May 29, 2023

Hypothyroidism nursing lecture about pathophysiology, medications/pharmacology, and complications such as myxedema coma. Hypothyroid is where the thyroid gland is under active and is not producing enough T3 and T4. This video is part of a hypothyroidism vs hyperthyroidism series and in this NCLEX review lecture I will discuss the pathophysiology of the thyroid gland, T3, T4, TSH, thyroid negative feedback loop, signs and symptoms of hypothyroidism, causes, nursing interventions. In addition, I will go into detail about myxedema coma and the thyroid hormone medications like Synthroid which will include patient education.

Hey everyone it’s sarah register nurse re and calm and in this video i’m going to be going over hypothyroidism what i want to be doing is i’m going to be doing an ink lex review to cover the signs and symptoms the causes the nursing interventions and the pharmacological aspects of things you need to know for nclex and your nursing lecture exam now in the next video

I’m going to be covering hyperthyroidism so be sure to check that out so you can see the differences between these two conditions now after you watch this video please go to my website register nurse orion comm and take the free quiz that will test you on the differences between hypo and hyperthyroidism and a card should be popping up so you can access that quiz

So let’s get started first let’s start out defining what is hypothyroidism what it is plain and simple it is an underactive thyroid gland that isn’t producing enough t3 and t4 which are thyroid hormones that keep our body working efficiently how is it diagnosed usually a physician will order a blood test and they will look at your t3 t4 and tsh levels which is

Thyroid stimulating hormone to diagnose this but first let’s cover the pathophysiology because in order to understand why you’re seeing these certain signs and symptoms that causes the medications we need to understand what’s going on in the body normally when these are normal and the key players involved first let’s look at the anatomy of the thyroid gland okay

Your thyroid glands sits below your larynx your voice box right below the adam’s apple on men laryngeal prominence and it’s like a butterfly-shaped gland and inside the gland you have parathyroid glands and your parathyroid is responsible for regulating your calcium levels and anytime you have damage to the thyroid gland like in a thyroidectomy or something like

That you have to watch your parathyroid to because you can have low calcium levels so remember that for thyroidectomy so what does a thyroid do what’s its role the thyroid produces thyroid hormones t3 and t4 and those who are moans play a huge role in our body’s metabolism temperature regulation and growth and development especially in your pediatric patients when

It they need to have good thyroid levels while they’re growing up so that brain can develop good now and like i said it produces t3 t4 and the calcitonin but what we’re worried about is t3 and t4 one important thing you want to remember this remember this in your brain the thyroid cannot make t3 and t4 whip out iodine so iodine you get that from food whenever you

Take that in for foot from food your thyroid gland takes that and helps develop t3 and t4 so if you’re not getting enough iodine you can struggle with hypothyroidism if you’re getting too much iodine you can struggle with hyperthyroidism so keep that in mind okay let’s talk about the function of t3 and t4 okay the functions this is what it does normally so remember

If you have way too much it’s the these what it does normally is want to go crazy if you don’t have enough it’s not going to do its job efficiently it’s going to be real slow so it normally burns calories you don’t have enough you’re not going to burn calories you’re going to gain weight determines how fast new cells replace dying cells how fast you digest food

So with hypo and foods going to move slowly through your body so you’re going to struggle with constipation it stimulates a sympathetic nervous system you don’t have enough you’re going to your sympathetic nervous system isn’t going to be stimulates you’re going to be drowsy lethargic because normally it causes you to have alertness quick responses quick reflexes

Keeps your body temperature increase you don’t have enough it’s going to lower it you’re not going to have body regulation so you’re going to struggle with feeling cold and regulates your heart rate brain development and the regulation of the thyroid stimulating hormone which we’re going to talk about the negative feedback loop here in a second so what does csh do

The thyroid stimulating hormone it is produced from anterior pituitary gland and whenever it is released from that it stimulates your thyroid gland to release t3 and t4 so let’s look at how it works okay your hypothalamus it releases trh which is tyrone tropen releasing hormone whenever that is released the anterior pituitary gland says hey i want to release tsh

Which is thyroid stimulating hormone and then whenever that’s relief the thyroid gland releases t3 and t4 now sometimes you can have some problems with this feedback loop for instance say you have a tumor on your anterior terry anterior pituitary gland what can happen is that it will not stick release the tsh which will not stimulate your thyroid to release t3 and

T4 so you could beginning hypothyroidism now this feedback it’s a feedback loop so it works continuously and constantly monitors these t3 and t4 levels so if you have just enough this will send to the hypothalamus that it doesn’t need to release its trh so it won’t release it until it needs to it’s just like a little constant loop that keeps going back and forth

Now let’s look at the signs and symptoms how does the patient want to look to you as a nurse with this condition let the conditions name help you whenever you’re thinking of these signs and symptoms we have hypothyroidism everything is working really slow and low because that is what hypo means low so what it’s going to be happening patients going to be struggling

With weight gain because they are not burning calories like howell t3 and t4 normally allows so they’re going to be gaining weight they’re going to be able to tolerate the cold because their thermostat is not working correctly they’re going to have a possible border on their neck you’ll see a bulging area on the neck and this is because you have constant stimulation

