Download Hypothyroidism

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Also referred to as underactive thyroid
◦ More common in women
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Hypothyroidism
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Thyroid Gland
◦ Consist of 2 lobes and an isthmus
Occurs when the thyroid gland fails to
produce a sufficient amount of thyroid
hormone
◦ T3 (triiodothyronine) and T4 (thyroxine)
◦ Resulting in an overall decrease in metabolism
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Thyroid gland is a high vascular organ
Function is to produce T3 and T4
T4 is believed to be the precursor of T3 which
is the active hormone.
Iodine is necessary for synthesis of T3
◦ 90% of the thyroid released from the thyroid gland
is T4
◦ T4 is converted to T3 the active hormone
x T4 molecule has 4 atoms of iodine
x T3 molecule has 3 atoms of iodine
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Most severe form of hypothyroidism
If untreated/ignored can lead to myxedema
coma
Signs/Symptoms
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As disease progresses
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Mask like expressions
Puffy eyelids
Hair loss of the eyebrows
Thick lips and broad tongue
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◦ Babies born w/out thyroid gland
◦ Thyroid gland does not work properly
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Signs and Symptoms
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Trouble feeding
Fail to grow and develop normally
Constipation
Poor muscle tone
Excessive sleepiness
Yellowing of skin and whites of the eyes
Frequent choking
A large, protruding tongue
Puffy appearance to face
Collect patient history
◦ Look for:
x Hx of thyroid disease
x Other autoimmune diseases/disorders
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If hypothyroidism in infants is left untreated
it can lead to severe physical and mental
retardation
Coarse Hair and alopecia
Cold intolerance
Constipation
Decreased Diaphoresis
Dry, flaky skin
Thinning of the nails
Edema
Fatigue
Hypothermia
Not common
Cases of hypothyroidism in infants
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Type 1 diabetes mellitus
Addisons disease
Vitiligo
Pernicious anemia (Vit. B12 deficiency)
Menstrual Disorders
Mental Sluggishness
Weight Gain or anorexia
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Constant stimulation of your thyroid to
release more hormones may lead to an
enlarged thyroid
If left untreated symptoms can gradually
become more severe
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Hashimoto’s Thyroiditis
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Malfunction of the Pituitary Gland
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Overuse of anti-thyroid drugs
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Thyroidectomy
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Use of radioactive iodine
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Primary Objective
◦ In the management of hypothyroidism it is to
restore a normal metabolic state by replacing the
missing hormone
x T3 and T4
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Blood Chemistry
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Normal levels
◦ Decrease in T3, T4 and sodium levels
◦ Increase of TSH and cholesterol levels
◦ Radioactive Iodine Uptake (RAIU) is decreased
◦ T3
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◦ T4
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◦ TSH
x Adult 0.4-4.2 uU/mL
x Children 0.7-6.4 uU/mL
x Neonates (1-4 days) 1-39 uU/mL
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T3
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T4
Adults 80-200 ng/dL
Adolescents (12-23) 82-213 ng/dL
Children (1-14) 105-245 ng/dL
Pregnancy 116-247 ng/dL
Adults 4.5-11.5 ug/dL
Children 6.4-13.3 ug/dL
Neonates 11.8-22.6 ug/dL
◦ <50 ng/dL or >300 ng/dL
◦ >20 ug/dL or Thyroid storm is possible
◦ <2.0 ug/dL Myxedema Coma is possible
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TSH
◦ Values <0.1 mU/L are an indication of primary
hypothyroidism or exogenous thyrotoxicosis. Risk
exists for atrial fibrilation at TSH levels of <0.1
mU/L (major risk factor for stroke)
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Radioactive Iodine Uptake Test
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Available in capsule of liquid form
◦ Measures the ability of the gland to concentrate and retain
iodine
◦ When iodine is administered it is rapidly absorbed into to
blood stream
◦ Measures the rate of accumulation , incorporation, and
release of iodine by the thyroid
◦ Test is done in conjunction with imaging and assessment of
thyroid blood levels
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Pharmacological
◦ Synthetic Levothyroxine (Synthroid or Levothroid)
x Preferred treatment
x Dosage depends on patients serum TSH concentration
x Suppression of nontoxic goiters
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Activity Intolerance r/t fatigue and depressed
cognitive process
Risk for imbalanced body temperature
Constipation r/t depressed gastrointestinal
function
Deficit knowledge about the therapeutic regimen
for lifelong thyroid replacement therapy
Ineffective breathing pattern r/t depressed
ventilation
Disturbed thought process r/t depressed
metabolism, altered cardiovascular and respiratory
status
Increase participation in activities and
increase independence
Maintenance of normal body temperature
Return of normal bowel function
Knowledge and acceptance of the prescribed
therapeutic regimen
Absence of complications
True or False?
If hypothyroidism is left untreated it can lead
to myxedema.
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Administer medications as ordered to maintain or improve
patients condition
Encourage physical activity and mental stimulation to enhance
self-esteem
Provide a warm environment to promote comfort.
◦ Patient may be sensitive to cold
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Provide extra blankets and clothing
Educate on the importance of not using electrical blankets or
heating pads when at home
Provide frequent rest periods
Check for constipation and edema
Monitor and record VS
Avoid sedation administer ½-1/3 normal dose of opioids
What are the two types of hypothyroidism?
A) Hyper and Hypo
B) Underactive and Active
C) Primary and Secondary
What would be some signs and symptoms of
hypothyroidism?
A) Dry flaky skin, sensitivity to cold
B) Coarse hair, constipation
C) Fatigue and edema
D) All of the above
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True or False Hashimoto’s Disease is an
autoimmune disease?
Fischbach, F. (2009). A Manual of Laboratoty and Diagnostic
Tests (8 ed.). Philadelphia: Lippincott Williams & Wilkins.
Hurd, R. (2006, may 12, 2006). Medical EncyclopediaHypothyroidism. Retrieved March 10, 2009,
www.nlm..nih.gov/medineplus/ency/imagepage
Lipincott (2005). NCLEX-RN Review (4 ed.). USA: Lipincott
Williams & Wilkins.
Meek, A. (2009, March 10, 2009). Endocrine Powerpoint notes.
Retrieved March 10, 2009,
Smeltzer, S. C. (2008). Brunner & Suddarth's Textbook of
Medical-Surgical Nursing. (11 ed.). Philadelphia: Lippincott
Williams & Wilkins.
Sprinhouse (2000). Medical Surgical Nursing (2 ed.). USA:
Springhouse.
Staff, M. C. (2008, June 12, 2008). Hypothyroidism (underactive
thyroid). Retrieved March 09, 2009,
www.mayoclinic.com/hypothyroidism/DS00353
Lab values for hypothyroidism will be…..
A) A decrease in T3, T4 and sodium levels
B) Increase of TSH and cholesterol levels
C) Radioactive Iodine Uptake (RAIU) is decreased
D) All of the above