Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis

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Study Tools For Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis

Hashimoto’s Thyroiditis (Picmonic)
Hyper vs. Hypothyroidism (Cheatsheet)
Symptoms of Hypothyroidism (Mnemonic)
Symptoms of Hypothyroidism (Image)
Facial Symptoms of Hypothyroidism (Image)
Hypothyroidism Pathochart (Cheatsheet)
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Outline

Overview

Pathophysiology: This is caused by an autoimmune disorder that results in a deficiency of the thyroid hormone and the gland is unable to make sufficient amounts of the thyroid hormone.

  1. Hashimoto’s thyroiditis
    1. Autoimmune
    2. Thyroid destruction –> hypothyroidism

Nursing Points

General

  1. Autoimmune disorder
    1. Antibodies attack thyroid –> injury
    2. Thyroid hormones decrease
    3. Result = hypothyroidism
    4. Purpose of thyroid hormones
      1. Energy
      2. Warmth
      3. Proper organ function
  2. Diagnosed by lab values
    1. Elevated anti-thyroid peroxidase (TPO)–> antibodies against thyroid
    2. Elevated thyroid stimulating hormone (TSH) –> high levels overcompensating
      1. Made in brain, tells thyroid to release hormones
      2. Normal usually 0.4-5.0 mU/L
    3. Thyroid hormones
      1. Low T3 (nomal 80-180 ng/dL)
      2. Low T4 (normal 4.6-12 ug/dL)
  3. Autoimmune response triggered by…
    1. Genes
    2. Virus/Infection
    3. Drugs

Assessment

  1. Presentation
    1. Enlarged thyroid (goiter)
    2. Fatigue
    3. Coarse, dry skin
    4. Weight gain
    5. Sensitive to cold
  2. May not have symptoms

Therapeutic Management

  1. Monitor
    1. TSH levels
    2. Thyroid ultrasound –> visualize thyroid
  2. Give levothyroxine –> increase thyroid hormone release

Nursing Concepts

  1. Hormone regulation –> Immune system attack on thyroid results in decreased thyroid hormones and TSH
  2. Lab values –> Diagnosed by levels of TSH, T3, T4, TPO
  3. Pharmacology –> Treated with daily levothyroxine (synthetic hormone)

Patient Education

  1. Follow up with labs
  2. Continue physical activity
  3. Take medication every day

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Transcript

Hey guys! Welcome to the lesson where we will explore what Hashimoto’s thyroiditis is and how we manage it.

So Hashimoto’s thyroiditis is an autoimmune disorder, which means the body is attacking itself. The autoimmune process can be triggered by genes, a virus or infection, or even drugs. What happens is that the antibodies attack the thyroid which causes injury. The injured thyroid cannot release the normal amount of thyroid hormones, and the result is hypothyroidism.

To know whether or not a patient has Hashimoto’s thyroiditis, the doctor may order lab work. Anti-thyroid peroxidase levels will be high, showing that there are antibodies against the thyroid in the body. The thyroid stimulating hormones will be high as well from trying to overcompensate for the lack of thyroid hormones. Remember that the TSH is what tells the thyroid to make the thyroid hormones, so if they are low, more will be made. The thyroid hormones include T3 and T4 and will both be low. Alright guys, next let’s move on to exploring what the hormones do.

Thyroid hormones play a huge role with the metabolism in our body. The thyroid hormones actually bind to cell receptors and increase the breakdown of nutrients creation of energy. This helps our body regulate temperature so that we don’t get too cold. The thyroid hormones are needed for proper organ function. They affect the heart rate, GI motility, and neurological development. So if we have LESS thyroid hormone, these processes will be SLOWER. So the heart rate will be slower, our GI system will move slower, and it might become harder to think or rememer things.
So our patient that has Hashimoto’s thyroiditis might have an enlarged thyroid or goiter like this from the thyroid being attacked by the antibodies. Remember, everything is slowed down, so the patient will be tired, they might gain weight and feel cold because of the slower metabolism. Constipation can occur from that slowed GI motility. Less thyroid hormone results in decreased excretion of the skin glands, causing dry, coarse skin. The patient could present with myxedema where the skin looks swollen and puffy, usually around the eyes, hands, and feet. It’s important to also realize that these patients might not show these symptoms right away.

If your patient is diagnosed with Hashimoto’s thyroiditis, they will need regular monitoring of their TSH levels. They may need a thyroid ultrasound to see the damage to the thyroid gland. Levothyroxine is a drug given to patients with hypothyroidism to help increase the thyroid hormone release in the body. This drug is given early in the morning because it shouldn’t be taken with food that can interfere with the absorption of the drug.

