This document provides information on the management of thyroid disorders. It discusses the anatomy and function of the thyroid gland. It describes hypothyroidism and hyperthyroidism, their causes, signs and symptoms, and treatment approaches including medication management and lifestyle modifications. Nursing care focuses on monitoring the patient, promoting comfort, providing education and support, and evaluating treatment effectiveness and management of symptoms.

1. Justin V Sebastian

2. Management of Patients With Thyroid Disorders
• The thyroid gland:
– Is a butterfly-shaped organ located in the lower neck anterior to
the trachea.
– Is about 5 x 3 cm2 , weighs about 30 g.
– Has a very high blood supply (about 5 mL/min per gram of
thyroid tissue).
– Produces thyroxine (T4), triiodothyronine (T3), and
calcitonin. T4 & T3 are referred to collectively as thyroid
hormone.
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3. Thyroid Function and Dysfunction
• Various hormones and chemicals are responsible for normal thyroid function.
• Key among them are thyroid hormone, calcitonin, and iodine.
• The hypothalamus and the pituitary gland, which are located in the brain,
help control the thyroid gland.
• The hypothalamus releases thyrotropin-releasing hormone (TRH), which
stimulates the pituitary gland to release thyroid-stimulating hormone (TSH).
• When the hypothalamus and pituitary are working normally, they sense
when:
Thyroid hormone levels are low, so they secrete more TRH and TSH, which
stimulates the thyroid to make more hormones.
Thyroid hormone levels are too high, so they secrete less TRH and TSH,
which reduces hormone production by the thyroid. 3

4. Thyroid Hormone
• The two separate hormones, thyroxine (T4) and triiodothyronine (T3)
are produced by the thyroid gland and that make up thyroid hormone,
are amino acids that regulate the cellular metabolic activity. They
influence cell replication, are important in brain development, and
necessary for normal growth.
Thyroid hormones affect every cell and all the organs of the body. They:
• Regulate the rate at which calories are burned, affecting weight loss
or weight gain.
• Can slow down or speed up the heartbeat.
• Can raise or lower body temperature.
• Influence the rate at which food moves through the digestive tract.
• Control the way muscles contract.
• Control the rate at which dying cells are replaced.
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5. Calcitonin
• Is another important hormone secreted by the thyroid gland.
• It is secreted in response to high plasma levels of calcium. It reduces
the plasma level of calcium by increasing its deposition in bone.
Iodine
• Is essential to the synthesis of the thyroid gland hormones.
• Is mainly used by the thyroid.
• Deficiency alters thyroid function.
• Iodide is ingested in the diet, absorbed & its ions are converted to
iodine molecules.
• Molecules react with tyrosine (an amino acid) to form the thyroid
hormones.
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6. Assessment and Diagnostic Findings
• Inspection: Identification of landmarks.
• Look for swelling or asymmetry.
• Palpation: Palpate the gland for size, shape, consistency,
symmetry, and the presence of tenderness.
• Auscultate the enlarged gland to identify localized audible
vibration of a bruit. This indicates increased blood flow
necessitates referral to a physician.
Continued…..
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7. Thyroid Function Tests
• Thyroid function tests, TSH and free thyroxine (FT4), are
elevated in hyperthyroidism and decreased in hypothyroidism.
• Thyroid scanning.
• Biopsy.
• Ultrasonography.
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8. Abnormal Thyroid Function
• In infancy: Hypothyroidism results in stunted physical and
mental growth because of general depression of metabolic
activity.
• In adults: Hypothyroidism manifests as lethargy, slow
mentation, and generalised slowing of body functions.
• Hyperthyroidism is manifested by a greatly increased
metabolic rate.
• Over-secretion of thyroid hormones is usually associated with
an enlarged thyroid gland (goiter).
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9. Hypothyroidism
• Suboptimal levels of thyroid hormone.
• Thyroid deficiency can affect all body functions.
Causes of Hypothyroidism
• Chronic lymphocytic thyroiditis (Hashimoto’s thyroiditis).
• Atrophy of thyroid gland.
• Therapy for hyperthyroidism:
– Radioactive iodine (131I) & thyroidectomy
• Medications.
– Lithium (controversial), iodine rich compounds (amiodarone),
and antithyroid drugs (propylthiouracil).
• Radiation to head and neck.
• Infiltrative diseases of the thyroid (amyloidosis, scleroderma)
• Iodine deficiency and iodine excess. 9

