Hypothyroidism is a disorder where the thyroid gland fails to produce adequate hormones, leading to symptoms such as weight gain, fatigue, and metabolic slowdown. It is most commonly caused by Hashimoto's disease and can affect anyone, particularly those assigned female at birth over age 60. Diagnosis involves checking hormone levels, and treatment typically includes hormone replacement therapy to manage the condition effectively.

1. HYPO-THYROIDISM
RUBAB ZAHRA
24011714-019

2. Outlines
 Introduction
 Definition
 Cretinism and myxedema
 Types
 Etiology
 Pathophysiology
 Clinical menifestations
 Dignostic Evaluation
 Medical Management
 Nursing Dignosis
 Complications

3. Introduction
 Hypothyroidism is a common disorder in which the
thyroid gland can not produce enough hormones to
meet the body’s demand.
 As a result, your metabolism slows down. This can cause
unintentional weight gain and make you feel exhausted
all the time.
 In general, hypothyroidism is very treatable. Most
people can manage the condition with medication and
regular follow-up visits with their endocrinologist.
 Left untreated over long periods of time, hypothyroidism
can become life-threatening.

4. Thyroid gland
 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-iodo-thyronine (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.

6. Anatomy

7. Thyroid hormones
Mental growth and maturation
Physical growth and maturation
Sensitivity to adrenergic system
Basal Metabolic Rate

8. 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 leads to
thyroid insufficiency.

9. Difference between Cretinism and Myxoedema
CRETINISM MYXOEDEMA
Hypothyroidim in childrens Hypothyroidim in adults
Characterized by stunted growth Characterised by edematous appearence
Congenital absence of thyroid gland
Lack of iodine in diet
Diease of thyroid gland
Iodine deficiency
Deficiency of TSH
Hashimotos thyroiditis
Stunted growth
Guttural breathing
Swelling of Face
Bagginess under eyes
Anemia
Fatigue
Atherosclerosis

11. TYPES
Primary
Secondary
Tertiary

12. Primary hypothyroidism
 Also known as Underactive thyroid
 Directly impacts your thyroid and causes
it to make low levels of thyroid
hormones.
 In turn, your pituitary gland makes
more thyroid stimulating hormone (TSH).
 Autoimmune conditions like Hashimoto’s
disease can cause it, or it can happen
after thyroid gland surgery or
radiation therapy.
 Primary hypothyroidism is the most
common type.

13. Secondary Hypothyroidism
 occurs when you have an
underactive pituitary
gland (a pea-sized
gland at the base of
your brain). This rare
type of hypothyroidism
prevents your pituitary
gland from sending TSH
to your thyroid gland.

14. Tertiary hypothyroidism and subclinical hypothroidism
 happens when your
hypothalamus (a structure
in your brain that keeps
your body in a stable
state called homeostasis)
doesn’t make enough
thyrotropin-releasing
hormone (TRH). As a
result, your pituitary
gland can’t make enough
TSH.
 also known as mild
thyroid failure, happens
when you have slightly
elevated TSH levels, but
all other thyroid
hormone levels are
within a typical range.
Subclinical
hypothyroidism usually
goes away on its own in
about three months.

15. How common is hypothyroidism
 Hypothyroidism can affect anyone. It’s most common
among people assigned female at birth
(AFAB) over age 60, particularly after menopause.

16. What causes hypothyroidism
Hashimoto’s disease is the most common cause of hypothyroidism. It’s
an autoimmune disease, so it happens when your immune system attacks
your thyroid.
Other hypothyroidism causes include:
 Certain medications, including lithium, thalidomide and amiodarone.
 Conditions present at birth, like being born with no thyroid gland or
a thyroid gland that doesn’t work properly.
 Iodine deficiency (when you don’t have enough iodine in your body).
 Pituitary gland disorders, including noncancerous tumors.
 Thyroiditis (inflammation of the thyroid that can happen after a viral
illness or pregnancy)
 Thyroidectomy

17. Pathophysiology
Thyroid gland needs Iodine to secrete 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

18. 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.

20. Pathogenesis of hypothyroidism
 Pathogenesis of hypothyroidism through accumulation of
glycosaminoglycan is a key mecahnisn in certain type of
hypothyroidism
 GAGs are complex cabohydrates that play important
role in tissue structure and fuction
 In hypothyroidism, GAGs accumulate in thyroid gland
and interfere with thyroid hormone synthesis
 This lead to tissue swelling , inflammation and damage
especially in skin heart muscles and striated muscles

21. Clinical manifestation of hypo-thyroidsm
Symptoms and signs vary in relation to the magnitude
of the thyroid hormone deficiency, and the acuteness
with which the deficiency develops.
 Less prominent clinically and better tolerated when
gradual loss of thyroid function (as in most cases of
primary hypothyroidism)
 Symptoms develop acutely after thyroidectomy or
abrupt withdrawal of exogenous thyroid hormone

22. Signs and symptom of hypothyroidim

23. 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

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

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

26. 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

27. 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.

28. 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.

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

30. References
 https://
my.clevelandclinic.org/health/diseases/12120-hyp
othyroidism