CLINICAL PRESENTATION

IDENTIFICATION DATA

Name of patient: Mrs poonam saluja

Age: 22 years Bed no: 10 Reg. No: 453320500611

Unit/Ward: aabida II

Date of admission: 10/3 /2017

Date of delivery: 14/3 /2017

Date of discharge: 18/3/2017

Address: Gururanakar

Obstetrical score: G1 P0 L0 A 0

LMP: 03/6/16 EDD: 20/3/2017

Diagnosis: fullterm pregnancy with hypothyriidism

SOCIOECONOMIC STATUS

Religion: Hindu Age at marriage: 21yrs years of Marriage: 1yrs

Education: Husband: Graduate Wife: Graduate

Occupation: Husband: job Wife: house wife

Size of family: 2 member type of family: Nuclear

Family income: 20,000/month Earning members: 1 member

S .N Name Age Sex Relation Education

Occupation Health Remarks
status
1. Dilip 26 year M Husband Graduation Job Healthy
2. Poonam 22 year F Wife Graduation House wife Healthy .

Family tree: 26 yrs 22 year Keys

Male

Patient

1
DIATERY PATTERN

Vegetarian

Likes: No particular Dislikes: vegetable drumstick

Habit of smoking/Drinking/Tobacco: No any

HABITATION

Housing: Rented concrete No of room: 2 rooms

Ventilation: well ventilated Refuse Disposal: collected by Muncipal

Water supply: government water supply

MEDICAL HISTORY

Illness past: She had history of Hypothyroidism since 11/2 years and taking treatment as Tab.

Thyronorm 100mg daily.

Chronic illness: No any chronic illness

Surgery: No any surgery

Allergy: No any allergy

Illness in present: 39+2 days pregnancy with hypothyroidism

GENERAL EXAMINATION

General condition: Good

Hair: black Eyes: Normal Ears: Normal

Mouth: Normal Teeth: Normal

Neck: Normal Breast: Normal Nipples: inverted Chest: Normal

Arms: Normal Nails: pink Abdomen: NO scar Redness: No

Edema: Nill

Blood pressure: 110/70mmhg Pulse: 80/min Respiration: 20/min Temperature: 37.2˚c

Heart: lub and dub sound present. Lung: Clear Skin: pink

2
Spleen: Not palpable

Micturation: Not present Bowels: Normal Digestation: properly digest

Lymphatic system: Not palpable

Pain: Mild pain Discharge: slight discharge

INVESTIGATIONS

Blood Group: o Rh: positive Hb: 11% gm

VDRL: Negative HIV: Negative any other infection: Nil

Ultra sound: on 20/2/2017s

Impression: single live intra uterine foetus with foetus with normal cardiac activity (140/min)

and Normal foetal movement,vertex presentation liquor adequate.

Urine sugar: Nil

Special investigation: No any

OBSTETRICAL HISTORY

Menstrual History

Menarche: 13 years Duration: 4 days interval (cycle) Flow: 3 pads / day

LMP: 23/6/2015 EDD: 30/3/2016

OBSTETRICAL EXAMINATION (ABDOMEN)

Palpation

Period of gestation in week: 39+5days. Presentation : cephalic position: ROA

Lie: longitudinal Attitude: completely flexed

Height of uterus in weeks: 39 weeks

Fetal heart rate: 140/min Abdominal girth: 95cm

Special Abnormal signs: Not present

Vaginal Examination

External Vaginal Assessment Edema: Nil Discharge: present

3
Infection: Nil

Internal vaginal Assessment Os: open Presenting part (pp): cephalic presentation

Dilatation: 1cm

Fetal monitoring (diagrammatical presentation)

ANATOMY AND PHYSIOLOGY

The Thyroid Gland: Anatomy & Physiology

The thyroid gland is butterfly shaped and sits on the trachea, in the anterior neck. It is comprised
of two lobes connected in the middle by an isthmus. Inside, the gland is made up of many hollow
follicles, whose epithelial cell walls (also known as follicle cells) surround a central cavity filled
with a sticky, gelatinous material called colloid. Para follicular cells are found in the follicle
walls, protruding out into the surrounding connective tissue.

4
The thyroid is the largest exclusively endocrine gland in the body. The hormones secreted by the
thyroid gland are essential in this process, targeting almost every cell in the body (only the adult
brain, spleen, testes, and uterus are immune to their effects.) Inside cells, thyroid hormone
stimulates enzymes involved with glucose oxidation, thereby controlling cellular temperature
and metabolism of proteins, carbohydrates, and lipids. Through these actions, the thyroid
regulates the body’s metabolic rate and heat production. Thyroid hormone also raises the
number of adrenergic receptors in blood vessels, thus playing a major role in the regulation of
blood pressure. In addition, it promotes tissue growth, and is particularly vital in skeletal,
nervous system, and reproductive development

TH (particularly T4) is synthesized in the gland’s colloid filled lumen from the combination of
the glycoprotein thymoglobulin and stored iodine atoms. This process involves six interrelated
steps that are initiated when thyroid stimulating hormone (TSH), released by the pituitary gland,
binds to follicle cell receptors. Thymoglobulin is then made in the follicle cells from tyrosine
amino acid and discharged into the lumen where it becomes part of the colloid mass. Follicle
cells are simultaneously trapping iodide (the element’s form most readily available in food) from
the blood stream- retrieving it via active transport from the lumen. There, the iodides are
converted to iodine as electrons are removed through oxidation. Within the colloid, the iodine
then attaches to tyrosine amino acid on the thymoglobulin molecules. When one iodine attaches
to the tyrosine, monoiodotyrosine (T1) is formed; the bonding of second iodine creates
diiodotyrosine (T2). Enzymes then link T1 and T2- two T2 makes the hormone T4, while a T1
and a T2 leads to the hormone T3. Follicle cells then recover the hormones, where they pass
through an enzymatic process and are then released into the bloodstream.

When TH enters a cell, it attaches to receptor sites in various locations. Within the cytoplasm, it
primarily connects to the mitochondria, where it helps control cellular metabolism through
oxidative phosphorolation. During this process the mitochondria use oxygen to generate energy
as ATP (Adenosine triphosphate); heat is released as a by-product of this reaction. Thus, the
thyroid controls body temperature and food metabolism through its role in stimulating
mitochondrial activity. TH also enters the cell nucleus where it binds to DNA; here it
precipitates gene transcription, and the synthesis of messenger RNA and cytoplasmic proteins.
Other hormones, including Growth Hormone (GH) and Prolactin, also depend on the presence of
TH to exert their own effects on cells; the absence of TH inhibits their activity.

