For some individuals, the healthcare they receive in the correctional environment is the first they have received in quite some time, and many have undiagnosed serious illnesses. In addition, many have risk factors for the development of chronic disease at an earlier age than the general population. The Correctional Nurse conducting health assessments and sick call must be aware of the signs and symptoms of many chronic diseases. The patients rely on our ability to identify abnormalities and properly inform providers so that further assessment and diagnostics can be done.
This month’s Clinical Update is about disorders of the thyroid. There is a Part I and a Part II.
There are many diseases and disorders associated with the thyroid. They can develop at any age and may be caused by a variety of things, including injury, disease, or dietary deficiency. Typically they are caused by either too little thyroid hormone or too much thyroid hormone being produced, abnormal thyroid growth, nodules within the thyroid, or cancer of the thyroid.
Since these hormones regulate the speed with which the cell metabolism works, any imbalance can impact the body’s functioning. For example, T3 and T4 regulate the heart rate and how fast the intestines process food. So if T3 and T4 levels are decreased, the heart rate may be slower than normal, and the patient may have constipation and weight gain. If T3 and T4 levels are elevated, there may be a rapid heart rate, and diarrhea and weight loss. Other symptoms of excess T3 and T4 in the body include anxiety, irritability or moodiness, nervousness, hyperactivity, sweating or sensitivity to high temperatures, tremulousness, hair loss, and missed or light menstrual cycles. When there is decreased levels of T3 and T4, symptoms include difficulty sleeping, tiredness and fatigue, difficulty with concentration, dry skin and hair, depression, sensitivity to cold temperatures, frequent heavy menstrual periods, and joint and muscle pain.
Hypothyroidism is a condition in which the body lacks sufficient thyroid hormone. Symptoms include fatigue; weakness; weight gain or increased difficulty losing weight; coarse; dry hair; dry, rough pale skin; hair loss; cold intolerance; muscle cramps and frequent muscle aches; constipation; depression; irritability; memory loss; abnormal menstrual cycles; and decreased libido.
Causes of Hypothyroidism
There are two common causes of hypothyroidism. The first is inflammation of the thyroid gland, which leaves a large number of the cells of the thyroid damaged and unable to produce sufficient hormone. The most common cause of thyroid gland failure is called Hashimoto’s Thyroiditis, a form of thyroid inflammation caused by the patient’s own immune system.
The second major cause is the broad category of “medical treatments.” The treatment of many thyroid conditions requires surgical removal of a portion, or all, of the thyroid gland. If the total mass of thyroid producing cells left within the body are not enough to meet the needs of the body, the patient will develop hypothyroidism.
Diagnosis and Treatment of Hypothyroidism
Since hypothyroidism is caused by too little thyroid hormone secreted by the thyroid, laboratory tests for the patient with hypothyroidism will indicate a high blood level of Thyroid-Stimulating Hormone (TSH) and a low blood level of T4. This occurs when the pituitary gland is stimulated by low levels of thyroid hormone circulating in the blood to produce additional TSH. When additional thyroid hormone is not produced by the thyroid, the TSH continues to go up. If the pituitary gland is not functioning properly (rather than it being a problem with the thyroid), the TSH will be low and the T4 level will be low as well in response to the lower level of TSH circulating in the blood.
The treatment for hypothyroidism is replacement of the thyroid hormone in the form of levothyroxine. It is most often administered in the morning. It is a pure synthetic form of the T4 that the human thyroid produces. The dosage should be re-evaluated and possibly adjusted monthly until the proper level is established. While most patients will notice some reduction in symptoms within 1 to 2 weeks, it typically takes a month or two for patients to return to baseline.
Be sure to read our next post on Thyroid Disorders – Hyperthyroid that will be posted next week and check out our Case Study about Ms. Sloan, a woman with heart palpitations at Nursing Behind the Wall.
Please share with your colleagues in the comments section below experiences you have had with patients newly diagnosed with a Thyroid Disorder, or caring for the patient with a Thyroid Disorder.