Hypothyroidism Hypothyroidism

1. HYPOTHYROIDISM AND
HYPERTHYROIDISM
PRESENTED BY GROUP 3
ROLL NO. 21 TO 30

2. GENERAL
OBJECTIVES
AT THE END OF THE PRESENTATION ,
STUDENTS WILL BE ABLE TO UNDERSTAND
WHAT IS HYPOTHYROIDISM AND
HYPERTHYROIDISM .

3. SPECIFIC OBJECTIVES
• EXPLAIN THE ANATOMY OF THYROID GLAND .
• EXPLAIN THE ACTION OF THYROID HORMONES .
• DEFINE HYPOTHYROIDISM AND HYPERTHYROIDISM .
• ENLIST THE TYPES OF HYPOTHYROIDISM AND HYPERTHYROIDISM .
• LIST DOWN THE CAUSES/ETIOLOGY OF HYPO AND HYPERTHYROIDISM .
• EXPLAIN THE PATHOPHYSIOLOGY OF HYPO AND HYPERTHYROIDISM .
• ENLIST THE RISK FACTORS OF HYPO AND HYPERTHYROIDISM .
• EXPLAIN THE CLINICAL MANIFESTATION OF HYPO AND HYPERTHYROIDISM .
• ASSESSMENT AND DIAGNOSTING FINDINGS OF HYPO AND HYPERTHYROIDISM .
• EXPLAIN THE MANAGEMENT OF HYPO AND HYPERTHYROIDISM .
• ENUMERATE THE NURSING DIAGNOSIS OF HYPO AND HYPERTHYROIDISM .
• INTERVENTION OF HYPO AND HYPERTHYROIDISM .
• LIST DOWN THE COMPLICATION OF HYPO AND HYPERTHYROIDISM .

4. ANATOMY OF THYROID
GLAND
THE THYROID GLAND IS A SMALL BUTTERFLY SHAPED GLAND
LOCATED IN THE ANTERIOR OF NECK BELOW THE LARYNX OR VOICE
BOX .
THE THYROID GLAND MAKES THYROID HORMONES –
• THYROXINE (T4)
• TRIIODOTHYRONINE (T3)
• CALCITONIN
WHICH CIRCULATE IN THE BLOOD STREAM .

5. ACTION OF THYROID
HORMONES
• INCREASE THE BASAL METABOLIC RATE .
• STIMULATE THE SYNTHESIS OF ADDITION SODIUM
POTASSIUM PUMP .
• REGULATION OF METABOLISM ,THYROID
HORMONE STIMULATE PROTEIN SYNTHESIS AND
INCREASE USE OF GLUCOSE .

6. HYPOTHYROIDISM
IT IS A DISORDER THAT OCCURS WHEN THE
THYROID GLAND DOES NOT MAKE ENOUGH
THYROID HORMONES TO MEET THE BODY
NEEDS .

7. TYPES OF HYPOTHYROIDISM
1. PRIMARY HYPOTHYROIDISM - INSUFFICIENT AMOUNT OF
THYROID HORMONE SECRETED BY THYROID GLAND .
2. SECONDARY HYPOTHYROIDISM – IT IS DUE TO PITUITARY
GLAND FAILURE (INADEQUATE SECRETION OF TSH )
3. TERTIARY HYPOTHYROIDISM – IT IS DUE TO HYPOTHALAMUS
FAILURE ( SUBNORMAL SECRETION OF TRH )
4. SUBCLINICAL HYPOTHYROIDISM – ALSO CALLED MID
THYROID FAILURE .

8. CAUSES/ETIOLOGY
• IODINE DEFICIENCY .
• ATROPHY OF THYROID GLAND .
• HASHIMOTO’S THYROIDITIS OR GRAVE’S
DISEASE ( AUTOIMMUNE DISEASE )

9. PATHOPHYSIOLOGY
HYPOTHALAMUS DYSFUNCTION (TERTIARY)
THYROTROPIN RELEASING HORMONE DECREASE TRH
ANTERIOR PITUITARY PITUITARY DYSFUNCTION (SECONDARY)
TSH DECREASED OR NORMAL TSH
THYRAID GLAND DESTRUCTION INFLAMMATION (PRIMARY)
THYROXINE (T4) TRIIODOTHYRONINE (T3) INCREASED TSH

