HYPOTHYROIDISM

HYPOTHYRIODISM
Results from suboptimal levels of thyroid hormone.
Commonly occurs in patients with previous

hyperthyroidism that has been treated with radioiodine or anti-thyroid medications or thyroidectomy.

*The most common cause of hypothyroidism in adults is autoimmune thyroiditis (Hashimotos disease), in which the immune system attacks the thyroid gland.

CAUSES:
Autoimmune disease (Hashimotos thyroiditis, post-Graves

disease)

Atrophy of thyroid gland with aging therapy for

hyperthyroidism Radioactive iodine (131I)

Thyroidectomy

Medications
Lithium Iodine compounds

Anti-thyroid medications
Radiation to head and neck for treatment of head and neck cancers,

lymphoma

Infiltrative diseases of the thyroid (amyloidosis, scleroderma,

lymphoma)

Iodine deficiency and iodine excess

TYPES:
itself.

1. primary or thyroidal hypothyroidism -which refers to dysfunction of the thyroid gland

2. central hypothyroidism
-the cause of the thyroid dysfunction is failure of the pituitary gland, the hypothalamus, or both 3. pituitary or secondary hypothyroidism -If the cause is entirely a pituitary disorder 4. hypothalamic or tertiary hypothyroidism - If the cause is a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation of TRH 5. Cretinism -thyroid deficiency present at birth

CLINICAL MANIFESTATION
Extreme fatigue Hair loss Brittle nails Dry skin Numbness &tingling of fingers

Husky/hoarse voice
Menstrual disturbances Loss of libido

Severe hypothyroidism:
-results in subnormal body temperature and pulse rate Associated with: Elevated serum cholesterol level Atherosclerosis Coronary artery disease Poor left ventricular function Weight gain Enlarge tongue
Thickened skin Enlarge hands and feet

Thin hair
Expression less face Irritable Slow speech

Deafness
Constipation Cold feeling

Advanced hypothyroidism
Characteristics of dementia
Inadequate ventilation Sleep apnea Pleural effusion Peroicardial effusion Respiratory muscle weakness

Hypothermic
Sensitive to sedatives, opioids, analgesic agents

MYXEDEMA COMA
-refers to the accumulation of mucopolysaccharides in subcutaneous and other interstitial tissues -occurs in long-standing hypothyroidism -common in elderly women

-common in cold weather

-may develop with:
Undiagnosed hypothyroidism

Infection
Systemic disease Use of sedative, opioid analgesic

SIGNS AND SYMPTOMS:

Depression Progressive carbon

Diminished cognitive

dioxide retention

status

Narcosis Coma Cardiovascular collapse shock

Lethargy Somnolence Respiratory drive

depressed

MEDICAL MANAGEMENT:
SYNTHETIC LEVOTHYROXINE (SYNTHOID/LEVOTHROID)
-treatment for hypothyroidism and suppressing nontoxic goiter DESICATED THYROID -elevated thyroid hormones T3

OTHER MANAGEMENT:
PREVENTION FOR CARDIAC DYSFUNCTION
-elevated serum cholesterol -atherosclerosis

-coronary artery disease

SUPPORTIVE THERAPY
Maintaining vital functions
Monitoring fluid administration Avoidance of external heat

Managing hypoglycemia
Medications

NURSING MANAGEMENT