What is a nursing priority when caring for a patient with hypothyroidism?

Hypothyroidism is a disorder in which the thyroid produces and releases insufficient thyroid hormone into the bloodstream, also known as underactive thyroid, which causes fatigue, weight gain, and an inability to tolerate cold temperatures.

Thyroid insufficiency affects all physiological processes and can range from minor to severe. As a result, the metabolism will slow down.  Patients who have had past hypothyroidism treated with radioiodine, antithyroid drugs, or thyroidectomy are more likely to develop hypothyroidism. Hormone replacement therapy is the most common treatment for hypothyroidism.

Types of Hypothyroidism

The types of hypothyroidism are categorized based on their causes:

1. Central hypothyroidism. The pituitary gland, the hypothalamus, or both are unable to stimulate thyroid hormone production.
2. Secondary or pituitary hypothyroidism. The cause is solely a problem in the pituitary gland itself.
3. Tertiary or hypothalamic hypothyroidism. This refers to a hypothalamic condition that causes insufficient TSH secretion as a result of diminished TRH stimulation.
4. Cretinism. The thyroid disease that is present from birth.
5. Myxedema or severely advanced hypothyroidism. Myxedema occurs when the thyroid levels are exceedingly low. Myxedema can cause a variety of symptoms, including:

• Low body temperature
• Anemia
• Heart failure
• Confusion
• Coma

Signs and Symptoms of Hypothyroidism

The severity of the hormone deficiency affects the signs and symptoms of hypothyroidism. Problems usually emerge gradually, over a period of years.

At first, hypothyroidism symptoms such as fatigue and weight gain may go unnoticed or may simply be attributed to becoming older. However, as the metabolism slows, the patient may experience more evident problems.

The symptoms of hypothyroidism commonly develop slowly over time. This can include:

• Fatigue
• Numbness and tingling in the hands
• Constipation
• Weight Gain
• Muscle Weakness
• High blood cholesterol levels
• Depression
• Cold Intolerance
• Dry, coarse skin and hair
• Decreased libido
• Frequent and heavy menstrual period
• Physical changes in the face including drooping eyelids, puffiness in the eyes and face
• Hoarseness of voice
• Brain fog

Causes of Hypothyroidism

Several diseases and factors could cause hypothyroidism, the following are included:

1. Inflammation of the thyroid gland which damages the gland’s cells.
2. Autoimmune diseases. Autoimmune thyroiditis or Hashimoto’s disease is the most common cause of hypothyroidism in adults.
3. Atrophy of the thyroid gland. When aging, the thyroid gland shrinks in size.
4. Therapy for hyperthyroidism, such as radioactive iodine and thyroidectomy.
5. Medications- TSH production can be reduced by certain drugs, iodine compounds, and antithyroid medicines.
6. Iodine deficiency or excess. The thyroid gland is affected by an imbalance in iodine levels in the body.
7. Autoimmune or Hashimoto’s thyroiditis. This happens when the immune system attacks the thyroid gland.
8. After pregnancy. This is often referred to as postpartum thyroiditis.

Risk Factors for Hypothyroidism

Hypothyroidism can affect people of all ages, genders and ethnicities, it is a common condition particularly among the following:

• Women above the age of 50
• Men who have had radiation therapy for head and neck cancer
• Patients who have primary or thyroidal hypothyroidism
• Family history of thyroid disease
• Family history of autoimmune disease
• Patients with autoimmune disease
• Caucasian or Asian ethnicity
• Women experiencing hormonal changes due to pregnancy, childbirth, or menopause
• People with chromosomal abnormalities like Down syndrome or Turner’s syndrome

Diagnosis of Hypothyroidism

1. Physical assessment – the thyroid gland is inspected and palpated on a regular basis in all patients.
2. Thyroid-stimulating blood tests- Because of its high sensitivity, measuring serum TSH concentration is the single best screening test for thyroid function.
3. Serum T3 and T4 tests – The quantities of protein-bound and free hormones that occur in response to TSH secretion are included in total T3 or T4 measurements.
4. Thyroid antibody test – Antithyroid antibodies can be detected using immunoassay techniques in patients with Hashimoto’s thyroiditis.

Treatment for Hypothyroidism

Hypothyroidism is a treatable condition. However, it is needed to continuously take the medication on a regular basis in order to balance the level of hormones in the body. The patient may live a normal and healthy life with careful management and follow-up check up with the healthcare practitioner to ensure that the treatment is working properly.

