COLLEGE OF NURSING AND ALLIED HEALTH PROFESSIONS

HYPOTHYROIDISM

Submitted by:
GROUP 2-B
Elaine Bea
Mary Angieline Casinillo
Rhea Kris Castro
Christine Correa
Renz Cruz
Andrea Del Valle
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I. INTRODUCTION

Hypothyroidism happens when your thyroid gland, located at the

front of your neck, doesn’t produce enough thyroid hormone
(underactive thyroid). There are several types of hypothyroidism.
The most common is Hashimoto’s thyroiditis, an autoimmune disease
where the immune system mistakenly attacks the thyroid gland. The
disease affects both sexes and all ages but is most common in
women over age 60. Because the thyroid gland helps regulate your
metabolism, low thyroid levels cause your body to slow down,
affecting everything from appetite to body temperature. Symptoms
can appear over time and can be hard to diagnose. Left untreated,
hypothyroidism can cause serious health complications.

There are different kinds of hypothyroidism with different

causes. In Hashimoto’s thyroiditis, antibodies in the blood
mistakenly attack the thyroid gland and start to destroy it.
Post-therapeutic hypothyroidism occurs when treatment for
hyperthyroidism leaves the thyroid unable to produce enough
thyroid hormone. And hypothyroidism with goiter happens when you
don’t get enough iodine in your diet. In the developed world
iodine is added to salt so goiter is rare, although it still
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happens in undeveloped countries. Hypothyroidism is one of the

most common chronic diseases. Symptoms may not appear until years
after the thyroid has stopped functioning and they are often
mistaken for signs of other illnesses, menopause, or aging.
Although this condition is believed to affect as many as 11
million adults and children, as many as two of every three people
with hypothyroidism may not know they have the disease.

Nicknamed "Gland Central" because it influences almost every

organ, tissue, and cell in the body, the thyroid is shaped like a
butterfly and located just below the Adam's apple. The thyroid
stores iodine the body gets from food and uses this mineral to
create T4. Low T4 levels can alter weight, appetite, sleep
patterns, body temperature, sex drive, and a variety of other
physical, mental, and emotional characteristics. Factors that
increase a person's risk of developing hypothyroidism include
age, weight, and medical history. Women are more likely to
develop the disease after age 50; men, after age 60. Obesity also
increases risk. A family history of thyroid problems or a
personal history of high cholesterol levels or such autoimmune
diseases as lupus, rheumatoid arthritis, or diabetes can make an
individual more susceptible to hypothyroidism.

II. DEFINITION

Hypothyroidism (underactive thyroid) is a medical condition were

the thyroid gland does not make enough thyroid hormone. A
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condition resulting from decreased production of thyroid

hormones. The symptoms vary between individuals.

The thyroid gland is located in the neck, near the base of the
throat. It makes hormones that help control some of your body’s
metabolic processes, such as heart rate, blood pressure, body
temperature and weight. Hypothyroidism occurs when your body
doesn’t produce enough thyroid hormones. The thyroid is a small,
butterfly-shaped gland that sits in front of windpipe. It
releases hormones that helps body regulate and use energy.

Thyroid hormones help control functions including how heart beats

and how your digestive system works. Without the right amount of
thyroid hormones, your body’s natural functions begin to slow
down.

Also called underactive thyroid, hypothyroidism usually affects

people over the age of 60 and is more common in women than men.
It may be discovered through a routine blood test or after
symptoms begin. Subclinical hypothyroidism is the name given to
an early, mild form of the condition. The disease gets more
common with age. People over 60 years old experience it more
frequently. Women are more likely to have an underactive thyroid.
In fact, 1 in 8 women will develop thyroid issues.

III. REVIEW OF ANATOMY AND PHYSIOLOGY

A butterfly-shaped organ, the thyroid gland is located anterior

to the trachea, just inferior to the larynx ([link]). The medial
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region, called the isthmus, is flanked by wing-shaped left and

right lobes. Each of the thyroid lobes are embedded with
parathyroid glands, primarily on their posterior surfaces. The
tissue of the thyroid gland is composed mostly of thyroid
follicles. The follicles are made up of a central cavity filled
with a sticky fluid called colloid. Surrounded by a wall of
epithelial follicle cells, the colloid is the center of thyroid
hormone production, and that production is dependent on the
hormones’ essential and unique component: iodine.

