Nursing Care Plan on Hypothyroidism

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.

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 Assessment

A thorough nursing assessment is essential for identifying signs and symptoms of hypothyroidism and evaluating the extent of the condition. Key components of the nursing assessment include:

Health History

• Gathering information on the patient’s medical history, including any previous thyroid disorders or treatments
• Assessing for symptoms of hypothyroidism, such as fatigue, weight gain, constipation, dry skin, and hair loss
• Reviewing the patient’s medication regimen to identify any drugs that may affect thyroid function
• Inquiring about family history of thyroid disease or autoimmune disorders

Physical Examination

• Evaluating the patient’s general appearance and noting any signs of hypothyroidism, such as puffy face, hoarse voice, and slowed speech
• Palpating the thyroid gland to detect enlargement, nodules, or tenderness
• Assessing vital signs, including heart rate, blood pressure, and body temperature, to identify bradycardia or hypothermia
• Examining the skin for dryness, roughness, and pallor, and assessing hair and nail quality

Laboratory Tests

• Ordering thyroid function tests, including serum TSH, T4, and T3 levels, to confirm the diagnosis of hypothyroidism
• Evaluating other relevant laboratory parameters, such as cholesterol levels and liver function tests

Nursing Intervention

Nursing interventions for patients with hypothyroidism aim to restore normal thyroid hormone levels, alleviate symptoms, and prevent complications. Key interventions include:

Medication Management

• Administering prescribed thyroid hormone replacement therapy, such as levothyroxine, and monitoring the patient’s response to treatment
• Educating the patient on the importance of taking medication consistently and on an empty stomach for optimal absorption
• Monitoring for signs of over-treatment, such as hyperthyroidism symptoms, and adjusting the medication dosage as needed

Symptom Management

• Encouraging regular physical activity to boost energy levels and prevent weight gain
• Providing dietary advice to manage weight and ensure adequate intake of nutrients, particularly iodine and selenium
• Recommending skin care measures to alleviate dryness and prevent complications

Patient Education and Support

• Educating the patient about hypothyroidism, its causes, symptoms, and treatment options
• Providing information on lifestyle modifications to manage symptoms and improve quality of life
• Offering emotional support and addressing any concerns or anxieties the patient may have about their condition

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 sequela 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.

Nursing Diagnoses and Rationales for Hypothyroidism

1. Fatigue

Rationale: Hypothyroidism slows down the body’s metabolism, leading to significant fatigue and low energy levels. Implementing strategies to manage fatigue such as promoting rest periods, encouraging a balanced diet rich in nutrients, and facilitating regular, gentle exercise can help patients cope. Educating patients on energy conservation techniques and the importance of adhering to their thyroid hormone replacement therapy can also enhance their energy levels.

2. Impaired Memory

Rationale: Cognitive impairment, including memory problems, is common in hypothyroidism due to reduced metabolic activity in the brain. Providing cognitive support through memory aids, routine scheduling, and mental exercises can help improve cognitive function. Encouraging patients to engage in stimulating activities and providing a quiet environment to reduce distractions can support better memory retention.

3. Constipation

Rationale: Hypothyroidism can lead to decreased gastrointestinal motility, resulting in constipation. Offering dietary education to increase fiber intake and ensuring adequate hydration are crucial measures. Encouraging regular physical activity and providing medications, if necessary, can help manage constipation effectively. Educating patients on establishing regular bowel habits can also promote gastrointestinal health.

4. Risk for Imbalanced Nutrition: More than Body Requirements

Rationale: Slower metabolism in hypothyroidism can contribute to weight gain and difficulty losing weight. Providing nutritional counseling to adopt a balanced, low-calorie diet and encouraging regular physical activity can help manage weight. Monitoring weight and educating patients on healthy eating practices are essential to prevent further weight gain and promote overall well-being.

5. Disturbed Sleep Pattern

Rationale: Hypothyroidism can cause changes in sleep patterns, including difficulty falling or staying asleep. Establishing a regular sleep routine and creating a conducive sleep environment can aid in improving sleep quality. Educating patients on sleep hygiene practices and possibly adjusting medication timing can also help in managing sleep disturbances.

6. Activity Intolerance

Rationale: Due to fatigue and reduced energy levels, patients with hypothyroidism may experience activity intolerance. Gradually increasing activity levels and setting achievable goals can help build endurance. Encouraging participation in low-impact exercises and providing rest periods to prevent overexertion can enhance tolerance to activity.

7. Altered Skin Integrity

Rationale: Hypothyroidism can lead to dry, coarse skin and hair, making patients susceptible to skin integrity issues. Promoting skin hydration through moisturizers, advising gentle skin care practices, and ensuring adequate nutrition can help maintain skin integrity. Educating patients on the importance of skin care and monitoring for any skin changes can also prevent complications.

8. Depression

Rationale: The chronic nature of hypothyroidism and its impact on daily functioning can lead to feelings of depression. Providing emotional support, offering counseling services, and encouraging social interaction can help address depressive symptoms. Educating patients on the importance of medication adherence and its role in managing mood can also be beneficial.

9. Impaired Thermoregulation

Rationale: Patients with hypothyroidism often experience cold intolerance due to slowed metabolism. Providing a warm environment, advising on appropriate clothing, and educating patients on how to keep warm can help manage this symptom. Monitoring for signs of hypothermia and ensuring timely medication adjustments are also important.

10. Ineffective Health Maintenance

Rationale: Managing hypothyroidism requires lifelong medication and lifestyle adjustments, which can be challenging for some patients. Providing comprehensive education on the disease, medication management, and lifestyle changes is crucial. Encouraging regular follow-up appointments, monitoring thyroid function tests, and supporting patients in adhering to their treatment plan can promote effective health maintenance.

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