Hypothyroidism is typically treated by supplementing the hormone that the thyroid no longer produces. This is usually done with the help of a medicine in which when taken orally, raises the amount of thyroid hormone the body produces, balancing its levels.

1. Medical Management.The main goal of hypothyroidism treatment is to replace the missing hormone and restore a normal metabolic state.
2. Pharmacological Treatment. The preferred preparation for treating hypothyroidism and suppressing nontoxic goiters.
3. Prevention of Cardiac Dysfunction. A decline in blood supply is tolerated without overt signs of coronary artery disease as long as metabolism is normal and the tissues require very little oxygen.
4. Supportive Therapy. The patient’s oxygen saturation should be monitored, fluids should be administered with caution, external heat should be avoided, and oral thyroid hormone therapy should be continued.

Prevention of Hypothyroidism

Hypothyroidism can be prevented by doing the following:

1. Increased consumption of iodine. In hypothyroidism, iodine intake is the most important preventive method.
2. Early detection. Thyroid tests after thyroid surgery or therapy may help to diagnose hypothyroidism early and treat it effectively.

Nursing Considerations for patients with Hypothyroidism

• Encourage rest. Rest and exercise as tolerated through space activities.
• Protect against cold. Provide the patient with an extra blanket or layer of clothing.
• Avoid excessive heat exposure. Instruct the patient to avoid use of an external heat source.
• Monitor the temperature. Keep an eye on the patient’s body temperature.
• Increase oral fluid intake Encourage the patient to increase fluid consumption while adhering to the fluid restriction guidelines.
• Provide fiber-rich foods to the patient.
• Take care of respiratory symptoms. Observe the patient’s breathing depth, rate, pattern, pulse oximetry, and ABG.
• Encourage pulmonary exercises. Encourage the patient to perform deep breathing, coughing, and the use of spirometry incentives.
• Always orient the patient about the current environment. Educate the patient about the time, place, date, and events that are taking place.

Nursing Diagnosis for Hypothyroidism

Hypothyroidism Nursing Care Plan 1

Imbalanced Nutrition: More Than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: More Than Body Requirements related to increased metabolic needs intake secondary to hypothyroidism, as evidenced by decreased appetite, sedentary level of activity, and weight gain.

Desired Outcome: The patient will be able to maintain a stable weight and take in necessary nutrients by adhering to the nutrition plan.

Hypothyroidism Nursing InterventionsRationaleDetermine the weight of the patient on a regular basis.  Patients with hypothyroidism gain weight and have trouble shedding it due to high fluid volume and a low basal metabolic rate.Assess the patient’s appetite.  Hypothyroid patients have a decreased appetite. Hypothyroidism manifests as in an inverse link between weight gain and decreased appetite.Provide the patient with a food diary.  Analyzing the patient’s food consumption for the previous 24 hours will offer baseline data for developing a personalized nutritional plan to meet the patient’s changing metabolic needs.Educate the patient and the family on the effects of hypothyroidism on body weight.          Teaching the patient and family about hypothyroidism will help them comprehend the inverse relationship between appetite and weight gain. The patient may experience weight loss when starting thyroid hormone replacement medication. There will, however, be an increase in hunger. To avoid further weight gain, this adjustment may necessitate a calorie-controlled diet.Collaborate with a nutritionist to assess the calorie requirements of the client.The dietician can figure out how many calories are needed to sustain nutritional intake and maintain a healthy weight.Encourage the patient to have six small meals during the day as recommended.  This will ensure that the patient with low energy levels gets an adequate supply of nutrients.Offer aid or assistance and encouragement to the patient during meal time.Due to a drop in energy levels, the patient will want assistance to maintain proper nutrient intake.Encourage the patient to consume fiber-rich foods and educate the patient which foods are the best to consume.Constipation is caused by hypothyroidism, which delays the digestive tract’s activity.  

Hypothyroidism Nursing Care Plan 2

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to exposure to the disease, new disease process and unawareness of available information resources secondary to hypothyroidism, as evidenced by asking a few and limited questions about the disease and thyroid hormone replacement and inability to handle the disease process.

Desired Outcomes:

• The patient will verbalize understanding of the disease by stating factual information.
• The patient will adhere to the medication regimen.

