Coursework on nursing process for diseases of the thyroid gland. How does the nursing process work for thyroid diseases? Nursing examination of a patient with thyroid diseases

1.1 Clinical picture hypothyroidism

Hypothyroidism in adults was first described at the end of the 19th century (1873) by Gall. The disease has long been referred to as “myxedema”, less commonly – Gall’s disease. The term hypothyroidism began to be used after the relationship between the myxedema symptom complex and thyroid deficiency was established.

Hypothyroidism is currently defined as clinical syndrome, caused by insufficient production of thyroid hormones due to disruption of the functioning of one or more parts of the hypothalamic-pituitary-thyroid system. Depending on the level of damage, primary, secondary and tertiary hypothyroidism are distinguished. Primary hypothyroidism is caused by damage to the thyroid gland itself, with secondary hypothyroidism pathological process is localized in the pituitary gland, and in the tertiary one - in the hypothalamus. The last two forms are usually referred to as hypothyroidism of central origin (hypothalamic-pituitary or secondary).

1.2 Diagnosis of hypothyroidism

Laboratory diagnosis of hypothyroidism syndrome is quite simple and involves, if a decrease in thyroid function is suspected, hormonal research, first of all, definition TSH level blood serum, and in some cases the level of free T4. However, hypothyroidism does not always manifest itself with clear clinical symptoms; in a significant number of cases, “monosymptomatic” forms of the disease occur, which distracts the doctor from correctly assessing the general condition of the patient and can cause an erroneous diagnosis of nutritional obesity, anemia, biliary dyskinesia, kidney disease accompanied by edema syndrome, depressive state, coronary disease heart with symptoms of heart failure, amenorrhea, infertility, etc. Therefore, the diagnosis of hypothyroidism in some cases encounters significant difficulties, and patients can be observed for a long time by a cardiologist, nephrologist, gynecologist, psychiatrist and doctors of other specialties regarding various somatic diseases. The reason for conducting a hormonal study in these cases may be the lack of the expected therapeutic effect from traditional therapeutic measures. Detection of individual clinical symptoms, such as bradycardia, poor cold tolerance, dry skin, constipation. If hypothyroidism is suspected, it is sufficient to determine only the level of TSH in the blood serum, which is the most sensitive indicator of the functional state of the thyroid gland.

1.3 General principles treatment and prevention of hypothyroidism

Treatment of both primary and secondary hypothyroidism involves lifelong replacement therapy with thyroid hormone preparations, ensuring normalization of the thyroid hormonal status and a good quality of life for patients. For a long time, preparations containing powder of the dried thyroid gland of slaughter cattle, in particular thyroidin, were used for therapeutic purposes, although their use did not guarantee an accurate dosage of thyroid hormones in the patient’s blood and created certain difficulties in carrying out therapeutic measures. All of the above, as well as the threat to the health and life of the patient taking drugs from the organs of slaughter cattle, which carry the danger of transmitting virus-like prion particles (similar to the causative agents of spongiform encephalitis) were the basis for banning their use in medical practice.

2.1 Analysis of the activities of the therapeutic department

Murmansk City Clinical Emergency Hospital medical care- one of the largest medical institutions in the Murmansk region. The hospital operates 24 hours a day, 7 days a week, 365 days a year. More than 300 thousand people live in its service area. Of these, more than 14,000 people become hospital patients every year, 85% of whom are admitted for emergency reasons. More than 1,300 employees are ready to immediately provide highly qualified assistance in 20 profiles. More than 580 people are receiving treatment at the hospital at the same time. The hospital has more than 50 structural divisions, whose employees, working in close cooperation, ensure continuity of the diagnostic and treatment process, which is largely the key to successful patient treatment.

2.2 The role of the nurse in the treatment process for hypothyroidism

Nurse should be more responsive to the needs of the population rather than the needs of the health care system. She must transform into a well-educated professional, an equal partner, who independently works with the population, contributing to the strengthening of public health. It is the nurse who now plays a key role in medical and social care for older people, patients with incurable diseases, health education, organization of educational programs, and promotion of a healthy lifestyle.

2.3 Assessing the effectiveness and quality of nursing care for patients with hypothyroidism

In order to study patient satisfaction with the quality of nursing care at the department, a sociological study was conducted in the form of a questionnaire. To conduct the survey, an original questionnaire was developed (Appendix K), consisting of 15 questions with suggested answer options, which were divided into two blocks. The first block of the questionnaire (6 questions) is devoted to characterizing the characteristics of patients.

CONCLUSION

Thyroid diseases are one of the most common forms of human pathology. IN last years In many regions of Russia, a significant increase in the frequency of thyroid diseases has been noted, which is associated with deteriorating environmental conditions, insufficient iodine intake, negative changes in the population’s diet, and an increase in the frequency of autoimmune diseases. Hypothyroidism occupies one of the leading places in the structure of thyroid pathology in terms of frequency and social significance.

