amenorrhea is a condition when female do not have regular mensural cycles by puberty or due to any causes this ppt can help the patient and nurses to gain knowledge about this disease process and apply their knowledge into their clinical practices
Effects of Carbegoline and Bromocriptine on Prolactin, Progesterone, Luteiniz...ijtsrd
This was an interventional study which evaluated the effects of bromocriptine and carbegoline on prolactin, progesterone, luteinizing and follicle stimulating hormones in hyperprolactinaemic infertile female subjects in Orlu, South East Nigeria.Hyperprolactinaemic females who were attending Gynaecology Clinic at Imo State University Teaching Hospital IMSUTH Orlu participated in the study. The participants were divided into two groups. Group A 30 hyperprolactinaemic females were administered 1.25mg bromocriptine at night for the first one week 2.5mg at week two then 2.5mg twice daily for eighteen weeks. Group B 30 hyperprolactinaemic females were administered 0.25mg carbegoline twice weekly for eight weeks. Serum prolactin, progesterone, LH and FSH were assayed before and after treatment using enzyme linked immunesorbent assay ELISA kits. The significant difference between the mean values of prolactin, LH, FSH and progesterone, in the pre and post treatment with carbergoline and bromocriptine was determined by paired t test. Independent student t test was used to compare between the two treatments. P value 0.05 was considered as statistically significant. Ajaero, Oluchi Chinwe | Unekwe, Prince Chiazor | Ajaero, Nnaemeka Uchendu "Effects of Carbegoline and Bromocriptine on Prolactin, Progesterone, Luteinizing and Follicle Stimulating Hormones in Hyperprolactinaemic Infertile Women in Orlu, Nigeria" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45169.pdf Paper URL: https://www.ijtsrd.com/medicine/other/45169/effects-of-carbegoline-and-bromocriptine-on-prolactin-progesterone-luteinizing-and-follicle-stimulating-hormones-in-hyperprolactinaemic-infertile-women-in-orlu-nigeria/ajaero-oluchi-chinwe
amenorrhea is a condition when female do not have regular mensural cycles by puberty or due to any causes this ppt can help the patient and nurses to gain knowledge about this disease process and apply their knowledge into their clinical practices
Effects of Carbegoline and Bromocriptine on Prolactin, Progesterone, Luteiniz...ijtsrd
This was an interventional study which evaluated the effects of bromocriptine and carbegoline on prolactin, progesterone, luteinizing and follicle stimulating hormones in hyperprolactinaemic infertile female subjects in Orlu, South East Nigeria.Hyperprolactinaemic females who were attending Gynaecology Clinic at Imo State University Teaching Hospital IMSUTH Orlu participated in the study. The participants were divided into two groups. Group A 30 hyperprolactinaemic females were administered 1.25mg bromocriptine at night for the first one week 2.5mg at week two then 2.5mg twice daily for eighteen weeks. Group B 30 hyperprolactinaemic females were administered 0.25mg carbegoline twice weekly for eight weeks. Serum prolactin, progesterone, LH and FSH were assayed before and after treatment using enzyme linked immunesorbent assay ELISA kits. The significant difference between the mean values of prolactin, LH, FSH and progesterone, in the pre and post treatment with carbergoline and bromocriptine was determined by paired t test. Independent student t test was used to compare between the two treatments. P value 0.05 was considered as statistically significant. Ajaero, Oluchi Chinwe | Unekwe, Prince Chiazor | Ajaero, Nnaemeka Uchendu "Effects of Carbegoline and Bromocriptine on Prolactin, Progesterone, Luteinizing and Follicle Stimulating Hormones in Hyperprolactinaemic Infertile Women in Orlu, Nigeria" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45169.pdf Paper URL: https://www.ijtsrd.com/medicine/other/45169/effects-of-carbegoline-and-bromocriptine-on-prolactin-progesterone-luteinizing-and-follicle-stimulating-hormones-in-hyperprolactinaemic-infertile-women-in-orlu-nigeria/ajaero-oluchi-chinwe
Amenorrhea - Define, Cause, Sign and Symptoms, Type- Pathological and Physiol...sonal patel
Amenorrhea - Define, Cause, Sign and Symptoms, Type- Pathological and Physiological Amenorrhea and It's Treatment and management, Cushing Syndrome - Define, Causes, Sign And Symptoms in PPT made By Sonal Patel
Congenital hypothyroidism is quite common in Indians and is the most common reversible congenital cause of mental retardation.
