Nursing care for thyroid. Nursing care for thyroid diseases: diffuse toxic goiter, hypothyroidism educational and methodological manual on the topic

Introduction

1. Endemic goiter

2. Diffuse toxic goiter

Conclusion

Literature

diffuse goiter thyroid sister process

Introduction

Diseases thyroid gland may start in force various reasons. For their etiology, factors such as: congenital anomalies of the thyroid gland, its inflammation in infectious and autoimmune processes, as a complication of surgical treatment and radioactive iodine therapy in diffuse toxic goiter, and also as a result of a lack of iodine in environment. Secondary hypothyroidism is a consequence of infectious, tumor or traumatic damage to the hypothalamic-pituitary system. An overdose of Mercazolil can cause functional primary hypothyroidism. With uncompensated hypothyroidism, psychoses can develop that resemble schizophrenia in their course.

Iodine deficiency leads to endemic goiter. This disease is widespread in all countries of the world. A deficiency of thyroid hormones inhibits the development and differentiation of brain tissues, inhibits higher nervous activity, so children with congenital and late diagnosed hypothyroidism develop incurable cretinism. Adults develop encephalopathy.

Diffuse toxic goiter belongs to the group of psychoendocrine pathology, develops against a genetically modified background with the presence of autoaggression of immunocompetent cells to antigens of thyroid tissues.

Diffuse toxic goiter is accompanied by an increase in the rate of exchange of corticosteroids in the body, an increase in their breakdown, excretion and the predominant formation of less active compounds. As a result, with this disease, relative adrenal insufficiency develops, which increases with thyrotoxic crisis.

1. Endemic goiter

Endemic goiter is a disease that occurs in areas with limited iodine content in water and soil. It is characterized by compensatory enlargement of the thyroid gland. The disease is widespread in all countries of the world. Sometimes there is a sporadic goiter enlargement of the thyroid gland without previous iodine deficiency.

In addition to iodine deficiency in the environment, the use of goitrogenic nutrients contained in some varieties of cabbage, turnip, rutabaga, and turnip are also of some importance. In response to an external lack of iodine, hyperplasia of the thyroid gland develops, the synthesis of thyroid hormones and iodine metabolism change.

There are diffuse, nodular and mixed forms of goiter. The function of the thyroid gland may be normal, increased or decreased. More often, however, hypothyroidism is noted. Typical manifestation thyroid insufficiency in children in endemic areas is cretinism. Significant sizes of the goiter can cause compression of the neck organs, respiratory disorders, dysphagia, voice changes. With the retrosternal location of the goiter, the esophagus, large vessels, and trachea can be compressed.

Absorption of I131 by the thyroid gland is usually increased, the level of T3 and T4 in the blood is reduced (with hypothyroidism), increased TSH level. Ultrasound helps in the diagnosis, with a retrosternal and intramediastinal location of the goiter - radiography.

Treatment of nodular and mixed forms of goiter is only surgical. The same applies to large goiter and ectopic localization. In other cases, antistrumine, microdoses of iodine (with unimpaired gland function), thyroidin, thyreocomb, thyroxine are used. In hypothyroidism, thyroid hormone replacement therapy is used in compensatory dosages. In endemic foci, preventive intake of iodized products and preparations of iodine, antistrumine is indicated.

2. Diffuse toxic goiter

Diffuse toxic goiter (DTG) is a disease characterized by hyperplasia and hyperfunction of the thyroid gland. The disease belongs to the group of psychoendocrine pathology, develops against a genetically modified background with the presence of autoaggression of immunocompetent cells to antigens of thyroid tissues. Mostly urban residents are ill, more often women aged 20 to 50 years.

The pathogenesis of the disease is based on a violation of immune control by genetically defective T-suppressors, leading to the formation of autoantibodies to thyroid tissues.

A feature of autoimmune processes in diffuse toxic goiter is that autoantibodies have a stimulating effect on thyroid cells. Among them, the most studied immunoglobulins LATS (long-acting thyroid stimulator), which are found in the blood of patients in 3/4 of all cases. LATS binds to the thyroid-stimulating hormone (TSH) receptors on the cell membranes of thyrocytes, which leads to an increased production of thyroid hormones by the cells.

Clinic of diffuse toxic goiter

Symptoms of diffuse toxic goiter are caused by the influence of an excess amount of thyroid hormones on various tissues and organs, as well as metabolic processes. Patients complain of irritability, tearfulness, increased suspiciousness and excitability, weakness, fatigue. Sleep is disturbed, excessive sweating, a tendency to diarrhea, there is a tremor of the fingertips or the whole body (“telegraph pole symptom”). Patients lose weight with preserved or even increased appetite, which is due to the influence of thyroid hormones on energy metabolism. In some cases, the disease is not accompanied by weight loss, but, on the contrary, by an increase in body weight (“fat Basedow”).

An important sign of the disease is an increase in the thyroid gland, which, however, does not correlate with the severity of clinical symptoms. Severe thyrotoxicosis can also develop with an increase in the thyroid gland of I-II degree. In addition, there is an ectopic localization of the goiter, for example, behind the sternum, so it is impossible to focus only on an increase in the gland during diagnosis. The thyroid gland is soft, elastic, evenly enlarged on palpation.

There are changes in the eyes - thyrotoxic exophthalmos. It is usually bilateral, without trophic disturbances and movement restrictions. eyeball. Ophthalmopathy in thyrotoxicosis is also autoimmune in nature. Exophthalmos develops as a result of swelling of the periorbital tissue within a few days, less often hours. Patients complain of lacrimation, photophobia, a feeling of "sand" in the eyes, swelling of the eyelids. important diagnostic sign is the absence of double vision. In addition, specific ocular symptoms of thyrotoxicosis are noted - wide opening of the palpebral fissures (Dalrymple's symptom), increased eye brilliance (Graefe's symptom), weakness of convergence (Moebius's symptom), lag upper eyelid when looking down with the appearance of a white strip of sclera (Kocher's symptom). All these changes disappear after compensation of thyrotoxicosis.

