Hypothyroidism: Difference between revisions
No edit summary |
Candace Goh (talk | contribs) No edit summary |
||
| (5 intermediate revisions by 2 users not shown) | |||
| Line 6: | Line 6: | ||
== Introduction == | == Introduction == | ||
[[File:Hypothyroidism image.jpeg|thumb|Hypothyroidism]] | [[File:Hypothyroidism image.jpeg|thumb|Hypothyroidism]] | ||
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.<ref name=":0">Patil N, Rehman A, Jialal I, Saathoff AD. [https://www.ncbi.nlm.nih.gov/books/NBK568746/ Hypothyroidism] (Nursing). Available:https://www.ncbi.nlm.nih.gov/books/NBK568746/ (accessed 13.1.2023)</ref> | Hypothyroidism results from low levels of [[Thyroid Gland|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.<ref name=":0">Patil N, Rehman A, Jialal I, Saathoff AD. [https://www.ncbi.nlm.nih.gov/books/NBK568746/ Hypothyroidism] (Nursing). Available:https://www.ncbi.nlm.nih.gov/books/NBK568746/ (accessed 13.1.2023)</ref> | ||
Watch this informative 6 minute video "Hypothyroidism:What is it, Causes, Symptoms and Treatments"{{#ev:youtube|h9WIzDa9big|300}}<ref>Hypothyroidism:What is it, Causes, Symptoms and Treatments. Available from: https://www.youtube.com/watch?v=h9WIzDa9big [last accessed 29/12/19]</ref> | |||
== Etiology == | == Etiology == | ||
Iodine deficiency is the most common cause of hypothyroidism worldwide. In iodine sufficient countries however, like Australia and USA, autoimmune thyroid diseases is the most common aetiology | Iodine deficiency is the most common cause of hypothyroidism worldwide. In iodine sufficient countries however, like Australia and USA, [[Autoimmune Disorders|autoimmune]] thyroid diseases is the most common aetiology ([[Hashimoto Thyroiditis|Hashimoto thyroiditis]] is the most common of the thyroid autoimmune disorders)<ref>Topliss DJ, Eastman CJ. 5: [https://pubmed.ncbi.nlm.nih.gov/14960142/ 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)</ref> Autoimmune thyroid disease may be [[Genetics and Health|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.<ref>Healthgrades [https://www.healthgrades.com/right-care/thyroid-disorders/autoimmune-thyroid-diseases Autoimmune Thyroid Diseases] Available:https://www.healthgrades.com/right-care/thyroid-disorders/autoimmune-thyroid-diseases (accessed 13.1.2023)</ref> | ||
Other typical causes of hypothyroidism include: drugs (eg amiodarone and lithium); thyroid radioactive iodine therapy or thyroid [[Surgery and General Anaesthetic|surgery]]; radiotherapy to head or neck area; central hypothyroidism from neoplastic, infiltrative, inflammatory, or iatrogenic disorders of the pituitary or [[hypothalamus]].<ref name=":0" /> | |||
== 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. <ref name="Goodman and Snyder">Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunders Elsevier, 2007.</ref><ref name="Goodman and Fuller">Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. St. Louis, Missouri: Saunders Elsevier; 2009.</ref><ref name="Porter">Porter R, Hypothyroidism. The Merck Manual Online Medical Library. 2008. Available at: http://www.merck.com/mmpe/index.html . Accessed February 17, 2010.</ref> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
[[File:Hypothyroidism.png|right|frameless|433x433px]]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 and decreased metabolism, dry skin, or cold sensitivity. | [[File:Hypothyroidism.png|right|frameless|433x433px]]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 and decreased metabolism, dry skin, or cold sensitivity. | ||
* Elderly patients have significantly fewer symptoms than do younger adults, and complaints are often subtle. Many elderly patients with hypothyroidism present with nonspecific geriatric symptoms like confusion, falling, incontinence, and decreased mobility. | * [[Older People - An Introduction|Elderly patients]] have significantly fewer symptoms than do younger adults, and complaints are often subtle. Many elderly patients with hypothyroidism present with nonspecific geriatric symptoms like confusion, [[Falls in elderly|falling]], [[Urinary Incontinence|incontinence]], and decreased mobility. | ||
* With progression, clinical signs become more obvious and severe. Myxedema usually appears in the later stages if not treated resulting in | * With progression, clinical signs become more obvious and severe. Myxedema usually appears in the later stages if not treated resulting in non-pitting [[Oedema Assessment|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 goiter may be present if not medically treated and presents as a large swelling on the anterior neck resulting from marked thyroid gland growth.. <ref name="Goodman and Synder">Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunders Elsevier, 2007.</ref><ref name="Goodman and Fuller" /><ref name="Porter" /><ref name="Allahabadia">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.</ref> | * Rarely, a goiter may be present if not medically treated and presents as a large swelling on the anterior neck resulting from marked thyroid gland growth.. <ref name="Goodman and Synder">Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunders Elsevier, 2007.</ref><ref name="Goodman and Fuller" /><ref name="Porter" /><ref name="Allahabadia">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.</ref> | ||
