Necessary Medical Care Prerequisite for Hypothyroidism

Hypothyroidism:

There are several diseases that are getting more and more effective and spreading at a wide range in the societies. This indicates towards hypothyroidism that is a condition in which thyroid gland does not produce thyroid hormone. It can be primary from a thyroid gland disease or secondary to hypothalamic-pituitary disease which is mentioned in numerous Nursing Assignments as well.

Ethology:

Primary hypothyroidism:

  • Idiopathic
  • Radioiodine therapy
  • Agenesis
  • Transient due to a withdrawal of thyroid hormone treatment.
  • Hashimoto’s thyroiditis
  • Drug-induced such as lithium, propylthiouracil, sulphonamides etc.
  • Inborn errors.
  • Endemic iodine deficiency.

Secondary hypothyroidism:

It can be due to pituitary lesions

Tertiary hypothyroidism:

It can be due to hypothalamic lesions.

Clinical features:

  • Early indications include exhaustion, weakness in overall health, laziness, arthralgia, muscle issues, myalgia, obstruction, cool narrow-mindedness, migraine, dry skin, and menorrhagia.
  • Late indications include moderate discourse, nonattendance of perspiring, fringe purification, dryness, a diminished feeling of taste, smell, muscle issues, deafness, and obesity.

Signs present in hypothyroid patients:

  • Hands:

Starting from hands, peripheral cyanosis, swelling, dry cold skin, and anemia can be present.

  • Arms:

Small volume pulses with bradycardia are present. Carpal tunnel syndrome with delayed reflexes can also be seen.

  • Face:

A patient can present with alopecia, dry thin hair, depression, mental slowness, general swelling, peril orbital enema, vitiligo or swollen tongue can be present.

  • Chest:

Pleural or pericardial effusion can be present.

  • Legs:

Enema, slow reflexes or peripheral neuropathy can be seen.

Investigations:

Low serum T4 levels with high serum TSH usually more than 20 MU/l is diagnostic. Other labs for anti-thyroglobulin antibodies or ant thyroid peroxidase, serum LDH, serum cholesterol, sodium can be done.

Management:

  • The management of hypothyroidism includes replacement therapy. Thyroxine available in 25,50 and 100 microgram tablets.
  • Starting thyroxine with the low dose for the first 3 weeks and then increasing the dose for next 3 weeks up to 100 micrograms and then taking 150 micrograms for the rest of life. The pills are taken in the morning to avoid concomitant with food and drugs which may interfere with the absorption.
  • Correct dose should be given which can restore the TSH to normal. In patients suffering from ischemic heart, diseases require less dose of 25 micrograms along with beta-blockers and vasodilators.
  • Patients feel better within 2 to 3 weeks of treatment and it can reduce weight and periorbital puffiness early.

Secondary hypothyroidism:

This is less common as compared to the primary one and is characterized by atrophy if thyroid gland which leads to failure of TSH secretion.

Pseudo hypothyroidism:

The inability to utilize thyroxine in tissue cells despite normal thyroid function.

Myxoedema coma:

Myxoedema coma is defined as a depressed state of consciousness or coma due to severe hypothyroidism. It is a medical emergency.

Patient presents with hypothermia, hyponatremia, hypoglycemia and in a confused or comatose stage.

Management of Myxoedema coma:

T3 2.5 to 5 microgram is given IV or orally 8 hourly until improvement is observed then starting thyroxine. Therefore, additional measures include oxygen if necessary.

Conclusion:

Hypothyroidism is more common in elder women and having a positive family history is one of its risk factor increasing its chance to three folds and leading many problems in the later life of women such as joint stiffness as well as infertility. But a good news is that it can be treated by supplementation with the hormone itself.