Hypothyroidism is one of the thyroid disorder in which thyroid gland not enable to produce enough thyroid hormones

1. DISORDERS OF THYROID GLAND
BY: Mr.Ganesh V. Naik
II year MSc(N)
Pediatric Dept
SDM Institute of
Nursing Science’s
Dharawad

2. THYROID GLAND
 It is located anteriorly in the neck below the cricoid
cartilage
 The thyroid gland consist of two lobes, joined by a
thin band called the isthmus
 The thyroid secretes two hormones
 Tri-iodothyronine(T3)
 Thyroxine(T4)
o Thyroid hormones are essential for normal growth
a CNS and metabolism of proteins, carbohydrates
and fats.

4. CONT..
 Hypothalamus secretes Thyrotropin releasing
hormone (TRH).
 TRH stimulates Anterior pituitary to secrete Thyroid
stimulating Hormone(TSH)
 TSH stimulates the thyroid gland to release T3 and
T4 Hormone.

5. HYPOTHYROIDISM

6. INTRODUCTION
 It is a condition of thyroid hormone deficiency
present at birth.
 Approximately 1 in 400 newborn infants has sever
deficiency of thyroid hormone
 If left untreated after birth, sever congenital
hypothyroidism can lead to growth failure, a
condition known as ‘Cretinism’

7. CLASSIFICATION
Depending on etiology
a)Primary Hypothyroidism
b)Secondary Hypothyroidism
c)Tertiary Hypothyroidism

8. A)PRIMARY HYPOTHYROIDISM
 Congenital
• Thyroid gland aplasia
• Inherited defect in thyroid hormone receptors
o Acquired
• Iodine deficiency
• Irradiation
• Autoimmune chronic lymphocytic thyroiditis
• Drug induced

9. B)SECONDARY HYPOTHYROIDISM
 Deficiency of TSH
 Hypopituitarism
c)Tertiary hypothyroidism
o Deficiency of TRH

10. PATHOPHYSIOLOGY
 Congenital hypothyroidism is most commonly
caused by developmental defect of thyroid gland
 At 8th week of gestation, the thyroid gland normally
occupies its permanent anatomic site and at term it
reaches maximum functioning
 Neonatal thyroid functioning is almost completelly
independent from that of mother

11. CONT…
 Hypothyroid fetus does not get maternal thyroid
hormones to meet its metabolic requirement
 The placenta doesnot allow passage of maternal
thyroid hormones
 As result baby of mother is born with
hypothyroidism and fetal goitre

12. CLINICAL FEATURES
 The clinical features appears first few weeks or
months of life
 Onset is gradual
 Patent fontanale and widely opened cranial sutures
 Prolonged physiologic jaundice due to delayed
maturation of glucoronide conjugation
 Birth weight is more than average
 Babies are dull, flaccid
 Pallor due to anemia
 Feeding difficulties
 Constipation

13. CONT…
Signs:
 Skin
• Yellow discoloration
• Skin is dry and cold
 Head and face
• Puffy face
• Swollen eyelids
• Open mouth with large protruding tongue
• Course brittle hair
• Neck is short
• Voice is hoarse

14. CONT…
 Trunk and extremities
• Retarded skeletal development and maturation
• Short stature
• Hands are broad and fingers are short
• Protruding abdomen
Vital signs
-Temperature is subnormal(decreased metabolic rate)
-Pulse is slow
-Dyspnea

15. CONT….
 Developmental assessment shows:
• Delayed physical and motor milestones
• Intellectual impairement

17. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Thyroid test :Serum T3 and T4 are low
Serum TSH and TRH are increased
 Thyroid scan done to detect structural abnormality
of gland

18. MANAGEMENT
Medical Management
Goal:
-To maintain circulating serum T3 and T4 level in
normal range and normalize the elevated TSH
level.
-Treatment :
 Daily dose of Thyroxin available
• Synthetic sodium levothyroxine for neonates the
dosage is 10-15mg/kg/day

19. NURSING DIAGNOSIS
 Activity intolerence related to fatigue
 Constipation related to depressed GI function
 Hypothermia related to slowed metabolic rate
 Knowledge deficiet related to disease condition

20. THANK YOU