ASUHAN KEPERAWATAN PADA

PASIEN DENGNA HIPOTIROID

DAN HIPERTIROID
NS. LALU M PANJI AZALI, M.KEP
DEPARTEMEN KEPERAWATAN MEDICAL BEDAH
SISTEM ENDOKRIN
 KELENJAR TIROID

ANATOMI
• Terdiri dari 2 lobus kiri dan kanan
yang dihubungnkan dengan isthmus
• Lobus piramidalis
• Sejajar C5-T1, dan isthmus melekat
pada cartilage thrakea 1, 2 dan 3
• Berat: 15-25 gram
• Panjang: 5x2.5x2.5cm
• Sebesar ibu jari tangan
LETAK POSISI

SUPERFICIAL:
• M. STERNOTYROID
• M. STERNOHYOID
• M.OMOHYOID
MEDIAL:
LARING, FARING, TRAKEA DAN ESOPHAGUS
POSTEROLATERAL: CAROTID
POSTERIOR: TERDAPAT 4 PARATIROID DIMASING MASING SISI
VASKULARISASI

• ARTERY
• A. TIROIDEA SUPERIOR
• A. TIROIDEA INFERIOR
• A. TIROIDEA IMA
VENA
V. TIROIDEA SUPERIOR
V. TIROIDEA MEDIA
V. TIROIDEA INFERIOR
HISTOLOGI

• UNIT TERKECIL TIROID

TERDIRI DARI 2 RUANGAN
BERONGGA YANG DISEBUT
DENGAN FOLIKEL DAN
DIDALAMNYA TERDAPAT
KOLOID YANG MENGANDUNG
TIROGLOBULIN
 KELENJAR TIROID
• FUNGSI: PRODUKSI, SIMPAN DAN SEKRESI HORMONE T3, T4 DAN CALCITONIN

SEL FOLIKULER
• BERKERJA DALAM MEMPRODUKSI HORMONE TIROID YANG BERFUNGSI SEBAGAI PENGATUR:
• METABOLISME KARBOHIDRAT
• PERTUMBUHAN, PERKEMBANGAN DAN DIFRESIASI SEL
• PERKEMBANGAN MENTAL
• KEGIATAN SYSTEM SYARAF
SEL C (PARA FOLIKULER)

• BEKERJA DALAM MEMPRODUKSI KALSITONIN YANG BERFUNGSI SEBAGAI PENGATUR ABSORBS KASIUM

TULANG DAN MENURUNKAN KADAR KALSIUM DALAM DARAH

 FISIOLOGI HORMONE TYROID

• ABSORBSI ION IODIDE OLEH TGI 

TRANSPORT IODIDE MELALUI
SODIUM IODIDE SIMPORTER (NIS)
MENUJU SEL FOLIKULER 
OKSIDASI ION IODIDE OLEH ENZIM
IODINE PEROKSIDASE  TIROKSIN
MERUBAH IODIUM MENJADI MIT
DAN DIT PENGGABUNGAN MIT
DAN DIT KEMUDIAN MENJADI T4
DAN T3 DI KOLOID PELEPASAN
DALAM DARAH (TIROID BANDING
GLOBULIN)
PELEPASAN HORMONE
T
Sekresi T3 dan T4

• Mekanisme umpan balik

• Hipotalamus
• Hipofise

Hormon tiroid:

• Tinggi: menurunkan TSH

• Rendang : meningkatkan TSH
 FUNGSI:
1. HORMON TIROKSIN DAN TRIIODOTIRONIN
KATABOLISME PROTEIN, LEMAK DAN KARBOHIDRAT DALAM SEMUA SEL
MENGATUR KECEPATAN METABOLISM SEMUA SEL
MENGATUR PRODUKSI PANAS TUBUH
MEMPERTAHANKAN SEKRESI HORMONE PERTUMBUHAN DAN PEMATANGAN TULANG
MEMPERTAHANKAN MOBILISASI KALSIUM
2. HORMON KALSITONIN
MENGURANGI KALSIUM DAN FOSFAT SERUM
MEMPENGARUHI ABSORBS KALSIUM DAN FOSFOR OELH GI
 KINERJA TIROID

• T4  DEIODINASI  T3 DIIKAT OLEH RESEPTOR NUCLEUS  SINTESIS PROTEIN 

SEL TARGET
• TARGET:
• GH, CNS (MATURASI NEUROSPITAL), BMR (BASAL METABOLIC RATE),
METABOLISME, CARDIOVASKULER
 KELAINAN TIROID
• CONGENITAL
• INFLAMASI
• GANGGUAN FUNGSI
• DIFFUSE DAN MULTINODULAR GOITER
• NEOPLASMA
 KELAINAN KONGENITAL
• AGNESIS
• HIPOPLASIA
• ECTOPIC (LINGUAL TYROID, CERVICAL, TYROTHYMIC)
• KISTA DUCTUS TYROIGLOSUS (KELAINAN PALING SERING TERJADI) : TERJADI
KARENA KEGAGALAN REGRESI DENGAN KOMPLIKASI RADANG DAN SINUS
 INFLAMASI TIROIDITIS

FASE AKUT BIAS TERJADI KARENA INFEKSI BAKTERI, JAMUR

INFLAMASI KARENA DISFUNGSI : FIBROSUS THYROIDITIS
AUTOIMUN: HASIMOTO
 GANGGUAN FUNGSI

• HIPOTIROID : CREATINISME (ANAK) DAN MIXEDEMA (DEWASA)

• HIPERTYROID : TIROTOXICOSIS ( MATA MENONJOL DAN KULIT TEBAL)
 KELENJAR PARATIROID

• MERUPAKAN KELENJAR YANG SANGAT KECIL YANG TELETAK PADA SETIAP LOBUS BAGIAN POSTERIOR DAN
TIROID. KELENJAR INI MENGHASILKAN HORMON PARA HORMONE. FUNGSI UTAMA KELENJAR INI ADALH
MENGATUR KADAR KALSIUM FOSFAT DALAM DARAH. KETIDAK SEIMBANGAN KASIUM FAN FOSFAT DALAM
DARAH AKAN MENGAKIBATKAN GANGGUAN TRANMISI IMPULS SARAF, KERUSAKAN GANGGUAN TULANG,
PERTUMBUHAN TULANG DAN TETANI OTOT.
• APABILA KADAR KALSIUM DALAM DARAH MENJADI RENDAH, PRAHORMON DAPAT MENINGKATKANYA DENGA:

1. MENSTIMULASI TULANG ( AKTIVITAS OKTIOKLAS) UNTUK MENGELUARKAN KALSIUM DALAM DARAH

2. MENINGKATKAN BSORBSI KALSIUM FOSFAT MELALUI GI. VITAMIN D JUGA DIPERLUKAN UNTUK REABSORBSI
KALSIUM MELALUI GI
3. MENINGKATKAN ABSORBS KALSIUM LEWAT TUBULUS GINJAL
 HIPERTIROID
• Hipertiroidisme adalah sekresi hormon tiroid yang berlebihan yang dimanifestasikan melalui
peningkatan kecepatan metabolisme. (Suzanne C. Smeltzer,2001). Hipertiroidisme dapat
didefinisikan sebagai respons jaringan-jaringan tubuh terhadap pengaruh metabolik hormon
tiriod yang berlebihan. Keadaan ini dapat timbul spontan atau akibat asupan hormon tiroid yang
berlebihan. (SYLVIA A. PRICE, DKK, 2005).
KLASIFIKASI
THAMRIN (2007) MENGKLASIFIKASIKAN HIPERTIROIDISME MENJADI EMPAT BAGIAN:
A. GOITER TOKSIK DIFUSA (GRAVE’S DISEASE)
• KONDISI YANG DISEBABKAN, OLEH ADANYA GANGGUAN PADA SISTEM KEKEBALAN TUBUH
DIMANA ZAT ANTIBODI MENYERANG KELENJAR TIROID, SEHINGGA MENSTIMULASI KELENJAR
TIROID UNTUK MEMPRODUKSI HORMON TIROID TERUS MENERUS. GRAVE’S DISEASE LEBIH BANYAK
DITEMUKAN PADA WANITA DARIPADA PRIA, GEJALANYA DAPAT TIMBUL PADA BERBAGAI USIA,
TERUTAMA PADA USIA 20 – 40 TAHUN. FAKTOR KETURUNAN JUGA DAPAT MEMPENGARUHI
TERJADINYA GANGGUAN PADA SISTEM KEKEBALAN TUBUH, YAITU DIMANA ZAT ANTIBODI
MENYERANG SEL DALAM TUBUH ITU SENDIRI.
B. PENYAKIT TIROID NODULAR (NODULAR THYROID DISEASE)
• PADA KONDISI INI BIASANYA DITANDAI DENGAN KELENJAR TIROID MEMBESAR DAN
TIDAK DISERTAI DENGAN RASA NYERI. PENYEBABNYA PASTI BELUM DIKETAHUI. TETAPI
UMUMNYA TIMBUL SEIRING DENGAN BERTAMBAHNYA USIA.
C. SUBAKUT TIROIDITIS
• DITANDAI DENGAN RASA NYERI, PEMBESARAN KELENJAR TIROID DAN INFLAMASI, DAN
MENGAKIBATKAN PRODUKSI HORMON TIROID DALAM JUMLAH BESAR KE DALAM DARAH.
UMUMNYA GEJALA MENGHILANG SETELAH BEBERAPA BULAN, TETAPI BISA TIMBUL LAGI
PADA BEBERAPA ORANG.
E. POSTPARTUM TIROIDITIS
• TIMBUL PADA 5 – 10% WANITA PADA 3 – 6 BULAN PERTAMA SETELAH
MELAHIRKAN DAN TERJADI SELAMA 1 -2 BULAN. UMUMNYA KELENJAR AKAN
KEMBALI NORMAL SECARA PERLAHAN-LAHAN.
 PATOFIS HIPERTIROID

• PADA HIPERTIROIDISME, KELENJAR TIROID “DIPAKSA” MENSEKRESIKAN

HORMON HINGGA DILUAR BATAS, SEHINGGA UNTUK MEMENUHI PESANAN
TERSEBUT, SEL-SEL SEKRETORI KELENJAR TIROID MEMBESAR.
• ADA BEBRAPA FACTOR YANG DAPAT MENYEBABKAN HIPERTIROID, TETAPI
TERDAPAT 2 PENYEBAB YANG PAING SERING, YAITU PENYAKIT GRAVE DAN
PENYAKIT GOITER MULTINODULAR TOKSIK, SEDANGKAN PENYEBAB LAINNYA
ADALAH TIROIDITIS, TIROTOKSIKOSIS T3, DAN HIPERTIROID AKIBAT KELEBIHAN
IODINE ATAU SUPLEMEN IODINE
CIRI CIRI PASIEN HIPERTIROID
• TREMOR DAN TAMPAK GUGUP
• OTOT TERASA LEMAS
• CEPAT LELAH
• BERAT BADAN MENURUN WALAUPUN NAFSU MAKAN MENINGKAT
• INTOLERANSI TERHADAP CUACA PANAS
• BIASANYA MENUNJUKAN EMOSI LABIL, INSOMNIA DAN UNTUK WANITA TERJADI
AMENOREA
ASSESSMENT OF THE THYROID GLAND
• INPEKSI DAN PALPASI ( PEMERIKSAAN FISIK)
DIAGNOSTIC FINDING
• ELEVATED THYROXINE (T4) LEVEL-   > 58.5 TO 150

• ELEVATED TRIIODOTHYRONINE (T3) LEVEL-  > 1.15 TO 3.10

• HIGH RADIOACTIVE IODINE UPTAKE (RAIU) THROUGH THYROID SCANNING.
• ELEVATED THYROID-STIMULATING HORMONE (TSH OR THYROTROPIN) LEVEL
USING SERUM IMMUNOASSAY
• ELEVATED FREE THYROXINE (FT4) LEVEL THROUGH SERUM IMMUNOASSAY.
• NEGATIVE(BENIGN) OR POSITIVE(MALIGNANT) RESULT AFTER ASPIRATION BIOPSY
• MEDICAL MANAGEMENT
• PROPYLTHIOURACIL (PTU)   –   BLOCK SYNTHESIS OF THYROID HORMONES TO DECREASE
OUTPUT OF T3 & T4. METHIMAZOLE THEIR LIFE-THREATENING ADVERSE EFFECT IS
AGRANULOCYTOSIS.
• SODIUM IODIDE- LYSE THYROID GLAND CELLS TO BRING THYROID GLAND’S ACTIVITY DOWN.
• SATURATED SOLUTION OF POTASSIUM IODIDE (SSKI)– RESERVED FOR SEVERE
THYROTOXICOSIS BY BLOCKING SYNTHESIS OF THYROID HORMONES TO DECREASE OUTPUT
OF T3 &  T4.
• PROPANOLOL- A BETA-ADRENERGIC BLOCKER TO RELIEVE SIGNS AND SYMPTOMS OF
HYPERTHYROIDISM E.G. HYPERTENSION, TREMORS, TACHYCARDIA, IRRITABILITY, & OTHER
HYPERSYMPATHETIC ACTIVITIES.
• THYROIDECTOMY– SURGICAL REMOVAL OF THE THYROID GLAND. SUBTOTAL
THYROIDECTOMY IS USUALLY DONE TO PATIENTS WITH HYPERTHYROIDISM WHEREIN 5/6 OF
THE TOTAL THYROID TISSUE IS REMOVED. PATIENTS NEED TO BE EVALUATED FOR
HYPOTHYROIDISM, WHICH CAN DEVELOP YEARS AFTER SURGERY.
• THYROIDECTOMY, ALTHOUGH RARE, MAY BE PERFORMED FOR PATIENTS WITH THYROID CANCER, HYPERTHYROIDISM, AND
DRUG REACTIONS TO ANTITHYROID AGENTS; PREGNANT WOMEN WHO CANNOT BE MANAGED WITH DRUGS; PATIENTS WHO
DO NOT WANT RADIATION THERAPY; AND PATIENTS WITH LARGE GOITERS WHO DO NOT RESPOND TO ANTI-THYROID DRUGS.
• THE TWO TYPES OF THYROIDECTOMY INCLUDE:
• TOTAL THYROIDECTOMY: THE GLAND IS REMOVED COMPLETELY. USUALLY DONE IN THE CASE OF MALIGNANCY. THYROID
REPLACEMENT THERAPY IS NECESSARY FOR LIFE.
• SUBTOTAL THYROIDECTOMY: UP TO FIVE-SIXTHS OF THE GLAND IS REMOVED WHEN ANTITHYROID DRUGS DO NOT
CORRECT HYPERTHYROIDISM OR RAI THERAPY IS CONTRAINDICATED.
• NURSING CARE PLANS
• THYROIDECTOMY REQUIRES METICULOUS POSTOPERATIVE NURSING CARE TO PREVENT COMPLICATIONS. NURSING
PRIORITIES WILL INCLUDE MANAGING HYPERTHYROID STATE PREOPERATIVELY, RELIEVING PAIN, PROVIDING INFORMATION
ABOUT THE SURGICAL PROCEDURE, PROGNOSIS, AND TREATMENT NEEDS, AND PREVENTING COMPLICATIONS.
• HERE ARE FIVE (5) NURSING CARE PLANS AND NURSING DIAGNOSIS FOR THYROIDECTOMY:
• ACUTE PAIN
• RISK FOR IMPAIRED AIRWAY CLEARANCE
• IMPAIRED VERBAL COMMUNICATION
• RISK FOR INJURY
• DEFICIENT KNOWLEDGE
• ASSESSMENT
• √ ASSESS AIRWAY – OBSTRUCTION DUE TO INFLAMMATION
√ ASSESS VITAL SIGNS- HELPS DETECT BLEEDING OR HEMORRHAGE
√ ASSESS BLEEDING- LOOK AT PATIENT’S DRESSING AT THE BACK OF THE NECK.
√ OBSERVE IF PATIENT ALWAYS SWALLOWS- SIGN OF BLEEDING
√ MONITOR FOR SIGNS OF HYPOCALCELMIA
√ MONITOR VOICE QUALITY
 MANAGEMENT KEPERAWATAN
• DATA SUBJEKTIF