* Symptoms of depression, anxiety, psychosis, cognitive impairments (eg memory loss) can be present.<ref name=":0" /> | * Symptoms of [[depression]], [[Generalized Anxiety Disorder|anxiety]], psychosis, [[Cognitive Impairments|cognitive impairments]] (eg [[memory]] loss) can be present.<ref name=":0" /> | ||
== Medical Management == | == Medical Management == | ||
Hypothyroidism is mainly treated with levothyroxine | 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 elderly 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. | * Advise patients that treatment for hypothyroidism is lifelong. | ||
| Line 36: | Line 35: | ||
* Obvious hypothyroidism, TSH levels are elevated, and free T4 levels are low. | * Obvious hypothyroidism, TSH levels are elevated, and free T4 levels are low. | ||
* Subclinical hypothyroidism, TSH levels are elevated, and free T4 levels are normal<ref name=":0" /> | * Subclinical hypothyroidism, TSH levels are elevated, and free T4 levels are normal<ref name=":0" /> | ||
== Physical Therapy Management == | == 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 the 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. <ref name="Goodman and Synder" /><ref name="Vaidya">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.</ref><ref name="Allahabadia" /> | 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 the 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. <ref name="Goodman and Synder" /><ref name="Vaidya">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.</ref><ref name="Allahabadia" /> | ||
Other issues possibly addressed include: | |||
* Encourage patient to use moisturiser if the skin is dry | |||
* Educate patient on compliance with thyroid hormone therapy | |||
* Encourage patient to follow with a mental health nurse since depression is common in hypothyroidism<ref name=":0" /> | |||
== References == | == References == | ||
Latest revision as of 06:30, 17 June 2023
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, Elaine Lonnemann, Wendy Walker, WikiSysop, Candace Goh and 127.0.0.1
Introduction[edit | edit source]
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[edit | edit source]
Iodine deficiency is the most common cause of hypothyroidism worldwide. In iodine sufficient countries however, like Australia and USA, autoimmune thyroid diseases is the most common aetiology (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; central hypothyroidism from neoplastic, infiltrative, inflammatory, or iatrogenic disorders of the pituitary or hypothalamus.[1]
Epidemiology[edit | edit source]
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[edit | edit source]
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 and decreased metabolism, dry skin, or cold sensitivity.
- Elderly patients have significantly fewer symptoms than do younger adults, and complaints are often subtle. Many elderly patients with hypothyroidism present with nonspecific geriatric symptoms like confusion, falling, incontinence, and decreased mobility.
- 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 goiter may be present if not medically treated and presents as a large swelling on the anterior neck resulting from marked thyroid gland growth.. [8][6][7][9]
- Symptoms of depression, anxiety, psychosis, cognitive impairments (eg memory loss) can be present.[1]
Medical Management[edit | edit source]
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 elderly 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[edit | edit source]
Screen for Serum TSH level (primary hypothyroidism).
- Obvious hypothyroidism, TSH levels are elevated, and free T4 levels are low.
- Subclinical hypothyroidism, TSH levels are elevated, and free T4 levels are normal[1]
Physical Therapy Management[edit | edit source]
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 the 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. [8][10][9]
Other issues possibly addressed include:
- Encourage patient to use moisturiser if the skin is dry
- Educate patient on compliance with thyroid hormone therapy
- Encourage patient to follow with a mental health nurse since depression is common in hypothyroidism[1]
References[edit | edit source]
- ↑ 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.
- ↑ 8.0 8.1 Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunders Elsevier, 2007.
- ↑ 9.0 9.1 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.
- ↑ 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.