DEFINITION

HYPOTHYROIDISM

Hypothyroidism is a thyroid hormone deficiency. It can be due to primary disease of thyroid

gland itself or to the lack of stimulation of the thyroid gland by the pituitary via the hormone
TSH (Thyroid stimulating hormone)

5
Hypothyroidism is a condition characterized by abnormally low thyroid hormone production.
There are many disorders that result in hypothyroidism. These disorders may directly or
indirectly involve the thyroid gland.

Hypothyroidism in pregnancy means lowered level of circulating thyroxine and higher level of
thyrotrophin. Clinical primary hypothyroidism in pregnancy is rare since woman become
infertile.

Subclinical hypothyroidism is encountered during pregnancy. Serious hypothyroidism is rare in

pregnancy because of anovulation and infertility.

INCIDENCE

Overt hypothyroidism has been reported in 1 in 1000 to 1 in 1600 deliveries .But subclinical
hypothyroidism is found in 0.19-2.5% of pregnancies. All forms of thyroid disease are 3-4 times
more common in women than in men.

ETIOLOGY

In book In patient

 Auto immune thyroid diseases 

e.g.; goitre

 Iodine deficiency 

 Post surgical changes ×

 Post viral thyroiditis ×

 Congenital hypothyroidism ×

 Treatment of grave’s disease by ×

radioactive iodine

 Subtotal thyroidectomy ×
 Hypothyroid women who ×
discontinued thyroid therapy.

 Hypothyroid women on excessive ×

hypothyroid drugs

 Women with lithium and ×

amedrone therapy

6
  Untreated hypothyroidism ×

 Failure of pituitary gland to ×

produce thyroid stimulating
hormone

 Radiation therapy ×

 Failure of hypothalamus to 
produce thyrotrophin releasing
hormone

 Use of anti thyroid drugs ×

 Family history of thyroid problem 

RISKFACTORS

In book In patient
 Personal history of thyroid dysfunction Personal history of thyroid dysfunction

 Family history of thyroid dysfunction √

 Advanced maternal age ×

 Diabetes diabeteis

 Autoimmune diseases ×

 Endocrinopathies ×

 Maternal obesity ×

TYPES

2 Types of hypothyroidism in pregnancy

Clinical hypothyroidism or overt hypothyroidism: Clinical hypothyroidism in pregnancy

is rare since women become infertile. In this type of hypothyroidism TSH will be elevated
and FT4will be in normal range. Overt hypothyroidism can lead to a miscarriage, preterm

7
delivery, decreased IQ in the unborn child, and gestational hypertension (high blood pressure
during pregnancy

Subclinical hypothyroidism: In this type of hypothyroidism TSH is elevated and FT4 is in

low range. Subclinical hypothyroidism is encountered during pregnancy. Subclinical
hypothyroidism has also been associated with miscarriage, preterm delivery, and decreased
IQ

PATHOPHYSIOLOGY

Hormone Changes: A normal pregnancy results in a number of important changes that alter
thyroid function. While usually normal, the TSH may be slightly low in the first trimester
due to high HCG levels and then return to normal throughout the duration of pregnancy.
Increased total T4 is often seen due to an increase in serum binding proteins caused by
estrogens. However, measurements of “Free” (or active) hormone remain normal. The
thyroid is functioning normally if the TSH, Free T4 and Free T3 are all normal throughout
pregnancy.

The thyroid gland can increase in size during pregnancy especially in iodine deficient areas,
which is relatively iodine-sufficient, the thyroid often increases only 10-15%, and sometimes
a significant goitre may develop, prompting the measurement thyroid function tests.

For the first 10-12 weeks of pregnancy, the baby is completely dependent on the mother for
the production of thyroid hormone. By the end of the first trimester, the baby’s thyroid
begins to produce thyroid hormone on its own. The baby, however, remains dependent on the
mother for ingestion of adequate amounts of iodine, which is essential to make the thyroid
hormones.

Increase in thyroid-binding globulin.

Thyroid hormones are transported in serum bound to three proteins: thyroxine-binding

globulin (TBG), transthyretin, and albumin. Although TBG is present in low abundance in
serum, it has a high affinity for thyroid hormones and is responsible for the transport of the
majority of T4 (68%) and T3 (80%)

(1). During pregnancy, the affinities of the three binding proteins for T4 and T3 are not
significantly altered, but the circulating concentration of TBG increases two- to threefold,
whereas the concentrations of albumin and transthyretin remain unchanged

(2) Serum TBG increases a few weeks after conception and reaches a plateau during midge
station The mechanism for this increase in TBG involves both an increase in hepatic
synthesis of TBG and an estrogens-induced increase in salivation, which increases the half-
life of TBG [from 15 min to 3 days for fully sialylated TBG

8
Increase in total T4 and T3.

Plasma concentrations of total T4 and T3 are also increased during pregnancy, Total T4 and
total T3 concentrations increase sharply in early pregnancy and plateau early in the second
trimester at concentrations 30–100% greater than prepregnancy. The etiology of this increase
in total circulating thyroid hormones involves, primarily, increased concentrations of plasma
TBG Another proposed mechanism for this increase in total thyroid hormone concentrations
is production of type III deiodinase from the placenta This enzyme, which converts T4 to
reverse T3, and T3 to diiodotyrosine (T2), has extremely high activity during fatal life
Increased demand for T4 and T3 has been suggested to increase production of these hormones
with, ultimately, increased concentrations in the circulation The increase in T4 and T3
concentrations is less than would be expected by the increase in TBGwhich is known as a
“relative hypothyroxinemia, this is reflected by a decrease in free T4 concentrations as well
as a progressively decreasing T4/TBG ratio during pregnancy

Thyroid stimulation by HCG

HCG has mild thyrotrophic activity During the first trimester of pregnancy, when hCG is at
its greatest concentration, serum TSH concentrations drop, creating the inverse image of hCG
In most pregnancies, this decrease in TSH remains within the health-related reference
interval, Under pathological conditions in which hCG concentrations are markedly increased
for extended periods, significant hCG-induced thyroid stimulation can occur, decreasing TSH
and increasing free hormone concentrations.

Increase in renal iodide clearance.

In pregnancy, the renal clearance of iodide increases substantially because of an increased
glomerular filtration rate. The iodide loss lowers the circulating concentrations of iodide and
produces a compensatory increase in thyroidal iodide clearance. In areas of the world where
iodine intake is sufficient, such as the US, the iodide losses in the urine are not clinically
important. In other areas of the world, however, iodine deficiency during pregnancy can lead
to hypothyroidism and goitre. Approximately 500 million people live in areas of overt iodine
deficiency in the nonpregnant condition, adequate iodine intake is estimated to be 100–150
μg/day. The World Health Organization recommends that during pregnancy, iodine intake be
increased to at least 200 μg/day

CLINICAL MANIFESTATION

The range of clinical symptoms of hypothyroidism during pregnancy is similar to those that
occur in non pregnant patients and may include fatigue, cold intolerance, constipation, and
weight gain. Symptoms may be overlooked or attributed to the pregnancy itself.

