of thyroid hormones which include triiodothyronine (T3)
and thyroxine (T4).
Different studies have been executed in order to determine the effects of selenium on thyroid
hormone levels.

Zinc is a micronutrient that has many important roles in human.

Although the role of zinc in thyroid function is complex it is a factor for several enzymes in relation
to the synthesis and activity of thyroid hormones.

Research Study: Mahmoodianfard (2015)

Based on this studys findings there is some evidence that shows an effect of Zn alone or in
combination with Se on specific thyroid hormones and their function.
 EVIDENCE-BASED NUTRITION
RECOMMENDATIONS: VITAMIN A, IRON, &
IODINE
Vitamin A plays a crucial role in the body.
Linkage between vitamin A and TSH through elements of transcription and hormone signaling.

Iron is another micronutrient that has a specific relationship and role in thyroid function.
Essential part of thyroid hormone syntheses largely due to thyroperoxidase which is an iron containing
enzyme

Iodine is one of the most recognized nutrients related to thyroid function.

Essential element for sufficient thyroid hormone production and deficiency actively effects TSH levels.

Research Findings: Kuiper (2012)

The results showed that TSH levels decreased significantly when comparing the group following the diet
high in Fe, Iodine, & Vitamin A than the control group.
 NUTRITION CARE PROCESS:
ASSESSMENT

Client History
Resident admitted over 5 years ago
Receives disability, and has two children
In the past he worked in retail before
he became severely ill
Unable to care for himself
 FOOD/NUTRITION-RELATED HISTORY
Receiving enteral feeds for all fluid and nutrition needs via Glucerna
1.2
Diet order :
1500 ml at 94ml/hr x 15 hrs from 9am to 6 pm
Water flush at 1500 ml
Total Feeding including water flush provides
1800 calories
90 g Protein
3000 ml Total Fluid
2710 ml Free Water
 PERTINENT MEDICATION WITH
POTENTIAL FDI
Medication Rationale Food-Drug Interaction
Detemir Insulin- It can treat diabetes by improving Weight gain, low potassium level in the
blood sugar control blood.
Levothyroxine Hormone- It can treat hypothyroidism. Increased appetite, weight loss, diarrhea,
vomiting, and abdominal cramps.
Anticoagulants- increase the catabolism of
vitamin K-dependent clotting factors,
adjusted accordingly.
Famatidine Antacid and antihistamine- Vomiting, nausea, abdominal discomfort,
It can treat ulcers in the stomach and anorexia, dry mouth, and decreases iron
intestines. and Vitamin B12 absorption.

Tylenol Analgesic- It can treat minor aches and

pains, and reduces fever.
Vitamin C Treat deficiencies related to enteral feeding. In high doses may interfere with the
blood-thinning effects of aspirin,
anticoagulants such as warfarin
Vitamin D2 Treat deficiencies related to Vitamin D
deficiency
Multivitamin Treat deficiencies related to enteral feeding.
 ANTHROPOMETRIC MEASUREMENTS

Height: 69
Weight 170.1 lbs
BMI of 25.1 Overweight

Weight trend for the last six months are as follows:

x30 days: 1/17 174 lb (2.2%)
x90 days: 11/16 173 lb (1.6%)
x180 days: 8/16 170 lb (stable)
 NUTRIENT NEEDS

Resident caloric needs were calculated based on the Mifflin St. Jeor
formula
Equation for Resident REE 1573 x AF 1.25= 1966 kcal / day

The Protein needs were calculated for based on the regular adult
formula appropriate for age
0.8-1.0/kg which estimated to be 61-77 g/day

Fluid needs were calculated to be 30-35ml/ kg

estimated to be 2310-2695 ml Fluid/day
 NUTRITION CARE PROCESS: DIAGNOSIS

PES: Overweight (NC-3.3) related to limited mobility and vegetative

state as evidenced by BMI 25.1
PES: Food and drug interaction (NC-2.3) related to Polypharmacy as
evidenced by prescription of 7 meds and fluctuating weight.
 NUTRITION CARE PROCESS:
INTERVENTIONS

Enteral Nutrition (ND-2.1)- Resident is on therapeutic formula designed to control

blood sugar levels for patients with diabetes.

Coordination of Oher Care During Nutrition Care (RC-1)- This is ongoing in a long
term care facility, doctors, nurses, speech pathologist all work together in order to
maintain the residents quality of life. This is done through
Focus meetings
Collaboration with MD on type of feeds and tolerance
Speech pathologist on evaluation of residents ability to swallow.
 NUTRITION GOALS

Resident will maintain weight of the range 170lb +/ 5lb x 90 days.

Resident will exhibit no signs and symptoms of dehydration x 90 days.

Resident will tolerate Tube-Feeding x 90 days.

Resident will be free from glycemic episodes x 90 days

 MONITORING TERMS
Monitor Tolerance of Tube Feeding and Intake (FH-1.3)
Monitor weight monthly (AD-1.1.2)
Monitor Labs as available (BD)
Monitor through Focus meeting
 THANK YOU.
Any Questions?