Early identification and intervention is important as Thyroid dependent brain development is complete by 3 years of age.
Universal screening is ideal as most cases are sporadic.
Positive cases on screening by filter paper test should be confirmed by serum levels estimation.
Serum Thyroid hormone levels are of primary importance in diagnosing and managing this condition, other investigations are ancillary.
Age based reference values must be followed in interpreting the results.
Timely monitoring (serum hormone levels, compliance, growth & development) and adequate counseling of care givers are key in managing this condition.
Amenorrhea - Define, Cause, Sign and Symptoms, Type- Pathological and Physiol...sonal patel
Amenorrhea - Define, Cause, Sign and Symptoms, Type- Pathological and Physiological Amenorrhea and It's Treatment and management, Cushing Syndrome - Define, Causes, Sign And Symptoms in PPT made By Sonal Patel
Congenital hypothyroidism is quite common in Indians and is the most common reversible congenital cause of mental retardation.
Early identification and intervention is important as Thyroid dependent brain development is complete by 3 years of age.
Universal screening is ideal as most cases are sporadic.
Positive cases on screening by filter paper test should be confirmed by serum levels estimation.
Serum Thyroid hormone levels are of primary importance in diagnosing and managing this condition, other investigations are ancillary.
Age based reference values must be followed in interpreting the results.
Timely monitoring (serum hormone levels, compliance, growth & development) and adequate counseling of care givers are key in managing this condition.
HYPOTHYROIDISM (MSN-1) Notes of hypothyroidism which includes definition, cau...ninamavancy321
Notes of hypothyroidism which includes definition, causes, clinical manifestations, diagnostic evaluation and nursing management .
Made by Ms. Vancy Ninama (Nursing Tutor)
Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. World Thyroid
Day May 25th
and International
Thyroid Awareness
Week May 25th to
31st, 2020.
THEME- “There are
still many people
living with some
kind
of thyroid disorder
without diagnosis.
4. Theme-2021
• “It’s not you. It‘s your thyroid” is the theme
of this year’s Thyroid Awareness Week. With
this theme, Thyroid Federation International
(TFI) – the initiator of Thyroid Awareness
Week – wants to make it clear that thyroid
disorders lead to symptoms that are often
misinterpreted by those affected.
5. • Curling (1850)- first case
of hypothyroidism in
children.
• Gull (1873) first to
identify adult
hypothyroidism
• Kocher(1883) -noticed
that the disorder occurs
after thyroidectomy.
• Ord(1878)-Myxedema
• Murray(1891)successful
treatment with
injections of sheep
thyroid extract for
myxedema.
• Kendall(1914)-thyroxin.
• Harrington elucidated
the precise constitution
of thyroxine in 1926.
HISTORY
6. INTRODUCTION-HYPOTHYROIDISM
• common endocrine disorder.
• deficiency of thyroid hormone
• a primary process -unable to produce
sufficient amounts of thyroid hormone.
• secondary—thyroid gland(normal)but
receives insufficient stimulation because of
low secretion of thyrotropin (ie, thyroid-
stimulating hormone [TSH]) from the pituitary
gland.
7. • tertiary hypothyroidism, inadequate secretion
of thyrotropin-releasing hormone (TRH) from
the hypothalamus leads to insufficient release
of TSH, which in turn causes inadequate
thyroid stimulation.
INTRODUCTION-HYPOTHYROIDISM
8. INTRODUCTION
• Worldwide, iodine deficiency remains the foremost cause
of hypothyroidism.
• In the United States and other areas of adequate iodine
intake, autoimmune thyroid disease (Hashimoto disease) is
the most common cause.