Main sign and symptoms are:-

9
 In book In patient

 Fatigue fatigue

 Sleeplessness sleeplessness

 Lethargy lethargy

 Cold intolerance Cold intolerence

 Dry skin Dry skin

 Mental slowing ×

 Sadness ×

 Depression ×

 Weight gain despite of poor Weight gain

appetite

 Arthaigia ×

 Muscle pain Muscle pain

 Hoarse voice ×

 Dull facial expressions ×

 Slow speech ×

 Droopy eyelids ×

 Puffy and swollen face ×

 Constipation constipation

 Sparse, coarse and dry hair ×

 Coarse, dry, and thickened ×

skin

 Carpal tunnel syndrome ×

10
  (hand tingling or pain)

 Slow pulse ×

 Muscle cramps ×

 Orange-colored soles and ×

palms

 Sides of eyebrows thin or fall ×

out

 Confusion ×

 Increased menstrual flow in ×

women

Screening for Thyroid Dysfunction during Pregnancy

In book In patient

 Women with a history of hyperthyroid or ×

hypothyroid disease, PPT, or thyroid
lobectomy

 Women with a family history of thyroid √

disease

 Women with a goiter ×

 Women with thyroid antibodies (when known √

 Women with symptoms or clinical signs ×

suggestive of thyroid under function or over
function, including anemia, elevated

11
 cholesterol, and hyponatremia

 Women with type I diabetes ×

 Women with other autoimmune disorder ×

 Women with prior therapeutic head or neck ×

irradiation

Diagnosis of hypothyroidism
In book In patient
 The proper diagnose of hypothyroidism can be done by  Complete history and
complete history and physical examination of the patient physical examination done.
and performing sensitive laboratory tests on the patient's
blood. Because symptoms of hypothyroidism can mimic
those of many other conditions, blood tests for measuring
levels of thyroid stimulating hormone (TSH) and free
thyroxine (T4) is the only definitive way to diagnose
hypothyroidism.
 TSH---0.91 iu/ml
Laboratory Investigations  T3T4--- 0.7mg/dl
 Serum Prolactin--- 9.44
 Thyroxine (T4) Hypothyroidism is a condition marked by
low thyroxine (T4) hormone levels, and a test can measure
levels of this hormone in the blood. However, this test is
usually inadequate for the following reasons

following reasons:

 T4 levels can be normal early in the disease process

leading to hypothyroidism. If hypothyroidism is
suspected, other tests are needed.
 T4 levels can be low in patients who do not have
hypothyroidism. For instance, thyroxine can be extremely
variable in very elderly or seriously ill patients and during
pregnancy
 Thyrotrophin (Thyroid-Stimulating Hormone or TSH)

12
 Measuring TSH is the most sensitive indicator of
hypothyroidism. (As with thyroxine levels, however, TSH
levels can vary in pregnant women and patients who are ill
with other conditions.) In general, results indicate the
following:

 TSH levels over 10mU/L. This is a clear indicator of

hypothyroidism if T4 levels are low -- and, in most
cases, even if they are normal. Patients usually need
thyroxine (T4) replacement therapy. They should also
be tested for high cholesterol levels and ant thyroid
antibodies.
 Levels between 4.5 - 10 mU/L. Patients with signs and
symptoms of hypothyroidism usually need thyroxine
replacement therapy. Patients without symptoms have
subclinical hypothyroidism and should be rechecked
every 6 - 12 months. Antibody tests may also be
performed.
 TSH levels between 0.45 - 4.5 mU/L. These indicate
normal thyroid function. (Abnormally low levels
suggest hyperthyroidism, which is overactive thyroid.)
 Specific TSH measurement -- even if it is significantly
higher than 10 mU/L -- is not associated with the
severity of the condition. This can be determined only
by measuring thyroxine levels and evaluating the
patient's symptoms

Antithyroid Antibodies If TSH levels suggest hypothyroidism or subclinical hypothyroidism,

the doctor may choose to perform a blood test for specific Antithyroid antibodies that act against
a factor called thyroperoxidase (TPO). Tests can also check for antibodies to thyroglobulin.
Results are particularly helpful in deciding how to treat someone with subclinical
hypothyroidism.

Other Hormone Tests Used for Thyroid Function. Other hormone tests are done if
hyperthyroidism is suspected. They include tests for triiodothyronine (T3) and thyroglobulin
(also called thyroid binding globulin). Such measurements, however, may also be helpful in
detecting sudden temporary increases in thyroid hormone (thyrotoxicosis) that can precede
certain forms of autoimmune thyroiditis.

13
Imaging Tests

Thyroid Scintigraphy Thyroid scintigraphy, or scan, can be used to determine which areas of
the thyroid are producing normal amounts of hormone. The patient drinks a small amount of
radioactive iodine or technetium and waits until the substance has passed through the thyroid.
Images of a properly functioning thyroid show uniform levels of absorption throughout the
gland. Overactive areas show up white, and underactive areas appear dark. Thyroid scans are
more likely to be done to evaluate goitre (swollen thyroid) or thyroid nodules. They can help
identify areas of the gland that may have cancer.

Ultrasound has limited value, but it can visualize the thyroid and specific abnormalities, such as
nodules. (It cannot measure the thyroid glands function, however.

More Advanced Imaging Tests

If laboratory tests suggest that a pituitary or hypothalamus problem is causing hypothyroidism,

the doctor will usually order brain imaging procedures using computed tomography (CT) scans
or magnetic resonance imaging (MRI). MRIs may also be used for determining the extent of
thyroid cancers and of goitres. MRIs are also being used for investigating hypothyroidism in
infants and for determining widespread effects of autoimmune thyroiditis (such as Hashimoto's
hypothyroidism)

Needle Aspiration Biopsy

Needle aspiration biopsy is used to obtain thyroid cells for microscopic evaluation. It may be
useful to rule out thyroid cancer in patients with thyroid nodules, abnormal findings on a thyroid
scan or ultrasound, or those who have a goitre that is large or feels unusual on physical exam.
Much like drawing blood, the doctor injects a small needle into the thyroid gland and draws cells

14
from the gland into a syringe. The cells are put onto a slide, stained, and examined under a
microscope.

