Hypothyroidism is when the thyroid gland is underactive and does not produce enough hormones. The thyroid is a small gland at the front of the neck that resembles a butterfly. Thyroid hormones regulate how the body uses energy, which impacts almost every organ in the body, including the heart rate.
People with hypothyroidism can be of any age, gender, or race. It is most prevalent in women over 60 years of age. After menopause, women are typically more likely to acquire hypothyroidism than earlier in life.
In this article:
- Causes of Hypothyroidism
- Nursing Process
- Nursing Care Plans
- Fatigue
- Ineffective Tissue Perfusion
- Risk for Imbalanced Fluid Volume
- Risk for Imbalanced Nutrition: Less Than Body Requirements
Causes of Hypothyroidism
There are primary and secondary causes of hypothyroidism.
Primary causes directly affect the thyroid and cause it to produce insufficient thyroid hormones.
Examples:
- An autoimmune disorder known as Hashimoto’s disease (the most common condition wherein the thyroid attacks its immune system)
- Inflammation of the thyroid (thyroiditis)
- Radiation treatment or surgical removal of the thyroid due to hyperthyroidism
- Iodine deficiency
- Hereditary conditions
Secondary causes prevent the pituitary gland from functioning correctly, which prevents it from sending thyroid-stimulating hormone (TSH) to the thyroid.
Early on in its development, hypothyroidism may not show any apparent signs. A range of health issues, including obesity, joint discomfort, infertility, and heart disease, can develop over time due to untreated hypothyroidism.
It is possible to identify hypothyroidism using thyroid function tests. Low thyroid hormones can then be supplemented synthetically to control symptoms.
Nursing Process
Levothyroxine monotherapy is the primary treatment for hypothyroidism. Ongoing evaluation of thyroid hormone levels may be required when adjusting the medication.
Watch for complications such as myxedema coma when caring for a patient with hypothyroidism treatment. Health teaching should focus on adopting lifetime treatment of hypothyroidism. Treatment adherence should improve the patient’s signs and symptoms and normalize thyroid hormone levels.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for hypothyroidism, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for hypothyroidism.
Deficient Knowledge
Deficient knowledge associated with hypothyroidism is related to insufficient knowledge of the condition and its signs and symptoms. Hypothyroidism is a lifetime condition requiring lifelong medication intake and management.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Inadequate knowledge about hypothyroidism
- Insufficient understanding of signs and symptoms of hypothyroidism
- Lack of information about treatment
- Misinterpretation of the condition
As evidenced by:
- Verbalization of concerns
- Inquiries about hypothyroidism
- Misconceptions about hypothyroidism
- Inaccurate recall of treatment plan
- Development of preventable complications such as myxedema coma
- Nonadherence with treatment
Expected outcomes:
- Patient will be able to verbalize understanding of hypothyroidism and its signs and symptoms.
- Patient will be able to identify behavior and lifestyle modifications suitable for adapting to life with hypothyroidism.
- Patient will be able to demonstrate adherence to hypothyroidism treatment.
Assessment:
1. Identify the patient’s knowledge level.
To personalize health instructions, the nurse must first evaluate the patient’s understanding of hypothyroidism and their treatment plan. The nurse can then create appropriate and suitable teaching for the patient.
2. Assess for misconceptions about hypothyroidism.
Ensure the patient understands the causes and complications of hypothyroidism. It is usually an easily treatable condition and is effectively managed with medication.
Interventions:
1. Encourage participation in developing a care plan.
Patient participation engages the patient in decision-making or expressing ideas regarding various treatment modalities, which involves sharing information, emotions, and physical symptoms and receiving advice from the nurse and other healthcare team members.
2. Educate on symptoms.
Patients may be unaware of symptoms related to their hypothyroidism. Educate that low hormone levels affect their metabolism and often cause increased sensitivity to cold, dry skin, joint stiffness, hair thinning, and more.
3. Discuss treatment and monitoring.
Instruct the patient that if changes are observed in their symptoms that they should have their TSH levels tested. If hormone levels are low, they may need adjustments in their medication.
5. Ask the patient to teach back complications.
An underactive thyroid can cause elevated cholesterol and heart disease, peripheral neuropathy, infertility, and depression. The nurse can evaluate the patient’s learning by asking the patient to teach back the education.
