D.Y.

Patil Education Society (Institution deemed to be university)

D.Y. Patil College of Nursing, Kolhapur

LESSON PLAN
ON
hypothyroidism
Submitted by :
Mrs. Susmita Mark Dhanawade
MSc Nursing 1ST Year
Speciality Medical Surgical Nursing
Submitted to : Mr. Rohan Phape
Asst Prof Dept Of Medical Surgical Nursing

Submitted on:
Programme : M.Sc. Nursing
Subject :Medical Surgical Nursing
Topic : Hypothyroidism
Group : B.Sc (N) – II Year, 3rd Semister
Teaching method :Lecture cum discussion
A.V. Aids :Black board, projector, posters, roller board, pamphlets.
Student teacher : Mrs.Susmita Mark Dhanawade
Guide :Mr. Rohan Phape
Evaluator : Mr. Rohan Phape
Venue : B.Sc. (N) II Year Lecture Hall
Date :
Time :

Previous Knowledge of the students:

Students have some knowledge regarding anatomy and physiology of thyroid.
.
General objective:
At the end of the class students will be able to gain adequate knowledge about hypothyroidism its definition, causes, signs
and symptoms, pathophysiology, diagnostic evaluation, management, complication and nursing management.
Specific Objectives:
At the end of this session, the student will be able to,
- Define hypothyroidism.

- Discuss the etiology of hypothyroidism.

- Explain the pathphysiology of hypothyroidism .

- Enumerate the clinical manifestation of hypothyroidism.

- Discuss the classification on hypothyroidism.

- Explain the diagnosis investigation of hypothyroidism.

- Explain the management of hypothyroidism.

- Discuss the complication of hypothyroidism.

- Discuss the nursing management of hypothyroidism.

Bibliography:

1. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s textbook of medical-
surgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.

2. Sommers m, Johnson s, beery t. DISEASES AND DISORDERS DISEASES AND DISORDERS A Nursing
Therapeutics Manual. 3rd ed. Philadelphia: F. A. Davis Company; 2007.

3. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s textbook of medical-
surgical nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.

4. Williams l, hopper p. Understanding medical surgical nursing. 5th ed. Philadelphia: f.a. Davis company; 2011.

5. Kasper, Braunwald, Fauci, Harrison’s principles of internal medicine. 16th ed. New Delhi: McGraw-Hill medical
publishing division; 2005.
Sl.no. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
1. SELF INTRODUCTION
Good afternoon, everybody. I Mrs.Susmita Mark
Dhanawade, student of M.Sc. (N) 1st year.
As a part of my curriculum, I will be engaging your
class today.
We are today going to look forward on
hypothyroidism.

2. Explaining TOPIC INTRODUCTION

anatomy and Explaini Listenin
physiology of THYROID ANATOMY PPT
hypohtyroidis  Largest endocrine gland. ng g and
um
 In the anterior neck – just under the thyroid cartilage. answeri
 Covers 2nd and 3rd tracheal rings. ng
 Right and let lobes and isthmus. questio
 Embryologically, forms just under the tongue. ns
 Descents into the neck by birth along the thyroglossal
tract.

PHYSIOLOGY
 Secretes thyroid hormones T3 and T4.
 T3 T4 synthesize from dietary iodine (iodide and amino
acid tyrocin).
 This is under control of TSH (thyrotropin) secreted by
anterior pituitary.
 TRH from hypothalamus stimulates the anterior
pituitary.
 Lack of T3 T4 leads to slowing down of all metabolism
Sl.no. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
of body.

3. 2min Define DEFINITION Explaini Listenin Roller

hypothyroidis Hypothyroidism happens when the thyroid gland doesn’t make enough board
m thyroid hormones this condition called hypothyroidism and its also called ng g and
underactive thyroid. answeri
ng
questio
ns
4. 4min Discuss the ETEOLOGY Explaini Listenin Pamphl
eiteology of et
hypothyroidis Congenital causes - Mainly responsible for cretinism and juvenile ng g and
m disease answeri
1. Hypoplasia of thyroid
ng
2. Mal descent & ectopic thyroid
questio
3. Iodine deficiency in a geographical area – endemic
cretinism
ns
4. Pituitary failure or pan hypopituitarism

Acquired causes - Commonly leads to adult myxoedema

1. Autoimmune thyroiditis like Hashimoto's or Reidles's
2. Total or near total thyroidectomy
3. Radio-iodine therapy
4. Sheehan's syndrome after PPH
5. Certain medications like iodides, over treatment by
antithyroid drugs, Lithium for MDP (Maniac
Depressive Psychosis)
Sl.no. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
6. Later years of Grave's disease.

- Reported The Overall Prevalence Of Hypothyroidism

To Be 10.95%, Which Included 7.48% Of Self-
Reported Hypothyroidism.