Other Blood Tests

Cholesterol levels need to be checked. Other blood tests may be performed to detect levels of
calcitonin, calcium, Prolactin, and thyroglobulin and to check for anaemia and liver function, all
of which may be affected by hypothyroidism.

Screening in Pregnant Women- Untreated overt hypothyroidism in a pregnant woman,

particularly in the first trimester, may cause premature delivery and birth defects. Birth defects
can affect a baby’s intelligence, mental development, and motor skills. Subclinical
hypothyroidism also may increase the risk for premature delivery but does not seem to be
associated with neurologic or developmental outcomes in children.

Current guidelines recommend targeting screening of women before or during pregnancy based
on symptoms or history. Factors that suggest screening is indicated include: History of thyroid
disease, goitre, type 1 diabetes or other autoimmune illnesses, history of miscarriages, and
history of head and neck radiation or surgery. Women with these factors should have their
thyroid checked before pregnancy, or within the first weeks of pregnancy, and should be retested
during each trimester.

MANAGEMENTS

PREPREGNANCY MANAGEMENT

Hypothyroid woman should have pregnancy counselling. The thyroxine dose is adjusted to
thyroid achieve TSH level below 2.5miro/l. Women with autoimmune thyroid disease and other
autoimmune disease like type 1 diabetes should be screened for TSH.

ANTENATAL MANAGEMENT

Fatal thyroid starts to functioning by 12-14 weeks, the fatal serum T4 level gradually increasing
up to 18 weeks .As fetes is entirely depend on the mother for its thyroid supply in the 1st
trimester and later for iodine. Supplemental thyroxine should be given from early pregnancy.
Treatment is 1.6microg/kg of Levothyroxine with variations on an individual basis. Already
woman being treated for hypothyroidism require an increase (20-50%) in thyroxine during
pregnancy. In post partum period the dose should be immediately decreased to prepregnancy
level. All women should undergo a thyroid function test 4-6weeks after delivery.

15
Management of hypothyroidism in pregnancy
Levothyroxine is the treatment of choice for hypothyroidism in pregnancy. Thyroid function
should be normalized prior to conception in women with pre-existing thyroid disease. Once
pregnancy is confirmed the thyroxine dose should be increased by about 30-50% and subsequent
titrations should be guided by thyroid function tests (FT4 and TSH) that should be monitored 4-6
weekly until euthyroidism is achieved. It is recommended that TSH levels are maintained below
2.5 mU/l in the first trimester of pregnancy and below 3 mU/l in later pregnancy. The
recommended maintenance dose of thyroxine in pregnancy is about 2.0-2.4 mcg/kg daily.
Thyroxine requirements may increase in late gestation and return to pre-pregnancy levels in the
majority of women on delivery. Pregnant patients with subclinical hypothyroidism (normal FT4
and elevated TSH) should be treated since the condition is associated with maternal and fatal
complications.

DRUGS USED FOR TREATMENT

S no BRAND NAME GENERIC NAME

1 Synthroid Levothyroxine
2 Levoxyl Levothyroxine
3 Cytomel Levothyroxine
4 Levothroid Levothyroxine
5 Eltroxin Thyroxine sodium
6 Thyronorm Thyroxine sodium
7 Thyrolar liotrix

DIETARY MANAGEMENT

Provide high bulk and low calorie diet. Maintain fluid restriction and low sodium diet. A high
roughage diet should be given to prevent constipation. If the cause is iodine deficiency then give
iodine supplements

Dietary intake is same as the pregnant lady, in iodine deficiency, the Maternal thyroid glands has
a greater affinity for iodine than placenta thus fetus is prone to cretinism. It is the leading
preventable cause of mental retardation. Iodine administration prior to conception and up to
second trimester improves neonatal outcome by protecting the fatal brain. Iodination of water,
salt or flour can easily supplement this deficiency.

Additional sodium is required in pregnancy to meet the need of intravascular and extra vascular
fluid volume and maintain normal isotonic state. At term fetus and placenta contains 500gms of
protein or approximately half of protein increase of pregnancy. Approximately 500gms of
protein is added to the uterus, breast, and maternal blood in the form of plasma protein. An

16
additional 300kcal are required during the 2nd and 3rd trimester. Calories expenditure varies slight
increase in early
Pregnancy and a sharp increase near the end of the 1st trimester throughout pregnancy. An
additional requirement of 10gmprotein /day is required. Carbohydrate should supply 55-60% of
calories in the diet and should be in the form of carbohydrate such as whole grains
cerelesproduct, starch and legumes. Fat intake should not be more than 30% of diet. Saturated fat
should not exceed 10% of the total calories. Iron supplements are 20-30% daily. Supplementary
iron is valuable and necessary during pregnancy and postpartum.

Hypothyroidism Diet Tips to Help Heal Thyroid

1. Avoid Anti-Thyroid Foods

The first hypothyroidism diet tip that there are some highly touted “health foods” that are eating
which are actually contributing to r hypothyroidism
Some of the first foods that are any food that contains soy. This includes soybeans, edamame,
soy milk, tofu, etc. Soy is very estrogenic and estrogens have been shown to inhibit the thyroid
gland from secreting its thyroid hormones.
Another very controversial food that directly contributes to hypothyroidism is the
polyunsaturated fats in diet. These fats suppress thyroid function on just about every level. First
of all, they block the secretion of thyroid hormone from the thyroid gland itself. Then they also
block the transportation of the thyroid hormone within your bloodstream. And lastly, they block
cells from properly utilizing the hormone once they get it.
2. Increase Saturated Fats
One of the major benefits of the saturated fats being part of your hypothyroidism diet is that they
help to cancel out the negative effects of the toxic polyunsaturated fats. They also help by
improving body’s insulin response which helps to maintain balanced blood sugar levels and
reduce stress hormones. Elevated stress hormones are also one of the many hypothyroidism
causes.

3. Eat Fruit

Fruit are one of best when it comes to hypothyroidism diet.

17
For starters, most fruit is very high in potassium which plays an important role in regulating
blood sugar. This helps to decrease the need of insulin which helps keeps blood sugar more
stable for longer periods of time.

And by regulating your blood sugar, automatically reduce stress hormone response which is a
common problem with hypothyroidism.
However, there are some fruits which are best avoided. Avocados are a good example because of
their high unsaturated fat content.

