home All hormones Abstract: Diseases of the thyroid gland. Endemic goiter. Nursing care for thyroid diseases Nursing care for thyroid diseases

Abstract: Diseases of the thyroid gland. Endemic goiter. Nursing care for thyroid diseases Nursing care for thyroid diseases

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 adenoma of the thyroid gland (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
Moebius 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)
Drug 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

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Nursing process for thyroid diseases

The nursing process in diseases of the thyroid gland plays an important role. It is the nurse who closely monitors the patient’s compliance with all the doctor’s prescriptions, and therefore brings recovery closer.

The thyroid gland is one of the most important organs of the human body and produces vital hormones: thyroxine (T3) and triiodothyronine (T4). They are responsible for metabolism, thermoregulation and have a direct effect on most organs and systems.

The thyroid gland, one of the endocrine glands, is susceptible to several diseases. They are caused by a number of reasons, for example: iodine deficiency, unfavorable environment, congenital anomalies, inflammatory and autoimmune diseases.

All diseases of this organ can be conditionally divided into 2 large groups. In some cases, the function of the gland decreases and it produces insufficient amounts of hormones. This condition is called hypothyroidism. Or, on the contrary, the gland produces an excess amount of hormones and poisons the body. Then they talk about hyperthyroidism.

Hypothyroidism is a rather unsafe condition that can lead to very serious consequences, especially if a child suffers from it. After all, a lack of thyroid hormones leads to mental retardation and even the occurrence of cretinism. Therefore, many countries around the world are very active in preventing this condition.

Hypothyroidism is a pathological condition in which the amount of hormones produced is significantly reduced. It can be caused by inflammatory diseases in the gland, lack of iodine in food and water, congenital aplasia of the gland, removal of most of it, or an overdose of certain medications (for example, Mercazolil).

This condition is diagnosed through blood tests, ultrasound, and other thyroid tests.

In case of hypothyroidism, the nurse plays an important role in treatment. Caring for such patients requires special patience, because the dysfunction of this organ is almost primarily reflected in the mental state of the patient. Here are the functions that a nurse performs:

Constant monitoring of heart rate, blood pressure, body temperature, stool frequency.
Monitoring the patient's weight. Weekly weighing is required.
Recommendations for diet therapy. Such patients are prohibited from consuming animal fats and are recommended to eat foods rich in fiber. This is due to a slowdown in metabolism.
Teaching relatives of patients how to communicate with them.
Organization of hygiene procedures and room ventilation.

Since patients with hypothyroidism often freeze, the nurse must ensure a comfortable air temperature in the room or use heating pads, warm clothes and blankets.

Diffuse toxic goiter

Diffuse toxic goiter is a pathology that is caused by the fact that the thyroid gland produces too much hormones T3 and T4. This leads to the fact that metabolic processes in the body are greatly accelerated, which ultimately leads to disruption of the functioning of many organs and systems.

This disease has a long course, so the nursing process for diffuse toxic goiter is especially important. Here are the functions that a nurse performs:

Creates conditions for patients to fully relax and ensures their psychological comfort.
Constantly monitors blood pressure, pulse rate, and bowel movements.
Monitors the patient's nutrition. Conducts weekly control weighing.
Monitors the patient's body temperature and room temperature. Use heating pads and warm blankets if necessary.
Creates a favorable microclimate around the patient, trains relatives to care for such a patient.

Patients with diffuse toxic goiter are very irritable, tearful, and conflict-ridden. Therefore, in this case, a lot of patience and tact are required from the sister.

It is the nurse who must monitor the implementation of all the doctor’s recommendations and teach relatives the basics of caring for patients.

As you can see, the nursing process for thyroid diseases plays almost a key role in the patient’s recovery. It is extremely important for the patient to follow all the recommendations of the medical staff and make every effort to overcome his illness.

nuzhenjod.ru

What are the features of caring for patients with hypothyroidism?

The concept of healthcare development in the Russian Federation implies new methods of nursing for diseases of the thyroid gland, in particular hypothyroidism.

Modern technologies of care and rehabilitation assume high responsibility and delineation of responsibilities of nurses and are aimed at improving the patient’s quality of life.

The term "nursing process" originated in the United States and was first used by Lydia Hall in 1995.

Specialists in this field of activity must be sufficiently qualified to independently identify problems and solve them according to the situation.

What do you have to deal with?

A condition in which a person does not have enough thyroid hormones is called hypothyroidism.

This disease was first identified and described at the end of the 19th century. Hypothyroidism is the opposite of another disease - hyperthyroidism, in which there is excessive hormonal activity of the thyroid gland.

The most severe forms of this disease are myxedema and cretinism.

Also, in advanced cases, the patient may fall into a myxedematous coma.

With a mild form of hypothyroidism, minimal assistance is required from the nurse, but with myxedema or coma, the amount of work increases many times over.

The body's reactions to hypothyroidism, which occur due to a lack of thyroid hormones, reduce the patient's performance and contribute to depressive syndrome.

A nurse should help a person perform minimal self-care procedures, eat normally, and feel well.

When the necessary substances are replenished, replaced by synthetic analogues, the symptoms of the disease usually go away.

The severity of symptoms is largely determined by the etiology of the disease.

Hypothyroidism can be caused by:

various pathological processes in the thyroid gland;
surgical interventions on the thyroid gland;
lack of iodine in the body;
heredity;
pathologies of the hypothalamus and pituitary gland.

In Russia, approximately 2% of the population suffers from this disease, which means that many medical personnel must be able to care for the victim.

Most thyroid pathologies are detected in women, and it is in patients that emotional lability is most acutely manifested.

The nurse should be trained to behave in conflict situations and be patient with the patient's condition.