Hypothyroidism Nursing InterventionsRationaleDetermine how well the patient understands hypothyroidism and thyroid hormone replacement therapy.Patient education should start with current information of the disease and how to manage it.Provide the patient more information and explanation about hypothyroidism and ask if there are questions about it.  Hypothyroidism can cause memory loss, disorientation, hearing loss, and a short attention span in patients. Learning new information can be hampered by these brain changes. Sessions with the client should be scheduled when the patient is most able to concentrate. It is necessary to recall knowledge in order to facilitate learning. The use of printed material complements the verbal presentation.Encourage the patient to have enough rest and emphasize the need for rest periods.  The patient should avoid fatigue; once the euthyroid state is established, the degree of activity will gradually increase.Encourage the patient to keep blood workup appointments on the T3, T4, and TSH levels.These values aid in determining the efficacy of medication.Explain to the patient the signs and symptoms of drug overdose and underdosage.The patient will be able to use this as a basis, to see if the therapeutic levels have been met.Encourage the patient to keep a medical identification about the hormone therapy and advise the patient to inform all of the healthcare providers.  Other healthcare providers can use medical identification to help them make decisions regarding their patients’ care. In circulation, the medicine for hormone therapy is strongly protein bound. Several drug interactions are caused by this drug characteristic. The patient must inform all of the healthcare providers when taking this medication.Educate the patient and the family about thyroid hormones include the following: To avoid insomnia, advise the patient to take the medicine first thing in the morning. Instruct the patient to take the prescription on an empty stomach.     Educate the patient about the expected benefits as well as any potential adverse effects.          To achieve hormone balance, thyroid hormone should be taken on a regular basis.   The patient is given a low dose at first, which is subsequently increased until euthyroid status is established. The patient will have insomnia and weight loss when the thyroid hormone level rises. Symptoms such as chest discomfort and palpitations should be reported by the patient because of the increased metabolic and oxygen consumption.  

Hypothyroidism Nursing Care Plan 3

Fatigue

Nursing Diagnosis: Fatigue related to impaired metabolic state secondary to hypothyroidism, as evidenced by lethargy, impaired concentration, increased rest periods, inability to perform daily tasks and lack of energy.

Desired Outcomes:

• The patient will be able to determine the source of fatigue as well as the specific areas of control.
• The patient will be able to express a reduction of fatigue and an increased ability to finish desired daily activities.

Hypothyroidism Nursing InterventionsRationaleEvaluate the patient’s ability to do daily activities (ADLs).      Due to a poor metabolic rate, the patient may feel tired with little effort. The patient’s ability to complete daily tasks like eating and self-care are hampered by this symptom.Keep track and evaluate the patient’s daily energy pattern.This will aid in determining the patient’s activity patterns and timing.Assess the patient’s energy level, as well as the muscle strength and tone.    Low energy levels can be caused by a slow metabolism. Mucin deposits in joints and interstitial spaces may make muscles weaker and joints stiffer. This sort of cellular edema can cause muscular contraction and relaxation to be delayed. The patient may complain of muscle soreness and generalized weakness.Plan the patient’s care to allow for adequate rest periods. Schedule activities when the patient has more energy.This will ensure that the patient will highly participate in the activities.  Provide the patient with non-stressful activities and allow stimulation through conversation.This will encourage the patient’s interest without putting too much stress.Provide an environment that is favorable to relieve fatigue.Even in a warm environment, the patient with hypothyroidism complains of feeling cold.Assess the patient’s characteristics of fatigue, including the severity, changes in severity over time, aggravating factors and alleviating factors.This will determine the patient’s fatigue level over time, and it is important to determine if the patient’s level of fatigue is constant.Examine the patient’s chief complaint and the patient’s medical history.  The patient’s current state could be contributing to the fatigue. Comorbidities and other illnesses could potentially be contributing to the patient’s fatigue.Determine whether or not social support is available for the patient.  When it comes to making adjustments, having a support system can be really helpful. The patient will require assistance in making the necessary changes to alleviate fatigue.   Educate the patient and family members about the signs of fatigue, including increased heart rate, increased blood pressure, increased respiratory rate and increased oxygen demand.Regular checks of vital signs and an overall observation of the patient’s general appearance will reveal the activity level.   

Hypothyroidism Nursing Care Plan 4

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to fatigue and reduced cognitive function secondary to hypothyroidism, as evidenced by inability to perform daily activities, muscle weakness and inability to sleep.