4. Increase Salt Intake

There are a lot of myths out there regarding salt and sodium. But it’s more important especially
when it comes to hypothyroidism diet.
Sodium is actually a very important nutrient that body needs to carry out a multitude of
functions. For example, sodium is necessary for properly regulating blood pressure. But it also
has some other important functions in dealing with hypothyroidism.
One of the more common hypothyroidism symptoms is oedema. And oedema is a problem with
cells that causes them to take up more water. But when cells take up water, they lose sodium
which is then excreted and lost through urine.
And when your sodium level is low, it actually slows metabolism and increases stress hormones
which can also lead to sleep problem. And because sodium gets from salt, it should make sense
that salt is a necessary component of hypothyroidism diet in order to help keep stress hormones
to a minimum and reverse hypothyroidism.

5. Get Plenty of Bone Broth

Bone broth is best known for being high in nutrients and very easy to digest. But it’s unique
because it contains a blend of very anti-inflammatory amino acids that are lacking among most
sources of meat.

6. Eat Some Shellfish

Shellfish in general are actually very beneficial to your thyroid and can play a crucial role in r
hypothyroidism diet. For starters, they are a good source of thyroid hormone which we rarely get
in our standard meat based diet these days. So eating shellfish alone can help give thyroid some
much needed support.

18
7. Cut the Processed Foods
Processed and/or packaged foods are loaded with processed grains that cause lots of problems
with blood sugar. And this causes a spike in insulin levels which causes low blood sugar. And
this creates another stress hormone response in order to raise blood sugar levels back to normal.

8. Cook Your Veggies

Because raw veggies are very difficult to digest, cook veggies well in order to help break down
the fiber and make the nutrients as readily available as possible. Otherwise, the fiber can become
food for bad gut bacteria which is problematic and also contributes to hypothyroidism

9. Don’t Overdo the Water

Most people are led to believe that they need 8 glasses of water a day or even more. But in
hypothyroidism is causes water retention. So this can cause sodium levels to drop which also
contributes to hypothyroidism.
The best recommendation for water while on hypothyroidism diet is to drink when thirsty

10. Drink Coffee

Coffee has some amazing benefits for thyroid. But keep in mind that it has to be taken right or
else it can have some negative effects. You should never drink coffee on an empty stomach. And
it’s important to add the right ratios of fat and sugar.
Coffee is high in caffeine which works to stimulate thyroid. It’s also high in magnesium and B
vitamins which are both necessary for proper thyroid function.

COMLICATIONS

Effect on mother

19
There is a significantly increased risk of spontaneous abortion, pregnancy induced abortion,
placental abruption, preterm labour, post partum haemorrhage and cardiac dysfunction.

Effect on featus

 Preterm labour
 Low birth weight baby
 Perinatal death
 Mental retardation
 Growth retardation
 Heart problems

Thyroid hormone is critical for brain development in the baby. Children born with congenital
hypothyroidism can have severe brain abnormalities if the condition is not recognized and
treated promptly.

RELATED RESEARCH

1. Tudosa Rodica,et. al,(April 2010),journal of medica(Buchar),Maternal and fetal

complications of the hypothyroidism-related pregnancy.

ABSTRACT

Thyroid pathology worsens during pregnancy. Hypothyroidism can be pre-existent or may

begin during pregnancy period. Most of the patients who presented hypothyroidism during
pregnancy have a history of thyroid disease for which they have undergone treatment (medical,
surgical or radioisotopes). Hypothyroidism is difficult to be diagnosed during pregnancy as the
signs can belong to pregnancy itself. Changes in thyroid function have a major negative impact
on both mother and fetus.

Complications that arise depend on the severity of hypothyroidism, on how appropriately and
early the treatment will be initiated, on other obstetrical and extragenital pathologies associated
with the present pregnancy. Clinical symptoms are polymorphic, often nonspecific, and are
related mainly to the time of occurrence and to the severity of thyroid hormone deficiency. The
appropriate, early administered treatment and maintenance of a normal level of thyroid
hormones minimize the risk of maternal and fetal complications and make it possible that the
pregnancy may be carried to term without severe complications.

 In 1999, Pop et al. (25) tested mental and psychomotor development in 220 10-month-old
infants living in The Netherlands, an iodine-sufficient country. They found that if the
mother’s free T4 was in the lowest 10th percentile at 12 weeks gestation, the infants had

20
 increased risk of delayed psychomotor development (relative risk, 5.8). These mothers were
three times as likely to be TPO antibody positive (25% vs. 8%). However, there were other
potential factors beyond hypothyroxinemia that may have contributed to the neurocognitive
abnormalities described. Major depression, a known risk factor for impaired childhood
development, was present in some mothers. In a previous study, those authors reported that
impaired development based on the Gestalt Cognitive Scale at 5 yr of age was observed in
children whose mothers were anti-TPO antibody positive but with entirely normal thyroid
function.

2. A recent report by Smit et al. (28) described the status of infants whose mothers had
subclinical hypothyroidism. They found a decrease in the mental development index at 6
and 12 months, but not 24 months. Psychomotor development and neurophysiologic and
neurologic assessments were unaffected. There is one study showing no effect of severe
first trimester hypothyroidism (low T4: TSH, 25–190 mU/L) when mothers had normal
thyroid function later in pregnancy and children had IQ tests at age 4–10 yr (29). - See
more at:

APPLICATION OF THEORY AND MODEL

Goal of Theory:
To work independently with other health workers to improve clients health status as soon as
possible.
Focus on Henderson’s Fourteen Components
Assessed needs of the client based on the fourteen components of basic nursing care.
 Provided supplementary O2 as prescribed to maintain normal breathing.
 Assisted her to eat and drink adequately.
 The client was assisted to eliminate her body wastes.
 Encouraged her to move & maintain posture.
 Provided opportunities for sleep & rest.
 Assisted her to dress or undress.
 Maintained her body temperature.
 Kept her body clean & welt groomed by encouraging her to take bath daily.
 Provided safe environment by avoiding dangers in the environment.
 She was given the opportunity to communicate with other.
 Provided periods to work ship.

21
 Learn, discover, or satisfy the curiosity that leads to normal development and health and use
the available health facilities, by clearing her queries and imparting health education.
 Play or participate in various forms of recreation, listening to music.
 Worship according to one’s faith.
Virginia Henderson's Definition of Nursing

Major Concepts:

A. Nursing (Intervention): The nurse has a unique function to help sick or well individual.
She maintains good nurse physician relationship.

 Assess the client’s ability to perform normal task. Note changes in equilibrium.
 Monitor laboratory studies.
 Provide supplemented O2 as indicated.
 Advise the client to take proper rest.
 Review required diet alteration to meet specific dietary need.
 Encourage her to take diet rich in iron such as spinach, rage, and almond.
 Emphasis the importance of inclusion of fresh fruit & green leafy vegetable in her diet.
 Encourage her to take small frequent diet.
 Provide a conducive environment while eating.
 Assess for the level of knowledge related to the disease condition.
 Encourage her to ask questions.
 Clear her doubts.
 Provide knowledge regarding diabetes & its prevention with in her level of understand

The 14 components of nursing care encompass all possible functions of nursing.