The disease also depends on geographical factors, since in some areas there may be a significant iodine deficiency.

In mountainous areas, medical staff encounters victims of hypothyroidism 2-5 times more often than in coastal areas.

People with hypothyroidism have the following symptoms:

The disease is diagnosed based on laboratory tests; if the condition is assessed as critical, the person should be admitted to a hospital.

In both inpatient and outpatient departments, the nurse assists the endocrinologist with diagnostic and therapeutic procedures.

The level of thyroxine and triiodothyronine in the blood is significantly reduced, and the amount of thyroid-stimulating hormones is increased.

For drug treatment, synthetic thyroid hormones such as thyroxine are used.

In a hospital setting, a nurse should dispense medications that compensate for hormonal imbalances.

If the patient is undergoing outpatient treatment, he buys and takes medications on his own; the help of a nurse may only be needed during a consultation with an endocrinologist.

What exactly do you need help with?

Caring for a patient by meeting his physical and psychological needs is called the nursing process.

There are state standards for performing this type of activity, including the organization and execution of care for patients with various diseases.

The goals of nursing interventions when caring for a person with hypothyroidism are:

Coma with hypothyroidism of the thyroid gland is a serious condition.

Most often it occurs in older people and in cases where treatment has been neglected.

Coma is caused by a sharp disruption of metabolic processes.

Against this background, pathologies of the adrenal glands and a decrease in the protective mechanisms of the human body develop.

The probability of such an outcome is about 38%.

Therefore, a person in this condition needs constant care and medical support.

Emergency care for a patient who has fallen into a coma includes:

preparing the site and placing the patient in the correct position;
oxygen therapy, or providing air flow to the patient's lungs;
collecting tests, measuring blood pressure and pulse;
preparation of drugs for intravenous administration.

Hypothyroidism develops gradually. Often, patients do not immediately notice the initial signs of this disease.

A sudden deterioration in condition and exacerbation of all symptoms of the disease precedes the onset of coma.

Drowsiness develops into loss of consciousness. Body temperature decreases to 20°C and breathing slows down.

Blood pressure decreases and the patient's pulse rate drops to 32 beats per minute.

After providing emergency care, the nurse's responsibilities include ongoing care for a person suffering from hypothyroidism.

He needs to be given 25 mcg of levothyroxine intravenously every few hours.

In case of collapse, you need to give injections of 150 mg of prednisolone or 300 mg of hydrocortisone and about 200 mg of dopamine.

In order to maintain a sufficient level of oxygen in the patient's body, oxygen therapy must be carried out.

You should also regularly place drips of glucose solution.

All prescriptions are given by the attending physician, the nurse simply does what the endocrinologist recommended.

Nurse training requirements

Nurses work in both private and public health care institutions.

To provide more effective patient care, there are nurse training and licensing requirements for educational institutions.

For hypothyroidism, it is necessary for the nurse to know and be able to carry out procedures and tests:

carrying out various diagnostic methods;
collection of tests and various indicators of the functioning of the body;
ability to carry out various medical procedures;
ability to work with documentation;
knowledge of the causes, symptoms and treatments of major diseases;
knowledge of safety precautions when working with devices and tools.

Depending on the geographic location, the scope of this profession may differ due to the uniqueness of the state culture and the quality of the health care system.

For example, in endemic areas, much attention is paid to the prevention of goiter.

The International Council of Nurses, whose symbol is a white heart, operates in more than 130 countries.

The Council gave its definition to the tasks and goals of the nursing process: this is the activity of joint and individual care for people suffering from various diseases, including thyroid pathologies.

The definition clarifies that patients of different ages and social groups have the same right to qualified care.

The nursing process also involves promoting a healthy lifestyle among those who are at risk for thyroid diseases.

Where can you find a great nurse?

You can hire a paid nurse in specialized clinics.

Regular clinics sometimes also provide home care, paid or free.

You can clarify this issue with an endocrinologist or at the reception.

Prices for medical support vary from 300 to 3000 rubles per visit; the price list for specific manipulations also has significant differences.

Care for elderly patients is sometimes provided at discounted prices, 20-50% lower than usual.

White heart

The responsibilities of a nurse or brother include providing emergency first aid, assisting during operations, caring for patients, and performing various therapeutic measures.

Florence Nightingale is considered the founder of nursing.

In her notes, this activity is characterized as using the environment to improve the health of the patient.

This woman's birthday is Nurse's Day.

Professionalism, participation and compassion are qualities inherent in workers in this field.

Thyroid diseases such as hypothyroidism or hyperthyroidism can cause severe conditions in which the nurse or brother will become the patient's friend and helper for a long time.

proshhitovidku.ru

Topic: "Nursing care for diseases of the endocrine system (hypothyroidism)."

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

autoimmune thyroiditis

congenital aplasia of the thyroid gland

surgical treatment (subtotal resection of the thyroid gland)

drug effects (overdose of Mercazolil)

Patient complaints:

Objective examination:

Appearance – adynamia, poor facial expressions, slow speech

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 (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 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:

Uptake of radioactive iodine J 131 by the thyroid gland (thyroid function test)

Thyroid scan

Ultrasound of the thyroid gland

Diet No. 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:

Decrease in intelligence,

Disturbances in satisfying needs: eating, excreting, maintaining body temperature, being clean, dressing, undressing, working.

Patient problems:

Muscle weakness

Chilliness

Memory loss

Increase in body weight.

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.

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.

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

In addition to iodine deficiency in the environment, the consumption of goitrogenic nutrients contained in certain varieties of cabbage, turnips, rutabaga, and turnips is also of some importance. In response to external iodine deficiency, hyperplasia of the thyroid gland develops, the synthesis of thyroid hormones and iodine metabolism change.