• Hypothyroidism may also be drug-induced or otherwise
iatrogenic.
• Some, but not all, studies have indicated that low vitamin
D levels can be linked to autoimmune thyroid diseases,
such as Hashimoto thyroiditis and Graves disease.
• No association has been found between vitamin D levels
and thyroid cancer.
9. EPIDEMIOLOGY
• NATIONAL
Prevalence
INDIA- 11%,
Aged 46–54 years-13·1%
Aged 18–35 years-7·5%
(Increases with age)
PAST- iodine was thought cause but
it is still prevalent despite its
promotion since 1983
• INTERNATIONAL
• Primary hypothyroidism –
worldwide(iodine-deficient
areas)
Prevalence
UK- 2% and USA- 4·6%
Gender- 2-8 times higher
in females.
(more common in women with
small body size at birth and low
body mass index during
childhood)
10. Studies
• A 2013 study showed that 42·2% of
households consumed inadequately iodised
salt and 10·5% consumed salt with no iodine.
• Across the world, with the advent of
iodisation, autoimmune thyroid disease has
become the most common cause of
hypothyroidism.
11. DEFINITION- HYPOTHYROIDISM
• Hypothyroidism is defined as a syndrome characterized
by the clinical and biochemical manifestations of
thyroid hormone deficiency in the target tissues of
thyroid hormone. Strictly speaking, hypothyroidism
denotes deficient thyroid gland production of thyroid
hormone. Hypothyroidism is diagnosed by an elevated
serum TSH in combination with a decreased serum
FT4.
• Hypothyroidism is seldom transient, and usually
requires lifelong treatment with daily levothyroxine
sodium tablets
22. Additional signs specific to different
causes of hypothyroidism,
Diffuse or nodular goiter
and pituitary enlargement or tumor, can occur.
23. Man with myxedema or severe
hypothyroidism
showing an expressionless face,
puffiness around the eyes and pallor
Additional symptoms include swelling
of the arms and legs and ascites.
26. Diagnostic Evaluation
• Third-generation thyroid-
stimulating hormone (TSH)
assays-Most sensitive screening
tool for primary hypothyroidism.
• If TSH levels are above the
reference range, the next step is
measure free thyroxine (T4).
Another option is to measure
total T4 and binding proteins.
• Assays for anti–thyroid
peroxidase (anti-TPO) and
antithyroglobulin (anti-Tg)
antibodies may be helpful in
determining the etiology of
hypothyroidism or in predicting
future hypothyroidism.
• The generally accepted
reference range for normal
serum TSH is 0.40-4.2
mIU/L.
• In addition, anti-TPO
antibodies have been
associated with increased
risk of infertility and
miscarriage; levothyroxine
(LT4) treatment may lower
this risk.
27. Important points to know
Patients who are critically ill include decreased TBG
levels and abnormalities in the hypothalamic-pituitary
axis.
During recovery, some patients have transient elevations
in serum TSH concentrations (up to 20 mIU/L).
Hence, thyroid function should not be evaluated in a
critically ill person unless thyroid dysfunction is strongly
suspected, and if evaluation is warranted, screening with
TSH alone is insufficient. When needed, however, multiple
thyroid hormone measurements over time may assist
with interpretation.
28. The complete blood count and metabolic profile may
show abnormalities in patients with hypothyroidism
• These include :
• Anemia
• dilutional hyponatremia
• hyperlipidemia,
• and reversible increases
in serum creatinine.
• Elevations in
transaminases and
creatinine kinase
29. Diagnostic evaluation contd...
• TRH--- prolactin along
with TSH.
• Prolactin levels in patients
with hypothyroidism tend
to be lower than those
usually seen with
prolactinomas (the latter
are usually 150-200 ng/mL
or higher).
• USG- neck and thyroid can
be used to detect nodules
and infiltrative disease.
• Serial images with fine-
needle aspiration (FNA) of
suspicious nodules may be
useful.
30.
31. Screening
Governmental bodies
frequently mandate
screening of neonates for
hypothyroidism so as to
prevent delay in the
recognition and treatment
of cretinism.
