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DISSERTATION PROTOCOL
1
NAME OF THE CANDIDATE AND Mrs.SUCHETA PRABHAKAR MANE
ADDRESS
FLAT NO 1,SARGAM B.SHRIPAL
COMPLEX,VIRAR(WEST)
TAL-VASAI,DIST-THANE
MAHARASHTRA
PIN CODE :401303
2
NAME OF INSTITUTION
S.B. COLLAGE OF NURSING,
YELAHANKA NEW TOWN,
BANGALORE-64
3
COURSE OF STUDY AND SUBJECT
M.Sc. NURSING
COMMUNITY HEALTH NURSING
4
5
DATE AND ADMISSION TO COURSE
25.10.2009
TITLE OF THE TOPIC:
“ASSESS
THE
EFFECTIVENESS
OF
STRUCTURED
TEACHING
PROGRAMME (STP) ON THE EFFECT OF HYPOTHYROIDISM AMONG
ADOLOSCENT
GIRLS
IN
A
BANGALORE,RURAL TALUKA”.
1
SELECTED
PU
COLLEGE
AT
6:BRIEF RESUME OF THE INTENDED WORK
6.1 : Needs for the study
The internal environment of the body is partly controlled by the nervous system
and partly by the endocrine system. The endocrine system is primitive system. The
secretion of endocrine gland is called hormone which is directly poured into the blood
and while circulating, picked up by target organ. The hormone is a chemical substance.
The exact amount of hormones are necessary to maintain sound physiology of the body.
The less or excess amount of secretion manifest physiological disorder.1
The thyroid is an one of endocrine gland situated in front of the neck,just below
the voice box or at the spot where a bow tie would rest.It is highly vascular, brownish red
with left and right halves(called lobes) that look like a butterfly, wings. It is light a
butterfly, too, and usually weighs less than an ounce.
As small as it is, though the thyroid has an enormously important job to do ,
especially for teen. It manufactures the hormone that help control metabolism and
growth. To do, its job, the thyroid needs a chemical element called iodine that the body
absorbs from the foods we eat and water we drink. The entire body contains about 50
milligrams of iodine. About 1/5 to 1/3 of that supply(10 to 15milligrams) is stored in your
thyroid. The thyroid combines the iodine with tyrosine (an essential amino acid) to make
important hormones.2
Hypothyroidism is an underactive thyroid gland. Hypothyroidism means that
the thyroid gland can not make enough thyroid hormones to keep the body running
normally. People are hypothyroid if they have too little thyroid hormone in the blood.
The common causes are autoimmune disease, surgical removal of part of the thyroid
gland, radiation treatment ,congenital disorder that child may born without or only a
partly formed or ectopic thyroid gland.Thyroditis usually caused by autoimmune disease
or viral infection. Certain medicine such as lithium and too much or too little iodine,
damage to pituitary gland and rare disorder that infiltrate the thyroid. 3
What kinds of complaints characterize an underactive thyroid system? Low
energy and fatigue or tiredness, especially in the morning, is frequent in these patients.
Difficulty losing weight, a sensation of coldness--especially of the hands and feet,
depression, slowness of thought processes, headaches, swelling of the face or fluid
retention in general, dry coarse skin, brittle nails, and chronic constipation are also
common. In women, menstrual problems--such as PMS and menstrual irregularities
including heavy periods and fertility problems are further signs and symptoms. People
with an underactive thyroid may also have stiffness of joints, muscular cramps, shortness
of breath on exertion, and chest pain. Be aware that a person with a low functioning
thyroid doesn't have to have all of these symptoms; he may have only a few. 4
2
In areas with relatively high iodine intake, the incidence rate of hypothyroidism is
several-fold higher than that of hyperthyroidism. Recently, we found a similarly high
prevalence rate of subclinical hypothyroidism compared with hyperthyroidism in a high
iodine intake area, while a relatively low prevalence of subclinical hypothyroidism was
observed in a low iodine intake area. In the present study we compared the incidence rate
(newly diagnosed in primary care and at hospital) of overt hypothyroidism with that of
hyperthyroidism in a well-defined geographical area in Jutland, Denmark, with an iodine
intake around 60 microg/day. The number of personsxyears studied was 569,108. Data on
hyperthyroidism have been published previously. The overall incidence of
hypothyroidism was 13.5/100,000 per year (F/M 22.9/3.6), hyperthyroidism 38.7/100.000
per year (F/M 63.0/13.0). The incidence of hypothyroidism was steadily increasing with
age up to 80/100,000 per year in subjects older than 70 years of age, but apart from
congenital hypothyroidism it was lower than that of hyperthyroidism at all ages. The
majority of patients (79%) was diagnosed to have spontaneous autoimmune
hypothyroidism (16% with goiter, 84% with no thyroid visible or palpable). In
conclusion, in an area with moderately low iodine intake, hypothyroidism was
considerably less common than hyperthyroidism. This is in contrast to findings in high
iodine intake areas. The iodine intake of an area seems to be of major importance for the
pattern of thyroid disorders observed.
