Transcript Hypothyroid - College of Saint Benedict and Saint John's

Hypothyroid Part II
Module 7
Main Causes:
Primary (direct and 95% of cases)
• Destruction of thyroid tissue
–
–
–
–
Radioactive Iodine
Hashimoto’s
Surgical removal/radiation
Untreated Graves’ disease (which eventually
destroys gland)
• Defective hormone synthesis
– Iodine deficiency
Secondary (indirect and 5% of cases)
• Pituitary/hypothalmic neoplams
• Congenital hypopituitarism
What role does Iodine have?
The Iodine we ingest
from salt intake is the
precursor for thyroid
hormones T3 and T4.
Iodine and Hypothyroidism
• Iodine is needed for
production of T3, T4.
• Without Iodine T3/T4
production decreases
• Decreased T3 and T4
stimulates TSH
• TSH stimulates the
thyroid gland causing
it to enlarge (which
may result in a goiter)
Pituitary keeps
Sending
TSH
Decreased
Feedback
To Pituitary
Thyroid grows to try
And respond to
Pituitary signal
Low TH in
body
What is the link between the pituitary gland,
hypothalmus and thyroid gland?
Secondary Cause
of Hypothyroidism
• Hypothyroidism can
be a result of
decreased function
of the anterior
pituitary gland
• This results in
decreased TSH
production and lower
T3/T4 levels
Hashimoto’s disease
• Destruction of the glandular tissue
by circulating antibodies
• Autoimmune disease
• Familial
• More common in women
• Diagnosis:
– Presence of circulating thyroid
antibodies
– Thyroid hormone levels
– Radioactive iodine uptake
– Symptoms
– Presence of Goiter
Dr. Hashimoto
Hypothyroidism Clinical
Manifestations
• Weight gain
• Decreased heat
production
• Low BMR
• Cold intolerance
• Lethargy
• Tiredness
• Constipation
• Slightly lowered
body temperature
• Increased TSH which
may lead to goiter
• Altered thought
processes
• Which of these
symptoms did the
patient you interviewed
have?
• Stop and compare these
symptoms with those of
Bill Loney
Untreated hypothyroidism causes
Myxedema (“mucous swelling”)
• Decreased metabolism causes
• Build up of metabolites
(proteins/sugars:
glycosaminoglycans)
• Metabolites accumulate in the
tissues which in turn increases
mucous and water in the tissue
• Cellular/tissue edema which is
mucinous: myxedema
Myxedema
• See also Fig 48-6
on pp. 1319
• Dull, puffy skin with
mask-like
expression,
prominent tongue
and edema around
the eyes,
thin/sparse hair
Hypo vs. Hyper
• Compare and contrast the clinical
manifestations for hyper vs. hypo
thyroidism (see Table 48-4, pp. 1313)
• Keep in mind the two main reasons these
symptoms occur…what are they?
(Discuss and then click when you are done)
1. Alterations in metabolism
2. Alterations in tissue sensitivity to
sympathetic nervous system responses
Just like Bill
• External replacement of the thyroid
hormone is the treatment of choice
– Given orally , once a day
– Dosage regulated by patient response and
monitoring of patient’s lab values
• Surgery to remove goiter if it is large
and doesn’t decrease with hormone
therapy
Patient Teaching
• Review Table 48-10 pp. 1322 in your text
and the Nursing Care Plan on pp. 1321
• Are there any other interventions or
teaching items would you add as the nurse
caring for a patient with hypothyroidism?