There are diffuse, nodular and mixed forms of goiter. Thyroid function may be normal, increased or decreased. More often, however, hypothyroidism is noted. A typical manifestation of thyroid deficiency in children in endemic areas is cretinism. Significant goiter sizes can cause compression of the neck organs, breathing problems, dysphagia, and voice changes. When the goiter is located retrosternally, the esophagus, large vessels, and trachea can be compressed.

The uptake 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 diagnosis, and for retrosternal and intramediastinal goiter, radiography.

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

Currently, a number of painful conditions caused by the influence of iodine deficiency are known. The consensus (agreed opinion) of leading endocrinologists in our country on the problem of endemic goiter believes that insufficient intake of iodine into the human body at various periods of his life causes the following diseases.

Diseases caused by iodine deficiency

studfiles.net

Nursing process for diffuse toxic goiter

Nursing process in diffuse toxic goiter. Diffuse toxic goiter (Graves' disease, thyrotoxicosis) is a disease characterized by increased secretion of thyroid hormones. The main importance in the etiology of the disease is given to hereditary predisposition. Psychotrauma and infections (sore throat, flu, rheumatism) are also important in the occurrence of the disease. solar radiation, pregnancy and childbirth, organic lesions of the central nervous system (CNS), diseases of other endocrine glands. The main clinical manifestations of the disease are: enlarged thyroid gland, increased excitability, irritability. tearfulness. The patient's behavior and character change: fussiness, haste, touchiness, and hand tremors appear.

Complaints and medical history when questioned are poorly presented by the patient; he often focuses on trifles and misses important symptoms. Patients often complain of increased sweating, poor heat tolerance, low-grade fever, trembling of the limbs and sometimes the whole body, and sleep disturbances. significant and rapid weight loss with a good appetite. There are often changes in the cardiovascular system: palpitations, shortness of breath that worsens with physical activity, irregularities in the heart area. Women often experience menstrual irregularities. During examination, the patient’s appearance is noteworthy: the facial expression often takes on an “angry” or “frightened” look due to ocular symptoms and primarily due to exophthalmos (bulging eyes) and rare blinking. Graeffe's symptom (a lag of the upper eyelid when lowering the eyes, with a white stripe of the sclera visible) and Moebius' sign (loss of the ability to fix objects at close range), eye gloss and lacrimation appear. Patients may complain of pain in the eyes, sensations of sand, a foreign body, and double vision. From the cardiovascular system, pronounced tachycardia up to 120 beats is noted. min, possible atrial fibrillation, increased blood pressure.

Nursing process for diffuse toxic goiter: Patient problems: A. Existing (present): - irritability; - tearfulness: - touchiness: - palpitations, irregularities in the heart area: - shortness of breath; pain in the eyes; - weight loss: - increased sweating; - trembling of limbs; - weakness, fatigue; - sleep disturbance; - poor heat tolerance. B. Potential: - risk of developing “thyrotoxic crisis”; - “thyrotoxic heart” with symptoms of circulatory failure; - fear of the possibility of surgical treatment or treatment with radioactive iodine.

Collection of information during the initial examination:

Collecting information from a patient with diffuse toxic goiter sometimes causes difficulties due to the peculiarities of her behavior and requires tact and patience from the nurse when talking with him. A. Questioning the patient about: - the presence of thyroid diseases in close relatives; - previous diseases, injuries of the central nervous system; features of professional activity; connection of the disease with psychotrauma; - the patient’s attitude towards sun exposure, tanning: - duration of the disease; - observation by an endocrinologist and the duration of the examination, its results (when and where was the last time examined); - medications used by the patient (dosage, regularity and duration of use, tolerability); - for women, find out whether the manifestation of the disease is associated with pregnancy or childbirth, and whether there are any irregularities in the menstrual cycle; - patient complaints at the time of examination. B. Examination of the patient: - pay attention to the patient’s appearance, the presence of eye symptoms, tremor of the hands and body; - examine the neck area; - assess the condition of the skin; - measure body temperature; - determine the pulse and characterize it; - measure blood pressure; - determine body weight.

Nursing interventions, including work with the patient's family:

1. Provide physical and mental rest to the patient (it is advisable to place him in a separate room). 2. Eliminate irritating factors - bright light, noise, etc. 3. Observe deontological principles when communicating with the patient. 4. Conduct a conversation about the essence of the disease and its causes. 5. Recommend a nutritious diet with a high content of protein and vitamins, with a limit on coffee and strong tea. chocolate, alcohol. 6. Recommend wearing lighter and looser clothing. 7. Ensure regular ventilation of the room. 8. Inform about medications prescribed by a doctor (dose, features of administration, side effects, tolerability). 9. Monitor: - compliance with the regime and diet; - body weight; - pulse frequency and rhythm; - arterial pressure; - body temperature; - condition of the skin; - taking medications prescribed by a doctor. 10. Ensure the patient is prepared for additional research methods: biochemical blood test, test for accumulation of radioactive iodine in the thyroid gland, scintigraphy. Ultrasound.

11. Conduct a conversation with the patient’s relatives, explaining to them the reasons for changes in the patient’s behavior, reassure them, recommend that they be more attentive and tolerant with the patient.

sestrinskoe-delo.ru

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:

Objective examination:

Appearance – adynamia, poor facial expressions, slow speech

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 (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 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:

Uptake of radioactive iodine J 131 by the thyroid gland (thyroid function test)

Thyroid scan

Ultrasound of the thyroid gland

Treatment:

Diet No. 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:

Decrease in intelligence,

Disturbances in satisfying needs: eating, excreting, maintaining body temperature, being clean, dressing, undressing, working.

