Disorders

of the
Thyroid
Gland
HYPOTHYROIDISM
RESULTS FROM SUBOPTIMAL levels of thyroid
hormone
It affects all body functioning

Most common caused in adults:

HASHIMOTOS DISEASE own thyroid system
attacks its own thyroid gland
occurs most frequently in older women
 95% of hypothyroidism have PRIMARY OR THYROIDAL
hypothyroidism refers to the dysfunction of the
thyroid gland itself

Central hypothyroidism failure of the pituitary

gland, hypothalamus or both

PITUITARY or secondary hypothyroidism if the cause

is entirely the pituitary gland

HYPOTHALAMIC or tertiary hypothyroidism caused

by inadequate secretion of the hypothalamus to
secret TSH due to decrease stimulation of TRH
 If thyroid deficiency is present at birth
CRETINISM the mother also may have
thyroid deficiency

MYXEDEMA refers to the accumulation of

mucopolysaccharides in subcutaneous and
other interstitial tissues
occurs in long standing hypothyroidism
and is used to describe the extreme
symptoms of hypothyroidism
Clinical manifestations
Extreme fatigue difficult to complete a full
days work; participate in usual activities
Hair loss
Brittle nails
Dry skin
Numbness and tingling of the fingers may
occur
Voice may become husky; complain of
hoarness
Menstrual disturbances menorrhagia,
amenorrhea
Loss of libido
 WOMEN 5x more frequently than men and occurs
most often at ages 30-60

SEVERE HYPTHYROIDISM

RESULTS IN subnormal temperature and pulse rate

Pt. begins to gain weight even without an increase

in food intake;he /she maybe cachectic

Skin is thickened; hair thins and falls out; becomes

expressionless and masklike and apathetic

COMPLAINS OF BEING COLD EVEN IN A WARM

ENVIRONMENT
 SPEECH IS SLOW
tongue enlargement
hands and feet increase in size
Frequent complains of constipation
ADVANCED
HYPOTHYROIDISM
MAY PRODUCE PERSONALITY AND
COGNITIVE CHANGES cha of
dementia
Inadequate ventilation and sleep apnea

Pleural effusion

pericardial effusion

Respiratory muscle weakness

Associated with elevated serum

cholesterol level , atherosclerosis,

coronary artery disease and poor left
ventricular function
 HYPOTHERMIC
ABNORMALLY sensitive to

sedatives, opioids and

anesthetics agents
administered with EXTREME
CAUTION
MYXEDEMA
Describes the most extreme severe
stage of hypothyroidism
PT is HYPOTHERMIC and

UNCONSCIOUS
Respiratory drive is depressed

alveolar hypoventilation
Carbon dioxide retention
Coma

* needs vigorous therapy is pt. can

survive mortality rate is high
Nursing alert:
In all patients with hypothyroidism,
the effects of analgesic agents ,
sedatives and anesthetics agents are
prolonged adm. with caution in
administering to elderly
concurrent changes to liver and
renal function
Pharmacologic therapy
1. Synthetic levothyroxine
( Synthroid or levothroid )
Preferred preparation for treating

hypothyroidism and suppressing

nontoxic goiters
Dosage depends on pts serum TSH

concentration
2. DESSICATED thyroid used
infrequently often results with
transient elevated serum
concentrations
 3. Hormone replacement
therapy if adequate the
symptoms of edema disappear and
normal metabolic activity is
resume
Nursing alert
The nurse must monitor for
myocardial ischemia or infarction,
which can occur in response to
therapy in patients with severe long
standing hypothyroidism and
myxedema.

The nurse must alert for signs of

angina, especially during the early
phase of treatment , if detected , it
must be reported and treated at once
to avoid a fatal myocardial infarction.
 Prevention of medication
interaction
Thyroid hormones

1. increases blood sugar level

(adjust dosage of insulin and oral
hypoglycemics)
2. maybe increase by Phenytoin
(dilantin) and tricyclic antidepressants
3. increase pharmacologic effect of
digitalis glycosides,anticoagulant
agents,endomethacin careful
observations and assessment is needed
Supportive therapy
1. maintaining vital functions
2. ABG to determine carbon dioxide
retention; aid in the use of assisted
ventilation
3. Pulse oximetry measure oxygen
saturation levels
4. fluids are administered cautiously fluid
intoxication
5. avoid application of external heat pads
(increase oxygen requirements leads to
vascular collapse
6. if myxedema have progressed to
myxedema coma (levothyroxine 1 st per IV
until consciousness is regained continued
with oral thyroid hormone therapy
Modifying activity
Decreased in energy to severe
lethargy complication of
immobility