Fatigue
Fatigue associated with hypothyroidism can be caused by low metabolic energy production resulting in a lack of energy.
Nursing Diagnosis: Fatigue
Related to:
- Slow metabolism
- Thyroid hormone deficiency
- Inability to secrete thyroid hormone
- Autoimmune disorders such as Hashimoto’s thyroiditis
- Surgical removal of the thyroid gland
- Radiation therapy to the head and neck
- Myxedema (severe decrease in thyroid hormone)
- Medications that decrease thyroid hormone
- Congenital hypothyroidism
- Decreased iodine levels
As evidenced by:
- Verbalization of lack of energy
- Inability to maintain activities of daily living
- Impaired concentration
- Irritability
- Increased physical complaints
Expected outcomes:
- Patient will be able to verbalize an increase in energy.
- Patient will be able to complete ADLs and work/school responsibilities.
Assessment:
1. Assess the patient’s physical and psychological condition.
A decrease in physical and mental activity is a common sign of hypothyroidism.
2. Assess the effect on activities.
It may be more challenging to carry out activities due to hypothyroidism’s effect on the body’s ability to regulate mood, energy, heart rate, and temperature.
3. Monitor sleep patterns.
Hypothyroidism can disrupt sleep and cause insomnia. This exacerbates feelings of fatigue and causes excessive daytime sleepiness.
Interventions:
1. Take medication as prescribed.
Levothyroxine is effective at diminishing the symptoms of hypothyroidism. The medication should be taken at the same time each day, usually first thing in the morning before eating.
2. Plan activities.
Consider scheduling more complex tasks when patients have the most energy. Advise them to pace themselves and schedule adequate time for rest and sleep.
3. Keep a sleep log.
Keep a sleep journal to monitor bedtime habits, difficulty falling or staying asleep, and naps. This can help the provider monitor treatment effectiveness and recommend other interventions.
4. Recommend exercise.
Exercising when feeling fatigued may seem counterproductive. Moderate exercise is still recommended and will help boost energy during the day.
5. Watch caffeine and alcohol.
Caffeine products can worsen fatigue, especially if taken in the afternoon as they disrupt sleep. Excessive alcohol also disrupts quality sleep.
Ineffective Tissue Perfusion
Low thyroid hormone levels cause systemic effects that disrupt bodily processes.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Alteration in serum thyroid hormone levels
- Insufficient knowledge of hypothyroidism and its management
As evidenced by:
- Weak peripheral pulses
- Edema
- Paresthesias
- Dry skin
- Hair loss
- Cold intolerance
- Decreased sweating
Expected outcomes:
- Patient will maintain optimal tissue perfusion as evidenced by the following:
- Absence of edema
- Strong, palpable pulses
- Strong and shiny scalp hair
- Warm extremities
- Capillary refill <2 seconds
Assessment:
1. Assess subjective and objective symptoms.
Hypothyroidism causes various nonspecific symptoms that can affect the epidermis, dermis, hair and nails, and sweat glands. The patient may display or report:
- Cold intolerance
- Dry skin
- Hair loss
- Hypohidrosis (decreased sweating)
- Paresthesias (tingling or numbness)
- Pallor
- Edema
2. Monitor body temperature.
The reduced amount of thyroid hormone disrupts body temperature regulation. The body reacts by causing vasoconstriction to the skin resulting in coolness and reduced perfusion. Severe hypothyroidism (myxedema) can cause hypothermia.
Interventions:
1. Treat and prevent dry skin.
Use rich, fragrance-free moisturizers on the skin. Avoid hot showers or water that can irritate the skin and cause further dryness. Consider a humidifier to moisten the air.
2. Reduce edema.
Hypothyroidism can slow lymphatic drainage causing fluid retention. Instruct on reducing salt in the diet, elevating the extremities, and alleviating periorbital edema with a cool compress.
3. Refer to dermatology.
More severe skin concerns, like hair loss, rashes, eczema, and hyperpigmentation, can be assessed and treated by a dermatologist.
4. Keep an even skin temperature.
Suggest methods to prevent cold intolerance by using a small heater in an office or bedroom, wearing layers, soaking the hands and feet in warm water, and avoiding going outside in cold weather.
