Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone, leading to slowed metabolism. It is more common in women over age 60. The main types are primary hypothyroidism due to insufficient thyroid hormone production by the thyroid gland itself, secondary caused by low TSH from the pituitary gland, and tertiary from low TRH from the hypothalamus. Symptoms include fatigue, weight gain, dry skin and hair, and increased risk of heart disease. Treatment involves synthetic levothyroxine replacement therapy and monitoring of thyroid hormone levels. Nursing care focuses on monitoring for side effects, managing nutrition and fluid intake, providing skin care and comfort measures, and patient education.

1. HYPOTHYROIDISM
Compiled By –
Mr. Ashish H. Roy
(Nursing Tutor)

2. Introduction to Hypothyroidism
Hypothyroidism is a condition in which thyroid gland does not
produce enough thyroid hormone. Women espicially those are
older than 60 years or older are more likely to have
hypothyroidism. Hypothyroidism Upsets the normal balance of
chemical reactions in body and causes like obesity, joint pain,
infertility and heart disease.

3. Definition
Subnormal secretion of thyroid hormone by thyroid
glands is known as ‘hypothyroidism’.

4. TYPES
 PRIMARY : Insufficient amount of thyroid hormone secreted by thyroid gland.
 SECONDARY : It is due to pituitary gland failure (inadequate amount secretion of
TSH )
 TERTIARY : It is due to hypothalamus failure (sub normal TRH secretion).

5. CAUSES/ AETIOLOGY
 Use Of Radioactive Iodine
 Over Treated With Anti thyroid Drugs.
 Removing Of Thyroid Issue In Thyroidectomy
 Mal- Development
 Iodine Deficiency
 Congenital
 Malignancy Of Neck Or Forehead
 Pituitary Dysfunction.
 Goitrogenic Foods, E.G., Turnip , Cauliflower. Etc.

6. RISK FACTORS
 WOMEN OVER AGE OF 50 YEARS
 AUTOIMMUNE DISEASE ( TYPE 1 DIABETES , MULTIPLE
SCLEROSIS)
 RACE ( BEING WHITE OR ASIAN )
 TURNER’S SYNDROME
 DOWN’S SYNDROME
 ANTI- THYROID MEDICATIONS

7. CLINICAL MENIFESTATIONS
 CVS
Increase heart rate
Hyperlipidaemia
Hypercholesterolemia
Weak Contractility
Bradycardia
Anaemia
Tendency to develop –
CHF ( Congestive Heart Failure)
AP (Angina Pectoris)
MI (Myocardial Infarction )
 RESPIRATORY SYSTEM
Dyspnoea
 G.I.T SYSTEM
Loss of appetite

8. Continued…
Increase weight
Nausea vomiting
Distension in abdomen
 SKIN
Dry skin, thick and elasticity increase
Brittle nails
Dry hairs
Puffy face
Pallorness
Dry hair excessive sweating
Cold intolerance

9. Continued…
 MUSCULOSKELETAL SYSTEM
Fatigue
Weakness
Slow movement
Muscular pain
 REPRODUCTIVE SYSTEM
Decrease libido
Irregular menses
 OTHERS
Myxoedema ( A dry firm waxy swelling of skin )
Goitre
Sleepnessness

10. DIAGNOSTIC EVALUATIONS
SUBNORMAL T3 AND T4 LEVEL
ECG
ELEVATED SECRUM CHOLESTROL
SERUM ELECTROLYTE LEVEL ( SODIUM MAY BE IN
LOW LEVEL)

11. COMPLICATIONS
 MYXEDEMA : Myxedema is a term used synonymously with severe hypothyroidism. However, the
term is also used to describe a dermatological change that can occur in hyperthyroidism and (rare)
paradoxical cases of hypothyroidism. Myxedema refers to deposition of mucopolysaccharides in the
dermis, which results in swelling of the affected area. One manifestation of myxedema occurring in
the lower limb is pretibial myxedema, a hallmark of Graves disease, an autoimmune form of
hyperthyroidism. Myxedema can also occur in Hashimoto thyroiditis
 CONVULSIONS
 HYPOVENTILATION
 CEREBRAL HYPOXIA : Damage to specific areas of the brain. The specific prognosis depends on
which areas are damaged. For instance, severe...
Long-term loss of consciousness in the form of a coma. Some patients also enter a persistent vegetative
state. This loss...
Epilepsy or persistent seizures.
Damage to motor skills, especially fine motor skills. Sometimes this damage is localized to just one
region or one side...
Death, either immediately after the deprivation or due to the side...

12. MEDICAL MANGEMENT
 synthetic levothyroxine ( levothyroid or synothyroid ) is
preferred.
 concentrated glucose may be given if hypoglycemia is evident.
 if myxedema coma is present, thyroid hormone is given IV until
consciousness is restored.

13. DIETARY MANAGEMENT
 AVOID SOYABEAN
 AVOID GREEN LEAFY VEGETABLES
 IF PATIENT HAVING HYPOTHYROIDISM DUE TO IODINE DEFICIENCY TEHN
PROVIDE HIGH IODINE DIET.

14. NURSING DIAGNOSIS
 Altered nutrition less than body requirement related to increase metabolic rate of
body.
Impairement skin integrity related to-
Extreme diaphoresis
Pyrexia
Excessive restlessness
Rapid weight loss
 Risk for disturbed thought process related to insomnia increase CNS stiiulation,
insomnia and irritability related to altered thought process
 Deficient knowledge related to disease process, prognosis, treatment, self care
and discharge needs.

15. NURSING MANAGEMENT
 Monitor vital signs carefully (blood pressure, pulse and body temperature)
 Administer antithyroid drugs as prescribed.
 Instruct patient of need to take medication at the same time each day and on empty
stomach.
 Instruct the patient about importance of continunity medications after symptoms improve.
 Monitor T3, T4 and TSH Levels to determine the effectiveness of pharmacotherapy
 Encourage patient to increased fluid intake and inform the need to increase fluid intake to
at least 2 litre per day unless edema occurs.
 Monitor and record patient’s weight, fluid intake, and urine output.
 We should consult a dietitian to ensure a nutritious diet with adequate calories and fluids.
 Ensure that if iodine is part of the treatment, mix it with milk , juice, or water to prevent
gastrointestinal distress, and give it through a straw to prevent tooth discoloration.
 Provide high fibre and explain the difference about the calorie and fibre requirements
 Provide stool softeners, fibres and liquids.
 Monitor for decreasing symptoms related to hypothyroidism such as fatigue, constipation,
cold intolerance, lethargy, depression and menstrual irregularities.

16. Continued…
 Provide proper rest and make routine for physical exercise.
 Promote physical comfort and provide extra cloth and blankets.
 Advise to avoid high temperature environments and avoid using heating pads and
electric blankets as the risk of peripheral vasodilation.
 We should instruct the patient to check the pulse at least twice a week and to stop
the thyroid supplement and notify the physician if the pulse is greater than 100.

17. THANKYOU FOR YOUR ACTIVE
LISTENING AND ATTENTION..
IFANYQUERYREGARDINGTHETOPIC
KINDLYASK….
THE END.