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Hypothyroidism and
Hyperthyroidism
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 Thyroid Gland PAGE 03

• butterfly-shaped organ located in the lower neck,

anterior to the trachea.
•It consists of two lateral lobes connected by an
isthmus.
•The gland is about 5 cm long and 3 cm wide and
weighs about 30 g.
•The thyroid gland produces three hormones:
thyroxine (T4), triiodothyronine (T3), and calcitonin.
 Calcitonin PAGE 02

•Calcitonin, or thyrocalcitonin, is another important

hormone secreted by the thyroid gland.
•It is secreted in response to high plasma levels of
calcium
•it reduces the plasma level of calcium by increasing its
deposition in bone.
HYPOTHYROIDISM
 Hypothyroidism PAGE 04

•Hypothyroid state resulting from hyposecretion of thyroid

hormones and characterized by a decreased rate of body metabolism
•The T4 is low and the TSH is elevated
•In primary hypothyroidism, the source of the disfunction is the
thyroid gland and the thyroid cannot produce the necessary
amount of hormones.
•In secondary hypothyroidism, the thyroid is not being stimulated
by the pituitary to produce hormones.
 Hypothyroidism PAGE 05

•Central hypothyroidism.
-failure of the pituitary gland, the hypothalamus, or both
•Pituitary or secondary hypothyroidism
-a pituitary disorder
•Hypothalamic or tertiary hypothyroidism.
-a disorder of the hypothalamus resulting in inadequate secretion
of TSH due to decreased stimulation of TRH
 Hypothyroidism PAGE 06

•Cretinism
-thyroid deficiency is present at birth
•Myxedema
-extreme symptoms of severe hypothyroidism.
 Risk Factors PAGE 07

•Patients with previous hyperthyroidism

•Affects women five times more frequently than
men and occurs most often between 40 and 70 years
of age.
•The prevalence of the disease increases with
increasing age.
•Occurs most frequently in older women
 Causes PAGE 08

•Autoimmune disease (Hashimoto’s thyroiditis,

Graves’ disease)
•Atrophy of thyroid gland with aging
•Therapy for hyperthyroidism
- Radioactive iodine (131I)
- Thyroidectomy
 Causes PAGE 09

•Medications
- Lithium
- Iodine compounds
- Antithyroid medications
•Radiation to head and neck for treatment of head
and neck cancers, lymphoma
•Iodine deficiency and iodine excess
 Signs and Symptoms
PAGE 10

•Lethargy and fatigue

•Weakness, muscle aches, paresthesias
•Intolerance to cold
•Weight gain
•Dry skin and hair loss and loss of body hair, face
becomes expressionless and masklike
•Bradycardia
 Signs and Symptoms
PAGE 11

•Constipation
•Generalized puffiness and edema around the eyes
and face (myxedema)
•Forgetfulness and loss of memory
•Menstrual disturbances
•Goiter may or may not be present
•Cardiac enlargement, tendency to develop heart
failure
 Medical Management
PAGE 13

Pharmacologic Therapy
•Synthetic levothyroxine (Synthroid or Levothroid)
- preferred preparation for treating hypothyroidism and
suppressing nontoxic goiters.
•Desiccated thyroid
used infrequently today, because it often results in
transient elevated serum concentrations of T3, with
occasional symptoms of hyperthyroidism.
Nursing Management PAGE 14
Nursing Management PAGE 15
Nursing Management PAGE 16
 Complication PAGE 17

•Myxedema coma
-It is the decompensated state of severe hypothyroidism in
which the patient is hypothermic and unconscious (Kwaku
& Burman, 2007).
-The condition occurs most often among elderly women in
the winter months and appears to be precipitated by cold
 SIGNS AND SYMPTOMS OF
MYXEDEMA COMA PAGE 18

•Hypotension
•Bradycardia
•Hypothermia
•Hyponatremia
•Hypoglycemia
•Generalized edema
•Respiratory Failure
•Coma
 Nursing Interventions for
Myxedema Coma PAGE 19

•Maintain a patent airway

•Institute aspiration precautions
•Administer IV Fluids as prescribed
•Administer Levothyroxine sodium intravenously as
prescribed
•Administer glucose intravenously as prescribed
•Administer corticosteroids as prescribed
 Nursing Interventions for
Myxedema Coma PAGE 20

•Assess the client’s temperature hourly

•Monitor blood pressure frequently
•Keep the client warm
•Monitor for changes in mental status
•Monitor electrolyte and glocuse levels
 PAGE 20