RIWAYAT PENGALAAN PERUBAHAN STATUS EMOSIONAL DAN MENTAL

MENGALAMI SAKIT DADA
MENGALAMI DIPSNEA KETIKA MELAKUKAN AKTIVITAS ATAUPUN ISTIRAHAT
RIWAYAT PERUBAHAN PADA KUKU, RAMBUT, KULIT DAN BANYAK KERINGAT
MENGELUH GANGGUAN PENGELIHATAN DAN MATA CEPAT LELAH
PERUBAHAN ASUPAN MAKANAN DAN BERAT BADAN
PERUBAHAN ELIMINASI FESES, FREKUENSI DAN BANYAKNYA
INTOLERANSI TERHADAP CUACA PANAS
MENGELUH CEPAT LELAH DAN TIDAK MAMPU MELAKUKAN SEMUA KTIVITAS HIDUP SEHARI HARI
PERUBAHAN MENSTRUASI DAN LIBIDO
PENGETAHUAN TENTANGN PENYAKIT OBAT DAN SERTA EFEK OBAT DAN EFEK SSAMPING
 PENGKAJIAN
DATA OBJEKTIF
• KAJI STATUS MENTAL : PERHATIAN PENDEK, EMOSI LABIL, TREMOR, DAN HYPERKINESIA
• PERUBAHAN KARDIOVASKULER : TEKANAN SISTOLIK MENINGKAT DAN DIASTOLIC MENURUN, TAKIKARDI
WALUPUN DALAM KEADAAN ISTIRAHAT, DISRITMIA DAN MUR MUR
• PERUBAHAN PADA KULIT: HANYAT KEMERAHAN DAN BERKERINGAT YANG BANYAK
• PERUBAHAN PADA RAMBUT: HALUS DAN MENIPIS
• PERUBAHAN PADA MATA: LID LAG, GLOVE LAG, DIPLOPIA DAN PENGELIHATAN KABUR
• PERUBAHAN NUTRISI METABOLIC: BERAT BADAN MENURUN NAMUN NAFSU MAKAN MENINGKAT SERTA
KOLESTEROL DAN GLISERIDA MENURUN
• PERUBAHAN MUSCULOSKELETAL: OTOT LEMAH, TONUS OTOT KURANG, SULIT BERDIR DARI POSISI DUDUK
• HASIL PEMERIKSAAN DIAGDOSTIK TERJADI PENINGKATAN KADAR T3 DAN T4 DAN PENURUNAN TSH
 DIAGNOSIS KEPERAWATAN
• INTOLERANSI AKTIVITAS BERHUBUNGAN DENGAN KELEMAHAN DAN PENGECILAN OTOT (PERUBAHAN
EMTABOLISME)
• PENURUNAN CURAH JANTUNG BERHUBUNGAN DENGAN DISARITMIA NAMUN KEGIATAN SIMPATIS
MENNINGKAT
• KETIDAKEFEKTIFAN KOPINNG BERHUBUNGAN DENGAN EMOSI LABIL DAN PERHATIAN PENDEK
• PERUBAHAN NUTRISI KURANG DARI KEBUTUHAN TUBUH BERHUBUNGAN DENGAN PENINGKATAN
METABOLISM
• GANGGUAN POLA TIDUR BERHUBUNGAN DENGAN KEGELISAHAN DAN MENINGKATNYA METABOLISME
• PERUBAHAN SENSORIS PENGELIHATAN BERHUBUNGAN DENGAN GANGGUAN FUNGSI SARAF OPTIC DAN
OTOT EKSTRA OKULER (EDEMA)
• DEFISIT PENGETAHUAN BERHUBUNGAN DENGAN KURANGNYA INFORMASI TENTANG PENYAKIT DAN
PENGOBATAN
 HARAPAN CAPAIAN
• MENUNJUKAN PENGENDALIAN TOLERANSI TERHADAP AKTIVITAS DENGAN MENINGKATKAN AKTIVITAS
SECARA BERTAHAP DALAM 2-3 BULAN
• MENUNJUKAN TANDA TANDA PERFUSI JARINGAN YAN GBAIK DAN CURAH JANTUNG ADEKUAT, STATUS
MENTAL NORMAL, TIDAK ADANYA EDEMA, DENYUT JANTUNG NORMAL DAN BUNYI PERNAFASAN NORMAL
• MENUNJUKAN KOPING EFEKTIF
a. MENILAI SENDIRI RASA CEMAS
b. DAPAT MENGUNGKAPKAN CARA EFEKTIF UNTUK MENANGANI PERASAAN
• BERAT BADAN TIDAK BERKURANG DAN BERAT BADAN KEMPALI PADA BERAT BADAN SEBELUM SAKIT
• TIDAK MENGELUH SAKIT MATA DAN DIPLOPIA
• POLA TIDUR KEMBALI PADA SEBELUM SAKIT DAN BIAS BERISTIRAHAT PADA SIANG HARI
• DAPAT MENJELASKAN SIFAT PENYAKIT, PENGOBATAN SERTA EFEKNYA
 INTERVENSI KEPERAWATAN

ONEC
ISTIRAHAT YANG CUKUP:
KAJI POLA ISTIRAHAT DAN HAL TERKAIT
LINGKUNGAN YANG TENANG DAN NYAMAN
MASASE RINGAN PADA PUNGGUNG SEBELUM TIDUR MALAM
JELASKAN PASIEN MENGENAI PENTINGNYA UNTUK BERBARING TENANG
WALAUPUN IA TIDAK BIAS TIDUR
EDUKASI KELUARGA TENTANG PENGARUH HIPERTIROID TERADAP POLA
ISTIRAHAT
MEMPERTAHANKAN ATAU MENINGKATKAN TOLERANSI TERHADAP KEGIATAN
KAJI KEMAMPUAN DALAM AKTIVITAS (KEMAMPUAN MAKSIMAL DAN MINIMAL)
AJARKAN LATIHAN EXERCISE
ISTIRAHAT DIANTARA KEGIATAN
HENTIKAN KEGIATAN APABILA MERASA LELAH

MEMPERTAHANKAN NURISI ADEKUAT SESUAI KEBUTUHAN

KAJI POLA MAKAN DAN ASUPAN SERTA KEBUTUHAN
TIMBANG BERAT BADAN SETIAP HARI
PANTAU ASUPAN NUTRISI
MENGKONDUSI MAKANAN YANG TINGGI PROTEI DAN TINGGI KALORI
PANTAU ASUPAN DAN PENGELUARAN SETIAP 8 JAM
PEMBERIAN DIET TERJADWAL
MEMPERTAHANKAN PERAWATAN YANG BAIK PADA MATA
• KAJI INDRA PENGELIHATAN (DO DAN DS)
• LAKUKAN PENGKAIAN VISUAL SETIAP SHIFT
• TARAPKAN TINDAKAN YANG DAPAT MEMBANTU PERAWATAN MATA
• PAKAI KACAMAT GELAP
• TINGGIKAN BAGIAN KEPALA TEMPAT TIDUR
• TETESKAN AIRMATA BUATAN PADA KEDUA MATA
• TUTUP MATA DENGAN PENUTUP MATA PADA WAKTU TERTENTU
• HERE ARE SEVEN (7) NURSING CARE PLANS (NCP) AND NURSING DIAGNOSIS FOR PATIENTS WITH
HYPERTHYROIDISM:
• RISK FOR DECREASED CARDIAC OUTPUT
• FATIGUE
• RISK FOR DISTURBED THOUGHT PROCESSES
• RISK FOR IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS
• ANXIETY
• RISK FOR IMPAIRED TISSUE INTEGRITY
• DEFICIENT KNOWLEDGE
• OTHER POSSIBLE NURSING CARE PLANS
• RISK FOR DECREASED CARDIAC OUTPUT
• RISK FOR DECREASED CARDIAC OUTPUT : AT RISK FOR INADEQUATE BLOOD PUMPED BY THE HEART TO MEET
METABOLIC DEMANDS OF THE BODY.
• RISK FACTORS MAY INCLUDE
• UNCONTROLLED HYPERTHYROIDISM, HYPERMETABOLIC STATE
• INCREASING CARDIAC WORKLOAD
• CHANGES IN VENOUS RETURN AND SYSTEMIC VASCULAR RESISTANCE
• ALTERATIONS IN RATE, RHYTHM, CONDUCTION
• POSSIBLY EVIDENCED BY
• NOT APPLICABLE. A RISK DIAGNOSIS IS NOT EVIDENCED BY SIGNS AND SYMPTOMS, AS THE PROBLEM HAS NOT
OCCURRED AND NURSING INTERVENTIONS ARE DIRECTED AT PREVENTION.
• DESIRED OUTCOMES
• MAINTAIN ADEQUATE CARDIAC OUTPUT FOR TISSUE NEEDS AS EVIDENCED BY STABLE VITAL SIGNS,
PALPABLE PERIPHERAL PULSES, GOOD CAPILLARY REFILL, USUAL MENTATION, AND ABSENCE OF
DYSRHYTHMIAS.
Nursing Interventions
Monitor BP lying, sitting, and standing, if able. Note
widened pulse pressure.
Monitor central venous pressure (CVP), if available.
Investigate reports of chest pain or angina.
Assess pulse and heart rate while patient is sleeping.
Auscultate heart sounds, note extra heart sounds,
development of gallops and systolic murmurs.
Rationale
General or orthostatic hypotension may occur as a
result of excessive peripheral vasodilation and
decreased circulating volume. Widened pulse pressure
reflects compensatory increase in stroke volume and
decreased systemic vascular resistance (SVR).
Provides more direct measure of circulating volume
and cardiac function.
May reflect increased myocardial oxygen demands or
ischemia.
Provides a more accurate assessment of tachycardia.
Prominent S1 and murmurs are associated with forceful
cardiac output of hypermetabolic state; development of
S3 may warn of impending cardiac failure.
Nursing Interventions
Monitor ECG, noting rate and rhythm. Document
dysrhythmias.
Auscultate breath sounds. Note adventitious sounds.
Monitor temperature; provide cool environment, limit
bed linens or clothes, administer tepid sponge baths.
Observe signs and symptoms of severe thirst, dry
mucous membranes, weak or thready pulse, poor
capillary refill, decreased urinary output, and
hypotension.
Rationale
Tachycardia (greater than normally expected with
fever and/or increased circulatory demand) may reflect
direct myocardial stimulation by thyroid hormone.
Dysrhythmias often occur and may compromise
cardiac output.
Early sign of pulmonary congestion, reflecting
developing cardiac failure.
Fever (may exceed 104°F) may occur as a result of
excessive hormone levels and can aggravate diuresis
and/or dehydration and cause increased peripheral
vasodilation, venous pooling, and hypotension.
Rapid dehydration can occur, which reduces the
circulating volume and compromises cardiac output.

