present with all the usual, but exacerbated and serious symptoms of hypothyroidism, and they typically have

body temperatures below normal as well. hypothermia, with body temperature lower than 350C, is a key sign that myxedema coma may be impending. in addition, patients with myxedema coma may demonstrate serious cardiac symptoms, impaired ventilation, and neuromuscular weakness. timely diagnosis and intervention is essential in such cases because mortality rates are high. in addition, it is essential that the underlying problem be identified and treated since patients may have other problems such as myxedema megacolon, an abnormal dilation of the colon that is not caused by mechanical obstruction, due to reduced intestinal motility caused by hypothyroidism. this condition may lead health care providers to consider surgery when the primary need is for hormone replacement therapy. fortunately, abdominal symptoms usually subside when synthetic thyroid hormone is administered to the patient (Greco, 2001). in emergency situations, levothyroxine sodium, a more powerful injectable form of triiodothyronine, may be administered intravenously for treatment of myxedema coma. nurses must be particularly vigilant in assessment and reporting of cardiac symptoms, impaired ventilation, and neuromuscular weakness in these cases. patients may require ventilator assistance and other support measures to ensure survival immediately report signs of myxedema , a severe, life threatening illness with symptoms including facial edema , thick tongue (macroglossia), mental confusion, irritability, severe mood swings, significant hypothermia (910F to 950F), severely slowed pulse and respirations, decreased blood pressure, profound neuromuscular weakness, anemia, and signs of psychosis, because the mortality rate is high. avoid use of sedatives, opiates, or alcohol to prevent congestive heart failure and circulatory collapse. provide respiratory support with administration of oxygen and ventilation if needed. administer intravenous fluids with care, observing for plural effusion and congestive heart failure be prepared to administer fast-acting intravenous thyroid hormone to restore the bodys thyroxine level. slowly rewarm the patient to avoid causing refractory hypotension and increased oxygen demand. observe for signs of infection and treat infections immediately to avoid further compromise of the patient.

Health promotion the thyroid gland requires iodine to manufacture thyroid hormone. until iodine was added to salt sometime in the 1920s, hypothyroidism was not uncommon in some parts of the united states. patients should be encouraged to eat a healthy diet, to purchase salt enhanced with iodine, and ensure that iodine is ingested regularly. another food source high in iodine is seafood. health promotion for patients with thyroid disease most often revolves around instruction regarding medications for hormone

replacement therapy since therapy will be required for the remainder of the patients lifetime. some patients will find it difficult to accept the nation that lifetime drug therapy is advised for treatment of this disorder. for this reason, it is important for the nurse to assess the patients understanding of the disorder and the need for hormone replacement therapy. the genetic consideration for hypothyroidism box discusses the nurses role if a familial predisposition to hypothyroidism is suspected. collaborative management patients with thyroid disease will need the support of several members of the health care team. following diagnosis, the patient with hypothyroidism will benefit from instruction by the pharmacist regarding medication for replacement of thyroid hormone and medications to treat other symptoms such as anemia. the nutritionist or dietitian can provide helpful consultation on diet to address the hypometabolic needs of the patients body while therapy corrects and stabilizes thyroid hormones.