Page 340 - Critical Care Nursing Demystified

Chapter 7 CARE OF THE PATIENT WITH ENDOCRINE DISORDERS 325

basal metabolism, dystrophy of the bones and soft tissues, and myxedema. The
required treatment is lifelong thyroid hormonal therapy. The symptoms of cre-
tinism may not be apparent at birth because the newborn may still be carrying
some maternal thyroid hormone.

Hypothyroidism (Myxedema)

What Went Wrong?
Iodine-deficient diets can cause hypothyroidism, especially in parts of the world
where iodine availability is lacking, for example, Hashimoto’s thyroiditis. Anti-
bodies are produced that destroy substances needed to produce T3 and T4,
creating a decreased metabolism throughout all body systems.

Hallmark Signs and Symptoms
These include fatigue, weight gain, intolerance to cold temperatures, lethargy,
mental sluggishness, constipation, slowed and slurred speech, hoarse voice, a
thickened tongue, anorexia, anemia, somnolence, dry and flaky skin, coarse hair,
dry and brittle nails, and boggy, nonpitting edema seen around the eyes, hands,
and feet. EKG changes are additional causes for concern. Hormone replace-
ment therapy to reverse this disorder include Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Synthroid – levothyroxine
Lugol’s solution – small doses of iodine

Potassium iodide solution
Prognosis
The symptoms of Myxedema will subside and normal metabolic activity
restored with continued adequate hormone replacement therapy.

Myxedema Coma

This is a medical emergency that progresses gradually or rapidly into coma or
death as the symptoms of hypothyroidism continue unrelieved.

What Went Wrong?
Myxedema coma can be precipitated by infections, trauma, surgery, exposure
to cold temperatures, and taking medications such as narcotics, barbiturates,
and tranquilizers.

Hallmark Signs and Symptoms
Subnormal body temperatures below 80°F, as the patient with myxedema coma
cannot shiver to produce body heat; hypotension; bradycardia; and hypoventilation.