HYPOTHYROIDISM

A state of low serum thyroid

hormone, result from hypothalamic,
pituitary or thyroid insufficiency. The
disorder can progress to life-
threatening myxedema coma.
Hypothyroidism is more prevalent in
women than in men.
PATHOPHYSIOLOGY

• A genetic link is suspected in this

condition because there is evidence
that it is transmitted by the X
chromosome. A deficiency of iodized
salt is also considered a cause.
CAUSES

o Autoimmune thyroiditis
o Congenital defect
o Drugs, such as iodides and lithium
o Endemic iodine deficiency
o Inflammatory conditions
o Pituitary failure to produce thyroid
stimulating hormone (TSH)
o Thyroid gland surgery
SIGNS AND SYMPTOMS

 Early stage
 Constipation
 Fatigue
 Forgetfulness
 Sensitivity
 Unexplained weight gain
 Later stage
 Anorexia and abdominal distention
 Cardiovascular involvement leading to
decreased cardiac output, slow impulse rate, signs
of poor peripheral circulation and occasionally, an
enlarged heart
 Decreased libido
 Decreasing mental stability
 Progression to myxedema coma (usually gradual
but can be abrupt when stress aggravates severe or
prolong hypothyroidism)
DIAGNOSTIC TESTS
Increased TSH level reveals hypothyroidism due
to thyroid insufficiency; decreased TSH level shows
hypothyroidism due to hypothalamic or pituitary
insufficiency

In myxedema coma, laboratory test may also show

low serum sodium levels as well as decreased pH and
increased partial pressure of carbon dioxide,
indication respiratory acidosis.
TREATMENT
Therapy for hypothyroidism consists of gradual thyroid hormone
replacement with levothyroxine and occasionally liothyronine.
The TSH level is most reliable marker to follow primary
hypothyroidism. It should be kept within the normal range.

During myxedema coma, effective treatment supports vital

functions while restoring euthyroidism. To support blood
pressure and pulse rate, treatment includes IV administration of
levothyroxine and hydrocortisone to correct possible pituitary or
adrenal insufficiency. Hypoventilation requires oxygenation and
respiratory support.

Other supportive measures include fluid replacement and

antibiotics for infection.
NURSING CONSIDERATIONS

•Provide high-bulk, low-calorie diet, and encourage

activity to combat constipation and promote weight
loss. Administer cathartics and stool softener as needed.

•Monitor the patient for symptoms of hyperthyroidism,

such as restlessness, sweating and excessive weight loss
after thyroid replacement therapy begins.
•Tell the patient to report signs of aggravated
cardiovascular disease, such as chest pains and
tachycardia.

•Explain the importance of continuing the course of

thyroid medication even if symptoms subside.

•Warn the patient to report infection immediately and

to make sure any physician who prescribes drugs for
him knows about the underlying hypothyroidism.