 

Our patients with Hashimoto’s thyroiditis should be educated to follow up with lab tests to check the thyroid hormone levels regularly. Moderate physical activity should be encouraged to help the patient manage their weight, joint pain, and give them energy. Let your patient know to take their levothyroxine every day early in the morning and not with food.

Our priority nursing concepts for Hashimoto’s thyroiditis are hormone regulation, lab values, and pharmacology.

Alright guys, let’s review the key points. Hashimoto’s thyroiditis is an autoimmune disorder where a trigger causes the antibodies to attack the thyroid causing damage, decreasing the thyroid hormones resulting in hypothyroidism. Lab values to diagnose the disease include increased thyroid stimulating hormone or TSH, decreased T3 and T4, and increased anti-thyroid peroxidase or TPO. Remember, TSH is high because it’s trying to get the thyroid to make more T3 and T4. TPO is high because there are many antibodies attacking the thyroid gland.

So remember that hypothyroidism causes everything to slow down. The patient will present with cold, dry skin, they may be tired alot and have memory issues. The might have gained weight and be experiencing constipation from the decreased GI motility. The heart rate might be slow. Remember, they may not show any symptoms yet. The doctor will want to check TSH levels regularly to monitor the disease. They may order a thyroid ultrasound to view the thyroid gland. Levothyroxine is given to the patient to increase the production of thyroid hormones. The patient with Hashimoto’s thyroiditis should be educated to take the levothyroxine early in the morning every day, not with food. They should stay active, and follow up with lab work. 

Thanks so much for listening! I hope you have a good grasp on what Hashimoto’s thyroiditis is and how to care for patients with this disease. Now go out and be your best self today, and as always, happy nursing!

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Study Plan for Test 4

Concepts Covered:

  • Terminology
  • Disorders of Pancreas
  • Lower GI Disorders
  • Respiratory Disorders
  • Acute & Chronic Renal Disorders
  • Disorders of the Thyroid & Parathyroid Glands
  • Shock
  • Disorders of the Adrenal Gland
  • Liver & Gallbladder Disorders
  • Immunological Disorders
  • Disorders of the Posterior Pituitary Gland
  • Endocrine System
  • Urinary System
  • Eating Disorders
  • Musculoskeletal Disorders
  • Central Nervous System Disorders – Brain
  • Note Taking
  • Test Taking Strategies
  • Basics of NCLEX

Study Plan Lessons

Metabolic & Endocrine Terminology
Metabolic & Endocrine Terminology
Antidiabetic Agents
Methylprednisolone (Solu-Medrol) Nursing Considerations
Fluticasone (Flonase) Nursing Considerations
Iodine Nursing Considerations
Calcium Acetate (PhosLo) Nursing Considerations
Propylthiouracil (PTU) Nursing Considerations
Epinephrine (EpiPen) Nursing Considerations
Cortisone (Cortone) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Nursing Care and Pathophysiology for Hyperparathyroidism
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Management of Lyme Disease Nursing Mnemonic (BAR)
Diagnostic Criteria for Lupus Nursing Mnemonic (SOAP BRAIN MD)
Diabetes Insipidus Nursing Mnemonic (DDD)
Cushings Assessment Nursing Mnemonic (STRESSED)
Adrenal Gland Hormones Nursing Mnemonic (The 3 S’s)
Addisons Assessment Nursing Mnemonic (STEROID)
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan (NCP) for Rheumatoid Arthritis (RA)
Nursing Care Plan (NCP) for Lyme Disease
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Gout / Gouty Arthritis
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Metabolic & Endocrine Terminology
Hypoparathyroidism
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Thyroid Gland
Pituitary Gland
Adrenal Gland
Renin Angiotensin Aldosterone System (RAAS)
Potassium-K (Hyperkalemia, Hypokalemia)
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Phosphorus-Phos
Musculoskeletal Course Introduction
Musculoskeletal Module Intro
Nursing Care and Pathophysiology for Rheumatoid Arthritis (RA)
Nursing Care and Pathophysiology for Gout
Nursing Care and Pathophysiology for Lyme Disease
Systemic Lupus Erythematosus (SLE)
Metabolic/Endocrine Course Introduction
Metabolic & Endocrine Module Intro
Addisons Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Meningitis
Vasopressin
Corticosteroids
Renin Angiotensin Aldosterone System
Drawing Pictures
Outline Question Method (Note taking)
NCLEX® Question Traps
Test Taking Course Introduction