Role of a nurse: assist with care

and hygiene while encouraging
the patient to participate in
activities within establish
tolerance level
Enhancing physical comfort
Due to emotional reactions
and changes in appearance
Might suffer depression

Mgt: pt. and family may

require assistance and
counselling to deal with the
emotional concerns and
reactions
Continuing care:
Promote adherence to the
prescribed treatment plan

MGT:
1.nurse should help client revised a

schedule a schedule or record ensures

accurate and complete administration
of medications

2. nurse reinforces the importance of

continued thyroid replacement and
periodic follow up testing about the
signs of overmedication and
undermedication
GERONTOLIC CONSIDERATIONS
Most affected are ages of 40-70 yrs. old
Symptoms are attributed to the normal
aging process
Screening of TSH levels are recommended;
periodic monitoring is important due to
poor compliance with therapy
Recommended treatment: hormone
replacement due to altered immune
function
Medications may be continued for life
(though symptoms diasappears within 3-
12 weeks)
Nursing interventions
C/O Students
HYPERTHYROIDISM
-SECOND most prevalent endocrine disorder

-most common type GRAVES disease due to

excessive output of thyroid hormones caused
by abnormal stimulation of the thyroid gland

- Affects women 8x more than men

- CAUSES: thyroiditis and excessive ingestion

of thyroid hormone
CLINICAL
MANIFESTATIONS
Patients
exhibits group of signs and symptoms called:
THYROTOXICOSIS
Presenting symptom: NERVOUSNESS
Other symptoms:
1. Hyperexcitability
2. Irritable
3. Apprehensive
4. They cannot sit quietly
5. Palpitations
6. Rapid pulse( at rests and exertion)
7. Flushed skin-salmon color
8. Dry skin and pruritus
9. Fine tremor of the hands
10.EXOPTHALMOS
CONT.
Other s/sx
Increase appetite and dietary intake
Progressive weight loss
Abnormal muscular fatigability and weakness (e.g. difficult
climbing the stairs and rising from a
chair)
Amenorrhea
Changes in bowel functions
Pulse rate- 90 to 10 beats per minute
Atrial fibrillation
Cardiac decompensation heart failure (elderly clients)
Osteoporosis ( premature osteoporosis in women) and
fracture may occur
ASSESSMENT AND DX
FINDINGS
Thyroid gland is enlarged, some extend soft and may pulsate

A thrill often can be palpated and bruite is heard over the

thyroid arteries

A decrease in serum TSH

Increased free T4

Increase radioactive iodine uptake

MANAGEMENT
COMBINATION OF therapy:
1.Antithyroid agents- to interfere with the synthesis of
thyroid hormone
COMMON: PROPHYTHIOURACIL (PTU) and
METHIMAZOLE(Tapazole)
**BLOCKS EXTRATHYROIDAL CONVERSION OF T4 to T3
** gradual withdrawal of the medication should be observed

2.Radioactive iodine- thru irradiation

Goal: to destroy the overactive thyroid cells
**observed of signs of THYROID STORM
**client is monitored closely until euthyroid state is reached

3.Surgery
Overall GOAL of mgt : To reduce thyroid hyperactivity
THYROID STORM
(THYROTOXIC CRISIS)
A form of severe hyperthyroidism
usually of abrupt onset

UNTREATED: fatal but with

proper treatment mortality rate is
reduced
It is usually precipitated by :
Stress
Injury
Infection
Insulin reaction
Diabetic ketoacidosis
Abrupt withdrawal of antithyroid
medication
Extreme emotional stress
Vigorous palpation of the thyroid
Potassium iodide-suppress thyroid hormone (discontinue rash)
Sodium iodine-suppress (watch for edema, hemorrhage, gastrointestinal upset
HYPOTHYROIDISM DUE TO EXCESS
ANTITHYROID MEDICATION ARE
ADMINISTERED with the following drugs to
void stimulation of the thyroid gland by the
TSH:

LIOTHYROXINE SODIUM ( Synthroid )

LIOTHYRONINE SODIUM ( Cytomel )
GERONTOLOGIC
CONSIDERATIONS
60 years old accounts for 10%- 15 % of cases

Presenting manifestations:
Anorexia
Weight loss
Absence of ocular signs
Isolated fibrillation
Changes in bowel
May report cardiovascular symptoms
Difficulty climbing the stairs
NURSING PROCESS
c/o students