Hypothyroidism

Nursing Diagnosis, Interventions, and Care Plan for Hypothyroidism-A Student’s Guide

Introduction

Hypothyroidism, or under-activity of the thyroid gland, is a disorder in which an individual’s metabolism slows down. The condition can lead to weight gain and depression.

Individuals with hypothyroidism will often require medications to be taken daily for life (Armour Thyroid) or have their thyroid hormone levels monitored closely by blood tests every six months (Levothyroxine).In this blog post, we will discuss what hypothyroidism is, ways that medical practitioners can diagnose and treat the disorder to help patient with hypothyroidism feel better. 

This blog post aims to educate readers about hypothyroidism – its causes, interventions, care plan, and treatments. As you read, keep in mind that our top writers are ready to step in and help in case you are stuck with your assignment. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What Is Hypothyroidism?

Hypothyroidism refers to a condition where the thyroid gland does not produce enough hormones (or thyroxine) for your body’s needs. It may also occur if the thyroid gland produces too many of these hormones (hyperthyroidism). In both cases, however, people need more or less than usual amounts of thyroxine to regulate their metabolism and maintain healthy body weight. Some people with hypothyroidism have normal thyroxine levels in their blood. They have an overactive pituitary gland that tells the thyroid how much thyroxine to produce.

Hypothyroidism is also linked to some forms of cancer. There are screening tests that must be performed annually on individuals with hypothyroidism.

What Causes Hypothyroidism?

The most common cause of hypothyroidism is iodine deficiency. 

Hypothyroidism is also caused by Hashimoto’s thyroiditis (or autoimmune). It’s a condition in which your immune system produces antibodies that attack and destroy the cells of your thyroid gland.

Another cause of hypothyroidism includes surgery or radiation to the head and neck.

Other causes include;

-An overactive thyroid gland (hyperthyroidism), which can result -from Graves’ disease and Hashimoto’s thyroiditis; 

Iodine deficiency

pregnancy

certain medications or drugs

congenital disabilities

enlarged gland from inflammation or infection

damage to the pituitary gland that controls the production of TSH malfunctions in the hypothalamus or pituitary gland

defects in the protein structure of the thyroid.

Risk Factors 

People with the following risk factors may be more likely to develop hypothyroidism:

-Pregnancy, especially when not planned;  

-Exposure to high amounts of radiation or medications;

-Having a viral infection such as a cold or the flu

-Being a woman (especially after menopause);

-Having iodine deficiency;  

-Having had radiation to the neck as part of cancer therapy;

Epidemiology and Etiology

Hypothyroidism is much more common in women than men and affects approximately 4% of the population. Individuals can be born with hypothyroidism, or it can develop later in life.

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What Are the Signs and Symptoms of Hypothyroidism?

The following are the most common signs of hypothyroidism, although each person may experience symptoms differently:

-Fatigue (tiredness) that is not relieved by sleep or rest;

-Weight gain; especially in the face, abdomen, and around the neck (known as a ‘buffalo hump’);

-Constipation;

-Thinning, dry hair, and slow hair growth;

-Dry and brittle nails that crack or split easily;

-Hoarse voice; 

-Muscle weakness

Slow speech or difficulty finding words

Dry skin and hair (thin, brittle hair or excessive hair loss)

Prolonged heart rate

Depression or anxiety

Cold intolerance

Constipation

Menstrual irregularities

Muscle cramps

Weakness and poor memory

Other signs and symptoms may include: 

-Soreness of muscles after exercise, more stiffness than usual, especially in the morning;   

Diarrhea or other GI symptoms,

-Headaches, ringing in ears (tinnitus).

-Pain in your legs when walking

-Overgrowth of Candida Albicans (candida infection) and poor immune function

-Digestive problems such as chronic gas/bloating/indigestion

-Light sensitivity, a tendency for sunburns, or unexplained weight gain (especially in the face)

-Cravings for sugar and carbohydrates  and weight gain, especially in your face and midsection 

-Water retention with puffiness around the eyes or ankles; low sodium can also be a sign of hypothyroidism

-Loss of libido.

