Hypothyroidism

PATHOPHYSIOLOGY
Hypothyroidism: A deficiency of thyroid hormone 💥Two main causes of hypothryoidism

Clinical Manifestations by system:


Reproductive:

  • decreased libido
  • menorrhagia
  • erectile dysfunction
  • low total hormone values

Cardiovascular:

  • lowered cardiac output
  • increased peripheral vascular resistance
  • decreased intensity of heart sounds and variety of ECG changes
  • subnormal pulse rate

Pulmonary:

  • dyspnea
  • myxedemematous changes in respiratory muscles

Renal:

  • decreased renal excretion of water
  • increase in total body water and dilution hyponatremia
  • reduced production in erythropoietin

Gastrointestinal:

  • constipation
  • weight gain

Diagnostic, Medical and Pharmacologic Management

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Medical Management

Diagnostic

💥 Hashimoto Disease
(autoimmune thyroid disease)

💥 Iodine Deficiency Hypothyroidism

🏴most common form in the U.S. and other areas of adequate iodine intake.

🏴Hypothyroidism is
commonly noted in older women because of the prevalence of
autoimmune thyroiditis.

🚩remains the foremost cause worldwide
🚩Iodine is an element that is needed for the production of thyroid hormone
🚩The body does not make iodine, so it is an essential part of your diet. Iodine is found in various foods

⚠Severe form of hypothyroidism = Myxedema coma

⚠ Can develop in individuals with undiagnosed or untreated hypothyroidism who are subjected to an external stress

WHAT IS THE THYROID?
🖊the thyroid is a butterfly-shaped gland
🖊 located in the front of the neck just above the trachea

🔓produces and releases two potent hormones
✅ thyroxine (T4)
✅ triiodothyronine (T3)

Musculoskeletal:

  • muscle and joint aches and stiffness
  • decreased bone formation and resorption
  • increased bone density
  • fatigue

Endocrine:

  • increased TSH production
  • decreased rate of cortisol turnover
  • lowered body temperature

Integumentary:

  • dry, thickened, flaky skin
  • thinning and loss of hair
  • slowed nail growth and delayed healing
  • myxedema (cutaneous edema caused by deposition of connective tissue)

Hematologic:

  • decrease in red cell mass leading to anemia
  • inadequate folate or iron absorption in the GI tract

Neurologic:

  • confusion
  • syncope
  • slowed speech and emotional responses
  • hearing loss
  • memory loss
  • personality and cognitive changes

Nursing Care

Risks in treatment are associated with overdosing or underdosing, would result in the continuation of hypothyroidism and over dosing could cause hyperthyroidism.

Patients taking this hormone replacement will need their TSH levels checked every 6-10 weeks . The goal of treatment is to keep the patient TSH levels within a therapeutic range

Sign and symptoms of an overdose include, insomnia, increased appetite, shakiness, feeling overheated, shortness of breath, and palpation's

This condition is treated by replacing the missing hormone, Synthetic thyroxine pills are taken to replace the T4 hormone

Patients should seek medical attention if they experience any weight gain or loss, if they miss doses, or experience any hyperthyroid symptoms.

Treatment for Myxedema coma include correction of the electrolyte imbalances, the patient should be monitored on remote telemetry, covered with blankets to prevent hypothermia, along with intravenous thyroid hormone replacement.

❌ T4 is the principal hormone produced
by the thyroid gland and in circulation. Monodeiodination of its outer ring in both the cytoplasm and nucleus of target tissues converts it to T3 by the function of three tissue-specific deiodinases

❌ Deficiency of T3 actions cause hormonal, biochemical, ion-transport, and mechanical
changes in target tissues

🏴a condition in which your immune system attacks your thyroid

Pharmacologic Management

Hormone replacement therapy is the treatment of choice

Levothyroxine (Synthroid or Levothroid)

Diagnosis of primary hypothyroidism is made by documentation of the clinical symptoms of hypothyroidism and measurement of increased levels of TSH and decreased levels of TH

✅Monitor for chest pain, palpitations, and dizziness, especially in older adults and patients with coronary heart disease

✅Monitor T3, T4, and TSH levels and adjust medication dosage accordingly

✅Monitor glucose, weight, and increasing physical and mental energy