The American Thyroid
Association recommends
screening:
at age 35 years and every 5
years thereafter, with closer
attention to patients who are
at high risk, such as the
following:
Pregnant women
Women older than 60 years
Patients with type 1 diabetes
or other autoimmune disease.
Patients with a history of neck
irradiation
32. Management
• Hypothyroidism can’t be
cured. But in almost every
patient, hypothyroidism can
be completely controlled.
Goal of treatment
• To reverse clinical
progression and correct
metabolic derangements, as
evidenced by normal blood
levels of thyroid-stimulating
hormone (TSH) and free
thyroxine (T4).
33. Medical Management
Correct Thyroid hormone
deficiency
• constant daily dose of
levothyroxine (LT4)(50-75
µg/day )
• All hypothyroid patients
except those with severe
myxedema (life-threatening
hypothyroidism) can be
treated as outpatients, not
having to be admitted to the
hospital.
• In elderly patients and those
with known ischemic heart
disease, treatment should
begin with one fourth to one
half the expected dosage, and
the dosage should be adjusted
in small increments after no
less than 4-6 weeks
34. Patients should be monitored for symptoms and signs
of overtreatment, which include the following
• Tachycardia
• Palpitations
• Atrial fibrillation
• Nervousness, Tiredness
• Headache
• Increased excitability
• Sleeplessness
• Tremors
• Possible angina.
35. Medical Management
• Medical Management for
Myxedema and Myxedema
Coma
• Supportive measures begin
immediately and include
maintaining a patient airway ,
giving oxygen and replace
fluids intravenously.
• Keep the client warm
• Closely monitor vital signs
until the client begins to
recover.
• Vasopresseors for maintaining
tissue perfusion.
• Levothyroxine sodium I/V with
glucose and corticosteroids.
36. Medical Management
• Goitre Suppression
removing the stimulus causing the
decreased thyroid mass.
Suppression of the increase in TSH is
necessary to correct the stimulus for
growth of thyroid gland.
If goitrogenic foods are the cause
they should be eliminated.
Rule out iodine deficiency and
institute replacement appropriately.
• Exogenous hormone to inhibit TSH
secretion if cause is unknown and if
goitre associated with Hashimoto’s
disease.
• Dosage should be verified by RAIU
TEST that should have value less than
5%
• Surgery if suppression is not
accomplished with therapy
• If Surgery is done, Life long therapy
is required to manage
hypothyroidism.
37. Surgical Management
• Thyroidectomy to treat large
goitre, particularly those
compressing adjacent tissues
The patient is prepared for surgery
physically and emotionally in the
following ways:
• A special effort to ensure that patient
has a good night’s rest preceding
surgery.
• Explain to patient that speaking is to
be minimized immediately
postoperatively and that oxygen may
be administered to facilitate
breathing.
• Explain that postoperatively, fluids
may be given via IV line to maintain
fluid, electrolyte, and nutritional
needs; IV glucose may also be given
in the hours before the
administration of anaesthetic agents.
38. Postoperative Management
Monitor for bleeding and respiratory distress that indicates
laryngeal edema, secondary to swelling in the area of
surgery.
Watch for Signs of hypocalcemia i.e. irritability, twitching,
spasms of hands and feet.
monitorCalcium levels.
If in 48 hours level falls below 7 mg/100 mL (3 mEq), IV
calcium (gluconate, lactate) replacement is given
IV calcium is used cautiously in patients who have renal
disease or who are taking digoxin.
Thyroid function is monitored after surgery.
39. Complications
• Hemorrhage, edema of the glottis, damage to
laryngeal nerve.
• Hypothyroidism following subtotal
thyroidectomy occurs in 5% of patients in first
postoperative year; increases at rate of 2% to 3%
per year.
• Hypoparathyroidism occurs in about 4% of
patients and is usually mild and transient;
requires calcium supplements via IV
administration and orally when more severe.
40. Diet and Activity
• No specific diets
• Adequate nutrition(well balanced)
• Prescribed caloric intake to achieve
goals of weight loss if indicated.