How is Hypothyroidism Diagnosed?

Your health care provider may diagnose hypothyroidism with the help of a physical exam, blood tests, and imaging tests.

1. Medical History and Physical Exam

Your health care provider will ask you about your symptoms, medical history, and family background. It is essential to tell the doctor if you or anyone in your family has had thyroid problems. It would help if you also were up-to-date on any routine screening tests, such as colonoscopy, mammography, and EKG.

The doctor will do a physical exam with the following parts:

Skin -the skin is cool, dry, and pale; you may also have hair loss (especially around the outer edges of your face). The tops of your fingernails and toenails show thick, yellowish skin. The surface of your fingernails may be rough and uneven.

The thyroid gland -is usually enlarged and feels firm, although this fluctuates with the amount of hormone produced (i.e., it’s harder to think in the morning when levels are low).

Eyes -are dry and show a bit more of the red part of your eye than usual.

The mouth-your lips are cracked, and your tongue is rough or coated.

The heart and lungs-you may have high cholesterol levels, an enlarged heart, or blood in the urine if you also have polycythemia vera (a form of hyperthyroidism).     

2. Blood Tests

The blood tests completed during the initial evaluation are typically the following:  

T3, T4, and thyroid autoantibodies-may be low if you have hypothyroidism or may be high if you have hyperthyroidism. A specific type of antibody called thyroid peroxidase (TPO) antibodies are often present in the blood of people with Hashimoto’s disease, but they are not always elevated.

T3 uptake -this test measures the level of T3 in your blood. If your levels are low, it means you might be hypothyroid. This test is usually done using serum thyroid-stimulating hormone (TSH) and thyroxine (T4).

The urinary iodine concentration-Iodine is needed to make thyroid hormone. You are tested for iodine deficiency, which can make you more susceptible to thyroid problems.

Iodine is usually present in high amounts in the foods we eat and is added to salt. Sometimes if your body doesn’t need iodine, it will remove it from any areas where there’s too much of it; this process leads to lower iodine levels in the thyroid gland. This makes it hard for your body to make enough T3 and T4 hormones when you need them.

Hypothyroidism is very rare before puberty. Iodine deficiency resulting from dietary changes or salt iodization programs has an enormous impact on the baby boomer generation. Nearly 30% of US women of childbearing age have evidence of goiter, resulting in hypothyroidism and other thyroid problems. 

Adrenal Stress Index -this test is used to check how well your adrenal glands are functioning. This may be done if the hyperthyroidism symptoms first appear when you’re stressed.

Nuclear Medicine Scans -these scans, such as the thyroid scan and the radionuclide imaging study, show where a radioactive tracer is concentrated in your body.

3. Imaging Tests

These can be used to rule out other causes of hyperthyroidism. If you have goiter or Grave’s disease, these tests might include:

Thyroid ultrasound is a non-invasive test that uses sound waves to create an image of your thyroid. Sometimes this can result in false positives and, as such, should be confirmed by the second type of imaging.  The nurse or medical practitioner will look for a nodule on the gland (which may indicate cancer) or irregular areas where the tissue has been destroyed, and the land has been replaced by scar tissue.

Iron, calcium, and albumin tests -these are usually done to check for hyperthyroidism-related anemia or low serum protein levels (as is the case with hypothyroidism).    

We also have guides on diagnosis for Pressure Ulcers

Complications of Hyperthyroidism

Hyperthyroidism can affect your body in many ways.    

If you have Graves’ disease, your thyroid may become large and “tender.” As the disease progresses, you may get hyperthyroid eye problems that can cause double vision, dry eyes without any tears, inflammation of the outside tissue of the eye, and bulging of the extraocular muscles (the muscles around the eye). You may also develop a goiter, which is an enlargement of the thyroid gland.