Patient problems:

Muscle weakness

Chilliness

Memory loss

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.

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.

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

Diseases caused by iodine deficiency

In the structure of oncological diseases, thyroid cancer occupies a modest place, occurs mainly in women, and has a tendency to increase incidence in recent years in Russia.

The occurrence of malignant neoplasms of the thyroid gland is promoted by:

ionizing radiation caused by accidents at nuclear power plants or childhood irradiation of the head, neck or upper mediastinum for diagnostic or therapeutic purposes;
entry into the body of radioactive iodine when it contaminates the environment;
benign formations (adenomas, cysts, multinodular goiter, etc.), inflammatory diseases (thyroiditis) of the thyroid gland;
increased level of thyroid-stimulating hormone of the pituitary gland;
genetic factors: a family history of thyroid cancer.

The clinical course of malignant neoplasms of the thyroid gland depends on their morphological (histological) structure. Highly differentiated forms are characterized by a long course and a favorable prognosis, low-differentiated forms are characterized by an aggressive, extremely malignant course and an unfavorable prognosis; the medullary form of cancer occupies an intermediate position. There may be no clear clinical signs of cancer, but as it progresses, symptoms appear that make it possible to suspect a malignant tumor. First of all, this is the detection in the neck area of a single, fixed, dense, sometimes tuberous nodule, less often - multiple nodules or tumor formations. The spread of a malignant neoplasm beyond the thyroid gland may be accompanied by pain in the neck, hoarseness, cough, breathing and swallowing problems.

The clinical course of the disease is worsened by tumor metastasis to regional lymph nodes and, especially, to the lungs, pleura, bones, brain, liver and kidneys.

Diagnosis of thyroid cancer begins with a questioning of the patient regarding the possibility of irradiation in childhood of the mediastinum or tonsils, the presence of malignant diseases of the thyroid gland in his relatives. An objective examination involves assessing the general condition, examining the skin, visible mucous membranes and neck, palpation of the thyroid gland and regional lymph nodes.

Laboratory and instrumental studies:

clinical blood test with counting of rsticulocytes and platelets: possible decrease in hemoglobin concentration (anemia) and increase in ESR;
biochemical blood test - determination of the concentration of cholesterol, bilirubin, iron, calcium, alkaline phosphatase, total protein and protein fractions, alanine and aspartate aminotransferase, creatinine;
general urine analysis;
coprogram;
Ultrasound of the thyroid gland, cervical lymph nodes and abdominal organs;
aspiration biopsy with a thin needle of a nodular compaction on the joint, followed by histological (cytological) examination of the biopsy sample.

The leading role in the diagnosis (verification) of thyroid cancer belongs to two studies: ultrasound of the thyroid gland and, especially, aspiration biopsy, with the help of which it is possible to differentiate malignant and benign tumors.

Basic components of nursing care:

questioning the patient and identifying possible causes of thyroid cancer;
constant monitoring of the patient, palpation of tumor formations on the neck and regional lymph nodes;
informing the patient and his relatives about the essence of the disease, methods of its diagnosis and treatment;
providing pre- and postoperative care for the patient, teaching him self-care techniques;
monitoring the patient’s compliance with the radiation and hormonal therapy plan, identifying and treating their side effects;
providing physical, psychological, medical and social assistance to the patient and his family members;
organization of consultations with medical specialists (surgeon, endocrinologist, pulmonologist, psychotherapist, etc.).

Treatment of thyroid cancer involves the use of:

surgical methods (thyroidectomy, lobectomy with isthmus);
radiation therapy (external irradiation, use of radioactive iodine);
hormone therapy with the use of thyroid drugs (L-thyroxine, thyrocomb, etc.) to suppress the production of thyroid-stimulating hormone of the pituitary gland and the growth of malignant tumors.

The main method of treating differentiated forms of thyroid cancer is surgical, sometimes in combination with other methods - combined, complex. For undifferentiated forms of cancer, palliative treatment is mainly used.

Philosophy of Nursing

Decree of the Government of the Russian Federation dated November 5, 1997, No. 1387 “On measures to stabilize and develop healthcare and medical science in the Russian Federation” provides for the implementation of a reform aimed at improving the quality, accessibility and economic efficiency of medical care to the population in the conditions of the formation of market relations.

Nurses play one of the leading roles in solving the problems of medical and social assistance to the population and improving the quality and efficiency of medical services provided by nursing staff in health care facilities. The functions of a nurse are varied and her activities concern not only the diagnostic and treatment process, but also patient care with the goal of complete rehabilitation of the patient.

The first definition of nursing was given by the world famous nurse Florence Nightingale. In her famous Notes on Nursing in 1859, she wrote that nursing is “the act of using the patient’s environment to promote his recovery.”

Currently, nursing is an integral part of the healthcare system. It is a multifaceted medical and sanitary discipline and has medical and social significance, since it is designed to maintain and protect the health of the population.

In 1983, the First All-Russian Scientific and Practical Conference dedicated to the theory of nursing was held in Golitsino. During the conference, nursing was considered as part of the health care system, science and art, which are aimed at solving existing and potential problems relating to the health of the population in an ever-changing environment.

According to international agreement, the conceptual model of nursing is a framework based on the philosophy of nursing, which includes four paradigms: nursing, person, environment, health.

The concept of personality has a special place in the philosophy of nursing. The object of the nurse’s activity is the patient, a person as a set of physiological, psychosocial and spiritual needs, the satisfaction of which determines his growth, development and fusion with the environment.

The nurse has to work with different categories of patients. And for each patient, the nurse creates an atmosphere of respect for his present and past, his life values, customs and beliefs. She takes the necessary safety measures for the patient if his health is in danger from employees or other people.