Record I&O. Note urine specific gravity.
Weigh daily. Encourage chair rest or bedrest. Limit
unnecessary activities.
Note history of asthma and bronchoconstrictive
disease, sinus bradycardia and heart blocks, advanced
HF, or current pregnancy.
Observe for adverse side effects of adrenergic
antagonists: severe decrease in pulse, BP; signs of
vascular congestion/HF; cardiac arrest.
Administer IV fluids as indicated.
Record I&O. Note urine specific gravity.
Significant fluid losses through vomiting, diarrhea,
diuresis, and diaphoresis can lead to profound
dehydration, concentrated urine, and weight loss.
Activity increases metabolic and circulatory demands,
which may potentiate cardiac failure.
The presence or potential recurrence of these
conditions affect the choice of therapy. For example
use of [beta]-adrenergic blocking agents is
contraindicated.
Indicates need for reduction or discontinuation of
therapy.
Rapid fluid replacement may be necessary to improve
circulating volume but must be balanced against signs
of cardiac failure and need for inotropic support.
Significant fluid losses through vomiting, diarrhea,
diuresis, and diaphoresis can lead to profound
dehydration, concentrated urine, and weight loss.
Monitor laboratory and diagnostic studies: 
Hypokalemia resulting from intestinal losses, altered
intake, or diuretic therapy may cause dysrhythmias
and compromise cardiac function/output. In the
presence of thyrotoxic paralysis (primarily occurring
•Serum potassium
in Asian men), close monitoring and cautious
replacement are indicated because rebound
hyperkalemia can occur as condition abates releasing
potassium from the cells.
•Serum calcium Elevation may alter cardiac contractility.
Pulmonary infection is the most frequent precipitating
•Sputum culture
factor of crisis.
May demonstrate the effects of electrolyte imbalance
or ischemic changes reflecting inadequate myocardial
•Serial ECGs
oxygen supply in the presence of increased metabolic
demands.
Cardiac enlargement may occur in response to
•Chest x-rays increased circulatory demands. Pulmonary congestion
may be noted with cardiac decompensation.

Administer transfusions; assist with plasmapheresis,
hemoperfusion, dialysis.
Prepare for possible surgery.
May be done to achieve rapid depletion of
extrathyroidal hormone pool in a desperately ill or
comatose patient.
Subtotal thyroidectomy (removal of five-sixths of the
gland) may be the treatment of choice for
hyperthyroidism once a euthyroid state is achieved.
• FATIGUE
• FATIGUE: AN OVERWHELMING, SUSTAINED SENSE OF EXHAUSTION AND DECREASED CAPACITY FOR
PHYSICAL AND MENTAL WORK AT USUAL LEVEL.
• MAY BE RELATED TO
• HYPERMETABOLIC STATE WITH INCREASED ENERGY REQUIREMENTS
• IRRITABILITY OF CENTRAL NERVOUS SYSTEM (CNS); ALTERED BODY CHEMISTRY
• POSSIBLY EVIDENCED BY
• VERBALIZATION OF OVERWHELMING LACK OF ENERGY TO MAINTAIN THE USUAL ROUTINE, DECREASED
PERFORMANCE
• EMOTIONAL LABILITY/IRRITABILITY; NERVOUSNESS, TENSION
• JITTERY BEHAVIOR
• IMPAIRED ABILITY TO CONCENTRATE
• DESIRED OUTCOMES
• CLIENT WILL VERBALIZE INCREASE IN THE LEVEL OF ENERGY.
• CLIENT WILL DISPLAY IMPROVED ABILITY TO PARTICIPATE IN DESIRED ACTIVITIES.
Nursing Interventions Rationale

Monitor vital signs, noting pulse rate at rest and when Pulse is typically elevated and, even at rest,
active. tachycardia (up to 160 beats/min) may be noted.

O2 demand and consumption are increased in the

Note development of tachypnea, dyspnea, pallor, and
cyanosis. hypermetabolic state, potentiating the risk of hypoxia
with activity.

Provide for a quiet environment; cool room,

Reduces stimuli that may aggravate agitation,
decreased sensory stimuli, soothing colors, quiet
hyperactivity, and insomnia.
music.

Encourage patient to restrict activity and rest in bed as

Helps counteract effects of increased metabolism.
much as possible.

Provide comfort measures: touch therapy or massage,

cool showers. Patient with dyspnea will be most May decrease nervous energy, promoting relaxation.
comfortable sitting in high Fowler’s position.
Provide for diversional activities that are calming, Allows for use of nervous energy in a constructive
e.g., reading, radio, television. manner and may reduce anxiety.

Increased irritability of the CNS may cause the patient

Avoid topics that irritate or upset patient. Discuss
to be easily excited, agitated, and prone to emotional
ways to respond to these feelings.
outbursts.

Understanding that the behavior is physically based

Discuss with SO reasons for fatigue and emotional may enhance coping with the current situation and
lability. encourage SO to respond positively and provide
support for the patient.

Administer medications as indicated: Sedatives such

as phenobarbital (Luminal); antianxiety agents; Combats nervousness, hyperactivity, and insomnia.
chlordiazepoxide (Librium)
• RISK FOR DISTURBED THOUGHT PROCESSES
• RISK FOR DISTURBED THOUGHT PROCESS: AT RISK FOR A STATE IN WHICH INDIVIDUAL
EXPERIENCES A DISRUPTION IN COGNITIVE OPERATIONS AND ACTIVITIES.
• RISK FACTORS MAY INCLUDE
• PHYSIOLOGICAL CHANGES: INCREASED CNS STIMULATION/ACCELERATED MENTAL
ACTIVITY
• ALTERED SLEEP PATTERNS
• POSSIBLY EVIDENCED BY
• NOT APPLICABLE. A RISK DIAGNOSIS IS NOT EVIDENCED BY SIGNS AND SYMPTOMS, AS THE
PROBLEM HAS NOT OCCURRED AND NURSING INTERVENTIONS ARE DIRECTED AT
PREVENTION.
• DESIRED OUTCOMES
• CLIENT WILL MAINTAIN USUAL REALITY ORIENTATION.
• CLIENT WILL RECOGNIZE CHANGES IN THINKING/BEHAVIOR AND CAUSATIVE FACTORS
Nursing Interventions Rationale

Assess the thinking process. Determine attention Determines the extent of interference with sensory
span, orientation to place, person, or time. processing

May be hypervigilant, restless, extremely sensitive, or

Note changes in behavior.
crying or may develop frank psychosis.

Assess the level of anxiety. Anxiety may alter thought processes.

Reduction of external stimuli may decrease

Provide a quiet environment; decreased stimuli, cool
hyperactivity or reflexia, CNS irritability, auditory
room, dim lights. Limit procedures and/or personnel.
and/or visual hallucinations.

Helps establish and maintain awareness of reality and

Reorient to person, place, or time as indicated.
environment.
Present reality concisely and briefly without
Limits defensive reaction.
challenging illogical thinking.

Provide clock, calendar, room with outside window; Promotes continual orientation cues to assist the
alter the level of lighting to simulate day or night. patient in maintaining a sense of normalcy.

Aids in maintaining socialization and

Encourage visits by family and/or SO. Provide
orientation. Note: Patient’s agitation and/or psychotic
support as needed.
behavior may precipitate family conflicts.

Provide safety measures. Pad side rails, close

Prevents injury to the patient who may be
supervision, applying soft restraints as last resorts as
hallucinating or disoriented.
necessary.

Administer medication as indicated: sedatives, Promotes relaxation, reduces CNS hyperactivity and
antianxiety agents, and/or antipsychotic drugs. agitation to enhance thinking ability
• RISK FOR IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS
• RISK FOR IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS: INTAKE OF NUTRIENTS
INSUFFICIENT TO MEET METABOLIC NEEDS.
• RISK FACTORS MAY INCLUDE
• INCREASED METABOLISM (INCREASED APPETITE/INTAKE WITH LOSS OF WEIGHT)
• NAUSEA/VOMITING, DIARRHEA
• RELATIVE INSULIN INSUFFICIENCY; HYPERGLYCEMIA
• POSSIBLY EVIDENCED BY
• NOT APPLICABLE. A RISK DIAGNOSIS IS NOT EVIDENCED BY SIGNS AND SYMPTOMS, AS THE PROBLEM
HAS NOT OCCURRED AND NURSING INTERVENTIONS ARE DIRECTED AT PREVENTION.
• DESIRED OUTCOMES
• ADVERTISEMENTS
• CLIENT WILL DEMONSTRATE STABLE WEIGHT WITH NORMAL LABORATORY VALUES AND BE FREE
OF SIGNS OF MALNUTRITION.
Nursing Interventions Rationale

Monitor daily food intake. Weigh daily and report Continued weight loss in the face of adequate caloric
losses. intake may indicate failure of antithyroid therapy.

Encourage patient to eat and increase the number of Aids in keeping caloric intake high enough to keep up
meals and snacks. Give or suggest high-calorie foods with the rapid expenditure of calories caused by the
that are easily digested. hypermetabolic state.

To promote weight gain. Note: If the patient has

Provide a balanced diet, with six meals per day.
edema, suggest a low-sodium diet.