B. Person (Patient): The must maintain physiological and emotional balance and requires
help towards independence.
 Anxiety
 Knowledge Deficit
 Pain
 Fatigue

C. Health: Health is basic to human functioning which requires independence &

interdependence.

3. It is equated with independence or ability to perform activities without any aid in the 14
fundamental or basic human needs.
4. Nurses need to stress promotion of health, prevention of illness and its cure.

22
 5. Necessary strength, will, and knowledge are important in achieving health.
6. Health is basic to human functioning.
7. Health promotion is more important than care of the sick

D. Environment: Healthy individuals may be able to control their environment but illness
may interfere with that ability.

 It encompasses all external conditions and influences that affect life and development.
 Society wants and expects nurses to act for individuals who are unable to function
independently; in return, the nurse expects the society to contribute to nursing education.
 The environment may also include individuals in relation to families and the settings in
which an individual learns unique pattern for living.
 There are seven essentials that must be present in the environment which include light,
temperature, air movement, atmospheric pressure, appropriate disposal of waste, minimal
quantities of injurious chemicals, and cleanliness of any surfaces coming in contact with
individual.

 The environment can act positively or negatively upon the patient.

 It can an also be altered in such a way to support a patient

My patient is full term multigravid admitted in Sultania Zanana Hospital in ward

antenatal with diagnosis of Full Term Pregnancy with hypothyroidism.

23
CONCEPTUALE FRAME WORK

NUTRITION NURSE ACCOMPLISHED WORK

AIR RECREATION
ELIMINATE WASTE Environment FAITH

SLEEP Patient REST

Full term pregnancy

GROOMING with heart disease COMMUNICATION

MAINTAIN BODY TEMPERATURE AMBULATION

SAFE ENVIRONMENT

24
NURSING CARE PLAN

ASSESSMENT NURSING OBJECTIV PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS E
Subjective: Activity  Set the time  Time set done  To improve
patient says she is intolerance After 6 hours interval between interval between resting and After 6 hours of
feeling of tired, related to of nursing rest and activity rest and activity to exercise nursing
and weakness. generalized intervention to improve improve exercise that can be intervention
weakness as patient’s exercise that can that can be tolerated. patient’s
evidenced by weakness will be toleterated toleterated weakness was
Objective Data: facial be reduce reduced
. Dry yellowishes expression  Help the patient
skin, slow speech self- care  Helped the patient
activities when self- care  To prevent
the patient is in activities when decubitus
state of fatigue. sores.
the patient is in
state of fatigue.
 Give stimulation
through
convertation and  Amining to
 Given stimulation
activities that do avoid any
through
not cause stress. stress.
convertation and
activities that do
 Monitor the not cause stress.
patient’s  To
response to determine
 Monitored the
increased the
patient’s response
activity. developme
to increased
nt of the
activity.
activity in
patient.

25
 ASSESSMENT NURSING NURSING PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS GOAL
Subjective Anxiety related to Within the care Monitor Vital Vitals were To obtain At the end of
Client verbalizes hospitalization and the patient will be signs. monitored and baseline data. the care the
that she is upcoming delivery able to cope with were recorded. client will
concerned about process. the anxiety as Temp- 36.80C exhibit normal
the upcoming evidenced by: Pulse- 100bpm vitals:
delivery process Resp-18cpm Temp- 36.80C
and about the V/S within normal BP- 126/80mm of Pulse- 94bpm
child inside her range hg Resp- 16cpm
womb. Temp-36.5-37.50C BP- 110/80mm
Pulse-60-100bpm Assess the of hg
Objective Data Resp- 12-20cpm anxiety level
Exhibit poor eye BP- 110-130 /60- Patient was Identify areas Claimed that
contact. 90 mm of hg anxious and of concern that she was
anxiety level was might interfere worried about
Facial tension Acknowledging recorded through with the the pain she
observed. and discussing verbal and non normal has to undergo
fears. Employ a verbal cues. progress of as well as the
Impaired attention nonjudgmental labor. condition of the
noted. approach baby.
Absence of facial Verbalizes that
Appears tension and she will cope up
preoccupied. increased will be able to
attention span. deliver the
A warm and baby.
Verbalizes control Allow client to confidential
of situation. express her environment was To improve Verbalizes that
fears. created. nurse patient she is excited to
relationship. see her baby.

26
 Acknowledge
Expresses To provide normalcy of fear
confidence on Psychological and opportunity Provides She claims that
herself as well as support was given for healthy outlet she trusts the
on the nurses in questions and for fear and nurses in the
labor room. answers within anxiety reduces hospital.
patients tension.
understanding
level.

Good
interpersonal
relation was Provides a
maintained. sense of
security and
trust between
nurse and
patient.

27
 DRUG STUDY
S.No. Name of Dose Rout Action Side effect Contraindication Nursing responsibility
drug
1. Tab 1 tab P/O Hyoscine –N- Dizziness,increase Myasthemia gravis,  Drug compability
buscopan butylbromide (HNBB) ICP,drowsiness, headache, megacolon and should be monitored
acts by interfering confusion,dry mouth, narrow angle closely.
with the transmission constipation,urinary glaucoma,  Avoid driving and
of nerve impulses by retention. hypersensitivity to operating machinery
acetylcholine in the hyoscine. after parentral
parasympathetic administration.
nervous system.
2. Tab 40 mg P/O Proton pump inhibitor Redness/pain, swelling at the Atrophic gastritis  Do not share this
pantodac injection site ,interstital Nephritis medication with others

3. Tab Mv/Bc 25 P/O Multivitamins are a 1. Stomach upset 1. Drug should not be
mg combination 1of many No contraindication taken with dairy
once different vitamins that 2.Headache products.
are normally found in
foods and other 3. Metallic taste in mouth 2. Instruct patient to avoid
natural sources. concurrent use of alcohol
Multivitamins are
or OTC medicine without
used to provide consulting the physician.
vitamins that are not
taken in through the
diet. Multivitamins
are also used to treat
vitamin deficiencies
(lack of vitamins)
caused by illness,
pregnancy, poor
nutrition, digestive
disorders.

