Clinical Case Study on Hypothyroidism

Republic of the Philippines
TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
Department of Nursing
A Clinical Case Study

Presented to the
Faculty of the Department of Nursing
College of Science
Tarlac State University
Tarlac City
_______________
In Partial Fulfillment
Of the Requirements for
NCM 116 RLE
_______________
Submitted by:
Abedoza, Rodelyn S.
Arceo, Lei Ann Q.
Flores, Arliah Grace Q.
Garcia, Meagan Gail S.
Manalang, Jaime Lee J.
Melendez, Aleckza Jade S.
Rufino, Leslie Kriztel S.
Saddi, Ella Joyce S.
Santos, Alfred Dominic S.
Submitted To:
EMMANUEL DOMINIC RAYMOND M. BUGAYONG, RN
ELICE JUDE T. ROSETE, RN, MAN, MSN
MAY 2021
BSN 3-2 GROUP 1: HYPOTHYROIDISM
TABLE OF CONTENTS
I. INTRODUCTION……………………………………………………………………04
II. NURSING PROCESS………………………………………………………………06
III. 13 AREAS OF ASSESSMENT……………………………………………………08
IV. LABORATORY AND DIAGNOSTIC PROCEDURE……………………………16
V. ANATOMY AND PHYSIOLOGY…………………………………………………18
VI. PATHOPHYSIOLOGY………………………………………………………19
VII. NURSING CARE PLAN……………………………………………………21
VIII. DRUG STUDY ………………………………………………………………28
IX. MEDICAL MANAGEMENT……………………………………………20
X. DIET………………………………………………………31
2
XI. ACTIVITY AND EXERCISE………………………………………………33
XII. HEALTH TEACHING…………………………………………………………34
XIII. CONCLUSION……………………………………………………………………35
XIV. RECOMMENDATION……………………………………………………………35
XV. REVIEW OF RELATED LITERATURE…………………………………………36
XVI. BIBLIOGRAPHY……………………………………………………………………37
XVII. REFERENCE…………………………………………………………………………37
I. INTRODUCTION
Hypothyroidism is a condition in which the thyroid gland is not able to produce enough thyroid
hormone. Since the main purpose of thyroid hormone is to “run the body’s metabolism,” it is understandable
that people with this condition will have symptoms associated with a slow metabolism.
How common is hypothyroidism? About 4.6 percent of the U.S. population ages 12 and older has
hypothyroidism, although most cases are mild. That’s almost 5 people out of 100.
Prevalence of Congenital Hypothyroidism: Current Trends and Future Directions.” In this overview we
provide a summary of the issues addressed at the workshop and briefly describe the presentations, the details
of which are largely incorporated in other articles in this supplemental issue of Pediatrics. Most notably, the
future research directions set forth by workshop participants are detailed in the article by Shapira et al.2
The overall goal of the workshop was to present participants with detailed background information
about CH and data on incidence rates to develop future approaches to resolve the questions surrounding the
magnitude of and potential explanations for the increasing CH-incidence rates, whether real or artifactual. At
the outset, the workshop organizers compiled the following list of issues to address potential explanations for
the reported data trends:
changes in practice that might have occurred in the follow-up and medical management of screen-positive
cases identified by newborn screening, including the primary care provider’s perspective;
● Transient hypothyroidism: etiology, clinical implications, management, and changes in prevalence;
● Epidemiology and risk factors for CH, such as preterm birth, genetic factors, sex, race and ethnicity,
prenatal iodine intake, and autoimmunity (also co-occurring trends in these factors over the past 3 decades);
4
and
● Changes in laboratory approaches to newborn screening for CH, including laboratory methods and
screening paradigms.
Although anyone can develop hypothyroidism, you’re at an increased risk if you:
 Are a woman.
 Are older than 60.
 Have a family history of thyroid disease.
 Have an autoimmune disease, such as type 1 diabetes or celiac disease.
 Have been treated with radioactive iodine or anti-thyroid medications.