Avoid foods that increase peristalsis and fluids that Increased motility of the GI tract may result in
cause diarrhea. diarrhea and impair absorption of needed nutrients.

Consult with a dietitian to provide a diet high in May need assistance to ensure adequate intake of
calories, protein, carbohydrates, and vitamins. nutrients, identify appropriate supplements.

Given to meet energy requirements and prevent or

Administer medications as indicated: glucose, vitamin
correct hypoglycemia. Insulin aids in controlling
B complex, insulin (small doses).
serum glucose if elevated.
• ANXIETY
• ANXIETY: VAGUE UNEASY FEELING OF DISCOMFORT OR DREAD ACCOMPANIED BY AN AUTONOMIC
RESPONSE.
• MAY BE RELATED TO
• PHYSIOLOGICAL FACTORS: HYPERMETABOLIC STATE (CNS STIMULATION), PSEUDO
CATECHOLAMINE EFFECT OF THYROID HORMONES
• POSSIBLY EVIDENCED BY
• INCREASED FEELINGS OF APPREHENSION, SHAKINESS, LOSS OF CONTROL, PANIC
• CHANGES IN COGNITION, DISTORTION OF ENVIRONMENTAL STIMULI
• EXTRANEOUS MOVEMENTS, RESTLESSNESS, TREMORS
• DESIRED OUTCOMES
• CLIENT WILL APPEAR RELAXED.
• CLIENT WILL REPORT REDUCED ANXIETY TO A MANAGEABLE LEVEL.
• CLIENT WILL IDENTIFY HEALTHY WAYS TO DEAL WITH FEELINGS.
Nursing Interventions
Observe behavior indicative of the level of anxiety.
Monitor physical responses, noting palpitations,
repetitive movements, hyperventilation, insomnia.
Stay with the patient, maintaining a calm manner.
Acknowledge fear and allow the patient’s behavior to
belong to the patient.
Describe and explain procedures, surrounding
environment, or sounds that may be heard by the
patient.
Rationale
Mild anxiety may be displayed by irritability and
insomnia. Severe anxiety progressing to the panic
state may produce feelings of impending doom, terror,
inability to speak or move, shouting or swearing.
Increased number of [beta]-adrenergic receptor sites,
coupled with effects of excess thyroid hormones,
produce clinical manifestations of catecholamine
excess even when normal levels of norepinephrine or
epinephrine exist.
Affirms to patient or SO that although patient feels
out of control, environment is safe. Avoiding personal
responses to inappropriate remarks or actions prevents
conflicts or overreaction to a stressful situation.
Provides accurate information, which reduces
distortions and confusion that can contribute to
anxiety and/or fear reactions.
 Attention span may be shortened, concentration
Speak in brief statements. Use simple words.
reduced, limiting the ability to assimilate information.
Reduce external stimuli: Place in a quiet room;
Creates a therapeutic environment; shows recognition
provide soft, soothing music; reduce bright lights;
that unit activity or personnel may increase patient’s
reduce the number of persons having contact with the
anxiety.
patient.

Discuss with patient and/or SO reasons for emotional
lability and/or psychotic reaction.
Reinforce the expectation that emotional control
should return as drug therapy progresses.
Administer antianxiety agents or sedatives and
monitor effects.
Refer to support systems as needed: counseling, social Ongoing therapy support may be desired or required
services, pastoral care.
Understanding that behavior is physically based
enhances acceptance of the situation and encourages
different responses and approaches.
Provides information and reassures patient that the
situation is temporary and will improve with
treatment.
May be used in conjunction with a medical regimen
to reduce effects of hyperthyroid secretion.
by patient/SO if crisis precipitates lifestyle alterations
• RISK FOR IMPAIRED TISSUE INTEGRITY
• RISK FOR IMPAIRED SKIN INTEGRITY: AT RISK FOR ALTERED EPIDERMIS AND/OR DERMIS.
• RISK FACTORS MAY INCLUDE
• ALTERATIONS OF PROTECTIVE MECHANISMS OF EYE: IMPAIRED CLOSURE OF
EYELID/EXOPHTHALMOS
• POSSIBLY EVIDENCED BY
• NOT APPLICABLE. A RISK DIAGNOSIS IS NOT EVIDENCED BY SIGNS AND SYMPTOMS, AS THE
PROBLEM HAS NOT OCCURRED AND NURSING INTERVENTIONS ARE DIRECTED AT PREVENTION.
• DESIRED OUTCOMES
• CLIENT WILL MAINTAIN MOIST EYE MEMBRANES, FREE OF ULCERATIONS.
• CLIENT WILL IDENTIFY MEASURES TO PROVIDE PROTECTION FOR EYES AND PREVENT
COMPLICATIONS.
Nursing Interventions Rationale

Encourage the use of dark glasses when awake and

Protects exposed cornea if the patient is unable to
taping the eyelids shut during sleep as needed. Suggest
close eyelids completely because of edema or fibrosis
the use of sunglasses or eyepatch. Moisten conjunctiva
of fat pads and/or exophthalmos.
often with isotonic eye drops.

Elevate the head of the bed and restrict salt intake if Decreases tissue edema when appropriate: HF, which
indicated. can aggravate existing exophthalmos.

Instruct patient in extraocular muscle exercises if Improves circulation and maintains mobility of the
appropriate. eyelids.

Provide an opportunity for the patient to discuss Protruding eyes may be viewed as unattractive.
feelings about altered appearance and measures to Appearance can be enhanced with proper use of
enhance self-image. makeup, overall grooming, and use of shaded glasses.
Administer medications as indicated:

Lubricates the eyes, reducing the risk of lesion

•Methylcellulose drops
formation.

Given to decrease rapidly progressive and marked

•Adrenocorticotropic hormone (ACTH), prednisone
inflammation.

May decrease signs and symptoms or prevent

•Antithyroid drugs
worsening of the condition.

•Diuretics Can decrease edema in mild involvement.

Eyelids may need to be sutured shut temporarily to

protect the corneas until edema resolves (rare) or
Prepare for possible surgery as indicated. increasing space within sinus cavity and adjusting
musculature may return the eye to a more normal
position.
• DEFICIENT KNOWLEDGE
• DEFICIENT KNOWLEDGE: ABSENCE OR DEFICIENCY OF COGNITIVE INFORMATION RELATED TO A SPECIFIC TOPIC.
• MAY BE RELATED TO
• LACK OF EXPOSURE/RECALL
• INFORMATION MISINTERPRETATION
• UNFAMILIARITY WITH INFORMATION RESOURCES
• POSSIBLY EVIDENCED BY
• QUESTIONS, REQUEST FOR INFORMATION, STATEMENT OF MISCONCEPTION
• INACCURATE FOLLOW-THROUGH OF INSTRUCTIONS/DEVELOPMENT OF PREVENTABLE COMPLICATIONS
• DESIRED OUTCOMES
• CLIENT WILL VERBALIZE UNDERSTANDING OF DISEASE PROCESS AND POTENTIAL COMPLICATIONS.
• CLIENT WILL IDENTIFY THE RELATIONSHIP OF SIGNS/SYMPTOMS TO THE DISEASE PROCESS AND CORRELATE
SYMPTOMS WITH CAUSATIVE FACTORS.
• CLIENT WILL VERBALIZE UNDERSTANDING OF THERAPEUTIC NEEDS.
• CLIENT WILL INITIATE NECESSARY LIFESTYLE CHANGES AND PARTICIPATE IN THE TREATMENT REGIMEN.
Nursing Interventions Rationale

Provides knowledge base from which patient can make

Review the disease process and future expectations.
informed choices.

This information includes the severity of the condition,

Provide information appropriate to individual situation. cause, age, and concurrent complications to determine the
course of treatment.

Identify stressors and discuss precipitators to thyroid

Psychogenic factors are often of prime importance in the
crises: personal or social and job concerns, infection,
occurrence and/or exacerbation of this disease.
pregnancy.

A patient who has been treated for hyperthyroidism needs

Provide information about signs and symptoms of
to be aware of the possible development of
hypothyroidism and the need for continuous follow-up
hypothyroidism, which can occur immediately after
care.
treatment or as long as 5 yr later.

After 131I therapy, tell the patient not to expectorate or

cough freely. Stress need for repeated measurement of Saliva will be radioactive for 24 hours.
serum T4 levels.
 To detect leukopenia, thrombocytopenia, and
agranulocytosis if the patient is taking propylthiouracil
Monitor CBC periodically. and methimazole. Instruct to take medications with
meals to minimize GI distress and to avoid OTC cough
preparations because many contain iodine.

Antithyroid medication (either as primary therapy or in

preparation for thyroidectomy) requires adherence to a
Discuss drug therapy, including the need for adhering
medical regimen over an extended period to inhibit
to the regimen, and expected therapeutic and side
hormone production. Agranulocytosis is the most
effects.
serious side effect that can occur, and alternative drugs
may be given if problems arise.