Risk for Imbalanced Fluid Volume
Disruption in the homeostatic mechanism of fluid balance brought by consistently low thyroid hormones increases the risk of experiencing a fluid shift that may compromise health.
Nursing Diagnosis: Risk for Imbalanced Fluid Volume
Related to:
- Compromised regulatory mechanisms
- Low thyroid hormones
- Inadequate lymphatic drainage
- Extravascular accumulation of albumin and other plasma proteins
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will demonstrate adequate fluid balance as evidenced by the following:
- Good skin turgor
- Moist mucous membranes
- Urinary output 0.5 to 1.5 cc/kg/hour
- No weight gain
- Absence of edema
Assessment:
1. Monitor vital sign trends.
Myxedema coma is an extreme sequelae of poorly managed hypothyroidism. This condition happens due to the extravascular accumulation of plasma proteins causing generalized edema. Hypothermia, hypotension, bradycardia, decreased pulse pressure, and decreased respiratory rate are also observed.
2. Assess for edema.
Edema associated with hypothyroidism commonly manifests around the eyes (periorbital) but also occurs in the extremities.
3. Monitor daily weight.
Weight gain is a common manifestation of hypothyroidism. Inpatient monitoring of weight is necessary to assess for fluid overload.
Interventions:
1. Administer IV fluid as ordered.
Fluid resuscitation is indicated to prevent any hypovolemic complications and electrolyte imbalances.
2. Implement fluid restrictions in cases of severe hyponatremia.
Hypothyroidism can cause hyponatremia due to increased antidiuretic hormone levels leading to a significant reduction in free water excretion. Patients are at risk for fluid volume overload if fluid administration is not controlled.
3. Administer diuretics.
Diuretics can rid the body of excess fluid through the urine.
4. Administer IV levothyroxine.
IV synthetic thyroid hormone is required for the patient with myxedema coma to prevent worsening hypovolemia and electrolyte abnormalities.
Risk for Imbalanced Nutrition: Less Than Body Requirements
Risk for imbalanced nutrition: less than body requirements associated with hypothyroidism can be caused by a thyroid hormone deficiency resulting in slow metabolism.
Nursing Diagnosis: Risk for Imbalanced Nutrition
Related to:
- Slow metabolism
- Thyroid hormone deficiency
- Inability to secrete thyroid hormone
- Autoimmune disorders such as Hashimoto’s thyroiditis
- Surgical removal of the thyroid gland
- Radiation therapy on the head and neck
- Medications that decrease thyroid hormone
- Congenital hypothyroidism
- Decreased iodine levels
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will be able to verbalize understanding of how to adjust nutrition in relation to hypothyroidism.
- Patient will create an appropriate plan of meals based on the recommended nutrition guidelines for hypothyroidism.
Assessment:
1. Determine the patient’s risk factors.
Risk factors related to hypothyroidism include the following:
- Female gender
- Age 60 years and older
- Family history of thyroid disorder
- Surgical removal of the thyroid gland
- Radiation therapy on the head and neck
- Autoimmune disorders such as Hashimoto’s thyroiditis
- Medications that can decrease thyroid hormone
- Pregnancy or postpartum for six months
- Decreased iodine levels/intake
2. Monitor weight.
Gaining weight in the range of 5-10 pounds is common with an underactive thyroid.
3. Assess the patient for constipation.
Hypothyroidism causes slow metabolism which can lead to constipation.
Interventions:
1. Set nutritional goals with the patient.
If the patient is involved in developing a nutritional plan that fits their lifestyle, they are more likely to adhere to it.
2. Collaborate with a dietitian.
Iodine deficiency can cause hypothyroidism (uncommon in first-world countries) but iodine supplements are not necessary if taking levothyroxine. A dietitian will create a nutritional meal plan together with the patient and educate them on the iodine intake necessary to balance the thyroid hormone levels.
3. Administer thyroid replacement in relation to diet.
Levothyroxine should not be taken with foods containing iron, calcium, or fiber as they can decrease the absorption of the medication.
4. A special diet isn’t necessary.
A well-balanced diet and plenty of water are enough. A specific diet will not treat or prevent hypothyroidism.
References
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