In the clinic of thyrotoxicosis, changes from the side of of cardio-vascular system. A direct toxic effect of excess thyroxin on the myocardium was noted. Thyrotoxic cardiopathy develops - tachycardia varying degrees, tachysystolic form of atrial fibrillation, atrial flutter, in severe cases - heart failure. Tachycardia does not change with a change in body position and does not go away during sleep. A feature is also a weak response to glycoside therapy. The boundaries of the heart are expanded to the left, the tones are usually increased, the heart rate at rest is 120-140 beats per minute, systolic functional murmurs of various localization are noted. No typical changes are observed on the ECG. There may be frequent extrasystoles, atrial fibrillation, high pointed P and T waves. With adequate therapy of thyrotoxicosis, positive ECG dynamics is noted.

In severe or prolonged course of thyrotoxicosis, the phenomena of adrenal insufficiency develop: hypotension, severe adynamia, hyperpigmentation skin. On the part of the sexual sphere in women, a violation develops menstrual cycle, in men - impotence, sometimes gynecomastia, disappearing after stopping thyrotoxicosis.

In 3-4% of patients, there is a peculiar change in the skin of the anterior surface of the legs - pretibial myxedema. This is a one- or two-sided purplish skin thickening with clearly defined borders. The nature of this change is also considered to be autoimmune.

According to the severity, mild, moderate and severe forms of the disease are distinguished.

At mild form patients lose no more than 3-5 kg ​​in weight, the heart rate does not exceed 100 beats per minute, all symptoms of thyrotoxicosis are slightly expressed. The moderate form is characterized by pronounced symptoms of thyrotoxicosis, heart rate - 100-120 beats per minute, weight loss - 8-10 kg. In a severe form of the disease, the heart rate exceeds 140 beats per minute, a sharp weight loss and secondary changes in the internal organs develop.

In the blood of patients, the content of protein-bound iodine, thyroxine and triiodothyronine is increased, while the content of TSH is reduced. Thyroid uptake of TSH is high.

In doubtful cases, a test with thyroliberin is carried out - in the presence of thyrotoxicosis, the level of TSH in response to the administration of thyroliberin does not change.

Treatment of diffuse toxic goiter can be conservative (medical or with radioactive iodine) or surgical. Indications for surgical treatment- subtotal resection of the thyroid gland - are large goiter, compression or displacement of the esophagus, trachea and neurovascular bundle, retrosternal forms of goiter, severe forms thyrotoxicosis complicated by atrial fibrillation, lack of effect from conservative therapy, tendency to frequent relapses intolerance to thyreostatic drugs.

Drug therapy of thyrotoxicosis is effective only with an increase in the thyroid gland of no more than 3 degrees. The leading place is occupied by drugs of cytostatic action. First of all, Mercazolil is used at a dose of 30-60 mg per day, depending on the severity of the disease, with a further transition to a maintenance dose of 2.5-5 mg per day for 1-1.5 years. Possible development side effects (allergic reactions, leukopenia, agranulocytosis). If within 4-6 months there is a stable remission, Mercazolil is canceled, but monitoring of the patient cannot be stopped.

Treatment with iodine preparations is currently strictly limited, their appointment is possible only by an endocrinologist on an individual basis. Potassium perchlorate is sometimes used to block the entry of iodine into the thyroid gland. In mild to moderate cases, lithium carbonate can be used, but all recommendations are also given by the endocrinologist.

AT complex treatment widely used beta-blockers (anaprilin, obzidan, inderal). Indications for their use are persistent tachycardia, extrasystole, atrial fibrillation. Dosages are selected individually - from 40 to 160 mg per day under ECG control. With a properly selected dose, the effect of treatment occurs after 5-7 days.

Corticosteroid drugs are also widely used. Their effectiveness is especially high with concomitant ophthalmopathy. Long-acting preparations (kenologist) are successfully used topically (retrobulbar), and prednisolone is used orally in average physiological dosages of 10-15 mg per day. In severe cases, they switch to parenteral administration of hydrocortisone - 50-75 mg intravenously or intramuscularly. With significant exhaustion of patients, anabolic steroids and general restorative therapy are used.

Indications for treatment with radioactive iodine are the age of the patient at least 40 years old, severe heart failure (when surgery is risky), a combination of diffuse toxic goiter with tuberculosis, severe hypertension, myocardial infarction, neuropsychiatric disorders, relapse of thyrotoxicosis after subtotal resection of the thyroid gland. Contraindications are pregnancy and lactation, young age, a large degree of enlargement of the thyroid gland, retrosternal goiter, blood diseases, kidney disease, peptic ulcer.

3. Nursing Process with diffuse toxic goiter

Conclusion

So, endemic goiter is a disease that occurs in areas with a limited content of iodine in water and soil. It is characterized by compensatory enlargement of the thyroid gland. The disease is widespread in all countries of the world.

Patients with thyroid disease need careful monitoring and care. Often the condition of patients worsens from the most minor violations of the prescribed regimen. A gross violation of the diet, unacceptable physical activity can worsen the course of the process and cause the development of complications and the transition of the course of the disease to a more severe form.