Hypothyroidism is a clinical syndrome caused by a lack of thyroid hormones in the body or a decrease in their biological effect at the tissue level.

Having examined in our work the activities of the therapeutic department, which includes endocrinological beds, we came to the conclusion that the amount of congenital hypothyroidism has not changed over the analyzed period of time.

APPENDIX A

Table A.1 - Branch states

APPENDIX B

Table B.1 - Department performance indicators

APPENDIX B

Table B.1 - Structure of hospitalized patients by nosological forms in 2013.

APPENDIX D

Table D.1 - Structure of hospitalized patients by nosological forms in 2014

APPENDIX D

Table E.1 - Nursing care plan for a patient with hypothyroidism

APPENDIX E

Table E.1 - Patient structure by age and gender

APPENDIX G

Table G.1 - Factors determining the well-being and health status of respondents

APPENDIX AND

Table I.1 - Patients' opinions about the importance of the qualities nurses should have

APPENDIX K

Questionnaire for patients

As part of the ongoing research, we ask you to fill out a questionnaire assessing patient satisfaction with the quality of medical care in the department.

Introduction…………………………………………………………………………………3
Chapter 1. Thyroid diseases
1.1 Hypothyroidism………………………………………………………………..4
1.2 Hyperthyroidism………………………………………………………………………………….6
1.3 Endemic goiter……………………………………………………….12
Chapter 2. Nursing process for thyroid diseases…….16
General conclusions………………………………………………………………………………….22
References…………………………………………………………….24
Applications

Introduction
Relevance. Currently, thyroid diseases are among the most common in the world. Thus, thyroid hormone drugs are among the 13 most commonly prescribed drugs in the United States. In the UK, more than 1% of the country's population receives these same hormones. The high prevalence of thyroid diseases puts them on a par with diseases such as diabetes and diseases of cardio-vascular system. According to some reports, the prevalence of thyroid diseases is even higher than currently known. This is due to the frequent asymptomatic or subclinical course of many of its diseases.
Manifestations of thyroid lesions are varied. The most common and well-known symptom of thyroid disease among the population is an enlarged thyroid gland - the development of a goiter.
The incidence is growing further, which is due to many factors, among which iodine deficiency, increased background radiation and environmental pollution are especially important.
Therefore, pathologies of the thyroid gland require close attention, not only from medicine, but also from ecology, as a science that aims to reduce the consequences of human activity.
Objective: to review the nursing process for kidney disease
Tasks:
1. Study literature data on the topic.
2. Consider the characteristics of thyroid diseases
3. To specify the features of the nursing process for diseases of the thyroid gland

Chapter 1. Thyroid diseases
Thyroid diseases are divided into:
- decreased activity of the thyroid gland (hypothyroidism);
- increased activity of the thyroid gland (hyperthyroidism, thyrotoxicosis);
- endemic goiter.
1.1 Hypothyroidism

Hypothyroidism is a disease characterized by decreased function of the thyroid gland.
Etiology
The disease can be caused by the absence of the thyroid gland, delayed development of the thyroid gland (hypoplasia), defects in the enzyme systems of the thyroid gland, inflammatory and autoimmune processes in the thyroid gland, surgical removal glands due to tumor pathologies, inflammatory or tumor processes in the pituitary gland and hypothalamus.
Clinical manifestations
Congenital hypothyroidism (myxedema) is detected during the neonatal period. Characterized by a large weight of the child at birth (more than 4 kg), lethargy, drowsiness, jaundice of the newborn, rough facial features, wide bridge of the nose, widely spaced eyes, large swollen tongue, difficulty breathing through the nose, low voice, large belly with an umbilical hernia, dry skin , acrocyanosis, long body, short limbs. Subsequently, there are delays in physical and mental development, dystrophic disorders, slow maturation of bone tissue. (Appendix 1. Fig 1)
Acquired hypothyroidism is characterized by the appearance of puffiness of the face, retardation of speech and movements, poor performance at school, memory impairment, hair loss, brittle nails, dry skin, constipation, and chilliness.
A blood test in a hypothyroid state reveals an increased concentration of thyroid-stimulating hormone and a decrease in the levels of thyroxine and triiodothyronine. The concentrations of these hormones are always interdependent, since the neurohumoral regulation of the thyroid gland is based on the feedback principle. If the thyroid gland produces few hormones, then the synthesis of thyroid-stimulating hormone by the pituitary gland increases.
Complications
hypothyroid coma.
Diagnostics
1. UAC.
2. OAM.
3. Biochemical blood test.
4. Determination of thyroid hormone levels.
5. Ultrasound of the thyroid gland.
6. ECG.
7. Consultations with an endocrinologist, neurologist.
8. X-ray of the skull and tubular bones.
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Drug therapy: replacement therapy thyroid hormone preparations, vitamins, iron preparations, for autoimmune processes - immunosuppressive therapy.
4. Physiotherapy.
5. Exercise therapy.
6. Massage.
7. If the disease is of a tumor nature - surgery.
Prevention
Including iodine-rich foods in your diet. Increasing the dose of thyroid hormones in pregnant women with thyroid diseases accompanied by hypothyroidism to prevent congenital hypothyroidism in the fetus.
Nursing care
1. Children with hypothyroidism experience chilliness and have cold extremities, so it is recommended to dress them warmly.
2. To prevent constipation, you need to give your child fresh juices, fruits, vegetables, as well as dishes made from them. Of course, nutrition should be appropriate for the child’s age. It is necessary to enrich the diet with foods high in vitamins.
3. Skin changes due to hypothyroidism require special care. It is necessary to moisturize and soften the skin with children's cosmetics (baby creams, skin care oils).

