HASHIM

OTO’S
THYROID
ITIS
A Clinical Presentation on the
Disease Concept
1. Definition of the
disease
It shwows the background of the
disease and the overview of the
disease process
2. INCIDENCE
It includes the epidemiology and the
prevalence of the disease around the
world
3. RISK FACTORS
It presents the different
physiological, environmental and
behavioral factors that could
aggravate the symptoms of the
disease
4. PATHOPHYSIOLOGY
It entails the detailed and thorough
explanation on the disease process
5. Signs and symptoms
It describes the different
manifestations of the disease and its
6. MEDICAL
potential complications& NURSING
MANAGEMENT
It entails the diagnosis and the
different medical and nursing
interventions to prevent the
occurrence of the symptoms of the
disease
INTRODU
CTION
 HASHIMOTO’S THYROIDITIS
● Hashimoto's disease, or Hashimoto's thyroiditis, is an autoimmune
disease that damages the thyroid gland. It is the most common
cause of hypothyroidism (underactive thyroid). Hypothyroidism is
treatable with medicine.
● Hashimoto's disease is a condition in which your immune system
attacks your thyroid, a small gland at the base of your neck below
your Adam's apple. The thyroid gland is part of your endocrine
system, which produces hormones that coordinate many of your
body's functions.
● Inflammation from Hashimoto's disease, also known as chronic
lymphocytic thyroiditis, often leads to an underactive thyroid
gland (hypothyroidism).
● Hashimoto's disease is the most common cause of hypothyroidism.
INCIDENC
E
 HASHIMOTO’S THYROIDITIS
● After age six, Hashimoto is the most common
cause of hypothyroidism in the United States and
in those areas of the world where iodine intake is
adequate.
● The incidence is estimated to be 0.8 per 1000 per
year in men and 3.5 per 1000 per year in women.
 RISK
FACTORS
 HASHIMOTO’S THYROIDITIS

Sex Age Heredity

Women are much more Hashimoto's disease You're at higher risk
likely to get can occur at any age for Hashimoto's
Hashimoto's disease. but more commonly disease if others in
occurs during middle your family have
age. thyroid or other
autoimmune diseases.
 HASHIMOTO’S THYROIDITIS

Other autoimmune Radiation Bacterial

disease exposure Infections
Having another People exposed to Much like other autoimmune
autoimmune disease — excessive levels of diseases, Hashimoto’s may
such as rheumatoid be triggered by a number of
environmental
arthritis, type 1 diabetes or parasitic, yeast and fungal
lupus — increases your radiation are more
bacterial infections that start
risk of developing prone to Hashimoto's in the gastrointestinal tract
Hashimoto's disease. disease.
PATHOPHYSIO
LOGY

● Hashimoto disease is a form of
hypothyroidism.
● Hypothyroidism happens when there is too
little T3 and T4 in the body. When this
happens, there is too much TSH.
● Another term for Hashimoto disease is
autoimmune thyroiditis. Goiter formation is
significant in this form of hypothyroidism
due to inflammation. (McCance & Huether,
2014).
HASHIMOTO’S
THYROIDITIS
● Inflammation is caused by stimulation of
CD4 and T helper cells that are explicit to
your thyroid. This stimulation can be either
viral or bacterial in presence. (Lloyd, 2010).
● The influx of CD4 and T helper cells as well
as activation of other autoantibodies
produced by the B helper cells causes
destruction of thyroid tissue. Apoptosis is
activated by CD8 cells and is significant in
the destruction as well. (Lloyd, 2010).

● In normal hormonal regulation, the
hypothalamus secretes TSH Releasing
Hormone (TRH), which causes the pituitary
to secrete Thyroid Stimulating Hormone
(TSH), which then stimulates the thyroid to
secrete TH (specifically triiodothyronine, T3,
and thyroxine, T4) (McCance & Huether,
2014). By way of a negative feedback
mechanism, TH levels regulate the amount of
TRH and TSH secreted.
HASHIMOTO’S
THYROIDITIS
● Primary hypothyroidism, such is the case with
Hashimoto’s disease, is caused by a deficient
production of TH due to the loss of function of
the thyroid gland. (McCance & Huether,
2014).
● This leads to a decrease in TH and an increase
in TRH and TSH. One can look at this
relationship as you would a person, a
thermostat and a furnace. The person
(hypothalamus) is cold, so they go to the
thermostat (pituitary) and set the temperature
warmer.

