Hypo thyroidism

Hypo thyroidism

1. Hypo- thyroidism or (cretinism and myxodema ) Ratheesh.R SLMGNC

2. Introduction Hypothyroidism is a common disorder in which the thyroid gland can not produce enough hormones to meet the body’s demand. The thyroid gland is a butterfly-shaped gland located in the lower front of the neck, and is normally controlled by a gland in the brain known as the pituitary. When the pituitary releases thyroid stimulating hormone (TSH), the thyroid secretes two kinds of hormones – tri- iodothyronine (T3) and thyroxine (T4) – into the blood stream. The thyroid hormones help the body work properly by controlling the rate of metabolism and functions of many organ systems.

3. Definition This is a condition that arises from inadequate amount of thyroid hormone in the blood stream. Cretinism: - When thyroid deficiency is present at the birth, the condition is known as cretinism. Myxodema : - The accumulation of muco -polysaccharides in sub- cutanous and other intestinal tissues leads to thyroid insufficiency.

4. Types Primary hypo- thyroidism : - When inadequate amount of thyroid hormone in the blood stream is caused by thyroid gland itself. Secondary or Central hypo- thyroidism : - When inadequate amount of thyroid hormone in the blood stream is caused by thyroid and failure of pituitary gland, the hypothalamus or both.

5. Cont…. Tertiary or Hypothalamic hypothyroidism: - When thyroid hormone caused entirely by pituitary disorder resulting inadequate secretion of TSH because of decreased stimulation by TRH.

6. Etiology Autoimmune disease Use of radio active iodine Dietary iodine deficiency Sub acute thyroiditis Lithium therapy Over treatment with Antithytoid drugs Destruction, Suppression or removal of all or some of the thyroid tissue by thyroidectomy .

7. Pathophysiology Thyroid gland needs Iodine tosecreate thyroid hormone Production of thyroid depends upon the TSH, Iodine intake and also protein intake Enlargement of thyroid gland results goitre form increased secretion of pituitary gland TSH stimulates the thyroid to secreate more level of T4

8. Cont…. In the blood, T4 levels are low, the thyroid gland will be more large and compress then neck and also the chest Causing in respiratory manifestation.

9. Clinical Manifestation Early Symptoms : Extreme fatigue Hair loss Brittle nails Dry skin Numbness and tingling of the fingers Voice may become husky Menorrhea Loss of libido

10. Cont…. Severe: Abnormal temperature and pulse rate Gain weight Skin thickening Hair thins and fall out Constipation Deafness

11. Cont…. Advanced: Personality and cognitive change Inadequate Ventilation Pleural Effusion Pericardial effusion Respiratory muscle weakness Sleep Apnea.

12. Diagnostic Evaluation History collection Physical examination To check Low T3 and T4 level Elevated TSH levels in primary hypothyroidism Elevation of serum cholestrol ABG analysis Electro Cardiogram

13. Medical Management T4 levothyroxine , T3 Liothyroxine , T3 & T4 thyro -globulin liotrix , are used to treat hypothyroidism and suppress non toxic goitre . Sodium levo-thyroxine is administered parentally to restore T4 level. Replacement therapy is used to myxedema disappear and normal metabolic activity. Fluids are administered cautionsly because of the danger of water intoxification .

14. Nursing Diagnosis Ineffective breathing pattern r/t depressed ventilation. Activity intolerance r/t fatigue and depressed cognitive process. Constipation r/t depressed gastro intestinal function. Knowledge deficit r/t therapeutic regimen for life and thyroid replacement therapy.

15. Complication Coma Hypoventilation Hyponatremia Hypothermia Cerebral hypoxia