Hypothyrodism

Hypothyrodism

• 1.
  HYPOTHYROIDISM Compiled By – Mr.Ashish H. Roy (Nursing Tutor)
• 2.
  Introduction to Hypothyroidism Hypothyroidismis a condition in which thyroid gland does not produce enough thyroid hormone. Women espicially those are older than 60 years or older are more likely to have hypothyroidism. Hypothyroidism Upsets the normal balance of chemical reactions in body and causes like obesity, joint pain, infertility and heart disease.
• 3.
  Definition Subnormal secretion ofthyroid hormone by thyroid glands is known as ‘hypothyroidism’.
• 4.
  TYPES  PRIMARY :Insufficient amount of thyroid hormone secreted by thyroid gland.  SECONDARY : It is due to pituitary gland failure (inadequate amount secretion of TSH )  TERTIARY : It is due to hypothalamus failure (sub normal TRH secretion).
• 5.
  CAUSES/ AETIOLOGY  UseOf Radioactive Iodine  Over Treated With Anti thyroid Drugs.  Removing Of Thyroid Issue In Thyroidectomy  Mal- Development  Iodine Deficiency  Congenital  Malignancy Of Neck Or Forehead  Pituitary Dysfunction.  Goitrogenic Foods, E.G., Turnip , Cauliflower. Etc.
• 6.
  RISK FACTORS  WOMENOVER AGE OF 50 YEARS  AUTOIMMUNE DISEASE ( TYPE 1 DIABETES , MULTIPLE SCLEROSIS)  RACE ( BEING WHITE OR ASIAN )  TURNER’S SYNDROME  DOWN’S SYNDROME  ANTI- THYROID MEDICATIONS
• 7.
  CLINICAL MENIFESTATIONS  CVS Increaseheart rate Hyperlipidaemia Hypercholesterolemia Weak Contractility Bradycardia Anaemia Tendency to develop – CHF ( Congestive Heart Failure) AP (Angina Pectoris) MI (Myocardial Infarction )  RESPIRATORY SYSTEM Dyspnoea  G.I.T SYSTEM Loss of appetite
• 8.
  Continued… Increase weight Nausea vomiting Distensionin abdomen  SKIN Dry skin, thick and elasticity increase Brittle nails Dry hairs Puffy face Pallorness Dry hair excessive sweating Cold intolerance
• 9.
  Continued…  MUSCULOSKELETAL SYSTEM Fatigue Weakness Slowmovement Muscular pain  REPRODUCTIVE SYSTEM Decrease libido Irregular menses  OTHERS Myxoedema ( A dry firm waxy swelling of skin ) Goitre Sleepnessness
• 10.
  DIAGNOSTIC EVALUATIONS SUBNORMAL T3AND T4 LEVEL ECG ELEVATED SECRUM CHOLESTROL SERUM ELECTROLYTE LEVEL ( SODIUM MAY BE IN LOW LEVEL)
• 11.
  COMPLICATIONS  MYXEDEMA :Myxedema is a term used synonymously with severe hypothyroidism. However, the term is also used to describe a dermatological change that can occur in hyperthyroidism and (rare) paradoxical cases of hypothyroidism. Myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. One manifestation of myxedema occurring in the lower limb is pretibial myxedema, a hallmark of Graves disease, an autoimmune form of hyperthyroidism. Myxedema can also occur in Hashimoto thyroiditis  CONVULSIONS  HYPOVENTILATION  CEREBRAL HYPOXIA : Damage to specific areas of the brain. The specific prognosis depends on which areas are damaged. For instance, severe... Long-term loss of consciousness in the form of a coma. Some patients also enter a persistent vegetative state. This loss... Epilepsy or persistent seizures. Damage to motor skills, especially fine motor skills. Sometimes this damage is localized to just one region or one side... Death, either immediately after the deprivation or due to the side...
• 12.
  MEDICAL MANGEMENT  syntheticlevothyroxine ( levothyroid or synothyroid ) is preferred.  concentrated glucose may be given if hypoglycemia is evident.  if myxedema coma is present, thyroid hormone is given IV until consciousness is restored.
• 13.
  DIETARY MANAGEMENT  AVOIDSOYABEAN  AVOID GREEN LEAFY VEGETABLES  IF PATIENT HAVING HYPOTHYROIDISM DUE TO IODINE DEFICIENCY TEHN PROVIDE HIGH IODINE DIET.
• 14.
  NURSING DIAGNOSIS  Alterednutrition less than body requirement related to increase metabolic rate of body. Impairement skin integrity related to- Extreme diaphoresis Pyrexia Excessive restlessness Rapid weight loss  Risk for disturbed thought process related to insomnia increase CNS stiiulation, insomnia and irritability related to altered thought process  Deficient knowledge related to disease process, prognosis, treatment, self care and discharge needs.
• 15.
  NURSING MANAGEMENT  Monitorvital signs carefully (blood pressure, pulse and body temperature)  Administer antithyroid drugs as prescribed.  Instruct patient of need to take medication at the same time each day and on empty stomach.  Instruct the patient about importance of continunity medications after symptoms improve.  Monitor T3, T4 and TSH Levels to determine the effectiveness of pharmacotherapy  Encourage patient to increased fluid intake and inform the need to increase fluid intake to at least 2 litre per day unless edema occurs.  Monitor and record patient’s weight, fluid intake, and urine output.  We should consult a dietitian to ensure a nutritious diet with adequate calories and fluids.  Ensure that if iodine is part of the treatment, mix it with milk , juice, or water to prevent gastrointestinal distress, and give it through a straw to prevent tooth discoloration.  Provide high fibre and explain the difference about the calorie and fibre requirements  Provide stool softeners, fibres and liquids.  Monitor for decreasing symptoms related to hypothyroidism such as fatigue, constipation, cold intolerance, lethargy, depression and menstrual irregularities.
• 16.
  Continued…  Provide properrest and make routine for physical exercise.  Promote physical comfort and provide extra cloth and blankets.  Advise to avoid high temperature environments and avoid using heating pads and electric blankets as the risk of peripheral vasodilation.  We should instruct the patient to check the pulse at least twice a week and to stop the thyroid supplement and notify the physician if the pulse is greater than 100.
• 17.
  THANKYOU FOR YOURACTIVE LISTENING AND ATTENTION.. IFANYQUERYREGARDINGTHETOPIC KINDLYASK…. THE END.