The thyroid gland is located in the lower neck and produces three important hormones. It can become overactive (hyperthyroidism) or underactive (hypothyroidism), both of which have distinct signs and symptoms. Hypothyroidism is treated with thyroid hormone replacement drugs while hyperthyroidism may be treated with anti-thyroid medications, radioactive iodine therapy, or surgery. Nursing care focuses on monitoring for complications and educating patients about lifelong management of the condition.

1. Prepared by: LAURENCE A. ADENA, MAN

2. THE THYROID GLAND
a butterfly-shaped organ located in the lower neck, anterior to
the trachea.
It consists of two lateral lobes connected by an isthmus.
The gland is about 5 cm long and 3 cm wide and weighs about
30 g.
The blood flow to the thyroid is very high (about 5 mL/min per
gram of thyroid tissue) approximately five times the blood
flow to the liver.
The thyroid gland produces three hormones:
thyroxine (T4) , triiodothyronine (T3), and calcitonin.

3. Assessment and Diagnostic Findings
1. Palpation to determine the size, shape, consistency, symmetry and presence of
tenderness.
Normal Findings Abnormal Findings
a. Thyroid tissue rise when
swallowing as per instruction to
patient.
b. Isthmus is firm and rubber band
consistency upon palpation.
a. Tenderness
-refer to MD. Needs further
evaluation.
b. Enlargement
-refer to MD. Needs further
evaluation.
c. Nodularity
- refer to MD. Needs further
evaluation.

5. 2. Auscultation using the diaphragm of stethoscope is done if enlargement is present.
Audible vibration “bruit sound” is indicative of increased blood flow to the area. Immediate
referral to MD is needed.

6. 3. Serum TSH – used as
diagnostic test and at the same
time to monitor the effectiveness
of Thyroid Replacement Therapy
Below Normal Normal Range Above Normal
Primary Hypothyroidism 0.4 – 6.15µU/ml Primary
Hyperthyroidism

7. 4. T3 Resin Reuptake Test
 Indirect measurement of unsaturated TBG (Thyroxine Binding Globulin)
 Determine the amount of hormone bound to TBG
 Determine the available number of available binding sites
 Indexing the amount of thyroid hormone present in the circulation
 Normal T3 uptake value is 25% - 35% (relative fraction 0.25 – 0.35) which means that 1/3 of
the available sites of TBG are occupied of thyroid hormone
Hypothyroidism Hyperthyroidism
Available site = T3 uptake
(less than 25%)
Available site = T3 uptake
(greater than 35%)

8.  T3 Normal Value: 70 -220 mg/dL (58.5 – 150 mmol/L)
o Above Normal: Hyperthyroidism
o Below Normal: Hypothyroidism
 T4 Normal Level: 4.5 – 11.5 (58.5 – 150 mmol/L)
o Below Normal: Hypothyroidism
5. Serum Free Thyroxine (FT4)
 Confirmatory of abnormal TSH and direct measurement
of free thyroxine
 Normal Level: 0.9 – 1.7 mg/dL (11.5 – 21.8 mmol/L)
6. Serum Triiodothyronine (T3) and Thyroxine (T4)

9. Determine the location,
size, shape and anatomic
function of the thyroid
tissue
Isotopes being used: Iodine-
123 (most commonly used),
Technitium-99m, Thalium,
Americium; usually given via
IV
Used scintillation detector
or gamma camera
7. Thyroid Scan

10.  Measures body’s oxygen consumption at the
lowest cellular activity
 Patient should be put on NPO 10-12 hours prior
to examination
 Night sleep at least 8 hours and up
 Instruct the patient not to get up in bed the
morning the examination until the test is finished
 A device with nose clip and a mouthpiece will be
used while the client is performing deep
breathing exercises
 Normal Value:±20%
8. BMR (Basal Metabolic Rate)

11.  Measures the rate of iodine uptake by the thyroid gland
 Given a Tracer dose of iodione-123 per Orem
 2º, 6º, 24º - exposure to scintillation counter which detects and count the gamma rays
released from the breakdown of iodine-123
 Nursing Health Teaching:
⮚ If the patient is taking oral contraceptive pills, temporarily discontinue the intake
because it may increase metabolism
⮚ No foods rich in iodine (seafoods etc.) 7-10 days prior to examination
⮚ No drugs and dyes (used as contrast media) with iodine 7-10 days prior to
9. Radioactive Iodine Uptake (RAIU)
Uptake = Hyperthyroidism Uptake = Hypothyroidism