Many symptoms of an underactive thyroid (hypothyroidism) are the same as those of other conditions, so it can
easily be confused for something else.
 tiredness.
 being sensitive to cold.
 weight gain.
 constipation.
 depression.
 slow movements and thoughts.
 muscle aches and weakness.
 muscle cramps.
II. Nursing Process
A. ASSESSMENT
1. PERSONAL DATA
a. DEMOGRAPHIC DATA
NAME: Patient X
AGE: 35 years old
GENDER: Female
CIVIL STATUS: Married
OCCUPATION: Housewife
POSITION/ROLE IN THE FAMILY: Wife
ADDRESS: Concepcion Tarlac
CHIEF COMPLAINT: Weight gain and swelling of the whole body for months, cold intolerance for
months, increased sleepiness, lethargy, anorexia, and weakness for months, constipation for months,
and lack of concentration and poor memory for months.
B. ENVIRONMENTAL STATUS
The patient also complains of intolerance to cold and prefers warm environment. For the last …
months, she feels very lethargic, extremely weak, generalized body ache and constipation.
6
C. LIFESTYLE
Mrs. …, 35 years old, housewife, normotensive, nondiabetic, hailing from, presented with the
weight gain and generalized swelling of the whole body for … months, which is progressively increasing
in spite of her less appetite.
She also feels sleepiness during most of the time even during working hours, lack of concentration and
disturbance of memory since the beginning of her illness. Recently, her voice has changed and become
hoarse. She also noticed that her skin is rough and dry. There is no history of chest pain, palpitation,
breathlessness, tingling, numbness of hands or feet or loss of consciousness.
GENOGRAM
No such illness in her family. All the family members are alright.
3. HISTORY OF PAST ILLNESS
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Patient X is 35 years old, housewife she has no history of thyroid disease, thyroid surgery, radiation to
the neck or drugs. Within the last 6 months he denies childbirth or difficult delivery.
4. PRESENT HEALTH HISTORY
According to the statement of the patient, she was alright … months back. Since then, she is suffering
from weight gain and generalized swelling of the whole body, which is progressively increasing in spite of her
less appetite. The patient also complains of intolerance to cold and prefers warm environment. For the last …
months, she feels very lethargic, extremely weak, generalized body ache and constipation. She also feels
sleepiness during most of the time even during working hours, lack of concentration and disturbance of
memory since the beginning of her illness. Recently, her voice has changed and become hoarse. She also
noticed that her skin is rough and dry. There is no history of chest pain, palpitation, breathlessness, tingling,
numbness of hands or feet or loss of consciousness. She also complains of excessive menstrual bleeding for
the last 3 months, although it was normal previously. Prior to her present illness, she did not take any drugs.
There is no history of taking any oral contraceptive pill. After the illness, she has only taken multivitamin tablets
and iron tables prescribed by a local physician.
III. 13 AREAS OF ASSESSMENT
1. SOCIAL STATUS
Patient X is 35 years old, married, and a stay-at-home mom. She lives in Conception, Tarlac with her
husband and children. According to her, she used to do the household chores and watch television afterwards.
She sometimes socialized with her relatives and other neighbors, but most of her time was just at home. She
has a good relationship with her husband and children.
NORMS:
Social status includes family relationship or friends that state the patient's support system in times of
stress and in need. It meets a fundamental human need for social ties, making life less stressful and social
support buffers the negative effects of the stress, thus, indicating indirectly contributing to good health
8 outcomes (Friedman and Smith 1988)
ANALYSIS/INTERPRETATION:
Patient X has good relationship with her family and neighbor.
2. MENTAL STATUS
During the interview, Patient X lacked her concentration and experienced mental disturbances. She is
aware that she is in the hospital but she's having difficulty recalling recent and remote memories she's
experienced. She was able to speak, but not clearly because her voice is coarse or husky.
NORMS:
The content of the patient's message should make sense. The patient should be able to correctly
respond to questions and to identify all the objects as requested. The patient should be able to evaluate and
act appropriately in situations requiring judgement. (Health assessment and physical examination 3rd Edition
by Mary Ellen Zator Estes).
ANALYSIS:
Patient X experienced lack of concentration and mental disturbances
3. EMOTIONAL STATUS
The patient appeared extremely weak and lethargic. She had no idea what was wrong with her, and she
was bothered by the symptoms she had been experiencing for months, so she decided to go to the hospital for
a check-up.
NORMS:
Normally, the patient should have the ability to manage stress and to express emotion appropriately. It
also involves the ability to recognize, accept and express feelings and to accept one’s limitations.
(Fundamentals of Nursing: Concepts, Process, and Practice, 10th Edition, 2018)

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ANALYSIS:
The patient is worried about the symptoms she is experiencing.
4. SENSORY PERCEPTION
a. Sense of Sight
With the use of penlight, the following were observed. The eyes of the patient are equal, and round and it
is reactive to light. Sclera is white in color and eyes are moving symmetrically. She verbalized that she's
experiencing blurring of vision because of periorbital swelling and baggy eyelids.
NORMS:
Normal vision of a person is 20/20 in a distance of 20 feet without wearing or using an eyeglasses or corrective
grades lenses. (Estes, 2011)

ANALYSIS:
Patient has blurred vision because of periorbital swelling and baggy eyelids
b. Sense of touch
The patient was assessed on her tactile sensitivity by first asking her consent to touch her in order to
determine her sense of touch. We gently put a bottle on her skin with warm water and ask her what she is
feeling. The patient verbalizes that it is warm.
NORMS:
The skin contains receptors for pain, touch, pressure and temperature. Sensory signals that help to determine
precise locations on the skin are transmitted along rapid sensory pathways and less distance signals such as
pressure or poorly located touch are sent via slower or sensory pathways. (Estes, 2011)
ANALYSIS:
10 Based on the assessment, the patient's sense of touch is normal. She was able to tell what she felt
when the warm water in the bottle was on her skin.
c. Sense of Taste
According to the patient, her taste has not change. She can still differentiate which one is sour, salty, and
sweet.
NORMS:
A person can identify the taste of bitter, sweet and sour. (Estes, 2011)
ANALYSIS:
Patient’s sense of taste is normal and can describe correctly the taste of the food that she ate.
d. Sense of Hearing
The patient's hearing was identified using a watch tick test. The watch was placed in her ear and asked
the patient what she was hearing and the patient verbalized she was hearing the sounds of the clock 'tick tack
tick tack'.
NORMS:
Patient should be able to hear the sounds of the clock (Estes, 2011)
ANALYSIS:
The patient can hear well and able to verbalize the sounds of the clock.
e. Sense of Smell
The patient's nose is at the midline of the face and is symmetrical. The patient was able to identify and
detect the smell of the alcohol presented.
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NORMS:
The nose must be symmetrical and along the midline of the face. Nostrils must be patent and able to
recognize the smell of different object. (Estes, 2011)
ANALYSIS:
Patient's sense of smell is normal and can identify the smell of different objects.
5. MOTOR STABILITY
The patient appeared weak and lethargic. She experienced generalized body ache. That is why she
having difficulty moving. She feels pain when she attempts to exchange her position in bed.
NORMS:
Normal motor stability includes the ability to perform different activities. (Estes, 2011)
ANALYSIS:
The patient's motor stability is not in normal status and can't perform different activities because her
body is aching.
6. BODY TEMPERATURE
The patient's body temperature is 35. 5 °C. She experienced cold intolerance and preferred warm environment.
NORMS:
The normal body temperature of a person is within 36.4 ℃ to 37.4 ℃. (Estes,2011)
ANALYSIS:
Patient’s is hypothermic, her body temperature is below normal.