The sister carefully monitors the patient's condition, his activity, well-being, mood. Violations of the mental sphere in varying degrees are observed in all patients. Characterized by apathy, indifference to the environment, along with which there may be increased nervousness or irritability. Patients cannot concentrate, the speed of reactions decreases, sleep is perverted (drowsiness during the day and insomnia at night), intelligence decreases. The sister reports any change in the patient's condition to the attending physician.

Forecast with correct and timely treatment favorable, but after surgical treatment possible development of hypothyroidism. The cause of postoperative hypothyroidism is usually the progression of the autoimmune process or the radical nature of the operation. Patients should avoid sun exposure. Abuse of iodine-containing drugs and foods rich in iodine is unacceptable, especially for people who have such patients in the family.

The prognosis of diffuse toxic goiter depends on timely diagnosis. On the early stages with adequate therapy or after a successful operation, a complete recovery is possible.

Literature

1. Davlitsarova K.E. Fundamentals of patient care. First aid: Tutorial.- M.: Forum: Infa - M, 2004.-386s.

2. Fundamentals of nursing: Textbook / Weber V.R., Chuvakov G.I., Lapotnikov V.A., etc. - M .: Medicine, 2001.-496s.

3. Directory of nurses. - M .: Eksmo Publishing House, 2002. -896s.

4. Physician's guide general practice. In 2 volumes. / Ed. Vorobieva N.S. –M.: Eksmo Publishing House, 2005.- 960s.

5. Smoleva E.V. Nursing in therapy. - Rostov n / a: Phoenix, 2007 - 473s.

6. Yaromich I.V. Nursing business. Textbook./ 5th ed. LLC "Onyx 21st century", 2005.-464s.

Patients in a state of hypothyroid coma should be hospitalized in the department intensive care or resuscitation.

It is necessary to immediately take blood for the content of thyroid hormones, blood pH, glucose, sodium, chlorides, acid-base balance, record an ECG, perform catheterization Bladder. A progressive decrease in body temperature worsens the prognosis. To warm the patient, it is necessary to wrap the patient in blankets, gradually increase the room temperature. Heating pads, hot water bottles are not recommended for warming, as peripheral vasodilation appears, which worsens the blood flow of internal organs (danger of collapse).

In a specialized hospital, the patient will be given intravenous L-thyroxine, intravenous glucocorticoids, to eliminate hypoglycemia - 40% glucose solution intravenously and 5% intravenous drip solution, to combat collapse - reopoliglyukin, 10% albumin solution, to increase blood pressure - angiotensinamide, with heart failure - cardiac glycosides (in a small dosage, since the myocardium in hypothyroidism is highly sensitive to glycosides), to improve metabolism in the myocardium - pyridoxal phosphate, lipoic acid, riboxin, cocarboxylase.

Urgent care in hypothyroid coma

General activities include: slow gradual warming of the patient not higher than one degree per hour during hypothermia, hydrocortisone is administered intravenously (50-100 mg, daily dose up to 200 mg), thyroxine is prescribed (daily dose 400-500 mcg) in the form of a slow infusion.

Along with this, oxygen therapy is carried out in combination with artificial ventilation of the lungs. To combat anemia, a blood or red blood cell transfusion is indicated (the latter is preferable). Infusion therapy is carried out with great care, at the same time glucocorticoids are administered.

Vigorous antibiotic therapy is mandatory to suppress co-infection or prevent an outbreak of a dormant infection. In patients in a coma, atony of the bladder is constantly noted, therefore, a permanent urinary catheter is placed.

NURSING ACTIVITY IN HYPOTHYROISIS

Nursing uses a variety of theories and knowledge. This knowledge is used by the sister in informing the patient, teaching him and guiding him or guiding him.

Currently, the theory of Virginia Henderson is being applied. Within the framework of this theory, Henderson tried to highlight the basic human needs, the satisfaction of which should be aimed at patient care. These needs include:

1. Breath

2. Nutrition and fluid intake

3. Physiological functions

4. Motor activity

5. Sleep and rest

6. Ability to dress and undress independently

7. Maintenance of body temperature and the possibility of its regulation

8. Personal hygiene

9. Ensuring your own safety

10. Communication with other people, the ability to express their emotions and opinions

11. Ability to observe customs and rituals according to religions

12. Being able to do what you love

13. Recreation and entertainment

14. Need for information

Henderson is also known for her definition of nursing: "The unique function of the nurse is to assist the individual, sick or well, in carrying out such activities that contribute to the preservation or restoration of health, which he could provide for himself if he had the necessary strength, will and knowledge

Nursing Process– the scientific method of organizing and providing nursing care, the implementation of a care plan for therapeutic patients, based on the specific situation in which the patient and nurse.

The Purpose of the Nursing Process:

Ø timely identify real and potential problems;

Ø meet the violated vital needs of the patient;

Ø provide psychological support to the patient;

Ø Maintain and restore the patient's independence in meeting the daily needs of his daily activities.

Nursing process in hypothyroidism

Stage I: nursing examination (collection of information)

When questioning the patient: the nurse finds out

ü Increased fatigue

o hair loss

Stage II: identification of disturbed needs and problems of the patient

Possible violated needs:

physiological:

muscle pain

· hair loss

increase in body weight

Possible problems patient:

ü Aching pain in the heart, shortness of breath

ü in women, menstrual irregularities (may be infertile)

in men, decreased libido

lethargy, weakness, drowsiness

ü chilliness

ü memory loss

psychological:

Depression due to an acquired disease;

Fear of instability of life;

Underestimation of the severity of the condition;

Lack of knowledge about the disease;

Lack of self-service;

Care in sickness;

Lifestyle change

social:

loss of ability to work

Financial difficulties in connection with a decrease in working capacity;

social isolation.

spiritual:

Lack of spiritual participation.

priority:

aching pain in the heart, shortness of breath

potential:

risk of developing complications.