12. – used to detect malignancy by taking tissue sample using small-gauge needle from a thyroid
mass
10. Fine Needle Biopsy

15. HYPOTHYROIDISM
⮚ Deficiency of circulating thyroid hormones that leads to decrease basal metabolic rate
and heat production .
Etiology:
⮚ Iodine deficiency

16. CLASSIFICATIONS:
PRIMARY ● Iodine deficiency (provinces endemic for iodine deficiency)
● Autoimmune (Hashimoto Disease)
● Iatrogenic : result from total or sub-total thyroidectomy, external
irradiation of neck for lymphoma or cancer
● Drugs: Lithium, anti-thyroid drugs
● Congenital hypothyroidism; absent or ectopic thyroid gland
HYPOTHYROIDISM
TRANSIENT ● Silent thyroiditis including postpartum thyroiditis
● Sub acute thyroiditis
● Withdrawal from thyroxine treatment

17. SECONDARY ● Hypopituitarism: tumor, pituitary surgery or irradiation
● Hypothalamic deficiency: tumor, trauma, infiltrative disorder,
idiopathic
HYPOTHYROIDISM
CLASSIFICATIONS:

19. ⮚ Decreased BMR (due to
decreased level of T3)
⮚ Decreased Body Heat Production
(due to decreased level of T4)
⮚ Hypercalcemia (due to decreased
level of thyrocalcitonin)
Clinical Manifestations:

20. Clinical Manifestations of Hypothyroidism
(descending Order of Frequency)
Symptoms Signs
● Tiredness, weakness
● Dry skin
● Feeling cold
● Hair loss
● Difficulty concentrating and poor memory
● Constipation
● Weight gain with poor appetite
● Dyspnea
● Hoarse voice
● Menorrhagia (later oligomenorrhea or amenorrhea)
● Paresthesia
● Dry coarse skin; cool peripheral extremities
● Puffy face, hands, and feet
● Diffuse alopecia
● Bradycardia
● Peripheral edema
● Delayed tendon reflex relaxation
● Serous cavity effusions

22. HYPOTHYROIDISM
Nursing Management
• Prevent immobility. Provide activities within
tolerance level.
• Assist with ADL for minimal energy
consumption.
• Provide warm environment and extra clothing
and blanket to combat the effect of cold
intolerance.
• Increase fiber in the diet to prevent
constipation.
• Include the family in care: medication schedules,
side effects that needs to be reported
immediately.
• Patient airway.
• Keep patient warm and check VS frequently.
• Give IV glucose and corticosteroids as ordered.

23. HYPOTHYROIDISM
Medical Management:
1. Replacement of thyroid hormones
2. Synthetic Levothyroxine (Synthroid), liothyronine
(Cytomel)
● May increase blood glucose level; insulin and oral
hypoglycemic agents must be adjusted for clients
with DM during stress and illness
● Effects maybe increased with Dilantin (Phenytoin)
and TCA’s.
Monitor cardiopulmonary status to prevent complication

25. Activity intolerance related to fatigue and depressed
cognitive process
Risk for imbalanced body temperature
Constipation related to depressed gastrointestinal function
Deficient knowledge about the therapeutic regimen for
lifelong thyroid replacement therapy
Ineffective breathing pattern related to depressed
ventilation
Disturbed thought processes related to depressed
metabolism and altered cardiovascular and respiratory
status

26. HYPERTHYROIDISM

27. ⮚Excessive secretion of thyroid gland or hyperactivity of the thyroid
gland
⮚Metabolism of all tissues of the body becomes greatly increased
HYPERTHYROIDISM
Etiology:
1. Primary
● Toxic multinodular goiter
● Toxic adenoma
● Functioning thyroid carcinoma metastases
● Drugs: iodine excess (Jod-basedow phenomenon)

28. 2. Secondary
● TSH-secreting pituitary adenoma
● Thyroid hormone resistance
syndrome: occasional patients may
have features of thyrotoxicosis
● Chorionic Gonadotropin – secreting
tumors
● Gestational thyrotoxicosis
3. Thyrotoxicosis
● Subacute thyroiditis
● Silent thyroiditis
● Other causes of thyroid destruction:
amiodarone, radiation, infarction of
adenoma
● Ingestion of excess thyroid hormone
(thyrotoxicosis factitia) or thyroid tissue
HYPERTHYROIDISM
Etiology:

