Hypothyroidism
By Ns. Retno Setyawati,
DEFINISI
Hipotiroidisme merupakan
suatu sindroma klinis akibat dari
defisiensi hormon tiroid, yang
kemudian mengakibatkan
perlambatan proses metabolic.
Kelainan ini kadang-kadang
disebut sebagai miksedema.
Hypothyroidism
The result of decreased thyroid
hormone.
Classified as primary and secondary
Age of onset is usually over 40 years
Incident higher in women 5-10:1
ETIOLOGY
Primary-True Thyroid
Dysfunction
Chronic Thyroiditis
(Hashimoto’s)
Thyroid Surgery
Radioactive Iodine
Goitrogens (kobis, cabai,
spinach and seafood,dsb)
Pituitary Dysfunction
Hypothyroidism
-Etiology
Secondary-Anterior Pituitary
Dysfunction
Insufficient stimulation of
thyroid
Malfunctioning pituitary
Malfunctioning
hypothalamus
Pathophysiology of hypothyroidism
Lack of thyroid hormone lead
to decrease in all body
processes, progressing to coma
The body try to compensate by:
Peripheral vasoconstriction
decrease blood flow to the
extremities.
Cardiovascular= decreased
Pathophysiology of hypothyroidism
Interstitial accumulation of
mucopolysaccharide substance
(greatly increased quantities
hyaluronic acid chondroitin
sulfate binds with a protein to
form excessive tissue gel in the
interstitial spaces)
As a result, water accumulated in
the interstitial spaces, which
Clinical Features
❏ GENERAL: fatigue, cold
intolerance, slowing of mental
and physical performance,
hoarseness, enlarged tongue
❏ CVS: slow pulse, generalized
atherosclerosis (increased serum
cholesterol and triglycerides),
pericardial effusion
❏ GI: anorexia, weight gain,
constipation, poor appetite
NEUROLOGY: paresthesia, slow
speech, muscle cramps, delay in
relaxation phase of
deep tendon reflexes (“hung
reflexes”)
❏ GU: menorrhagia, amenorrhea,
anovulatory cycles
❏ DERMATOLOGY: puffiness of face,
periorbital edema, cool, dry and
rough skin, hair dry and coarse,
eyebrows thinned (lateral 1/3)
❏ HEMATOLOGY: anemia
Hypothyroid Face
Notice the apathetic facies,
bilateral ptosis, and absent
eyebrows
Faces of Clinical Hypothyroidism
Hypothyroidism-
Assessment
Diagnostic Tests -
Decreased T3 and T4
Increased or Decreased TSH
Decreased Radioactive Iodine Uptake Scan
Other abnormal findings are elevated cholesterol
and triglycerides, anemia, and increased creatine
kinase
Hypothyroidism
Complications
Mental sluggishness
Drowsiness
Lethargy progress gradually or suddenly
to impairment of consciousness or coma
Myxedema coma
Can be precipitated by infection, drugs,
cold, or trauma
Characterized by subnormal
temperature, hypotension, and
hypoventilation
Hypothyroidism-
Medical Management-
Thyroid Hormone Deficiency
Levothyroxine - most commonly used
Iodine Deficiency
Iodized Salt
Potassium Iodide - Lugol’s Solution
Increase dietary intake of seafood
SSKI- saturated solution of potassium iodide
Nursing Management
Nursing Assessment
Health History
Changes in BP
Anemia
Family history of CHF, thyroid
disorders
Immigration from area
deficient in iodine
Nursing Management
Nursing Assessment
Dyspnea
Decreased appetite, weight gain
Fatigue, weakness, aches and pains
Lethargy, forgetfulness, hoarseness,
paresthesias, anxiety or depression
Prolonged or absent menstrual
periods, infertility, decreased libido
Cold intolerance
Nursing Management
Nursing Assessment
Objective Data
Distant heart sounds
Distended abdomen
Enlarged, scaly tongue
Dry, thick, inelastic, cold
skin
Nursing Management
Nursing Assessment
Objective Data
Poor turgor of mucosa
Puffy face
Pallor
Slow movements
Slow, slurred speech
Decreased hearing
Nursing Management
Nursing Diagnoses
Hypothermia
Imbalanced nutrition: more
than body requirements
Activity intolerance
Constipation
Disturbed thought processes
Nursing Management
Planning
Experience relief of
symptoms
Maintain a euthyroid state
Maintain a positive self-
image
Comply with life-long thyroid
replacement therapy
Nursing Management
Nursing Implementation
Acute Intervention
Patient with myxedema coma
often requires mechanical
respiratory support and cardiac
monitoring
Administer thyroid hormone
replacement therapy and other
medications IV
Nursing Management
Nursing Implementation
Acute Intervention
Monitor core temperature as
patient is often hypothermic
Assess vitals, weight, I & O,
and visible edema
Nursing Management
Nursing Implementation
Ambulatory and Home Care
Explain nature of thyroid
hormone deficiency and self-
care practices to prevent
complications
Patient and family must
understand replacement
therapy and that it is lifelong
Nursing Management
Nursing Implementation
Ambulatory and Home Care
Teach measures to prevent skin
breakdown
Emphasize need for warm
environment
Caution patient to avoid
sedatives or use lowest dose
possible
Nursing Management
Nursing Implementation
Ambulatory and Home Care
Discuss measures to minimize
constipation
Avoid enemas because of vagal
stimulation in cardiac patient
Caution patient to avoid sedatives or
use lowest dose possible
Teach patient to notify physician
immediately if signs of overdose
appear
Nursing Management
Nursing Implementation
Ambulatory and Home Care
Patient with DM should test
capillary blood glucose at least
daily as return to euthyroid state
frequently increases insulin
requirements
Thyroid preparations potentiate the
effects of some common drug
groups
Antidepressants
Digitalis compounds
Nursing Management
Evaluation
Expected Outcomes
Have relief from symptoms
Maintain euthyroid state as
evidenced by normal thyroid
hormone and TSH levels
State need to adhere to
lifelong therapy