The environment is considered as the most important factor influencing human life and health. It includes a set of social, psychological and spiritual conditions in which human life takes place.

Health is viewed not as the absence of disease, but as the dynamic harmony of the individual with the environment, achieved through adaptation.

Nursing is a science and art aimed at solving existing problems associated with human health in a changing environment.

The philosophy of nursing establishes the basic ethical responsibilities of professionals in serving people and society; the goals that the professional strives for; moral character, virtues and skills expected of practitioners.

The core principle of nursing philosophy is respect for human rights and dignity. It is realized not only in the nurse’s work with the patient, but also in her collaboration with other specialists.

The International Council of Nurses has developed a code of conduct for nurses. According to this code, the fundamental responsibility of nurses has four main aspects: 1) promoting health, 2) preventing disease, 3) restoring health, 4) alleviating suffering. This code also defines the responsibility of nurses to society and colleagues.

In 1997, the Russian Association of Nurses adopted the Code of Ethics for Russian Nurses. The principles and norms that make up its content specify moral guidelines in professional nursing activities.

II. Main part

1. The concept of the nursing process (theoretical part)

The nursing process is one of the basic concepts of modern nursing models. In accordance with the requirements of the State Educational Standard for Nursing, the nursing process is a method of organizing and performing nursing care for a patient, aimed at meeting the physical, psychological, social needs of an individual, family, and society.

The goal of the nursing process is to maintain and restore the patient's independence and meet the basic needs of the body.

The nursing process requires from the nurse not only good technical training, but also a creative attitude towards patient care, the ability to work with the patient as an individual, and not as an object of manipulation. The constant presence of the nurse and her contact with the patient make the nurse the main link between the patient and the outside world.

The nursing process consists of five main stages.

1. Nursing examination. Collection of information about the patient’s health status, which can be subjective and objective.

The subjective method is physiological, psychological, social data about the patient; relevant environmental data. The source of information is a survey of the patient, his physical examination, study of medical documentation data, conversation with the doctor, and the patient’s relatives.

The objective method is a physical examination of the patient, including assessment and description of various parameters (appearance, state of consciousness, position in bed, degree of dependence on external factors, color and moisture of the skin and mucous membranes, presence of edema). The examination also includes measuring the patient's height, determining his body weight, measuring temperature, counting and assessing the number of respiratory movements, pulse, measuring and assessing blood pressure.

The end result of this stage of the nursing process is the documentation of the information received and the creation of a nursing medical history, which is a legal protocol - a document of the independent professional activity of the nurse.

2. Identifying the patient's problems and formulating a nursing diagnosis. The patient's problems are divided into existing and potential. Existing problems are those problems that are currently bothering the patient. Potential - those that do not yet exist, but may arise over time. Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, and also identifies the patient’s strengths that he can counteract the problems.

Since a patient always has several problems, the nurse must establish a system of priorities. Priorities are classified as primary and secondary. Primary priority is given to problems that are likely to have a detrimental effect on the patient in the first place.

The second stage ends with the establishment of a nursing diagnosis. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, while nursing diagnosis is based on describing patients' reactions to health problems. The American Nurses Association, for example, identifies the following as the main health problems: limited self-care, disruption of normal functioning of the body, psychological and communication disorders, problems associated with life cycles. As nursing diagnoses, they use, for example, phrases such as “deficiency of hygiene skills and sanitary conditions”, “decreased individual ability to overcome stressful situations”, “anxiety”, etc.

3. Determining the goals of nursing care and planning nursing activities. The nursing care plan must include operational and tactical goals aimed at achieving specific long-term or short-term results.

When forming goals, it is necessary to take into account the action (execution), criterion (date, time, distance, expected result) and conditions (with the help of what and by whom). For example, “the goal is that the patient, with the help of a nurse, should get out of bed by January 5.” Action - get out of bed, criterion January 5, condition - help from a nurse.

After determining nursing goals and objectives, the nurse develops a written nursing care manual that details the nurse's specific nursing actions to be recorded in the nursing record. sister process thyroid gland

4. Implementation of planned actions. This stage includes measures that the nurse takes to prevent diseases, examine, treat, and rehabilitate patients.

doctor's orders and under his supervision. Independent nursing intervention involves actions carried out by the nurse on his own initiative, guided by his own considerations, without direct demands from the doctor. For example, teaching the patient hygiene skills, organizing the patient’s leisure time, etc.

Interdependent nursing intervention involves the joint activities of the nurse with the doctor, as well as with other specialists.

In all types of interactions, the sister's responsibility is exceptionally great.

5. Assessing the effectiveness of nursing care. This stage is based on the study of the dynamic reactions of patients to the nurse's interventions. The sources and criteria for assessing nursing care are the following factors to assess the patient's response to nursing interventions; the following factors serve to assess the degree to which the goals of nursing care have been achieved: assessment of the patient’s response to nursing interventions; assessing the degree to which nursing care goals have been achieved; assessing the effectiveness of nursing care on the patient’s condition; active search and assessment of new patient problems.

An important role in the reliability of assessing the results of nursing care is played by the comparison and analysis of the results obtained.

Therapeutic nutrition for endemic goiter

The main etiological factor of endemic goiter is insufficient intake of iodine into the body due to its low content in soil, water and, consequently, food in some areas (Western Ukraine, Belarus, Uzbekistan, Russia (Karelia, the upper reaches of the Volga River, Mari El, Ural , Central and Northern Caucasus, Kyrgyzstan, Transbaikalia).

The development of this disease is facilitated by insufficient, monotonous, unbalanced nutrition (poor in protein, vitamins, mainly carbohydrates, with sufficient or excess fat).

