Hypothyroidism Nursing Diagnosis and Care Plans

Hypothyroidism, or underactive thyroid, occurs when the thyroid gland does not produce enough thyroid hormone to meet the body’s needs.

Levothyroxine, a synthetic version of thyroid hormone, is a hormone replacement therapy most often prescribed to treat hypothyroidism. Because hypothyroidism is a chronic disease, a multidisciplinary approach is required to provide lifelong care and treatment. Nurses play a vital role in the care of people with hypothyroidism.

Read on to learn more about hypothyroidism and nursing care. 

Hypothyroidism Symptoms

When thyroid hormone levels are low, body processes begin to slow down. Because hypothyroidism symptoms are often vague, particularly in the earliest stages of the disease, they may initially be overlooked or attributed to something else, such as stress or aging. 

Symptoms of hypothyroidism vary from person to person and can range from mild to severe with a significant impact on quality of life. The most common symptoms of hypothyroidism include:

• Fatigue
• Weight gain
• Cold intolerance
• Joint and muscle pain
• Dry skin 
• Brittle hair 
• Depression
• Menstrual irregularities 
• Forgetfulness 
• Slow heart rate
• Constipation 

Nursing Assessment for People With Hypothyroidism

A nursing assessment is an essential step in getting appropriate care for hypothyroidism. The information nurses gather during the evaluation—including physical, psychological, spiritual, social, and lifestyle factors specific to each person—can help nurses provide individualized, person-centered care.

A nursing assessment for people with hypothyroidism includes:

• Collecting information about physical and psychological symptoms: For example, a nurse may ask if a person is experiencing constipation, dry skin, muscle cramps, cold intolerance, insomnia, menstrual cycle changes, weight gain, anxiety, depression, trouble focusing, or fatigue. 
• Taking family and personal medical history: This includes a family history of thyroid disease and personal surgical, medication, psychosocial, and reproductive history (e.g., number of pregnancies and live births). 
• Monitoring vital signs: Including heart rate, blood pressure, temperature, respiratory rate, and pain levels.
• Physical examination: Closely looking at the neck and throat for signs of an enlarged thyroid, palpating (examining by touch) the thyroid to feel texture and firmness, and looking for skin/hair changes.

This assessment helps identify a person's current and future needs. The information gathered is evaluated to help provide an accurate diagnosis and create a personalized treatment plan. 

Nursing Diagnosis for Hypothyroidism

A nursing diagnosis is a nurse's clinical judgment of hypothyroidism's impact on a person's life.

It's important to distinguish a nursing diagnosis from a medical diagnosis. A physician or advanced healthcare practitioner makes a medical diagnosis. Diagnostic tests, including blood tests that measure thyroid hormone levels, focus on the medical aspects of hypothyroidism to make a diagnosis.

A nursing diagnosis, however, focuses on the physical, mental, spiritual, or psychosocial aspects of hypothyroidism; it examines the overall holistic care of a person with hypothyroidism based on their response to the condition and how it affects their day-to-day life. A nursing diagnosis generally has three elements:

• Diagnosis: Explains and defines the health problem
• Etiology: Describes the cause(s) of the diagnosis
• Defining characteristics: Person-specific signs and symptoms that explain the diagnosis and etiology.

Examples of a nursing diagnosis for a person with hypothyroidism include:

• Fatigue related to slowed metabolism evidenced by activity intolerance and an increased need for rest
• Constipation related to an impaired gastrointestinal/digestive system as evidenced by a bloated stomach and physical discomfort
• Imbalanced nutrition related to greater intake than the body needs as evidenced by weight gain
• Deficient knowledge related to a lack of awareness as evidenced by unfamiliarity with potential treatments and lifestyle changes for hypothyroidism

Other nursing diagnoses for hypothyroidism may include:

• Activity intolerance
• Obesity
• Risk for problems with body temperature regulation
• Depression
• Memory problems

Following the nursing diagnosis, goals are created for nursing interventions with measurable outcomes to provide the best care. 

Nursing Interventions for Hypothyroidism

Nursing interventions are actions a nurse takes to improve someone's health outcomes. Research shows that nursing interventions can effectively increase thyroid disease awareness, boost medication compliance, and improve the long-term outcomes of people with thyroid disease.

Nursing interventions for patients with hypothyroidism may include:

• Educating the person and their family about hypothyroidism 
• Consulting with a dietitian to provide guidance on a hypothyroidism-friendly diet and nutrition 
• Encouraging the use of moisturizing care products for dry skin and hair 
• Monitoring and assessing body weight 
• Providing education on thyroid hormone replacement therapy and the importance of continuing medication 
• Checking lab results to assess thyroid hormone levels 
• Sharing available resources (e.g., mental healthcare providers, hypothyroidism support groups) 
• Encouraging regular exercise 
• Monitoring response to levothyroxine and other treatments (if applicable) 
• Reporting any warning signs of worsening hypothyroidism to healthcare providers

Nursing Care Plan for Hypothyroidism

Nursing care plans contain information about a person's diagnosis, treatment goals, nursing interventions, and potential outcomes. These plans help nurses keep all relevant information in one place so every care team member can access it as needed.

The nursing care plan aims to provide accessible, person-centered care and should include the following: 

• Nursing diagnosis
• Desired outcomes/goals
• Nursing interventions and rationale

Nursing Considerations

Nursing considerations, also known as nursing implications, are considerations and actions that are taken into account as they develop a care plan and provide care. Nursing considerations for hypothyroidism include:

• Evaluating potential drug interactions of other medications the person is taking with thyroid hormone replacement therapy (levothyroxine)
• Regularly monitoring thyroid hormone levels
• Educating on dietary and lifestyle changes as needed to improve treatment effectiveness and patient quality of life
• Educating on thyroid hormone replacement therapy (levothyroxine) and how/when to take the medication (e.g., daily, on an empty stomach)
• Providing further support and resources as needed to meet physical and mental health needs
• Monitoring pulse for bradycardia (slow heart rate) and/or low blood pressure

Summary

Hypothyroidism is a common condition requiring a multidisciplinary approach to care and lifelong treatment for most people. A nursing care plan focuses on the physical, mental, social, and spiritual needs of the person with hypothyroidism.

Person-centered plans are developed to focus on specific symptoms a person with hypothyroidism is experiencing, such as fatigue or weight gain, and provide nursing interventions to improve their overall health and well-being. 

A Word From Verywell

Living with hypothyroidism may feel overwhelming or exhausting from time to time. If you need support to manage symptoms or improve your quality of life, a nurse and a nursing care plan may help you deal with the difficulties of living with a chronic disease that impacts so many areas of your life.