Desired Outcomes:

• The patient will be able to participate in physical activities.
• The patient will achieve an increased conditioned physical state.
• The patient will have unremarkable vital signs.
• The patient will verbalize an increased tolerance to perform daily activities.
• The patient will demonstrate effective energy management techniques.

Hypothyroidism Nursing InterventionsRationaleExamine the patient’s understanding of the causes of activity intolerance.    Causative elements might be physical or psychological, and they can be transitory or permanent. Identifying the cause will assist the nurse in guiding the nursing intervention.Determine the patient’s nutritional needs.  During physical exertion, adequate energy reserves are required.  Observe and record the patient’s sleeping pattern, as well as the amount of sleep obtained in the last several days.Sleep deprivation and sleep issues can impair a patient’s activity level; these must be addressed before successful activity progression can occur.Examine how the patient views the causes of activity intolerance.      Causative elements can be both physical and psychological, and they can be transient or permanent. The nurse can utilize the cause to guide her nursing intervention.Determine the nutritional status of the patient.During activity, it is required to have enough energy reserves.Observe and track the patient’s sleeping pattern, as well as the amount of sleep gotten in the previous few days.  Sleep deprivation and sleep disorders can impair a patient’s activity level; these issues must be addressed before successful activity progression can occur.Establish activity guidelines and goals with the patient and significant others.    When the patient is involved in goal-setting, it boosts motivation and collaboration.  Allow the patient to do the activity at a slower pace, for a longer period of time, with more rest or pauses, or with assistance if needed.It aids in the development of activity tolerance.  Assess the patient’s need for additional assistance at home.  When it comes to aiding the patient in conserving energy, coordinated efforts are more meaningful and effective.Encourage the patient to gradually raise the activity level by doing active range-of-motion exercises in bed, then moving on to sitting and finally standing.Overexertion is avoided by gradually increasing the intensity of the exercise.Assist with Activities of Daily Living while avoiding dependency on the patient.    Assisting the patient with ADLs allows for energy conservation. Maintain a careful balance of support; facilitating developing endurance will improve the patient’s exercise tolerance and self-esteem in the long run.

Hypothyroidism Nursing Care Plan 5

Constipation

Nursing Diagnosis: Constipation related to reduced gastrointestinal function secondary to hypothyroidism, as evidenced by infrequent passage of stool, anorexia and distended abdomen.

Desired Outcomes:

• The patient will be able to pass soft, formed stool at a frequency that the patient considers “normal.”
• The patient will verbalize relief from constipation.
• The patient will be able to choose how to prevent or cure constipation.
• The patient will verbalize constipation prevention techniques

Hypothyroidism Nursing InterventionsRationaleDetermine the patient’s regular elimination pattern, including stool frequency and consistency.      It’s critical to understand what’s “normal” for each patient. Stool passage might occur anywhere from twice every day to once every third or fourth day. Constipation is often characterized by dry and firm stools.Assess the patient’s normal food habits, eating routine, and beverage intake.  Constipation can be caused by irregular mealtimes, food types, and disruptions to one’s typical schedule.    Determine the patient’s degree of activity.  Constipation is caused by sedentary lifestyles such as sitting all day, lack of exercise, prolonged bed rest, and inactivity.    Encourage the patient to drink 2000 to 3000 mL of fluid per day if it is not medically prohibited.      To keep the fecal material soft, enough fluid is required. However, some people, particularly the elderly, may have cardiovascular issues that necessitate a lower fluid consumption.  Encourage the patient to consume at least 20 grams of dietary fiber per day such as raw fruits, fresh vegetables, whole grains.Because fiber goes through the intestine practically intact, it adds weight to the stool and makes defecation simpler.Encourage the patient to get some exercise and physical activities. Isometric abdominal and gluteal workouts should be considered.Peristalsis is aided by movement. Exercises that strengthen the abdominal muscles make it easier to defecate.Encourage the patient to eliminate on a regular basis and explain its importance.The gastrocolic reflex causes most people to defecate after their first daily meal or coffee.    Eliminate the fecal impaction digitally if necessary.  Stool that sits in the rectum for an extended amount of time becomes dry and hard, and debilitated patients, particularly the elderly, may be unable to pass these stools without assistance.  Determine the degree to which the patient reacts to the need to defecate.    Because the rectum no longer perceives or responds to the presence of feces, ignoring the desire to evacuate eventually leads to chronic constipation. The feces grow drier and tougher the longer it stays in the rectum. This will make passing the stool difficult.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Nursing Stat Facts

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Nursing Stat Facts

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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