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7. RESPIRATORY STATUS
The patient respiratory status is 22 breaths per minute.
NORMS:
When Patient X was auscultated, her breath sounds are normal, no cough and no difficulty in breathing
noted. A normal respiratory rate ranges from 12–20 CPM. (Kozier, Fundamentals of Nursing, 7th Edition).
ANALYSIS:
The patient’s respiratory rate is elevated due to the pain she is experiencing.
8. CIRCULATORY STATUS
The patient pulse rate is 50 beats per minute. The patient blood pressure is 120/90 mmHg
NORMS:
The normal pulse rate for adult ranges from 60 to 100 beats per minute and the average Blood
pressure for the adult is <120/<80mmHg (Potter and Perry,2009)
ANALYSIS:
The pulse rate of the patient during the assessment is below normal, the patient is noted bradycardic.
The blood pressure is elevated from normal.
9. NUTRITIONAL STATUS
According to the patient she's fond eating vegetables, meat, chicken and fish. She eat meals 3x a day
and consume 8 glasses of water. For the past months she is suffering from weight gain and generalized
swelling of her body which is progressively increasing in spite of her less appetite.
NORMS:
The normal eating pattern of a person is minimum of three times per day depending upon the metabolic
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demand and needs of the patient. (Monahan, 2017)
ANALYSIS:
The nutritional status of the patient is not normal. She gained weight in spite of her less appetite.
10. ELIMINATION STATUS
The patient's elimination pattern was urinating 4 to 5 times per day. Normally, she defecates three times
per week, but in recent months, she has become constipated, her bowel movements have become less
frequent, and her stools have become difficult to pass.
NORMS:
Normal urinary output of a person is 2 liters per day and should typically defecate from once a day to
every 3 to 5 days.
ANALYSIS:
The patient experienced constipation for months.
11. REPRODUCTIVE STATUS
The patient had her menstruation sheen she was 13-year-old. Patient X stated that she never used any
contraceptives prior to pregnancy. There are no abnormalities noted and denies difficulty delivery. The patient
delivered her two children via Normal Spontaneous Delivery (NSD). During the interview, she complained of
excessive menstrual bleeding for the last 3 months, though it was normal previously.
NORMS:
The first menstruation which is menarche occurs at an average of 9 to 17 years old. (Maternal and Child
Health Nursing 4th edition by Pilli Terri)
ANALYSIS:
The patient experienced heavy menstruation for the past 3 months.

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12. SLEEP AND REST PATTERN
The patient claims that her number of hours of sleep ranges from 6-8 hours every day, but for the past
months she has felt very lethargic, extremely weak and has increased sleepiness. She also stated that most of
the time, even during working hours, she feels sleepy.
NORMS:
Sleep exerts physiological effects on both nervous system and other body structures. Usually a person
need 7 to 8 hours of sleep a night. Avoid doing homework or office work before or after going to bed because it
affects your ability to fall asleep. (Kozier&Erb’s 2016)
ANALYSIS:
A patient's sleep or rest pattern is disturbed. She often feels sleepy even when she's in working hours.
13. STATE OF SKIN APPENDAGES
The patient's skin is rough, dry, cold and thick. She appeared pale and apathetic. The color of her skin
is brown in color and appropriate for the whole body. The hair is evenly distributed, the skin is cold to touch and
there is the presence of edema on the whole body. The nails are trimmed and clean with no presence of nail
clubbing. The patient is mildly anemic. A normal capillary refill is noted that returns after 1-2 seconds. There is
the presence of stretch marks in the hips, abdomen, and legs related to pregnancy.
NORMS:
Skin, hair and nails changes are evident in an aging person. The skin become drier and lose its
elasticity, there will be a hair loss and change of color. In women the hair of the eyebrows and some facial hair
become coarse. The nail grows more slowly and thicken, it also tends to split. (Kozier&Erb’s 2015)
ANALYSIS:
Patient X is diagnosed with a rare form of melanoma, a dark spot formed on her sole of feet. According
15 to norms, patient skin and appendages status is not normal.
IV. LABORATORY AND DIAGNOSTIC PROCEDURE
DIAGNOSTIC/LABORATORY INDICATION/PURPOSE RESULTS INTERPRETATION