30. Clinical Manifestations
⮚ Increased BMR (due to
increased level of T3)
⮚ Increased Body Heat
Production (due to increased
level of T4)
⮚ Hypocalcemia (due to
increased level of
thyrocalcitonin)
Clinical Manifestations of Hyperthyroidism
(Descending Order of Frequency)
Symptoms Signs
● Hyperactivity, irritability, dysphoria
● Heat intolerance and sweating
● Palpitations
● Fatigue and weakness
● Weight loss with increased
appetite
● Diarrhea
● Polyuria
● Oligomenorrhea, loss of libido
● Tachycardia; atrial fibrillation in the
elderly
● Tremor
● Goiter
● Warm, moist skin
● Muscle weakness, proximal
myopathy
● Lid retraction or lag
● Gynecomastia
HYPERTHYROIDISM

32. 1. Hypermetabolic Rate
⮚ Imbalanced nutrition, less than body requirement
⮚ Activity intolerance
2. Exophthalmos
⮚ Body image disturbance
⮚ Low self-esteem related to changes in physical appearance
⮚ Risk for injury related to drying cornea
3. Irritability
⮚ Ineffective individual coping
4. Diarrhea
⮚ Risk for fluid volume deficit
5. Hyperthermia
⮚ Altered body temperature

33. Nursing Management
Provide high calorie, high protein food to compensate the hypermetabolic requirement.
Stimulants such as coffee, tea and colas are generally discouraged
Weigh the patient daily to monitor nutritional improvement
Minimize stress. Provide a calm environment to decrease stimulation.
Cool environment to combat heat intolerance
Eye care and protection. Wearing sunglasses during sunny days and giving of ophthalmic
ointment or drops (artificial tears) prevent corneal ulceration.
HYPERTHYROIDISM

34. Medical Management
⮚ Measures to reduce thyroid hyperactivity
⮚ Relieve symptoms and prevention of complication
1. Irradiation administration
– to destroy the overactive thyroid cell by using radioisotopes of iodine per- orem
● Educate the patient that it is tasteless and odorless radioiodine
● Used to treat toxic adenomas and multinodular goiter
● Less side effects compared to antithyroid medications
HYPERTHYROIDISM

35. 2. Anti-thyroid medications – inhibit thyroid synthesis. May reduce the amount of the
thyroid tissue to decrease thyroid hormone production
● Commonly used: Propylthiouracil (Propacil, PTU), Methimazole (Tapazole)
● Side Effects:
✔ Fever
✔ Rash
✔ Urticaria
✔ Agranulocytosis – report s/s of infection e.g. sore throat
✔ Thrombocytopenia – report s/s of bleeding
HYPERTHYROIDISM
Medical Management

36. 4. Beta Blockers
- given to counteract the increased
metabolic effect of thyroid hormones
 Relieve symptoms of tachycardia, tremors,
anxiety and heat intolerance
● Commonly used: Propanolol (Inderal),
Atenolol (Tenormin), Metoprolol
(Lopressor)
HYPERTHYROIDISM

37. Surgical Management:
⮚Thyroidectomy
 Used to remove a part or all of the thyroid gland
 Done after the thyroid hormone return to normal
(4-6 weeks) and vascularity is reduced to avoid
hemorrhagic complication
 Used to reduce the obstructive effect of enlarged
thyroid
 Complication: Hemorrhage and accidental removal
of parathyroid gland
● Watch out for signs of hemorrhage post-op
HYPERTHYROIDISM

39. Monitor signs and symptoms
of hypocalcemia
● Chevostek Sign –
spasm of cheeks
● Trousseau’s Sign –
carpopedal spasm
HYPERTHYROIDISM
Surgical Management:
⮚Thyroidectomy

42. Nursing Diagnoses:
✔ Imbalanced nutrition, less than body requirements, related to
exaggerated metabolic rate, excessive appetite, and increased
GI activity
✔ Ineffective coping related to irritability, hyper-excitability,
apprehension, and emotional instability
✔ Low self-esteem related to changes in appearance, excessive
appetite, and weight loss
✔ Altered body temperature

44. Study while others are playing.
Decide while others are delaying.
Prepare while others are daydreaming.
Begin while others are procrastinating.
Work while others are wishing.
Save while others are wasting.
Listen while others are talking.
Smile while others are frowning.
Persist while others are quitting.