Early identification of toxic reactions (thiourea

Identify signs and symptoms requiring medical
therapy) and prompt intervention are important in
evaluation: fever, sore throat, and skin eruptions.
preventing the development of agranulocytosis.
 Antithyroid medications can affect or be affected
Explain the need to check with a physician and/or
by numerous other medications, requiring
pharmacist before taking other prescribed or OTC
monitoring of medication levels, side effects, and
drugs.
interactions.

Prevents undue fatigue; reduces metabolic demands.

Emphasize the importance of planned rest periods. As euthyroid state is achieved, stamina and activity
level will increase.

Provides adequate nutrients to support the

hypermetabolic state. A hormonal imbalance is
Review need for a nutritious diet and periodic review
corrected, the diet will need to be readjusted to
of nutrient needs. Tell patient to avoid caffeine,
prevent excessive weight gain. Irritants and stimulants
red/yellow food dyes, artificial preservatives.
should be limited to avoid cumulative systemic
effects.

Necessary for monitoring the effectiveness of therapy

Stress necessity of continued medical follow-up.
and prevention of potentially fatal complications.
• OTHER POSSIBLE NURSING CARE PLANS
• OTHER NURSING DIAGNOSES FOR HYPERTHYROIDISM YOU CAN DEVELOP INTO A CARE PLAN:
• ADVERTISEMENTS
• IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS —MAY BE RELATED INTAKE LESS THAN
METABOLIC NEEDS SECONDARY TO EXCESSIVE METABOLIC RATE.
• RISK FOR INJURY —RELATED TO TREMORS.
• RISK FOR HYPERTHERMIA —MAY BE RELATED TO LACK OF METABOLIC COMPENSATORY MECHANISMS
SECONDARY TO HYPERTHYROIDISM.
• ACTIVITY INTOLERANCE —MAY BE RELATED TO FATIGUE, EXHAUSTION SECONDARY TO EXCESSIVE METABOLIC
RATE.
• DIARRHEA —MAY BE RELATED TO INCREASED PERISTALSIS SECONDARY TO EXCESSIVE METABOLIC RATE.
• IMPAIRED COMFORT —MAY BE RELATED TO HEAT INTOLERANCE AND PROFUSE DIAPHORESIS.
• RISK FOR IMPAIRED TISSUE INTEGRITY: CORNEAL —MAY BE RELATED TO THE INABILITY TO CLOSE EYELIDS
SECONDARY TO EXOPHTHALMOS.
• RISK FOR INEFFECTIVE THERAPEUTIC REGIMEN MANAGEMENT—MAY BE RELATED TO INSUFFICIENT
KNOWLEDGE OF CONDITION, TREATMENT REGIMEN, PHARMACOLOGIC THERAPY, EYE CARE, DIETARY
MANAGEMENT, AND SIGNS AND SYMPTOMS OF COMPLICATION.
• HYPOTHYROIDISM MERUPAKAN KONDISI DIMANA KLENJAR TIROID TIDAK CUKUP
MEMPRODUKSI HORMONE T3 DAN T4 SESUAI DENGAN KEBUTUHAN TUBUH. HIPOTIROID
YANG DIAKIBATKAN OLEH KELAINAN KONGENTAL DAPAT MENGAKIBATKAN
GANGGUAN PERTUMBUHAN ATAU YANG BIASA DISEBUT DENGAN KREATINISME,
SEDANGKAN JIKA TERJADI PADA USIA DEWASA (UMUMNYA USIA 30-60 TAHUN) DAPAT
MENGAKIBATKN MYXEDEMA, GOITER DAN GANGGUAN LAINNYA.
• TERDAPAT BEBERAPA FACTOR YANG DAPAT MENYEBABKAN HIPOTIROIDISME ADALAH:
• HILANGNYA ATAU ATROFI JARINGAN TIROID AKIBAT PEMBEDAHAN TIROIDEKTOMI
TOTAL, OBAT TIROTOKSIK, TIROIDITIS AUTO IMUN, DAN DAN TERAPI RADIASI PADA
KEPALA ATAU LEHER AKIBAT MALIGNANSI
• HILANGNYA SIMULASI TROFIK KARENA DISFUNGSI HIPOFISIS. DAN DISFUNGSI
HIOTALAMUS
• FAKTOR LINGKUNGAN: DEFISIENSI IODINE
• GOITER BISA TIMBUL APABILA KELENJAR HIPOFISIS MENGELUARKAN TSH SEBAGI
RESPON TERHADAP KURANGNYA HORMONE TIROID DALAM DARAH. KELENJAR AKAN
MENJADI MEMBESAR SEBAGAI KOMPENSASI. DENGAN KONDISI FACTOR TERSEBUT
SECARA PERLAHAN KELENJAR TIROID MENJADI TIDAK MAMPU MENGELUARKAN
HORMONE YANG CUKUP SEHINGGA AKAN TIMBUL HIPOTIROIDISE.
• PEMEBESARAN GOITER JUGA DAPAT DISEBABKAN FACTOR LAIN, YAITU BIAS KARENA
KANKER, INFLAMASI. HAL TERSEBUT DIKENAL DENGAN ISTILAH SIMPLE GOITER.
• GOITER AKAN DIKATAKAN SEBAGAI ENDEMIC APABILA TIMBUL PADA DAERAH
TERTENTU DENGAN PENYEBAB YANG SAMA YAITU DEFISIENSI IODINE.
• TIROIDITIS ADALAH PERADANGAN PADA KELENJAR TIROID YANG DAPAT BERSIFAT
AKUT, SUBAKUT ATAUPUN KRONIS. PENYEBAB YANG PALING SERING ADALAH
TIROIDITIS HASIMOTO. KONDISI TERSEBUT TERJADI KARENA LIMFOSIT DAN ANTIBODY
MENGINFLITRASI ATAU MEMASUKI KELENJAR TIROID. HASIMOTO JUGA DISEBUT
SEBAGAI AUTOIMUN
• HAL YANG PERLU DICATAT ADALAH PADA TAHAP TERTENTU DENGAN KONDISI
HIPOTIROID AKIBAT TIROIDITIS AKAN MENGAKIBATKAN HIPERTIROID, NAMUN
KEJADIAN TERSEBUT AKAN BERLANGSUNG SEMENTARA, NAMUN PADA
AKHIRNYA AKAN MENGAKIBATKAN ATROFI.
• BERBAGAI KONDISI DI ATAS AKAN MENYEBABKAN PENURUNAN KECEPATAN
METABOLISM DAN MEMPERLAMBAT FUNGSI SYSTEM TUBUH, MISALNYA
INTERGUMENTUM, KARDIOVASKULER, GUGUP, KELEMAHAN
MUSCULOSKELETAL, TERJADI MIKSEDEMA (PENGATURAN CAIRAN TUBUH)
SEHINGGA PADA BAGIAN WAJAH AKAN TAMPAK KASAR, TEBAL DAN GEMUK
 HIPOTIROID
1. USIA PERTUMBUHAN : CRETINISME
• KEKURANGAN HORMONE TIROID SEJAK BAYI
• TERJADI GANGGUAN PERKEMBANGAN FISIK DAN MENTAL
• KULIT KERING DAN KASAR
• JARAK MATA DAN HIDUNG LEBAR
• LIDAH BESAR DAN MENONJOL
KEJADIAN HIPOTIROIDISME PADA MASA BAYI TIDAK AKAN TAMPAK SAMPAI
DENGAN USIA BEBERAPA BULAN. TANDA TANDA YANG DAPAT DIAMATI ADALAH
KEJADIAN RETRADASI MENTAL, GANGGUAN PERTUMBUHAN, DAN
PERKEMBANGAN YANG IREVERSIBEL.
2. DEWASA : MEXIDEMA

