436 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
● Thyroid scan or ultrasound may be indicated to confirm the presence and position of the thyroid gland. ● Bone age x-ray is used to assess delayed growth. ● Assessment of infant’s or child’s growth velocity may also indicate hypothyroidism, especially if there are extreme differ- ences between height and weight percentiles. Nursing Interventions ● Assess height and weight on growth chart to determine growth delay and/or excessive weight gain. ● Obtain history of the child’s activity level, appetite, incidences of hair loss or thinning, constipation, or other symptoms of hypothyroidism. ● Obtain family history for autoimmune thyroid problems, especially in female family members. ● Provide patient education regarding thyroid replacement therapy and medication administration. Caregiver Education ● Instruct parents to give thyroid medications at the same time each morning and not to skip or double doses. ● Instruct parents to administer medication via needleless oral syringes and not to put medication back in the bottle. ● Reinforce the importance of medication compliance and the lifelong need for thyroid medications. ● Instruct parents on the potential side effects of thyroid replacement medications and instruct them to notify their physician immediately if side effects are experienced. ● Stress the importance of follow-up physician visits every 6 months so that thyroid blood levels can be assessed. The dos- age of thyroid medications depends on body weight, and the dose may need to be adjusted frequently as the child grows. ● Teach parents to modify the child’s diet with fruit and bulk if he or she experiences constipation. ● Teach parents about complications related to lack of thyroid treatment, such as myxedema.
HYPERTHYROIDISM
Hyperthyroidism is an overproduction of thyroid hormone often referred to as Graves’ disease. It occurs most frequently in teens between 12 and 14 years old. It tends to be familial, and the manifestation period is between 6 and 12 months. If untreated, hyperthyroidism can cause lifelong complications to the body systems, especially the eyes, CNS, and GI tract. Thyroid storm is a life-threatening condition that requires medical intervention and hospitalization. This can occur if hyperthyroidism goes un- treated for a long period and symptoms become severe. CLINICAL JUDGMENT Laboratory Indicators for Hypothyroidism When evaluating laboratory results for hypothyroidism, the nurse will see the following laboratory indicators: Serum T4 ↓ Serum T3 normal Serum TSH ↑
SAFE AND EFFECTIVE NURSING CARE: Understanding Medication
Thyroid Hormone Replacement Therapy DRUG: levothyroxine sodium (Synthroid, Levoxyl, Levothroid, and others) PREPARATIONS: ● Oral solution 13 mcg/mL, 25 mcg/mL, 50 mcg/mL, 75 mcg/ mL, 88 mcg/mL, 100 mcg/mL, 112 mcg/mL, 125 mcg/mL, 137 mcg/mL, 150 mcg/mL, 175 mcg/mL, 200 mcg/mL ● Tabs—25, 50, 75, 88, 100, 112,125, 137, 150, 175, 200, or 300 mcg ● IV, IM—50% to 80% of oral dose ● Injection—100 mcg/vial, 200 mcg/vial, 500 mcg/vial Available as powder that must be reconstituted DOSING RECOMMENDATIONS: Doses will vary depending on the age and weight of the child From Vallerand A. H., & Sanoski. C. A. (2021). Davis’s drug guide for nurses (17th ed.). F.A. Davis. Assessment Assessment for hyperthyroidism in pediatric patients includes the following measures. Clinical Presentation ● Elevated serum levels of T4 and T3 with low or undetectable levels of TSH
SAFE AND EFFECTIVE NURSING CARE: Promoting Safety
Myxedema A severe complication of hypothyroidism is a condition known as myxedema (Ilie, 2020). This life-threatening crisis occurs when thyroid levels are extremely low. TSH levels are critically high, and T4 levels are usually undetectable. Clinical manifestations of myxedema include nonpitting edema, round face from severe edema, edema of the tongue, metabolic disturbances, and hy- pothermia. If this condition is not treated immediately, the child or infant will progress to hypoglycemia, hypotension, cardio- vascular arrest, and coma (myxedema coma). This condition is rare in children but does exist in those who are untreated for hypothyroidism.
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