Hypothyroidism, insufficiency of thyroid gland hormon, hypothyroid, disorders of thyroid gland, endocrine disorder

1. Adult Health Nursing
Endocrine
Disorders
October 21, 2022

2. Thyroid Gland
 Butterfly-shaped organ
 Present in lower neck
 Anterior to the trachea
 Two lateral lobes connected by isthmus
 Gland is about 5 cm long and 3 cm wide
 Weighs about 30 g

3. Hormones
The thyroid gland produces three hormones:
 Thyroxine (T4)
 Triodothyronine (T3)
 Calcitonin.
The blood flow to the thyroid is very high (about 5 mL/min per gram of
thyroid tissue), approximately five times the blood flow to the liver.

4. Functions of Thyroid Hormones
 Control cellular metabolic activity
 Influence cell replication
 Important in brain development
 Necessary for normal growth

5. Functions of Thyroid Hormones
 Heat production
 Regulates metabolism of carbohydrates, proteins and fats
 Enhance the effects of adrenaline and nor adrenaline
T4, a relatively weak hormone
T3 is about five times as potent as T4

6. Related Disorders
Cretinism
 Inadequate secretion of thyroid hormone
 During fetal and neonatal development results in
 Stunted physical and mental growth (cretinism)
 General depression of metabolic activity

7. Related Disorders
Goiter
“Goiter also commonly occurs with iodine deficiency”
 Lack of iodine reduces thyroid hormones
 Increased release of TSH
 Elevated TSH
 Hypertrophy of the thyroid gland

8. Physical Examination
Palpation
 Identification of landmarks
 Lower neck region between the
sternocleidomastoid muscles
 Inspect for swelling or asymmetry

9. Procedure  Patient is instructed to extend the neck
slightly and swallow
 Thyroid tissue rises normally
 The thyroid is then palpated for:
 Size
 Shape
 Consistency
 Symmetry
 Presence of tenderness

10. Physical Examination
Auscultation
 Localized audible vibration of a bruit
 Indicates increased blood flow
through the thyroid gland

11. Thyroid Tests
Serum Thyroid-Stimulating
Hormone
Best screening test of thyroid function
Normal
Value: 0.5 to
5.0 mlU/L

12. Thyroid Tests
Serum Free T4
The test most commonly used to confirm an abnormal TSH
result is free T4.
Normal
Range: 0.9 to
1.7 ng/dL

13. Thyroid Tests
Serum T3 and T4
Measurement of total T3 or T4 includes protein bound and
free hormone levels that occur in response to TSH
secretion.
Normal Range T4: 4.5 to 11.5 g/dL
Normal Range T3: 70 to 220 ng/dL

14. Thyroid Tests
T3 Resin Uptake Test:
 Determine the amount of thyroid hormone bound to
TBG
 The number of available binding sites.
 This provides an index of the amount of thyroid
hormone already present in the circulation.
Normal Range:
Normal T3 uptake value is 25% to 35%

15. Thyroid Tests
Thyroid Antibodies:
Antithyroid antibodies are positive in chronic
autoimmune disease
Radioactive Iodine Uptake Test:
The radioactive iodine uptake test measures the rate
of iodine uptake by the thyroid gland.

16. Thyroid Tests
Fine Needle Aspiration Biopsy
Use of a small-gauge needle to sample the thyroid tissue for
biopsy is a safe and accurate method of detecting
malignancy.
Thyroid Scan
Scans are helpful in determining the location, size, shape,
and anatomic function of the thyroid gland.

17. Hypothyroidism
Hypothyroidism results from suboptimal levels of
thyroid hormone.
 Thyroid deficiency can affect all body functions
It ranges from mild to
advanced stage
(Myxedema)

18.  Autoimmune disease (Hashimoto’s thyroiditis,
post Graves’ disease)
 Atrophy of thyroid gland with aging
 Therapy for hyperthyroidism
 Radioactive iodine (131I)
 Thyroidectomy
 Lithium
Causes

19.  Lithium
 Iodine compounds
 Antithyroid medications
 Radiation to head and neck
 Infiltrative diseases of the thyroid
(amyloidosis, scleroderma, lymphoma)
Iodine deficiency and iodine excess
Causes

20. Types
Primary or thyroidal hypothyroidism:
 Refers to dysfunction of the thyroid gland itself
 95% of people have thyroidal hypothyroidism
Central Hypothyroidism:
 Due to failure of the pituitary gland
 Failure of hypothalamus, or both