10. Why Does High Iodine Intake Induce Hypothyroidism?
• The thyroid gland has a capacity to reduce thyroid hormone
production in the presence of excess iodine.
• This effect is usually temporary and within a few days thyroid
hormone synthesis returns to normal through the so-called
'escape' phenomenon.
• However in a few normal individuals and in some susceptible
patients, the escape does not occur.
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11. Pathophysiology of Hypothyroidism
• Thyroidal hypothyroidism is responsible for more than 95% of
patients with hypothyroidism.
• Central hypothyroidism causes thyroid dysfunction due to
failure of the pituitary gland, the hypothalamus, or both.
• Secondary hypothyroidism is caused entirely by a pituitary
disorder.
• Neonatal thyroid deficiency is known as cretinism.
• The term myxedema, advanced case of hypothyroidism, refers
to the accumulation of mucopolysaccharides in subcutaneous
and other interstitial tissues.
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12. Clinical Manifestations of Hypothyroidism
• Early symptoms are nonspecific.
• Extreme fatigue.
• Hair loss, brittle nails, dry skin, and numbness and tingling of the fingers may occur.
• Voice may become husky [hoarse and dry].
• Menstrual disturbances & loss of libido.
• In severe hypothyroidism:
– Hypothermia & bradycardia.
– Weight gain even without ↑ in food intake.
– Thick skin, thin hair that falls out.
– Expressionless and mask like face.
Continued…
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13. • Subdued emotional responses, and dull mental processes.
• Slow speech and enlarged tongue, hands, and feet.
• Constipation.
• Sleep apnea, pleural effusion, and pericardial effusion.
• ↑cholesterol level, atherosclerosis, coronary artery disease, and poor
left ventricular function.
• Intraoperative hypotension and postoperative heart failure may
occur to undiagnosed patients.
• Myxedema coma describes the most extreme, severe stage of
hypothyroidism, in which the patient is hypothermic and
unconscious.
• The patient would develop respiratory complications culminating in
coma.
• Cardiovascular collapse and shock. Mortality rate is high. 13

14. • The aim of medical management is to:
– restore a normal metabolic state by replacing the missing
hormone.
Pharmacologic Therapy
– Synthetic levothyroxine (Synthroid or Levothroid) is the
preferred preparation for treating hypothyroidism and
suppressing nontoxic goiters.
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15. Nursing Management
Modifying Activity
• The patient experiences decreased energy and lethargy. As a result,
the risk for complications from immobility increases.
• The patient has decreased ability to exercise and participate in
activities due to changes in cardiovascular and pulmonary status.
• The nurse’s role is to assist with care and hygiene while encouraging
the patient to participate in activities as tolerated to prevent the
complications of immobility.
Continued….
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16. Monitoring Physical Status
• Close monitoring of the vital signs and cognitive level to detect
the following:
– Deterioration of physical and mental status
– Signs and symptoms indicating that treatment has resulted
in the metabolic rate exceeding the ability of the
cardiovascular and pulmonary systems to respond.
– Continued limitations or complications of myxedema
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17. Promoting Physical Comfort
• Extra clothing and blankets are provided.
• Use of heating pads and electric blankets is avoided. This is
because the patient could be burned by these items without
being aware of it because of delayed responses and decreased
mental status.
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18. Providing Emotional Support
• The patient may experience severe emotional reactions. The
nonspecific, early symptoms may produce negative reactions
by family members and friends, who may have labeled the
patient mentally unstable, uncooperative, or unwilling to
participate in self-care activities.
• The nurse informs the patient and family that the symptoms
and inability to recognize them are common but treatment is
successful and symptoms are reversible. The patient and
family may require assistance and counseling to deal with the
emotional concerns and reactions that result. 18

