1. Hypothyroidism By: Michelle Russell 1

2. 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 2

3. 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 3

4. Pathophysiology o Thyroxine (T-4) &Ttriiodothyronine(T-3) o T-4 converts into T-3 4

5. 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 5

6. 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 6

7. 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… 7

8. A visual recap OVERVIEW: Pathophysiology and Causes 8

9. 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 9

10. Signs and Symptoms Most common o Tiredness and weakness-feeling "run down" o Weight gain or difficulty losing weight o Constipation o Depression o Thinning or brittleness of the hair or nails o Cold intolerance o Sleepiness o Memory loss o Decreased libido o Muscle aches and pains o Hoarse voice Severe o Dryness and thickening of skin o Slowed speech o Altered menstrual cycle o Puffiness in face, hands, feet o Decrease capacity to taste or smell o Jaundice o Increase in tongue size 10

11. 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 11

12. Example Goiter 12

13. 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 13

14. Example Myxedema 14

15. Diagnostic testing o Blood test: TSH, T3, T4 o Thyroid antibody test to detect Hashimoto’s: TgAB o Ultrasound:  Detect nodules, tumors, heterogeneous appearance 15

16. Patient Relevance o 51 years old o Presenting problems:  Stress- new job, different state, cultural differences, newly- wed, 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 16

17. 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”. 17

18. 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 18

19. Outpatient thyroid surgery: Should patients be discharged on the day of their procedures? 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 Article 1 19

20. Assessment and Management of Patients With Hypothyroidism 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 Article 2 20

21. 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 21

22. 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 22

23. 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 23

24. 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 24

25. Works Cited o Berber, E., & Rehan, K. (2011, January 18). endocrineweb. Retrieved from http://www.endocrineweb.com/conditions/hypothyroidism/complications- hypothyroidism http://www.endocrineweb.com/conditions/hypothyr o 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 http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=21&hid=1 o Living with hashimoto's disease. (2009, January 12). Retrieved from http://vitamvas.tripod.com/thyroid.html o Mathur, R. (2011). Medicine.net. Retrieved from http://www.medicinenet.com/myxedema_coma/article.htm http://www.medicinenet.com/myxedema_coma o Mayo Clinic Staff. (2010, June 12). Hypothyroidism underactive thyroid. Retrieved from http://www.mayoclinic.com/health/hypothyroidi sm/DS00353/DSECTION=symptomshttp://www.mayoclinic.com/health/hypothyroidi o Medicine.net. (n.d.). medicinenet.com. Retrieved from http://www.medicinenet.com/hashimotos_thyroiditis/article.htm http://www.medicinenet.com/hashimotos_thyroiditis/article.htm o 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 http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=18&hid=1 o WebMD. (2010, June). Webmd. Retrieved from http://www.webmd.com/a-to-z- guides/thyroid-hormone-testshttp://www.webmd.com/a-to-z- guides/thyroid- 25

26. Questions? 26