Diet therapy is based on the functional state of the thyroid gland. If its function is normal, diet No. 15 is indicated. With increased thyroid function, you should follow the recommendations indicated for diffuse toxic goiter. For patients whose goiter occurs with decreased thyroid function, the diet recommended for patients with hypothyroidism is indicated. It is especially important to introduce a sufficient amount of iodine into the body. For this purpose, it is necessary to consume iodized salt (contains 25 g of potassium iodide per 1 ton of sodium chloride) and foods rich in iodine (sea and ocean fish dishes, crabs, shrimp, squid, seaweed).

There are indications of the goitrogenic effect of some products (cabbage, radishes, rutabaga, turnips, dill, walnuts), and therefore it is advisable to limit their consumption.

Treatment of endemic goiter

The main method of treating endemic goiter is the use of thyroid drugs. They inhibit the release of thyrotropin according to the feedback principle, reducing the size of the thyroid gland. These drugs also reduce autoimmune reactions in the thyroid gland, are a means of preventing hypothyroidism and malignancy in patients with euthyroid goiter, and are a means of replacement therapy for the development of hypothyroidism.

Indications for prescribing thyroid drugs for endemic goiter:

diffuse euthyroid goiter grade 1b-2-3. increase (according to some endocrinologists - 1a-2-3 degrees);

hypothyroidism in a patient with any form and any degree of enlargement of the thyroid gland (for treatment methods, see chapter “Treatment of hypothyroidism”)

For the treatment of endemic goiter, L-thyroxine, triiodothyronine, tireotom, and tireotom-forte are used.

L-thyroxine is initially prescribed at 50 mcg per day in the morning before meals (if dyspeptic symptoms occur after eating). In the absence of symptoms of drug-induced hypothyroidism (sweating, tachycardia, feeling of irritability and heat), after 4-5 days you can gradually increase the dose and bring it to the optimal level - 100-200 mcg per day. The drug should be prescribed primarily in the first half of the day.

The initial dose of triiodothyronine is 20 mcg 1-2 times a day (in the first half of the day), then every 5-7 days, with good tolerance and the absence of symptoms of drug-induced hyperthyroidism, the dose can be gradually increased and brought to 100 mcg per day.

Treatment with thyrotomy (1 tablet contains 10 mcg T3 and 40 mcg T4) begins with ½ tablet per day (in the morning), then gradually increases the dose every week and brings it up to 2 tablets per day.

Tireotom-forte (1 tablet contains 30 mcg T3 and 120 mcg T4) is initially prescribed at ½ tablet per day, then, if well tolerated, the dose of the drug is increased to 1-11/2 tablets per day.

Less commonly, thyrocomb is used in the treatment of endemic goiter. 1 tablet of thyrocomb contains 10 mcg T3, 70 mcg T4 and 150 mcg potassium iodide. The initial dose of the drug is 1/2 tablet per day, then the dose is gradually increased every 5-7 days and brought to the optimal dose (1-2 tablets per day). Considering the presence of potassium iodide in thyrocomb and in order to avoid an overdose of iodine, leading to iodine-Basedowism, it is advisable to carry out treatment with thyrocomb in courses of 2-3 months with breaks for the same period.

Treatment of patients with endemic goiter with thyroid drugs lasts a long time - for 6-12 months, depending on the dynamics of the size of the thyroid gland.

During treatment with thyroid drugs, control examinations of the patient should be carried out every 3 months with changes in neck circumference, ultrasound of the thyroid gland, and palpation of the goiter. As the goiter decreases, the dose of thyroid medications can be reduced.

In recent years, reports have appeared about the possibility of treating diffuse euthyroid goiter with potassium iodide. The drug is produced by Berlin-Chemie in tablets containing 262 mcg of potassium iodide in 1 tablet, which corresponds to 200 mcg of iodine.

According to the company's instructions, the dosages of potassium iodide are as follows:

for newborns, children and adolescents - 1/2-1 tablet per day (i.e. 100-200 mcg of iodine);

young adults - 1 1/2-2 1/2 tablets per day (i.e. 300-500 mcg of iodine).

Treatment of goiter in newborns usually takes 2-4 weeks. Treatment of goiter in children, adolescents and adults lasts for 6-12 months or longer.

It is believed that the above doses of potassium iodide do not cause the Wolf-Caikoff effect (i.e., it does not inhibit the organization of iodine in the thyroid gland, its absorption and does not disrupt the synthesis of thyroid hormones). This effect develops only when doses of iodine exceed 1 mcg per day.

In case of endemic goiter with hyperthyroidism, optimal doses of thyroid drugs are prescribed for compensation, but these doses are reached gradually, especially in the elderly.

Hypothyroidism is treated with thyroid medications for life.

Treatment of hypothyroidism

Hypothyroidism is a syndrome of insufficient supply of thyroid hormones to the body.

Depending on the cause, the following forms of the disease are distinguished: primary, secondary, tertiary, peripheral, mixed, congenital, acquired.

Primary hypothyroidism is insufficient production of thyroid hormones, caused by various pathological processes in the gland itself. This form of hypothyroidism is the most common and accounts for 90-95% of all cases of thyroid deficiency.

Secondary hypothyroidism is insufficient function of the thyroid gland, caused by impaired formation or secretion of thyroid-stimulating hormone by the adenohypophysis.

Tertiary hypothyroidism is insufficient function of the thyroid gland, caused by damage to the hypothalamus and a decrease in the secretion of thyroid hormone-releasing hormone.

The peripheral form of hypothyroidism is hypothyroidism associated with inactivation of thyroid hormones during circulation or caused by a decrease in the sensitivity of cellular receptors of thyroid-dependent organs and tissues to thyroxine and triiodothyronine during normal biosynthesis and secretion of thyroid hormones.

