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 is Part II of this month’s Clinical Update about disorders of the thyroid. You can find Part I here.
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.
Hyperthyroidism is a condition in which the thyroid gland is overactive and makes excessive amounts of thyroid hormone (T3 and T4). When the thyroid gland is overactive, the body’s processes speed up and a person may experience nervousness, anxiety, rapid heartbeat, hand tremor, excessive sweating, weight loss, sleep problems, skin dryness, light or missed menstrual periods, and increased frequency of bowel movements. A goiter (enlargement of the thyroid gland) may result from this overactivity.
Causes of Hyperthyroidism
The most common cause of hyperthyroidism is the autoimmune disorder Grave’s disease. Hyperthyroidism also may be caused by a toxic nodular or multinodular goiter, which are lumps or nodules in the thyroid gland that cause the thyroid to produce excessive amounts of thyroid hormones. Thyroiditis, inflammation that can result from a virus or a problem with the immune system, may temporarily cause symptoms of hyperthyroidism. In addition, the ingestion of excess iodine, either from foods or supplements, or from medications containing iodine (such as amiodarone) may cause the thyroid gland to overproduce thyroid hormones. Finally, hyperthyroidism may develop during pregnancy or in the first year after giving birth.
Diagnosis and Treatment of Hyperthyroidism
Since hyperthyroidism results in too much thyroid hormone secreted by the thyroid, laboratory tests for the patient with hyperthyroidism will indicate a low blood level of TSH and a normal or high blood level of T3 and T4. Diagnosis is also made with palpation and identification of a goiter, and thyroid scans.
Hyperthyroidism can be treated with anti-thyroid medications that interfere with the production of thyroid hormones (primarily methimazole; propylthiouracil is now typically only used for women in the first trimester of pregnancy). Other medications may be prescribed to alleviated some of the symptoms of hyperthyroidism, such as beta-blockers (Inderal, propranolol) to slow a rapid heart rate and reduce hand tremors.
Hyperthyroidism may also be treated with radioactive iodine therapy to damage the cells that make thyroid hormones. This is the most recommended permanent treatment for hyperthyroidism. This therapy is based upon the fact that thyroid cells are the only cells in the body that have the ability to absorb iodine. By giving a radioactive form of iodine, the thyroid cells that absorb it will be damaged or killed. Because iodine is not absorbed by any other cells in the body, there is very little radiation exposure for the rest of the body. Radioiodine can be taken by mouth without the need to be hospitalized. This form of therapy often takes one to two months before the thyroid has been killed, but the radioactivity medicine is completely gone from the body within a few days. The majority of patients are cured with a single dose of radioactive iodine. Overkilling of the thyroid cells, which causes the patient to become hypothyroid, is a potential risk with radioactive iodine therapy treatment.
In rare cases, a thyroidectomy may be required.
In case you missed Thyroid Disorders, Part I, you can find it here.
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.