Which clinical manifestations would the nurse assess in a patient with hypothyroidism?
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Disclaimer Show Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always … More Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. You do not currently have access to this chapter. HistoryHypothyroidism commonly manifests as a slowing in physical and mental activity but may be asymptomatic. Symptoms and signs of this disease are often subtle and neither sensitive nor specific. Classic signs and symptoms (eg, cold intolerance, puffiness, decreased sweating, and coarse skin) may not be present as commonly as was once believed. Many of the more common symptoms are nonspecific and difficult to attribute to a particular cause. Individuals can also present with obstructive sleep apnea (secondary to macroglossia) or carpal tunnel syndrome. Women can present with galactorrhea and menstrual disturbances. Consequently, the diagnosis of hypothyroidism is based on clinical suspicion and confirmed by laboratory testing. It has not yet been established whether hypothyroidism has a direct biochemical link to insomnia, although research has suggested that untreated subclinical hypothyroidism may be associated with poor sleep quality. It is also possible that the symptoms of an underactive thyroid, including muscle and joint pain, cold intolerance, and increased anxiety, may adversely affect sleep. [65] In addition to impaired fertility, hypothyroidism in women can lead to heavy or irregular menstrual periods. [66] Myxedema coma is a severe form of hypothyroidism that results in an altered mental status, hypothermia, bradycardia, hypercapnia, and hyponatremia. Cardiomegaly, pericardial effusion, cardiogenic shock, and ascites may be present. Myxedema coma most commonly occurs in individuals with undiagnosed or untreated hypothyroidism who are subjected to an external stress, such as low temperature, infection, myocardial infarction, stroke, or medical intervention (eg, surgery or hypnotic drugs). The following are symptoms of hypothyroidism:
Approximately one third of individuals with hypothyroidism suffer from headache. However, the actual association between hypothyroidism and headache is uncertain, with there being evidence of a possible bidirectional relationship between the two, particularly in the case of migraine. [68] “Brain fog,” characterized by lack of energy, forgetfulness, and fatigue, is another symptom of hypothyroidism. In one survey, 905 out of 5282 people (17.1%) reported suffering from symptoms of brain fog not long after being diagnosed with hypothyroidism. [69] A study by Tricarico et al suggested that patients with hypothyroidism undergoing hormone replacement therapy (HRT) have a greater likelihood for recurrence of benign paroxysmal positional vertigo, particularly individuals who have Hashimoto thyroiditis and positive thyroid antibodies. The investigators indicated that this may signal a connection between autoimmunity and recurrent vertigo. [70] Research indicates that hypothyroidism is linked to sexual dysfunction in males, including erectile dysfunction, delayed ejaculation, and hypoactive sexual desire (HSD). It is also suggested that sexual dysfunction in males results from the hypothyroid state itself rather than from the antibodies that lead to hypothyroidism. [71, 72] Hashimoto thyroiditis is difficult to distinguish clinically, but the following symptoms are more specific to this condition:
Physical ExaminationIn hypothyroidism, facial changes include dulled expression, drooping eyelids, and puffiness of the eyes and face. [73] Signs found in hypothyroidism are usually subtle, and their detection requires a careful physical examination. Moreover, such signs are often dismissed as part of aging; however, clinicians should consider a diagnosis of hypothyroidism when they are present. Physical signs of hypothyroidism include the following: · Weight gain · Slowed speech and movements · Dry skin (rarely, yellow hued from carotene) · Jaundice · Pallor · Coarse, brittle, straw-like hair · Loss of scalp hair, axillary hair, pubic hair, or a combination · Dull facial expression · Coarse facial features · Periorbital puffiness · Macroglossia · Goiter (simple or nodular) · Hoarseness · Decreased systolic blood pressure and increased diastolic blood pressure · Bradycardia · Pericardial effusion · Abdominal distention, ascites (uncommon) · Hypothermia (only in severe hypothyroid states) · Nonpitting edema (myxedema) · Pitting edema of lower extremities · Hyporeflexia with delayed relaxation, ataxia, or both Additional signs specific to different causes of hypothyroidism, such as diffuse or nodular goiter and pituitary enlargement or tumor, can occur. A study by Piantanida et al indicated that an increased risk of masked hypertension exists with subclinical and overt hypothyroidism. The study included 64 newly diagnosed hypothyroid patients, with masked hypertension found in 26.3% of those with the subclinical condition and 15.4% of those with overt hypothyroidism, compared with 10% of controls. [74]
