Nursing Care Plans for Hypothyroidism – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Hypothyroidism plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.


Hypothyroidism, also called underactive thyroid disease, is a common disorder. Hypothyroidism causes the thyroid gland not to make enough thyroid hormone. The thyroid gland is located in the front lower part of your neck. Hormones released by the gland travel through the bloodstream and affect nearly every part of your body, from your heart and brain to muscles and skin.

Thyroid Hormone

The thyroid controls how the body’s cells use energy from food through the process known as metabolism. Among other things, your metabolism affects the body’s temperature, heartbeat, and how well the body burns calories. Lack of enough thyroid hormone makes the body processes slow down. That means that the body makes less energy, and metabolism becomes sluggish.

Symptoms of Hypothyroidism

Symptoms of hypothyroidism may be vague and can often mimic other conditions. They may include:

  1. Changes in the menstrual cycle
  2. Constipation
  3. Depression
  4. Dry hair and hair loss
  5. Dry skin
  6. Elevated cholesterol
  7. Fatigue
  8. Greater sensitivity to cold
  9. Hoarse voice
  10. Joint pain, stiffness, and swelling
  11. Problems with memory
  12. Muscle aches and stiffness
  13. Muscle weakness
  14. Puffy face
  15. Slow heart rate
  16. Swelling of the thyroid gland (goitre)
  17. Unexplained weight gain or difficulty losing weight
  18. Carpal tunnel syndrome

Hypothyroidism Symptoms in Infants

  1. Cold hands and feet
  2. Constipation
  3. Extreme sleepiness
  4. Hoarse cry
  5. Little or no growth
  6. Low muscle tone (floppy infant)
  7. Persistent jaundice (yellowing of the skin and whites of the eyes)
  8. Poor feeding habits
  9. Puffy face
  10. Stomach bloating
  11. Swollen tongue
  12. Umbilical hernia

Hypothyroidism Symptoms in Teenager and Children

  • Delays in puberty
  • Delays in growth and shorter stature
  • Slow mental development
  • Slower development of permanent teeth

Causes of Hypothyroidism

The most common cause of hypothyroidism is Hashimoto’s thyroiditis. “Thyroiditis” is an inflammation of the thyroid gland. Hashimoto’s thyroiditis is an autoimmune disorder. With Hashimoto’s, your body produces antibodies that attack and destroy the thyroid gland. A viral infection may also cause thyroiditis.

Other causes of hypothyroidism include:

Radiation therapy to the neck area. Treating certain cancers, such as lymphoma requires radiation to the neck. Radiation damages the cells in the thyroid. This makes it more difficult for the gland to produce hormones.

Radioactive iodine treatment. This treatment is commonly prescribed to people who have an overactive thyroid gland, a condition known as hyperthyroidism. However, radiation destroys the cells in the thyroid gland. This usually leads to hypothyroidism.

Use of certain medications. Certain medicines to treat heart problems, psychiatric conditions, and cancer can sometimes affect the production of thyroid hormones. These include amiodarone (Cordarone, Pacerone), interferon alpha, and interleukin-2.

Thyroid surgery. Surgery to remove the thyroid will lead to hypothyroidism. If only part of the thyroid is removed, the remaining gland may still produce enough hormone for the body’s needs.

Too little iodine in the diet. The thyroid needs iodine to produce thyroid hormone. Your body doesn’t make iodine, so you need to get it through your diet. Iodized table salt is rich in iodine. Other food sources of iodine include shellfish, saltwater fish, eggs, dairy products, and seaweed. Iodine deficiency is rare in the U.S.

Pregnancy. The reason isn’t clear, but sometimes, thyroid inflammation occurs after pregnancy. This is called postpartum thyroiditis. Women with this condition usually have a severe increase in thyroid hormone levels followed by a sharp drop in thyroid hormone production. Most women with postpartum thyroiditis will regain their normal thyroid function.

