Download Hypothyroidism

Hypothyroidism
By: Michelle Russell
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Objectives
o To understand hypothyroidism and how it effects
the body
• Causes
• Signs/ symptoms
o Become familiar with current treatment and nursing
interventions
o Develop appropriate nursing diagnoses
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What is Hypothyroidism?
o Occurs when the
thyroid gland doesn’t
produce enough
thyroid hormone (T-3,
T-4)
o State of metabolic slow
down
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Pathophysiology
oThyroxine (T-4)
&Ttriiodothyronine(T-3)
oT-4 converts into T-3
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Primary causes
o Hashimoto’s disease
• Autoimmune disorder usually with a genetic
component
• Antibodies are attacking the thyroid gland
• 80% of all cases- most common cause
o Other- cancer, nodules, infection, pregnancy,
congenital disease (1 in 3,000 babies),
thyroidectomy
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Other causes
o secondary (5% of cases)
 Failure of the Pituitary gland to produce enough TSH
o Tertiary
 Failure of the Hypothalamus to make TRH
o BOTH are usually caused by tumors and are rare
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Iodine deficiency- cause
o Iodine is needed to synthesize T4 and T3
o Iodine deficiency is most common cause in
developing countries
 Its not a problem in the U.S. because it is included in our
salt!
 But stay aware…
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A visual recap
OVERVIEW: Pathophysiology
and Causes
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Epidemiology
o Most common in women
 between 30-50 years of age
o Approximately 10% of ALL adults have evidence of
Hashimoto’s disease
 Hashimoto’s is more prevalent in white females
 20% of cases are inherited with a autosomal recessive
pattern
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Signs and Symptoms
Most common
o Tiredness and weakness-feeling
o
o
o
o
o
o
o
o
o
o
"run down"
Weight gain or difficulty losing
weight
Constipation
Depression
Thinning or brittleness of the hair
or nails
Cold intolerance
Sleepiness
Memory loss
Decreased libido
Muscle aches and pains
Hoarse voice
Severe
o Dryness and thickening of
o
o
o
o
o
o
skin
Slowed speech
Altered menstrual cycle
Puffiness in face, hands,
feet
Decrease capacity to taste
or smell
Jaundice
Increase in tongue size
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Complications
o Goiter
 Enlargement of the thyroid gland
o Thyroid cancer and nodules
o Heart disorders
 Higher risk for developing heart disease, atherosclerosis,
heart attack, and stroke
o Infertility
 Affect ovulation and decrease chances of conceiving
o Mental status
 Depression- usually when left untreated
 May lead to dementia
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Example
Goiter
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Myxedema
o Rare and life threatening (50% mortality rate)
o May cause a coma
 Not enough thyroid hormone, your body cannot utilize
glucose
o Symptoms
 Similar to hypothyroidism but EXTREME
 Edema- swelling around the eyes, body and thickening of
the tongue (heavy mushy skin)
o Triggors- infections, stroke, trauma, heart failure,
GI bleeding, hypothermia
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Example
Myxedema
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Diagnostic testing
o Blood test: TSH, T3, T4
o Thyroid antibody test to detect Hashimoto’s: TgAB
o Ultrasound:
 Detect nodules, tumors, heterogeneous appearance
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Patient Relevance
o 51 years old
o Presenting problems:
 Stress- new job, different state, cultural differences, newlywed, small income
 Started developing symptoms which she contributed to stress
 Life gradually settled, but symptoms did not disappear
o Symptoms:
 Cognitive- concentration, memory, focusing difficulties,
tiredness, fatigue
 Goiter
o Diagnosis: Hashimoto’s Thyroiditis
o Treatment: Armour Thyroid
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Subjective information
o “I am usually very tired even after getting up in the
morning”.
o “Trying to stay awake during lectures, meetings,
and movies is very difficult”.
o “I am very busy/active while teaching, and I have
no problem staying awake. But once my kids go to
bed I have difficulty concentrating, staying awake,
and getting paperwork done”.
