1. The client/caregiver has a basic understanding of the anatomy and physiology of the thyroid gland.
   1. The thyroid gland is located in the lower neck and in front of the trachea.
   2. It is divided into two lobes and is joined by a band of tissue called isthmus.
   3. It concentrates iodine from food and uses it to synthesize two hormones.
   4. These two hormones regulate the body’s metabolic rate.
2. The client/caregiver can define hypothyroidism.
   1. Hypothyroidism is a disease resulting from a deficiency of thyroid hormones.
   2. Hypothyroidism can affect infants, children, and adults.
   3. Severe hypothyroidism is myxedema.
3. The client/caregiver can state possible causes of hypothyroidism.
   1. Congenital deficiency
   2. Tumors
   3. Inflammation of the thyroid
   4. Pituitary disease
   5. Surgical removal of thyroid
   6. Iodine deficiency
   7. Radioactive iodine treatment
4. The client/caregiver can recognize signs and symptoms of hypothyroidism.
   1. Adults
      • Lethargy and fatigue
      • Forgetfulness
      • Weight gain
      • Dry, scaly skin
      • Puffy face and swollen around the eyes
      • Thinning and loss of hair
      • Hoarse voice
      • Constipation
      • Irregular menstrual periods or heavy flow
      • Increased sensitivity to cold
      • Hypersensitivity to drugs such as barbiturates and sedatives and to anesthesia
   2. Congenital hypothyroidism
      • Excessive sleeping and lack of energy
      • Greater risk for delayed mental development
      • Constipation or bloated abdomen
      • Puffy face and swollen tongue
      • Hoarse cry
      • Low muscle tone
      • Cold extremities
      • Increased birth weight, but little to no growth later
5. The client/caregiver can list measures for the management of symptoms of the disease.
   1. Exercise regularly with planned rest periods.
   2. Set realistic goals to increase activity as tolerated.
   3. Eat a diet that is low in sodium, cholesterol, fat, and calories.
   4. Avoid constipation with a diet high in fiber, adequate fluids, stool softeners, and so forth.
   5. Take thyroid medication as instructed at the same time each day (thyroid medication and laboratory testing must be taken lifelong).
   6. Contact physician before taking any over- the-counter medication (sedatives or hypnotics can cause respiratory depression).
   7. Keep follow-up appointments with physician.
   8. Provide a warm environment to promote comfort.
   9. Avoid pressure or irritation to the skin to prevent skin breakdown.
   10. Avoid excess stress, which increases metabolic rate.
   11. Use a Medic Alert bracelet or card.
6. The client/caregiver can list what signs and symptoms to report to physician.
   1. Signs/symptoms of hyperthyroidism are weight loss, restlessness, fast heart rate, fatigue, loose bowel movements, or heat intolerance (hyperthyroidism can be caused by hormone therapy).
   2. Signs/symptoms of hypothyroidism are a puffy, mask-like face and swelling around the eyes.
   3. Signs/symptoms of respiratory infections are fever, cough, and cold symptoms.
   4. Signs/symptoms of urinary infections are burning, frequency, and urgency.
7. The client/caregiver is aware of signs and symptoms of possible complications.
   1. Enlarged heart and/or heart failure
   2. Organic psychosis
   3. Myxedema coma
   4. Intestinal obstruction
   5. Anemia

Resources

National Institute of Diabetes and Digestive and Kidney Diseases
www.niddk.nih.gov

American Thyroid Association
https://www.thyroid.org

National Institutes of Health/Thyroid Disease
www.nlm.nih.gov/medlineplus/thyroiddiseases

Community support group

Dietician or nutritionist

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care.
Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott
Williams & Wilkins. Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott
Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com