Hyperthyroidism and Hypothyroidism

By SWA

Hyperthyroidism

  • Excessive circulating thyroid hormones, calcitonin
  • Risk Factors: Graves's disease, toxic nodular goiter, exogenous hyperthyroidism
  • Manifestations:
    • Insomnia, hypertension, hyperventilation, hyperactivity
    • Heat intolerance, diaphoresis, weight loss, diarrhea, alopecia
    • Irregular heartbeat, goiter, bulging eyes (exophthalmos), thyroid storm
  • Labs: ↑TSH, ↑T3 & ↑T4
  • Labs to Check: Serum TSH, T3, T4
  • Meds:
    • Tapazole, PTU inhibit production of thyroid hormones
    • Beta blockers - treats tachycardia & palpitations
  • Nursing Care: Minimize energy expenditure, calm environment, assess/maintain cardiac status, monitor HR, vital signs, ensure no abrupt changes, avoid excessive iodine or thyroid, admit.
  • Complications: Hypercalcemia, tetany, nerve damage.

Hypothyroidism

  • Inadequate amount of circulating thyroid hormones causing a milder metabolism, accumulation of mucinous connective tissue
  • Risk Factors: Hashimoto’s, thyroidectomy, iodide insufficiency, or amiodarone
  • Manifestations:
    • Bradycardia, cold intolerance, cool/pale skin, thinning eyebrows, a husky voice, myxedema, depression
    • Weight gain, lethargy, constipation, menorrhagia, anemia
  • Labs: ↓T3 & ↓T4, ↑TSH, ↑blood cholesterol, anemic CBC
  • Labs to Check: Serum TSH, T3, T4
  • Meds: Levothyroxine (Synthroid) - thyroid hormone replacement
  • Nursing Care: Monitor for any changes, frequent rest periods, ambulation to stimulate circulation, elevate legs, deep breathing exercises, teach patient and caregivers encouraging self-care behaviors.

Complications: Myxedema (changes in MS) 

Salt iodization is a public health measure aimed at preventing iodine deficiency disorders, which can lead to a range of health issues including thyroid gland problems.
Iodine is an essential nutrient for thyroid function, as it is a critical component in the synthesis of thyroid hormones, thyroxine (T4) and triiodothyronine (T3).

The thyroid-stimulating hormone (TSH), produced by the pituitary gland, regulates the production of these thyroid hormones by the thyroid gland. Here’s how iodized salt can influence TSH levels:

  1. Prevention of Iodine Deficiency: Iodine deficiency can lead to decreased production of T4 and T3, which can cause the pituitary gland to release more TSH in an attempt to stimulate the thyroid gland to produce more hormones. This condition is known as hypothyroidism. By consuming iodized salt, individuals increase their intake of iodine, helping to ensure adequate thyroid hormone production and maintaining normal TSH levels.

  2. Regulation of Thyroid Function: Adequate iodine intake through iodized salt helps maintain the balance of thyroid hormone synthesis. When thyroid hormone levels are adequate, the feedback mechanism to the pituitary gland leads to a normalization of TSH secretion.

  3. Prevention of Goiter: Iodine deficiency can also lead to goiter, an enlargement of the thyroid gland. The increased TSH levels in response to low thyroid hormone levels stimulate the thyroid gland to grow larger, which is the body's way of trying to capture more iodine from the bloodstream. Iodized salt, by preventing iodine deficiency, also helps prevent the development of goiter.

  4. Potential for Excessive Iodine Intake: While iodine deficiency can be problematic, excessive iodine intake can also lead to thyroid dysfunction. In some cases, too much iodine can lead to either an overactive thyroid (hyperthyroidism) or a blockade in thyroid hormone synthesis (the Wolff-Chaikoff effect), leading to hypothyroidism. However, it is generally rare for iodized salt to cause excessive iodine intake because of the relatively small amount of iodine added.

Overall, the use of iodized salt is crucial in maintaining thyroid health by ensuring adequate iodine intake, which helps regulate TSH levels and overall thyroid function. In populations where iodine intake is sufficient, iodized salt helps to maintain a balance that supports normal thyroid function.

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