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Mariano Marcos State University
COLLEGE OF HEALTH SCIENCES Department of Nursing Batac City, 2906, IlocosNorte

Prepared by: Agcaoili, KristelAngelie Agullana, DharlineAbbygale Alog, John Alwin Aragon, Jesusa Mae Ballesteros, Gerly Bolusan, Kelvin Bonoan, Rodalie Cabrera, GuiaAmerie Caliw-caliw, Hannah Lou Cariño, Mary Joy

July 14, 2011

It is also characterised by invasion of the thyroid tissue by common. Family history of thyroid disorders. Germany. although in its acute phase.HASHIMOTO S THYROIDITIS I. Pathophysiology T cell suppressed (helper T cells produced autoantibodies) Thyroid gland is perceived as foreign by the immune system B and T lymphocytes attack thyroid gland thyroid gland Destruction of thyroid cells Antibodies Block the TSH receptors on the Decreased TSH receptor sites Decreased Production of T3 and T4 hormones Decreased Basal Metabolic Rate Decreased Body Temp. 2. Cold Intolerance Decreased metabolism of nutrients Excessive sleepiness . mainly T-lymphocytes. Incidence and Prevalence of Hashimoto s Thyroiditis This disorder is believed to be the most common cause of primary hypothyroidism. the disease can be detected clinically by looking for these antibodies in the blood. Definition Hashimoto thyroiditis is part of the spectrum of autoimmune thyroid diseases (AITDs). and is most prevalent between 45 and 65 years of age. In many cases. a Japanese surgeon working in Berlin. Accordingly. Hashimoto's thyroiditis usually results in hypothyroidism. antibodies against thyroid peroxidase and/or thyroglobulin cause gradual destruction of follicles in the thyroid gland. It occurs far more often in women than in men (10:1 to 20:1). Causes 1. it is a histologic diagnosis first described by Hakaru Hashimoto. Physiologically. II. By strict criteria. Patients with chromosomal disorders IV. III. it can cause a transient hyperthyroidism thyrotoxic state known as hashitoxicosis. It is also known as chronic lymphocytic thyroiditis where the immune system attacks the thyroid gland resulting to inflammation of the gland that leads to underactive thyroid gland leading to hypothyroidism. with the HLA(human leukocyte antigens) -DR5 gene most strongly implicated conferring a relative risk of 3 in the UK.

or traumatic injury. called hashitoxicosis. Excessive sleepiness 6. On the other hand. a drop in body temperature. They are not specific (which means they can mimic the symptoms of many other conditions) and are often attributed to aging. a slowing of the heart rate. worsening heart failure. Fatigue 2. stress. Patients with mild hypothyroidism may have no signs or symptoms. untreated hypothyroidism can lead to an enlarged heart (cardiomyopathy). surgery. Constipation 8. The symptoms generally become more obvious as the condition worsens and the majority of these complaints are related to a metabolic slowing of the body. Modest weight gain 4. Cold intolerance 5. Decreased concentration 11. and an accumulation of fluid around the lungs (pleural effusion). Dry. Other symptoms and signs include: a) Swelling of the thyroid gland (due to the inflammation). before eventually becoming hypothyroid. Muscle cramps 10. Dry skin 9. Clinical Manifestations The symptoms of Hashimoto's thyroiditis are similar to those of hypothyroidism in general. Swelling of the legs As hypothyroidism becomes more severe. (the enlarged thyroid gland) called a goiter c) Difficulty swallowing solids and/or liquids due to the enlargement of the thyroid gland with compression of the esophagus . coarse hair 7. Common symptoms are listed below: 1. severe hypothyroidism may lead to a life-threatening coma (myxedema coma). In a severely hypothyroid individual.Modest Weight Gain (H20 Retention) Lack of available energy Fatigue Swelling of legs Dry Skin and Hair Decreased Muscle pain Concentration Constipation V. and heart failure. In its most profound form.There are a few patients with Hashimoto's thyroiditis who may undergo a hyperthyroid phase (too much thyroid hormone). leading to a feeling of tightness or fullness in the throat b) A lump in the front of the neck. there may be puffiness around the eyes. a myxedema coma tends to be triggered by severe illness. which are often subtle. Depression 3.

