Table of Contents
- Statistics and Epidemiology
- Clinical Manifestations
- Assessment and Diagnostic Findings
- Medical Management
- Nursing Management
- Practice Quiz: Hypothyroidism
- See Also
Thyroid deficiency can affect all body functions and can range from mild, subclinical forms to advanced forms.
- Hypothyroidism results from suboptimal levels of thyroid hormone.
- Hypothyroidism also commonly occurs in patients with previous hypothyroidism that has been treated with radioiodine or antithyroid medications or thyroidectomy.
- The term myxedema refers to the accumulation of mucopolysaccharides in subcutaneous and other interstitial tissues.
The types of hypothyroidism are classified according to their causes:
- Central hypothyroidism. There is a failure of the pituitary gland, the hypothalamus, or both to stimulate production of thyroid hormones.
- Secondary or pituitary hypothyroidism. The cause is entirely a pituitary disorder in secondary hypothyroidism.
- Tertiary or hypothalamic hypothyroidism. This refers to the cause as a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation of TRH.
- The thyroid disorder is already present at birth in cretinism.
Statistics and Epidemiology
Hypothyroidism occurs in specific individuals in different instances.
- Hypothyroidism occurs most frequently in older women.
- There is an increased incidence of thyroid cancer in men who have undergone radiation therapy for head and neck cancer.
- More than 95% of patients with hypothyroidism have primary or thyroidal hypothyroidism.
Several diseases and factors could cause hypothyroidism.
- The most common cause of hypothyroidism is inflammation of the thyroid gland, which damages the gland’s cells.
- Autoimmune diseases. The most common cause of hypothyroidism in adults is autoimmune thyroiditis or Hashimoto’s disease.
- Atrophy of the thyroid gland. The thyroid gland shrinks in size as a result of aging.
- Therapy for hyperthyroidism. Therapies such as radioactive iodine and thyroidectomy could also cause hypothyroidism.
- Medications such as lithium, iodine compounds, and antithyroid medications could decrease the production of TSH.
- Iodine deficiency or excess. The imbalance in the iodine levels in the body also affects the thyroid gland.
- Autoimmune or Hashimoto’s thyroiditis, in which the immune system attacks the thyroid gland, is the most common example of this.
- Some women develop hypothyroidism after pregnancy (often referred to as “postpartum thyroiditis”).
The signs and symptoms of hypothyroidism include:
- Extreme fatigue. Extreme fatigue makes it difficult for the person to complete a full day’s work or participate in usual activities.
- Menstrual disturbances. Menorrhagia or amenorrhea may also occur.
- Increase in weight. The patient usually begins to gain weight even without an increase in food intake.
- Cold intolerance. The patient often complains of being cold even in a warm environment.
- Thick skin. The skin becomes thickened because of an accumulation of mucopolysaccharides in the subcutaneous tissues.
Prevention of hypothyroidism can be achieved with the following:
- Increase in iodine intake. Iodine intake is the foremost prevention strategy in hypothyroidism.
- Early detection. Undergoing thyroid tests after thyroid surgery or therapy could result in early detection and prompt treatment of hypothyroidism.
Hypothyroidism can be a life-threatening disease if left unchecked.
- Myxedema coma. This is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious.
Assessment and Diagnostic Findings
Hypothyroidism can be detected in many ways.
- Physical examination. The thyroid gland is inspected and palpated routinely in all patients.
- Serum thyroid-stimulating tests. Measurement of the serum TSH concentration is the single best screening test of thyroid function because of its high sensitivity.
- Serum T3 and T4. Measurement of total T3 or T4 includes protein-bound and free hormone levels that occur in response to TSH secretion.
- Thyroid antibodies. Results of testing by immunoassay techniques for antithyroid antibodies are positive in Hashimoto’s thyroiditis (100%).
The primary objective in the management of hypothyroidism is to restore a normal metabolic state by replacing the missing hormone.
- Pharmacologic therapy. Synthetic levothyroxine is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters.
- 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.
- 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 care for a patient with hypothyroidism includes the following:
Assessment of the patient with hypothyroidism should include:
- Assessment of the thyroid from an anterior or posterior position.
- Auscultation of the lobes of the thyroid gland using the diaphragm of the stethoscope if there are abnormalities palpated.
- Assess thyroid gland for firmness (Hashimoto’s) or tenderness (thyroiditis).
- Activity intolerance related to fatigue and depressed cognitive process.
- Risk for imbalanced body temperature related to cold intolerance.
- Constipation related to depressed gastrointestinal function.
- Ineffective breathing pattern related to depressed ventilation.
- Disturbed thought processes related to depressed metabolism and altered cardiovascular and respiratory status.
Planning & Goals
To achieve a successful nursing care plan, the following goals should be realized:
- Increase in participation in activities.
- Increase in independence.
- Maintenance of normal body temperature.
- Return of normal bowel function.
- Improve respiratory status.