• Subclinical hypothyroidism has been
seen in increased frequency in
patients with greater iodine intake.
• The World Health Organization
(WHO) recommends a daily dietary
iodine intake of 150 µg for adults,
200 µg for pregnant and lactating
women, and 50-120 µg for children.
Activity
• Patients who have hypothyroidism
have generalized hypotonia and may
be at risk for ligamentous injury,
particularly from excessive force
across joints. Thus, patients should
exercise caution with certain
activities, such as contact sports and
heavy physical labor.
• Patients with uncontrolled
hypothyroidism may have difficulty
maintaining concentration in low-
stimulus activities and may have
slowed reaction times.
• Patients should use caution when
engaging in an activity that poses a
risk of injury (eg, operating presses
or heavy equipment and driving.
43. Activity intolerance R/T poor work capacity associated with
poor cardiac function, decreased breathing capacity and muscle
stiffness
Interventions :
Goal: To promote activity to the level of patient
tolerance
• Increased the activity of the patient gradually and as
per tolerance.
• e.g., ask the patient to move around in the room. Teach
patient to keep a record of physical activity, noting
duration, intensity, and level of fatigue.
• Monitor the cardiovascular response to new activities,
if the patient complains of chest pain or develops an
unacceptable heart rate, stop the activity and then
resume at slow rate.
44. Body image disturbance R/T change in appearance (weight
gain, hair and skin changes), changes in functioning (decreased
mental and physical function).
Interventions:
– Promote positive body image.
– Provide the information that helps patient and
significant others to understand the relationship
of body changes to hypothyroidism.
– Educate about reversible body changes.
– Stress the positive changes that have occurred.
46. Hypothermia R/T decreased heat production
associated with decreased metabolic rate.
• Interventions
• Treat hypothermia
• Monitor temperature every 2-4 hours
• Maintain an environmental temperature i.e.
comfortable for the patient
• Use blanket to increase body temperature if necessary
47. Knowledge deficit: disease, treatment, expected outcomes, self
–monitoring, follow up, R/T new interventions with no
previous exposure to information.
Interventions
• Teach the patient and his care givers about the nature of the
disorder, diagnostic tests and treatment, need for lifelong
replacement therapy.
• Provide information regarding medication, its dosage and
side-effects.
• Self monitoring of vital signs, weight, skin integrity and
bowel function.
• Teach them methods to prevent skin breakdown and
constipation.
• Educate them regarding the need for periods of rest
alternating with activity.
• Need for follow up care.
48. Pain R/T Headache and joint pain associate with chronic
thyroid problems.
Interventions:
• Promote comfort:
– Use non-medicinal comfort measures such as massage, cold
compress and distraction to promote pain control.
– If medication are used, monitor patient carefully, patient will
have lower tolerance for sedatives.
49. Impaired thought process R/T slowing of intellectual functions
associated with chronic deficits of thyroid hormone.
• Interventions:
• Facilitate a safe environment and orientation and monitor
neurological status every shift.
• Reorient the patient frequently, use resources such as
current events, clocks and newspapers.
• Maintain a safe environment remove any clutter, keep bed
rails up.
• Check on patient frequently, especially at night, and use
nightlights to prevent confusion.
• Inform significant others of relationship between mental
status and hypothyroidism.
• Involve patient, as possible in decision about care.[12]
50. Risk for Injury related to possible removal of
parathyroid glands.
• Nursing Interventions
• Observing for Hemorrhage and Airway Edema
• Administer humidified oxygen, as prescribed, to
reduce irritation of airway and to prevent edema.
• Move patient carefully; provide adequate support
to the head so that no tension is placed on the
sutures.
• Place patient in semi-Fowler’s position, with the
head elevated and supported by pillows; avoid
flexion of neck.
51. Risk for Injury related to possible
removal of parathyroid glands.
Interventions contd...
Monitor vital signs frequently, watching for tachycardia and hypotension
that indicates hemorrhage (most likely between 12 and 24 hours
postoperatively).
