CHAPTER 51 ENDOCINE HYPOTHYROIDISM: One of the most common disorders in the U.

S affecting 8% of women 2% of men Over 50 Occurs most often in ages 30-60 Hypothyroidism is a clinical state that occurs when the thyroid fails to secrete sufficient hormones resulting in: A slowing of the bodys metabolic processes Causes may be: A condition of the thyroid itself Failure t hr pituitary gland to furnish sufficient TSH for proper stimulation of thyroid secretion Sometimes an unfortunate sequel of the medical or surgical treatment of hyperthyroidism MYXEDEMA: Severe hypothyroidism in adults CRETINISM: Congenital hypothyroidism Estimated to occur in 1 of every 4000-5000 newborns CLINICAL MANIFESTATIONS Range from mild to severe and depend on the degree of thyroid deficiency present There is a slowing of all the bodys metabolic processes resulting in: o Decreased production of body heat o Intolerance to cold o Weight gain Atherosclerotic changes may result in coronary artery diseases ASSESSMENT: SUBJECTIVE Patients mental and emotional status because he/she may display: o Depression or paranoia o Impaired memory o General slowing of thought process Speech and hearing may be deficient Patient is lethargic, forgetful, and irritable

Because of the bodys slowed metabolism: Anorexia Constipation May develop Both sexes experience libido and reproductive difficulty Females suffer: Menstrual irregularities Difficulty conceiving Completing pregnancy o Many experience spontaneous abortions Contributes to emotional distress and anxiety Nurse should assess coping ability OBJECTIVE: Assessment of skin and hair Hair thins and may fall out Skin becomes thickened and dry Facial features may enlarge and give the patient an edematous appearance Masklike facial expression is common Voice is characteristically low and hoarse Decreased metabolism usually causes: Bradycardia Decreased B/P and respirations Exercise intolerance The patients ability to perform activity may decrease because of: Weakness Clumsiness Ataxia Respiratory must be closely monitored after giving any CNS depressant The abdomen must be evaluated for distention because myxedema ileus may occur DIAGNOSTIC TESTS Diagnoses based on physical examination and history of laboratory tests such as: TSH T3 T4 Free T4 (FT4)

Low levels of T3, T4, and FT4 are the underlying stimuli for TSH Therefore a compensatory elevation of TSH occurs in patients with primary hypothyroid states and low levels of T3, T4, and FT4 are present In children when T4 replacement begins for epiphyseal fusion Chance for normal growth is greatly improved MEDICAL MANAGEMENT Replacement therapy with desiccated animal thyroid o (Armour Thyroid) o Thyroglobulin (Proloid) Synthetic products: Levothyroxine sodium (Levothroid) Liothyronine sodium (Cytomel) These mediations are usually given in the morning to enhance utilization of nutrients ingested during the daily meals The patient is unusually given low dose Increased as necessary until desired effect is established Maintenance dose will be established Early in treatment: Monitoring of hormone level Q6-8 wks until patients TSH level is normal and at least yearly once normalized Nurse should watch patient for adverse effects of therapy which mimic the S&S of hyperthyroidism Lifetime hormone replacement is usually required NUSRING INTERVENTIONS Hospitalized patient care usually focuses on symptomatic relief Room must be kept @ least 20--23 C ( 68--74) Patient should not be chilled during bathing or other procedures Extra time should be allowed for physical care So patient doe not feel rushed Accurate bowel elimination must be kept Because constipation may be severe Stool softeners and bulk laxatives may be ordered

Diet: High protein High fiber Low calorie Fluids are encouraged Concentrated carbohydrates such as sweets are avoided to prevent excess weight gain The nurse should watch for: Chest pain Dyspnea Accompanied by changes in rate and rhythm of heart because these may indicate development of cardiac involvement PATIENT TEACHING Patient should be taught no to stop taking the thyroid hormone without consulting physician Medication is taken for life Patients with hypothyroidism are more sensitive to effects of: Sedatives Hypnotics Anesthetics Nurse must be alert for possible adverse effects when these agents are given Regular checkups are necessary because drug dosage may need to be adjusted Instruct patient to eat well balanced meal of: High fiber foods o Fruits o Vegetables o Hole grain cereals and bread Adequate intake of iodine in foods o Saltwater fish o Eggs o Milk Increased fluids to prevent constipation Mental and physical slowness will improve with thyroid replacement therapy

Table on page 1774 Medication Levothyroxine Synthroid Levothroid

Action Side Effects Nursing Implications Thyroid replacement Most due to Give in morning to Hormone therapeutic overdose minimize insomnia include: Use caution in older Anxiety adult with CAD Insomnia H/A Monitor for S&S of HTN overdose Tremors Angina Do not switch Dysrhythmias brands unless Tachycardia instructed Menstrual irregularities

Table 51-1 Medication Hypothyroidism Levothyroxine sodium (Levothroid,Synthroid, Eltroxin) Liothyronine sodium (Cytomel, Tertroxin) Liotrex (Euthroid, Thyrolar) Thyroglobulin (Proloid) Thyroid (Armour Thyroid, Thyro-Teric, Westthroid) Common Side Effects Nervousness Leg cramps Irritability Fever Tremors Insomnia Tachycardia HTN Palpations Cardiac dysrythmias V/N Diarrhea Appetite changes Weight loss Menstrual irregularities