Nursing Care of Patient with Thyroid Diseases .

NURSING CARE OF PATIENT WITH THYROID

DISEASES

Specific Objectives:
By the end of this topic the students will be able to:
1. List hormones produced by thyroid gland.
2. List the functions of thyroid gland hormones.
3. Define hyperthyroidism, hypothyroidism.
4. Identify the types of hyperthyroidism and hypothyroidism.
5. Identify signs and symptoms of hyperthyroidism and hypothyroidism.
6. Discuss steps of management and nursing care in hyperthyroidism
and hypothyroidism.

Thyroid Gland:
It is the largest gland in the body, located in the anterior portion of the
neck in the front of the trachea.

Hormones Produced by Thyroid Gland:

♦ Thyroxine (T4)
♦ Triiodothyronine (T3)
♦ Calcitonin.

Function of Thyroid Gland Hormones:

T3 & T4: Affect
- metabolic rate.
- Caloric requirements.
- Oxygen consumption.
- Carbohydrates, lipid metabolism.
- Growth and development.
- Brain function.
- Nervous function.
- Nervous system activities.

Calcitonin:
- Inhibits calcium resorption from bone.
- Increases calcium storage in bone.
- Increases renal excretion of calcium and phosphorus,
thereby,
- Lowers serum calcium level.

Disorders of Thyroid Gland:

I. Hyperthyroidism:
Hyperthyroidism (diffuse toxic goiter) is excessive activity of the
thyroid gland.
Incidence
More common in women than in men; occurs in about 2% of the
female
population.
Types:

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 Nursing Care of Patient with Thyroid Diseases .9

1. Graves’ disease (most prevalent) – diffuse hyperfunction of the

thyroid gland associated with ophthalmopathy.
2. Toxic nodular goiter (single or multiple)

Clinical Course and Manifestations:

1. Nervousness, emotional lability, irritability, apprehension.
2. Difficulty in sitting quietly.
3. Rapid pulse at rest as well as on exertion (ranges between 90 and
160); palpations.
4. Heat intolerance, profuse perspiration; flushed skin (e.g. hands change
in bowel habits-constipation or diarrhea).
5. Increased appetite and progressive weight loss; frequent stools.
6. Muscle fatigability and weakness; amenorrhea.
7. Atrial firbillation possible (cardiac decompensation common in elderly
patients).
8. Bulging eyes (exophthalmos)-produces a startled expression.
9. Thyroid storm or crisis, an extreme form of hyperthyroidism, is
characterized by hyperpyrexia, diarrhea, dehydration, tachycardia,
dysrhythmias, extreme irritation, delirium, coma, shock, and death. If
not adequately treated.
10. Thyroid storm may be precipitated by stress (surgery, infection, etc.)
or inadequate preparation for surgery in a patient with known
hyperthyroidism.

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Figure 9 – 1 Clinical picture of toxic crisis

Management:
A. Types of Treatment:
1. Antithyroid drug therapy.
2. Radiation.
3. Surgery.

• Treatment depends on causes, age of patient, severity of disease, and

complications.

1. Antithyroid Drugs:
a. Drugs That Inhibit Hormone Formation:
e.g. Preparations: thionamides”

b. Drugs to Control Peripheral manifestations of hyperthyroidism.

1. Propranolol (inderal)
Abolishes Tachycardia, tremor, excess sweating, nervousness.

2. Glucocorticoids:
Decreases the peripheral conversion of thyroxine to
triiodothyronine.

3. Radioactive Iodine:
Action: Limits secretion of thyroid hormone by destroying
thyroid tissue.

2. Surgery:
a. Surgery is an effective treatment modality in selected patients,
those with very large goiters, or those for whom the use of
radioiodine or thionamides is contraindicated.
b. Subtotal thyroidectomy:
Involves removal of most of the thyroid gland.

3. Preparation For surgery:

a. The patient must be euthyroid at time of surgery.
b. Thionamides are administered to control hyperthyroidism.
c. Iodide is given to increase firmness of thyroid gland and reduce
is vascularity.

Complications of Hyperthyroidism:
A. Thionamide toxicity

B. Hypothyroidism
Radioactive iodine therapy causes patient to become hypothyroid with
time.

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C. Complications of Thyroidectomy:
1. Hypothyrodism.
2. Hypoparathyroidism.

D. Eye Complications:
1. Exophthalmos – abnormal protrusion of the eyeball, most
commonly seen in Graves’ disease.
2. Proptosis – a forward bulging (displacement) of the eye.
3. Ophthalmoplegia – paralysis of the eye muscle.