Underactive thyroid disorders are common and it remains undiagnosed till severe
manifestation of disease. so I want to create awareness regarding hypothyroidism among
the adolescence girls. As a early diagnosis is very important to prevent further
complications. Hence the investigator this topic for the study.
6.2 Review of literature
An underactive thyroid produces too little thyroid hormone, resulting
in hypothyroidism. ("Hypo" means "under" or "below.") When the amount of hormone
released into the bloodstream is below normal, the body uses up energy more slowly, and
chemical activity (metabolism) in the cells slows down.A person with mild
hypothyroidism may feel just fine — in fact, the condition might cause no symptoms at
all. However, symptoms can become more obvious if hypothyroidism progresses2
People with underactive thyroidsmight feel depressed and sluggish. They
might gain weight, even though they're not eating more or getting less exercise than
usual. Teens with hypothyroidism also might have slow growth in height, slow sexual
development, irregular menstrual periods in girls, muscle weakness, dry skin, hair loss,
poor memory,anddifficultyconcentrating.Hashimoto'sthyroiditis (pronounced: hah-shemoe-toes thy-roy-dye-tiss) is also an autoimmune disease and is the most common cause
of hypothyroidism in teens. In this condition, the body's immune system attacks the cells
in the thyroid gland, preventing it from producing enough thyroid hormone. The thyroid
responds by working harder to make enough hormones. This can make it become
enlarged and may result in a goiter.Hypothyroidism is usually easily diagnosed with a
3
physical examination and blood tests, and treatment with thyroid hormone replacement
pills can restore normal levels of thyroid hormone in the blood. This treatment is pretty
simple, but it does require doctor visits once or twice a year for an examination, blood
tests, and medication adjustments as needed.
 Heavy Periods / Menorrhagia: Menorrhagia is defined as excessively heavy or
prolonged menstrual bleeding, for example, soaking through pad every hour for several
hours. Hypothyroidism is associated with menorrhagia
More Frequent, Longer Periods: Hypothyroidism is known to cause periods to
come more frequently - for example, some women will find their 28 day cycle
shortens to a 25 day cycle, and their normally 5 days long
mensetruallasts6or7days.PainfulMenstruation,Dysmenorrhea: Hypothyroidism
is
associated with painful menstrual periods, known as dysmenorrhea. Dysmenorrhea can
include
an
achy
or
stabbing
low
backache,nausea,legaches,feelingsofullness,headaches,andboweldisturbances.
Some women with extremely heavy periods, can benefit from iron supplementation
during the menstrual period. A typical dosage may be approximately 100 mg of iron per
day. Note: if you are on thyroid hormone replacement, allow for at least 4 hours between
taking thyroid hormone and iron.

Some herbs may help bring on a delayed menstrual period, including parsley,
ginger, yarrow, sage, and feverfew.

Some herbs that are thought to help with painful menstruation include chamomile,
red raspberry, lemon balm, red clover, catnip, and comfrey root.Hypothyroidism
in adults causes and incidence (professional guide to diseases(English edition))
Hypothyroidism result from inadequate production of thyroid hormone usually
because of dysfunction of the thyroid gland due to due to surgery (thyroidectomy),
irradiation therapy (particularly with 131I), inflammation
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chronic autoimmune thyroiditis autoimmune thyroiditis Hashimoto’s disease) or, rarely,
conditions such as amyloidosis and sarcoidosis. It may also result from pituitary failure
(pituitary failure) to produce thyroid-stimulating hormone (TSH), hypothalamic failure to
produce thyrotropin-releasing hormone
thyrotropin-realeasing hormone, in born errors of of thyroid hormone synthesis, the
inability to synthesized hormone because of iodine deficiency (usually dietary) or the use
of antithyroid medications such as propylthiouracil(propylthiouracil). In patients with
hypothyroidism,
infection,
exposure
to
cold,
and
sedatives
may
precipitate myxedema coma (myxedema coma).
