Notes of hypothyroidism which includes definition, causes, clinical manifestations, diagnostic evaluation and nursing management . Made by Ms. Vancy Ninama (Nursing Tutor)

1. HYPOTHYROIDISM
MADE BY:-
MS.VANCY
NURSING TUTOR

2. DEFINITION
Hypothyroidism is a medical condition characterized by abnormally low thyroid
hormone production.

3. CAUSES
1.Autoimmune thyroiditis (Hashimoto's thyroiditis): An autoimmune condition where
the body's immune system attacks the thyroid gland, leading to inflammation and
impaired function.
2.Iodine deficiency: Iodine is a key component in the production of thyroid hormones. A
lack of iodine in the diet can contribute to hypothyroidism.
3.Thyroid surgery or radiation therapy: Treatment for thyroid cancer or other thyroid
conditions may involve removing or damaging the thyroid gland.
4.Certain medications: Some medications, such as lithium or amiodarone, can interfere
with thyroid function and lead to hypothyroidism.
5.Congenital hypothyroidism: Some individuals are born with defective thyroid gland
due to a genetic condition.

4. PATHOPHYSIOLOGY
•Primary hypothyroidism occurs when thyroid gland fails to produce enough TH even there is
enough TSH secreted by the pituitary gland. The pituitary responds to the low level or TH by
producing more TSH.
•When thyroid dysfunction is caused by failure of pituitary gland, hypothalamus is known as
secondary hypothyroidism.
•Secondary hypothyroidism is caused by low level of TSH which fail to stimulate release of TH.
•Because thyroid hormone responsible for metabolism, low level of hormone result in slow
metabolic rate rate which cause many symptoms of hypothyroidism.
•Symptoms related to myxedema which refer to nonpitting of edema.
•If occur in infant then result cretinism.hypothyroidism that develop in adult is called myxedema.

5. CLINICAL MANIFESTION
•Fatigue and weakness
•Weight gain
•Cold intolerance
•Dry skin and hair
•Constipation
•Depression
•Muscle aches and stiffness
•Menstrual irregularities
Decrease sweating
•Swelling around eyes
•Decrease lung function
•Shortness of breath
•Myxedema
•Weaken the heart contraction
•Slows the heart rate

6. DIAGNOSTIC EVALUATION
•Clinical Assessment:
•Symptoms and Medical History: A healthcare provider will discuss the patient's
symptoms, medical history, family history, and any potential risk factors for
hypothyroidism.
•Physical Examination: The healthcare provider may conduct a physical examination to
check for physical signs of hypothyroidism, such as dry skin, brittle nails, swelling in the
face or extremities, and changes in hair texture.

7. Thyroid Function Tests:
•Thyroid Stimulating Hormone (TSH) Test: To measure the level of T3 and T4
indicate hypothyroidism.
•Free Thyroxine (FT4) Test: This test measures the amount of free T4, the inactive
form of thyroid hormone circulating in the blood. Low levels may suggest
hypothyroidism.
•Triiodothyronine (T3) Test: T3 is another thyroid hormone, and its levels may also
be measured. However, T3 levels are often within the normal range in
hypothyroidism.

8. Antibody Tests:
•Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb): These
tests can help diagnose autoimmune thyroiditis, such as Hashimoto's thyroiditis.
Imaging Studies (if needed):
•Thyroid Ultrasound: An ultrasound of the thyroid may be performed to assess the size,
structure, and abnormalities of the thyroid gland.

9. •Radioactive Iodine Uptake (RAIU) Test: In certain cases, this test may be used to assess
thyroid function by measuring the uptake of radioactive iodine by the thyroid gland.
Iodine Levels (if relevant):
•Iodine Urine Test: If iodine deficiency is suspected as a cause of hypothyroidism, a urine
test may be done to measure iodine levels.
•Thyroid scan:- shows how and where iodine is distributed in thyroid

10. MANAGEMENT
Thyroid Hormone Replacement Therapy:
•Levothyroxine (T4 Replacement): The treatment for hypothyroidism is levothyroxine, a
synthetic form of the thyroid hormone thyroxine (T4). It is usually taken orally on an
empty stomach in the morning. The dosage is adjusted based on regular monitoring of
thyroid function tests.
Regular Monitoring:
•Thyroid Function Tests: Regular monitoring of thyroid function. These tests help
ensure that the levothyroxine dosage is appropriate and that thyroid hormone levels are
within the normal range.
Patient Education:
•Medication Adherence: Educate patients about the importance of taking levothyroxine
consistently and as prescribed. To achieve the right dosage.

11. •Timing of Medication: Instruct patients to take levothyroxine on an empty stomach, at
least 30 minutes to 1 hour before breakfast, and to avoid taking it with certain
medications or supplements that may interfere with absorption.
Lifestyle Modifications:
•Dietary Considerations: While iodine deficiency is less common in many regions,
maintaining a well-balanced diet is still important for overall health. Patients should be
encouraged to consume a diet rich in fruits, vegetables, and lean proteins.
•Exercise: Regular physical activity can help manage weight and improve overall well-
being.

12. Symptom Management:
•Fatigue and Weakness: Encourage patients to get adequate rest and manage fatigue
by balancing activity with rest.
•Cold Intolerance: Advise wearing appropriate clothing and keeping the home
environment warm.
•Constipation: Promote a high-fiber diet and adequate fluid intake.

13. NURSING MANAGEMENT
Assessment:
•Conduct a thorough health history, including symptoms, past medical history, and family
history of thyroid disorders.
•Assess the patient's physical and mental status, including vital signs, weight, skin
condition, and cognitive function.
•Monitor for signs of myxedema, a severe form of hypothyroidism, such as altered
consciousness, hypothermia, and respiratory depression.
Medication Management:
•Administer thyroid hormone replacement medications, such as levothyroxine, as
prescribed by the healthcare provider.

14. ◦ Educate the patient on the importance of taking medications as prescribed and the need for
lifelong therapy.
◦ Monitor for potential side effects or complications related to medication therapy.
•Patient Education:
◦ Provide comprehensive education about hypothyroidism, its causes, and the importance of
medication adherence.
◦ Instruct the patient on the proper timing of medication administration, emphasizing
consistent dosing and the need to take it on an empty stomach.
◦ Explain the importance of regular follow-up appointments for monitoring thyroid function and
adjusting medication dosage as needed.

15. Nutritional Counseling:
•Discuss the importance of a well-balanced diet, including foods rich in iodine (if iodine
deficiency is a concern) and nutrients that support overall health.
•Encourage the patient to maintain a healthy weight through proper nutrition and regular
physical activity.
Monitoring and Evaluation:
•Monitor vital signs, especially for signs of cardiovascular complications, such as
bradycardia and hypotension.
•Regularly assess thyroid function through laboratory tests, including TSH, T4, and, if
necessary, T3 levels.
•Evaluate the patient's response to medication therapy and adjust treatment as needed.