MSEM10S.pdf

11/20/23, 1:51 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swte… Summary Hypothyroidism is an underactive thyroid gland. Hypothyroidism means that the thyroid gland cannot make enough thyroid hormone to keep the body running...

11/20/23, 1:51 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swte… Summary Hypothyroidism is an underactive thyroid gland. Hypothyroidism means that the thyroid gland cannot make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood. Common causes are autoimmune disease, such as Hashimoto’s thyroiditis, surgical removal of the thyroid, and radiation treatment. When thyroid hormone levels are too low, the body’s cells cannot get enough thyroid hormone and the body’s processes start slowing down. Hypothyroidism has many symptoms that can vary from person to person. Some common symptoms of hypothyroidism include the following: fatigue weight gain a puffy face trouble tolerating cold joint and muscle pain constipation dry skin dry, thinning hair decreased sweating heavy or irregular menstrual periods fertility problems depression slowed heart rate goiter Many of these symptoms, especially fatigue and weight gain, are common and do not always mean that someone has a thyroid problem. Hypothyroidism has several causes, including the following: Hashimoto’s disease thyroiditis, or inflammation of the thyroid congenital hypothyroidism, or hypothyroidism that is present at birth surgical removal of part or all of the thyroid radiation treatment of the thyroid Because hypothyroidism develops slowly, many people do not notice symptoms of the disease for months or even years. There is no cure for hypothyroidism, and most patients have it for life. There are exceptions: many patients with viral thyroiditis have their thyroid function return to normal, as do some patients with thyroiditis after pregnancy. It is treated by replacing the amount of hormone that the patient’s own https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swtew1H3xVYA2sj… 1/4 11/20/23, 1:51 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swte… thyroid can no longer make to bring the T4 and TSH levels back to normal levels. So even if the thyroid gland cannot work right, T4 replacement can restore the body’s thyroid hormone levels and the body’s function. Synthetic thyroxine pills contain hormone exactly like the T4 that the thyroid gland itself makes. Some medicines can interfere with thyroid hormone production and lead to hypothyroidism, including the following: amiodarone: a heart medicine interferon alpha: a cancer medicine lithium: a bipolar disorder medicine interleukin-2: a kidney cancer medicine Less often, hypothyroidism is caused by too much or too little iodine in the diet or by pituitary disease. Surgical removal of part or all of the thyroid - When surgeons remove part of the thyroid, the remaining part may produce normal amounts of thyroid hormone, but some people who have this surgery develop hypothyroidism. Removal of the entire thyroid always results in hypothyroidism. Surgeons may remove part or all of the thyroid as a treatment for the following: hyperthyroidism a large goiter thyroid nodules, which are noncancerous tumors or lumps in the thyroid that can produce too much thyroid hormone thyroid cancer NIH external link Radiation treatment of the thyroid - radioactive iodine, a common treatment for hyperthyroidism, gradually destroys the cells of the thyroid. Most people who receive radioactive iodine treatment eventually develop hypothyroidism. Treatment of hypothyroidism is administration of a synthetic preparation of thyroxine, such as levothyroxine (T4). Levothyroxine provides the normal levels of T3and T4, providing the therapeutic effects of the hormones. Absorption of the drug is reduced by food; therefore, clients should be instructed to take levothyroxine on an empty stomach in the morning, at least 30 minutes before breakfast. Certain drugs, such as histamine2blockers, proton pump inhibitors, sucralfate, and calcium supplements, can also reduce the absorption of levothyroxine and should be administered 4 hours after the levothyroxine dose. Levothyroxine, when administered at appropriate doses, rarely causes adverse effects. Clients should be instructed that levothyroxine therapy is for life and will require routine laboratory testing to review TSH levels. Levothyroxine (Synthroid, Levoxyl), a synthetic preparation of T4, is the drug of choice for longterm treatment of hypothyroidism. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swtew1H3xVYA2sj… 2/4 11/20/23, 1:51 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swte… Thyroid replacement therapy in the patient with hypothyroidism is lifelong; no clear-cut guidelines exist regarding duration of antithyroid drug therapy because exacerbations and remissions can occur. Replacement therapy usually continues until the patient is euthyroid for 6 to 12 months. The nurse helps ensure that patients who take antithyroid drugs are monitored closely for hypothyroidism, which may typically develop within a year after receiving treatment for hyperthyroidism. People with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. The FDA has issued a BLACK BOX WARNING♦ regarding the use of thyroid hormones for the treatment of obesity or for weight loss, either alone or with other therapeutic agents. The diagnosis of hyperthyroidism is generally straightforward, with raised serum thyroid hormones and suppressed serum thyroid stimulating hormone (TSH) in almost all cases. Nursing interventions for hyperthyroidism include keeping the patient calm, daily weights, EKG and vital signs monitoring, education on medications and treatments and monitoring for Thyroid storm. Hyperthyroidism is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormone. The most common cause of this syndrome is Graves’ disease, followed by toxic multinodular goiter, and solitary hyperfunctioning nodules. Diagnosis: Hyperthyroidism can be diagnosed with blood tests that measure the amount of thyroid hormone and thyroid-stimulating hormone (TSH). Typically, the thyroid hormone level is high, and the TSH level is low. A thyroid scan or a blood test may also be recommended to help determine the cause of hyperthyroidism (Graves' disease, toxic nodular goiter, or thyroiditis). Symptoms: Heat intolerance, palpitations, anxiety, fatigue, weight loss, muscle weakness, and, in women, irregular menses. Clinical findings may include tremor, tachycardia, lid lag, and warm moist skin. Causes: Graves’ disease is the most common cause of hyperthyroidism and is frequently complicated by ophthalmopathy, which can be a debilitating component of the disease, resulting in impaired quality of life. The management of Graves’ disease aims to restore the patient to a euthyroid state and minimize the extent of extrathyroidal manifestations such as ophthalmopathy. Thyrotoxicosis is when there is excess thyroid hormone in the circulation due to any cause. The diagnosis of hyperthyroidism is generally straightforward, with raised serum thyroid hormones and suppressed serum thyroid stimulating hormone (TSH) in almost all cases. Thyrotoxicosis can be easily diagnosed by a high serum level of thyroxine (T4) and triiodothyronine (T3) and a low serum level of TSH. Thyroiditis is an inflammatory autoimmune disorder in which lymphocytic infiltration results in thyroid destruction and leads to transient mild thyrotoxicosis as thyroid hormone stores are released from the damaged thyroid. As the gland becomes depleted of thyroid hormone, progression to hypothyroidism occurs. Radioactive iodine — destroying the thyroid with radioiodine, called ablation, is a permanent way to treat hyperthyroidism. The amount of radiation used is small and does not cause cancer, https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swtew1H3xVYA2sj… 3/4 11/20/23, 1:51 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swte… infertility, or birth defects. This is the most widely used treatment for hyperthyroidism in the United States. Although surgical removal of the thyroid is a permanent cure for hyperthyroidism, it is used far less often than antithyroid drugs or radioactive iodine because of the risks (and expense) associated with thyroid surgery. Nursing interventions: focus on ongoing monitoring, protecting the patient from injury, reducing stress, and initiating teaching. Patients with exophthalmos or other visual problems might be more comfortable wearing sunglasses or eye patches to protect the eyes from light. Report any changes in visual acuity to the physician and use artificial tears to lubricate the eyes. Encourage the patient to follow the medication regimen and reassure him or her while waiting for it to take effect. To determine the response to treatment and to prevent thyroid storm, assess the cardiovascular status, fluid and diet intake and output, daily weights, bowel elimination, and the ability of the patient to perform activities of daily living without excessive fatigue. Appropriate treatment of hyperthyroidism relies on identification of the underlying cause. Antithyroid drugs, radioactive iodine, and surgery are the traditional treatments for the 3 common forms of hyperthyroidism. Beta-adrenergic blocking agents,propranolol, are used in most patients for symptomatic hyperthyroidism to suppress tachycardia and might be the only treatment needed for thyroiditis, which is transient. Drugs to treat hyperthyroidism include the thionamide drugs, propylthiouracil (PTU) and methimazole. When given in high doses, the patient could convert to a hyperthyroid state. Beta blockers (propranolol) are used as an Propylthiouracil is a thioamide antithyroid drug and is used alone to treat hyperthyroidism, as part of the preoperative preparation for thyroidectomy, before or after radioactive iodine therapy, and in the treatment of thyroid storm. The FDA has issued BLACK BOX WARNING♦ for propylthiouracil. Severe liver injury resulting in death or acute liver failure may occur within 6 months of treatment. All patients should receive instruction about the signs and symptoms of acute liver failure. Routine liver function testing is necessary to assess for liver failure. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZN5n24G8UktHULazYLeTIBFBizuuh93swtew1H3xVYA2sj… 4/4