Worldwide, iodine deficiency remains the foremost cause of hypothyroidism. In the
United States and other areas of adequate iodine intake, autoimmune thyroid disease is
most common. The prevalence of antibodies is higher in women, and increases with age.
Postpartum thyroiditis: Up to 10% of postpartum women may develop lymphocytic
thyroiditis in the 2-10 months after delivery. The frequency may be as high as 25% in
women with type 1 diabetes mellitus. The condition is usually transient (2-4 mo) and can
require a short course of treatment with levothyroxine (LT4), but postpartum patients
with lymphocytic thyroiditis are at increased risk of permanent hypothyroidism. The
hypothyroid state can be preceded by a short thyrotoxic state. High titers of anti-TPO
antibodies during pregnancy have been reported to be 97% sensitive and 91% specific for
postpartum autoimmune thyroid disease.7
NEW YORK, Feb 10 (Reuters Health) — Patients with hypothyroidism show greater
improvements in mood and brain function if they receive treatment with two types of
thyroid hormones instead of one, according to a report in the February 11th issue of The
New England Journal of Medicine.
Hypothyroidism, where the gland has ceased to function or has been removed, is usually
treated with daily doses of thyroxine hormone. But the researchers found that substituting
another thyroid hormone, triiodothyronine, for some of the thyroxine dose led to
improvements in mood and in neuropsychological functioning.8
The overall incidence rate of hypothyroidism increased during the study period: baseline,
38.3/100,000·yr; voluntary IF, 43.7 (not significant vs. baseline); early mandatory IF, 48.7
[vs. baseline, rate ratio (RR) = 1.27; 95% confidence interval (CI) = 1.10–1.47]; and late
mandatory IF, 47.2 (vs. baseline, RR = 1.23; 95% CI = 1.07–1.42). There was a
geographic difference because hypothyroidism increased only in the area with previous
moderate ID: Aalborg, late mandatory IF vs. baseline, 40.3/29.7 (RR = 1.11; 95% CI =
1.11–1.66); Copenhagen,56.7/51.6 (RR = 1.10; 95% CI = 0.90–1.34). The
increase occurred in young and middle-aged adults. 9
5
Iodine deficiency. The trace mineral iodine — found primarily in seafood, seaweed,
plants grown in iodine-rich soil and iodized salt — is essential for the production of
thyroid hormones. In some parts of the world, iodine deficiency is common, but the
addition of iodine to table salt has virtually eliminated this problem in the United States.
Infertility. Low levels of thyroid hormone can interfere with ovulation, which impairs
fertility. In addition, some of the causes of hypothyroidism — such as autoimmune
disorder — also impair fertility. Treating hypothyroidism with thyroid hormone
replacement therapy may not fully restore fertility. Other interventions may be needed, as
well. 10
6.3: STATEMENT OF PROBLEM:
To assess the effectiveness of structural teaching programme (STP) on the effect of
Hypothyroidism among adolescent girls in a selected rural PU College at Bangalore, rural
taluk.
6.4: OBJECTIVES OF THE STUDY:
1. To assess the knowledge on the effect of Hypothyroidism among the adolescent
girls.
2. To evaluate the effectiveness of structural teaching programme on effect of
hypothyroidism among the adolescence girls based on the pre and post test score.
3. To find out the association between post test knowledge scores of the adolescent
girls with their selected demographic variables.
6.5: RESEARCH HYPOTHESIS
H1: There will be significant difference between the pre and post test scores on the effect
of hypothyroidism on PU adolescent girls
H2: There will be significant association between post level knowledge with the selected
demographic variables.
6.6: OPERATIONAL DEFINITION:
ASSESS:
It refers to the statistical measurement of effectiveness of structured teaching programme
on the level of knowledge regarding the effect of hypothyroidism among the adolescent
girls.
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EFFECTIVENESS:
It refers to the quality of being or able to bring an effect or efficient of structured teaching
programme on the level of knowledge or gain more awareness regarding effects of
hypothyroidism.
STRUCTURAL TEACHING PROGRAMME:
It is a systematically planned teaching programme designed to provide information
regarding hypothyroidism among the adolescent girls.
HYPOTHYROIDISM:
Physiological disorder resulting from less secretion of Thyroxin hormone secreted by
Thyroid gland and manifestation of abnormal changes in body function, especially
metabolism and growth.
