Let’s Talk About Hypothyroidism

• Hypothyroidism is when the thyroid gland produces too little thyroid hormone.  
• Complications of hypothyroidism can affect every organ.  
• The goal of treatment is to return the patient to the pre-thyroid state and to prevent complications. 

In hypothyroidism, the thyroid gland produces too little thyroid hormone, lowering basal metabolism. Many people with hypothyroidism often remain undiagnosed, but the hormone disturbance may lead to atherosclerosis or medical complications, such as intraoperative hypotension and cardiac complications after surgery. 

In severe hypothyroidism, a hydrophilic, or “water-loving,” mucopolysaccharide is deposited throughout the body, causing nonpitting edema or myxedema and thickening facial features. The severe level of the disease is myxedema coma, which is a life-threatening condition characterized by cardiovascular collapse, severe electrolyte imbalances, respiratory depression, and cerebral hypoxia.

Hypothyroidism can be classified as cretinism, juvenile hypothyroidism, and adult hypothyroidism. Cretinism occurs in infants, a severe form of hypothyroidism, leading to altered skeletal muscle maturation and central nervous system development, resulting in retardation of physical growth or mental growth, or both. Juvenile hypothyroidism is most often caused by chronic autoimmune thyroiditis and affects the growth and sexual maturation of the child. Signs and symptoms are similar to adult hypothyroidism, and treatment reverses most of the clinical manifestations of the disease. 

Hypothyroidism complications can affect every organ. Cardiovascular depression can lead to poor peripheral perfusion, congestive heart failure, and heart enlargement. It can also cause intestinal obstruction, anemia, psychiatric problems, carpal tunnel syndrome, deafness, and impaired fertility. These are a few of the systemic complications that are caused by hypothyroidism.   

Causes of Hypothyroidism

Hypothyroidism can be a primary, secondary, or tertiary disease caused by other factors. However, it’s mostly a primary disorder resulting from the loss of thyroid tissue, leading to inadequate production of thyroid hormones. Often, it happens due to an autoimmune disorder that destroys the thyroid gland tissues. But it can also occur because of iodine deficiency.

Secondary hypothyroidism occurs if pituitary gland fails to stimulate the thyroid gland or as a result of a failure of the target tissues to respond to the thyroid hormones. Tertiary hypothyroidism is caused by failure of the hypothalamus to produce thyroid-releasing factor.

Clinical Signs of Hypothyroidism 

If hypothyroidism is suspected, nurses should take a complete medical history. The patient may describe a history of constipation, fatigue with little activity, weight gain with decreased food intake, achiness, stiffness, generalized weakness, slowing of intellectual functions, impaired memory, and loss of initiative.

Patients with hypothyroidism often complain about cold intolerance, and if accompanied by goiter, they may also have discomfort with clothes or jewelry that is close fitting around the neck. Hair loss and slow growth of nails and hair could also occur. Women may have heavy, irregular menstrual periods, and men may have impotence. Both may experience decreased libido.

Check if the patient’s diet includes iodine. Foods such as cabbage, spinach, radishes, and antithyroid medications or lithium salts can cause hypothyroidism in a person predisposed to the disease. Moreover, medications such as digoxin and insulin are potentiated by the hypothyroid state.

The most common early symptoms of hypothyroidism are sensitivity to cold, fatigue, and weight gain. People often contact their healthcare provider because of sleep apnea or carpal tunnel syndrome. Patients with hypothyroidism exhibit slowed metabolism and slow tendon-reflex relaxation. They also have a slow speech pattern, flat affect, and difficulty forming replies to interview questions.

With hypothyroidism, the patient may have a dry, thick tongue and hoarseness, dry, flaky skin with a pale or yellowish tint, and edema of the hands and feet. Fingernails and toenails may appear thick, grooved, and brittle. The patient’s face may have a distinctive appearance, with thick features such as a masklike appearance, edema around the eyes, drooping eyelids, and abbreviated eyebrows. The patient’s hair is often thin and dry; patchy hair loss is common.

If the patient has had hypothyroidism for some time, their skin feels calm, rough, and “doughy” on palpation. On examination, the thyroid tissue may not be found unless the patient has a goiter. Common findings of hypothyroidism include weak peripheral pulses, hypotension, and distant heart sounds. 

With hypothyroidism, the patient has either decreased or absent bowel sounds and may have abdominal distention. Other findings include hypothermia, shortness of breath, and either depressive or agitated mood states. Rare findings include hypoventilation, pericardial or pleural effusions, deafness, and carpal tunnel syndrome.  

The Bottom Line

Patients with hypothyroidism are often diagnosed at an outpatient clinic. The goal of treatment is to return the patient to the pre-thyroid state and prevent complications. The treatment of choice is to provide thyroid hormone supplements to correct hormonal deficiencies.

During early thyroid drug therapy, check the patient for signs and symptoms of cardiac abnormalities such as palpitations, chest pain, shortness of breath, and rapid heart rate. Compel your patients diagnosed with hypothyroidism to take medications as directed by the physician and attend follow-up visits.   

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