Treatment: The treatment of choice for Hashimoto's thyroiditis (or hypothyroidism of any cause) is thyroid hormone replacement.4 .6-1.used to measure antibodies of the thyroid protein thyroglobulin. 3. Presence of thyroid antibodies (+) hashimoto s disease. 2. T3 Test. levothyroxine sodium-to restore a clinically and biochemically euthyroid state. Serum TSH-measures the amount of thyroid stimulating hormone (TSH) in your blood. only 1 indicated that combined therapy seemed to improve the mood. However. Antithyroglobulin Antibody Test.VI. 4. T4 test/thyroxine test low levels of T4 indicate early hashimoto s disease Normal Ranges: 4.5 to 11. The free T4 and TSH levels are within reference ranges in the biochemically euthyroid state.0 mIU/L (milli-international units per liter).4. a literature review found that out of 9 controlled clinical trials. Combined use of liothyronine (T3) and levothyroxine-most popular used to mimic more closely thyroid hormone physiology.low levels of T3 indicate possibility of hashimoto s disease. Normal Ranges: 100 to 200 ng/dL (nanograms per deciliter). Normal Ranges: negative VII. but the dose is patient dependent. with the TSH level in the lower half of the reference range. quality of life. Normal Ranges: 0. TSH is produced by the pituitary gland and tells the thyroid gland to make and release the hormones thyroxine (T4) and triiodothyronine (T3). and psychometric performance of patients more than did levothyroxine alone.8 mcg/kg lean body weight per day. Nursing Diagnoses and Possible Interventions 1) Activity Intolerance related to fatigue and depressed cognitive process Nursing Intervention . High serum TSH (+) hashimoto s disease. Medical Management and Treatment Medical management: 1. The standard dose is 1. 2. VIII.2 micrograms per deciliter (mcg/dL). Diagnostic Procedures -Hashimoto s disease could be diagnosed by the following: 1.

To provide reality orientation to the patient 2.To encourage activities while allowing time for adequate rest 2.To permit evaluation of the effectiveness of the treatment. Monitor patients response to increasing activities . 2) Risk for Imbalanced Body Temperature Nursing Intervention Rationale 1.Provide stimulation through conversation and non stressful activities . Avoid and discourage use of external heat source .To allow for timely intervention 4.and under.To provide reassurance to patient and family about the cause of the cognitive changes. Monitor patients body temperature and report decreases from patients baseline value . date. Spacing of activities . Orient patient to time. 4. 4.To promote interest without overly stressing the client. Protect from exposure to cold and drafts .To provide stimulation within patience level of tolerance to stress 3.exertion by the client. Provide extra layer of clothing or blanket . and events around him/her .To prevent over. .Rationale 1. Explain to the patient and family that change in cognitive and mental functioning is a result of the disease process .Topermit patient to participate to extent possible in self care activities 3.To make patient feel comfortable and minimize heat loss 3) Disturbed thought processes related to depressed metabolism Nursing Intervention Rationale 1. Monitor cognitive and mental processes and response of these to medication and therapy .To reduce risk of peripheral vasodilation and vascular collapse 3. place. Provide stimulation through conversation and nonthreatening activities . Assist with self-care activities when patient is fatigued .To minimize heat loss 2.

and type 1 diabetes mellitus. although initially. Nevertheless.and antibodymediated immune processes. Patients with Hashimoto's thyroiditis have antibodies to various thyroid antigens. 3. Other antithyroid antibodies found in AITD (including Hashimoto's thyroiditis) include thyroid-stimulating antibody and cytotoxic antibody. 4] The thyroid gland is typically goitrous but may be atrophic or normal in size. The initiating process is not well understood.Pathophysiology Hashimoto's thyroiditis is characterized by the destruction of thyroid cells by various cell. y y y y y . TSH receptor-blocking antibodies. preformed thyroxine T4 and triiodothyronine (T3) may "leak" into the circulation from damaged cells. Antibodies binding to and blocking the TSH receptor have also been described and may contribute to further impairment in thyroid function. the most frequently detected of which include anti-thyroid peroxidase (anti-TPO).[2. The result is inadequate thyroid hormone production and secretion. adrenal insufficiency. including pernicious anemia. antithyroglobulin (anti-Tg). and to a lesser extent. a small percentage of patients with Hashimoto's thyroiditis (approximately 10-15%) may be antibody negative. Other variants of AITD include the following conditions: Atrophic thyroiditis Juvenile thyroiditis[5] Postpartum thyroiditis Silent thyroiditis Focal thyroiditis Hashimoto thyroiditis has a markedly higher clustering of other autoimmunity diseases.