ADOLOSCENCE:
The period of physical and psychological development from the onset of puberty to
maturity.
PU COLLEGE:
The college providing education to the Pre-university Course, 1st and 2nd years for girls.
6.7: ASSUMPTION:
1) Adolescent girls studying in 1st and 2nd year PU College have some knowledge of
hypothyroidism.
3) Structured teaching programme will enhance the knowledge of PU students regarding
effects of hypothyroidism.
7: MATERIALS AND METHODS:
7.1: SOURCE OF DATA:
Adolescent girls who are studying in the 1st and 2nd years in a PU College at Bangalore
rural Taluk.
7.2: METHOD OF DATA COLLECTION:
The data will be collected by investigator herself by using structured closed-ended
questionnaire.
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7.2.1: RESEARCH DESIGN AND APPROACH:
The quasi experimental design will be used by the investigator for the proposed study
among the pre-university girl students, for the pre and post test approach without control
group.
7.2.2: SETTING:
This study will be conducted in a selected PU College at Bangalore rural Taluk.
7.2.3: POPULATION:
The population of this study will be adolescent girls of PU College at Bangalore rural
Taluk.
7.2.4: SAMPLE SIZE:
Sample size will be 100 students.
7.2.5: SAMPLE PROCEDURE:
Purposive Sampling Technique will be used for the proposed study.
7.2.6: SAMPLING CRITERIA:
INCLUSION CRITERIA:
Students who are,
•
Studying in PU College at Bangalore rural Taluk.
•
Available during the data collection period.
•
Able to understand and speak in kannada and English.
•
Willing to participate.
EXCLUSION CRITERIA:
The students who are not,
•
Studying in PU College at Bangalore rural Taluk.
•
Available during the data collection period.
•
Able to understand and speak in kannada and English.
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•
Willing to participate.
7.2.7: DATA COLLECTION TOOL:
Structured close-ended Questionnaire will be used by the researcher herself to assess the
knowledge regarding effect of hypothyroidism among adolescent girls of PU College at
Bangalore rural Taluk.
The data will be collected in month of March/April 2011.
7.2.8: DATA ANALYSIS METHOD:
1. Appropriate descriptive and inferential statistics will be used for data analysis and
presented in form of tables, graphs and figures etc.
2. The effectiveness of pre and post test scores of knowledge level will be analysed by
Paired 'T' test
3. The significance of the relationship between the selected demographic variables and
knowledge will be analysed by Chi-square test.
7.2.8: DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR
ANIMAL? IF SO, DESCRIBE BRIEFELY.
----- YES ----7.3: HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3
Required ethical clearance will be obtained from the concerned authority before the
main study.
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8.LIST OF REFERRANCES
1. Rose and Wilson Anatomy and Physiology 4th edition Nervous system.
2. http://kidshealth.org/teen/diseases_conditions/growth/thyroid.html
3. American thyroid association 1923,www.thyroid.org
4. Michel
Sachachter MD,F.A.C.A.M The Diagnosis and Treatment of
Hypothyroidism.
5. http://www.thyroid-info.com/articles/menstruation.htm
6. www.wrong diagnosis.com/hypothyroidism/prevalence.htm
7. http://www.e medicine.medscape.com article/122393
8. http://www.metabolism.com/2008/08/23/hypothyroid-benefit-t3-cytomel/
9. The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 8 3122-3127
10. http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=alterna
tive-medicine
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9.
SIGNATURE OF THE
STUDENT
10.
REMRKS OF THE
This research project will be useful for
GUIDE
improving the Knowledge of adolescent girls
regarding effects hypothyroidism. The need
for
study
and
literature
review
is
appropriate to the statement of problem.
Hence, can be approved for undertaking this
study.
11.
NAME AND
Mr.Nagarajappa.D
DESIGNATION OF THE
Principal
GUIDE
S.B. Collage of Nursing
Bangalore-560106
11.1
GUIDE SIGNATURE
11.2
HEAD OF THE
Mr.Nagarajappa.D
DEPARTMENT
Principal
S.B. Collage of Nursing
Bangalore-560106
11.3
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SIGNATURE
REMARKS OF THE
The study is based on health problem of
CHAIRMAN AND
adoloscent girls and the research proposal
PRINCIPAL
approved by the research committee.
Hence ,the study can be conducted
12.1
SIGNATURE
11
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