From that anterior pituitary gland trying to say hey thyroid release the t3 and t4 so we can increase our levels so from that class of stimulation it starts to swell and you get the border and this is a big song in hashimoto’s and disease which is a cause of hypothyroidism which will go over here in a second so remember that they’ll feel very tired and fatigued

Have a slow heart rate remember sympathetic nervous system just isn’t working right thinning and brittle hair they’ll struggle with depression constipation from the slow gi process they’ll have memory loss foggy mind just brain just doesn’t feel like it’s working they can have myxedema which is swelling of the eyes / face puffy face with a waxy type appearance dry

Skin and neutral problems like heavy periods periods or irregular periods now these signs and symptoms in the early stages the person tends just to be struggling with fatigue feeling tired and then once i get in the late stages they’ll start having these thinning hair these big symptoms that make them start noticing what’s going on now let’s talk about the causes

What causes this condition this mainly affects women middle-aged to older adults and one cause is hashimoto’s thyroiditis this is the most common cause of hypothyroidism it’s an autoimmune condition so the body is causing it to attack itself what it’s doing it is attacking your thyroid gland where it’s causing it to not to produce any more t3 and t4 so thyroid

Gland is not working and remember they’re going to probably have that water from that because they interior anterior pituitary glands trying to stimulate the thyroid hey produce some t3 and t4 but it’s not and so you get swelling of the neck so remember that that’s a telltale sign with hashimoto’s or they are not consuming enough iodine this is another cause iodine

Deficiency and so it’s important for them to consume foods that are high in iodine like your seafoods seaweed eggs dairy things like that now here in the us it used to be a problem that’s not very much because our table salt is now have iodine but in countries who don’t put iodine and salt people do struggle with how to consume enough iodine so watch out for that

A pituitary tumor again that’s just because the you have a tumor on the pituitary anterior pituitary it’s not releasing the tsh thyroid gland actually is fine it’s not messed up but it’s just not getting enough stimulation so that’s why the physician would check a tsh level to see if it’s how those levels have been and another thing that can cause hypothyroidism

Is actually a patient being treated for hyperthyroidism so there are getting the radioactive iodine or the anti-thyroid medicine medications that can cause their levels to just bottom out and it can actually send them into hypothyroidism now let’s look at the nursing interventions and the medications so what are you going to do for this patient as the nurse the

Nursing interventions first thing we want to do is we want to monitor them for mix edema coma which is a life-threatening condition caused by uncontrolled hypothyroidism maybe where they abruptly stopped taking their medications or there was the removal of the thyroid gland and there’s a snow hormones present so what happened the body literally is shutting down

It’s slowing down to the point of death and again it’s going to mimic a lot of those symptoms of hypothyroidism but it’s going to be exaggerated what you’re going to get you’re going to get hypothermia they’re not just going to be able to not tolerate the cold but they’re going to go into hypothermia they’re going to have extreme drowsiness respiratory failure

Bradycardia that goes along with literally the sympathetic nervous system it’s just shutting down hypoglycemia hyponatremia hypoglycemia because your thyroid hormone plays a role in gluco genesis so you’re going to have that drop and this is just going to progress to a coma so it needs to be treated so we need to give them some thyroid replacement hormones fast

Also with this condition with hypothyroidism or in nursing interventions you want to monitor their heart rate their blood pressure respiratory rate blood glucose their weight because remember wait and keep the patient warm another important thing to remember these patients patients with hypothyroidism are very sensitive to sedatives and opioids so they’re having

Pain you need to go with something that’s non-narcotic so you don’t want to do narcotics like dilaudid morphine fentanyl instead like tylenol ah because these patients are super sensitive to those medications and it can send them into a mix edema coma so be aware of that now medications let’s talk about the thyroid replacement therapy with this this is a lot easier

Than hyperthyroidism okay a most common thyroid replacement drug for hypothyroidism you’ve probably seen if you’ve even worked in a hospital for a day if synthroid seems like everyone’s on the centauri synthroid also called levo thyroxine it’s most commonly prescribed you also have side emil also noticed iii or levosa random sodium there’s also side roller or ly

O tricks which is another name for that so those are the three common but synthroid is the absolute most common so patient education very important a lot of test questions come from this okay where are you going to educate the patient about never stop taking these medications abruptly these medications take a while for the patient to start seeing improvement in

Their signs and symptoms so they may think it’s not working but they need to be educated about that it takes a while never just stop because they can go into the mix edema coma and it’s best especially synthroid to take this medication in the morning without any food just water one hour before you eat so early in the morning to take this medicine that’s how you

Take it signs and symptoms of toxicity they need to know in case they were getting way too much of the hormone replacement which would be your typical hypo hyperthyroidism symptoms like increase heart rate chest pain heat intolerance i need to notify their doctor because they’re probably toxic and another thing don’t take these medications within four hours of

Taking a gi med like kara fate aluminum hydroxide or smith also known as gasset because these drugs decrease absorption of thyroid medications so don’t take within four hours of those medicines okay so that is about hypothyroidism now going to take that quiz on my website register nurse orange comm and check out the video on hyperthyroidism and thank you so much

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Transcribed from video
Hypothyroidism Nursing Lecture NCLEX Pathophysiology & Medications By RegisteredNurseRN