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Disorders of Thyroid Gland HYPOTHYROIDISM (myxedema) Hyposecretion of the thyroid hormone characterized by decreased rate of body metabolism.

. Causes: Interventions: ASSESSMENT: Subjective data: Objective data: Weakness, fatigue, lethargy, headache, slow memory, loss of interest in sexual activity. Depressed BMR; intolerance to cold Cardiomegaly, bradycardia, hypotension, anemia Menorrhagia, amenorrhea, infertility Dry skin, brittle nails, coarse hair, hair loss Slow speech, hoarseness, thickened tongue Weight gain: edema, periorbital puffiness Lab data: elevated TRH, TSH; normal-low serum T4 & T3; decreased RAUI. Autoimmune disease (Hashimotos thyroiditis, Post Graves disease) Atrophy of thyroid gland with aging Therapy for hyperthyroidism: radioactive iodine, thyroidectomy Medications: lithium, iodine compounds, antithyroid medications Radiation to head & neck for treatment of head & neck cancers, lymphoma Infiltrative diseases of the thyroid (amyloidosis, scleroderma, lymphoma) Iodine deficiency & iodine excess Monitor HR including rhythm. Instruct patient re: thyroid replacement therapy. Instruct on low-calorie, low-cholesterol, low-saturated fat diet. Assess for constipation & provide roughage. Provide for warm environment. Monitor for overdose of thyroid meds. Primary or thyroidal hypothyroidism refers to dysfunction of the thyroid gland itself. Central hypothyroidism the cause of thyroid dysfunction is failure of the pituitary gland, the hypothalamus, or both. Pituitary or secondary hypothyroidism - the cause of thyroid dysfunction is entirely a pituitary disorder Hypothalamic or tertiary hypothyroidism the cause is a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation of TRH. Cretinism thyroid deficiency is present at birth

NURSING MANAGEMENT: 1. 2. 3. 4. 5. 6. Provide for comfort and safety monitor for infection or trauma provide warmth prevent heat loss & vascular collapse administer thyroid meds as ordered Health teaching: a. Diet: low calorie, high protein b. S/Sx of hypothyroidism & hyperthyroidism c. Lifelong meds, dosage, desired effects, side effects. d. Stress-management techniques e. Exercise program

MYXEDEMA COMA Rare but serious d/o which result from persistently low thyroid hormone precipitated by acute illness, rapid withdrawal of thyroid meds, use of sedatives & narcotics Used to describe extreme symptoms of severe hypothyroidism Signs & symptoms: Hypotension Bradycardia

Interventions: Medications:

Hypothermia Hyponatremia hypoglycemia respiratory failure death Patent airway Keep patient warm & check V/S frequently Administer IV fluids & levothyroxine Na (Synthroid) Give IV glucose & corticosteroids

Synthetic levothyroxine (Synthroid or Levothroid) Is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters.