NCLEX Review on Hypothyroidism

Hey everyone, it's Sarah with RegisteredNurseAriene.com and in this video I'm going to be going over hypothyroidism. What I'm going to be doing is I'm going to be doing an NCLEX 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, registernurserian.com, 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... 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 pathogen. In order to understand why you're seeing these signs and symptoms, the 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. Your thyroid gland sits below your larynx, your voice box, right below the Adam's apple on men, the laryngeal prominence. It's like a butterfly shaped gland. 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 too because you can have low calcium levels so remember that for a thyroidectomy so what does a thyroid do what's its role the thyroid produces thyroid hormones t3 and t4 and those hormones play a huge huge role in our body's metabolism, temperature regulation, and growth and development, especially in your pediatric patients. They need to have good thyroid levels while they're growing up so that brain can develop good. Now, 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 in your brain, the thyroid cannot make T3 and T4 without the thyroid. iodine. So iodine, you get that from food. Whenever you take that in 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... it does normally. So remember, if you have way too much, what it does normally is going 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, food's going to move slowly through your body, so you're going to struggle with constipation. It stimulates... sympathetic nervous system, you don't have enough, your sympathetic nervous system isn't going to be stimulated, so you're going to be drowsy, lethargic, because normally it causes you to have alertness, quick responses, quick reflexes, keeps your body temperature increased, you don't have enough, it's going to lower, you're not going to have body regulation, so you're going to struggle with feeling cold, regulates your heart rate, brain development, and the regulation of the thyroid stimulating hormone, which we're going to to talk about the negative feedback loop here in a second. So what does TSH do? The thyroid stimulating hormone. It is produced from the 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 thyrotropin releasing hormone. Whenever that is released, the anterior pituitary gland says, hey, I'm going to release TRH. release TSH, which is thyroid stimulating hormone. Whenever that's released, 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… pituitary gland. What can happen is that it will not release the TSH which will not stimulate your thyroid to release T3 and T4. So you could be getting hypothyroidism. Now Now, this feedback, it's a feedback loop, so it works continuously and it 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 it. It's just like a little constant loop that keeps going back and forth. Now let's look at the signs and symptoms. How is the patient going to look to you as a nurse with this condition? Let the condition's 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's going to be happening? He's going to be struggling with weight gain because they are not burning calories. like how T3 and T4 normally allows. So they're gonna be gaining weight. They're not gonna be able to tolerate the cold because their thermostat is not working correctly. They're gonna 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 constant stimulation, it starts to swell and you get the border. So you're gonna have a lot of pressure and this is a big sign in Hashimoto's disease which is a cause of hypothyroidism which we'll 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 myoxidemia, which is swelling of the eyes. face, puffy face with a waxy type appearance, dry skin, and menstrual problems like heavy periods or irregular periods. Now these signs and symptoms in the early stages, the person tends to just be struggling with fatigue and feeling tired. And then once they 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 is attacking your thyroid gland where it's causing it to not produce any more T3 and T4. So thyroid gland is not working and remember they're going to probably have that border from that because the 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. 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, but it's not. not very much because our table salt is now have iodine, but in countries who don't put iodine in salt, people do struggle with not consuming enough iodine, so watch out for that. Pituitary tumor, again, that's just because 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. H level to see if it's how those levels have been. Another thing that can cause hypothyroidism is actually a patient being treated for hyperthyroidism. So if they were getting the radioactive iodine or the antithyroid 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 intervention? First thing we want to do is we want to monitor them for myxedema 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 just no hormones present. So what happens? The body literally is shutting down. It's slowing down to the point of death. 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 is 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 drought. drowsiness, respiratory failure, and bradycardia. Hypoglycemia, hyponatremia, hypoglycemia because your thyroid hormone plays a role in glucogenesis, 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 some more in nursing interventions You want to monitor their heart rate their blood pressure respiratory rate blood glucose their weight because remember they're gaining weight And keep the patient warm Another important thing to remember these patients patients with hypothyroidism are very sensitive sensitive to sedatives and opioids. So if 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, because these patients are super sensitive to those medications and it could send them into a myxedema 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. Most common thyroid replacement drug for hypothyroidism you've probably seen if you've even worked in a hospital for a day is Synthroid. It seems like everyone's on Synthroid. Synthroid also called Levothyroxine. It's most commonly prescribed. You also have Cytomel also known as T3 or Levothyronine sodium. There's also Thyrolar or Lyotrix which is another name for that. So those are the three common but Synthroid is the absolute most common. 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 myxedema coma. It's best, especially Synthroid, to take this medication in the morning without any food, just one. water one hour before you eat. So early in the morning, take this medicine. That's how you take it. Signs and symptoms of toxicity, they need to know in case they're getting way too much of the hormone replacement, which would be your typical hyperthyroidism symptoms like increased heart rate, chest pain, heat intolerance. They 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 caraphae, aluminum hydroxide or simethicone also known as Gasex because these drugs decrease absorption of thyroid medications. So don't take within 4 hours of those medicines. Okay so that is about hypothyroidism. Now go take that quiz on my website registernurseRN.com and check out the video on hyperthyroidism and thank you so much for watching and please consider subscribing to this YouTube channel.

