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T3: Thyroid

Hypothyroidism

QuestionAnswer
A deficiency of thyroid hormone that causes general slowing of the metabolic rate. hypothyroidism
Classifications of hypothyroidism primary hypothyroidism and secondary hypothyroidism
Is caused by destruction of thyroid tissue or defective hormone synthesis. primary hypothyroidism
Is caused by pituitary disease with decreased TSH secretion or hypothalamic dysfunction w/decreased thyrotropin-releasing hormone (TRH) secretion. secondary hypothyroidism
Hypothyroidism may also be transient and related to what? Thyroiditis or discontinuance of thyroid hormone therapy.
What is the most common cause of hypothyroidism worldwide? iodine deficiency
What is the most common cause of primary hypothyroidism in the U.S.? atrophy of the thyroid gland
In hypothyroidism, atrophy of the thyroid gland is the end result of what? Hashimoto's thyroiditis or Graves' disease - these autoimmune disease destroy the thyroid gland
Hypothyroidism may also develop as a result of what treatment? Treatment for hyperthyroidism specifically the surgical removal of the thyroid gland or RAI therapy.
What drugs can cause hypothyroidism? amiodarone (Cordarone) contains iodine and lithium which blocks hormone production
What is it called when hypothyroidism develops in infancy causing thyroid hormone deficiencies during fetal or early neonatal life. cretinism
Hypothyroidism has systemic effects characterized by what? a slowing of body processes
Manifestations can vary depending on what? The severity and the duration of thyroid deficiency, as well as the patient's age at the onset of the deficiency.
The onset of symptoms may occur over months to years unless hypothyroidism occurs after what? A thyroidectomy, thyroid ablation, or during treatment with antithyroid drugs.
CM of hypothyroidism Dec. cardiac contractility & CO; angina, HF, MI; anemia; cobalamin, iron, folate deficiencies causing easy bruising; inc serum cholesterol & triglycerides; low exercise tolerance, SOB on exertion; fatigue, lethargy, impaired memory, mental changes
Hypothyroidism is associated w/decreased cardiac contractility and decreased cardiac output, so the patient may experience what? low exercise tolerance and SOB on exertion
Anemia is a common feature of hypothyroidism. What occurs with erythropoietin levels and oxygen demand? Erythropoietin levels may be low or normal. Because the metabolic rate is lower, oxygen demand is reduced.
Increased serum cholesterol and triglyceride levels and the accumulation of mucopolysaccharides in the intima of small blood vessels can result in what? coronary atherosclerosis
What occurs with the respiratory system in hypothyroidism? Low exercise tolerance and SOB on exertion
What occurs with the neurologic system in hypothyroidism? Pt is often fatigued, lethargic, have personality/mental changes including impaired memory, slowed speech, dec. initiative, & somnolence (appear sleepy/drowsy), appear depressed
CM of the GI system in hypothyroidism Decreased appetitie, N/V, weight gain, constipation, distended abdomen, enlarged, scaly tongue, Celiac disease
CM of the Integumentary system in hypothyroidism Dry, thick, inelastic, cold skin; thick, brittle nails; dry, sparse, coarse hair; poor turgor of mucosa; generalized interstitial edema; puffy face; decreased sweating; pallor
CM of the Musculoskeletal system in hypothyroidism fatigue, weakness; muscular aches & pains; slow movements; arthralgia
CM of the Reproductive System in hypothyroidism Prolonged menstrual periods or amenorrhea; decreased libido, infertility
Other CM of hypothyroidism Increased susceptibility to infection; increased sensitivity to opioids, barbiturates, anesthesai; intolerance to cold; decreased hearing; sleepiness; goiter
Patients with severe long-standing hypothyroidism may display this type of physical appearance of the skin and subcutaneous tissues. myxedema
Due to the accumulation of hydrophilic mucopolysaccarides in the dermis and other tissues. myxedema
What does myxedema cause? Puffiness, facial and periorbital edema, and a masklike affect
What is myxedema coma? A medical emergency due to the mental sluggishness, drowsiness, & lethargy of hypothyroidism it may progress gradually or suddenly to a notable impairment of consciousness or coma.