1.2 Hyperthyroidism
Diffuse toxic goiter is a disease based on hyperfunction and hyperplasia of the thyroid gland. The resulting hyperthyroidism (increased production of hormones) leads to disruption of the functioning of all organs and systems of the body.
In case of diffuse toxic goiter, a study of the level of blood hormones is carried out: an increased concentration in the blood of triiodothyronine, thyroxine and a decreased concentration of thyroid-stimulating hormone are determined.
Etiology
Toxic goiter is an autoimmune disease that is inherited.
Clinical manifestations
Defeat nervous system: increased excitability, irritability, hasty speech and fussy movements, anxiety, tearfulness, increased fatigue, sleep disturbance, general weakness.
Autonomic disorders: low-grade fever body, sweating, feeling hot, trembling of hands, eyelids, tongue, sometimes tremors of the whole body, lack of coordination.
Complaints from the cardiovascular system: feeling........

Bibliography

1. Bomash N.Yu. Morphological diagnosis of thyroid diseases. M. Medicine, 2011
2. Valdina E.A. Diseases of the thyroid gland (surgical aspects). Moscow, 2012
3. Smoleva E.V. Nursing in therapy with a primary care course, Rostov-on-Don, Phoenix. 2014
4. Paleeva A.V. Medical care. A complete nurse's handbook. Moscow. 2011
5. Internet resources

Medicina/zabolevanija_shitovidnoi_zhelezy_lechenie_i_profilaktika/p4.php

Topic: “Nursing care for thyroid diseases:

diffuse toxic goiter, hypothyroidism"

Diffuse toxic goiter (DTZ)– a disease caused by excessive secretion of thyroid hormones (thyroxine and triiodothyronine) by the thyroid tissue, leading to dysfunction various organs and systems. DTZ is genetically determined autoimmune disease, caused by the formation of specific thyroid antibodies that have a stimulating effect on the function of thyroid cells.

Causes:

• mental trauma
• dysfunction of the pituitary gland
• hereditary predisposition

Complaints:

• From the side of the central nervous system : tremor of the fingers, feeling of internal trembling, sleep disturbance, irritability, tearfulness, conflict in the family and at work
• From the outside CVS: palpitations, heart pain, shortness of breath during exercise
• From the side digestive system: increased appetite, increased stool frequency (up to 3-4 times a day), decreased body weight,
• From the g side hole: sensation of feeling sand", lacrimation, decreased visual acuity.
• From the endocrine system:a feeling of tightness in the neck, difficulty swallowing, menstrual irregularities.

General complaints : increased sweating, increased body temperature to low-grade levels, constant sensation heat, muscle weakness.

Objective research methods:

The patient has a youthful appearance,

Neck deformity (enlarged thyroid gland).

The skin is moist, warm, velvety to the touch

Reduction of subcutaneous fat layer (loss of body weight)

Increased body temperature.

Eye symptoms:

• sparkle in eyes
• Stellwig's symptom - wide opening of the palpebral fissure (staring, “angry” look)
• Mobius sign - violation of the convergence of the eyeballs
• Graefe's symptom - the appearance of a white stripe when moving eyeball down between the edge of the upper eyelid and the edge of the cornea

CVS - tachycardia, atrial fibrillation; increased blood pressure (systolic)

CNS - finger tremor

Laboratory methods:

• Clinical blood test (hypochromic anemia, leukopenia)
• Blood test for thyroid hormones (increased levels of T3 and T4 hormones, decreased TSH levels)
• Biochemical blood test (low cholesterol levels)
• Blood test for sugar (hyperglycemia)

Instrumental methods:

• 131
• Ultrasound of the thyroid gland

Treatment:

1. Hospitalization for moderate and severe thyrotoxicosis

2. Diet No. 15 with a high content of protein and vitamins

3. Drug therapy:

Basic therapy - drugs from the group of thyreostatics - Mercazolil at a dose of 20-30 mg

per day (under control clinical analysis blood)

Symptomatic therapy:

• sedatives – valerian tincture, motherwort tincture,
• minor tranquilizers phenazepam, seduxen, etc.
• cardiac glycosides - corglucon, strophanthin (for heart failure and atrial fibrillation).
• - adrenergic blockers (anaprilin, obzidan) to normalize blood pressure and heart rate

4. Surgical methods treatment – ​​subtotal resection of the thyroid gland.

Complications:

• thyrotoxic crisis,
• exophthalmos, prolapse of the eyeball, clouding and ulceration of the cornea,
• compression of the organs of the enlarged neck thyroid gland.

