Hypothyroidism, also known as cretinism and myxedema, is a condition where the thyroid gland does not produce enough hormones to meet the body's demands. The thyroid gland, located in the lower front of the neck, normally produces thyroid hormones which help control metabolism and organ functions. Hypothyroidism can be caused by autoimmune disease, radioactive iodine treatment, iodine deficiency, thyroid surgery or damage, or pituitary issues. Left untreated, it can lead to fatigue, weight gain, dry skin, constipation, cognitive changes, breathing problems, and even coma. Treatment involves lifelong thyroid hormone replacement therapy to manage symptoms and prevent complications.

1. HYPO-THYROIDISM
OR
(CRETINISM AND MYXODEMA)
Ratheesh.R
SLMGNC

2. Introduction
 Hypothyroidism is a common disorder in
which the thyroid gland can not produce
enough hormones to meet the body’s demand.
The thyroid gland is a butterfly-shaped gland
located in the lower front of the neck, and is
normally controlled by a gland in the brain
known as the pituitary. When the pituitary
releases thyroid stimulating hormone (TSH),
the thyroid secretes two kinds of hormones –
tri-iodothyronine (T3) and thyroxine (T4) – into
the blood stream. The thyroid hormones help
the body work properly by controlling the rate
of metabolism and functions of many organ
systems.

3. Definition
 This is a condition that arises from inadequate
amount of thyroid hormone in the blood
stream.
Cretinism:
- When thyroid deficiency is present at the
birth,
the condition is known as cretinism.
Myxodema:
- The accumulation of muco-polysaccharides
in
sub-cutanous and other intestinal tissues

4. Types
 Primary hypo-thyroidism:
-When inadequate amount of
thyroid hormone in the blood stream is
caused by thyroid gland itself.
 Secondary or Central hypo-thyroidism:
- When inadequate amount of
thyroid hormone in the blood stream is
caused by thyroid and failure of pituitary
gland, the hypothalamus or both.

5. Cont….
 Tertiary or Hypothalamic hypothyroidism:
- When thyroid hormone caused entirely
by
pituitary disorder resulting inadequate
secretion of TSH because of
decreased
stimulation by TRH.

6. Etiology
 Autoimmune disease
 Use of radio active iodine
 Dietary iodine deficiency
 Sub acute thyroiditis
 Lithium therapy
 Over treatment with Antithytoid drugs
 Destruction, Suppression or removal of all
or some of the thyroid tissue by
thyroidectomy.

7. Pathophysiology
Thyroid gland needs Iodine tosecreate thyroid
hormone
Production of thyroid depends upon the TSH, Iodine
intake and also protein intake
Enlargement of thyroid gland results goitre form
increased secretion of pituitary gland
TSH stimulates the thyroid to secreate more level of
T4

8. Cont….
In the blood, T4 levels are low, the thyroid gland
will be more large and compress then neck
and also the chest
Causing in respiratory manifestation.

9. Clinical Manifestation
 Early Symptoms:
 Extreme fatigue
 Hair loss
 Brittle nails
 Dry skin
 Numbness and tingling of the fingers
 Voice may become husky
 Menorrhea
 Loss of libido

10. Cont….
 Severe:
 Abnormal temperature and pulse rate
 Gain weight
 Skin thickening
 Hair thins and fall out
 Constipation
 Deafness

11. Cont….
 Advanced:
 Personality and cognitive change
 Inadequate Ventilation
 Pleural Effusion
 Pericardial effusion
 Respiratory muscle weakness
 Sleep Apnea.

12. Diagnostic Evaluation
 History collection
 Physical examination
 To check Low T3 and T4 level
 Elevated TSH levels in primary hypothyroidism
 Elevation of serum cholestrol
 ABG analysis
 Electro Cardiogram

13. Medical Management
 T4 levothyroxine, T3 Liothyroxine, T3 & T4
thyro-globulin liotrix, are used to treat
hypothyroidism and suppress non toxic goitre.
 Sodium levo-thyroxine is administered
parentally to restore T4 level.
 Replacement therapy is used to myxedema
disappear and normal metabolic activity.
 Fluids are administered cautionsly because of
the danger of water intoxification.

14. Nursing Diagnosis
 Ineffective breathing pattern r/t depressed
ventilation.
 Activity intolerance r/t fatigue and depressed
cognitive process.
 Constipation r/t depressed gastro intestinal
function.
 Knowledge deficit r/t therapeutic regimen for
life and thyroid replacement therapy.

15. Complication
 Coma
 Hypoventilation
 Hyponatremia
 Hypothermia
 Cerebral hypoxia