HYPOTHYROIDISM

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HYPOTHYROIDISM

WHAT A TYPICAL PATIENT EXPERIENCING HYPOTHYOIDISM WOULD PRESENT LIKE: OUR PATIENT: 71-year-old female, Marie Smith. Indigenous Australian BROUGHT INTO THE HOSPITAL BECAUSE: Patient was experiencing extreme lethargy, voiced feeling “extremely cold” and “not being able to warm herself up”, noticed a change in her voice, noticed a sudden onset of hair loss, confusion and her skin feeling “drier than normal”. HISTORY: Past medical history of: Type one diabetes, celiac disease, total right hip replacement and anxiety. Social history: Lives alone, smokes a pack of tobacco cigarettes daily, consumes an average of 6-7 standards alcoholic drinks per day, away from family and low health literacy.

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PATHOPHYSIOLOGY OF Hypothyroidism

“Hypothyroidism refers to the common pathological condition of thyroid hormone deficiency.” ( Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P, 2017, pp. 1550). “Clinical primary hypothyroidism is defined as thyroid stimulating hormone (TSH) concentrations above the reference range and free thyroxine concentrations below the reference range. Mild or subclinical hypothyroidism, which is commonly regarded as a sign of early thyroid failure is defined by TSH concentrations above the reference range and free thyroxine concentrations within the normal range.” ( Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P, 2017, pp. 1550). The thyroid is essential for many functions throughout the body like “normal maturation of the brain, musculoskeletal and reproductive systems, and are involved in the maintenance of some body systems in adulthood.” (Bullock, S., Hales, M, 2018, pp. 362).  Symptoms in adults being “fatigue, lethargy, cold intolerance, weight gain, constipation, change in voice, dry skin” ( Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P, 2017, pp. 1552). and in some cases, some patients may also experience shortness of breath, decreased vision, taste or hearing, impaired memory or deterioration of kidney function. ( Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P, 2017). “within the hypothalamus and the pituitary, T4 is converted to T3, which acts on thyroid hormone receptors (TRs), located in the nucleus of the cells” (Gomes-Lima C.J., Burman K.D, 2019, pp. 236). “T3 also induces directly TSH gene expression in the pituitary. TSH, in turn, acts via TSH receptors (TSHR) on the surface of thyroid cells to stimulate thyroid hormone synthesis and release.”  (Gomes-Lima C.J., Burman K.D, 2019, pp. 236).

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1: MYXEDEMA COMA

”The clinical manifestations of hypothyroidism range from life threatening-in the case of myxedema coma, which was first described in the late 1900s as an outcome of long standing untreated and severe hypothyroidism” ( Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P, 2017). “Myxedema coma is defined by severe and prolonged depletion of thyroid hormone leading to altered mental status, typically associated with hypothermia and other symptoms related to widespread organ system dysfunction.” (Loriaux, L., & Vanek, C, 2021, pp. 94). “Patients with severe hypothyroidism can develop effusions (pericardial and pleural) that do not cause organ compromise because of their slow rate of formation. Decreased mental status and hypothermia are characteristics of myxedema coma.” (Loriaux, L., & Vanek, C, 2021, pp. 94).

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2: GOITRE

ISSUES RELATING TO HYPOTHYROIDISM

Bullock, S., Hales, M. (2018).  Principles of pathophysiology ebook . [Infographic] ProQuest Ebook Central  https://ebookcentral.proquest.com

Bullock, S., Hales, M. (2018).  Principles of pathophysiology ebook . [Infographic] ProQuest Ebook Central  https://ebookcentral.proquest.com

- In this case of hypothyroidism, “the levels of thyroid-stimulating hormone (TSH) released from the pituitary increase in an attempt to boost thyroid hormone production by the thyroid gland. The gland increases in size in response to the extra signalling.” (Bullock, S., Hales, M, 2018).

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NURSING INTERVENTIONS

”Because the disease course is striking, with mortality of 40% despite treatment early recognition is vital” ( Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P, 2017, pp. 1552). 1: Assessing for signs and symptoms of a myxedema coma. “dry skin, scaly elbows and knees, yellowness of the skin without scleral icterus, coarse hair, puffiness of the face and hands, thinning of the lateral aspects of the eyebrows, macroglossia, hoarseness, delayed relaxation phase of deep tendon reflexes, and bradycardia. Patients with severe hypothyroidism can develop effusions (pericardial and pleural) that do not cause organ compromise because of their slow rate of formation. Decreased mental status and hypothermia are characteristics of myxedema coma.” (Loriaux, L., & Vanek, C, 2021, pp. 94). 2: Monitor vital signs and weight frequently and provide patient with education regarding any new thyroid medications.

