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` Also referred to as underactive thyroid ◦ More common in women ` Hypothyroidism ` 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 ` ` ` ` 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 ` ` ` Most severe form of hypothyroidism If untreated/ignored can lead to myxedema coma Signs/Symptoms ◦ ◦ ◦ ◦ ` As disease progresses ◦ ◦ ◦ ◦ ◦ ` ` ` ` ` ` ` ` ` ` Mask like expressions Puffy eyelids Hair loss of the eyebrows Thick lips and broad tongue ` ` ◦ Babies born w/out thyroid gland ◦ Thyroid gland does not work properly ` Signs and Symptoms ◦ ◦ ◦ ◦ ` 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 x x x x 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 ` ` ` Type 1 diabetes mellitus Addisons disease Vitiligo Pernicious anemia (Vit. B12 deficiency) Menstrual Disorders Mental Sluggishness Weight Gain or anorexia ` ` Constant stimulation of your thyroid to release more hormones may lead to an enlarged thyroid If left untreated symptoms can gradually become more severe ` Hashimoto’s Thyroiditis ` Malfunction of the Pituitary Gland ` Overuse of anti-thyroid drugs ` Thyroidectomy ` Use of radioactive iodine ` Primary Objective ◦ In the management of hypothyroidism it is to restore a normal metabolic state by replacing the missing hormone x T3 and T4 ` Blood Chemistry ` Normal levels ◦ Decrease in T3, T4 and sodium levels ◦ Increase of TSH and cholesterol levels ◦ Radioactive Iodine Uptake (RAIU) is decreased ◦ T3 x x x x ◦ T4 x x x ◦ 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 ` T3 ` 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 ` 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) ` Radioactive Iodine Uptake Test ` 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 ` Pharmacological ◦ Synthetic Levothyroxine (Synthroid or Levothroid) x Preferred treatment x Dosage depends on patients serum TSH concentration x Suppression of nontoxic goiters ` ` ` ` ` ` ` ` ` ` ` ` ` 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. ` ` ` 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 ` ` ` ` ` ` ` ` ` ` ` ` ` ` ` 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 ` ` ` ` ` ` ` ` 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