28
4 Tab 100 P/O Synthetically Nervousness, Contraindicated in  Monitor pulse before
Thyronom mg prepared excitability, tremor, patients with each dose during dose
monosodium salt muscle weakness, untreated adjustment. If reate
and levo- isomer of cramps, increased hyperthyroidism,rec ismore then 100, consult
thyroxine, with sweating, flushing, heat ent heart attack and physician.
similar actions and intolerance,headache, hypersensitivity.  Monitor for adverse
uses (thyroxine, insomnia, rappid heart effect during early
principal component rate, palpitayion, chest adjustment.
of thyroid gland pain.  Note: Levothyroxine
secretions, may aggravate severity
determines normal of previously obstructed
thyroid function) symptoms of diabetes
insipidus.

29
ASSESSME NURSING GOAL PLANNING IMPLEMENTATIO RATIONALE EVALUATIO
NT DIAGNOSIS N N
Subjective: Pain related to 1. To assess the 1. Pain was 1. Pain was assessed
Patient false pain whether assessed by by assessing the False contractions will The patient
complains of contractions as it’s false assessing the degree, frequency be irregular, and was having
pain lower evidenced by contraction or degree, frequency and interval of subsides with exercises false
abdomen on verbalization true contraction. and interval of pain. and walk. contraction
and off. of patient and pain. since the
facial frequency was
Objective: grimaces. not regular and
The patient subsided after
rates the pain 2. Advice patient 2. Patient was advised 2.walking and 3 hours of
as 6/10 on for comfortable 2. Patient was to walk to alleviate Change of position admission.
pain scale. position and advised to walk to the pain and to relieved the patient of
ambulation. alleviate the pain assume left lateral lower abdominal pain. The patient
The facial and to assume left position Left lateral position was able to get
grimaces of lateral position prevents supine relief from
patient hypotension and pain on
indicate pain. improves placental walking and
perfusion assuming left
lateral position.

30
ASSESSMENT NURSING PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS
Subjective Nutrition To maintain stable Nutritional history was Identifies My patient had
Patient verbalizes that imbalance less weight gain. taken to know about deficiencies and few leafy
she doesn’t feel like to than body dietary habits. suggests possible vegetables and
eat due to nausea and requirement To change dietary interventions. meat in her diet.
vomiting related to habits in patient.
anorexia as Patient was advised to Jaggery is rich
evidence by Experience no include iron rich fruits source of iron. Patient stated that
verbalization. signs of such as Chiku, jaggery she has included
Objective malnutrition in her diet. She was Rice water and in her diet fruits
Patients ANC record advised to take rice water of cooked and green leafy
reveals that her weight water and vegetables. vegetables is rich in vegetables in her
gain during pregnancy nutrients and is diet.
is only 5 kg readily available.

Patient verbalized she Patient was advised to Metoclopramide

was not taking proper take antiemetic tab (Raglan) acts by
food due to nausea and raglan before half an increasing pressure Patient had
vomiting. To reduce the hour of the food. at the lower decreased episode
incidence of esophageal of nausea and
nausea and sphincter, as well as vomiting.
vomiting. speeding transit
through the
stomach. This drug
has been shown to
be more effective
than placebo in the
treatment of
hyperemesis
gravidarum.

31
ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATIO RATIONALE EVALUATIO
DIAGNOSIS N N
Subjective: ,patients Decreased After 6 Independent  Monitored blood  Comparison of After 6 hours
reports of fatigue, cardiac output hours of  Monitor pressure of pressuires provides a of nursing
weakness and malaise related to nursing blood patient. Measured more complete intervention s
change in stroke intervention pressure of in both arms and picture of vascular the patient was
Objective:venous volume s the patient patient. thighs three involvement or scope participate in
distention,generalized will times, 3-5 of the problem activities that
edema participate minutes apart reduce blood
Vital sign taken as in activities while patient is at pressure or
flows that reduce rest, then sitting, cardiac work
T - 35˚c blood then standing for load
P -50 pressure or initial evaluation.  Presence of pallor,
R – 13 cardiac  Observe cool, moist skin and
Bp – 130/90 work load skin  Observed skin delayed capillary
colour, colour, moisture, refill time may be due
moisture, temperature and to peripherial
temperatur capillary refill vasoconstriction.
e and time.
capillary
refill time. .

 May indicate heart

 Note failure, renal or
dependent  Note done, vascular impairement
or general dependent or
edema. general edema  Help reduce
sympathetic
 Provide stimulation, promotes
calm,  Provided calm, relaxation
restful restful
surroundin surroundings,

32
 gs, minimize
minimize environmental  Reduce physical
environme activity or noise stress and tension that
ntal affect blood pressure
activity or and course of
noise  Maintained hypertension
activity  Can reduce stressful
 Maintain restrictions stimuli, produce
activity calming effect,
restriction thereby reduce blood
pressure
 Instruct in
relaxation  Instructed in  These restrictions can
technique, relaxation help manage fluid
and guided technique, and retention and with
imagery guided imagery associated
hypertensive
response, which
Collaborati decrease cardiac
ve workload.
 Implement  Implemented
diatery diatery sodium,
sodium, fat, and
fat, and cholesterol
cholesterol restrictions as
restrictions indicated
as
indicated

33
Immunization detail
Mother has taken 2 dose of T T injection during her second trimester of pregnancy.

DIET PLAN

Calorie Protein
Food Item Nutrifact
(Kcal) (Gms )

Early Morning : (7.00 Am)

Milk Is the best way to start your day, It will cool

Rose flavored Milk(1
150 4 the acid rush down, and the nutrients in milk will
glass)
be are absorbed better on empty stomach

Dry Carbs in the Morning helps in relieving

Wheat Rusks(2 pieces) 50 2
Morning Sickness

Soaked Almonds (6
50 4 It is a good souce of protein and omega 3 acids
pieces)

It helps in maintaining Ph balance in blood due to

Dates (2 pieces) 25 1
rise in blood volume

Breakfast (9.00 Am)

Carrots help in providing fiber , keeps you away

Carrot Stuffed Paratha(2 from skin and digestion problem during
200 6
medium size) pregnancy , and cuts on th risk of baby
developing jaundice at birth.

curd Provides calcium, protein, Vit A and D very

Curd1 Soup Bowl(1
75 4 beneficial during pregnancy, And helps you
Soup Bowl)
enhance your mood during downs.

OR

Eggs are easy to make and best sources of

Egg Omlette(2 No.) 160 10
proteins that helps in baby’s growth.

34
Toasted Brown Bread(2
100 3 Dry carbs Helps in relieving Morning sickness
slices)

OR

Vegetable oats upama (1 Multi nutrients from veggies and good fiber to
250 3
soup bowl) tackle constipation

11.00 Am

Apple / Orange /
These fruits help in maintaining hydration and Ph
Pomegranate (1 medium 40 –
balance in increasing blood volume.
size)

12.00 Pm

It Benefits in constipation, sluggish digestion,

Coconut water /
30 – heart burn and urinary tract infections during
Lemonade (1 glass)
pregnancy

LUNCH(1.30 Pm)

Chapati / Phulka(2 no) 200 6 –

Fish helps in obtaining nutrients like pufa and

Dal tadka / Fish curry(1
150 6 mufa and good quality protein for development of
soup bowl)
the baby.