Stage III: nursing intervention planning

The nurse, together with the patient and his relatives, formulates goals and plans nursing interventions for a priority problem.

The goal of nursing interventions is to promote recovery, prevent the development of complications and the transition to a more severe course.

IV stage: implementation of nursing interventions

Nursing interventions:

Dependent (performed as prescribed by a doctor): ensuring the intake of medications, performing injections, etc.;

Independent (performed by a nurse without the doctor's permission): recommendations on diet, measurement of blood pressure, pulse, respiratory rate, organization of the patient's leisure and others;

Interdependent (performed by a medical team): providing advice from narrow specialists, ensuring research.

Stage V: evaluation of the effectiveness of nursing interventions

The nurse evaluates the result of interventions, the patient's response to measures of assistance and care. If the set goals are not achieved, the nurse adjusts the nursing intervention plan

Manipulations performed by a nurse

BP measurement

Target: diagnostic.

Indications: doctor's appointment, preventive examinations.

Equipment: tonometer, phonendoscope, alcohol, tampon (napkin), pen, temperature sheet.

Note. At the first visit of the patient, the pressure on both hands should be measured, later on only on one, noting which one. If a stable significant asymmetry is detected, all subsequent measurements should be carried out on the arm with higher rates. Otherwise, measurements are carried out, as a rule, on the “non-working hand”.

Topic: "Nursing care for thyroid diseases:

diffuse toxic goiter, hypothyroidism"

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

The reasons:

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

Complaints:

• From the CNS : tremor of the fingers, a feeling of internal trembling, sleep disturbance, irritability, tearfulness, conflict in the family and at work
• From the side CCC: palpitations, heart pain, shortness of breath on exertion
• From the side of digestive system: increased appetite, increased stool (up to 3-4 times a day), weight loss,
• From the side of eye: a feeling of feeling sand”, lacrimation, decreased visual acuity.
• From the side endocrine system: feeling of pressure in the neck, difficulty in swallowing, menstrual irregularities.

General complaints : increased sweating, fever to subfebrile numbers, constant feeling of heat, muscle weakness.

Objective research methods:

The patient has a youthful appearance,

Neck deformity (enlargement of the thyroid gland).

The skin is moist, warm, velvety to the touch

Reduction of the subcutaneous fat layer (weight loss)

Increase in body temperature.

Eye symptoms:

• eye glitter
• Stelwig's symptom - wide opening palpebral fissure(sharp, "angry" look)
• Mobius sign - violation of the convergence of the eyeballs
• Graefe's symptom - the appearance of a white strip when the eyeball moves down between the edge of the upper eyelid and the edge of the cornea

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

CNS - tremor of fingers

Laboratory methods:

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

Instrumental Methods:

• 131
• Thyroid ultrasound

Treatment:

1. Hospitalization for moderate and severe thyrotoxicosis

2. Diet number 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 the control clinical analysis blood)

Symptomatic therapy:

• sedatives - valerian tincture, motherwort tincture,
• small tranquilizers phenazepam, seduxen, etc.
• cardiac glycosides - korglukon, strophanthin (with heart failure and atrial fibrillation).
• - adrenergic blockers (anaprilin, obzidan) to normalize blood pressure and pulse 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 neck organs by an enlarged thyroid gland.

Disrupted satisfaction of needs:eat, drink, breathe, sleep, be clean, maintain body temperature, communicate, work.

Patient problems:

• Irritability,
• Tearfulness
• heartbeat
• Sleep disturbance
• Increased stool
• sweating
• Conflict in the family and at work

Nursing care:

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

Medical examination:

• Observation at the endocrinologist (control turnout as prescribed by the endocrinologist)
• Examination by an ophthalmologist once every six months
• ECG monitoring once every six months
• Clinical blood test
• Blood for sugar.
• Control of blood pressure, pulse rate.

Hypothyroidism.

Hypothyroidism - a disease caused by a decrease in thyroid function or its complete loss.

The reasons:

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

Patient complaints:

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

Objective examination:

• Appearance - adynamia, facial expressions are poor, speech is slowed down
• 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 (there is no fossa when pressed)
• Body temperature is reduced
• Weight gain
• decrease in blood pressure,
• The decrease in heart rate - less than 60 beats. per minute (bradycardia)

Laboratory and instrumental methods research

Laboratory methods:

Clinical blood test (anemia)

Blood chemistry:

• Determination of the level of thyroid hormones (T3, T4 - the level is reduced)
• The level of thyroid-stimulating hormone (TSH) is elevated
• The level of antibodies to thyroid tissue
• Cholesterol level - hypercholesterolemia

Instrumental Methods:

• Absorption of radioactive iodine J 131 thyroid gland (examination of thyroid function)
• Thyroid Scan
• Thyroid ultrasound

Treatment:

• Diet number 10 (exclude foods rich in cholesterol, reduce energy value food, recommend foods containing fiber)
• Drug Therapy: Substitution hormone therapy: thyroxine, L-thyroxine

Complications :

1. Decrease in intelligence,

Need Disorders: eat, excrete, maintain body temperature, be clean, dress, undress, work.

Patient problems:

• muscle weakness
• chilliness
• Decreased memory
• constipation
• Increase in body weight.

Nursing care:

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

Medical examination:

• Regular follow-up visits to the endocrinologist.
• Control of the level of thyroid hormones, cholesterol levels.
• ECG monitoring once every six months.
• Body weight control.

Test questions:

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

People suffering from metabolic disorders struggle with being overweight. How to lose weight with thyroid disease? It is difficult for many of the patients to solve this issue, since it requires constant control over oneself, one's diet.