Hyperthyroidism
START
 Hyperthyroidism PAGE 21

• Hyperthyroid state resulting from hypersecretion of

thyroid hormones (T3 and T4)
• Characterized by an increased rate of body metabolism
• Clinical manifestations are referred to as thyrotoxicosis
• The T3 and T4 are usually elevated and the TSH level is
low
 Hyperthyroidism PAGE 22

• Grave’s Disease
- also known as toxic diffuse goiter.
- the most common type of hyperthyroidism, results from
an excessive output of thyroid hormones caused by
abnormal stimulation of the thyroid gland by circulating
immunoglobulins
 Risk Factors PAGE 23

•It affects women eight times more frequently than men,

with onset usually between the second and fourth decades
(Tierney, et al., 2005).
 Causes PAGE 24

• The disorder may appear after an emotional shock, stress,

or an infection, but the exact significance of these
relationships is not understood.
• Thyroiditis
• Excessive ingestion of thyroid hormone
 Signs and Symptoms PAGE 25

• Personality changes such as irritability, agitation, and

mood swings
• Nervousness and fine tremors of the hands
• Heat intolerance
• Weight loss
• Smooth, soft skin and hair
• Palpitations, cardiac dysrhythmias, such as tachycardia or
atrial fibrillation
 Signs and Symptoms PAGE 26

• Diarrhea
• Exophthalmos may be present
• Diaphoresis
• Hypertension
• Enlarged thyroid gland
 Assessment and
Diagnostic Findings PAGE 27

• The thyroid gland invariably is enlarged to some extent.

• It is soft and may pulsate; a thrill often can be palpated,
and a bruit is heard over the thyroid arteries.
• Adecrease in serum TSH, increased free T4, and an
increase in radioactive iodine uptake.
 Medical Management PAGE 28

Radioactive Iodine
radioisotope iodine 131
the most common form of treatment for Graves’ disease
Destroys overactive thyroid cells
 Medical Management PAGE 29

ANTI-THYROID MEDICATIONS
Tapozole
- It inhibits synthesis of thyroid hormones

Monitor and report

• Signs and symptoms of hypothyroidism
• Fever and sore throat
 Medical Management PAGE 30

Thyroidectomy
Surgical removal of most of the thyroid gland
pregnant women who are allergic to antithyroid
medications, in patients with large goiters, or in
patients who are unable to take antithyroid agents.
five sixths of the thyroid tissue is removed (subtotal
thyroidectomy)
 Medical Management PAGE 31

POST-OP:
• S/sx: *Paresthesia
•Airway
Muscle spasm/ twitching
Position: semi
•Carpal: TROUSSEAU SIGN
fowler’s
•Facial: CHVOSTEK SIGN
•Calcium deficit
•Hypertonic muscle : tetany
Cause: removal of
the parathyroid
gland
 Potential Complications PAGE 32

• Hypothyroidism
• Thyrotoxicosis or thyroid storm
this acute and life-threatening condition occurs in a
client with uncontrollable hyperthyroidism
It can be caused by manipulation of the thyroid
hormone into the blood stream; it also can occur from
severe infection and stress
 SIGNS AND SYMPTOMS OF
THYROID STORM PAGE 33

Fever Confusion
Tachycardia Seizure
Ssystolic Hypertension Delirium
Nausea Coma
Vomiting
Diarrhea
Agitation
 Nursing Management PAGE 34

Improving Nutritional Status

well-balanced meals of small size
Avoid highly seasoned foods and stimulants
High-calorie, high protein foods
Enhancing Coping Measures
Use a calm, unhurried approach
 Nursing Management PAGE 35

•Maintaining Normal Body Temperature

the nurse maintains the environment at a cool, comfortable
temperature and changes bedding and clothing as needed.
Cool baths and cool or cold fluids are encouraged
Monitoring and Managing Potential Complications
The nurse closely monitors the patient with
hyperthyroidism for signs and symptoms that may be
indicative of thyroid storm
 PAGE 35

•Maintaining Normal Body Temperature

the nurse maintains the environment at a cool, comfortable
temperature and changes bedding and clothing as needed.
Cool baths and cool or cold fluids are encouraged
Monitoring and Managing Potential Complications
The nurse closely monitors the patient with
hyperthyroidism for signs and symptoms that may be
indicative of thyroid storm
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SO MUCH