Satisfaction of needs is impaired:eat, drink, breathe, sleep, be clean, maintain body temperature, communicate, work.

Patient problems:

• Irritability,
• Tearfulness
• Heartbeat
• Sleep disturbance
• Increased frequency of bowel movements
• Sweating
• Conflict in the family and at work

Nursing care:

• recommendations on work and rest schedules
• nutritional recommendations - inclusion of foods rich in protein and vitamins in the diet
• psychological support for patients.
• regular walks before bed, ventilation of the room.
• monitor heart rate, blood pressure, body weight
• teach the patient the rules of skin care.
• change of underwear and bed linen
• for exophthalmos, it is recommended to wear dark glasses on sunny days
• talk with the patient about the need to take thyreostatic drugs
• train relatives to create a psychological climate in the family
• teach relatives the rules of counting heart rate, respiratory rate, measuring blood pressure, weighing, thermometry

Clinical examination:

• Observation by an endocrinologist (control appearance as prescribed by an endocrinologist)
• Examination by an ophthalmologist once every six months
• ECG monitoring once every six months
• Clinical blood test
• Blood for sugar.
• Monitoring blood pressure and pulse rate.

Hypothyroidism.

Hypothyroidism – a disease caused by decreased function of the thyroid gland or its complete loss.

Causes:

• autoimmune thyroiditis
• congenital aplasia of the thyroid gland
• surgical treatment (subtotal resection of the thyroid gland)
• drug effects (overdose of Mercazolil)

Patient complaints:

• lethargy, weakness, drowsiness
• fatigue
• memory loss
• chilliness
• aching pain in the heart area, shortness of breath
• muscle pain
• hoarseness of voice
• hair loss
• constipation
• weight gain
• in women, menstrual irregularities (may be infertility)
• in men, decreased libido

Objective examination:

• Appearance – adynamia, poor facial expressions, slow speech
• Puffy face
• The palpebral fissures are narrowed, the eyelids are swollen
• Hoarseness of voice
• The skin is dry, cold to the touch, dense swelling of the feet and legs (no pit remains when pressed)
• Body temperature is reduced
• Weight gain
• Decreased blood pressure
• Decreased heart rate - less than 60 beats. per minute (bradycardia)

Laboratory and instrumental research methods

Laboratory methods:

Clinical blood test (anemia)

Blood chemistry:

• Determination of thyroid hormone levels (T3, T4 – reduced level)
• Thyroid-stimulating hormone (TSH) levels are elevated
• Level of antibodies to thyroid tissue
• Cholesterol levels – hypercholesterolemia

Instrumental methods:

• Absorption of radioactive iodine J 131 thyroid gland (thyroid function test)
• Thyroid scan
• Ultrasound of the thyroid gland

Treatment:

• Diet No. 10 (exclude foods rich in cholesterol, reduce energy value food, recommend foods containing fiber)
• Drug therapy - replacement hormone therapy: thyroxine, L-thyroxine

Complications :

1.Decreased intelligence,

Disorders of need satisfaction: eat, excrete, maintain body temperature, be clean, dress, undress, work.

Patient problems:

• Muscle weakness
• Chilliness
• Memory loss
• constipation
• Increase in body weight.

Nursing care:

• Give recommendations for diet therapy (exclude foods containing animal fats, include foods rich in fiber - bran bread, raw vegetables and fruits, limit the consumption of carbohydrates).
• Control of frequency, pulse, blood pressure, weight control, stool frequency,
• Teach the patient how to maintain personal hygiene.
• Train relatives on how to communicate with patients
• Train relatives to care for patients.
• It is recommended to wear warm clothes during the cold season.
• Follow doctor's orders.

Clinical examination:

• Regular control visits to the endocrinologist.
• Controlling thyroid hormone levels and cholesterol levels.
• ECG monitoring once every six months.
• Body weight control.

Control questions:

• Define diffuse toxic goiter.
• The main causes of the development of diffuse toxic goiter.
• Main complaints in thyrotoxicosis.
• Main eye symptoms of thyrotoxicosis.
• Definition of hypothyroidism
• Main clinical manifestations of hypothyroidism

Type of lesson: lecture
Venue: college
Time: 90 min
Compiled by: Lebedeva O.D.