The diagnosis of "hypothyroidism" means that the human thyroid gland constantly lacks the necessary hormones. With thyrotoxicosis and hyperthyroidism, on the contrary, too much hormones are produced. They are necessary for the optimal functioning of all systems of the human body. Acceleration of metabolism - the most important factor affecting weight loss. Excess and lack of hormones slows down metabolic processes and leads to the formation of excess weight. It's pretty hard to fight him. But doctors say that losing weight with such diseases is possible. To do this, you need to follow a number of rules.

Why People with Thyroid Disease Don't Lose Weight

If the activity of the thyroid gland is defective, the substances are absorbed and released more slowly. The body stores energy in the form of fat. Therefore, getting rid of even 1 kg often becomes a very time-consuming process. Hypothyroidism gives fatigue and takes energy, so necessary for an active life. That's why doing even simple physical exercises it gets hard.

Slow metabolic processes and lack of physical activity leads to an increase in unnecessary mass. In all people, thyroid diseases cause undesirable consequences in the form of excess weight. If body weight tends to change too dramatically, this is a reason to contact an endocrinologist to check thyroid function.

Another reason for the dramatic weight gain, scientists believe hormonal changes in the body of women during pregnancy and after childbirth. There are examples when women in labor gained over 25 kg in a couple of months, since there was a malfunction in the thyroid gland. With this turn of affairs, doctors have been dealing with the issue of losing weight for more than one year and have made significant progress in solving the problem.

The thyroid gland is shaped like a butterfly. In terms of size, it is small. Its location is the middle part of the neck. This organ produces hormones that are extremely important for life: triiodothyronine (T3), thyroxine (T4). Their correct ratio forms an optimal energy production process. This includes the transfer of oxygen to cells (energy is produced in them).

So, the thyroid gland takes control of almost all chemical reactions. For example, if T3 is in the cell and stimulates its metabolic processes, other hormones are immediately connected to this activity.

In a number of diseases of the thyroid gland - goiter, cancer, postpartum thyroiditis. But most often, doctors fix hypothyroidism and hyperthyroidism. The reasons for the lack of thyroid hormones are as follows:

• Adrenal insufficiency and associated fluctuating cortisol levels.
• Lack or excess of progesterone or estrogen.
• Insulin dependence or vice versa.
• hereditary factors.
• Constant diets or malnutrition due to social disadvantage.

In any case, the doctor will make the correct diagnosis associated with a sharp increase in weight. It is necessary to address to the endocrinologist.

Measures to be taken

First of all, make a promise to yourself that you will not self-medicate. But you can check the level of iodine in the body, which has a direct effect on the functioning of the thyroid gland, at home. Expand your hand inside up and cotton swab draw a grid with iodine just below the elbow bend. The situation when it is absorbed literally before our eyes indicates a lack of this element in the body.

Now go to the endocrinologist. You should not think that by coming to the pharmacy and buying a vitamin complex for people with hypothyroidism, you will solve your problem. An extensive examination is necessary and, in case of abnormalities in the functioning of the thyroid gland, the appointment of individual treatment. Without a comprehensive examination, the selection of drugs or measures of influence is impossible.

Among the diagnostic procedures:

• General blood analysis.
• Analysis of urine.
• Blood test for thyroid hormones.
• Ultrasound of this organ.

In a number of symptoms that are disturbing when the thyroid gland malfunctions, in addition to excess weight:

• irritability;
• a sharp change in mood;
• irascibility;
• unstable mental state;
• insomnia or excessive sleepiness.

Please note that if you have identified shortcomings in the work of this body, it is better not to sunbathe in the sun and solariums, cancel trips to the bath or sauna.

Development of weight loss tactics

Optimization of the activity of the thyroid gland, which consists in compensating for the missing elements, also consists in developing the necessary tactics for weight loss. Neither during treatment, nor after it, one should not go on strict diets. Daily cardinal fasting will adversely affect the functioning of the thyroid gland. You will not get the expected effect, but you will gain a couple more kilograms.

It is necessary to build your diet based on considerations of usefulness and a sufficient amount of the necessary substances for the body. Meals for people suffering from poor thyroid function and losing weight should contain:

• Lots of seafood.
• Seaweed.
• Greens (more lettuce).

In cases where it is impossible to reset the excess, proper treatment thyroid gland will help prevent the set of new kilograms. An optimal metabolism will also establish an energy balance in the body.

With hypothyroidism, the doctor prescribes hormonal therapy. The deficiency of substances that affect metabolic processes is compensated by preparations containing hormones of this gland. All drugs of this type contain synthetic forms of thyroid hormones.

In order not to break loose and disrupt the process of recovery and weight loss, you need to remember that only everyday work on yourself will help you lose excess weight and prevent excess weight from forming. It is important for the patient to know that healthy man can lose a couple of kilograms in a week, and those suffering from thyroid diseases in 2-3 weeks. But with regular physical activity and a balanced diet is possible. Efforts will not go in vain. Even in the program of progressive treatment of hypothyroidism, weight loss is included.

Avoid high-calorie desserts. Instead, eat fresh fruit. The amount of carbohydrates, especially fast ones, should be reduced as much as possible.

There is no universal diet, but it is important to eat healthy foods, give up spicy, smoked, fried, salty, fatty foods. You need to get enough iodine. The foods that you will include in your diet should be saturated with proteins.

Balance the substances in the meals you eat. Each meal should provide the body with healthy fats, fiber and carbohydrates in optimal proportions. So you will not leave a single chance for the accumulation of hated kilograms.

What should be abandoned or, conversely, what should be preferred?

