Thyroid Disorders and Treatment

Biography

Biography: Shenila Anwarali

Abstract

Objective: Thyroid is a ductless gland located in the neck which secretes growth regulating hormones and controls development through metabolism. Alteration in the release of this hormone can result in hypo (decreased) or hyper (increased) secretion resulting in various disorders. Thyroid hormone plays a perilous role throughout pregnancy for both; in the development of a healthy baby and in sustaining the well-being of the mother. During pregnancy the release of 2 hormones HCG and estrogen results an increase in thyroid hormone in blood. Early diagnosis is essential for successful management. The objective of this literature review is to present the evidence based nursing practice for mother with thyroid dysfunction during pregnancy. Methodology: The literature review was done from the period of January to November 2015 from various online databases such as PubMed, CINAHL and Allied Health Literature. Key words used: ‘Hypothyroidism’, ‘Hyperthyroidism’, ‘Pregnancy’ and ‘Nursing care’ using Boolean (AND, OR) words. The final reference list consists of 20 relevant articles ranging from 2010 to 2015, which include qualitative and quantitative researches, literature reviews, peer reviews, and index articles. Results: Literature review depicted that altered regulation of thyroid hormone during pregnancy can be life threatening to both the mother and the baby and can lead to serious complications such as congestive heart failure, preeclampsia- a dangerous rise in blood pressure in late pregnancy, thyroid storm- a sudden and severe worsening of symptoms, miscarriage, premature birth, low birth weight and impaired neurophysiological development of the brain. For mother who has already been diagnosed with thyroid dysfunction need to be vigilantly evaluated at all antenatal visit for signs of complication. Furthermore, nurses and midwives should be aware of the signs and symptoms of hypothyroidism such as appetite change (decrease or increase), difficulty in sleeping (insomnia), fatigue, frequent bowel movement perhaps diarrhea, heart palpitations, heat intolerance, increased sweating, irritability, light menstrual periods perhaps even missed periods, mental disturbances, muscle weakness, nervousness, problems with fertility, shortness of breath, sudden paralysis, tremor/shakiness, vision changes, weight loss-but perhaps, weight gain, dizziness, thinning of hair, itching and hives, possible increase in blood sugar and hyperthyroidism in which fatigue, weakness, weight gain or increased difficulty losing weight, coarse, dry hair, dry, rough pale skin, hair loss, cold intolerance (you can't tolerate cold temperatures like those around you), muscle cramps and frequent muscle aches, constipation, depression, irritability, memory loss, abnormal menstrual cycles, decreased libido in order for timely diagnosis and treatment. Moreover, evidence based nursing care recommends to monitor T3, T4, and TSH levels as these levels help to determine the diagnosis and effectiveness of drugs. Ultrasonography of the fetal thyroid gland by an experienced ultra-sonographer is an excellent diagnostic tool. Health care team members should also provide psychological support to the client and ensure that treatment options are available. Nursing intervention also includes monitoring of vital signs, signs and symptoms and educating clients regarding the disease process. Nurses also need to perform fetal examination and identify emergency signs and opt for help as soon as possible. Conclusion: Hence it is essential to rule out thyroid alteration because it can lead to deleterious outcomes affecting mother and the baby. It can result in irreversible damage to the offspring’s brain causing disrupted neurodevelopment. It is suggested that for those mother who have been diagnosed with the altered thyroid activity need to be frequently re-evaluated of the maternal and fetal complication whereas, for those who show classical signs and symptoms need to be investigated for a proper diagnosis. Awareness sessions need to be held and clients should be accurately educated about the treatment modalities.