PROCEDURE
Physical Examination During the examination, the thyroid Thyroid gland is not enlarged.  Instruct the patient to extend the neck slightly and swallow.
gland is inspected and palpated Neck veins are not engorged.  The thyroid is then palpated for size, shape, consistency,
routinely in all patients symmetry, and the presence of tenderness.
Having the patient swallow during the maneuver may assist the
examiner to locate the thyroid as it ascends in the neck.
DIAGNOSTIC/LABORATORY INDICATION/PURPOSE RESULTS INTERPRETATION

PROCEDURE
Thyroid Stimulating Hormone A TSH test is often performed to A reading of 6.0 mIU/L  The TSH test doesn’t require any special preparation. However,
Test (TSH) determine the underlying cause of it’s important to instruct the patient to avoid taking medications
abnormal thyroid hormone levels. that might interfere with the accuracy of the TSH measurement.
Some medications that could interfere with a TSH test are
amiodarone, dopamine, lithium, prednisone, potassium iodide,
and biotin.
Since it involves taking a sample of blood, first, clean the area with an
antiseptic or other sterilizing solution.
V. ANATOMY AND PHYSIOLOGY
The Thyroid Gland
The thyroid gland is located in the neck where it wraps around the trachea. (a) Anterior
view of the thyroid gland. (b) Posterior view of the thyroid gland. (c) The glandular tissue is
composed primarily of thyroid follicles. The larger parafollicular cells often appear within the
matrix of follicle cells.
A butterfly-shaped organ, the thyroid gland is located anterior to the trachea, just inferior
to the larynx. The medial region, called the isthmus, is flanked by wing-shaped left and right
lobes. Each of the thyroid lobes are embedded with parathyroid glands, primarily on their
posterior surfaces. The tissue of the thyroid gland is composed mostly of thyroid follicles. The
follicles are made up of a central cavity filled with a sticky fluid called colloid. Surrounded by a
wall of epithelial follicle cells, the colloid is the center of thyroid hormone production, and that
production is dependent on the hormones’ essential and unique component: iodine.
Physiology
The thyroid gland is responsible for the production of iodothyronines, of which there are
three. The primary secretory product is inactive thyroxine, or T4, which is a prohormone of
triiodothyronine, or T3. T4 is converted to T3 peripherally by type 1 deiodinase in tissues with
high blood flow, such as the liver and kidneys. In the brain, T4 is converted to active T3 by type
2 deiodinase produced by glial cells. The third iodothyronine is called reverse T3, or rT3. rT3 is
inactive and forms by type 3 deiodinase activity on T4.
These iodothyronines are composed of thyroglobulin and iodine. Thyroglobulin is formed
from amino acids in a basal to apical fashion within the thyroid cells themselves. Thyroglobulin
is then secreted into the follicular lumen, where it is enzymatically combined with iodine to form
iodinated thyroglobulin. Endosomes containing this iodinated thyroglobulin then fuse with
lysosomes, which enzymatically release the thyroglobulin from the resultant thyroid hormone.
The thyroid hormones are next released from the cell while the remaining thyroglobulin is
deiodinated and recycled for further use.
VI. PATHOPHYSIOLOGY
Book Based
Inadequate secretion of thyroid hormone during fetal and neonatal development results
in stunted physical and mental growth (cretinism) because of general depression of metabolic
activity. In adults, hypothyroidism manifests as lethargy, slow mentation, and generalized
slowing of body functions. This results from suboptimal levels of thyroid hormone. The most
common cause of hypothyroidism in adults is autoimmune thyroiditis (Hashimoto’s disease), in
which the immune system attacks the thyroid gland. Symptoms of hyperthyroidism may later be
followed by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in
patients with previous hyperthyroidism that has been treated with radioiodine or antithyroid
medications or thyroidectomy. The condition occurs most frequently in older women. In addition,
there is an increase incidence of thyroid cancer in men who have undergone radiation therapy
for head and neck cancer. Other causes of hypothyroidism:
• Autoimmune diseases (Hashimoro’s thyroiditis, post-Graves’ disease)
• Atrophy of thyroid gland with aging
• Therapy for hyperthyroidism (Radioactive Iodine, Thyroidectomy)
• Medications such as lithium, iodine compounds, antithyroid medications
• Radiation to head and neck for treatment of head and neck cancers, lymphoma
• Infiltrative diseases of the thyroid (amyloidosis, scleroderma, lymphoma)