Palak Paneer(1 small Spinach is rich in folic acid and iron and helps in
150 6
bowl) maintaining healthy pregnancy.

Vitamin C from Lemon helps in taking care of

Lemon Rice(1 small
100 2 the huge metabolic wastes produced in body
bowl)
during pregnancy.

sliced tomatoes(2 Anti oxidant lycopene helps in taking care of

40 –
medium size) metabolic wastes.

2.30 Pm

Buttermilk(1 glass) 40 1 Helps in hydration and heart burn

35
4.30 Pm

Tea(1 cup) 50 2 –

cheese has good calcium and protein which helps

cheese chilly toast(2
150 4 in growth of baby. It also helps in formation of
slices)
smooth stools, which helps relieve constipation.

6.00 Pm

good protein and iron content for heamoglobin

Roasted chana(Handful) 50 1
formation

Jaggery( small pieces Its iron content helps in increasing heamoglobin

25 –
(15 gms )) with increasing blood volume.

OR

Dry fruit chikki (made

100 2 Good combination of iron and protein
in gurr )(4 small pieces)

7.30 Pm

Vegetable soup /
Chicken soup(1 soup 125 2 —–
bowl)

DINNER (8.00 Pm)

Jowar / bajra roti with

These grain are easy to digest and do not burden
ghee (1 tsp )(2 medium 200 6
the system.
size)

Mung dal and methi good combination of protein and iron for baby’s
150 4
sabji(1 bowl) growth

Kadhi / potato gravy(1

150 3 —
bowl)

Its iron content helps in increasing heamoglobin

jaggery(2 spoon) 25
with increasing blood volume.

36
Koshimbir / salad(1
50 2 Fiber helps in better digestion
bowl)

Beet root and carrots increase heamoglobin and

Beetroot + carrot
150 6 are ich in Vitamin A and other essential nutrients
kheer(1 bowl)
that helps in growth of the baby.

10.00 Pm

Along with good nutrition, a glass of warm milk

Milk(1 glass) 150 4
at bedtime helps in getting a good night sleep.

It helps in maintaining Ph balance in blood due to

2 dates (2 pieces) 25 1
rise in blood volume

TOTAL 2600 77

HEALTH EDUCATION
 Help the patient and family members to understand the patient physical and mental
changes.
 Teach them to identify the sign and symptoms of life threatening myxedema.
 Explain long term hormone replacement therapy.
 Advice the patient to always wear a medical identification bracelet and carry drugs also.
 Tell the patient and family members to keep accurate records of daily weight and intake
output.
 Instruct patient to take high fibre rich diet to prevent constipation.
 Explain the patient about the postnatal exercise to avoid fatigue and get adequate rest.
 Explain the need to avoid extreme cold temperature
 Explain the importance of continuing medication exactly as directed by your doctor daily
and at the same time every day.
 Advice the patient to take medicine on an empty stomach 30 minutes to an hour before
breakfast.
 Advice the patient, not stop taking the medication even if you feel better.
 Educate not take your thyroid medication at the same time as fibre supplements, calcium,
iron, multivitamins, or aluminium hydroxide antacids or any medications that bind bile
acids. Take thyroid medication and these medications at least 4 hours apart.
 Advice any adverse effects or concerns, immediately report them to your primary health
care provider.

37
  Advice about the adverse effects of excessive amounts of thyroid hormone, which include
palpitations, rapid weight loss, restlessness or shakiness, sweating, and insomnia.
 Explain about the importance and benefits of Colostrum and breast feeding
 Explain about the importance of regular follow up
 Explain how to take care of baby, and how to bath and feed the baby
 Explain the importance of postnatal care, including :-
 Diet, postnatal hygiene, Rest and Sleep, Bowel, Care of Breast etc
 Explain about importance of spacing child and family planning methods

DISCHARGE TEACHING

MEDICATIONS

 Explained the importance of medication

 Instruct to take regular medicine
 Explain the route and dose of drugs

DIET

 Encourage the patient to have diet rich in protein and calories

 Advised to have plenty of fluid

BREAST FEEDING

 Advised the mother for exclusive breast feeding for six months
 Taught the mother the proper feeding techniques
 Educated the mother regarding the proper breast hygiene and care

EXERCISE

 Encourage patient for deep breathing exercise. Move extremities when lying.
 Elevate the head when sleeping to promote increase peripheral circulation
 Exercises like tailor sitting, squatting, pelvic rocking and abdominal muscle contraction.
 Explain the importance of Yoga

EXPECTATIONS (PROGNOSIS)

Very early diagnosis generally results in a good outcome. Newborns diagnosed and treated in the
first month or so generally develop normal intelligence. Untreated, mild hypothyroidism can lead
to severe mental retardation and growth retardation. Critical development of the nervous system
takes place in the first few months after birth. In my patient prognosis is very good.

38
SUMMARY AND CONCLUSION

Once hypothyroidism is diagnosed, thyroid hormone replacement therapy may be used to treat
the mother. Dosage of thyroid hormone replacement therapy is based on the individual's levels of
thyroid hormones. The treatment is safe and essential to both mother and fetus. When the fetus is
born, routine newborn screening includes a test of thyroid hormone levels.
My patient Mrs poonam saluja 22 years old female with 9 months pregnancy was admitted in
SULTANIA JANANA HOSPITAL with the complaints of white vaginal discharge since last two
days, leaking per vagina was delivered by Injection Pitocin accelerated Full term vaginal
delivery (FTVD) on 25/3/20116 at 9.14 pm, male baby with of 2.7kg. Placenta and membrane
expelled completely after10 minutes. Her condition is better and she discharged on
28/3/2016.She was called for follow up after 15 days.

REFERENCES
1. Basvantthapa B. T. Text Book of Reproductory Health Nursing.1st edition. New Delhi.
Jaypee publication.

2. Basvantthapa B. T. Text Book of Nursing Theories.1st edition. New Delhi. Jaypee

publication.
3. Dutta D.C. (2004). A Text book Of Obstetrics Including Perinatology and
Contraception.6th edition. Kolkata: New Central Agency Publication
4. Jacob A. (2012). A Comprehensive Text book Of Midwifery and Gynecological
Nursing.3rd edition. New Delhi: Jaypee Publications

39
40