Problems with the thyroid at birth. Some babies may be born with a thyroid gland that did not develop correctly or does not work properly. This type of hypothyroidism is called congenital hypothyroidism—most hospitals in the U.S. screen babies at birth for this disease.

Pituitary gland damage or disorder. Rarely, a problem with the pituitary gland can interfere with thyroid hormone production. The pituitary gland makes a hormone called thyroid-stimulating hormone (TSH), which tells your thyroid how much hormone it should make and release.

Disorder of the hypothalamus. An extremely rare form of hypothyroidism can occur if the hypothalamus in the brain does not produce enough of a hormone called TRH. TRH affects the release of TSH from the pituitary gland.

Primary hypothyroidism is caused by a problem with the thyroid gland itself.

Secondary hypothyroidism occurs when another problem interferes with the thyroid’s ability to produce hormones. For example, the pituitary gland or hypothalamus produces hormones that trigger the release of thyroid hormone. A problem with one of these glands can make your thyroid underactive.

Hypothyroidism Risk Factors

Women, particularly older women, are more likely to develop hypothyroidism than men. You are also more likely to develop hypothyroidism if you have a close family member with an autoimmune disease. Other risk factors include:

  1. Race (being white or Asian)
  2. Age (growing older)
  3. Prematurely graying hair
  4. Autoimmune disorders such as type 1 diabetes, multiple sclerosis, rheumatoid arthritis, celiac disease, Addison’s disease, pernicious anemia, or vitiligo
  5. Bipolar disorder
  6. Down syndrome
  7. Turner syndrome

Diagnosis of Hypothyroidism

If you have symptoms of hypothyroidism, your doctor will order blood tests to check hormone levels. These may include:

Thyroid-stimulating hormone (TSH)

T4 (thyroxine)

Lower-than-normal T4 levels usually mean you have hypothyroidism. However, some people may have increased TSH levels while having normal T4 levels. This is called subclinical (mild) hypothyroidism. It is believed to be an early stage of hypothyroidism.

If your test results or physical exam of the thyroid are abnormal, your doctor may order a thyroid ultrasound or thyroid scan to check for nodules or inflammation.

Hypothyroidism Treatment

Doctors prescribe a synthetic (human-made) thyroid hormone T4 to treat hypothyroidism. This pill is taken daily.

Regular blood tests are required to check the thyroid hormone levels to enable the doctor to make any needed adjustments to medication dose from time to time.

If the dosage is too high, it causes several side effects, including:

  • Appetite increases
  • Can’t sleep
  • Heart palpitations
  • Shakiness

People with severe hypothyroidism or heart disease may start out with a low dose of synthetic hormone and then gradually increase the amount so their hearts can adjust to it.

Complications of Hypothyroidism

Untreated, hypothyroidism may cause complications, such as:

  1. Balance problems. Older women are at extra risk for balance problems if their thyroid hormone levels are too low.
  2. Goiter. If the thyroid is always trying to produce more hormones, the gland can swell and change the appearance of the neck.
  3. Heart problems. Hypothyroidism puts a person at greater risk for heart disease and can raise LDL or “bad” cholesterol levels.
  4. Infertility. Too little thyroid hormone may disrupt the production of eggs (ovulation) and make it harder to conceive.
  5. Joint pain. Low levels of thyroid hormone can cause aches and pains in the joints and muscles and tendonitis.
  6. Mental health issues. Low thyroid hormones can cause memory or concentration lapses and decreased interest in activities a person used to enjoy.
  7. Obesity. Although hypothyroidism may curb your appetite, a person can gain weight because the metabolism slows down too and doesn’t burn enough calories.
  8. Peripheral neuropathy. Over time, low thyroid hormones can damage the peripheral nerves. A person may notice pain, tingling, or numbness in the limbs.
  9. Thyroid problems in a pregnant woman can affect the developing baby. During the first three months of pregnancy, the baby receives all thyroid hormones from its mother. If the mother has hypothyroidism, the baby does not get enough thyroid hormone. This can lead to problems with mental development.
  10. Extremely low levels of thyroid hormone can cause a life-threatening condition called myxedema. Myxedema is the most severe form of hypothyroidism. A person with myxedema can lose consciousness or go into a coma. The condition can also cause the body temperature to drop very low, which can cause death.