Observe for bleeding at sides and back of the neck, and anteriorly, when
patient is in dorsal position.
Watch for repeated clearing of the throat or for complaint of smothering
or difficulty swallowing, which may be early signs of hemorrhage.
Watch for irregular breathing, swelling of the neck, and choking— other
signs pointing to the possibility of hemorrhage and tracheal compression.
Reinforce dressing, if indicated.
Be alert for voice changes, which may indicate damage to laryngeal nerve.
Keep a tracheostomy set in patient’s room for 48 hours for emergency use.
52. Preventing Tetany
• Watch for the development of tetany caused by removal or disturbance of
parathyroid glands through a progression of signs: Tingling of toes and
fingers and around the mouth; apprehension.
• Positive Chvostek’s sign—tapping on the cheek over the facial nerve
causes a twitch of the lip or facial muscles
• Positive Trousseau’s sign—carpopedal spasm induced by occluding
circulation in the arm with a BP cuff
• Be prepared to treat hypocalcemic tetany.
• Position patient for optimal ventilation; remove pillow to prevent head
from bending forward and compressing trachea.
• Keep side rails padded and elevated and position the patient to prevent
injury if a seizure occurs; do not use restraints because they only
aggravate the patient and may result in muscle strain or fractures.
• Have equipment available to treat respiratory difficulties that includes
airway suction equipment, tracheostomy, and cardiac arrest equipment.
• Administer IV calcium, as directed.
54. Other Nursing diagnosis:
• Altered nutrition more than body requirement
R/T decreased metabolic rate
• Self care deficit, total(varies): bathing-hygiene;
dressing –grooming, feeding, toileting
• Sexual dysfunctioning R/T alterations in
menstrual cycle, sperm production and libido
• Impaired skin integrity R/T mucinous deposits in
skin, decreased circulation, immobility.
• Risk for Injury related to invasive procedure of
the neck.
55. Patient Education and Health
Maintenance
• Teach patient about complications to look for if
discharge occurs within a day or two of surgery.
• Advise patient to rest at home and to prevent
any strain on suture line, as directed by surgeon.
• Advise nutritious diet; report difficulty
swallowing.
• Encourage follow-up for monitoring and thyroid
hormone replacement after surgery[13]
•
56. Referrals
• Appropriate referrals might include home care
nursing, physical therapy ,and social services if
family /personal resources are limited.
57. Discharge education/Follow-up
Client will be instructed at the time of discharge /follow up
instructions as following:
• You’ll need to have your TSH checked 6 to 10 weeks after a
thyroxine dose change.
• You may need tests more often if you’re pregnant or you’re taking
a medicine that interferes with your body’s ability to use
thyroxine.
• The goal of treatment is to get and keep your TSH in the normal
range.
• Babies with hypothyroidism must get all their daily treatments
and have their TSH levels checked as they grow, to prevent mental
retardation and stunted growth.
• Once you’ve settled into a thyroxine dose, you can return for TSH
tests about once a year.
58. YOU NEED TO RETURN SOONER IF ANY OF THE
FOLLOWING APPLY TO YOU:
• Your symptoms return or get worse.
• You want to change your thyroxine dose or brand, or change
taking your pills with or without food.
• You gain or lose a lot of weight (as little as approx. 5 kg
difference for those who weren’t overweight to begin with).
• You start or stop taking a drug that can interfere with
absorbing thyroxine (such as certain antacids, calcium
supplements and iron tablets), or you change your dose of
such a drug.
• Medications containing estrogen also impact thyroxine doses,
so any change in such a medication should prompt a re-
evaluation of your thyroxine dose.
59. Contd..
• You start or stop taking certain medicines to control
seizures such as phenytoin or tegretol, as such medicines
increase the rate at which thyroxine is metabolized in your
body, and your dose of thyroxine may need to be adjusted.
• You’re not taking all your thyroxine pills. Tell your doctor
honestly how many pills you’ve missed.