In addition to hyperthyroidism symptoms and hypothyroidism symptoms, a patient with hypothyroidism may have nodules or masses on their thyroid, making it hard for the medical practitioner to examine them by hand. 

What Are Some Nursing Interventions for Hypothyroidism?

Some nursing interventions for hypothyroidism include;

-Hormone replacement therapy with levothyroxine sodium given orally

-Periodic monitoring of serum TSH levels to ensure dose remains adequate

-Educate on diagnosis and treatment of hypothyroidism

-Restart thyroid replacement medication;

-Monitor patient for improvement or return of symptoms such as fatigue or weight gain;

Hypothyroidism Nursing Care Plan

The first step is assessing the patient’s diagnosis of hypothyroidism through history and physical examination and other diagnostic tests such as labs.

Once the diagnosis has been confirmed, it is essential to assess whether or not there are any comorbidities present with treatment planning based on these findings. It is also necessary to educate patients about their disease state to take an active role in their self-care by understanding how this impacts them and what actions they can take to improve their quality of life.

Step two is to implement nursing interventions that ensure the patients with hypothyroidism remains oriented, has adequate nutrition intake and fluid volume for hydration, and has regular sleep patterns for healthy thyroid gland function.

-Educate patients with hypothyroidism about medication usage and side effects

– Diet modifications; choose whole grains, such as whole-wheat bread and pasta, brown rice, oatmeal, nuts, fruits (not dried fruit), and vegetables.

– Help to manage depression and anxiety

– Prevention of osteoporosis

– Appropriate referrals to specialists if needed (e.g., endocrinologist);

– Monitoring for signs of heart failure due to reduced cardiac output from decreased blood volume in heart chambers because less blood falls on the back wall of the heart.

-Monitor the patient’s thyroid function by obtaining a complete history, including past drug reactions and allergies. Review current medications and assess for any recent illnesses.

-Monitor patient’s thyroid hormonal levels through blood testing every six months.

-Periodic monitoring of serum TSH levels to ensure the dose of medication remains adequate. 

-Monitor for signs of high and low thyroid levels, including weight gain, fatigue, decreased appetite, changes in digestion, or bowel elimination patterns.

Also, check the care plan for Diverticulitis

How Do You Care for Someone With Hypothyroidism?

The patients with hypothyroidism has a slow metabolism. Your health care provider will treat your hypothyroidism by replacing the thyroid hormone that is missing from your body:

-Take Levothyroxine (T4) once or twice per day, usually in the morning. The dose and time of day you take may change as your health care provider adjusts the medication to suit your needs.

-Take a multivitamin once per day, with or after breakfast. This will replace any vitamins that are not absorbed when your thyroid is not working well.

-It may take several weeks for your hypothyroidism medicine to start working. Please do not stop taking it because of this.

-If you miss a dose of Levothyroxine, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double your doses or take extra medicine to make up for a missed dose.

-If you have trouble remembering to take your medicine, ask your health care provider for help.

-If you are taking other medications or planning to start any new medicines, tell your health care provider about the hypothyroidism medicine you take and how much of it you take. This includes supplements such as vitamins, minerals, herbs, or others. Some medications could affect how your hypothyroidism medicine works in your body. 

-Do not stop Levothyroxine without talking to your health care provider. You must follow their instructions about withdrawing from it, if necessary, under their supervision.

-The medical doctor will check with you during and after thyroid hormone replacement therapy for side effects such as fast or irregular heartbeat, sweating, diarrhea, high blood pressure, and changes in your menstrual period.

-Hypothyroidism cannot be cured but can be controlled with proper diagnosis and treatment.   

If the disease is left untreated, it can lead to more severe health conditions, including anemia (due to low production of red blood cells), osteoporosis (due to low estrogen level), and depression. 

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What Are the Health Consequences of Untreated Hypothyroidism?

