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Hypothyroid Part II

Module 7

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Main Causes:

Primary (direct and 95% of cases)

Destruction of thyroid tissue Radioactive Iodine

Hashimotos

Surgical removal/radiation

Untreated Graves disease (which eventuallydestroys gland)

Defective hormone synthesis Iodine deficiency

Secondary (indirect and 5% of cases)

Pituitary/hypothalmic neoplams

Congenital hypopituitarism

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What role does Iodine have?

The Iodine we ingestfrom salt intake is the

precursor for thyroid

hormones T3 and T4.

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Iodine and Hypothyroidism

Iodine is needed forproduction of T3, T4.

Without Iodine T3/T4

production decreases Decreased T3 and T4

stimulates TSH

TSH stimulates the

thyroid gland causingit to enlarge (whichmay result in a goiter)

Low TH inbody

DecreasedFeedback

To Pituitary

Pituitary keepsSending

TSH

Thyroid grows to try

And respond toPituitary signal

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What is the link between the pituitary gland,

hypothalmus and thyroid gland?

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Secondary Cause

of Hypothyroidism

Hypothyroidism can

be a result of

decreased function

of the anteriorpituitary gland

This results in

decreased TSHproduction and lower

T3/T4 levels

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Hashimotos disease

Destruction of the glandular tissueby 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

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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 interviewedhave?

Stop and compare these

symptoms with those of

Bill Loney

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Untreated hypothyroidism causes

Myxedema (mucous swelling)

Decreased metabolism causes

Build up of metabolites

(proteins/sugars:glycosaminoglycans)

Metabolites accumulate in thetissues which in turn increases

mucous and water in the tissue Cellular/tissue edema which is

mucinous: myxedema

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Myxedema

See also Fig 48-6on pp. 1319

Dull, puffy skin with

mask-likeexpression,prominent tongueand edema aroundthe eyes,thin/sparse hair

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Hypo vs. Hyper

Compare and contrast the clinicalmanifestations for hyper vs. hypo

thyroidism (see Table 48-4, pp. 1313)

Keep in mind the two main reasons thesesymptoms occurwhat are they?

(Discuss and then click when you are done)

1. Alterations in metabolism2. Alterations in tissue sensitivity to

sympathetic nervous system responses

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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 patients lab values

Surgery to remove goiter if it is large

and doesnt decrease with hormone

therapy

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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?