Nurse Oliver should expect a client with hypothyroidism to report which health concerns?
A. Increased appetite and weight loss
B. Puffiness of the face and hands
C. Nervousness and tremors
D. Thyroid gland swelling
Correct Answer: B. Puffiness of the face and hands
Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves’ disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter). Hypothyroidism results from low levels of thyroid hormone with varied etiology and manifestations. Untreated hypothyroidism increases morbidity and mortality.
Option A: Inquire about dry skin, voice changes, hair loss, constipation, fatigue, muscle cramps, cold intolerance, sleep disturbances, menstrual cycle abnormalities, weight gain, and galactorrhea. Also obtain a complete medical, surgical, medication, and family history.
Option C: It is important to maintain a high index of suspicion for hypothyroidism since the signs and symptoms can be mild and nonspecific and different symptoms may be present in different patients. Typical features such as cold intolerance, puffiness, decreased sweating and skin changes may not be present always.
Option D: Autoimmune thyroiditis causes an increase in the turnover of iodine and impaired organification. Chronic inflammation of the parenchyma leads to predominant T-cell lymphocytic infiltration. If this persists, the initial lymphocytic hyperplasia and vacuoles are replaced by dense fibrosis and atrophic thyroid follicles.
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