Hypothyroidism
Original Editors - Beth Lee from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Beth Lee, Admin, Kim Jackson, Lucinda hampton, Dave Pariser, Ahmed M Diab, 127.0.0.1, Elaine Lonnemann, Wendy Walker, WikiSysop, Candace Goh and Misha Ahir
Introduction
Hypothyroidism results from low levels of thyroid hormone. It has varied etiology and manifestations. The thyroid gland secretes thyroid hormones and is essential for multiple metabolic functions for many organ systems. Hypothyroidism is treated with with levothyroxine, left untreated hypothyroidism leads to ill health and possibly death.[1]
Watch this informative 6 minute video "Hypothyroidism:What is it, Causes, Symptoms and Treatments"
Etiology
Iodine deficiency is the most common cause of hypothyroidism worldwide. In iodine-sufficient countries however, like Australia and USA, autoimmune thyroid diseases are the most common etiology (Hashimoto thyroiditis is the most common of the thyroid autoimmune disorders)[3] Autoimmune thyroid disease may be genetic in origin. Like many autoimmune disorders, it is more likely to occur with autoimmune disorders of other organ systems. Environmental factors eg infections, iodine overconsumption, or medication side effects possibly have a role in the development of autoimmune thyroid diseases; however, the extent to which environmental factors influence the disease is not known.[4]
Other typical causes of hypothyroidism include drugs (eg amiodarone and lithium); thyroid radioactive iodine therapy or thyroid surgery; radiotherapy to head or neck area; and central hypothyroidism from neoplastic, infiltrative, inflammatory, or iatrogenic disorders of the pituitary or hypothalamus.[1]
Epidemiology
Hypothyroidism is more prevalent in women, who have a four to ten times greater likelihood of developing this than men. Hypothyroidism can be present at birth but has a higher occurrence rate between the ages of 30 and 60. It occurs in close to 10% of women and 6% of men over the age of 65. Primary Hypothyroidism is more common than secondary, with approximately 95% of all people diagnosed categorised as the primary type. [5][6][7]
Clinical Presentation
Clinical signs are widespread and affect numerous body systems. With early onset of the disease, signs may be indistinct and go undetected, such as general fatigue, slight weight gain from fluid retention, decreased metabolism, dry skin, or cold sensitivity.
- older adult patients have significantly fewer symptoms than younger adults, and complaints are often subtle. Many older adults with hypothyroidism present with nonspecific geriatric symptoms like confusion, falling, incontinence, and decreased mobility.
- Proximal muscles weakness. [8]
- With progression, clinical signs become more obvious and severe. Myxedema usually appears in the later stages if not treated resulting in non-pitting edema present around the eyes, hands, and feet. Myxedema may also cause thickening of the tongue and tissues of the larynx and pharynx, slurred speech and hoarseness.
- Rarely, a goitre may be present if not medically treated and presents as a large swelling on the anterior neck resulting from marked thyroid gland growth.. [9][6][7][10]
- Symptoms of depression, anxiety, psychosis, cognitive impairments (eg memory loss) can be present.[1]
- Individuals with hypothyroidism may have an increased risk of developing trigger finger[11]
Medical Management
Hypothyroidism is mainly treated with levothyroxine mono-therapy. The hormone replacement is started at a low dose and then is gradually increased until a proper level is achieved and maintained. This is especially true for the older adult population who may have heart co-morbidities because this drug therapy can create temporary levels of hyperthyroidism for several hours and increases the risk for cardiac events.
- Advise patients that treatment for hypothyroidism is lifelong.
- Clients take medications 30-60 minutes before the first meal of the day.[1]
Diagnostic Tests/Lab Tests/Lab Values
Screen for Serum TSH level (primary hypothyroidism).
- Obvious hypothyroidism, TSH levels are elevated, and free T4 levels are low.
- In subclinical hypothyroidism, TSH levels are elevated, and free T4 levels are normal[1]
Physical Therapy Management
Developing an exercise program for a patient with Hypothyroidism can be helpful in many ways. First, it helps to rebuild activity tolerance, increase muscle strength, and reduce apathy secondary to the decreased metabolism caused by the disorder. Exercise to help correct such problems should only be implemented once the patient has begun hormone replacement therapy, otherwise the issues cannot be resolved. Increasing the patient’s exercise tolerance can also be extremely helpful for patients who are severely constipated from the disorder. It helps increase peristaltic activity and overall metabolism. Also, because many patients with hypothyroidism have co morbid heart conditions, increasing aerobic activity can have benefits on the cardiovascular health of the patient and reduce risk factors for cardiac events. [9][12][10]
Other issues possibly addressed include:
- Encourage the patient to use moisturizer if the skin is dry
- Educate patient on compliance with thyroid hormone therapy
- Encourage the patient to follow up with a mental health nurse since depression is common in hypothyroidism[1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Patil N, Rehman A, Jialal I, Saathoff AD. Hypothyroidism (Nursing). Available:https://www.ncbi.nlm.nih.gov/books/NBK568746/ (accessed 13.1.2023)
- ↑ Hypothyroidism:What is it, Causes, Symptoms and Treatments. Available from: https://www.youtube.com/watch?v=h9WIzDa9big [last accessed 29/12/19]
- ↑ Topliss DJ, Eastman CJ. 5: Diagnosis and management of hyperthyroidism and hypothyroidism. Medical journal of Australia. 2004 Feb 16;180(4):186-94.Available:https://pubmed.ncbi.nlm.nih.gov/14960142/ (accessed 13.1.2023)
- ↑ Healthgrades Autoimmune Thyroid Diseases Available:https://www.healthgrades.com/right-care/thyroid-disorders/autoimmune-thyroid-diseases (accessed 13.1.2023)
- ↑ Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunders Elsevier, 2007.
- ↑ 6.0 6.1 Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. St. Louis, Missouri: Saunders Elsevier; 2009.
- ↑ 7.0 7.1 Porter R, Hypothyroidism. The Merck Manual Online Medical Library. 2008. Available at: http://www.merck.com/mmpe/index.html . Accessed February 17, 2010.
- ↑ Alharbi M, Alsaleem HN, Almuhaisni R, Alzeadi HS, Alsamani RI, Alhammad SI, Alharbi AM, Alsamani R. Association between subclinical hypothyroidism and the prognosis of diabetes mellitus and subsequent complications: a retrospective cohort study. Cureus. 2023 Nov 5;15(11). [1]
- ↑ 9.0 9.1 Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunders Elsevier, 2007.
- ↑ 10.0 10.1 Allahabadia A., Razvi S., Abraham P., Franklyn . Diagnosis and treatment of primary hypothyroidism. British Medical Journal (International Edition) [serial online]. 2009;338:1090. Available from: Health Module. Accessed February 19, 2010, Document ID: 1731734701.
- ↑ Brozovich N, Agrawal D, Reddy G. A critical appraisal of adult trigger finger: pathophysiology, treatment, and future outlook. Plastic and Reconstructive Surgery–Global Open. 2019 Aug 1;7(8):e2360. [2]
- ↑ Vaidya B., Pearce S.. Management of hypothyroidism in adults. British Medical Journal (International Edition) [serial online]. 2008;337:284. Available from: Health Module. Accessed February 19, 2010, Document ID: 1542959701.