The problem is that if left untreated, Hashimoto’s can lead to the destruction of the thyroid. Those individuals who do not suffer destruction become hypothyroid. The vast majority of people with Hashimoto’s also have other autoimmune disorders, like pernicious anemia, type 1 diabetes, rheumatoid arthritis, or lupus. In contrast, Graves’ disease and nodular thyroid carcinoma (both of which are different types of hyperthyroidism) occur almost exclusively in older adults. Moreover, these two disorders can be cured with radioactive iodine or surgery (if there’s a cancerous growth).

Untreated hypothyroidism increases the risk of cardiovascular disease – Research shows that hypothyroidism is associated with an increased risk of cardiovascular disease (CVD). This is particularly true when TSH levels are above 10mU/L, and free T3 is low.

Treatment for Hypothyroidism

Treatment aims to control the symptoms of hypothyroidism, prevent serious complications, and restore your metabolic rate by bringing your thyroid levels back into the normal range.

Medication

Medication such as Levothyroxine is usually given to start replacing the hormones in your body. Still, a small percent of patients with hypothyroidism cannot take medication and must be treated only with thyroid replacement therapy.

Lifestyle Changes

Your lifestyle should aim to prevent the most common complications related to hypothyroidism: osteoporosis (bone loss), muscle weakness, high cholesterol, weight gain, and depression.

Surgery

Surgery for hypothyroidism is rare and reserved for those with a specific type of overactive thyroid that cannot be treated with medication or in whom the medicines do not work well. Surgery for hypothyroidism is only performed if there are significant symptoms that interfere with your daily activities.

Dietary Changes for Hypothyroidism

Avoid or limit refined carbohydrates such as white bread, pasta, cakes, cookies, candy, sugar cereals, and foods high in added sugars (fruit drinks, punch). Instead, choose whole grains, such as whole-wheat bread and pasta, brown rice, oatmeal, nuts, fruits (not dried fruit), and vegetables. If you eat dairy products, choose low-fat or fat-free milk and yogurt instead of full-fat versions.

Avoid Excess Iodine in Foods and Medication

To reduce the chance that you will react to excess thyroid medication, do not take medicines containing iodine unless your doctor tells you what type and dose of medication is safe in your case. 

Eat Foods High in Selenium

Some pills used to treat depression may affect your thyroid gland and cause it to make too much thyroid hormone (hyperthyroidism). The main culprits that have this effect are called selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), which are very different types of antidepressants.

Stay Away from Foods High in Goitrogens

Certain substances in your diet may affect your thyroid gland and cause it to make too little thyroid hormone (hypothyroidism). These are called goitrogens, and they are found in raw cruciferous vegetables such as broccoli, cabbage, cauliflower, and the non-cruciferous greens turnip and mustard greens. Cooking destroys most of these substances, so eating steamed or sautéed vegetables is fine.

Do Not Consume Soy Products Unless They Are Fermented

Some foods contain substances called phytates (also called phytic acid), which can build up and damage your thyroid gland. These are found in soybeans and soybean products.

You may also check the treatment for metabolic alkalosis

Conclusion

Hypothyroidism is a condition in which your thyroid gland does not produce enough hormones.

In the case of Hypothyroidism, the thyroid gland is either underactive or inactive due to some condition that we have already mentioned above.  When this happens, you feel like slowing down and tired all the time, even when you’re doing nothing and want to sleep more than usual or more than twenty hours a day.

Because of this, your heart rate is affected and the way you feel, which causes depression and suicidal tendencies.  It can also cause some issues like high cholesterol, osteoporosis, muscle weakness, weight gain, and even cancer. 

You should seek immediate medical care if you experience any symptoms of hypothyroidism or if anyone in your family has been diagnosed with hypothyroidism.

Lastly, we highly recommend that you check our other articles on the nursing metaparadigms to better your knowledge on the nursing philosophy, or check the nursing leadership styles to prepare you to be a leader in the nursing fraternity. Also, in case you prefer our top writers to handle your nursing assignment, then press the “Write my Nursing/Medical Assignment” button below and follow the simple steps.

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