Thyroid Gland

The thyroid gland is located in the neck where it wraps around

the trachea. (a) Anterior view of the thyroid gland. (b)
Posterior view of the thyroid gland. (c) The glandular tissue is
composed primarily of thyroid follicles. The larger
parafollicular cells often appear within the matrix of follicle
cells.
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The following steps outline the hormones’ assembly:

Binding of TSH to its receptors in the follicle cells of the

thyroid gland causes the cells to actively transport iodide ions
(I–) across their cell membrane, from the bloodstream into the
cytosol. As a result, the concentration of iodide ions “trapped”
in the follicular cells is many times higher than the
concentration in the bloodstream.

Iodide ions then move to the lumen of the follicle cells that
border the colloid. There, the ions undergo oxidation (their
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negatively charged electrons are removed). The oxidation of two

iodide ions (2 I–) results in iodine (I2), which passes through
the follicle cell membrane into the colloid.

In the colloid, peroxidase enzymes link the iodine to the

tyrosine amino acids in thyroglobulin to produce two
intermediaries: a tyrosine attached to one iodine and a tyrosine
attached to two iodine. When one of each of these intermediaries
is linked by covalent bonds, the resulting compound is
triiodothyronine (T3), a thyroid hormone with three iodine. Much
more commonly, two copies of the second intermediary bond,
forming tetraiodothyronine, also known as thyroxine (T4), a
thyroid hormone with four iodine.

In the bloodstream, less than one percent of the circulating T3

and T4 remains unbound. This free T3 and T4 can cross the lipid
bilayer of cell membranes and be taken up by cells. The remaining
99 percent of circulating T3 and T4 is bound to specialized
transport proteins called thyroxine-binding globulins (TBGs), to
albumin, or to other plasma proteins. This “packaging” prevents
their free diffusion into body cells. When blood levels of T3 and
T4 begin to decline, bound T3 and T4 are released from these
plasma proteins and readily cross the membrane of target cells.
T3 is more potent than T4, and many cells convert T4 to T3
through the removal of an iodine atom.

In the bloodstream, less than one percent of the circulating T3

and T4 remains unbound. This free T3 and T4 can cross the lipid
bilayer of cell membranes and be taken up by cells. The remaining
99 percent of circulating T3 and T4 is bound to specialized
transport proteins called thyroxine-binding globulins (TBGs), to
 COLLEGE OF NURSING AND ALLIED HEALTH PROFESSIONS

albumin, or to other plasma proteins. This “packaging” prevents

their free diffusion into body cells. When blood levels of T3 and
T4 begin to decline, bound T3 and T4 are released from these
plasma proteins and readily cross the membrane of target cells.
T3 is more potent than T4, and many cells convert T4 to T3
through the removal of an iodine atom.

Regulation of TH Synthesis

The release of T3 and T4 from the thyroid gland is regulated by

thyroid-stimulating hormone (TSH). As shown in [link], low blood
levels of T3 and T4 stimulate the release of thyrotropin-
releasing hormone (TRH) from the hypothalamus, which triggers
secretion of TSH from the anterior pituitary. In turn, TSH
stimulates the thyroid gland to secrete T3 and T4. The levels of
TRH, TSH, T3, and T4 are regulated by a negative feedback system
in which increasing levels of T3 and T4 decrease the production
and secretion of TSH.

Classic Negative Feedback Loop

A classic negative feedback loop controls the regulation of

thyroid hormone levels.
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IV. PATHOPHYSIOLOGY

The most common form of hypothyroidism is the inability of the

thyroid gland to produce a sufficient amount of thyroid
hormone however, less commonly pituitary and hypothalamus may
also result in thyroid dysfunction. The hypothalamus secretes
thyrotropin-releasing hormone or the (TRH) that stimulates the
pituitary gland to produce thyroid-stimulating hormone or
(TSH). Thyroid-stimulating hormone stimulates the thyroid
gland to produce and secrete mainly T4 (approximately 100-125
nmol daily) and smaller quantities of T3. The half-life of T4
is 7-10 days, and eventually, T4 is converted to T3
peripherally by 5 deiodination. Levels of T3 majorly and T4,
to some extent, in turn, exert negative feedback on the
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production of TRH and TSH. Alteration in the structure and

function of any of these organs or pathways can result in
hypothyroidism. The decline in the production of T4 results in
an increase in the secretion of TSH by the pituitary gland,
causing hypertrophy and hyperplasia of the thyroid parenchyma,
thereby leading to increased T3 production.
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V. S/SA
 Tiredness
 Being sensitive to cold
 Weight gain
 Constipation
 Depression
 Slow movements and thoughts
 Muscle aches and weakness
 Muscle cramps
 Dry and scaly skin
 Loss of libido (sex drive)