• Iodine deficiency and iodine excess
PATIENT BASED
VII. NURSING CARE PLAN
ASSESSMENT NURSING PLANNING NURSING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
SUBJECTIVE: Knowledge WITH IN 1-2 • VS taken and  To monitor normal After 2 hours of rendering appropriate
deficit related to HOURS OF recorded as follows: baseline data nursing intervention patient was able
Anong nangyayari unfamiliarity with RENDERING  BP: 120/90  Client teaching should verbalized correct information about
sakin? Nagdadiet information as APPROPRIATE  PR: 50 Bpm begin with the current hypothyroidism and taking thyroid hormone
naman ako pero bakit evidenced by NURSING  RR: 21 cpm knowledge about the replacement.
lumalaki pa din ako? Verbalization of INTERVENTION  T: 36.2c disease and its
As verbalized by the lack of PATIENT will be • Assess the client’s management.
patient information able TO: knowledge of  Teaching sessions should Goal is met. Document
about the hypothyroidism and be planned at times when
OBJECTIVE: disease and its Verbalize correct thyroid hormone the client is best able to
V/S as follows: management. information about replacement concentrate
BP: 120/90 hypothyroidism therapy.  Levothyroxine sodium
PR: 50 Bpm and taking thyroid • Provide information (Synthroid) is a manmade
RR: 21 cpm hormone about thyroid hormone that is
T: 36.2c replacement. hypothyroidism used to treat
+periorbital edema Educate the client and hypothyroidism.
+generalized swelling family regarding thyroid  The client should report
 Hoarness hormones. symptoms such as chest
 Weak and pain/palpitations; these
lethargic in Teach the expected happen due to the
appearance benefits and possible increased metabolic and
side effects. oxygen consumption.
Dry and rough skin  Avoid undue fatigue; As
the euthyroid state is
achieved, the activity level
will eventually increase
 Medical identification
provides other health care
Emphasized the
importance of rest providers with information
periods. to guide decisions about
care. Levothyroxine is
highly protein bound in
circulation.
 This drug characteristic
Encourage the client to contributes to many drug
have medical interactions. The client
identification about needs to notify all health
hormone therapy and to care providers about
inform all health care taking this drug.
provider
DIAGNOSIS
SUBJECTIVE: Activity WITH IN 4-5 • VS taken and  To monitor normal After 5 hours of rendering appropriate
intolerance HOURS OF recorded baseline data nursing intervention Client was able to
Mabilis akong related to RENDERING verbalize reduction of fatigue and increased

mapagod as weakness and APPROPRIATE the ability to complete desired activities as
verbalized by the
apathy NURSING evidence by patient’s performed ADL with
patients INTERVENTION • Assess the client’s  The client may experience no complains of fatigue and difficulty.
ability to perform fatigue with minimal Goal is met. Document
OBJECTIVE: exertion due to a slow
Client will activities of daily
V/S as follows:
verbalize a living (ADLs). metabolic rate. This
BP: 120/90
PR: 50 Bpm symptom hinder the
RR: 21 cpm reduction of client’s ability to perform
T: 36.2c fatigue and daily activities
+periorbital edema increased the
+generalized swelling ability to complete  This will ensure maximize
 Hoarness desired activities. • Plan care to allow
participation
 Weak and individually
lethargic in adequate rest
appearance
periods. Schedule
activities for periods
Dry and rough skin when the client has
the most energy.

 Promotes interest without
• Provide stimulation putting too much stress to
through the client.
conversation and
non stressful
activities.
 The client with

hypothyroidism often
• Promote complains of being cold
an environment even in a warm
conducive to relieve environment.
fatigue. .

DIAGNOSIS
SUBJECTIVE: Altered fecal WITH IN 5-6 • VS taken and  To monitor normal After 6 hours of rendering appropriate
elimination HOURS OF recorded baseline data nursing intervention patient was able to
Ilang araw na kong di related to RENDERING regain normal bowel elimination patterns,
 It is very crucial to
nakakatae. As decreased APPROPRIATE • Check on the usual having a soft, formed stool and verbalized
verbalized by the carefully know what is
peristalsis, as NURSING pattern of elimination, relief from discomfort of constipation.
patient evidenced by INTERVENTION “normal” for each patient. Goal is met.
including frequency and
patient’s PATIENT will The normal frequency of document
OBJECTIVE: consistency of stool.
verbatim report regain normal stool passage ranges from
V/S as follows: • Encourage to
of constipation bowel elimination twice daily to once every
BP: 120/90 increase fluid intake
for a month patterns, having a third or
PR: 50 Bpm • Encourage to eat
soft, formed stool fourth day.
RR: 21 cpm fruits and
at least every
T: 36.2c vegetables which
other day.
+periorbital edema are rich in fiber and
+generalized swelling avoid meat.  Enough fiber intake helps
 Hoarseness defecation easier
 Weak and
lethargic in • Encourage to start
appearance liquid or soft diet
 Dry and rough  To hydrate and help
skin soften fecal mass
 Distended
• Take account of a
abdomen
possible laxative
 bowel since  There is a big factor when
and enema use,
day of patient becomes
type, and frequency.
admission dependent on laxatives
 Poor and enemas
• Check out usual
peristalsis
dietary habits,
upon
eating habits,
auscultation
eating schedule,
 Sedentary lifestyle such
and liquid
as sitting all day, lack of
intake.
exercise, prolonged bed
rest and inactivity
contribute to constipation.
• Assess the
patient’s activity
level.
• Urge patient for
some physical  Movement promotes
activity and peristalsis. Abdominal
exercise. exercises strengthen
Consider abdominal muscles that
isometric facilitate defecation.
abdominal and
gluteal
exercises.
• Encourage a  Most people defecate
regular period following the first daily
for elimination. meal or coffee, as a result
of the gastrocolic reflex.
 The warmth of the water
• Warm sitz bath relaxes muscles before
defecation attempts.
• Perform
abdominal
massage  Abdominal massage has been
• Using the heel known to be helpful in
of the hand or a neurogenic bowel disorder but
tennis ball, apply not for constipation in older
and release adults.
pressure firmly
but gently
around the
abdomen in a
clockwise
direction.