• AKTIVITAS PEREDARAN DARAH MENURUN

• LAJU METABOLISM RENDAH
• MUDAH LELAH, GELISAH DAN DEPRESI
• KONSTIPASI, MENSTRUASI TIDAK TERATUR
• NYERI SENDI PADA TANGAN DAN KAKI
• OBESITAS DAN BENTUK BADAN MENJADI KASAR
• BENGKAK PADA MATA DAN WAJAH SERTA TERJADINYA KERONTOKAN RAMBUT
PADA ORANG DEWASA TANDA GEJALA DINI YANG TIMBUL ADALAH CEPAT LELELAH,
LETARGI, DAN MERASA LEMAS SEHINGGA TIDAK DAPAT MELAKUKAN AKTIVITAS SEHARI
HARI. PASIEN TIDAK DAPAT MENTOLERANSI DINGIN DAN MENGALAMI KONSTIPASI
BERDASARKAN JENIS KELAMIN
• PADA WANITA, MENSTRUASI TIDAK TERATUR, MENORAGIA DAN INFERTILE
• PRIA DAN WANITA AKAN MENGALAMI HILANGNYA LIBIDO, TIDAK NAFSU
MAKAN, NYERI PADA OTOT, SENDI DAN DADA, DAN BIAS MENGALAMI
DISFUNGSI MENTAL
CACATAN
HIPOTIROID YAN GTIDAK DITANGAN AKAN MENGAKIBATKAN KEGAWATAN YANG
DISEBUT KOMA MIKSEDEMA DENGAN FAKTOR PENCETUS, SEDATIVE, NARKOTIK,
CUACA DINGIN, INFEKSI, DAN TRAUMA
MANAGEMEN KOLABORATIF
1. UJI DIAGNOSTIC
PEMERIKSAAN DILAKUKAN DENGAN T4 DAN T3 SERUM SERTA TSH ESSAY. APABILA DICURIGAI MENGALAMI PENYAKIT
HASIMOTO MAKA AKAN DILAKUKAN PEMERIKSAAN LAB ANTIBODY TIROID DAN BIOPSY JARUM HALUS UNTUK
MEMASTIKAN TIDAK ADA MALIGNANSI
2. MEDIKASI
SUPRESI GOITER. FOKUS TINDAKAN UNTUK MENYINGKIRKAN STIMULUS PENYEBAB PEMBESARAN TIROID. SUPRESI
PENINGKATAN TSH PERLU DILAKUKAN. JIKA PENYEBAB KARENA KURANGAN ASUPAN IODINE, AKAN DIPERLUKAN
PERGANTIAN IODINE DAN JIKA PENGOBATAN TIDAK DAPAT DILAKUKAN, MAKA AKAN DILAKUKAN TINDAKAN PEMBEDAHAN
TERAPI SULIH HORMONE. HAL INI DILAKUKAN DENGAN TERAPI PEMBERIAN HORMONE TIROID, DENGAN OBAT SODIUMLEVO-
TYROKSIN. DOSIS PERTAMA 12,5-25, DAN KEMUDIAN DITINGKATKAN SECARA BERTAHAP 25-50 SETIAP 2-4 MINGGU SEHINGGA
KECEPATAN METABOLISM YANG DIINGINKAN TERCAPAI.
3. PEMBEDAHAN
TIROIDEKTOMI DILAKUKAN JIKA PENGOBATAN TIDAK DAPAT BERHASIL SERTA KEADAAN PEMBESARAN MENEKAN JARINGAN
SEKITAR. TEKANAN PADA TRAKEA DAN ESOPHAGUS AKAN MENIMBULKAN RESIKO TERJADINYA STRIDOR DAN DISFAGIA DAN
TEKANAN PADA LARING AKAN MENYEBABKAN SUARA SERAK
4. DIET MAKANAN YANG SEIMBANG DIANJURKAN SESUAI DENGAN KEBUTUHAN TUBUH SERTA ASUPAN CAIRAN YANG CUKUP
5. AKTIVITAS
DISESUAIKAN DENGAN KEMAMPUAN TUBUH, DAN DITINGKATKAN SECARA BERTAHAP
 ASUHAN KEPERAWATAN

1. PENGKAJIAN
2. DIAGNOSA
3. PLANNING
4. INTERVENSI
5. IMPLEMENTASI
6. EVALUASI
PENGKAJIAN
SUBJEKTIF:
1. KAJI PERUBAHAN PADA KEKUATAN FISIK, STATUS MENTAL DAN NEUROLOGIS
2. PERUBAHAN PADA KULIT DAN RAMBUT
3. SAKIT PADA DADA, OTOT SENDI DAN KEPALA
4. KETAHANAN PADA CUACA DINGIN
5. PERUBAHAN NAFSU MAKAN (ANOREKSIA) BERAT BADAN DAN KONSTIPASI
6. PERUBAHAN FUNGSI SEKSUAL, PADA WANITA MENGELUHKAN GANGGUAN
MENSTRUASI, INFERTILE SEDANGKAN PADA PRIA TERKAIT LIBIDO DAN EREKSI
7. KAJI PENGETAHUAN TENTANG PENYAKIT DAN PENGOBATAN
DATA OBJEKTIF
1. STATUS MENTAL : FUNGSI INTELKTUAL, BICARA, MEMORI, SOMNOLENS, LETARGI
DAN BINGUNG
2. BERAT BADAN DAN SUHU TUBUH
3. KULIT: TEMPRATUR DAN ADANYA EDEMA PITTING
4. KEPADA DAN LEHER: RAMBUT PALPASI TIROID DAN WAJAH\KARDIOVASKULER:
KECEPATAN NADI, TEKANAN DARAH SAAT BERISTIRAHAT, BERKERINGAT DAN
BESARNYA JANTUNG
5. RESPIRASI: KECEPATAN DAN BUNYI NAFAS
6. ABDOMEN: BISING USUS
7. MOTORIK: KEKAKUAN DAN KELEMAHAN OTOT, TONUS SERTA MASA, SERTANGN
GERAK SENDI DAN REFLEX TENDON
8. UJI DIAGNOSTIC: KADAR TSH NAIK ATAU TURUN
DIAGNOSA KEPERAWATAN:
1. INTOLERANSI AKTIVITAS YAG BERHUBUNGAN DENGAN CURAH JANTUNG BERKURANG, MASA OTOT DAN
TONUS OTOT BERKURANG, SERTA NYERI SENDI
2. GANGGUAN CITRA TUBUH BERHUBUNGAN DENGAN BERAT BADAN BERLEBIH, KULIT KERING, BERSISIK, DAN
MENEBAL, SERTA RAMBUT TIPIS DAN WAJAH MIKSIDEMA
3. KONSTIPASI YANG BERHUBUNGAN DENGAN GERAKAN PERISTALTIC USUS BERKURANG, IMOBILITAS DAN
KURANGNYA KEGIATAN FISIK
4. HIPOTERMIA BERHUBUNGAN DENGAN PRODUKSI PANAS BERKURANG
5. GANGGUAN RASA NYAMAN BERHUBUNGAN DENGAN SAKIT KEPALA, DADA SERTA NYERI SENDI DAN OTOT
6. KETIDAKSEIMBANGAN NUTRISI BERHUBUNGAN DENGAN ANOREKSIA, PENURUNAN NAFSU MAKAN DAN
KECEPATAN METABOLISM MENURUN
7. DEFISIT PENGETAHUAN (PENYAKIT, DIAGNOSIS, PENGOBATAN) YANG BERHUBUNGAN DENGAN KURANGNYA
INFORMASI DAN KURANNGYA RESPON TERHADAP INFORMASI
8. DEFISIT PERAWATAN DIRRI (ADL) BERHUBUNGAN DENGAN CEPAT LELAH DAN FUNGSI TUBUH MENURUN
9. DISFUNGSI SEKSUAL BERHUBUNGAN DENGAN GANGGUAN LIBIDO, EREKSI, OVULASI DAN PRODUKSI
SPERMA
10. GANGGUAN PROSES PIKER BERHUBUNGAN DENGAN GANGGUAN ATAU PENURUNAN FUNGSI INTELEKTUAL
 NURSING CARE PLAN

• KETIDAK SEIMBANGAN NUTRISI

• DEFISIT PENGETAHUAN
• FATIGUE
 INTERVENSI KEPERAWATAN

• SESUAIKAN KEGIATAN DENGAN TOLERANSI PASIEN

• PADA PERMULAAN TOLERANSI PASIEN MUNGKIN AKAN SANGAT TERBATAS, DENGAN
HANYA MAMPU BERJALAN SEBENTAR DI DALAM KAMAR, SEHINGGA PERLU
DITINGKATKAN SECARA PERLAHAN
• PANTAU RESPON KARDIOVASKULER TERHADAP KEGIATAN APABILA TIMBUL RASA NYERI,
SESAK, SAKIT DADA. JIKA HAL TERSEBUT MUNCUL LATIHAN PERLU DIISTIRAHATKAN
SEJENAK SEBELUM MULAI KEMBALI
• PANTAU TEKANAN DARAH, NADI DAN PERNAFASAN PASIEN SEBELUM DAN SESUDAH
KEGIATAN ATAU LATIHAN
BANTU PASIEN MENINGKATKAN CITRA TUBUH YANG POSITIF
• JELASKAN KEPADA PASIEN DAN KELUARGA MENGENAI KAITAN PERUBAHAN
TUBUH TERKAIT HIPOTIROIDISME
• JELASKAN PERUBAHAN YANG REVESIBEL

PULIHKAN DEFEKASI YANG TERGANGGU

• PANTAU DEFEKASI
• TINGKATKAN ASUPAN CAIRAN
• BERI MAKANAN YANG KAYA SERAT
PERBAIKI HIPOTERMIA
• PANTAU SUHU SETIAP 2 SAMPAI 4 JAM
• PERTAHANKAN TEMPRATUR KAMAR YAN GCOCOK DENGAN PASIEN
• PAKAI SELIMUT HANGAT UNTUK MENGHANGATKAN TUBUH PASIEN