5. 5 min Explain the PATHOPHYSIOLOGY Explaini Listenin PPT

pathphysiolog
y of 1.Thyroid gland needs lodine to secreate thyroid ng g and
hypothyroidis answeri
m Hormone
ng
2. Production of thyroid depends upon the TSH, questio
ns
lodine intake and also protein intake
3. Enlargement of thyroid gland results goitre form
increased secret in of pituitary gland
4. TSH stimulates the thyroid to secreate more level of
In the blood, T4 levels are low, the thyroid gland will
be more large and compress then neck and also the
chest
5. Causing in respiratory manifestation and leads to
hypothyroidism
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Objectives Activity Activity

6. 3 min Enumerate the CLINICAL MANIFESTATION Explaini Listenin PPT

clinical
manifestation
1. Cretinism – ng g and
of  Lethargic infant answeri
hypothyroidis  Failure to grow
m
ng
 Falls asleep while feeding questio
 Pot belly with umbilical hernia ns
 Puffy face
 Large protruding tongue
 Dry skin
 Retarted bone growth
 Delayed fontanelle closer
 Short stunted stature
 Hoarse cry
 Mental retardation
2. Juvenile hypothyroidism
 4 to 12 years age
 Short stature
 Plump and fat
 Mental retardation is not marked
 Infantile skeletal proportion (crown to pubic
symphysis > pubic symphysis to ground)
 If goes undetected, may cause more severe
symptoms
3. Myxoedema
Early symptoms –
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Objectives Activity Activity
 May be asymptomatic
 Constipation
 Reduced appetite
 Unusual weight gain
 Coarse dry skin, less sweating, hair loss
 Tingling numbness of fingers
 Carpel tunnel syndrome (medial nerve
pressure)
 Slow movements
 Extreme lethargy and fatigue
 Bradycardia
Late symptoms –

 Slow slurred speech

 Husky voice
 Non pitting oedema over the legs and arms
 Shortness of breath on slight exertion
 Dementia like mental changes
 Menorrhagia
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Objectives Activity Activity
 Sleep apnea
 Hypoventilation and cyanosis
May go into coma

7. 3min Discuss the CLASSIFICATION Explaini Listenin PPT

classification
on
 According to site of the defect ng g and
hypothyroidis 1. Primary- Fault is in the thyroid gland itself answeri
m e.g.- Autoimmune thyroiditis ng
Irradiated gland questio
ns
Removal of the gland

Non developed gland

2. Secondary- The thyroid is normal, but fault is in the

hypothalamus or anterior pituitary- lack of
TSH- lack of T3 T4
e.g.- Pan hypopituitarism

Sheehan’s syndrome

Hypothalamic failure

 According to age of onset

1. Cretinism- Defect is from birth
e.g.- Pituitary failure
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Objectives Activity Activity
Non development of gland

2. Juvenile hypothyroidism – Starts in early childhood

after a period of normal growth
e.g. – Ectopic small thyroid

Thyroid hypoplasia

3. Adult onset – Called myxoedema. Starts in adult

life.
e.g. – Autoimmune thyroiditis (Hashimoto’s)

Sheehan’s syndrome

8. 3 min Explain the DIAGNOSIS INVESTIGATIONS Explaini Listenin Hand

diagnosis outs
investigation ng g and
 History collection
of answeri
hypothyroidis
ng
m  Physical examination
questio
ns
 T3 T4 TSH level estimation (TSH very high T3 T4 very
low)
 Estimation of antithyroid antibody in the blood.
 BMR (very low)
 ECG – low voltage, bradycardia
Sl.no. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
 High serum cholesterol.
 Thyroid ultrasound (may show very little thyroid tissue
or mild goitre)
 Thyroid isotope scan – low I131 uptake
 X-rays of long bones helps to diagnose juvenile
hypothyroidism

9. 5 min Explain the MANAGEMENT Explaini Listenin PPT

management
of High suspicion, confirmation of diagnosis and early hormone replacement ng g and
hypothyroidis
therapy is important.
answeri
m
Early treatment can maintain normal linear growth and avoid mental
ng
questio
retardation in cretinism and juvenile disease
ns
Medical management -
Replacement Therapy

 L thyroxin tablets are available (25, 50, 75, 100 µgm)

 Treatment is started slowly with 25 µgm/day in single
dose.
 It is slowly increased over every month until euthyroid
status is achieved.
 Thereafter lifelong replacement therapy is necessary

10. 2 min Discuss the PPT

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Objectives Activity Activity
complication Listenin
of
hypothyroidis COMPLICATION g and
m Explaini answeri
Myxoedema coma – ng ng
 Dreadful complication questio
 There is impaired consciousness
ns

 Severe bradycardia
 Hypothermia
 Hypoventilation
 Cyanosis
 Coma
 Death

Precipitated by
 Inadequate or no treatment
Hand
11. 2 min Discuss the  Overnight inadvertent exposure to cold outs
nursing
management  Infections
of
hypothyroidis  Trauma (including surgery)
m
Listenin
Nursing management – g and
Explaini answeri
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Objectives Activity Activity
 Monitoring the body temperature ng ng
questio
 Protect from exposure to cold ns

 Encourage high fluid intake

 Encourage mobility within patient's exercise tolerance

 Assess client weight and appetite

 Consult with a dietitian to provide a menu for the patient (an

increased fiber to counter constipation)

 Educate the patient and family

 Manage constipation with laxatives

 Encourage patient to use moisturizer if the skin is dry

 Educate patient on compliance with thyroid hormone therapy

 Encourage exercise

 Check labs for levels of thyroid hormone

 Encourage patient to follow with a mental health nurse since

depression is common in hypothyroidism

Summary:
I would like to summarize my topic. So today in this
topic, we have studied about hyperthyroidism, its
Sl.no. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
definition, etiology, clinical manifestations.
complications, pathophysiology and management.

I.ASSIGNMENT:
Write a nursing care plan on hypothyroidism.