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Nursing Interventions/
Assessment
o Give Synthroid (Levothyroxine) at least 30 min.
before breakfast!
 Typically done on night shift as a 6am med.
o Physical exam
o Palpate thyroid gland
o Assess for paleness, puffiness or lack of facial expression
o Skin & hair may be dry
o Monitor vitals/ Labs
o Slowed HR and RR; EKG may eventually be done
o Patient education
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Outpatient thyroid surgery:
Should patients be
discharged on the day of their
procedures?
Article 1
o Yes, with appropriate Interventions…
o Nursing Interventions
o Patient education
o Verbal and written instructions
o Signs and symptoms of complications
o Counseling with pamphlet
o Follow up telephone call the next day from the Nurse
o Thyroidectomies- prescription for calcium replacement to prevent
Hypocalcemia
o Follow up visit two weeks after surgery
o 99.6% of patients were discharged as planned with only
1.7% readmitted
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Assessment and
Management of Patients
With Hypothyroidism
Article 2
o Nursing Interventions:
o Start with comprehensive history- Symptoms
o Be aware of Hypothyroid symptoms in order to
formulate questions
o Underactive Thyroid-Dependent Quality of Life
Questionnaire (ThyDQoL)
o Pregnancy- *** Need to have an increase in
medication dose
o Myxedema- IV bolus T3 Q8H
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Are there gaps between
research and practice?
o Absolutely!
o Not enough patient education
o Never a thorough assessment
o Synthroid is sometimes not given enough time
before breakfast
o CAUSES- Nurse shortage and too many patients
for one Nurse to care for
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Prognosis
o Generally pretty well if continue to have follow up
visits, frequent monitoring, and medication
compliance
o Patient from the article:
o She continues to experience symptoms
o But they have gotten better since she started supplementation
o But has learned to manage/ cope with them
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Nursing Diagnosis
o Activity intolerance R/T disease status AEB
Verbalization of lack of energy, tiredness, and
weakness
o Others:
o Constipation
o Low self esteem
o Fatigue
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Conclusion
o This is a common condition
o Understand the signs/ symptoms of
hypothyroidism
o Such as cold intolerance, weight gain, tiredness, memory
loss and depression
o Slowed HR and RR
o Causes: Hashimoto Thyroiditis is most common
o Patient education about the illness is needed/
importance of medication compliance
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Works Cited
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Berber, E., & Rehan, K. (2011, January 18).
endocrineweb. Retrieved from
http://www.endocrineweb.com/conditions/hypothyr
oidism/complicationshypothyroidism
Carson, M. (2009). Assessment and management of patients with
hypothyroidism.
Learning Zone, 28(18), 51-55. Retrieved from
http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=21&hid=1
22&sid=8584a050-a8ed-4ac9-b7a7-a1f8e0e5960f%40sessionmgr13
Living with hashimoto's disease. (2009, January 12). Retrieved from
http://vitamvas.tripod.com/thyroid.html
Mathur, R. (2011). Medicine.net. Retrieved from
http://www.medicinenet.com/myxedema_coma
/article.htm
Mayo Clinic Staff. (2010, June 12). Hypothyroidism
underactive thyroid. Retrieved
from http://www.mayoclinic.com/health/hypothyroidi
sm/DS00353/DSECTION=symptoms
Medicine.net. (n.d.). medicinenet.com. Retrieved from
http://www.medicinenet.com/hashimotos_thyroiditis/article.htm
Trottier, D. C., Barron, P., Moonje, V., & Tadros, S. (2009). Outpatient thyroid surgery: Should
patients be discharged on the day of their procedures?. Research, 52(3), 21-25.
Retrieved from
http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=18&hid=1
22&sid=8584a050-a8ed-4ac9-b7a7-a1f8e0e5960f@sessionmgr13
WebMD. (2010, June). Webmd. Retrieved from
http://www.webmd.com/a-to-zguides/thyroidhormone-tests
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Questions?
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