1229 Exam 5: Congenital Hypothyroidism Flashcards
A deficiency of thyroid hormone believed to be present at birth
Infants with Down Syndrome have a much higher rate of this..
May be permanent or transient
Occurs in one in 3,000-4,000 live births
Congenital Hypothryoidism
Clinical Manifestations for Hypo
most appear about 6 months of age
Depressed nasal bridge Short forehead Puffy eyelids Large tongue Thick, dry, mottled skin that feels cold to the touch Course, dry, lusterless hair Hoarse cry Herniated belly button Daily persistent constipation with bloated abdomen Difficulty feeding Minimum crying Excessive sleepiness
The most severe consequence of congenital hypothyroidism is…
Delayed development of the nervous system, which can lead to profound mental retardation
Diagnostic Evaluation for Hypo
Neonatal screening of T4 and TSH: -T4 high, TSH low -T4 low, TSH high Further diagnostic thyroid blood levels Thyroid scan and uptake
Therapeutic Management for Hypo
Thyroid replacement with Synthroid or Levothroid
The average dose is 35-50 mcg/day
The goal is to reach normal thyroid level by weeks of age
The child will be seen by MD every 2-3 months for 3 years
Continued thyroid level measurements
Nursing Considerations for Hypo
The most important nursing objective is early identification of congenital hypothyroidism.
Be certain that thyroid screening is performed
Teaching with the parents on thyroid hormone replacement therapy, and the need to continue therapy throughout the child’s lifetime
Genetic counseling referral for parents
Usually associated with an enlarged thyroid gland and exophthalmus
Peak incidence is between 12-14 years of age
May be present at birth with thyrotoxic mother
Incidence 5x higher in girls than in boys
Familial tendency
Hyperthyroidism (Graves Disease)
Diagnostic Evaluation for Hyper
Increased T3 and T4 levels
TSH suppressed to immeasurable levels
Clinical Manifestations for Hyper
Emotional lability Restlessness Change in classroom performance Increased appetite with weight loss in most cases Fatigue Exophthalmus (protruding eyeballs) Dysphagia Frequent stools or diarrhea Infrequent or light menses Can be fatal with thyroid storm
Clinical Manifestations for Hyper continued…
Goiter Accelerated linear growth Heat intolerance Fine hair that is unable to hold a curl Warm, moist skin Tremor Dyspnea on exertion
Therapeutic Management for Hyper
Treatment is directed at retarding the rate of hormone secretion
Antithyroid drugs (Tapazole)
Subtotal thyroidectomy
Ablation with radioactive iodine
Beta blockers such as Inderal, Tenormin, or Lopressor for treatment of palpitations
Nursing Management for Hyper
Identify the child with hyperthyroidism (difficult to recognize due to gradual onset of symptoms)
Quiet, non-stimulating environment with frequent rest periods
Regular routines
Restriction on physical activity
Monitor for side effects of drugs
Surgical Management for Hyper
Administer iodine several weeks prior to surgery (give thru straw, stains teeth)
Psychologically prepare child for surgery
Position the neck slightly flexed following surgery to avoid strain on suture line
Observe for stridor and hoarseness