● The thermostat now tells the furnace (thyroid)
to kick on and heat the house. However,
since this furnace (thyroid) is not functioning
properly, the house will not heat up. No
matter how much the person attempts to make
the thermostat activate the furnace, it will not
heat the home properly.
HASHIMOTO’S
THYROIDITIS
● At early stages, thyroid gland can be
enlarged and nodular. When the disease
progress there will be a reduction in size of
thyroid gland and fibrosis.
● Then there will be destruction of thyroid
follicles and lymphocyte infiltration.

● Helper T lymphocytes interact with specific
antigents on thyroid follicular membrane due
to the defect in suppressor T lymphocyte.
• Autoantibodies formed which react with
these antigens.
 Thyroglobulin antibody
 Thyroidal Peroxidase Antibody
 TSH receptor-blocking Antibody.
HASHIMOTO’S
THYROIDITIS
o Cytokine release and inflammation causes
gland destruction
o Thyroid-associated orbitopathy is a set of
ophthalmic symptoms resulting from an
autoimmune process in which the swelling
of extraocular tissues leads to exophthalmos
either caused by hypersecretion and
accumulation of glycosaminoglycans in the
orbit fibroblasts or being the result of
inflammatory processes in the oculomotor.

● The thyroid controls your metabolism with a
few specific hormones — T4 (thyroxine,
contains four iodide atoms) and T3
(triiodothyronine, contains three iodide
atoms). These two hormones are created by
the thyroid and they tell the body's cells how
much energy to use.
HASHIMOTO’S
THYROIDITIS
o Thyroxine (T4) is responsible for your
metabolism, mood, and body temperature,
among other things. T3, too, is made in the
thyroid gland, and it can also be made in
other tissues within the body by converting
T4 (in a process called deiodination) into
T3. This hormone is at the center of your
digestive and metabolic function, and it also
oversees bone health.
SIGNS AND
SYMPTOMS
SYMPTOMS OF THE
DISEASE Paleness or puffiness of
the face
depression
Slowed heart rate
Inability to get warm/ cold
intolerance
high cholesterol

Weight gain
Irregular or heavy
menstrual periods
Joint and muscle pain
lower body muscle
weakness

ADDITIONAL INFORMATION
● Thyroid-associated orbitopathy is a set of
ophthalmic symptoms resulting from an
autoimmune process in which the swelling of
extraocular tissues leads to exophthalmos
either caused by hypersecretion and
accumulation of glycosaminoglycans in the
orbit fibroblasts or being the result of
inflammatory processes in the oculomotor.
HASHIMOTO’S
THYROIDITIS
o Hashimoto's can often be associated with
some weight gain — it's mostly salt and
water weight, which is why you look
puffy,” she says. “However, the weight gain
seen with Hashimoto's thyroiditis is usually
less dramatic than the weight loss seen with
autoimmune hyperthyroidism (Graves
disease)
complications
 HASHIMOTO’S THYROIDITIS