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, registernurserian.com, 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... 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 pathogen.

In order to understand why you're seeing these signs and symptoms, the 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. Your thyroid gland sits below your larynx, your voice box, right below the Adam's apple on men, the laryngeal prominence.

It's like a butterfly shaped gland. 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 too because you can have low calcium levels so remember that for a thyroidectomy so what does a thyroid do what's its role the thyroid produces thyroid hormones t3 and t4 and those hormones play a huge huge role in our body's metabolism, temperature regulation, and growth and development, especially in your pediatric patients. They need to have good thyroid levels while they're growing up so that brain can develop good. Now, 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 in your brain, the thyroid cannot make T3 and T4 without the thyroid. iodine. So iodine, you get that from food. Whenever you take that in 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...

it does normally. So remember, if you have way too much, what it does normally is going 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, food's going to move slowly through your body, so you're going to struggle with constipation.

It stimulates... sympathetic nervous system, you don't have enough, your sympathetic nervous system isn't going to be stimulated, so you're going to be drowsy, lethargic, because normally it causes you to have alertness, quick responses, quick reflexes, keeps your body temperature increased, you don't have enough, it's going to lower, you're not going to have body regulation, so you're going to struggle with feeling cold, regulates your heart rate, brain development, and the regulation of the thyroid stimulating hormone, which we're going to to talk about the negative feedback loop here in a second. So what does TSH do?

The thyroid stimulating hormone. It is produced from the 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 thyrotropin releasing hormone. Whenever that is released, the anterior pituitary gland says, hey, I'm going to release TRH.

release TSH, which is thyroid stimulating hormone. Whenever that's released, 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… pituitary gland. What can happen is that it will not release the TSH which will not stimulate your thyroid to release T3 and T4.

So you could be getting hypothyroidism. Now Now, this feedback, it's a feedback loop, so it works continuously and it 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 it.

It's just like a little constant loop that keeps going back and forth. Now let's look at the signs and symptoms. How is the patient going to look to you as a nurse with this condition?

Let the condition's 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's going to be happening? He's going to be struggling with weight gain because they are not burning calories. like how T3 and T4 normally allows. So they're gonna be gaining weight.

They're not gonna be able to tolerate the cold because their thermostat is not working correctly. They're gonna 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 constant stimulation, it starts to swell and you get the border.

So you're gonna have a lot of pressure and this is a big sign in Hashimoto's disease which is a cause of hypothyroidism which we'll 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 myoxidemia, which is swelling of the eyes. face, puffy face with a waxy type appearance, dry skin, and menstrual problems like heavy periods or irregular periods. Now these signs and symptoms in the early stages, the person tends to just be struggling with fatigue and feeling tired. And then once they 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 is attacking your thyroid gland where it's causing it to not produce any more T3 and T4.

So thyroid gland is not working and remember they're going to probably have that border from that because the 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. 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, but it's not. not very much because our table salt is now have iodine, but in countries who don't put iodine in salt, people do struggle with not consuming enough iodine, so watch out for that.

Pituitary tumor, again, that's just because 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.

H level to see if it's how those levels have been. Another thing that can cause hypothyroidism is actually a patient being treated for hyperthyroidism. So if they were getting the radioactive iodine or the antithyroid 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 intervention? First thing we want to do is we want to monitor them for myxedema 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 just no hormones present.

So what happens? The body literally is shutting down. It's slowing down to the point of death.

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 is 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 drought.

drowsiness, respiratory failure, and bradycardia. Hypoglycemia, hyponatremia, hypoglycemia because your thyroid hormone plays a role in glucogenesis, 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 some more in nursing interventions You want to monitor their heart rate their blood pressure respiratory rate blood glucose their weight because remember they're gaining weight And keep the patient warm Another important thing to remember these patients patients with hypothyroidism are very sensitive sensitive to sedatives and opioids. So if 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, because these patients are super sensitive to those medications and it could send them into a myxedema 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.

Most common thyroid replacement drug for hypothyroidism you've probably seen if you've even worked in a hospital for a day is Synthroid. It seems like everyone's on Synthroid. Synthroid also called Levothyroxine.

It's most commonly prescribed. You also have Cytomel also known as T3 or Levothyronine sodium. There's also Thyrolar or Lyotrix which is another name for that. So those are the three common but Synthroid is the absolute most common. 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 myxedema coma.

It's best, especially Synthroid, to take this medication in the morning without any food, just one. water one hour before you eat. So early in the morning, take this medicine.

That's how you take it. Signs and symptoms of toxicity, they need to know in case they're getting way too much of the hormone replacement, which would be your typical hyperthyroidism symptoms like increased heart rate, chest pain, heat intolerance. They 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 caraphae, aluminum hydroxide or simethicone also known as Gasex because these drugs decrease absorption of thyroid medications. So don't take within 4 hours of those medicines.

Okay so that is about hypothyroidism. Now go take that quiz on my website registernurseRN.com and check out the video on hyperthyroidism and thank you so much for watching and please consider subscribing to this YouTube channel.

Transcript for:NCLEX Review on Hypothyroidism

Transcript for:
NCLEX Review on Hypothyroidism