21. Types
Pituitary or Secondary Hypothyroidism
 Cause is entirely a pituitary disorder
 It is pituitary or secondary hypothyroidism
Hypothalamic or Tertiary Hypothyroidism
 Disorder of the hypothalamus
 Inadequate secretion of TSH
 It is hypothalamic or tertiary hypothyroidism

22.  Extreme fatigue
 Difficulty in completing daily activities
 Hair loss
 Brittle nails
 Dry skin
 Numbness and tingling of finger
 Husky voice
 Menorrhagia
 Amenorrhea
 Loss of libido
Clinical
Manifestations

23.  Subnormal body temperature
 Subnormal pulse rate
 Weight gain
 Cachexia
 Thickened skin (mucopolysaccharides
accumulation)
 Masklike face
 Hypothermia
 Irritability
 Dull mental processing
Clinical
Manifestations

24.  Slow speech
 Tongue enlargement
 Hand and feet enlarges in size
 Deafness
 Constipation
Clinical
Manifestations

25. Advance Hypothyroidism
 Dementia
 Sleep apnea
 Pleural effusion
 Pericardial effusion
 Respiratory muscle weakness
 Serum cholesterol level
 Atherosclerosis
 Coronary artery disease
 Poor left ventricular function

26. Complications
Abnormal sensitivity to:
 Sedatives
 Opioids
 Anesthetic agents
Should
administered
with extreme
caution

27. Myxedema Coma
 Rare life-threatening condition
 Decompensated state of severe hypothyroidism
 Patient is hypothermic and unconscious
 Develop with undiagnosed hypothyroidism

28. Precipitating Factors
 Infection
 Systemic disease
 Use of sedatives
 Opioid analgesic agents
 Among elderly women in the winter months
 Appears to be precipitated by cold

29. Myxedema Coma
 Depression
 Diminished cognitive status
 Lethargy
 Somnolence
 Stupor
 Depressed respiratory drive
Clinical
Manifestation

30.  Alveolar hypoventilation
 Progressive carbon dioxide
retention
 Narcosis
 Coma
 Cardiovascular collapse
 Shock
Clinical
Manifestation
Requires aggressive
supportive
hemodynamic
therapy

31. Nursing Alert
In all patients with hypothyroidism, the effects of analgesic
agents, sedatives, and anesthetic agents are prolonged;
special caution is necessary in administering these agents
to elderly patients because of concurrent changes in liver
and renal function!

32. Primary objective in the management is to restore
normal metabolic state by replacing the missing
hormone
Pharmacological Therapy
 Synthetic levothyroxine (Synthroid or Levothroid)
 Desiccated thyroid
Medical
Manangement

33. Prevention
Cardiac Dysfunction
 Hypothyroidism for a long period elevates serum
cholesterol, atherosclerosis, and coronary artery disease
 As thyroid hormone is administered, the oxygen demand
increases.
 But oxygen delivery cannot be increased unless, or until,
the atherosclerosis improves.

34. Prevention
 The occurrence of angina is the signal that the oxygen needs
of the myocardium exceed its blood supply.
 If angina or dysrhythmias occur, thyroid hormone
administration must be discontinued immediately.
Nurse must be alert for
the signs of myocardial
ischemia

35. Prevention
Medication Interaction
 Thyroid hormones increase blood glucose levels
 Necessitate adjustment in the dosage of insulin
 Increase the effects of digitalis glycosides, anticoagulant
agents, and Indomethacin (Indocin)

36. Medication Interaction
 Phenytoin (Dilantin) and Tricyclic
antidepressant agents increase the effects of
thyroid hormone
 Bone loss and osteoporosis may also occur

37.  Arterial blood gases (to determine carbon dioxide)
 Oxygen saturation levels should be monitored
using pulse oximetry
 Fluids are administered cautiously to avoid water
intoxication
 To prevent hypoglycemia provide glucose without
precipitating fluid overload
Supportive
Therapy

38. Teaching Patient’s Self Care
Oral and written instructions should be provided
regarding the following:
 Desired actions and side effects of medications
 Correct medication administration
 Importance of continuing medications
 When to seek medical attention
 Importance of nutrition and diet to promote weight
loss and normal bowel patterns
 Importance of periodic follow-up testing
Nursing
Management