RNSG 1341 Hypo and Hyper thyroid signs and symptoms Lecture Notes

GOAL OF THERAPY FOR BOTH: MAINTAIN EUTHYROID STATE – NORMAL
STATE


HYPOTHYROIDISM “LOW & SLOW”

Primary Hypothyroidism – causes
- More common in women
- Hashimoto’s disease – most common cause
- Surgical removal of thyroid

Signs and symptoms of hypothyroidism are often nonspecific and include:
 Sleepiness
 Fatigue
 Cold intolerance – always cold brrrrr
 Weight gain
 Muscle aches
 Menstrual irregularities
 Decreased libido
 Pale, dry skin
 Thin, brittle hair or nails
 Bradycardia
 Constipation
 Unintentional weight gain
 Edema (especially periorbital)
 Difficulty with concentration and memory
 Slowing of relaxation phase of tendon reflexes
 May have higher diastolic blood pressure
 Most serious form of hyperthyroidism is myxedema
 Proximal myopathy
 Warm, moist skin
 Hyperkinesis
 Stare, lid lag, lid retraction, and exophthalmos (with Graves disease)
 Emotional liability
 Hyperactive reflexes
 Thyroid enlargement (Goiter)
 Goiter possible
Myxedema Coma – severe form of hypothyroidism. From
untreated
Lab tests:

, - TSH HIGH (thyroid caused)
- LOW (pituitary caused)
- T4/T3 LOW
- Thyroid antibodies present? = Autoimmune issue.
- Monitor high cholesterol and triglycerides
Diagnostic testing:
- Thyroid scan
- Fine-needle biopsy
- Ultrasound
- Radioactive iodine uptake
Medical management:
Levothyroxine (Synthroid)
- Start with low dose. 75-150 mcg
- Lower dose for geriatrics 50 mcg
- Monitor for chest pain, weight loss, nervousness, tremors
insomnia
- Increase dosing 4–6-week intervals PRN based on TSH
levels
- MUST TAKE FOR LIFE 
Nursing Assessment
- Health history
 Hyperthyroidism treatment
 Iodine-containing meds
 Changes in appetite/weight
 Activity level
 Speech, memory, skin changes
- Physical exam
- Patient Education
 Follow-up care
 DO NOT SWITCH BRANDS; DON’T ABRUPTLY STOP