Deficiency in secretion of Thyroid Hormone leading to decreased metabolic rate, decreased heat production, and other effects on body systems Congenital
o Spontaneous gene mutation o An autosomal recessive genetic transmission of an enzyme deficiency o Hypoplasia or aplasia of thyroid gland Acquired o Idiopathic o Autoimmune thyroiditis (Hashimoto) Hypothyroidism: Symptoms Congenital (if not treated) • Thick, protruding tongue; thick lips • Hypotonia • Bradycardia • Larger posterior fontanel that stays open longer • Prolonged neonatal jaundice • Difficulty feeding • Hypothermia Acquired • Decreased appetite • Thinning hair • Bradycardia • Depressed deep tendon reflexes • Growth slows • Fatigue • Constipation • Cold Sensitivity • May be asymptomatic Congenital Hypothyroidism Before Treatment After
Congenital Hypothyroidism: Diagnosis Newborn screening T4 and TSH levels EARLY detection key to prevent neurological and developmental delays Those detected <3 months of age have best outcome with mental development Acquired Hypothyroidism: Diagnosis T3, T4, TSH Thyroid scan or ultrasound to evaluate thyroid Bone age X-ray to evaluate delayed growth Hypothyroidism: Treatment Thyroid hormone levothyroxine ( Synthroid ) for life Dose will need to be adjusted as child grows Check apical pulse and blood pressure prior to administration o Cause HTN o Hypo – brady & hypotension o High thyroid opposite Signs of toxicity/overdose? o Opposite signs of hypo o Hyperthyroidism sx Hypothyroidism: Nursing Interventions Plotting growth Instruct to not skip doses of medication and not to run out Monitor for continued signs of hypothyroidism: weight gain, sluggish, cold, hair loss Teach parents med administration, need for consistency in time; avoid mixing with soy formulas (soy interferes with body’s ability to absorb Synthroid) Need for lifelong monitoring and medication Hyperthyroidism (Grave’s Disease) Overproduction of thyroid hormone o High T3 & T4, low TSH Autoimmune Most common in ages 12-14 years Familial (often runs in families) Hyperthyroidism: Diagnosis Elevated serum T3 and T4 Low or undetectable levels of TSH
Hyperthyroidism: Symptoms Exophthalmos May have goiter or enlarged thyroid Behavior issues/ irritability/restlessness o Misdiagnosed with ADHD always check thyroid prior to ADHD tx Difficult to relax/sleep; restlessness, fatigue Tachycardia, high blood pressure, increased appetite, weight loss Heat intolerance Hyperthyroidism: Treatment Medications Anti-thyroid medications (interfere with biosynthesis of TH) Beta-blockers (comfort) – to slow HR = comfort Radioactive iodine therapy Surgery to remove a nodule or entire thyroid. If entire thyroid is removed or if remaining thyroid is suboptimal in functioning, patient will need lifelong thyroid replacement therapy Disorder of Adrenal Function Cushing’s Disease Caused by excessive
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- Spring '17