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Nursing care plans for hypothyroidism
Nursing Care Plans for Hypothyroidism

Nursing Diagnosis for Hypothyroidism

  1. Deficient Knowledge
  2. Fatigue
  3. Imbalanced Nutrition: More than Body Requirements

Nursing Care Plans for Hypothyroidism Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Deficient Knowledge

It may be related to:

  • Lack of exposure to hypothyroidism.
  • New disease process.
  • Unfamiliarity with information resources.

Possibly evidenced by

  • Limited questioning about hypothyroidism and taking thyroid hormone replacement.
  • Verbalization of lack of information about the disease and its management.

Desired Outcomes

The patient and family members will verbalize correct information about hypothyroidism and taking thyroid hormone replacement.

Nursing InterventionsRationale
Assess the patient’s knowledge of hypothyroidism and thyroid hormone replacement therapy.Patient teaching should begin with the current knowledge about the disease and its management.
Provide information about hypothyroidism.Patients experiencing hypothyroidism may have impaired memory, confusion, hearing loss, and a decreased attention span. These neurologic changes can hinder learning new information. Teaching sessions should be planned at times when the patient is best able to concentrate. Recalling information is needed to facilitate learning. Using written information reinforces verbal presentation.
Educate the patient and family regarding thyroid hormones.Levothyroxine sodium (Synthroid) is an artificial thyroid hormone that is used to treat hypothyroidism.
Instruct the patient to take the dose in the morning to avoid insomnia.Thyroid hormone should be taken regularly to achieve a hormone balance.
Instruct the patient to take the medication on an empty stomach.The patient is initially given a small dose that gradually increases until a euthyroid state is achieved. When the thyroid hormone level increases, the patient experiences insomnia and weight loss.
Teach the expected benefits and possible side effects.The patient should report symptoms such as chest pain/palpitations; these happen due to increased metabolic and oxygen consumption.
Emphasized the importance of rest periods.Avoid undue fatigue; the activity level will eventually increase as the euthyroid state is achieved.
Encourage the patient to follow appointments for blood workups (T3, T4, and TSH levels).These levels help determine the effectiveness of pharmacotherapy
Describe the signs and symptoms of over-and-under dosage of the medications.This will serve as a check for the patient to determine if the therapeutic levels are met.
Encourage the patient to have medical identification about hormone therapy and to inform all health care providers.Medical identification provides other health care providers with information to guide decisions about care. Levothyroxine is highly protein-bound in circulation. This drug characteristic contributes to many drug interactions. The patient needs to notify all health care providers about taking this drug.

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Nursing care plans for hypothyroidism
Nursing Care Plans for Hypothyroidism

Nursing Care Plan 2: Diagnosis – Fatigue

It may be related to an impaired metabolic state.

Possibly evidenced by:

  • Lethargic or listless.
  • Compromise concentration.
  • Increased rest requirements.
  • Unable to complete the desired activities.
  • Verbalizes overwhelming lack of energy.

Desired Outcomes

The patient will identify the basis of fatigue and individual areas of control.

The patient will verbalize a reduction of fatigue and increase the ability to complete desired activities.

Nursing InterventionsRationale
Assess the patient’s ability to perform activities of daily living (ADLs).With minimal exertion, the patient may experience fatigue due to a slow metabolic rate. This symptom hinder the patient’s ability to perform daily activities (e.g., self-care, eating)
Note daily energy patterns.This will help in determining the pattern/timing of activity.
Assess the patient’s energy level, muscle strength, and muscle tone.A slow metabolism can result in decreased energy levels. The muscle may be weaker and joints stiffer due to mucin deposits in joints and interstitial spaces. This type of cellular edema may contribute to delayed muscle contraction and relaxation. The patient may report generalized weakness and muscle pain.
Plan care to allow individually adequate rest periods. Schedule activities for periods when the patient has the most energy.This will ensure maximum participation.
Provide stimulation through conversation and nonstressful activities.Promotes interest without putting too much stress on the patient.
Promote an environment conducive to relieving fatigue.Patient with hypothyroidism often complains of being cold even in a warm environment.

