Hypothyroidism (Myxedema coma)

Hypothyroidism is a condition characterized by abnormally low thyroid hormone production. There are many disorders that result in hypothyroidism. These disorders may directly or indirectly involve the thyroid gland. Because thyroid hormone affects growth, development, and many cellular processes, inadequate thyroid hormone has widespread consequences for the body.

Etiology and Pathophysiology

Primary Hypothyroidism
■ Autoimmune lymphocytic destruction (Hashimoto’s thyroiditis); secondary to toxic effect of hyperthyroidism therapy, atrophy with aging, genetics,
iodides, lithium

Secondary Hypothyroidism
■ Hypothalamus and/or pituitary problems → ↓thyrotropin releasing
hormone (TRH) or ↓thyroid stimulating hormone (TSH)

Signs and Symptoms

■ ↑Weight, lethargy, dry pale skin, brittle hair/nails

■ ↓T, ↓P, ↓R, cold intolerance

■ Dull expression, apathy

■ Constipation, deafness, enlarged tongue, periorbital edema, anemia

■ ↓T3, ↓T4, ↑TSH

■ Sensitivity to CNS depressants, ↑cholesterol, ↓HDL, ↑LDL

■ Severe hypothyroidism (myxedema) may cause coma

Treatment

■ Hormone replacement with levothyroxine

■ TSH levels are monitored as dose is gradually ↑ to determine optimum
dose

Nursing Management

■ Monitor S&S, ↑rest, keep warm

■ Explain that symptoms will improve with hormone replacement

■ Teach S&S of ↑ and ↓ thyroid function

■ Teach to ↑fluids and fiber to ↓constipation

■ Monitor for toxic effects of drugs (especially CNS depressants) secondary
to ↓metabolism
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