Adult Medical-Surgical Nursing Endocrine Module: Hypothyroidism

Hypothyroidism: Aetiology  Infant cretinism (maternal hypothyroidism)  Iodine deficiency (most common cause worldwide)  Hashimoto’s disease: chronic thyroiditis (auto-immune: lymphocytes attack thyroid)  Grave’s disease end-stage (exhausted)  Result of surgery, radiation therapy or overdose of anti-thyroid drugs  Occurrence: 5 x more often in females

Hypothyroidism  Cretinism in infancy: slow growth and development, mental retardation  In adult: insidious slowing of body processes →  Myxoedema: advanced hypothyroidism → coma and death

Hypothyroidism: Pathophysiology  Compensatory hypertrophy of thyroid gland if possible (goitre)  ↓ BMR  Cardiomyopathy ( ↓ contractility)  Pericardial effusion  Disturbed lipid metabolism ( ↑ cholesterol, atherosclerosis, coronary artery disease, ↓ cerebral blood flow)

Hypothyroidism: Pathophysiology(cont)  Accumulation of muco-polysaccharides in tissues → thickened skin  Disturbed reproductive cycle  Inadequate ventilation → sleep apnoea  Reduced erythropoietin levels → reduced bone marrow function

Hypothyroidism: Clinical Manifestations  Fatigue, lethargy, somnolence ( → coma)  Impaired memory, cognition; slow speech  Face expressionless, mask-like  Feeling cold, sub-normal temperature  Bradycardia, hypotension  Hair loss, dry coarse thick skin, brittle nails  Peri-orbital oedema (puffiness)  Muscle weakness

Hypothyroidism: Clinical Manifestations (cont)  Weight gain  Constipation  Anaemia  Pre-disposition to bruising  Menstrual disturbance  Hypoventilation and sleep apnoea

Hypothyroidism: Diagnosis  Patient history and clinical picture  Hormonal assays: TSH, T3, T4  Histology of inflamed gland (Hashimotos)

Hypothyroidism: Medical Management  Hormone replacement therapy (HRT): Thyroxine (gradually increased to avoid strain on heart) until euthyroid status  Iodine also if iodine-deficiency is the cause

Hypothyroidism: Nursing Considerations  Patient and family health education  Monitor patient’s general condition carefully: temperature, pulse, respirations, BP, patient weight  Monitor conscious level and alertness  Monitor bowel function to manage constipation  Monitor medications and effect