Hypothyroidism

Question 1

What is hypothyroidism (3)?

Answer 1

Deficiency of thyroid hormone
Slow metabolic rate
More common in women

Question 2

There are two types of hypothyroidism what are they each?

Answer 2

Primary and secondary

Question 3

What is primary hypothyroidism?

Answer 3

Caused by destruction of thyroid tissue or defective hormone synthesis

Question 4

What is secondary hypothyroidism?

Answer 4

Caused by pituitary or hypothalamic dysfunction

Question 5

What are the 5 things that causes hypothyroidism?

Answer 5

Iodine deficiency
Atrophy of the gland
Treatment for hyperthyroidism
Drugs ( amiodarone & lithium )
Creatinism if occurs in infancy

Question 6

Notes
Most common cause of primary hypothyroidism is atrophy of the thyroid gland
- results from hashimoto thyroiditis or Graves’ disease

Question 7

Notes
Clinical manifestation
Systemic effects characterized by slowing of body process

Manifestations variable
Slow onset!!

Question 8

Notes
Cardiovascular clinical manifestations
- Decrease cardiac contractility & output
- Angina, heart failure, MI
- Anemia
( cobalamin, iron, folate deficient )
- Serum increase cholesterol & trigs

Answer 8

Decrease cardiac contractility & output

Angina, heart failure, MI
Anemia
( cobalamin, iron, folate deficient )

Serum increase cholesterol & trigs

Question 9

Notes
Respiratory clinical manifestations
- Low exercise tolerance
- Shortness of breath on exertion

Answer 9

Low exercise tolerance
Shortness of breath on exertion

Question 10

Notes
Neurologic systemic clinical manifestations
- Fatigue & lethargy
- Personality & mood changes
- Impaired memory
- Slow speech
- Decrease initiative & somnolence
- Depressed

Answer 10

Fatigue & lethargy
Personality & mood changes
Impaired memory
Slow speech
Decrease initiative & somnolence
Depressed

Question 11

Notes
Gastrointestinal system
- decreased appetite !!
- nausea & vomiting
- weight gain!!
- constipation
- distended abdomen
- enlarged scaly tongue !!
- celiac disease

Question 12

Notes
Integumentary system
- dry, think, in elastic, cold skin
- thick brittle nails
- dry, sparse coarse hair !!
- poor tugor or mucosa
- generalized interstitial edema
- puffy face !!
- decreased sweating
- pallor

Question 13

Notes
Musculoskeletal system
- fatigue, weakness
- muscular aches and pains !!
- slow movements
- arthralgia !!

Question 14

Notes
Reproductive systemic
- prolonged menstrual periods
- amenorrhea!!
- decreased libido
- infertility

Question 15

Notes
Other clinical manifestation
- increased susceptibility to infection
- increased sensitivity to opioids, barbiturates, anesthesia
- intolerance to cold
- decreased hearing
- sleepiness
- goiter

Question 16

In patients who have severe hypothyroidism they will end up getting what?

Answer 16

Myxedema coma

Question 17

Myxedema coma
It impairs your what?
Your precipitated by (4)?
You have what type of collapse?
What do you treat it with?

Notes
Subnormal temperature, hypotension, hypoventilation

Answer 17

Consciousness
Infection, drugs, cold trauma
Cardiovascular collapse
IV thyroid hormone

Question 18

Diagnostic studies for hypothyroidism? (3)

Answer 18

History and physical exam
TSH & FT4
Thyroid antibodies

Question 19

Primary hypothyroids TSH?
Secondary hypothyroidism TSH?
Up or down?

Answer 19

Above for primary
Low for secondary

Question 20

Above or low for all of the following
Cholesterol
Triglycerides
Creatine kinase
RBCS ( anemia )

Answer 20

Above
Above
Above
Low

Question 21

What is the main goal for hypothyroidism?
Dont over think it

Answer 21

Restoration of euthyroid state as safely and rapidly as possible

Question 22

What type of diet will these patients be on?

Answer 22

Low calorie diet

Question 23

What type of medication do we give?

Answer 23

Levothyroxine ( synthroid )

Question 24

When giving levothyroxine ( synthroid ). What should we look at for?

Answer 24

Cardiovascular side effects
( chest pain, dysrthythmias, weight loss, nervousness, tremors, insomnia )

Question 25

Notes about levothyroxixne

Start with low dose
Increase dose in 4-6 weeks intervals
Lifelong therapy !!

Question 26

Notes
Nursing assessment
Health history

Hyperthyroidism treatment
Iodine- containing meds
Changes in appetite
Weight gain
Activity level
Speech memory or skin changes

Question 27

Notes
Nursing assessment
Physical examination
- cold intolerance !!
- constpiation
- signs of depression
- heart rate
- gland tenderness
- edema

Question 28

Notes
Nursing diagnoses
- imbalanced nutrition
( more than body requirements )
- constipation
- impaired memory

Question 29

Notes
What is the planning
- experience relief of symptoms
- maintain a euthyroid state
- maintain a positive self image
- comply with lifelong thyroid replacement therapy !!

Question 30

Notes
Nursing implementation
- screen populations at high risk
- family History
- history of neck irradiation
- women older than 50
- postpartum women

Question 31

What are the 4 nursing implementation of mxyexema coma
Acute care ?

Answer 31

Mechanical respiratory support
Cardiac monitoring
IV thyroid hormone replacement
Monitoring of core temperature

Question 32

Notes
Nursing implementation acute care
- skin care
- vitals signs, weight, I&O, edema
- cardiac vascular response
- energy level
- mental alertness

Question 33

Notes
Nursing implementation teaching patient

• written instructions
• long life therapy !!
• side effects of medication
• signs and symptoms of hypo and hyper thyroids
• regular follow up care
• don’t switch brands
• comfortable warm environment
• measures to prevent skin breakdown
• emphasize need for warm environment
• avoid sedatives or use lowest dose possible
• measures to minimize constipation
• avoid use of enemas

Question 34

Notes
Nursing management evaluation
- have relief from symptoms
- maintain euthyroid state
- avoid complications
- adhere to lifelong therapy !

Question 35

When do you want to take thyroid medication ?
And how?

Answer 35

Morning and empty stomach