• Administer Stool
softeners as
prescribed
• Suppositories  These laxatives soften stool
• Oil retention and lubricate intestinal
enema mucosa.
 These laxatives aid in
softening stools and stimulate
rectal mucosa; best results
occur when given 30 minutes
before usual defecation time
or after breakfast.
VIII. DRUG STUDY
NAME OF DRUG ROUTE, MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING RESPONSIBILITY
DOSAGE, ACTION
FREQUENCY
Generic Name: Initial dose: 0.05 Synthetic form of  Replacement  Contraindicated  Nervousness,  Assess patient history for
Levothyroxine mg PO, with thyroxine that affects therapy in with allergy to excitability, tremor, allergies, thyrotoxicosis,
Sodium increasing the growth of tissues, hypothyroidism active or muscle weakness, acute MI uncomplicated
increments energy expenditure,
by hypothyroidism,
and the turnover of all  Pituitary TSH extraneous cramps; sweating,
Brand Name: of0.025 mg PO
Tab. Thyroxine q 2–4 week; substrates. suppression in the constituents of flushing, heat Addison’s disease,
maintenance of treatment and drug, intolerance, lactation.
Classification: up to 0.2 Therapeutic Action: prevention of thyrotoxicosis, and headache, insomnia,  Monitor response carefully
Therapeutic class: mg/day Levothyroxine euthyroid goiters acute MI tachycardia, at start of therapy and
Thyroid Hormone sodium increases the and in the uncomplicated by palpitations, angina adjust dosage. Full
Replacement basal metabolic rate hyperthyroidism pectoris, excessive therapeutic effect may not
management of
(BMR) of be seen for several days
Pharmacologic carbohydrates, fats thyroid cancer  Use cautiously with wt loss, menstrual
class: and proteins. It is  Thyrotoxicosis in Addison’s disease irregularities,  Administer oral drug as a
Thyroid Hormones also involved in the conjunction with (treat diarrhoea, vomiting. single daily dose before
regulation and antithyroid drugs hypoadrenalism  Potentially Fatal: breakfast with a full glass
differentiation of cell and to prevent with corticosteroids Convulsions, cardiac of water.
growth. These effects goitrogenesis, before thyroid arrhythmia, heart  Arrange for regular,
are mediated at the periodic blood tests of
hypothyroidism, therapy), lactation, failure, coma.
cellular level by the thyroid function.
thyroxine metabolite, and thyrotoxicosis patients with
tri-iodothyronine.. during pregnancy coronary artery  During on-going therapy
disease or angina. instruct patient to report
Treatment of any signs of headache,
myxedema coma chest pain, palpitations,
fever, weight loss,
sleeplessness,
nervousness, irritability,
unusual sweating,
intolerance to heat,
diarrhea.
 Instruct patient to do not
discontinue without
consulting health care
provider; serious problems
can occur.
NAME OF DRUG ROUTE, MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING RESPONSIBILITY
DOSAGE, ACTION
FREQUENCY
Generic Name: 1 tab P.O It works on the It is useful in treating  Hypersensitivity  Constipation Advise patient the following:
Multivitamins OD body’s immune and preventing vitamin  Undiagnosed  Dark stools  It should be taken with food
system to improve and mineral to reduce the side effects of
anemias,  Nausea and vomiting
Brand Name: the effect on viral deficiencies. It also
hemochromatosis  Abdominal pain. GI irritation.
Folgard, Natalins replication. It helps in protecting the
Rx, Nestabs CBF, enhances the body’s body from damage, (formulations with  Do not consume it more
Nestabs FA absorption of calcium improving immunity, iron), Wilson's than the quantity prescribed
and phosphorous metabolism, and other disease by your doctor.
Classification: required for strong body functions. It also (formulations with  Do not use this supplement
Vitamin and bones and also promotes skin, hair, copper), pre- if you are allergic to any of
mineral supplement metabolizes bones, healthy joints. the component of this
existing
carbohydrates to
hypervitaminosis medicine.
maintain normal
growth.  Not recommended to be
used along with alcohol.
Refrain from consuming
alcohol for at least three
days after the last dosage
of medicine.
IX. MEDICAL MANAGEMENT
NAME OF DRUG DATE ROUTE, DOSAGE, MECHANISM OF INDICATION CLIENT NURSING RESPONSIBILITY
ADMINISTERED FREQUENCY ACTION RESPONSE
Brand Name: N/A IVF- PNSS 1 L to run Normal saline is a Used because it has Showed no signs  Monitor vital signs, signs of
Plain NSS for 8 hours. sterile, non-pyrogenic little to no effect on the of adverse effects. edema, lung sounds, and
solution for fluid and tissues and make the heart sounds, and continue,
Other Name: electrolyte person feel hydrated
monitoring during and after
0.9% Sodium replenishment. preventing hypovolemic
Chloride Solution shock or hypotension. the infusion.
 Monitor for signs of
Classification: hypervolemia such as
Isotonic hypertension, bounding
Intravenous pulse, pulmonary
Solution  crackles, dyspnea,
shortness of breath,
peripheral edema, jugular
vein distension (JVD)
and extra heart sounds
such as S3.
 Check the level of the IVF:
 Correct solution,
medication, and volume.
 Check and regulate the
drop rate.
X. DIET
Type of Diet Date Indications Nursing Responsibility
Iodine Rich Diet N/A Iodine is an essential Consider adding iodized

