Hypothyroidism disease (Underactive thyroid) is a condition in which thyroid gland does not make enough thyroid hormone. It occurs primarily in women in 30 to 60 years old. If severe hypothyroidism occurs in infant, it is called cretinism. If it is develop in adult, it is called myxedema.
Sign and Symptoms of Hypothyroidism Disease:
There are various sign and symptoms of hypothyroidism disease which are mentioned in the below:
- Fatigue and weakness,
- Change in the menstrual cycle,
- Increased sensitivity to cold,
- Dry, rough and cold skin,
- Thin, coarse hair,
- Hair loss,
- Puffiness of face, eye area and feet,
- Unexplained weight gain,
- Little or no growth,
- Impaired memory ,
- Extreme sleepiness,
- Increased serum lipid levels,
- Muscles aches, tenderness and stiffness,
- Carpal tunnel syndrome,
- Decreased libido,
- Swelling of thyroid gland (Goiter),
- Low muscle tone (Floppy infant),
- Poor feeding reflex of infant,
- Stomach bloating,
- Swollen tongue.
Etiology for Hypothyroidism Disease:
Different types of Etiology for hypothyroidism disease are mentioned in the following:
- Congenital disease,
- Pituitary disorder,
- Inflammation of the thyroid gland,
- Iodine deficiency,
- Postpartum pituitary necrosis,
- Radiation therapy to treat head and neck cancer,
- Treatment of hyperthyroidism,
- Some medicine that used for psychiatric disorder,
- Certain medicines to treat heart problems such as Amioderone, Lithium, Interferon Alpha and Interleukin-2of thyroid hormone,
- Disorder of the hypothalamus.
Risk factors of Hypothyroidism Disease:
Various risk factors of Hypothyroidism disease are in the below:
- Women over age 50,
- Autoimmune disease (Type-1 diabetes, multiple sclerosis, pernicious anemia or vertigo),
- Race(Being white or Asian),
- Bipolar mood disorder,
- Down syndrome,
- Turner syndrome,
- Anti-thyroid medications,
- Prematurely graying hair.
Test and Diagnosis for Hypothyroidism Disease:
There are different types of test and diagnosis for hypothyroidism disease, which are mentioned in the following:
- Medical and family history,
- Physical examination,
- Thyroid stimulating hormone (TSH),
- Thyroid function test T4,
- Cholesterol (Can be elevated),
- CBC (May show Anemia),
- Liver function test (Can be elevated),
- Prolactine (Can be elevated),
- Serum electrolytes level (Sodium can be low).
Treatment for Hypothyroidism Disease:
The goal of treatment is to return the patient to the normal state and to prevent complications. The treatment of choice is to provide thyroid hormone supplements to correct hormonal deficiencies. Standard treatment option for hypothyroidism involves –
Monotherapy with Levothyroxine remains the first line treatment of choice for hypothyroidism disease.
Features of Levothyroxine treatment are as follows:
- For young and healthy patients can be started on Levothyroxine at expected full replacement doses.
- With known ischemic heart disease and elderly patients, begin with one fourth to one half the anticipated dose and adjust the dose in small enhancement after no less than 4-6 weeks.
- For most cases of mild to moderate hypothyroidism, a starting Levothyroxine dose of 50-75 µg daily will continue.
- Clinical advantage begin in 3-5 days and level off after 4-6 weeks.
- To determine the right dosage of Levothyroxin check TSH hormone level every 2 to 3 month.
- Diet rich in soy and soy- based foods, kale, broccoli, cauliflower cabbageand high fibre can interfere with levothyroxine absorptions. Some medication and supplement also can reduce absorption. These include –
- Calcium supplements,
- Iron supplements,
- Albuminum hydroxide, which is found in some antacids.
Complications of Hypothyroidism Disease:
There are different types of complications for hypothyroidism disease, those are mentioned in the below:
- Heart problems,
- Joint pain,
- Miscarriage, preeclampsia or preterm birth,
- Severe depression.
Nursing Intervention for Hypothyroidism Disease:
Various ways of nursing intervention for hypothyroidism disease are described in the following:
- Monitor vital signs carefully( blood pressure, pulse, and body temperature).
- Administer of correct prescribed antithyroid medication timely.
- Instruct client of the need to take medication at the same time each day and on empty stomach.
- Oral and written instructions should be provided regarding all medications, actions and side effects of medications.
- Inform clients about importance of continuing medications after symptoms improve.
- Monitor T3, T4, and TSH levels. (These levels help determine the effectiveness of pharmacotherapy).
- Evaluate serum electrolyte levels, and check for hyperglycemia and glycosuria.
- Measure neck circumference daily to check for progression of thyroid enlargement.
- Encourage patient to increased fluid intake and inform the need to increase fluid intake to at least 2000 ml. per day unless edema occurs.
- Monitor and record patient’s weight, fluid intake, and urine output.
- Consult a dietician to ensure a nutritious diet with adequate calories and fluids.
- 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 food and explain the difference about the caloric and fibre requirements.
- Provide stool softeners, fibre and liquids.
- Monitor for decreasing symptoms related to hypothyroidism such as fatigue, constipation, cold intolerance, lethargy, depression, and menstrual irregularities.
- Ensure proper rest and set time for physical exercise.
- Help patient meet all self needs as fatigue present.
- Check patient mental status and give psychological care.
- Promote physical comfort and provide extra cloth and blankets.
- Avoid high temperature environments and avoid using heating pads and electric blankets as the risk of peripheral vasodilatation.
- Instruct patient to monitor weight at least weekly.
- The patient should report to physician about any abnormal weight gain or loss or change in bowel elimination.
- 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.
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