A number of foods that we are accustomed to eating contain substances that increase the glycemic index.

Refuse to consume a large number beets, carrots, corn, turnips, potatoes, parsnips, bananas, grapefruit, oranges, pineapples, raisins, papaya, watermelons.

In addition to these fruits and vegetables, it is undesirable to give preference to white bread, buns, sweets, rice, semolina, pasta.

To process protein, we need more energy than to digest fat and carbohydrates. Metabolic processes will be accelerated if a lot of protein is included in the diet. In addition to seafood, it contains legumes, meat (lean), egg whites.

At least 30 g of fiber per day should enter the body.

This component slows down the digestion of food and prevents simple carbohydrates from being quickly absorbed. Therefore, it is advisable to consume more lentils, apples, beans, broccoli, pears, cauliflower, greens, cereals, nuts, especially almonds, flax seeds.

Not to do here without vitamins and minerals. Zinc is important. Scientists have proven that it significantly prevents a decrease in T3. Selenium works in the same direction. The acceptable dose of these elements for the body for people with poor thyroid function is up to 25 mg of zinc and up to 450 mg of selenium.

The main stages of the nursing process in hypothyroidism

Being a paramedical staff, a nurse controls the work of nurses, nurses and nannies. The speed of recovery of a patient with hypothyroidism depends on her professionalism and knowledge, his mental and physical state upon discharge home.

Hypothyroidism, or an underactive thyroid gland, often causes childhood cretinism or myxedema in adults.

A hormonal disorder can be caused by congenital or acquired as a result of surgical intervention absence of the thyroid gland, hypoplasia, a defect in the enzyme systems of the body, pathogenic phenomena in the hypothalamus or pituitary gland.

Manifestations of hypothyroidism

Congenital pancreatic insufficiency is diagnosed immediately after the birth of a child. The pathology is characterized by a large weight of the baby, lethargy, drowsiness, a rough voice, a long torso and short limbs, dry, pale skin, a flat bridge of the nose and widely spaced eyes, and a voluminous stomach. At an older age, mental retardation, dystrophy, and disproportion of the skeleton are noted.

Acquired hormonal imbalance is manifested by:

• pastosity of facial tissues;
• memory impairment and lethargy;
• thinning, brittleness and dryness of nails and hair;
• violation heart rate, low blood pressure;
• constant chilliness and constipation.

In severe cases, myxedema coma occurs.

Insufficiency of the thyroid gland is always difficult and requires not only specific treatment, but also all kinds of procedures to care for the patient. Often, patients are affected by the central nervous system, the neuropsychic state worsens, it becomes aggressive, capricious and irritable. Therefore, the nurse requires a lot of endurance, calmness and patience in relation to such patients.

Responsibilities of a nurse

The nurse plays one of the main roles in the production medical care population and the effectiveness of the services provided. The functions of a nurse are varied. They affect not only diagnostic and therapeutic measures, but also directly relate to the care of patients with the aim of their speedy recovery.

For a good nurse, stress resistance, accuracy, diligence, cleanliness, attentive attitude to patients, and, of course, special knowledge are very important. Therefore, there are certain requirements for the training of nurses.

A nurse, working with patients with hypothyroidism, must be qualified to carry out the following procedures;

• independently collect the patient's history and carry out some diagnostic measures;
• work with documents, fill out and store medical records, submit discharge forms;
• monitor the physical and emotional state of the patient;
• each nurse should be able to provide first aid in the absence of a doctor;
• carry out the nursing process necessary procedures(droppers, dressings, injections), distribute dosed doses of drugs;
• be interested in the well-being of patients, prepare patients for tests and take them, measure temperature and pressure;
• quickly and accurately follow the orders of the doctor.

In addition, the nurse must be well versed in the causes and symptoms of the disease, know the methods of therapy and correctly apply them.

Goals of nursing care for hypothyroidism

Nursing process in hypothyroidism is the care of the patient, in which his psychological and physical needs are fully satisfied. Possessing the necessary knowledge and skills, the nurse must inform and educate the patient, guide him.

There are specific goals for the nursing process in caring for patients with hypothyroidism.

They are as follows:

• Detect existing and potential problems in a timely manner.
• Satisfy the needs of the patient, provide an acceptable quality of life.
• Provide moral support to the patient, his family and friends, inform them about the state of health and the course of the disease.
• Maintain and restore the patient's independence in meeting daily needs.

Based on these points, the tactics of the nursing process for patients with hypothyroidism are built. A single goal may include many activities that contribute to its successful implementation.

Nursing process in hypothyroidism

For patients admitted to the hospital with a diagnosis of hypothyroidism, a special tactic of the nursing process has been determined, consisting of several stages. All of them are interconnected. Each stage of nursing care is another step towards achieving the main goal of treatment - the complete recovery of the patient.

Stage I - collection of anamnesis

This period includes a survey of the patient. The nurse reveals:

• lethargy, apathy, fatigue, lack of interest in life;
• hair loss, thinning and brittle nails;
• chest pain, shortness of breath and other symptoms of hypothyroidism.

All collected information is analyzed by a nurse, and based on it, the explicit and hidden needs of the patient are determined.

Stage II - identifying the patient's problems

After taking an anamnesis, a nursing diagnosis is made and impaired needs are identified.

The problems of a patient with hypothyroidism are conditionally divided into existing ones that are currently worrying and possible ones (may appear in the future).

A survey conducted by a nurse reveals existing difficulties. Among them, the most common are:

• psychological (stress, immersion in illness, low self-esteem, fear of losing a job);
• social (lack of funds due to illness and long-term disability);
• spiritual.

