Hypothyroidism

Learn about the nursing care management of patients with hypothyroidism in this nursing study guide.

Table of Contents

• Hypothyroidism
• Classification
• Statistics and Epidemiology
• Causes
• Clinical Manifestations
• Prevention
• Complications
• Assessment and Diagnostic Findings
• Medical Management
• Nursing Management
  • Nursing Assessment
  • Diagnosis
  • Planning & Goals
  • Nursing Interventions
  • Evaluation
  • Discharge and Home Care Guidelines
  • Documentation Guidelines
• See Also

Hypothyroidism

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.

Classification

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.

Causes

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”).

Clinical Manifestations

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

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.

Complications

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%).

Medical Management

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 Management

Nursing care for a patient with hypothyroidism includes the following:

Nursing Assessment

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).

Diagnosis

Based on the assessment data, the nursing diagnoses appropriate for a patient with hypothyroidism are:

• 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

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.

Evaluation

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.

Documentation Guidelines

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.

See Also

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