GANGGUAN NUTRISI
• BERIKAN DIET TERJADWAL UNTUK PASIEN
• ANJURKAN POLA MAKAN SEDIKIT TAPI SERING
• ANJURKAN MAKANAN KAYA SERAT
• ANJURKAN PASIEN UNTUK MENGURANGI MAKANAN KALORI TINGGI, RENDAH
KOLESTEROL DAN RENDAH LEMAK
KENYAMANA
• BERI RASA NYAMAN DENGAN MEMANFATKAN TINDAKAN NON MEDIS, CONTOH MASASE
RINGAN PADA PUNGGUNG, KOMPRES PANAS ATAU DINGIN, MUSIC RELAKSASI DAN
LINGKUNGAN YANG TENANG
EDUKASI PASIEN TERKAIT GANGGUAN SEKSUAL YANG DIALAMI DENGAN HIPOTIROIDISME
PERTAHANKAN INTGRITAS KULIT
• KEBERSIHAN KULIT
• JIKA PASIEN TIRAH BARING, BANTU PASIEN UNTUK PERUBAHAN POSISI SETIAP 2 JAM
• BERIKAN SEPREI LEMBUT
• BERIKAN PELEMBAB TERUTAMA KULIT KERING DAN BERESIKO LUKA DECUBITUS JIKA
PASIEN TIRAH BARING
PENYULUHAN KESEHATAN
• JELASKAN PASIEN DAN KELUARGA TERKAIT SIFAT PENYAKIT, UJI DIAGNOSTIC,
PENGOBATAN DAN PENTINGNYA PERGANTIAN HORMONE SEPANJANG HIDUP
• OBAT: DOSIS, CARA PEMAKAIAN, SERTA EFEK SAMPINGNYA
• PEMANTAUAN MANDIRI: TTD, BERAT BADAN, INTGRITAS KULIT DAN DEFEKASI
• PENTINGNYA ISTIRAHAT DAN AKTIVITAS
PROMKES:
MASYARAKAT PERLU DI EDUKASI TERKAIT PENTINGNYA ASUPAN IODINE
TERUTAMA PADA MAS PERTUMBUHAN DAN PERKEMBANGAN ANAK.
PEMAMPARAN TENTANG RESIKO YANG AKAN MUNCUL JIKA TERJADINYA
HIPOTIROIDISME
 Nursing Interventions Rationale
Pada pasien dengan hipotiroid cendrung akan
mengalami kelebihan berat badan karena lambatnya
kaji berat badan pasien metabolism tubuh. Dengan menilai berat badan, dapat
dijadikan indicator penilaian keberhasilan intervensi
sebelum dan sesudah
Pasien dengan hipotiroidisme mengalami penurunan
Kaji nafsu makan pasien
nafsu makan atau selera.
Menilai intake makanan selama 24 jam akan
memberikan gambaran kepada perawat untuk
Kaji pola makan pasien
perencanaan kebutuhan nutrisi harian untuk memenuhi
kebutuhan nutrisi tubuh harian.
Melibatkan keluarga akan membantu keberhasilan
terapi, mulai dari pengelolaan terapi mulai dari awal
Edukasi pasien dan keluarga terkait perubahan berat
terapi pergantian hormone dan dapat membantu dalam
badan terkait hipotiroid
pengelolaan pemasukan nutrisi pasien dan atau
pengontrolan diet dan sampai dengan exercise

Kolaborasi dengan nutrisionist dalam perencanaan
nutrisi lengkap dan penjadwalan yang seimbang
Anjurkan pasien untuk makan sedikit tapi sering jika
mengalami penurunan nafsu makan
Anjurkan pasien atau keluarga untuk menyiapakan
asistan untuk membantu klien mendapatkan intake
nutrisi cukup dan sesuai penjadwalan
Anjurkan pasien mengkonsumsi makanan tinggi serat
Anjurkan pasien untuk menghindari makanan
berkolesterol dan tinggi lemak
Kolaborasi dengan tim gizi dapat membantu
menilai dan menghitung jumah kebutuhan
sehingga pasien dapat menjaga intake nutrisi
seimbang dan memproleh berat yang ideal
Untuk memastikan pasien mendapatkan intake nutrisi
secara adekuat untuk mempertahankan energy untuk
beraktifitas
Pada kasus tertentu pasien akan mengalami penurunan
energy sehingga perlu adanya bantuan yang adekuat
untuk membantu memenuhi nutrisi hariann.
hipoHypothyroidism mengalami gangguan dalam
pencernaan makanan (peristaltic usus) yang dapat
mengakibatkan konstipasi
Rendahnya hormone tiroid menyebabkan tubuh tidak
dapat berfungsi normal dalam metabolism sehingga
berpotensi terjadi penumpukan kolesterol.
• DEFICIENT KNOWLEDGE
• DEFICIENT KNOWLEDGE: ABSENCE OR DEFICIENCY OF COGNITIVE INFORMATION RELATED TO A
SPECIFIC TOPIC.
• 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
• ADVERTISEMENTS
• CLIENT AND FAMILY MEMBERS WILL VERBALIZE CORRECT INFORMATION ABOUT HYPOTHYROIDISM
AND TAKING THYROID HORMONE REPLACEMENT.
 Nursing Interventions Rationale

Assess the client’s knowledge of hypothyroidism and Client teaching should begin with the current
thyroid hormone replacement therapy. knowledge about the disease and its management.

Clients experiencing hypothyroidism may have

impaired memory, confusion, hearing loss, and a
decreased attention span. These neurologic changes
can hinder with learning new information. Teaching
Provide information about hypothyroidism.
sessions should be planned at times when the client is
best able to concentrate. Recalling of information is
needed to facilitate learning. Using written
information reinforces verbal presentation.

Educate the client and family regarding thyroid Levothyroxine sodium (Synthroid) is a manmade
hormones. thyroid hormone that is used to treat hypothyroidism.
•Instruct the client to take the dose in the morning Thyroid hormone should be taken on a regular
to avoid insomnia. basis to achieve a hormone balance.

The client is initially given a small dose that gradually

•Instruct the client to take the medication on an empty increases until a euthyroid state is achieved. When the
stomach. thyroid hormone level increases, the client
experiences insomnia and weight loss.

The client should report symptoms such as chest pain

•Teach the expected benefits and possible side effects. /palpitations; these happen due to the increased
metabolic and oxygen consumption.

Avoid undue fatigue; As the euthyroid state is

Emphasized the importance of rest periods.
achieved, the activity level will eventually increase.

Encourage the client to follow appointments for blood These levels help determine the effectiveness of
workups (T3, T4, and TSH levels). pharmacotherapy
Describe the signs and symptoms of over- and This will serve as a check for the client to determine
underdosage of the medications. if the therapeutic levels are met.

Medical identification provides other health care

providers with information to guide decisions about
Encourage the client to have medical identification
care. Levothyroxine is highly protein bound in
about hormone therapy and to inform all health care
circulation. This drug characteristic contributes to
provider.
many drug interactions. The client needs to notify all
health care providers about taking this drug.
• FATIGUE
• FATIGUE: AN OVERWHELMING, SUSTAINED SENSE OF EXHAUSTION AND DECREASED CAPACITY FOR
PHYSICAL AND MENTAL WORK AT THE USUAL LEVEL.
• MAY BE RELATED TO
• 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
• CLIENT WILL IDENTIFY THE BASIS OF FATIGUE AND INDIVIDUAL AREAS OF CONTROL.
• CLIENT WILL VERBALIZE A REDUCTION OF FATIGUE AND INCREASED THE ABILITY TO COMPLETE DESIRED
ACTIVITIES.
 Nursing Interventions
Assess the client’s ability to perform activities of daily
living (ADLs).
Note daily energy patterns.
Assess the client’s energy level and muscle strength
and muscle tone.
Plan care to allow individually adequate rest periods.
Schedule activities for periods when the client has the
most energy.
Provide stimulation through conversation and
nonstressful activities.
Promote an environment conducive to relieve fatigue.
Rationale
The client may experience fatigue with minimal
exertion due to a slow metabolic rate. This symptom
hinder the client’s ability to perform daily activities
(e.g., self-care, eating)
This will help in determining the pattern/timing of
activity.
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 client may
report generalized weakness and muscle pain.
This will ensure maximize participation.
Promotes interest without putting too much stress to
the client.
The client with hypothyroidism often complains of
being cold even in a warm environment.
 REFREMSI

• LAWRENCE M. T. JR, STEPHEN J. MCP, MAXINE A. P. (2001). CURRENT MEDICAL DIAGNOSIS AND
TREATMENT, MCGRAW-HILL COMPANIES INC. 2001.
• SMELTZER. (2001). BUKU AJAR KEPERAWATAN MEDIKAL BEDAH BRUNNER & SUDDARTH. JAKARTA : EGC.
• BJÖRVELL, C., THORELL-EKSTRAND, I., & WREDLING, R. (2000). DEVELOPMENT OF AN AUDIT
INSTRUMENT FOR NURSING CARE PLANS IN THE PATIENT RECORD. BMJ QUALITY & SAFETY, 9(1), 6-13.
• CARPENITO-MOYET, L. J. (2009). NURSING CARE PLANS & DOCUMENTATION: NURSING DIAGNOSES AND
COLLABORATIVE PROBLEMS. LIPPINCOTT WILLIAMS & WILKINS.
• GULANICK, M., & MYERS, J. L. (2016). NURSING CARE PLANS: DIAGNOSES, INTERVENTIONS, AND
OUTCOMES. ELSEVIER HEALTH SCIENCES.