C H A P T E R 3 7
Thyroid and parathyroid agents
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CRITICAL THINKING
What teaching plans should be developed for this woman?
What interventions would be appropriate in helping Mr and
Mrs R. accept the diagnosis and the pathophysiological
basis for Mrs R’s complaints and problems?
What body image changes will H.R. experience as her body
adjusts to the thyroid therapy?
How can H.R. be helped to adjust to these changes and
re-establish her body image and self-concept?
DISCUSSION
Hypothyroidism develops slowly. With it comes fatigue,
lethargy and lack of emotional affect—conditions that
result in the person’s losing interest in appearance, activities
and responsibilities. In this case, the woman’s husband,
not knowing that there was a physical reason for the
problem, became increasingly frustrated and even angry.
Mr R. should be involved in the teaching program so that
his feelings can be taken into consideration. Any teaching
content should be written down for later reference.
(When H.R. starts to return to normal, her attention span
and interest should return; anything that was missed
or forgotten can be referred to in the written teaching
program.)
H.R. may be encouraged to bring a picture of herself
from a year or so ago to help her to understand and
appreciate the changes that have occurred. Many people
are totally unaware of changes in their appearance and
activity level because the disease progresses so slowly and
brings on lethargy and lack of emotional affect.
The teaching plan should include information about
the function of the thyroid gland and the anticipated
changes that will be occurring to H.R. over the next week
and beyond. The importance of taking the medication daily
should be emphasised. The need to return for follow-up
to evaluate the effectiveness of the medication and the
effects on her body should also be stressed. Both H.R. and
her husband will need support and encouragement to deal
with past frustrations and the return to normal. Lifelong
therapy will probably be needed, so further teaching will be
important once things have stabilised.
CARE GUIDE FOR H.R.: THYROID HORMONE
Assessment: History and examination
Review the person’s history for allergies to any of these
drugs, Addison’s disease, acute myocardial infarction
not complicated by hypothyroidism, breastfeeding and
thyrotoxicosis.
Focus the physical examination on the following:
Neurological: orientation and affect
Skin: colour and lesions
CV: pulse, cardiac auscultation, blood pressure and
electrocardiogram findings
Respiratory: respirations, adventitious sounds
Haematological: thyroid function tests
Implementation
Administer the drug once a day before breakfast with a full
glass of water.
Provide comfort, safety measures (e.g. temperature control,
rest as needed, safety precautions).
Provide support and reassurance to deal with drug effects
and lifetime need.
Provide teaching regarding drug name, dosage, adverse
effects, precautions and warning signs to report.
Evaluation
Evaluate drug effects: return of metabolism to normal;
prevention of goitre.
Monitor for adverse effects: anxiety, tachycardia,
hypertension, skin reaction.
Monitor for drug–drug interactions as indicated for each
drug.
Evaluate the effectiveness of the teaching program and
comfort and safety measures.
TEACHING FOR H.R.
• This hormone is designed to replace the thyroid hormone
that your body is not able to produce. The thyroid
hormone is responsible for regulating your body’s
metabolism, or the speed with which your body’s cells
burn energy. Thyroid hormone actions affect many
body systems, so it is very important that you take this
medication only as prescribed.
• Never stop taking this drug without consulting with your
healthcare provider. The drug is used to replace a very
important hormone and will probably have to be taken
for life. Stopping the medication can lead to serious
problems.
• Take this drug before breakfast each day with a full glass
of water.
• Thyroid hormone usually causes no adverse effects.
You may notice a slight skin rash or hair loss in the first
few months of therapy. You should notice the signs and
symptoms of your thyroid deficiency subsiding, and you
will feel “back to normal”.
• Report any of the following to your healthcare provider:
chest pain, difficulty breathing, sore throat, fever, chills,
weight gain, sleeplessness, nervousness, unusual sweating
or intolerance to heat.
• Avoid taking any over-the-counter medication without
first checking with your healthcare provider because
several of these medications can interfere with the
effectiveness of this drug.
• Tell any doctor, nurse, midwife or other healthcare
provider involved in your care that you are taking this
drug. You may also want to wear or carry medical
identification showing that you are taking this medication.