In the future, a sharp increase in body weight, constipation is possible. Women often have a disorder monthly cycle and infertility.

Stage III - strategy of nursing interventions

During this period, the nurse, together with the patient and his family, plans nursing activities. The main goal of the nursing process is to speed up the recovery of the patient and reduce the risk of possible complications.

The nursing intervention plan should include both short-term and long-term issues.

Stage IV - implementation of nursing interventions

At this stage, the nursing process is carried out according to a plan agreed with the leading doctor and the patient or his relatives.

Nursing interventions are:

• Dependents. Produced only by order of the doctor (appointment medicines and procedures).
• Independent. Performed by a nurse independently (measurement of blood pressure, setting droppers, injections).
• Interdependent.

At this stage, the nurse performs direct care for patients with hypothyroidism. It consists in thoroughly cleansing, moisturizing and softening the skin, as the skin becomes rough, dry and flaky.

In nursing care for patients who are often chilly, it is necessary to control the ambient temperature. If necessary, the patient should be offered a heating pad or an extra blanket.

Since the body temperature in this pathology reflects the degree of development of the disease, it is advisable to carry out thermometry several times a day.

Patients with hypothyroidism often suffer from low blood pressure and bradycardia, so the nurse needs to monitor blood pressure, committing all changes. With angina attacks, measures generally accepted in such cases are carried out.

Replacement therapy involves taking hormonal drugs, which are dosed and issued by a nurse strictly on time. Apart from drug treatment, patients are prescribed a diet that helps reduce the symptoms of hypothyroidism. Diet control is also part of the nursing process.

If a patient develops a myxedema coma, the nurse should immediately notify the doctor and do a test for the content of thyroid hormones in the blood. Then take ECG readings, measure blood pressure, conduct a bladder catheterization and warm the patient with blankets and increase the temperature in the room.

After providing the first support, the duties of a nurse are supplemented by regular infusion of levothyroxine and oxygen therapy. In the event of a developed collapse, injections of prednisolone, dopamine or hydrocortisone are necessary. The treatment regimen is prescribed by a doctor.

Stage V - assessment of the nursing process

If, after all nursing interventions, a patient with hypothyroidism has a persistent improvement in well-being, we can talk about the effectiveness of nursing care.

In case of failure of the measures taken, the nurse corrects the plan of nursing interventions, coordinating it with the endocrinologist.

Hypothyroidism is quite serious illness which can lead to serious complications. The patient needs constant therapy to alleviate the condition and maintain the quality of life, so the nurse can become his friend and assistant for many years.

Methods for the treatment of postoperative hypothyroidism

Treatment of congenital hypothyroidism in children

Therapy for hypothyroidism

What is the latent form of hypothyroidism characterized by and can it be cured

How to treat thyroid disease in men?

Causes of hypothyroidism of the thyroid gland

Is it possible to get pregnant without a thyroid gland?

Many women are concerned about the question, in their opinion, the most important. Is pregnancy possible after thyroidectomy?

The thyroid gland is an organ of the endocrine system responsible for the synthesis of iodine-containing hormones. Malfunctions in the work of the gland lead to a change in the hormonal background. Treatment of destructive changes in the thyroid gland often ends with the complete removal of the organ. The natural synthesis of hormones is replaced by medications. The operation is not a sentence, it is possible to become a mother, but is it possible?

Removal of the thyroid gland introduces qualitative changes in the functioning of the reproductive organs and the central nervous system. Of course, changes in the biological rhythm adversely affect the development of the unborn fetus.

Changes in the work of the female body:

1. Hormonal imbalance leads to violations of the menstrual cycle, which is responsible for the period of maturation of the egg. Violation of natural biological processes makes pregnancy impossible. A lifelong course of hormone replacement therapy can eliminate anomalies.
2. Hypocalcemia is a state of acute calcium deficiency in the blood plasma. Low level calcium in the body adversely affects the intrauterine development of the fetus, increases the likelihood of developing pathological abnormalities. Compliance with a strict diet, treatment with calcium-containing drugs allows you to restore a delicate balance.
3. The introduction of radioactive iodine (suppression malignant neoplasms) has a toxic effect on the body. Beta and gamma elements increase the likelihood of exposure, changes in the original DNA code occur. The course of catalysts helps to reduce the radioactive impact on the body.

A properly selected course of treatment, adherence to a strict diet is the key to the speedy recovery of the body.

Thyroid hormones play a key role in fetal development. Hormones are especially important, starting from the second trimester of pregnancy, when the child develops internal organs. Violation hormone synthesis leads to the development congenital pathologies in the cardiovascular, reproductive and nervous systems. Thyroxine and triiodothyronine are responsible for the formation of the brain, the musculoskeletal system, and regulate metabolic processes in the unformed fetal body.

The complete absence of thyroid hormones in the mother's body triggers pathological processes, having a detrimental effect on the child. Often, doctors ascertain the fading of pregnancy, miscarriages on later dates, stillbirth.

Today, no pregnancy without a thyroid gland is complete without hormone therapy. Synthetic hormones fully compensate for the activity of the thyroid gland, the body does not experience stress.

For women with thyroidectomy, pregnancy should be planned. "Spontaneous" pregnancy often ends in a fatal outcome of the fetus, the endocrinologist needs to prepare the body for the harmonious development of the future little man. The appointment of a multivitamin complex will help a woman successfully become pregnant.

During pregnancy, a healthy thyroid gland increases by 2-2.5 times, on average, hormone production increases by 40-60%. At the stage of pregnancy planning, the endocrinologist forms a pyramidal course of hormone therapy in order to avoid the response of the central nervous system. Starting from the 14th week of intrauterine development, the baby's thyroid gland begins to produce hormones on its own, which means it needs a large amount of iodine. At 17-18 weeks, the body completes its formation, goes into full-fledged functioning.