mineral that’s needed table salt to your patient
to make thyroid meals or eating more
hormones. Thus, iodine-rich foods like
people with iodine seaweed, fish, dairy, and
deficiency might be at eggs.
risk of
hypothyroidism.
Selenium Rich Diet N/A  Selenium  Adding selenium-

helps “activate” rich foods to your
thyroid hormones so patient diet is a great
they can be used by way to boost the
the body selenium levels. This
 Selenium is a includes Brazil nuts,
powerful mineral tuna, sardines, eggs,
that is essential and legumes.
for the proper  Advice patient to
functioning of your avoid taking a
body. It plays a selenium
critical role in supplement unless
metabolism and advised by the
thyroid function healthcare provider.
and helps protect Supplements
your body from provide large doses,
damage caused and selenium may
by oxidative be toxic in large
stress. amounts
Zinc N/A Like selenium, zinc Advice client to eat more

helps the body zinc-rich foods like oysters
“activate” thyroid and other shellfish, beef,
hormones. Zinc is a and chicken.
mineral that's
essential for good
health. It's required
for the functions of
over 300 enzymes
and involved in many
important processes
in your body. It
metabolizes nutrients,
maintains your
immune system and
grows and repairs
body tissues.
There are plenty of food options for people with hypothyroidism, including:
• eggs: whole eggs are best, as much of their iodine and selenium are found in the yolk, while the whites
are full of protein
• meat: all meats, including lamb, beef, chicken, etc.
• fish: all seafood, including salmon, tuna, halibut, shrimp, etc.
• vegetables: all vegetables — cruciferous vegetables are fine to eat in moderate amounts, especially
when cooked
• fruits: all other fruits, including berries, bananas, oranges, tomatoes, etc.
• gluten-free grains and seeds: rice, buckwheat, quinoa, chia seeds, and flax seeds
• dairy: all dairy products, including milk, cheese, yogurt, etc.
• beverages: water and other non-caffeinated beverages
• People with hypothyroidism should eat a diet based around vegetables, fruits, and lean meats. They are
low in calories and very filling, which may help prevent weight gain.
32 BSN 3-2 GROUP 1: HYPOTHYROIDISM
XI. ACTIVITY AND EXERCISE
Here are a few tips to help maintain a healthy weight.
 Get plenty of rest. Aim to get 7–8 hours of sleep every night. Sleeping less than this is linked to fat
gain, especially around the belly area.
 Practice mindful eating. Mindful eating, which involves paying attention to what you’re eating, why
you’re eating, and how fast you’re eating can help you develop a better relationship with food.
Studies also show that it can help you lose weight.
 Try yoga or meditation. Yoga and meditation can help you de-stress and improve your overall
health. Research also shows that they help you maintain a healthy weight.
 Try a low to moderate carb diet. Eating a low to moderate amount of carbs is very effective for
maintaining a healthy weight. However, avoid trying a ketogenic diet, as eating too few carbs may
lower your thyroid hormone levels.

XII. HEALTH TEACHING
 Eat a high-fiber, low-calorie diet to relieve constipation and maintain a healthy weight.
 Exercise. Start slow, with a 5 to 15 minute walk each day. Try to work up to 10,000 steps, or 3 20-
minute walks each day.
 Take your medicine with a full glass of water. Take it at least 1 before you eat breakfast. Or at
bedtime, at least 3 hours after eating.
 Do not take calcium or iron within 4 hours of taking your thyroid medicine. And ask your healthcare
provider about taking other medicines with your thyroid pill.
 Follow-up with your healthcare provider, or as advised.
 Call your healthcare provider right away if you have any of the following: Extreme fatigue, Puffy
hands, face, or feet, Irregular heartbeat, Confusion

DISCHARGE PLANNING
One of the most important roles of a nurse to make sure client agrees with and competent to
accomplish the home care procedures.
MEDICATION
Patient X take multivitamins and mineral supplements as prescribed.
FOLLOW- UP
The patient will notify the physician for any signs and symptoms of illness.
XIII. CONCLUSION
Hypothyroidism is a common endocrinological disorder with many different etiologies. In infants, it is
primarily due to congenital thyroid dysgenesis, while in children, it is primarily due to chronic autoimmune
thyroiditis. Hypothyroidism may present with abnormalities in metabolism and development. If left untreated the
patient may have developmental delays. Diagnosis relies on a detailed history and physical exam to illicit
potential causes of hypothyroidism. Key laboratory tests are serum TSH and free T4 levels. Treatment is
through thyroid replacement therapy and should begin immediately to prevent development complications, with
TSH and T4 levels being monitored regularly. Therapy is continued throughout life, although in some cases the
patient may become euthymic after puberty.
XIV. RECOMMENDATION

Student Nurse
The case study is recommended for student nurses to serve as their guideline and reference on their
studies in the clinical practice in handling endocrine disorders so they can be knowledgeable and equipped
enough to render quality nursing care to their patients.
Patient
The patient is the focus of care; therefor, the patient should be aware and should recognize the
condition, the importance and the risk; to have a quality well-being and health for herself; their family and as
well as their community.

