Hypothyroidism NCLEX Review

Hypothyroidism NCLEX review notes for students who are prepping

to take the NCLEX exam. The endocrine system is made-up of many
disorders, such as hypothyroidism and hyperthyroidism.

As a student prepping for NCLEX, it is very important you know the

differences between the two conditions.

As the nurse taking care of the patient with hypothyroidism it is

important you understand the signs and symptoms, pathophysiology,
causes, nursing interventions, and medical treatments.

Don’t forget to take the quiz on hypothyroidism vs hyperthyroidism.

In this NCLEX review, you will learn the following:

Pathophysiology of the thyroid gland

Negative feedback loop of thyroid gland
Signs and symptoms of hypothyroidism
Causes of Hypothyroidism
Nursing Interventions
Medications for Hypothyroidism
Treatments

Lecture on Hypothyroidisim
:
 Hypothyroidism
Definition: Low secretion of thyroid hormone

Key Players:

Thyroid: produces thyroid hormones that play a big role in body

metabolism, regulation of body temperature, and growth/development.

These hormones are known as: T3 Triiodothyronine, T4 Thyroxine

(most important when talking about hypo/hyper thyroidism), and
Calcitonin.
Thyroid can NOT make thyroid hormones without iodine which
comes from foods (if you don’t have enough iodine in your diet…
low t3 and t4…this leads to hypothyroidism and if you have too
much hyperthyroidism)

T3 & T4: plays a huge role in:

burning calories
how new cells replace dying cells
how fast we digest food
:
 stimulate sympathetic nervous system (alertness, quick
responsiveness/reflexes)
increases body temperature and heart rate
brain development
muscle contraction
fertility
regulates TSH (thyroid-stimulating hormones through the negative
feedback loop)

TSH: produced from the anterior pituitary gland that stimulates T3

and T4 production

Negative Feedback Loop of Thyroid Hormone

Production
Hypothalamus produces -> TRH (Thyrotropin-releasing hormone)…
this causes the Anterior Pituitary Gland to produce ->TSH (thyroid-
stimulating hormone)….this cause the thyroid gland to produce-> T3
& T4

There can be problems with the feedback system where the

pituitary gland is not stimulating the thyroid gland enough so
hormones are not produced or the thyroid is not receptive to the
TSH from the pituitary gland.

Thyroid problems diagnosed with blood tests that look at T3, T4

(free) levels, and TSH to make a conclusive diagnosis.

Signs and Symptoms Hypothyroidism

Let the condition’s name help you: everything is going to be LOW and
:
 SLOW due to the body working at a very slow metabolism rate

Weight Gain
Unable to tolerate cold
Possible goiter from constant thyroid stimulation to get the thyroid
gland to produce T3 and T4 MOST COMMON SIGN IN
HASHIMOTO’S
Extremely tired and fatigued
Slow heart rate
Thinning and brittle hair
Depression
Constipation
Memory loss
Myxedema: swelling of the skin (eyes and face) that gives it a waxy
appearance
Dry skin
Joint, muscle pain
Menstrual problems (irregular or heavy periods)

***early signs are feeling tired and fatigue…then as hypothyroidism

progresses the patient starts to exhibit other symptoms

Causes of Hypothyroidism
Affects mainly women (middle-aged to older-aged)

Hashimoto’s thyroiditis (most common cause): autoimmune disorder

where the body attacks the thyroid gland which causes it to stop
releasing T3 and T4. GOITER LIKELY

Iodine deficiency: not consuming enough foods with iodine

:
 Pituitary Tumor: stops the anterior pituitary from secreting TSH which
stimulates the thyroid gland to secrete T3 and T4.

Treatment for hypothyroidism:

Thyroid Hormone replacement (Synthroid, Thyrolar, Cytomel)

Avoid sedatives and narcotics because these patients are very
sensitive to them and they increase the chances of myxedema
coma

Nursing Interventions for Hypothyroidism

Monitor for Myxedema Coma: caused from uncontrolled low thyroid
production usually due to illness, abrupt stopping thyroid replacement
medication, or removal of thyroid gland

Presents with everything shutting down (or slowing down to the

point of death)
Temperature regulation doesn’t work (hypothermia)
Extreme drowsiness
Respiratory failure, bradycardia (remember t3 and t4 play a role in
sympathetic system)
Low blood glucose, sodium levels…progress to a coma

Monitor vitals sign: HR, BP, EKG

Monitor weight

Keep patient warm and assess for constipation (very uncomfortable)…

encourage fluids

Medications for Hypothyroidism

:
 Thyroid hormone replacement:

Cytomel “Liothyronine sodium”

Thyrolar “Liotrix”
Synthroid “Levothyroxine” MOST COMMON

Patient education:

Don’t abruptly stop taking (takes a while for signs and symptoms
to improve)
Take at the same time every day in the morning without food
Don’t take within 4 hours of multivitamins, GI medications like
Carafate, aluminum hydroxide, simethicone….decreases
absorption of thyroid medication
Watch for signs and symptoms of toxicity which would present as
signs and symptoms of hyperthyroidism (fast heart, feeling hot,
sweating)

Note patients with hypothyroidism are sensitive to narcotics like

opioids (avoid dilaudid, morphine, fentanyl) and other sedatives (could
lead to myxedema coma). Instead use alternatives for pain as
prescribed like non-narcotics (Tylenol, Ibuprofen)

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