19. Promoting Home and Community-Based Care
Teaching Patients Self-Care
• The patient and family require information and instruction that will
enable them to monitor the patient’s condition and response to therapy.
• The nurse instructs the patient and a family member about
medications.
• The nurse provides written instructions and guidelines for the patient
and family.
• Dietary instruction is provided to promote weight loss once medication
has been initiated.
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20. Hyperthyroidism
• Hyperthyroidism: The second most prevalent endocrine
disorder.
• Graves’ disease: Excessive output of thyroid hormones.
• It affects women eight times more frequently than men.
• It may appear after an emotional shock, stress, or an
infection.
• Other common causes of hyperthyroidism include
thyroiditis and excessive ingestion of thyroid hormone.
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21. Clinical Manifestations
• Patients exhibit a characteristic group of signs and symptoms
(thyrotoxicosis). The presenting symptom is often nervousness.
• Emotionally hyper-excitable, irritable, and apprehensive; cannot
sit quietly; palpitations; tachycardia at rest and on exertion.
• Poor heat tolerance and unusual perspiration.
• The skin is flushed continuously.
• Exophthalmos.
Continued…..
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22. • Increased appetite and dietary intake, weight loss, abnormal
muscular fatiguability and weakness, amenorrhea, and changes
in bowel function.
• Elevation of systolic blood pressure
• Atrial fibrillation.
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23. Medical Management
• Aims at reducing thyroid hyperactivity to relieve symptoms
and remove the cause of important complications.
• Treatment depends on the cause of the hyperthyroidism and
may require a combination of therapeutic approaches.
Continued….
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24. Pharmacologic Therapy
• Radioactive iodine therapy
– Destroys the overactive thyroid cells.
– Is the most common treatment in elderly patients.
• Antithyroid medications
– The overall aim of pharmacotherapy is to decrease thyroid hormone
production.
– The most commonly used medications are propylthiouracil (Propacil,
PTU) or methimazole (Tapazole) until the patient is euthyroid.
– Medications may take several weeks for relief of symptoms.
Withdrawal of the medication is gradual.
– Toxic complications of antithyroid medications are relatively
uncommon. 24

25. Surgical Management
• Surgery is reserved for special circumstances.
• Subtotal thyroidectomy ensures a prolonged remission in most
patients with exophthalmic goiter.
• Before surgery, propylthiouracil is administered until signs of
hyperthyroidism have disappeared.
• Propranolol may be used to reduce the heart rate.
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26. Nursing Management of Patient with Hyperthyroidism
• Assessment: Focus should be on the patient’s:
– and family’s report of irritability and increased emotional
reaction.
– ability to cope with stress.
– nutritional status.
– changes in vision and appearance of the eyes.
– cardiac status.
– emotional & psychological status.
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27. Nursing Diagnoses
• Imbalanced nutrition, less than body requirements, related to
exaggerated metabolic rate, excessive appetite, and increased
gastrointestinal activity.
• Ineffective coping related to irritability, hyper-excitability,
apprehension, and emotional instability.
• Low self-esteem related to changes in appearance, excessive
appetite, and weight loss.
• Altered body temperature.
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28. Planning and Goals
• Improved nutritional status.
• Improved coping ability.
• Improved self-esteem.
• Maintenance of normal body temperature.
• Absence of complications.
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29. Nursing Interventions
Improving Nutritional Status
• Up to six well-balanced meals of small size are offered daily.
• Foods and fluids are selected to replace fluid lost through
diarrhea and diaphoresis.
• To reduce diarrhea, highly seasoned foods and stimulants such
as coffee, tea, cola, and alcohol are discouraged.
• High-calorie, high-protein foods are encouraged.
• Monitor weight, dietary intake, and nutritional status.
Continued….
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30. Enhancing Coping Measures
• Reassure the patient that the emotional reactions will be
controlled with effective treatment.
• Similar reassurance needs to be made to family and friends.
• Minimise stressful experiences for the patient.
• Keep the patient’s environment quiet and noiseless.
• Educate patient about medications to be taken in anticipation
for surgical intervention.
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31. Improving Self-esteem
• The patient with hyperthyroidism may lose self-esteem
due to changes in appearance, appetite, and weight, and
due to his inability to cope well with family and the
illness.
• Cover or remove mirrors.
• Remind family members and personnel to avoid
bringing these changes to the patient’s attention.
• Explain the temporary nature of these changes.
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32. Maintaining Normal Body Temperature
• The patient with hyperthyroidism frequently finds a
normal room temperature too warm because of an
exaggerated metabolic rate and increased heat
production.
• The nurse maintains the environment at a cool,
comfortable temperature and changes bedding and
clothing as needed. Cool baths and cool or cold fluids
may provide relief.
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33. Teaching Patients Self-Care
• Provide instruction and written plan about the medications.
• Provide verbal and written instruction about the actions and
possible side effects of the medications.
• Identify adverse effects that should be reported.
• Provide information to the patient about what to expect if total
or subtotal thyroidectomy is anticipated.
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34. Evaluation
Expected Patient Outcomes
1. Improves nutritional status
a. Reports adequate dietary intake and ↓ hunger
b. Identifies foods with high-calorie, high-protein and those to be
avoided
c. Avoids use of alcohol and other stimulants
d. Reports decreased episodes of diarrhea
2. Achieves increased self-esteem
a. Verbalizes feelings about self and illness
b. Describes feelings of frustration and loss of control
c. Describes reasons for increased appetite
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