Heart problems, Anemia High Confusion and loss Depression

including heart cholesterol of consciousness
failure
MEDICAL DIAGNOST
MANAGEM IC
ENT PROCEDU
● THYROID
RES
FUNCTION
TEST
● ANTIBODY
TEST
 THYROID FUNCTION TEST
● This blood test tells whether your body has the
right amounts of thyroid stimulating hormone
(TSH) and thyroid hormone. A high level of TSH
is a sign of an underactive thyroid. When the
thyroid begins to fail, the pituitary gland makes
more TSH to trigger the thyroid to make more
thyroid hormone. When the damaged thyroid can
no longer keep up, your thyroid hormone levels
drop below normal.
 Antibody test
● This blood test tells whether you have the
antibodies that suggest Hashimoto’s
disease. More than one in 10 people have
the antibodies but have normal thyroid
function. Having only the antibodies does
not cause hypothyroidism.
 MEDICAL MANAGEMENT
● The mainstay of treatment for hypothyroidism is
THYROID HORMONE REPLACEMENT. The drug of
choice is titrated levothyroxine sodium administered orally.
It has a half-life of 7 days and can be given daily. It should
not be given with iron or calcium supplements, aluminum
hydroxide, and proton pump inhibitors to avoid suboptimal
absorption. It is best taken early in the morning on an
empty stomach for optimum absorption.
 MEDICAL MANAGEMENT
Diagnosis:
● 1.) Thyroid-stimulating hormone test or A thyroid-
stimulating hormone (TSH)
  Test is a blood test that is one of the go-to tests for
diagnosing hypothyroidism. The goal of the TSH test is
to determine whether your TSH levels are within the
normal range. If they are higher than they should be,
this may indicate Hashimoto's thyroiditis (and, in turn,
hypothyroidism).
 MEDICAL MANAGEMENT
Diagnosis:
● 2.) Anti-thyroid antibodies tests o Anti-thyroid antibodies
(ATA) tests,
 Such as the microsomal antibody test (also known as
thyroid peroxidase antibody test) and the anti-
thyroglobulin antibody test, are commonly used to
detect the presence of Hashimoto's thyroiditis.
● 3.) Anti-thyroid antibodies tests
 Detect the presence of these antibodies and measure
their levels. This test is commonly used to confirm or
exclude Hashimoto's thyroiditis as the reason for
hypothyroidism.
 MEDICAL MANAGEMENT
Diagnosis:
4.) Free T4 hormone test
  Is the portion of total T4 thyroid hormone that is
available to your tissues. If TSH test comes back normal,
but symptoms resemble those of hypothyroidism, a free T4
test may help reveal any thyroid hormone problems. Low
levels of free T4 indicate some deficiency in thyroid
hormone production, even if your TSH levels are normal.
 MEDICAL MANAGEMENT
Treatment:
Medical Treatment:
1. Prevention of cardiac dysfunction
  As long as metabolism is subnormal and the tissues
require relatively little oxygen, a reduction in the blood
supply is tolerated without overt symptoms of coronary
artery disease.

2. Supportive therapy
  Oxygen saturation levels should be monitored; fluids
should be administered cautiously; application of external
heat must be avoided, and oral thyroid hormone therapy
should be continued.
 NURSING MANAGEMENT
● Administer medication:
 Levothyroxine
● Education patients and caregivers regarding the need for
thyroid replacement and how to properly take the
medication: give medication in the morning on an empty
stomach approx 1 hour before meal for most effective
treatment.
● Monitor food intake and appetite; encourage healthy food
choices, avoid comfort foods
● Patients often have a decreased appetite, but continue to
gain weight. Take note of a patient’s eating habits and
provide nutrition recommendations
 NURSING MANAGEMENT
● Assess skin integrity; dry skin and brittle hair; apply moisturizers
and encourage adequate hydration
● As the metabolism slows, skin and hair begin to dry out and
become thin and brittle. Encourage moisturizers applied to the
skin after bathing and conditioner for hair. Note any excoriations
or wounds as healing may also be impaired.
● Provide a comfortable environment and limit exposure to cold.
Patients are more sensitive to colder temperatures and often
complain of being cold, even in hot weather. Provide blankets as
needed.
● Monitor weight regularly
● Patients tend to gain weight but should begin to lose weight as the
medication takes effect.
SOURCES:
Lewis, S., Bucher, L, & Heitkemper, M.,
Harding, M., Kwong, J., & Roberts, J.
(2017). Medical-Surgical Nursing:
assessment and management of clinical
problems . St. Louis, Missouri: Elsevier

Ignatavicius, D.D., Workman, M.M., Rebar,

C.R., Heimgartner, N.M. (2017). Medical-
Surgical Nursing: concepts for
interprofessional collaborative care. St.
Louis, Missouri: Elsevier
Thank you
for
listening
A presentation of
Valdriz, B., Villanueva, S.N, & Oao, S.