• You want to try stopping thyroxine treatment. If ever you
think you’re doing well enough not to need thyroxine
treatment any longer, try it only under your doctor’s close
supervision. Rather than stopping your pills completely, you
might ask your doctor to try lowering your dose. If your TSH
goes up, you’ll know that you need to continue
treatment.[14]
60. Summary
• Hypothyroidism is a very common condition, also called an underactive
thyroid.
• It can happen due to damage to the thyroid gland from inflammation or
after certain treatments like surgery.
• If it is not treated it can lead to other illnesses such as heart disease and
may even be life threatening.
• It also causes symptoms like fatigue and weight gain.
• Patients with hypothyroidism need to take thyroid hormone which is
often a lifelong treatment.
• Client need to take well balanced diet and monitor weight, and need to
maintain weight in normal range.
• Client should be asked to resume physical activity as per tolerance.
• Client should be given discharge education and counselling for healthy
behaviour to manage hypothyroidism and prevent complication.
• Appropriate referrals might include home care nursing, physical therapy,
and social services if family /personal resources are limited. Follow up
instructions should be given to clients.
61. Conclusion
• We as health care professional should be aware about the
national health programme related to prevention of thyroid
disorders
(National Newborn Screening Programme including
congenital hypothyroidism, Rashtriya Bal Swasthya
Karyakram, National Guidelines for Screening of
Hypothyroidism during Pregnancy, National Iodine Deficiency
Disorders Control Programme and National Family Health
Survey 3 and 4.)
• and May 25th –world thyroid day, International Thyroid
awareness week: May25-May 31,and the theme for 2020-
Thyroid issue: Mother and baby...so as to make public aware
about prevention of thyroid disorders, screening of thyroid and
early diagnosis and treatment.
62. TAKE HOME MESSAGE
“Supplement the thyroid
hormones your gland can not
produce, regular follow
up...you can have a perfectly
normal life’’
66. Q-2.) In women, hypothyroidism can
affect pregnancy by:
A. Reducing the chance of getting pregnant
B. Boosting the chance of getting pregnant
C. Making miscarriage more likely
D. Making labor and delivery more difficult
72. Q-6.)Which of the following is the initial treatment indicated in
most cases of mild to moderate hypothyroidism?
A. Levothyroxine at a dose of 50-75 µg/day
B. Levothyroxine at a dose of 4 µg per kilogram of lean
body weight as an intravenous bolus, with 100 µg
administered 24 hours later
C. Desiccated thyroid at a dose of 15-30 mg orally per
day
D. Liothyronine at a dose of 25 µg orally per day
74. Q-7.) you are performing discharge teaching with a patient who is going
home on Synthroid. Which statement by the patient causes you to re-
educate the patient about this medication?
A. “I will take this medication at bedtime with a
snack.
B. “I will never stop taking the medication
abruptly.
C. “If I have palpitations, chest pain, intolerance to
heat, or feel restless, I will notify the doctor.”
D. “I will not take this medication at the same time
I take my Carafate.”
75. Answer-7
A- Synthroid is best taken in the MORNING on
an empty stomach. All the other statements
are correct about taking Synthroid
76. Q-8.) Myxedema coma is a severe form of hypothyroidism that
most commonly occurs in which of the following?
A. Male patients with hypothyroidism and excessive
weight gain
B. Female patients with galactorrhea and menstrual
disturbances secondary to hypothyroidism
C. Patients with hypothyroidism and decreased
appetite, sleepiness, hair loss, and dry skin
D. Patients with untreated hypothyroidism who are
subjected to an external stress
77. Answer-8
D- Patients with untreated hypothyroidism who are subjected
to an external stress.
Myxedema coma is a severe form of hypothyroidism that
results in an altered mental status, hypothermia,
bradycardia, hypercarbia, and hyponatremia. Cardiomegaly,
pericardial effusion, cardiogenic shock, and ascites may be
present. Myxedema coma most commonly occurs in
individuals with undiagnosed or untreated hypothyroidism
who are subjected to an external stress, such as low
temperature, infection, myocardial infarction, stroke, or
medical intervention (eg, surgery or hypnotic drugs)
78. Q-9.) A patient was recently discharged home for treatment of
hypothyroidism and was ordered to take Synthroid for
treatment. The patient is re-admitted with signs and symptoms
of the following: heart rate 42, blood pressure 70/56, blood
glucose 55, and body temperature of 96.8 ‘F.