XV. REVIEW OF RELATED LITERATURE
Hypothyroidism in Women
Donna Dunn, PhD, CNM, FNP-BC

Carla Turner, DNP, ACNP-BC DOI:
Abstract
Hypothyroidism, a disease in which the thyroid gland does not make enough thyroid hormone, is the
second most common endocrine disorder among women. Symptoms of hypothyroidism include fatigue, weight
gain, alteration in cognition, infertility, and menstrual abnormalities. The most common cause of hypothyroidism
in the United States is Hashimoto’s thyroiditis. The American Thyroid Association recommends an initial
screening for thyroid disease at age 35 years and every 5 years thereafter. Thyroid-stimulating hormone is
highly sensitive to thyroid dysfunction and is used to evaluate thyroid disorders. Monotherapy with
levothyroxine is the standard for treating hypothyroidism. Diagnosing hypothyroidism requires appropriate
diagnostic tests to facilitate prompt diagnosis and treatment.
https://nwhjournal.org/article/S1751-4851(15)00004-5/fulltext
https://doi.org/10.1016/j.nwh.2015.12.002
XVI. BIBLIOGRAPHY
• Patient's Medical Record
• From Observation and Patient's Assessment
• Clinical Instructors
• Lectures
• Google References
• Book References
XVIII. BOOK REFERENCE
Elaine N. Marieb, Suzanne M. Keller –Essentials of Human Anatomy & Physiology Twelfth Edition

Kozier & Erb (2018). Fundamentals of Nursing: Concepts, Process, and Practice, 10th Edition.
Friedman & Smith (1988).
Estes M. (2011). Health Assessment and Physical Examination, 3rd edition.
Flemming et.,al (1990).
Pilliterri. Maternal and Childh Health Nursing, 4th Edition
Potter & Perry (2009). Fundamentals of Nursing
Monahan (2017).

Clinical Case Study on Hypothyroidism

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Republic of the Philippines

TARLAC STATE UNIVERSITY

A Clinical Case Study

II. NURSING PROCESS………………………………………………………………06

III. 13 AREAS OF ASSESSMENT……………………………………………………08

IV. LABORATORY AND DIAGNOSTIC PROCEDURE……………………………16

V. ANATOMY AND PHYSIOLOGY…………………………………………………18

VII. NURSING CARE PLAN……………………………………………………21

VIII. DRUG STUDY ………………………………………………………………28

IX. MEDICAL MANAGEMENT……………………………………………20

XII. HEALTH TEACHING…………………………………………………………34

XV. REVIEW OF RELATED LITERATURE…………………………………………36

the reported data trends:

● Transient hypothyroidism: etiology, clinical implications, management, and changes in prevalence;

Although anyone can develop hypothyroidism, you’re at an increased risk if you:

 Are older than 60.

 Have a family history of thyroid disease.

 Have an autoimmune disease, such as type 1 diabetes or celiac disease.

 Have been treated with radioactive iodine or anti-thyroid medications.

easily be confused for something else.

 being sensitive to cold.

 slow movements and thoughts.

 muscle aches and weakness.

II. Nursing Process

AGE: 35 years old

CIVIL STATUS: Married

POSITION/ROLE IN THE FAMILY: Wife

ADDRESS: Concepcion Tarlac

and lack of concentration and poor memory for months.

in spite of her less appetite.

breathlessness, tingling, numbness of hands or feet or loss of consciousness.

3. HISTORY OF PAST ILLNESS

4. PRESENT HEALTH HISTORY

and iron tables prescribed by a local physician.

III. 13 AREAS OF ASSESSMENT

has a good relationship with her husband and children.

Patient X has good relationship with her family and neighbor.

by Mary Ellen Zator Estes).

Patient X experienced lack of concentration and mental disturbances

(Fundamentals of Nursing: Concepts, Process, and Practice, 10th Edition, 2018)

The patient is worried about the symptoms she is experiencing.

experiencing blurring of vision because of periorbital swelling and baggy eyelids.

grades lenses. (Estes, 2011)

feeling. The patient verbalizes that it is warm.

when the warm water in the bottle was on her skin.

detect the smell of the alcohol presented.

recognize the smell of different object. (Estes, 2011)

The normal body temperature of a person is within 36.4 ℃ to 37.4 ℃. (Estes,2011)

Patient’s is hypothermic, her body temperature is below normal.

The patient respiratory status is 22 breaths per minute.

pressure for the adult is <120/<80mmHg (Potter and Perry,2009)

The blood pressure is elevated from normal.

10. ELIMINATION STATUS

frequent, and her stools have become difficult to pass.

The patient experienced constipation for months.

11. REPRODUCTIVE STATUS

Health Nursing 4th edition by Pilli Terri)

The patient experienced heavy menstruation for the past 3 months.

12. SLEEP AND REST PATTERN

the time, even during working hours, she feels sleepy.

affects your ability to fall asleep. (Kozier&Erb’s 2016)

13. STATE OF SKIN APPENDAGES