- Maintenance of normal breathing pattern.
- Improve thought processes.
Nursing interventions for a patient with hypothyroidism include the following:
- Promote rest. Space activities to promote rest and exercise as tolerated.
- Protect against coldness. Provide extra layer of clothing or extra blanket.
- Avoid external heat exposure. Discourage and avoid the use of external heat source.
- Mind the temperature. Monitor patient’s body temperature.
- Increase fluid intake. Encourage increased fluid intake within the limits of fluid restriction.
- Provide foods high in fiber.
- Manage respiratory symptoms. Monitor respiratory depth, rate, pattern, pulse oximetry, and ABG.
- Pulmonary exercises. Encourage deep breathing, coughing, and use of incentive spirometry.
- Orient to present surroundings. Orient patient to time, place, date, and events around him or her.
A successful nursing care plan has achieved the following goals:
- Increased participation in activities.
- Increased independence.
- Maintained normal body temperature.
- Return of normal bowel function.
- Improved respiratory status.
- Maintained normal breathing pattern.
- Improved thought processes.
Discharge and Home Care Guidelines
At the completion of the home care instruction, the patient or caregiver will be able to:
- Medication compliance. State that compliance to medical regimen is life-long.
- Cold intolerance. State the need to avoid extreme cold temperature until condition is stable.
- Follow-up visits. State the importance of regular follow-up visits with health care provider.
- Weight reduction. Identify strategies for weight reduction and prevention of constipation such as high-fiber, low-calorie intake and adequate fluid intake.
The focus of documentation should include:
- Level of activity.
- Vital signs before, during, and after activity.
- Record of core temperature, initially and prn.
- Results of laboratory and diagnostic studies.
- Usual and current bowel pattern, duration of the problem, and individual contributing factors.
- Characteristics of stool.
- Respiratory pattern, breath sounds, and use of accessory muscles.
- Plan of care.
- Teaching plan.
- Response to interventions, teaching, and actions performed.
- Attainment or progress toward desired outcomes.
- Modifications to plan of care.
- Long term needs.
Practice Quiz: Hypothyroidism
1. The preferred medication for treating hypothyroidism is:
2. A clinical manifestation usually associated with hypothyroidism is:
A. A pulse rate lower than 95 bpm but greater than 60 bpm.
B. An elevated systolic blood pressure.
C. Muscular fatigability.
D. Weight loss.
3. Nursing care for a patient with hypothyroidism includes assessing for clinical manifestations associated with hypothyroidism. A manifestation not consistent with her diagnosis is a:
A. Change in her menstrual pattern.
B. Pulse rate of 58 bpm.
C. Temperature of 95.88 ºF.
D. Weight loss of 10 lbs over a 2-week period.
4. The principle objective of medical management is to:
A. Irradiate the gland in an attempt to stimulate hormonal secretion.
B. Replace the missing hormone.
C. Remove the diseased gland.
D. Withhold exogenous iodine to create a negative feedback response, which will force the gland to secrete hormones.
5. Nursing comfort measures for a patient with hypothyroidism should include:
A. Encouraging frequent periods of rest throughout the day.
B. Offering the patient additional blankets to help prevent chilling.
C. Using a cleansing lotion instead of soap for the skin.
D. All of the above.
Answers and Rationale
1. Answer: D. Synthroid.
- D: Synthetic levothyroxine is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters.
- A: Lithium is not recommended for patients with hypothyroidism.
- B: Propranolol is not recommended for patients with hypothyroidism.
- C: Propylthiouracil is not recommended for patients with hypothyroidism.
2. Answer: C. Muscular fatigability.
- C: Extreme fatigue makes it difficult for the person to complete a full day’s work or participate in usual activities.
- A: A pulse rate lower than 95 bpm but greater than 60 bpm is considered normal.
- B: An elevated systolic blood pressure is not a sign of hypothyroidism.
- D: Weight loss is not a sign of hypothyroidism.
3. Answer: D. Weight loss of 10 lbs over a 2-week period.
- D: Weight gain occurs in hypothyroidism.
- A: A change in her menstrual pattern is a sign of hyperthyroidism.
- B: A pulse rate of 58 bpm is a sign of hyperthyroidism.
- C: A temperature of 95.88⁰F is a sign of hyperthyroidism.
4. Answer: B. Replace the missing hormone.
- B: To balance the level of thyroid hormones, the principal objective of medical management should be to replace the missing hormone.
- A: Irradiating the gland could worsen the disorder.
- C: Removing the diseased gland could worsen the disorder.
- D: Withholding exogenous iodine could worsen the disorder.
5. Answer: D. All of the above.
- D: All of the interventions listed above are appropriate for a patient with hypothyroidism.
- A: Promoting rest could avoid extreme fatigue.
- B: Additional blankets could prevent chilling for the cold-intolerant patient.
- C: Using a cleansing lotion could moisturize the dry skin instead of soap.
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