The patient is very fatigued and drowsy. The family reports the
patient has not been taking Synthroid since being discharged
home from the hospital.
Which of the following conditions is this patient most likely
experiencing?
A. Thryoid Storm
B. Myxedema Coma
C. Iodism
D. Toxic Nodular Goiter
79. Answer-9
B- Myxedema Coma…The red flags in this
question are the patient’s signs/symptoms
and the report from the family the patient
hasn’t been taking the prescribed Synthroid.
The patient is showing signs and symptoms of
extreme hypothyroidism known as Myxedema
coma (which is life-threatening if not treated).
80. Q-10.) ___________ is an autoimmune disorder
where the body attacks the thyroid gland that causes
it to stop releasing T3 and T4. The patient is likely to
have the typical signs/symptoms of hypothyroidism,
however, they may present with what other sign as
well?
•
A. Myxedema coma; joint pain
B. Thyroid storm; memory loss
C. Hashimoto’s Thyroiditis; goiter
D. Toxic nodular goiter (TNG); goiter
83. References
1. Curling TB. Two cases of absence of the thyroid body, and symmetrical swellings
of fat tissue at the sides of the neck, connected with defective cerebral
development. Med Chir Trans. 1850;33: 303–6.
2. WW. On a cretinoid state supervening in adult life in women. Trans Clin Soc Lond.
1873/1874;7:180–5.
3. Kocher T. Ueber kropfexstirpation und ihre folgen. Arch Klin Chir. 1883;29:254–
337.
4. Ord W.M.: Report of a committee of the Clinical Society of London nominated
December 14, 1883 to investigate the subject of myxoedema. Trans Clin Soc Lond
1888.
5. Murray GR. Note on the treatment of myxoedema by hypodermic injections of
an extract of the thyroid gland of a sheep. Br Med J. 1891;2:796
6. https://emedicine.medscape.com/article/122393-overview, updated on Nov 5,
2019, accessed, on 29-11-2020.
7. Aoki Y, Belin RM, Clickner R, et al. Serum TSH and total T4 in the United States
population and their association with participant characteristics: National Health
and Nutrition Examination Survey (NHANES 1999-2002). Thyroid. 2007 Dec. 17
(12):1211-23. [Medline].
84. Contd...
8. Kajantie E, Phillips DI, Osmond C, Barker DJ, Forsen T, Eriksson JG. Spontaneous
hypothyroidism in adult women is predicted by small body size at birth and
during childhood. J Clin Endocrinol Metab. 2006 Dec. 91(12):4953-6. [Medline].
9. www.thelancet.com/diabetes-endocrinology Vol 2 October 2014
10. http://www.clinicalkey.com.elibpgimer.remotexs.in/#!/browse/book/3-s2.0-
C20121030524 Wilmar M. Wiersinga Endocrinology: Adult and Pediatric, 7Th
edition,Chapter 88, 1540-155
11. Institute of Medicine (US) Committee on Medicare Coverage of Routine Thyroid
Screening; Stone MB, Wallace RB, editors. Medicare Coverage of Routine
Screening for Thyroid Dysfunction. Washington (DC): National Academies Press
(US); 2003. 2, Pathophysiology and Diagnosis of Thyroid Disease. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK221541
12. http://egyankosh.ac.in//handle/123456789/31527,Unit -4,Nursing
Management in endocrine disorders,IGNOU, accessed on 27-11-2020.
13. Sandra M. Nettina .lippinicott manual of practice.10th edition
14. https://www.thyroid.org/hypothyroidism/ American thyroid association
follow-up instructions, accessed on 02-12-2020
Editor's Notes
Worldwide, around 200 million people suffer from thyroid disorders, with almost 50% of cases remaining undiagnosed. This has consequences for health and well-being, since this little organ regulates processes that are essential to survival.