nursing.elitecme.com Page 37 Complete Your CE Test Online - Click Here Postpartum thyroiditis alert! Some women with the disease develop symptoms only of hyperthyroidism or only of hypothyroidism, but not both[18] . Treatment varies depending on signs, symptoms, and thyroid hormone levels[5,18] . Most women do not need treatment, but are simply monitored for severity of signs and symptoms and thyroid hormone levels, which are usually assessed every 4 to 8 weeks[18] . For severe signs and symptoms of hyperthyroidism, women may be prescribed beta blockers to inhibit the effects of the excessive amounts of thyroid hormone on the body. These drugs are not usually prescribed for women who are breastfeeding; however, propranolol might be recommended because it is not as concentrated in breast milk as other beta blockers[18] . For those women who experience severe signs and symptoms of hypothyroidism, thyroid replacement therapy might be prescribed for 6 to 12 months. After medication is discontinued, women are monitored at 2, 3, and 6 months for recurrence of hypothyroidism. If lab results are normal, hormone levels are then checked on an annual basis[18] . Nursing consideration: Nurses are in a unique position to facilitate proper health care for new mothers. Teach them (and their families and friends) not to attribute unusual signs and symptoms as simply stress related to caring for a newborn. As described in the hypothetical scenario at the beginning of this section, sometimes new mothers’ health concerns are dismissed as trivial combined with an attitude that “all new mothers are tired and anxious.” Help women monitor their health and recognize the occurrence of signs and symptoms that need medical evaluation. Hashimoto’s thyroiditis Hashimoto’s thyroiditis is a chronic progressive disease of the thyroid gland. It is an autoimmune disorder characterized by thyroid infiltration of lymphocytes. This causes progressive destruction of the parenchyma and hypothyroidism if left untreated. As the immune system “attacks” thyroid gland it gradually swells, and damage is sustained[6,19] . Hashimoto’s thyroiditis is generally thought to be the most common cause of adult hypothyroidism. Its exact etiology is unknown, but it is believed to be genetically transmitted and perhaps related to Graves’ disease. Ninety-five percent of Hashimoto’s thyroiditis cases occur in women in their 40s or 50s, and incidence of the disease is increasing [6] . Clinically, the disease progresses very slowly, taking months or even years to be identified[19] . Clinical manifestations of Hashimoto’s thyroiditis include[6,19] : ● ● Slow development of a firm, enlarged thyroid gland. ● ● Low basal metabolic rate. ● ● No gross nodules of the thyroid gland. ● ● T3 and T4 may be normal initially, but levels fall below normal as the disease progresses and thyroid tissue is destroyed. ● ● Anti-thyroglobulin antibodies and anti-microsomal antibodies are nearly always present. ● ● Symptoms of an underactive thyroid gland appear such as fatigue, weight gain, constipation, dry skin, and depression. Hashimoto’s thyroiditis cannot be cured, and low levels of thyroid hormone are usually permanent. Thus, life-long treatment with thyroid hormone replacement is usually necessary[19] . Insufficient or delayed treatment may result in a significantly sized goiter (thyroid gland enlargement). If the goiter compresses the trachea or causes other complications, surgical resection may be needed[6,19] . For detailed nursing considerations see the section on hypothyroidism. Subacute thyroiditis Subacute thyroiditis is a self-limiting, painful inflammation of the thyroid gland that usually occurs following a viral infection [5,6] . The disease is associated with a three-phase clinical course of hyperthyroidism, hypothyroidism, and return to normal thyroid gland functioning. It is estimated that sub acute thyroiditis may be responsible for 15% to 20% of patients presenting with hyperthyroidism and 10% of patients presenting with hypothyroidism [20] . There are three forms of subacute thyroiditis[20] : ● ● Subacute granulomatous thyroiditis: Also known as subacute painful or deQuervain thyroiditis. ● ● Lymphocytic thyroiditis: Also known as subacute painless thyroiditis. ● ● Subacute postpartum thyroiditis: See section on postpartum thyroiditis. Subacute thyroiditis predominantly affects younger women. Its clinical course is characterized by four stages[20] : ● ● Stage 1: High thyroid levels occur when thyroid follicles are destroyed and thyroid hormones are released into the bloodstream. This hyperthyroidism stage lasts for between 4 and 10 weeks. ● ● Stage 2: The disease goes into remission and thyroid hormone levels return to normal. ● ● Stage 3: At this stage, the thyroid is depleted of colloid and cannot produce adequate amounts of thyroid hormone, which leads to hypothyroidism. This stage may last up to 2 months. The hypothyroidism is usually mild and no thyroid hormone therapy is required unless the patient presents with significant signs and symptoms of hypothyroidism. ● ● Stage 4: The disease resolves itself and normal thyroid functioning is restored as thyroid follicles regenerate. Ninety percent to 95% of patients experience a return to normal thyroid function. Subacute thyroiditis alert! About 10% of patients experience permanent hypothyroidism, necessitating long-term or life-long thyroid hormone replacement[6] . General signs and symptoms of sub acute thyroiditis include[6] : ● ● Pain, swelling, and tenderness of the thyroid gland that lasts for several weeks or months and then disappears. ● ● Fever, sore throat, referred ear pain. ● ● Fever, malaise, and chills. Depending on the stage of the disease, patients may present with symptoms of hyper- or hypothyroidism. Hyperthyroidism symptoms include anxiety, nervousness, irritability, insomnia, weight loss, and heat intolerance. Hypothyroidism symptoms include lethargy, cold intolerance, weight gain, and constipation[5,6] . Treatment of this usually self-limiting disease is supportive. Analgesics to reduce pain, a restful environment, and emotional support to help relieve anxiety generally facilitate recovery[6] . Riedel thyroiditis Riedel thyroiditis (also known as Riedel’s thyroiditis) is a rare, chronic inflammatory disease of the thyroid gland. The disease is characterized by a “dense fibrosis that replaces normal thyroid parenchyma [21] .” The fibrotic process extends to nearby structures of the neck and reaches beyond the thyroid capsule. Function of the thyroid depends on the amount of normal thyroid tissue that has been replaced with fibrotic tissue. Although most patients retain normal thyroid functioning, about 30% of them become hypothyroid[21] .