10. RISK FACTORS
 FEMALES
 OLD AGE
 RACE ( BEING WHITE OR ASIAN )
 FAMILY HISTORY OF THYROIDITIS
 GENETIC DEFECTS
 PREGNANT OR POSTPARTUM
 THYROID SURGERY

11. CLINICAL MANIFESTATION
• DECREASED HEART RATE
• ANAEMIA
• DYSPNEA
• LOSS OF APPETITE
• CONSTIPATION
• WEIGHT GAIN
• FATIGUE
• HAIR LOSS
• POOR HEARING

12. ASSESSMENT AND
DIAGNOSTIC FINDINGS
• HISTORY TAKING
• PHYSICAL EXAMINATION – THYROID GLAND IS INSPECTED
AND PALPATED ROUTINELY IN ALL PATIENT .
• SERUM TSH
• SERUM T3 AND T4 – MEASUREMENT OF TOTAL T3 OR T4
INCLUDES PROTEIN BOUND .
• SERUM CHOLESTEROL
• TRH STIMULATION TEST
• SERUM ELECTROLYTE LEVEL

13. MANAGEMENT
 MEDICAL MANAGEMENT
• SYNTHETIC LEUTHYROXINE IS PERFORMED .
• CONCENTRATED GLUCOSE MAY BE GIVEN IF HYPOGLYCEMIA IS
EUDENT
• IF MYXEDEMA IS PRESENT , THYROID HORMONE ID GIVEN IV UNTIL
CONSCIOUSNESS IS RESTORED .
 DIETARY MANAGEMENT
• IF ITS BECAUSE OF IODINE DEFICIENCY PROVIDE HIGH IODINE DIET .
• AVOID SOYABEAN
• AVOID GREEN LEAFY VEGETABLES .

14. NURSING MANAGEMENT
• MONITOR VITAL SIGNS OF PATIENT .
• ADMINISTER ANTITHYROID DRUG AS PRESCRIBED .
• MONITOR T3 AND T4 LEVELS TO DETERMINE THE
EFFECTIVENESS OF PHARMACOTHERAPY .
• PROVIDE HIGH FIBRE DIET .
• MONITOR FOR DECREASING SYMPTOMS RELATED
TO HYPOTHYROIDISM .
• ADVISE TO AVOID HIGH TEMPERATURE
ENVIRONMENT .

15. NURSING DIAGNOSIS
• DECREASE CARDIAC OUTPUT RELATED TO
DECREASE METABOLIC RATE AND DECREASE
CONDUCTION OF HEART .
• ACTIVITY INTOLERANCE RELATED TO FATIGUE
AND LETHARGY .
• DEFICIT KNOWLEDGE RELATED TO DISEASE
CONDITION , PROGNOSIS , TREATMENT ,
SELFCARE AND DISCHARGE NEEDS .

16. INTERVENTION
1. RISK FOR DECREASE CARDIAC OUTPUT
• MONITOR BP , ECG AND HEART RATE .
• ADMINISTER IV FLUID AS NEEDED .
• ADMINISTER MEDICATION .
• PROVIDE SUPPLEMENTAL OXYGEN TO SUPPORT AND INCREASE METABOLIC
DEMANDS .
2 . KNOWLEDGE DEFICIT
• ASSES KNOWLEDGE AND UNDERSTANDING LEVEL ABOUT PARTICULAR
DISESASE .
• DISCUSS DIETARY PLAN .
• ENCOURAGE PATIENT FOR EXERCISE REGULARLY .

17. 3 . ACTIVITY INTOLERANCE
• INSTRUCT PATIENT TO DO EXERCISES ON A
REGULAR BASIS WITH PLAN .
• ENCOURAGE PATIENT TO EAT CARBOHYDRATE
SNACKS BEFORE EXERCISING TO AVOID
HYPOGLYCEMIA .