Nursing Care Plan 3: Diagnosis – Unfamiliarity with information resources.

It may be related to greater intake than metabolic needs.

Possibly evidenced by:

  • Decreased appetite.
  • Sedentary activity level.
  • Weight gain.

Desired Outcomes

A patient will maintain a stable weight and take in necessary nutrients.

Nursing InterventionsRationale
Assess the patient’s weight.Due to excess fluid volume and low basal metabolic rate, patients with hypothyroidism experience weight gain and difficulty losing extra weight
Assess the patient’s appetite.Patients with hypothyroidism have decreased appetite. This opposite relationship between weight gain and decreased appetite is a manifestation finding in hypothyroidism.
Provide a food diary to the patient.Looking into the patient’s food intake over the 24 hours will provide baseline data for an individualized nutritional plan for the patient’s changing metabolic needs.
Educate the patient and family regarding body weight changes in hypothyroidism.Teaching the patient and family will make them understand the opposite relationship between appetite and weight gain in hypothyroidism. During the start of the thyroid hormone replacement therapy, the patient can experience weight loss. However, there will be an increase in appetite. This change may require a calorie-controlled diet to prevent additional weight gain.
Collaborate with a dietician to determine the patient’s caloric needs.The dietician can calculate the appropriate caloric requirements to maintain nutrient intake and achieve a stable weight.
Encourage the patient to eat six small meals throughout the day.This will make sure that the patient has an adequate intake of nutrients in the patient with decreased energy levels.
Provide assistance and encouragement as needed during mealtime.Due to a decrease in energy levels, the patient will need support to ensure the adequate intake of essential nutrients.
Encourage the intake of foods rich in fiber.Hypothyroidism slows the action of the digestive tract causing constipation.
Encourage the patient to follow a low-cholesterol, low-calorie, low-saturated-fat diet.When thyroid hormone levels are low, the body doesn’t break down and remove bad cholesterol as efficiently as usual; Also, since the patient has a slow metabolism, they require fewer calories to support the metabolic need.

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Nursing care plans for hypothyroidism
Nursing Care Plans for Hypothyroidism

Related FAQs

1. What are some nursing interventions for hyperthyroidism?

Nursing Management

  • Monitor vital signs, especially heart rate and blood pressure (both increase in hyperthyroidism)
  • Ask if the patient has chest pain (Due to increased heart work)
  • Listen to the heart for murmurs.
  • Obtain ECG (atrial arrhythmias may occur in hyperthyroidism)
  • Teach the patient to relax.

2. What can you teach a patient with hypothyroidism?

Start slow, with a 5 to 15 minute walk each day. Try to work up to 10,000 steps, or 3 20-minute walks each day. Remember, hypothyroidism is associated with increased cholesterol and an increased risk of heart disease. Correcting hypothyroidism generally improves cholesterol levels.

3. What is hypothyroidism nursing?

Hypothyroidism is a disorder in which the thyroid produces and releases insufficient thyroid hormone into the bloodstream, also known as underactive thyroid, which causes fatigue, weight gain, and an inability to tolerate cold temperatures.

4. What would be the priority intervention for the nurse to do for a patient in thyroid storm?

If thyroid storm is suspected, emergency treatment needs to be instituted immediately. Patients may need cardiac monitoring, intubation and mechanical ventilation with supplemental oxygen, and IV fluids. The patient requires antithyroid medications and may receive IV corticosteroids and beta-adrenergic medications.

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