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Sunday, September 25, 2022

Hypothyroidism: Symptoms, Causes, Diagnosis, Management, Complication Nursing Assessment By Nurses Note


Hypothyroidism is a condition that arises from inadequate amounts of thyroid hormone in the bloodstream.

Pathophysiology and Causes of  Hypothyroidism

1. Primary hypothyroidism is the most common form of this condition and is generally caused by (in order of frequency): 

 a. Autoimmune disease (Hashimoto’s thyroiditis). 

 b. Use of radioactive iodine. 

 c. Destruction, suppression, or removal of all or some of the thyroid tissue by thyroidectomy. 

 d. Dietary iodide deficiency. 

 e. Subacute thyroiditis. 

 f. Lithium therapy. 

 g. Overtreatment with antithyroid drugs. 

 2. Secondary hypothyroidism is caused by inadequate secretion of TSH caused by disease of the pituitary gland (ie, tumor, necrosis, head trauma). 

 3. Inadequate secretion of thyroid hormone leads to a general slowing of all physical and mental processes. 

 4. General depression of most cellular enzyme systems and oxidative processes occurs. 

 5. The metabolic activity of all cells of the body decreases, reducing oxygen consumption, decreasing oxidation of nutrients for energy, and producing less body heat. 

 6. The signs and symptoms of the disorder range from vague, nonspecific complaints that make diagnosis difficult to severe symptoms that may be life-threatening if unrecognized and untreated. 

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 Signs and Symptoms of  Hypothyroidism

 1. Fatigue and lethargy. 

 2. Weight gain. 

 3. Complaints of cold hands and feet. 

 4. Temperature and pulse become subnormal; patient cannot tolerate cold and desires increased room temperature. 

 5. Reduced attention span; impaired short-term memory. 

 6. Severe constipation; decreased peristalsis. 

 7. Generalized appearance of thick, puffy skin; subcutaneous swelling in hands, feet, and eyelids. 

 8. Thinning hair; loss of the lateral one third of eyebrow. 

 9. Menorrhagia or amenorrhea; may have difficulty conceiving or may experience spontaneous abortion; decreased libido. 

 10. Neurologic signs include polyneuropathy, cerebellar ataxia, muscle aches or weakness, clumsiness, prolonged deep tendon reflexes (especially ankle jerk).

11. Hyperlipoproteinemia and hypercholesterolemia. 

 12. Enlarged heart on chest x-ray. 

 13. Increased susceptibility to all hypnotic and sedative drugs and anaesthetic agents. 

 14. Syndrome of subclinical hypothyroidism: state in which the patient is asymptomatic and the free T4 level is within the normal range; however, the TSH level is elevated, suggesting impending thyroid gland failure. Therefore, many clinicians may elect to treat this condition as if the patient were symptomatic.

Diagnostic Evaluation of  Hypothyroidism

 1. Low T3 and T4 levels. 

 2. Elevated TSH levels in primary hypothyroidism. 

 3. Elevation of serum cholesterol. 

 4. Electrocardiogram (ECG)—sinus bradycardia, low voltage of QRS complexes, and flat or inverted T waves. 

 5. Elevation of thyroid peroxidase antibodies and antithyroglobulin antibodies.

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Management of  Hypothyroidism

 1. Depends on severity of symptoms; may necessitate replace ment therapy in mild cases or lifesaving support and treatment in severe hypothyroidism and myxedema coma. 

 2. As thyroid hormone levels gradually return to normal, the patient is monitored closely to prevent complications resulting from sudden increases in metabolic rate and oxygen requirements.

Restoration of Normal Metabolic State (Euthyroid) 

 1. Thyroid hormone: T4 -levothyroxine; T3 -liothyronine; T3 and T4 mixed. T4 replacement therapy is typically the treatment of choice. 

a. Because T3 acts more quickly than T4 , it is given via nasogastric tube if patient is unconscious (myxedema coma). 

b. Sodium levothyroxine is administered parenterally (until consciousness is restored) to restore T4 level. 

c. Later, the patient is continued on oral thyroid hormone therapy. 

d. With rapid administration of thyroid hormone, plasma T4 levels may initiate adrenal insufficiency; hence, steroid therapy may be started. 

e. Mild symptoms in alert patients or asymptomatic cases (with abnormal laboratory results only) require only initiation of low-dose thyroid hormone given orally. 

 2. Monitoring to anticipate treatment effects. 

 a. Diuresis, decreased puffiness. 

 b. Improved reflexes and muscle tone. 

 c. Accelerated pulse rate. 

 d. A slightly higher level of total serum T4 . 

 e. All signs of hypothyroidism should disappear in 3 to 12 weeks. 

 f. Decreasing TSH level.

Complications of  Hypothyroidism

1. Myxedema coma—hypotension, unresponsiveness, bradycardia, hypoventilation, hyponatremia, (possibly) convulsions, hypothermia, cerebral hypoxia. 

2. High mortality in myxedema coma.

Nursing Assessment of  Hypothyroidism

1. Obtain history of symptoms, medication program, and past history of thyroid disease, surgery, or treatment. 

2. Perform multisystem assessment, including cardiac, respiratory, neurologic, and GI systems. 

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