18. HYPERTHYROIDISM
IT IS A DISORDER THAT OCCURS WHEN
THE THYROID GLAND MAKES MORE
THYROID HORMONE THAN THE BODY
NEEDS .
HYPERTHYROIDISM IS SOMETIMES
CALLED THYROTOXICOSIS , THE
TECHNICAL TERM FOR TOO MUCH
THYROID HORMONE IN THE BLOOD

19. CAUSES/ETIOLOGY
• OVER FUNCTIONING OF ENTIRE GLAND .
• OVER WORK
• EMOTIONAL UPSET
• WORRY
• ANXIETY
• ACUTE INFECTION
• STIMULATION OF SYMPATHETIC SYSTEM

20. PATHOPHYSIOLOGY
HYPERTHYROIDISM CHARACTERIZED BY LOSS OF NORMAL
REGULATORY CONTROL OF THYROID SECRETION
THE ACTION OF THYROID HORMONE ON THE BODY IS STIMULATORY
HYPER METABOLIC RESULT
INCREASE SYMPATHETIC NERVOUS SYSTEM ACTIVITY
ALTERATION SECRETION OF THYROID HORMONE STIMULATE THE
CARDIAC SYSTEM AND INCREASE ADRENERGIC RECEPTOR

21. TACHYCARDIA AND INCREASE CARDIAC OUTPUT , STROKE
VOLUME AND PERIPHERAL BLOOD FLOW
NEGATIVE NITROGENOUS BALANCE , LIPID DEPLETION AND
RESULTANT STATE OF NUTRITION
HYPERTHYROIDISM RESULT

22. CLINICAL MANIFESTATION
• HYPERTENSION
• TACHYCARDIA
• DYSPNEA
• DIARRHEA
• SPLENOMEGALY
• FATIGUE
• MUSCLE WEAKNESS
• INSOMNIA
• AMENORRHEA

23. ASSESSMENT AND
DIAGNOSTIC FINDINGS
• HISTORY TAKING
• PHYSICAL EXAMINATION
• PROTRUDING OF EYES
• PHYSICAL APPEARANCE
• ENLARGE NECK
• TSH ASSAY
• ELEVATED THYROXINE RADIO IMMUNOASSAY
• THYROID AUTOANTIBODIES

24. COMPLICATION
• HYPERTENSION
• HEART FAILURE

25. MANAGEMENT
 MEDICAL MANAGEMENT
• ANTITHYROID DRUGS
o METHAMAZOLE
o RADIO IODINE THERAPY
oB – ADRENERGIC BLOCKERS
 SURGICAL MANAGEMENT
• SUBTOTAL THYROIDECTOMY
• TOTAL THYROIDECTOMY

26. NURSING MANAGEMENT
• PROVIDE ADEQUATE REST
• PROVIDE COOL AND QUITE ENVIRONMENT
• MONITOR WEIGHT DAILY
• PROVIDE HIGH CALORIE DIET
• ADMINISTER ANTITHYROID MEDICATION AS
PRESCRIBED

27. NURSING DIAGNOSIS
• IMBALANCE NUTRITION LESS THAN BODY
REQUIREMENT RELATED TO INCREASE METABOLIC
RATE OF THE BODY
• IMPAIRED SKIN INTEGRITY RELATED TO PYREXIA
OR EXTREME DIAPHAROSIS
• INSOMNIA AND IRRITABILITY RELATED TO
ALTERED THOUGHT PROCESS
• DEFICIT KNOWLEDGE RELATED TO DISEASE
PROCESS

28. INTERVENTION
 IMPAIRED SKIN INTEGRITY
• ASSESS SKIN FREQUENTLY TO DETECT ANY
CHANGES
• AVOID USE OF ADHESIVE TAPE
• INSTRUCT

29. SUMMARY
WE DISCUSSED ABOUT –
ANATOMY OF THYROID GLAND , ACTION OF THYROID
GLAND , DEFINITION OF HYPO AND HYPERTHYROIDISM ,
RISK FACTORS , ETIOLOGY , CLINICAL MANIFESTATION ,
PATHOPHYSIOLOGY , ASSESSMENT AND DIAGNOSTIC
FINDINGS , THEIR MANAGEMENT AND NURSING
DIAGNOSES AND INTERVENTIONS OF HYPO AND
HYPERTHYROIDISM .

30. CONCLUSION
AN INCREASE AND DECREASE IN THE THYROID
HORMONES SECRETION LEAD TO DIFFERENT
CLINICAL AND PATHOLOGICAL CHANGES .

31. BIBLIOGRAPHY
1) HTTPS://WWW.MAYOCLINIC.ORG/DISEASES-
CONDITIONS/HYPOTHYROIDISM/SYMPTOMS-CAUSES/SYC-20350284
2) HTTPS://NURSESLABS.COM/HYPERTHYROIDISM-NURSING-CARE-PLAN-
NCP/