Purpose of the lesson

Introduce students to
nursing care for
diseases of the thyroid gland:
thyrotoxicosis and hypothyroidism

Thyrotoxicosis

Conditional condition
excessive secretion of thyroid
hormones (thyroxine and
triiodothyronine) tissue
thyroid gland, leading to
dysfunction of various
organs and systems

Causes of thyrotoxicosis:

Diffuse toxic goiter (Graves' disease)
Multiple nodes producing excess
amount of hormones
Toxic thyroid adenoma (disease
Plumer)
Increased iodine intake
Pituitary gland diseases
Hormone overdose during treatment of hypothyroidism

Clinical manifestations

From the side of the central nervous system
From the SSS side
Eye symptoms

Changes in the central nervous system during thyrotoxicosis

Irritability
Aggression
Excitability
Conflict
Feeling of inner trembling
Sleep disorders
Tremor of fingers

Changes in cardiovascular system during thyrotoxicosis

Heartbeat
Pain in the heart area
Shortness of breath on exertion
Increasing A/D
ECG changes
Rhythm disorders

Gastrointestinal changes in hyperthyroidism

Increased appetite
Increased frequency of bowel movements
Weight loss
Liver damage
Swallowing disorder

Appearance of a patient with thyrotoxicosis

Youthful appearance
Thyroid enlargement
Skin is moist and warm
Increased body temperature

Eye symptoms in thyrotoxicosis

Krause's sign - increased shine in the eyes
Exophthalmos - bulging eyes, rare
flashing
Graefe's symptom - lag of the upper
eyelids when looking down
Mobius sign - violation
convergence of eyeballs
Stellwig's sign - wide opening
palpebral fissure, angry look

Laboratory research methods

Clinical blood test:
leukopenia, anemia
Biochemical analysis: level
cholesterol lowered
Thyroid hormones:
increased T3 T4, decreased TSH

Instrumental research methods

Radioisotope research
thyroid gland
Ultrasound of the thyroid gland

Treatment of DTZ

Eliminating Risk Factors
Hospitalization
High calorie diet
exclude stimulating foods
– coffee, chocolate
Sedatives: valerian,
motherwort
Symptomatic treatment

Treatment of thyrotoxicosis

Conservative and surgical
Thyrostatics: Mercazolil
Iodine preparations
Surgical treatment: resection
thyroid gland

Complication of thyrotoxicosis:

Thyrotoxic crisis.
May be caused by: infection,
psychological trauma, untreated
thyrotoxicosis, surgical
interventions.
Manifestations: tremor, agitation,
increase in body temperature, increase
A/D, anuria, cardiac disorders
activities.
Loss of consciousness, death.

If the condition worsens - hospitalization
Patient-friendly mode
Preventive work with relatives
Recommendations for maintaining a daily routine and
recreation
Recommendations for maintaining a calm
lifestyle
Wearing clothes made from natural fabrics
(cotton, linen). Frequent change of linen
increased sweating

Nursing care for thyrotoxicosis

Dietary recommendations: exclude
stimulating foods, seasonings, coffee,
tea, alcohol
High calorie food



Control of A/D, heart rate, respiratory rate
Weight control

Hypothyroidism

Disease caused by
decreased thyroid function
gland or its complete loss

Myxedema (mucous swelling)

Primary hypothyroidism - develops when
damage to the thyroid gland,
accompanied by an increase in TSH
Secondary hypothyroidism - with damage
hypothalamic-pituitary system,
decreased TSH and decreased function
thyroid gland.
Tertiary hypothyroidism develops when
damage to the hypothalamus.

Risk factors for primary hypothyroidism

Autoimmune thyroiditis
Congenital aplasia of the thyroid
glands
Surgical treatment (resection
thyroid gland)
Medical treatment
(overdose)
Iodine deficiency

With congenital hypothyroidism
cretinism develops -
mental retardation and
mental development

Clinical manifestations of hypothyroidism

In adults - myxedema
Drowsiness, weakness, fatigue
Memory loss
Chilliness
Weight gain
Hoarseness of voice
Hair loss
Decrease in intelligence
Muscle pain
Menstrual irregularities

Clinical manifestations of hypothyroidism

Body temperature is reduced
Weight gain
Decrease in A/D
Bradycardia
Puffiness of the face
Skin is dry, cold
Facial expressions are poor
Tendency to constipation
Caries

Hidden hypothyroidism

Headaches (increased intracranial
pressure)
Mask for cervical or thoracic osteochondrosis
(paresthesia, muscle pain, weakness in
hands)
Cardiac masks (increased A/D,
increased cholesterol levels)
Edema
Decreased immunity
Anemia

Laboratory data for hypothyroidism

Clinical blood test -
anemia
Blood chemistry -
increased cholesterol
Increased TSH levels
Decreased hormone levels
thyroid gland

Treatment of hypothyroidism

Low-calorie diet with high
amount of fiber
Patient activation
Staying outdoors
Wearing warm clothes
Replacement therapy:
"thyrosxin", "thyrocomb",
"thyroidome", "levothyroxine sodium"

The role of the nurse

Recommendations for the patient on activation,
spending time in the fresh air
Diet recommendations
Preparing patients for laboratory and
instrumental research methods
Monitoring medication intake
Control of A/D, heart rate, respiratory rate
Weight control

Emergency care for hypothyroid coma.