What can cause myxedema coma? Infection, drugs (especially opioids, tranquilizers, & barbiturates), exposure to cold, & trauma
What are the characteristics of myxedema? subnormal temperature, hypotension, & hypoventilation
In myxedema coma, cardivascular collapse can result from what? hypoventilation, hyponatremia, hypoglycemia, and lactic acidosis
What must be done for a patient to survive a myxedema coma? Vital functions must be supported, and IV thyroid hormone replacement must be administered.
What are the most common and reliabel lab tests for thyroid function? TSH & free T4
TSH and free T4 values correlated with this can confirm the diagnosis of hypothyroidism. Symptoms gathered from the history and physical examination
Serum TSH levels help to determine what in hypothyroidism? the cause of
When serum TSH is high, then the defect is in the what? the thyroid
When serum TSH is low then the defect is in the what? the pituitary or hypothalamus
The presence these suggests an autoimmune origin of the hyothyroidism. thyroid antibodies
What are some abnormal lab findings in hypothyroidism? Increased cholesterol, increased triglycerides, increased creatine kinase, decreased RBCs (anemia)
What is the treatment goal for a patient with hypothyroidism? Restoration of a euthyroid state as safely and rapidly as possible with hormone therapy.
What type of diet should patients with hypothyroidism have? A low calorie diet to promote weight loss or prevent weight gain.
What is the drug of choice to treat hypothyroidism? levothyroxine (Synthroid)
When thyroid hormone therapy is initiated (levothyroxine), why is it important that the initial dosages are low? To avoid increases in resting heart rate and blood pressure.
In a young and otherwise healthy patient, the maintenance replacement dose of levothyroxine is adjusted according to what? the patient's response and lab findings
In a hypothyroidism patient w/compromised cardiac status, what should you monitor for? Monitor for cadiovascular SE (chest pain, dysrhythmias), weight loss, nervousness, tremors, insomnia; monitor HR, report pulse >100 bpm or an irregular beat.
Hypothyroidism patients with compromised cardiac status need to be carefully monitored when the dosage is started and adjusted. Why? The usual dose may increase myocardial oxygen demand. The increased oxygen demand may cause angina and cardiac dysrhthmias.
In a patient with no side effects from the levothyroxine therapy, what should be done to the dose at 4-6 week intervals? increased
It is important that the patient regularly take replacement medication because what is usually required? lifelong thyroid therapy
When assessing a patient with hypothyroidism what important information from the patient's health history should be obtained? Previous hx of hyperthyroidism & tx w/antithyroid medications, radioactive iodine, or surgery. Ask the pt about prescribed iodine containing meds & changes in appetite, weight, activity level, speech, memory, & skin such as inc. dryness or thickening.
During the physical examination of a patient suspected of hypothyroidism what should you assess? Assess for cold intolerance, constipation, and signs of depression. Assess HR, tenderness over the thyroid gland, and edema in the extremities and face.
Most individuals w/hypothyroidism are treated on an outpatient basis except for the patients that develop this. What kind of care would these patients need? Myxedema coma pts would require acute nursing care often in an ICU setting.
What are some nursing interventions for myxedema coma? Mechanical resp. support & cardiac monitoring are freq. necessary. Administer thyroid hormone therapy & all other meds IV b/c ileus may be present. Monitor the core temp. b/c hypothermia often occurs.
What are some acute interventions for hypothyroidism? skin care: use soap gently, moisturize freq. to prevent skin brkdwn., frq changes in position & low pressure mattress; Monitor vitals, weight, I&O, edema; cardiovascular response to hormone; energy levels; mental alertness
These are used to determine continuing levothyroxine treatment. the patient's neurologic status and free T4 levels
When should thyroid hormones be taken? in the morning before food
Patient teaching for hypothyroidism Regular f/u care; don't switch brands of hormones; comfortable, warm environment; measures to prevent skin breakdown; emphasize need for warm environment; avoid seadtives or use lowest dose; measures to minimize constipation, avoid enemas
If sedatives must be used, the lowest dose possible should be given. What should the caregiver closely monitor? mental status, LOC, and respirations
What suggestions would you give a patient to help minimize constipation? Gradual increase in activity and exercise. Increased fiber in diet. Use of stool softeners. Regular bowel elimination time.
Why should the patient avoid using enemas? They produce vagal stimulation which can be hazardous if cardiac disease is present.
What are the expected outcomes for hypothyroidism? Have relief from symptoms. Maintain a euthyroid states AEB normal thyroid hormone & TSH levels. Avoid complications. Adhere to lifelong therapy.
Created by: eblanc1