VI. DRUG STUDY

Standard treatment for hypothyroidism involves daily use of

the synthetic thyroid hormone levothyroxine (Levo-T,
Synthroid,others). This oral medication restores adequate
hormone levels, reversing the signs and symptoms of
hypothyroidism.

VII. MED/SURG MANAGEMENT

Medical Management
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The primary objective in the management of hypothyroidism is

to restore a normal metabolic state by replacing the missing
hormone.

Pharmacologic therapy. Synthetic levothyroxine is the

preferred preparation for treating hypothyroidism and
suppressing nontoxic goiters. Prevention of cardiac
dysfunction. As long as metabolism is subnormal and the
tissues require relatively little oxygen, a reduction in the
blood supply is tolerated without overt symptoms of coronary
artery disease. Supportive therapy. Oxygen saturation levels
should be monitored; fluids should be administered cautiously;
application of external heat must be avoided, and oral thyroid
hormone therapy should be continued.

Surgical Management

Partial thyroidectomy if only part of your thyroid is removed,

the remaining portion typically takes over the function of
entire thyroid gland. So you might not need thyroid hormone
therapy.

Complete thyroidectomy if your entire thyroid is removed, your

body can’t make thyroid hormone. Without replacement you’ll
develop signs and symptoms of underactive thyroid
(hypothyroidism). Therefore, you’ll need to take a pill every
day that contains the synthetic thyroid hormone levothyroxine
(Synthroid, Unithroid, others).
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This hormone replacement is identical to the hormone normally

made by your thyroid gland and performs all of the same
functions. Your doctor will test your blood to know how much
thyroid hormone replacement you need.

VIII. NURSING MANAGEMENT

Nursing management for a patient with hypothyroidism include

the following:

 Promote activity. Space activities to promote rest and

exercise as tolerated.
 Protect against coldness. Provide extra layer of clothing
or extra blanket.
 Avoid external heat exposure.
 Discourage and avoid the use of external heat source.
 Mind the temperature. Monitor patient’s body temperature.
 Increased fluid intake. Encourage increased fluid intake
within the limits of fluid restriction.
 Provide foods high in fiber.
 Manage respiratory depth, rate, pattern, pulse oximetry,
and ABG.
 Pulmonary exercises. Encourage deep breathing, coughing,
and use of incentive spirometry.
 Orient to present surroundings.
 Orient patient to time, place, date, and events around
him or her.
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I. REFERENCES

introduction for hypothyroidism - Search (bing.com)

Hypothyroidism (Underactive Thyroid): Symptoms, Causes, Treatment

(healthline.com)

Hypothyroidism | definition of hypothyroidism by Medical

dictionary (thefreedictionary.com)

http://pressbooks-dev.oer.hawaii.edu/anatomyandphysiology/
chapter/the-thyroid-gland/
https://www.nhs.uk/conditions/underactive-thyroid-
hypothyroidism/symptoms/
https://www.mayoclinic.org/diseases-conditions/hypothyroidism/
diagnosis-treatment/drc-20350289#:~:text=Standard%20treatment
%20for%20hypothyroidism%20involves,signs%20and%20symptoms%20of
%20hypothyroidism.
https://www.mayoclinic.org/tests-procedures/thyroidectomy/about/
pac-20385195?
fbclid=IwAR2yqd35U_f7Z0KX_Z2Y6VpEfckjebloxdSsA2eqBXiCNmdsP1jsn8oY
OYs#:~:text=Thyroidectomy%20is%20used%20to%20treat,on%20the
%20reason%20for%20surgery
https://nurseslabs.com/hypothyroidism/?
fbclid=IwAR1sGzXbph9RCqORdftAa-
2KSejnM9H_28PeKU7JqcS37FRVbhcvW9BwRm8