Nurse's actions	Rationale
1. Call a doctor.	To provide qualified assistance
2. Calm the patient, warm him (cover, heat pads to the extremities, warm drink), give him a comfortable position in bed.	To normalize heat exchange and a comfortable state
3. Give humidified oxygen. If necessary, transfer to artificial ventilation.	Reduce hypoxia
4. Take an ECG. Monitoring blood pressure, heart rate, respiratory rate, body temperature.	Condition monitoring
5. Prepare and administer 5% glucose, rheopolyglucin, polyglucin intravenously as prescribed by the doctor.	To correct hypovolemia
6. Intravenous glucocorticosteroids prednisolone, hydrocortisone 200-400 mg/day.	To normalize hemodynamics
7. Thyroid hormones: levothyroxine 400-500 mcg intravenously slowly.	To replenish hormone deficiency
8. Sodium bicarbonate solution 4% intravenous drip.	To correct acidosis
9. Emergency hospitalization in the intensive care unit.	For further treatment

Laboratory methods: IN general analysis blood signs of anemia and accelerated ESR are noted. IN biochemical analysis blood: hypoalbuminemia, hypercholesterolemia. Blood test for hormones: with primary hypothyroidism high level TSH (thyroid-stimulating hormone produced by the pituitary gland) and low levels of T3 and T4 in the blood; in secondary and tertiary hypothyroidism, the TSH level is reduced with low levels of T3 and T4.

Instrumental methods: at radioisotope research thyroid gland absorption of radioactive iodine by the thyroid gland decreases.

Treatment.Mode free. Diet– table B (No. 15) with a high content of protein, vitamins, limitation of carbohydrates and fats. Drug therapy Hypothyroidism involves lifelong replacement of thyroid hormone deficiency. Currently most often prescribed L-thyroxine, a synthetic hormone preparation that is no different in structure from the human hormone. The dose of L-thyroxine for adults is from 100 to 200 mcg per day, taken once a day, 30 minutes before breakfast. The correct dose of L-thyroxine is determined by analyzing the level of TSH in the blood, which must be maintained at normal level. The effectiveness of treatment is judged after 1-3 months from the start of treatment. Other drugs are also prescribed: triiodothyronine hydrochloride, thyroidin, tireotome, etc. Patients with ischemic heart disease require special monitoring, because Taking thyroid medications can cause an attack of angina. At secondary or tertiary hypothyroidism, it is necessary to eliminate the cause of the disease from the pituitary gland or hypothalamus - remove the tumor, carry out anti-inflammatory therapy, radiation therapy etc. The drug can be used thyrotropin-releasing hormone(replacement therapy for damage to the hypothalamus). If the diagnosis of hypothyroidism has been made correctly, then replacement therapy should be carried out for life. In most cases, the cause of underfunction of the thyroid gland is permanent and progressive. Non-hormonal drug therapy for hypothyroidism is carried out antioxidants(antioxidant complex - vitamins A, E, C or trivit), means, improving microcirculation(chimes, trental, cavinton). Massage, exercise therapy, and water treatments are provided.

Nursing care. The nurse ensures physical and mental rest for the patient, monitors compliance with the medical and protective regime and diet with limited fat, carbohydrates, cholesterol and a high content of vitamins A, E and C, seafood, foods fortified with iodine (bread, table salt), ensures ventilation of the room , wet cleaning, quartz treatment, and, if necessary, oxygen therapy. The nurse must accurately and timely follow the doctor’s orders and monitor possible side effects medicines, watch for appearance the patient, measure blood pressure, heart rate, respiratory rate, weigh regularly, monitor physiological functions, prepare and collect material for laboratory tests, prepare for instrumental studies and consultations with specialists.

Nursing process in hypothyroidism. Patient E., 46 years old, is being treated in the endocrinology department with a diagnosis of hypothyroidism. A nursing examination revealed complaints of: fatigue, decreased performance, drowsiness. The patient is inhibited, her speech is slow, her voice is low and rough. Notes indifference to the environment, current events, and an increase in body weight. Objectively: general state moderate severity. The skin is dry, the subcutaneous fat layer is excessively expressed. The face is pale, puffy, the hair is thin and sparse. Heart sounds are muffled, blood pressure is 100/70 mm Hg. Art., pulse 56 beats/min, rhythmic, respiratory rate 16 per minute.

Tasks: 1. Identify the needs whose satisfaction has been disrupted and formulate the patient’s problems.2. Set goals and plan nursing interventions with motivation.

Sample answer:

1. Needs violated: sleep, work, communicate, be healthy, maintain normal body temperature.

The real problems: fast fatiguability; decrease in working capacity; apathy, decreased interest in life's manifestations; drowsiness; increase in body weight.

Potential problem: risk of myocardial dystrophy.

Priority issue: fast fatiguability.

2. Short term goal: the patient will note an improvement in well-being and a decrease in fatigue by the 7th day of treatment. Long term goal: the patient will note the absence fatigue after a course of treatment.