Author Philip R Orlander, MD, FACP Director and Professor, Division of Endocrinology, Diabetes and Metabolism, Associate Dean for Educational Programs, Vice-Chair of Medicine for Education, Edward Randall III Chair in Internal Medicine, Program Director for Internal Medicine Residency Program, University of Texas Health Science Center at Houston Philip R Orlander, MD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, Endocrine Society, Texas Medical Association Disclosure: Nothing to disclose. Coauthor(s) Jeena M Varghese, MD Assistant Professor, Department of Internal Medicine, Division of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center Jeena M Varghese, MD is a member of the following medical societies: Endocrine Society, Harris County Medical Society, Texas Medical Association Disclosure: Nothing to disclose. Sapna Naik, MD Assistant Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Texas Health Science Center at Houston, McGovern Medical School Sapna Naik, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, Endocrine Society, Texas Medical Association Disclosure: Nothing to disclose. Chief Editor George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine George T Griffing, MD is a member of the following medical societies: American Association for Physician Leadership, American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society, International Society for Clinical Densitometry, Southern Society for Clinical Investigation Disclosure: Nothing to disclose. Additional Contributors Lance M Freeman, MD Fellow, Division of Endocrinology, University of Texas Health Science Center at Houston Disclosure: Nothing to disclose. Acknowledgements Anu Bhalla Davis, MD Assistant Professor, Department of Internal Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Texas Medical School at Houston Disclosure: Nothing to disclose. Shikha Bharaktiya, MD Physician in Endocrinology, Diabetes, and Metabolism, Endocrinology Clinics of Texas, PA Disclosure: Nothing to disclose. Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, Endocrine Society, and International Society for Clinical Densitometry Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Walter R Woodhouse, MD, MSA Associate Clinical Professor, Department of Family Practice, Medical College of Ohio Walter R Woodhouse, MD, MSA is a member of the following medical societies: American Academy of Family Physicians, American Academy of Pain Medicine, and Society of Teachers of Family Medicine Disclosure: Nothing to disclose. Frederick H Ziel, MD Associate Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician-In-Charge, Endocrinology/Diabetes Center, Director of Medical Education, Kaiser Permanente Woodland Hills; Chair of Endocrinology, Co-Chair of Diabetes Complete Care Program, Southern California Permanente Medical Group Frederick H Ziel, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society for Bone and Mineral Research, California Medical Association, Endocrine Society, andInternational Society for Clinical Densitometry Disclosure: Nothing to disclose. What are some clinical manifestations of hypothyroidism?Common symptoms include:. tiredness.. being sensitive to cold.. weight gain.. constipation.. depression.. slow movements and thoughts.. muscle aches and weakness.. muscle cramps.. Which clinical manifestations would the nurse is assessing a patient with hyperthyroidism?Hyperthyroidism may manifest as weight loss despite an increased appetite, palpitation, nervousness, tremors, dyspnea, fatigability, diarrhea or increased GI motility, muscle weakness, heat intolerance, and diaphoresis.
How do you assess a patient with hypothyroidism?The most common blood test for hypothyroidism is thyroid-stimulating hormone (TSH). TSH is the most sensitive test because it can be elevated even with small decreases in thyroid function. Thyroxine (T4), the main product of the thyroid gland, may also be measured to confirm and assess the degree of hypothyroidism.
What are the most common clinical manifestations of clients who have hyperthyroidism?The classic symptoms of hyperthyroidism include heat intolerance, tremor, palpitations, anxiety, weight loss despite a normal or increased appetite, increased frequency of bowel movements, and shortness of breath.
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