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REFERENCES:

Bullock, S., Manias, E. (2016).  Fundamentals of pharmacology ebook . ProQuest Ebook Central  https://ebookcentral.proquest.com Bullock, S., Hales, M. (2018).  Principles of pathophysiology ebook . ProQuest Ebook Central  https://ebookcentral.proquest.com Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism .  The Lancet, 390 (10101), 1550-1562. http://dx.doi.org.ezproxy.lib.swin.edu.au/10.1016/S01406736(17)30703-1 Loriaux, L., & Vanek, C. (2021).  Endocrine emergencies. New York: Springer Nature eBook. Retrieved from https://link-springer-com.ezproxy.lib.swin.edu.au/book/10.1007%2F978-3-030 - 67455-7?page=1#toc Feldt-Rasmussen, U., Effraimidis, G., & Klose, M. (2021). The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions.  Molecular And Cellular Endocrinology ,  525 , 111173. doi: 10.1016/j.mce.2021.111173 Gomes-Lima C.J., Burman K.D. (2019) Hypothyroidism. In: Luster M., Duntas L., Wartofsky L. (eds) The Thyroid and Its Diseases. Springer, Cham. https://doi org.ezproxy.lib.swin.edu.au/10.1007/978-3-319-72102-6_16 Kay Weng Choy, Kay Hau Choy. (2016). Hypothyroidism Following Hemithyroidectomy: Incidence, Risk Factors, and Clinical Characteristics. The Journal of Clinical Endocrinology & Metabolism, 101(10). 93. https://doi.org/10.1210/jc.2016-2633 Mahmoud F, S. (2021).  Thyroid Disease Challenges and Debates [Ebook] (1st ed.). Cham : Springer International Publishing : Imprint: Springer. https://link-springer- com.ezproxy.lib.swin.edu.au/book/10.1007%2F978-3-030-48775-1 Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2016). Diseases in the elderly: Age related changes and pathophysiology. Springer International Publishing.

Bullock, S., Manias, E. (2016).  Fundamentals of pharmacology ebook . ProQuest Ebook Central  https://ebookcentral.proquest.com Bullock, S., Hales, M. (2018).  Principles of pathophysiology ebook . ProQuest Ebook Central  https://ebookcentral.proquest.com Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism .  The Lancet, 390 (10101), 1550-1562. http://dx.doi.org.ezproxy.lib.swin.edu.au/10.1016/S01406736(17)30703-1 Loriaux, L., & Vanek, C. (2021).  Endocrine emergencies. New York: Springer Nature eBook. Retrieved from https://link-springer-com.ezproxy.lib.swin.edu.au/book/10.1007%2F978-3-030 - 67455-7?page=1#toc Feldt-Rasmussen, U., Effraimidis, G., & Klose, M. (2021). The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions.  Molecular And Cellular Endocrinology ,  525 , 111173. doi: 10.1016/j.mce.2021.111173 Gomes-Lima C.J., Burman K.D. (2019) Hypothyroidism. In: Luster M., Duntas L., Wartofsky L. (eds) The Thyroid and Its Diseases. Springer, Cham. https://doi org.ezproxy.lib.swin.edu.au/10.1007/978-3-319-72102-6_16 Kay Weng Choy, Kay Hau Choy. (2016). Hypothyroidism Following Hemithyroidectomy: Incidence, Risk Factors, and Clinical Characteristics. The Journal of Clinical Endocrinology & Metabolism, 101(10). 93. https://doi.org/10.1210/jc.2016-2633 Mahmoud F, S. (2021).  Thyroid Disease Challenges and Debates [Ebook] (1st ed.). Cham : Springer International Publishing : Imprint: Springer. https://link-springer- com.ezproxy.lib.swin.edu.au/book/10.1007%2F978-3-030-48775-1 Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2016). Diseases in the elderly: Age related changes and pathophysiology. Springer International Publishing.