Nursing interventions	Motivation
1. Provide a therapeutic and protective regime, compliance with the prescribed diet.	To create mental and emotional peace
2. Regularly measure blood pressure, determine pulse, respiratory rate, weigh the patient	To monitor the effectiveness of treatment
3. Organize the patient’s leisure time	To raise emotional tone
4. Follow the doctor’s orders in a timely and correct manner	For effective treatment
5. Control physiological functions	Condition monitoring
6. Carry out hygienic measures for skin and hair care	For effective treatment
7. Conduct a conversation with the patient and relatives about the nature of the disease, treatment and care	For effective treatment

Assessing the effectiveness of nursing interventions: The patient notes an increase in interest in life, activity, and the absence of fatigue. The goal has been achieved.

Prevention. Primary: healthy image life, balanced nutrition, physical activity, timely and correct treatment thyroid diseases. Secondary: clinical observation by an endocrinologist.

Endemic (iodine deficiency) goiter is a compensatory enlargement of the thyroid gland, which develops as a result of iodine deficiency in people living in areas where there is little iodine salt in the soil and water.

Etiology. The main cause of the disease is a lack of iodine in food products produced in this region. An adult should receive from 100 to 200 micrograms of iodine per day from food and water. Children and adolescents before puberty should receive up to 100 mcg of iodine per day, during puberty - up to 200 mcg, adults - up to 150 mcg, pregnant and lactating women - up to 200 mcg of iodine per day. If the amount of iodine decreases, a compensatory increase in the size of the thyroid gland occurs, and endemic goiter develops. According to WHO, 13% of all humanity has some form of iodine deficiency disease. In regions with normal iodine intake, goiter is sporadic and its prevalence is about 5%. About endemic goiter they say that 5% of children and 30% of adults have an enlarged thyroid gland of the first and higher degrees. In the CIS, such regions are Belarus, some regions of Ukraine, the republics of Central Asia and Transcaucasia, regions of Siberia, the Urals, and the Middle Volga region.

However, not all residents of goiter-prone areas are affected. For the development of endemic goiter you need contributing factors: 1) poor nutrition, in which insufficient amounts of protein and vitamins are supplied to food; 2) lack of microelements in food: copper, zinc, selenium, cobalt; 3) excess calcium, fluorine, manganese in food; 4) consumption of products called goitrogenic, i.e. products that interfere with the absorption of iodine by the thyroid gland (cabbage, radish, carrots, soybeans, radishes, peanuts); 5) hereditary predisposition to the development of goiter; 6) exposure to ionizing radiation (blocking the thyroid gland with radioactive iodine). In women, according to various sources, endemic goiter occurs 4-8 times more often than in men.

Pathogenesis. Insufficient intake of iodine into the body is accompanied by its insufficient intake into the thyroid gland and, as a consequence, a decrease in the production of the thyroid hormones thyroxine and triiodothyronine. According to the feedback law, the lack of these hormones in the blood causes an increase in the production of thyroid-stimulating hormone (TSH) in the pituitary gland, which in turn stimulates the thyroid gland and causes its compensatory increase. However, individual thyroid cells are more sensitive to TSH stimulation, resulting in preferential growth. This is how it is formed nodular and multinodular euthyroid goiter. Subsequently, mutations accumulate in individual actively dividing thyrocytes, among which the most important are the so-called activating ones, as a result of which the daughter cells acquire the ability to autonomously, i.e. beyond the regulatory effects of TSH , produce thyroid hormones, leading to hyperthyroidism. Therefore, the final stage of development of iodine deficiency goiter is nodular and multinodular toxic goiter. This process takes many decades, so nodular and multinodular toxic goiter most often occurs in the elderly.

Classification of endemic goiter.

According to morphology distinguish: 1) diffuse goiter(uniform enlargement of the gland without nodes); 2) nodular goiter(tumor-like growth of a tissue area in the form of a dense node; 3) diffuse-nodular or mixed Goiter – against the background of diffuse enlargement, nodes are identified.

In accordance with the WHO classification, goiter is divided into degrees 0,1,2 (see above).

By function allocate:

Ø Hyperthyroid goiter (gland function is increased),

Ø Hypothyroid goiter (gland function is reduced),

Ø Euthyroid goiter (function preserved).

About half of patients have goiter with normal thyroid function.

clinical picture. Long-term iodine deficiency initially leads to decreased thyroid function. In children and adolescents, this causes delayed mental, physical and sexual development, decreased academic performance and a tendency to chronic diseases. In adults and the elderly, performance and physical activity decrease, fatigue, and reluctance to live and work appear. Among women childbearing age Iodine deficiency leads to severe pregnancy or miscarriage, anemia. In newborns - to high perinatal mortality, many birth defects, subsequently to reduced intelligence.

