A.

Brief definition of the specific disease condition

Hypothyroidism may be due to failure or resection of the thyroid gland itself

or deficiency of pituitary TSH. It occurs most often in patients with preexisting
autoimmune thyroiditis and in patients who are not iodine-deficient. It may also
develop in patients with a high iodine intake from other sources, especially if they
have underlying lymphocytic thyroiditis.
Hypothyroidism is common, affecting over 1% of the general population and
about 5% of individuals over age 60 years. Thyroid Hormone deficiency affects
almost all body functions. In addition to that, Levothyroxine is given to correct
hypothyroidism only after the patient is assessed for cortisol – deficiency or
already receiving corticosteroids. The typical maintenance dose is about 1.6
mcg/kg body weight. However, dosage requirements vary widely, averaging 125
mcg daily with a range of 25-300 mcg daily. The optical replacement dose of
thyroxine for each patient must be carefully assessed clinically on an individual
basis.

B. Possible Causes

MECHANISM CAUSE
Deficiency of TRH (Thyrotropin – Hypothalamic Disease
Releasing Hormone)
Deficiency of TSH (Thyroid Stimulating Pituitary tumor or infarction
Hormone)
Thyroid Destruction Chronic inflammation

Surgical ablation

Radioiodine ablation

Irradiation of the neck (usually for the

malignant disease)
Thyroid Deficiency Iodine deficiency (substrate lack)

Iodine excess (interference with hormone

release)

Antithyroid Drugs

Biosynthetic Defects
Hashimoto’s Disease is probably the most common cause of hypothyroidism, except for
iodine deficiency. This disorder would be better called chronic thyroiditis or chronic
lymphocytic thyroiditis. Its cause may be debated by some, but of the bulk of the
evidence points to an autoimmune process. The disorder is far more common in women
than in men (7:1), and can usually be perceived by the clinician as a diffuse swelling of
the thyroid gland in a patient who may be hypothyroid. Nearly all such patients can be
shown to have circulating thyroid antibodies. Biopsy of the thyroid shows marked
lymphocytic infiltration with atrophy and loss of thyroid follicles. This process is
progressive. It is of interest that the relatives of these patients frequently may have a
history thyroid disease, and they may also have antithyroid antibodies. Whether the
disease arises from an earlier infection with some virus has not yet been shown. The
patient with chronic lymphocytic thyroiditis is treated with thyroid replacement, and this is
usually lifelong requirement.

C. Signs and Symptoms

Signs of Hypothyroidism
• low serum [Ca²+] hypocalcemia and tetany
• high serum [phosphate] hyperphosphatemia
• urinary phosphate excretion

Symptoms of Hypothyroidism
• low metabolic rate
• weight gain
• positive nitrogen balance
• low heat production (cold sensitivity)
• low cardiac output
• hypoventilation
• lethargy, mental slowness
• drooping eyelids
• myxedema
• growth and mental retardation (perinatal)
• goiter

1. Common Manifestations – Mild hypothyroidism often escapes detection without

screening (ie, serum TSH). Common symptoms of hypothyroidism include weight
gain, fatigue, lethargy, depression, weakness, dyspnea on exertion, arthralgias or
myalgias, muscle cramps, menorrhagia, constipation, dry skin, headache,
paresthesias, carpal tunnel syndrome, and cold intolerance.
 2. Less Common Manifestations- It includes diminished appetite and weight loss,
hoarseness, decreased sense of taste and smell, and diminished auditory acuity.
Some patients may complain of dysphagia or neck discomfort.

D. Treatment and Nursing Responsibilities

Appropriate use of Thyroid Test

TEST COMMENT
For Hypothyroidism Serum TSH High in primary and low in
secondary hypothyroidism
Antithyroglobulin and
antithyroperoxidase Elevated in Hashimoto
antibodies Thyroiditis

The success of treatment for hypothyroidism still varies in different cases. Failures
are reported for people who takes low doses and slow supplementation of thyroid
hormone. Whereas patients who receives massive IV doses of T3 and T4 received more
success. Approximately, 100-300 micrograms of thyroid hormone administered daily, and
it is accompanied with plasma thyroid hormone levels monitoring. Hypothermia and cold
intolerance as felt by patients with hypothyroidism were treated by slow introduction of
endogenous body heat using a blanket. Rapid heating using hot baths or electrical
blankets can cause shock and death. Antimicrobial therapy should be done if there is an
evidence of infection. Patients who suffers from carbon dioxide retention should be
assisted by a respirator. Over hydration should be avoided because it can cause
congestive heart failure, cerebral edema, and death. Hyponatremia will be treated with
fluid restriction, rather than introduction of hypotonic saline.
Nursing management with Myxedema Coma focuses on management of
precipitating disease and control the side effects of the disease with the patient's organ
systems. Patient who are admitted in critical care should be placed in intubation and
mechanical ventilator. If the patient is in intubated, they must be monitored for respiratory
failure. Arterial blood should be monitored constantly. Patients that had over-hydrated
should be monitored with their electrolyte levels. Another side effect of the disease is
patients will tend to have dry skin. Broken skin should be avoided because it can cause
widespread infection and edema. Non-drying, hydrating soap followed by ointment should
be used and done accordingly. The patient should be introduced and given doses of the
hormone either orally or intravenously. Early recognition of the disease and the
willingness of the patient to undergo laboratory tests to confirm the diagnosis will allow
the therapy to be instituted as early sas possible by the clinical team.
 References :
Boyd,W. (1986). Introduction to the Study of the Disease. Library of Congress Cataloging
– in – Publication Data

Costanzo, L. (1998). Physiology (2nd ed.). William & Wilkins. Library of Congress,
United States of America

McPhee, S., Papadakis, M. & Rabow, M. (Ed.). (2011). Current medical diagnosis &
treatment (50th ed.). United States of America, The McGraw-Hill Companies, Inc.
Lough, M.,Stacy, K.,Urden, L.(2005). Thelan’s Critical Care Nursing Diagnosis and
Management (5th ed.). Mosby Inc.
ANATOMY AND PHYSIOLOGY

HYPOTHYROIDISM

(WRITTEN REPORT)

CATABAY, EUNICE

PAULE, LEA MARIE

QUITO, CHRISTINE

SALAZAR, NAYAN DEEP

(BSN1 – I)

REI ANGELO MANGIBIN,RN,MN

(CLINICAL INSTRUCTOR)