Hypothyroidism &

Hyperthyroidism

Diagnostic Test, Therapeutic,

& Educative Interventions
 Diagnostic Test:
Hypothyroidism &
Hyperthyroidism
 Physical Exam
O Physical Exam
Inspection:
1. identify land mark
2. Check for swelling & symmetry
3. Extend neck slightly and ask patient to
swallow
NORMAL: >No swelling & symmetrical
> Thyroid tissue rises with swallowing
AbN: > + swelling, asymmetrical, + tenderness,
enlargement, + nodules
> Thyroid tissue does not rises with
swallowing
Lower neck region btwn. Sternocleidomastoid
* a symmetrical thyroid
* Asymmetrical thyroid
 Physical Exam

O Palpation: Normal:
>Isthmus is firm
&
>Rubber band
in consistency

* let pt. flex neck slightly forward to the left

to assess left lobe
 Physical Exam
O Auscultation:
* may be performed if palpation discloses
in situations that thyroid gland is enlarged*

> use diaphragm of stet.

> AbN: Audible vibration of a bruit
 Lab & Dx Studies
O Thyroid Tests:
SERUM THYROID STIMULATING HORMONE
SERUM FREE T4
SERMUN T3 & T4
T3 RESIN UPTAKE TEST
THYROID ANTIBODIES
RADIOACTIVE IODINE UPTAKE
FINE-NEEDLE ASPIRATION BIOPSY
THYROID SCAN, RADIOSAN, OR SCINTISCAN
SERUM THYROGLOBULIN
 Lab & Dx Studies
O SERUM THYROID STIMULATING HORMONE
> blood collection
> Normal value: 0.4 to 6.15 miu/ml
> (>) than normal = hypothyroidism
> (<) than normal = hyperthyroidism
> to monitor thyroid hormone
replacement therapy
 Lab & Dx Studies
O Radioactive Iodine Uptake
Procedure:
A very small dose of radioactive iodine-123
(I-123) or I-131 is administered orally, and
images are taken at specified intervals after
the initial dose is administered.
The radionuclide emits gamma radiation,
which allows external measurement.
O Radioactive Iodine Uptake (cont)
The uptake of radionuclide in the thyroid
gland is measured as the percentage of
radionuclide absorbed in a specific amount of
time.
The iodine not used is excreted in the urine.
The thyroid gland does not distinguish
between radioactive and nonradioactive
iodine.
 Nursing Responsibility on
Thyroid Test
O * If patient has taken meds or agents that
contain:
1. Iodine containing meds
2.Contrast agents
3. topical antiseptic
4. multivitamins & food supplements
Hypothyroidism
 Therapeutic
Interventions
O *effects of analgesic agents, sedatives, and
anesthetic agents are prolonged*

1. Pharmacologic Therapy
a. Synthetic levothyroxine
(synthroid/Levothroid)
- Replace missing hormone
dosage is base on pts serum TSH
concentration
*WOF: inc. blood glucose (DM patients),
respiratory failure, osteoporosis
 Therapeutic
Interventions (cont)
O 2. Supportive Therapy severe hypothyro.
a. maintain vital functions
b. Fluid intake within limits of fluid
restriction WOF: water intoxication

O 3. Modifying activity
assist pt. with care and hygiene
- encouraging pt. to participate in activities
within established tolerance levels
 Therapeutic
Interventions (cont)
O 4. Monitor Physical Status
- VS
- physical & mental status
- S/s that ttt has exceed ability of
cardiovascular and pulmonary systems to
respond
O 5. Physical Comfort
- chilling/intolerance to cold => extra clothing
=> heat
- *avoid heating pads = > peripheral
vasodilation => further loss of body heat/
burn due to delayed response
 Educative Interventions
Avoid external heat exposure. Discourage and
avoid the use of external heat source.

Increase fluid intake. Encourage increased

fluid intake within the limits of fluid restriction.

Pulmonary exercises. Encourage deep

breathing, coughing, and use of incentive
spirometry.
 Educative Interventions
(cont)

O Orient to present surroundings. Orient patient to

time, place, date, and events around him or her.
Discharge and Home Care Guidelines
Medication compliance. State that compliance to
medical regimen is life-long.
Cold intolerance. State the need to avoid
extreme cold temperature until condition is stable.
Follow-up visits. State the importance of regular
follow-up visits with health care provider.
Weight reduction. Identify strategies for weight
reduction and prevention of constipation such as
high-fiber, low-calorie intake and adequate fluid
intake.
Hyperthyroidism
 Therapeutic Intervention
O Treatment
anti thyroid medications -Propylthiouracil
methimazole/tapazole

S/E: -rash,itching,abnormal hair loss, fever -

rare: cause liver damge , AGRANULOCYTOSIS

radioactive iodine -works gradually

destroying the thyroid

surgery( thyroidectomy) - total or partial

surgical removal of thyroid
 Educative Intervention
O Avoiding caffeine and reducing stress may help
relieve symptoms of anxiety, nervousness, poor
concentration, and fast heartbeat.

O Quitting smoking can reduce your risk of

developing Graves Ophthalmopathy if you have
Graves Disease.

O attend all of your doctor appointments

O take your antithyroid medication at the same time

each day
O References:

Smeltzer, A., Bare, B., Hinkle, J., Cheever, K.(2008). Brunner &
Suddarths Textbook of Medical-Surgical Nursing. 11th Edition.Volume
2. Lippincott Williams & Wilkins

Belleza, M.(2016). Hypothyroidism. Retrieved November 10, 2017

7:42 PM. n.u. https://nurseslabs.com/hypothyroidism/#discharge-
and-home-care-guidelines

O Davis's Lab & Diagnostic Tests. (2017). Radioactive Iodine Uptake.

Retrieved from
https://nursing.unboundmedicine.com/nursingcentral/view/Davis-
Lab-and-Diagnostic-Tests/425325/all/Radioactive_Iodine_Uptake