With normal thyroid function the patient may only be bothered by unpleasant sensations in the neck area associated with an enlarged thyroid gland: a feeling of pressure on the neck, intolerance to tight collars. If the size of the thyroid gland continues to increase, signs of compression of surrounding organs may appear, especially in a lying position; difficulty breathing and a feeling of obstruction when swallowing may occur. When the goiter is large, the vessels of the neck are compressed, which can lead to poor circulation and the development of heart failure.

Subsequently, as the function of the thyroid gland increases, complaints characteristic of hyperthyroidism: weight loss, hand tremors, increased excitability, irritability, muscle weakness, palpitations, a feeling of interruptions in the heart, a feeling of heat, sweating, sleep disturbance, diarrhea, decreased performance.

Diagnostics. The diagnosis of endemic goiter is established in an area where the disease is endemic when an enlarged thyroid gland is detected in the patient. The simplest objective method diagnosing goiter is palpation of the thyroid gland, which allows you to identify the presence of the goiter itself, assess the degree of its severity, and determine the size of the nodular formations. IN blood test for thyroid hormones thyroid-stimulating hormone (TSH or TSH) is determined - with endemic goiter its content in the blood is increased; thyroxine (T4), triiodothyronine (T3) - their content is reduced or increased depending on the function of the thyroid gland at a given stage. According to Ultrasound A goiter can be diagnosed if the volume of the thyroid gland exceeds 18 ml in women and 25 ml in men. There are also CT scan of the thyroid gland and thyroid scan with radioactive iodine– with hyperthyroidism, the absorption of iodine by the thyroid gland is increased; in the presence of nodes, absorption becomes uneven: functioning nodes look like “hot”, that is, they produce thyroid hormones in excess and therefore absorb iodine, and nodes without accumulation of radioactive iodine look like “cold”. If nodules are detected in the thyroid gland, an additional needle biopsy performed under ultrasound guidance to exclude a tumor.

Treatment of endemic goiter. The treatment tactics for endemic goiter depend on the degree of enlargement of the thyroid gland, its structure and state of function. All patients must comply mode work and rest (normal sleep, walks in the fresh air). Diet should ensure replenishment of iodine deficiency in the body with food. Recommended: seafood (shrimp, squid, crabs, cod, herring, halibut, pollock), seaweed; products containing iodine: iodized salt, iodized bread; fruits: lemons, berries (lingonberries, blueberries, black currants, rowan, rose hips); fresh juices; mineral water. Spicy foods, alcohol, and strong tea are excluded from the diet.

Treatment can be conservative or surgical. If the goiter is nodular, the nodes are large or rapidly growing, leading to compression of surrounding organs, surgery goiter Conservative treatment includes drug therapy: with a slight increase in the size of the gland (goiter of the first degree), it is usually limited to the introduction of iodine-rich foods into the diet, the administration of potassium iodide in an intermittent course, iodomarin (for adults 1 tablet per day, for pregnant women 2 tablets per day for a course of at least 6 months). If after 6 months there is a significant decrease or normalization of the size of the thyroid gland, it is recommended to continue taking iodine preparations in a prophylactic dose (for example, iodomarin 1/2-1 tablet per day) in order to prevent relapse of goiter. Compliance is mandatory correct dosage iodine, because its overdose not only causes inflammation of the gastric mucosa, allergy to iodine, but also provokes inflammatory changes in the thyroid gland. It is necessary to take into account cases when iodine preparations are contraindicated (individual iodine intolerance, increased function thyroid gland with thyrotoxicosis) . Courses are assigned vitamin therapy(antioxidant complex with iodine).

If, while taking iodine supplements for 6 months, the size of the thyroid gland has not normalized, then replacement therapy with thyroid drugs(thyrotom, levothyroxine, L-thyroxine, euthyrox, thyrocomb) or combination drugs L-thyroxine and iodine (iodothyrox) under the control of the content of thyroid hormones in the blood.

Prevention of endemic goiter. To overcome iodine deficiency, the following prevention methods are used: mass iodine prophylaxis– those. prevention on a population scale, carried out by adding iodine to the most common food products (salt, bread) and group iodine prophylaxis – prevention on the scale of population groups with increased risk development of iodine deficiency diseases: children, adolescents, pregnant and lactating women. This prevention is carried out by regular long-term use of drugs containing physiological doses of iodine. Every resident of an iodine-deficient region should receive an additional amount of iodine daily: children - 100 mcg; adolescents – 200 mcg; adults – 150 mcg; pregnant and lactating women – 200 mcg. Children infancy receive iodine from mother's milk. There is also individual iodine prophylaxis – This is prevention in individuals through long-term use of medications containing physiological doses of iodine. Individual prophylaxis is prescribed to patients who have undergone surgery on the thyroid gland or to persons working with goitrogenic substances. At the same time, it is recommended to consume iodized salt and foods rich in iodine: seaweed, sea fish and seafood, walnuts, persimmons. It should be remembered that iodized table salt should not be stored longer than the period indicated on the package, since iodine salts are destroyed, and this also happens when salt is stored in a humid atmosphere. It is necessary to salt food after cooking. When heated, iodine evaporates.