Nursing Interventions:
A. Improving Nutritional Intake:
1. Provide high calorie foods and fluids consistent with the patient’s
requirements.
2. Restrict stimulants (tea, coffee, alcohol); explain rationale of
requirements and restrictions to patient.
3. Encourage / permit the patient to eat alone if embarrassed or
otherwise disturbed by voracious appetite.
4. Monitor intravenous infusion when prescribed to maintain fluid and
electrolyte balance.
5. Monitor fluid and nutritional status by weighing the patient daily
and keeping accurate intake and output records.
6. Monitor vital signs to detect changes in fluid volume status.
7. Assess skin turgor, mucous membranes, and neck veins for signs
of increased or decreased fluid volume.

B. Maintaining Skin Integrity:

1. Assess skin frequently to detect diaphoresis.
2. Bathe frequently with cool water; change linens when damp.
3. Protect and relieve pressure.

C. Encouraging Normal Thought Processes:

1. Limit visitors; avoid stimulating conversations or television
programs.
2. Reduce stressors in the environment; reduce noise and lights.
3. Promote sleep and relaxation.
4. Employ safety measures to reduce risk of trauma or falls (padded
side rails, maintain bed in low position).

D. Achieving Relief of Anxiety:

1. Encourage the patient to verbalize concerns and fears.
2. Gain the patient’s confidence.

II Hypothyroidism:
Hypothyroidism may be classified as primary, secondary or tertiary.

Primary hypothyroidism is a condition resulting from the inability of

the thyroid gland to secrete a sufficient amount of hormone.

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Secondary hypothyroidism is caused by a failure of the pituitary

gland to secrete an adequate amount of TSH (thyroid-stimulating
hormone).

Tertiary hypothyroidism results from failure of the hypothalamus to

release thyroid-releasing hormone (TRH).

Cretinism is a severe form of hypothyroidism resulting from

deficiency of thyroid function during fetal life or shortly after birth. The
mother has usually had deficiency of thyroid hormone function during
pregnancy.

Clinical Manifestations:
1. Fatigue and lethargy.
2. Weight gain.
3. Complaints of cold hands and feet.
4. Temperature and pulse become subnormal; unable to tolerate cold and
desires room temperature increased.
5. Severe constipation; decreased peristalsis.
6. Generalized appearance of thick, puffy skin; subcutaneous swelling in
hands, feet, and eyelids.
7. Hair thins; loss of the lateral one third of eyebrow.
8. Menorrhagia or amenorrhea; may have difficulty conceiving or
experiences spontaneous abortion; decreased libido.
9. Neurological signs (polyneuropathy, cerebellar ataxia); muscle aches
or weakness, clumsiness.
10. Hyperlipoproteinemia and hypercholesterolemia.
11. Enlarged heart on chest x-ray.
12. Increased susceptibility to all hypnotic and sedative drugs and
anaesthetic agents.
13. In severe hypothyroidism-hypotension, unresponsiveness, bradycardia,
hypo-ventilation, hyponatremia, (possibly) convulsion, hypothermia,
cerebral hypoxia, and myxedema.

Management:
1. The management depends on the severity of the patient’s symptoms.
2. Restoration of a normal metabolic state (Euthyroid) as rapidly as
possible.
Thyroid hormone-levothyroxine.

Nursing Interventions:
A. Improving Cardiac Output:
1. Control factors that increase metabolic rate and threaten
cardiovascular status:
a. Monitor vital signs.
b. Monitor ECG.
c. Prevent chilling to avoid increasing metabolic rate, which, in
turn, places strain on the heart.
d. Even though hypothermia exists, do not apply external heat, as
the resulting increased oxygen requirements and decreased
peripheral vascular tone may compound the existing cardiac
failure.
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e. Administer fluids cautiously, even though hyponatremia is

present.
f. Give prescribed glucose in concentrated amounts to prevent
fluid overload if hypoglycemia is in evidence.

2. Administer all prescribed drugs with caution before and after

thyroid replacement begins:

B. Increasing Activity Tolerance and a Balance of Rest and

Activity:
1. Limit visitors to prevent excessive stimulation.
2. Prevent pulmonary complications of immobility by turning, and
encouraging the patient to cough and take deep breaths.
3. Provide good skin care to prevent skin breakdown.

C. Improving Nutritional Status:

1. Encourage frequent intake of fluids; include dietary fiber to prevent
constipation.
2. Discourage straining at stool because of increased strain on the
heart.

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