01.08 Hashimoto’s Thyroiditis

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Overview

  1. Hashimoto’s thyroiditis
    1. Autoimmune
    2. Thyroid destruction –> hypothyroidism

Nursing Points

General

  1. Autoimmune disorder
    1. Antibodies attack thyroid –> injury
    2. Thyroid hormones decrease
    3. Result = hypothyroidism
    4. Purpose of thyroid hormones
      1. Energy
      2. Warmth
      3. Proper organ function
  2. Diagnosed by lab values
    1. Elevated anti-thyroid peroxidase (TPO)–> antibodies against thyroid
    2. Elevated thyroid stimulating hormone (TSH) –> high levels overcompensating
      1. Made in brain, tells thyroid to release hormones
      2. Normal usually 0.4-5.0 mU/L
    3. Thyroid hormones
      1. Low T3 (nomal 80-180 ng/dL)
      2. Low T4 (normal 4.6-12 ug/dL)
  3. Autoimmune response triggered by…
    1. Genes
    2. Virus/Infection
    3. Drugs

Assessment

  1. Presentation
    1. Enlarged thyroid (goiter)
    2. Fatigue
    3. Coarse, dry skin
    4. Weight gain
    5. Sensitive to cold
  2. May not have symptoms

Therapeutic Management

  1. Monitor
    1. TSH levels
    2. Thyroid ultrasound –> visualize thyroid
  2. Give levothyroxine –> increase thyroid hormone release

Nursing Concepts

  1. Hormone regulation –> Immune system attack on thyroid results in decreased thyroid hormones and TSH
  2. Lab values –> Diagnosed by levels of TSH, T3, T4, TPO
  3. Pharmacology –> Treated with daily levothyroxine (synthetic hormone)

Patient Education

  1. Follow up with labs
  2. Continue physical activity
  3. Take medication every day

Reference Links

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Video Transcript

Hey guys! Welcome to the lesson where we will explore what Hashimoto’s thyroiditis is and how we manage it.

So Hashimoto’s thyroiditis is an autoimmune disorder, which means the body is attacking itself. The autoimmune process can be triggered by genes, a virus or infection, or even drugs. What happens is that the antibodies attack the thyroid which causes injury. The injured thyroid cannot release the normal amount of thyroid hormones, and the result is hypothyroidism.

To know whether or not a patient has Hashimoto’s thyroiditis, the doctor may order lab work. Anti-thyroid peroxidase levels will be high, showing that there are antibodies against the thyroid in the body. The thyroid stimulating hormones will be high as well from trying to overcompensate for the lack of thyroid hormones. Remember that the TSH is what tells the thyroid to make the thyroid hormones, so if they are low, more will be made. The thyroid hormones include T3 and T4 and will both be low. Alright guys, next let’s move on to exploring what the hormones do.

Thyroid hormones play a huge role with the metabolism in our body. The thyroid hormones actually bind to cell receptors and increase the breakdown of nutrients creation of energy. This helps our body regulate temperature so that we don’t get too cold. The thyroid hormones are needed for proper organ function. They affect the heart rate, GI motility, and neurological development. So if we have LESS thyroid hormone, these processes will be SLOWER. So the heart rate will be slower, our GI system will move slower, and it might become harder to think or rememer things.
So our patient that has Hashimoto’s thyroiditis might have an enlarged thyroid or goiter like this from the thyroid being attacked by the antibodies. Remember, everything is slowed down, so the patient will be tired, they might gain weight and feel cold because of the slower metabolism. Constipation can occur from that slowed GI motility. Less thyroid hormone results in decreased excretion of the skin glands, causing dry, coarse skin. The patient could present with myxedema where the skin looks swollen and puffy, usually around the eyes, hands, and feet. It’s important to also realize that these patients might not show these symptoms right away. 

If your patient is diagnosed with Hashimoto’s thyroiditis, they will need regular monitoring of their TSH levels. They may need a thyroid ultrasound to see the damage to the thyroid gland. Levothyroxine is a drug given to patients with hypothyroidism to help increase the thyroid hormone release in the body. This drug is given early in the morning because it shouldn’t be taken with food that can interfere with the absorption of the drug.

Our patients with Hashimoto’s thyroiditis should be educated to follow up with lab tests to check the thyroid hormone levels regularly. Moderate physical activity should be encouraged to help the patient manage their weight, joint pain, and give them energy. Let your patient know to take their levothyroxine every day early in the morning and not with food. 

Our priority nursing concepts for Hashimoto’s thyroiditis are hormone regulation, lab values, and pharmacology. 

Alright guys, let’s review the key points. Hashimoto’s thyroiditis is an autoimmune disorder where a trigger causes the antibodies to attack the thyroid causing damage, decreasing the thyroid hormones resulting in hypothyroidism. Lab values to diagnose the disease include increased thyroid stimulating hormone or TSH, decreased T3 and T4, and increased anti-thyroid peroxidase or TPO. Remember, TSH is high because it’s trying to get the thyroid to make more T3 and T4. TPO is high because there are many antibodies attacking the thyroid gland.

So remember that hypothyroidism causes everything to slow down. The patient will present with cold, dry skin, they may be tired alot and have memory issues. The might have gained weight and be experiencing constipation from the decreased GI motility. The heart rate might be slow. Remember, they may not show any symptoms yet. The doctor will want to check TSH levels regularly to monitor the disease. They may order a thyroid ultrasound to view the thyroid gland. Levothyroxine is given to the patient to increase the production of thyroid hormones. The patient with Hashimoto’s thyroiditis should be educated to take the levothyroxine early in the morning every day, not with food. They should stay active, and follow up with lab work. 

Thanks so much for listening! I hope you have a good grasp on what Hashimoto’s thyroiditis is and how to care for patients with this disease. Now go out and be your best self today, and as always, happy nursing!

Read more

  • Question 1 of 6

A nurse is working on discharge instructions for the client with Hashimoto’s thyroiditis. Which of the following should be included by the nurse for discharge education the client?

  • Question 2 of 6

A nurse received report on the client with Hashimoto’s thyroiditis. Which of the following medications would the nurse expect to administer?

  • Question 3 of 6

The client is newly diagnosed with Hashimoto’s thyroiditis. The client does not fully understand the disease so which of the following explanations should the nurse provide to the client about Hasmioto’s thyroiditis?

  • Question 4 of 6

A nurse is caring for a 43-year-old client who has been diagnosed with Hashimoto’s thyroiditis. The nurse expects which of the following findings with Hashimoto’s thyroiditis? Select all that apply.

  • Question 5 of 6

The nurse is caring for a client that has Hashimoto’s thyroiditis. Which of the following symptoms should the nurse expect to see with this client? Select all that apply.

  • Question 6 of 6

A client has complaints of being tired all the time, weight gain, and that she can’t seem to get warm enough to be comfortable. Which of the following tests would the nurse expect to see ordered to determine a diagnosis for the client? Select all that apply.