Etiological treatment

Etiological treatment of hypothyroidism is not always possible and is almost ineffective. In rare cases, etiological treatment may have a positive effect. Thus, timely anti-inflammatory therapy for infectious-inflammatory damage to the hypothalamic-pituitary region can lead to the restoration of the thyroid-stimulating function of the pituitary gland. Drug-induced hypothyroidism can be reversible.

Replacement therapy with thyroid drugs

The main methods of treating primary, secondary and tertiary hypothyroidism are replacement therapy with thyroid hormones and drugs containing them.

The following thyroid drugs are used.

Thyroidin (dried animal thyroid gland) - available in tablets of 0.05 and 0.1 g. The iodine content in thyroidin ranges from 0.1 to 0.23%. The content of T3 and T4 in thyroidin depends on the thyroid gland of which animal it is obtained from. In thyroidin obtained from the thyroid gland of a pig, the ratio of T4 to T3 is (2-3):1, in cattle - 3:1, in sheep - 4.5:1. Approximately 0.1 g of thyroidin contains 8-10 μg of T3 and 30-40 μg of T4.

L-thyroxine (euthyrox) is the sodium salt of levorotatory thyroxine, available in tablets of 50 and 100 mcg. The effect of L-thyroxine after oral administration appears after 24-48 hours, the half-life is 6-7 days.

Triiodothyronine - available in tablets of 20 and 50 mcg. The effect of triiodothyronine begins 4-8 hours after oral administration, the maximum effect occurs on the 2-3rd day, complete elimination of the drug from the body occurs after 10 days.

When triiodothyronine is taken orally, 80-100% of the drug is absorbed; triiodothyronine has 5-10 times greater biological activity than thyroxine.

Thyrotom - 1 tablet of the drug contains 40 mcg T4 and 10 mcg T3.

Thyrotom-forte - 1 tablet of the drug contains 120 mcg T4 and 30 mcg T3.

Thyrocomb - 1 tablet of the drug contains 70 mcg T4, 10 mcg T3 and 150 mcg potassium iodide.

The basic principles of treating hypothyroidism with thyroid drugs are:

replacement therapy with thyroid drugs is carried out throughout life, with the exception of transient forms of hypothyroidism (in case of overdose of thyroid drugs during the treatment of toxic goiter or in the early postoperative period after subtotal resection of the thyroid gland);

the selection of doses of thyroid drugs should be done gradually and carefully, taking into account the age of the patient, concomitant diseases, the severity of hypothyroidism and the duration of its treatment. The more severe the hypothyroidism and the longer the patients were without replacement therapy, the higher the sensitivity of the body (especially the myocardium) to thyroid drugs;

when treating elderly patients with concomitant ischemic heart disease, the initial doses of thyroid drugs should be minimal and their increase should be done slowly, under ECG monitoring. Large doses of drugs and rapid increases in doses can cause exacerbation of coronary artery disease, and the development of silent myocardial ischemia is possible;

the next dose is prescribed after the full effect of the previous dose has manifested itself (T3 requires 2-2.5 weeks to manifest the full effect, T4 - 4-6 weeks).

The drug of choice in the treatment of hypothyroidism is L-thyroxine due to the following circumstances:

the negative cardiotropic effect of L-thyroxine is much less pronounced than that of triiodothyronine and drugs containing it;

the constant conversion of thyroxine to triiodothyronine ensures minimal fluctuations in the blood level of triiodothyronine, a biologically more active hormone.

The initial dose of L-thyroxine in most cases is 1.6 mcg/kg once a day (on average 100-125 mcg per day. Taking into account the possibility of silent myocardial ischemia, elderly patients are prescribed L-thyroxine 25-50 mcg once a day.

The daily dose of the drug should be increased gradually, by 25-50 mcg every 4 weeks, until complete compensation of thyroid deficiency. Treatment is carried out under the control of the level of T4 and TSH in the blood and the dynamics of clinical manifestations. The TSH level in primary hypothyroidism is elevated and returns to normal slowly during treatment of hypothyroidism.

Typically, the dose of thyroxine required to achieve euthyroidism is 150-200 mcg per day. However, this dose may not be the same for all patients. The dose of thyroxine that ensures a euthyroid state is individual and may differ significantly from that indicated.

Monotherapy with triiodothyronine has not become widespread due to a more pronounced negative cardiotropic effect (especially in the elderly) compared to thyroxine, and also because more frequent doses are required to ensure a stable level of triiodothyronine in the blood.

Many endocrinologists use the method of combined treatment with triiodothyronine and thyroidine.

The initial doses of triiodothyronine are 2-5 mcg, thyroidine - 0.025-0.05 g. Then the dose of triiodothyronine is increased every 3-5 days by 2-5 mcg and thyroidine - by 0025-0.05 g every 7-10 days until the optimal dose causing euthyroidism is reached. state. This dose, of course, is individual and can reach 0.2-0.25 g for thyroidin, and 50 mcg for triiodothyronine. Sometimes these doses can be even higher.

It is believed that 25 mcg of triiodothyronine is equivalent to 100 mcg of thyroxine in its effect on the myocardium.

In the absence of thyroxine, for replacement therapy of hypothyroidism, you can use combination drugs - thyrocomb, thyrotom, thyrotom-forte. The initial dose of these drugs is 1/2 tablet once a day. Further increases in doses are made slowly - by ½ tablet once every 1-2 weeks until the optimal dose is reached (it can reach 1-2 tablets per day, sometimes more).

Thyroidin monotherapy is currently rarely used. This is due to the unstable composition of the drug, as well as its poor absorption by the gastrointestinal mucosa (in the intestine, thyroidin is first hydrolyzed and only then the T3 and T4 contained in it are absorbed into the blood). In addition, thyroidin contains thyroglobulin and other antigenic structures that can contribute to autoimmunization of the thyroid gland.