Lack of iodine in the body adversely affects the functioning of the endocrine system.

In pregnant women, macronutrient deficiency causes the development of intrauterine anomalies, for example:

1. Exhaustion / underdevelopment of the thyroid gland (in a baby).
2. Violation neural connections(deviations in mental development).
3. Congenital diseases of the endocrine system.
4. Violations of the functional activity of internal organs.
5. Defects in the structure of organs.
6. Congenital disorders of the central nervous system.

Starting with pregnancy planning, the expectant mother should be under the supervision of an endocrinologist. After a successful birth, the specialist examines the woman in labor and the child for the presence of pathologies in the thyroid gland.

According to statistics, children born against the background of problems with the thyroid gland (of the mother) are diagnosed with blood diseases, asymmetric growth of the pituitary gland, mental disorders. At the first suspicion of a disease, it is necessary to show the child to the doctor.

A potential danger to the baby is posed by toxic drugs involved in hormone replacement therapy. A long course of treatment has a detrimental effect on intrauterine development. As a rule, women do not experience problems with conception; after 3-4 weeks of pregnancy, spontaneous miscarriage occurs due to a high dose of synthetic hormones. During the planning of pregnancy, the endocrinologist is obliged to prescribe additional drugs that protect the fetus from intoxication.

Experts categorically forbid making a decision about pregnancy, bypassing the office of an endocrinologist. Based on the analyzes, the specialist will be able to predict the course of the full gestational age.

Hypothyroidism- a disease caused by a decrease in thyroid function or its complete loss.

The reasons:

autoimmune thyroiditis

congenital aplasia of the thyroid gland

surgical treatment (subtotal resection of the thyroid gland)

drug exposure (mercasolil overdose)

Patient complaints:

Objective examination:

Appearance - adynamia, facial expressions are poor, speech is slowed down

Puffy face

The palpebral fissures are narrowed, the eyelids are swollen

The skin is dry, cold to the touch, dense swelling of the feet and legs (there is no fossa when pressed)

Body temperature is reduced

Weight gain

decrease in blood pressure,

The decrease in heart rate - less than 60 beats. per minute (bradycardia)

Laboratory methods:

Clinical blood test (anemia)

Blood chemistry:

Determination of the level of thyroid hormones (T3, T4 - the level is reduced)

The level of thyroid-stimulating hormone (TSH) is elevated

The level of antibodies to thyroid tissue

Cholesterol level - hypercholesterolemia

Instrumental Methods:

Absorption of radioactive iodine J 131 by the thyroid gland (examination of thyroid function)

Thyroid Scan

Thyroid ultrasound

Treatment:

Diet number 10 (exclude foods rich in cholesterol, reduce the energy value of food, recommend foods containing fiber)

Drug therapy - hormone replacement therapy: thyroxine, L-thyroxine

Complications:

Decreased intelligence

Violations of the satisfaction of needs: eat, excrete, maintain body temperature, be clean, dress, undress, work.

Patient problems:

muscle weakness

chilliness

Decreased memory

• Increase in body weight.

Nursing care:

Give recommendations on diet therapy (exclude foods containing animal fats, include foods rich in fiber - bran bread, raw vegetables and fruits, limit carbohydrate intake).

Control of frequency, pulse, blood pressure, weight control, stool frequency,

Teach the patient about personal hygiene.

Teach relatives how to communicate with patients

Train relatives in patient care.

Follow doctor's orders.

Medical examination:

Regular follow-up visits to the endocrinologist.

Control of the level of thyroid hormones, cholesterol levels.

ECG monitoring once every six months.

Body weight control.

endemic goiter- a disease that occurs in areas with a limited content of iodine in water and soil. It is characterized by compensatory enlargement of the thyroid gland. The disease is widespread in all countries of the world. Sometimes there is a sporadic goiter enlargement of the thyroid gland without previous iodine deficiency.

In addition to iodine deficiency in the environment, the use of goitrogenic nutrients contained in some varieties of cabbage, turnip, rutabaga, and turnip are also of some importance. In response to an external lack of iodine, hyperplasia of the thyroid gland develops, the synthesis of thyroid hormones and iodine metabolism change.

There are diffuse, nodular and mixed forms of goiter. The function of the thyroid gland may be normal, increased or decreased. More often, however, hypothyroidism is noted. A typical manifestation of thyroid insufficiency in children in endemic areas is cretinism. Significant sizes of the goiter can cause compression of the neck organs, respiratory disorders, dysphagia, voice changes. With the retrosternal location of the goiter, the esophagus, large vessels, and trachea can be compressed.

Absorption of I131 by the thyroid gland is usually increased, the level of T3 and T4 in the blood is reduced (with hypothyroidism), and the level of TSH is increased. Ultrasound helps in the diagnosis, with a retrosternal and intramediastinal location of the goiter - radiography.

Treatment of nodular and mixed forms of goiter is only surgical. The same applies to large goiter and ectopic localization. In other cases, antistrumine, microdoses of iodine (with unimpaired gland function), thyroidin, thyreocomb, thyroxine are used. In hypothyroidism, thyroid hormone replacement therapy is used in compensatory dosages. In endemic foci, preventive intake of iodized products and preparations of iodine, antistrumine is indicated.

Currently, a number of disease states are known due to the influence of iodine deficiency. The consensus (agreed opinion) of the leading endocrinologists of our country on the problem of endemic goiter believes that insufficient intake of iodine in the human body at different periods of his life causes the following diseases.

Diseases caused by iodine deficiency