However, in the absence of other thyroid hormone preparations, it is necessary to carry out thyroid replacement therapy. The initial dose of thyroidin for young and middle-aged people is 0.05 g, and for older people - 0.025 g. Every 3-5 days, the dose is gradually increased, bringing it to the optimum (0.15-0.2 g per day, rarely more).

In the presence of coronary artery disease, thyroidin is prescribed at a dose of 0.02 g, increasing the dose every week by 0.01 g. At the same time, drugs that improve coronary circulation and metabolic processes in the myocardium should be prescribed.

Features of the treatment of hypothyroidism in patients with concomitant ischemic heart disease

During treatment with thyroid drugs in patients with coronary artery disease, angina attacks may become more frequent, blood pressure may increase, tachycardia may develop, and various arrhythmias are possible. Cases of myocardial infarction in patients with coronary artery disease during treatment with thyroid drugs have been described.

Rules for the treatment of hypothyroidism in patients with concomitant ischemic heart disease:

treatment of hypothyroidism should begin with minimal doses of thyroid drugs and slowly increase them to optimal doses that induce a euthyroid state;

preference among all thyroid drugs should be given to L-thyroxine as the least cardiotoxic;

treatment with thyroid drugs and especially increasing their dose should be carried out under the control of blood pressure, heart rate, and ECG;

the ability of thyroid drugs to enhance the effect of anticoagulants should be taken into account;

if myocardial infarction develops, it is necessary to discontinue thyroid drugs for several days and then prescribe them in a lower dose.

Treatment of congenital hypothyroidism

When treating congenital hypothyroidism, the following doses of L-thyroxine are recommended: at the age of 1-6 months - 25-50 mcg per day, at the age of 7-12 months 50-75 mcg per day, at the age of 2-5 years - 75-100 mcg per day day, at the age of 6-12 years - 100-150 mcg per day, at the age of over 12 years - 150 mcg per day.

Treatment of secondary hypothyroidism

When treating patients with secondary hypothyroidism, thyrotropin preparations are almost never used, since they have allergenic properties. Antibodies are produced to these drugs, which reduce their effectiveness.

The main method of treating secondary hypothyroidism is also thyroid replacement therapy. The principles of treatment are the same as for primary hypothyroidism, but it should be noted that secondary hypothyroidism is often combined with hypocorticism due to insufficient production of corticotropin and a rapid increase in the dose of thyroid hormones can cause acute adrenal insufficiency. In this regard, replacement therapy with thyroid drugs in the first 2-4 weeks should be accompanied by small doses of prednisolone (5-10 mg per day), especially in severe hypothyroidism.

In rare cases of secondary, not far advanced hypothyroidism (tumor of the hypothalamic-pituitary zone, infectious-inflammatory process in this zone), etiological treatment (radiation therapy, anti-inflammatory treatment) can lead to recovery.

In the treatment of tertiary hypothyroidism, treatment with thyroid hormone-releasing hormone is not widespread and the basis of therapy is the use of thyroid drugs.

In addition to replacement therapy with thyroid drugs, patients with hypothyroidism should receive multivitamin complexes; it is also necessary to correct lipid metabolism disorders and take drugs that improve the functional state of the brain (piracetam, nootropil).

Treatment for hypothyroidism is lifelong. After selecting the optimal dose of the hormonal drug, the patient should be examined annually, and the level of thyroid hormones and thyrotropin in the blood is mandatory. The optimal dose of thyroxine is considered to be one that ensures a euthyroid state and a normal level of thyrotopin in the blood. Usually this is 100-200 mcg of thyroxine or 2-4 tablets of thyrotom or 1.5-2.5 tablets of thyrocomb per day.

With long-term therapy with thyroid drugs, patient tolerance may improve, and with age, the need for thyroid drugs decreases somewhat. Nevertheless, the doctor must constantly pay attention to the possibility of side effects of thyroid drugs, which is most likely in case of an overdose:

tachycardia, cardiac arrhythmia, exacerbation of coronary artery disease;

arterial hypertension;

dyspeptic symptoms and epigastric pain.

In the treatment of the peripheral form of hypothyroidism, the use of plasmapheresis and hemosorption is currently recommended, which in some cases makes it possible to remove antithyroid antibodies from the blood and restore tissue sensitivity to thyroid hormones.

Clinical examination

Dispensary observation of patients with hypothyroidism is carried out by an endocrinologist for life.

The objectives of clinical observation are, first of all, to select an adequate, well-tolerated dose of thyroid drugs and ensure a euthyroid state.

Treatment on an outpatient basis is carried out for mild to moderate hypothyroidism. Patients with severe hypothyroidism and patients with hypothyroidism complicated by severe concomitant diseases (hypertension, coronary artery disease, etc.) are subject to hospitalization.

The patient is examined by an endocrinologist and therapist 3-4 times a year. During visits to the doctor, a general blood and urine test is performed, a blood test for cholesterol, triglycerides, b-lipoproteins, glucose is performed, and an ECG is recorded. Constant monitoring of the patient's body weight is necessary; the content of T3, T4, antibodies to thyroglobulin, cortisol, and thyroid-stimulating hormone in the blood is determined 2 times a year. The results of these studies are taken into account when choosing the dose of thyroid drugs.

During clinical observation, the issue of the patient’s ability to work is resolved. Patients with mild and moderate hypothyroidism, with timely initiation and adequate replacement therapy, restore their ability to work, but heavy physical labor and work associated with being outside during the cold season should be avoided.

With severe hypothyroidism, a significant decrease in working capacity is possible, especially in people with intellectual work.