Type of Thyroid Abnormality
- Acute thyroiditis
- Rarely Graves’-like disease
- Subclinical hypothyroidism
- Primary hypothyroidism
- Hyperthyroidism
Management
- Consider measuring anti-thyroid antibodies and/or TSH-receptor autoantibodies (TRAB) to establish autoimmune etiology
- If patient has not received IV iodinated contrast within 2 months, can consider a diagnostic thyroid uptake & scan
- Acute thyroiditis usually resolves or progresses to hypothyroidism; thus, can repeat TFTs in 4–6 weeks
- If TRAB high, obtain a thyroid uptake scan & refer to endocrinology
- Short period of 1 mg/kg prednisone or equivalent may be helpful in acute thyroiditis
- Consider use of beta blockers and immunotherapy hold for symptomatic patients (e.g., beta blockers for tachycardia/murmur and immunotherapy holds for patients who have acute thyroiditis threatening an airway). Therapy is often restarted when symptoms are mild/tolerable.
- Repeat TFTs in 4–6 weeks
- Begin thyroid replacement if symptomatic
- May consider repeating levels in 2-4 weeks if asymptomatic
- Levothyroxine dose 1.6 mcg per weight (kg) or 75–100 mcg daily
- Repeat TSH in 4–6 weeks and titrate dose to reference range TSH
- Consider radioactive iodine therapy or methimazole treatment
- Consider use of beta blockers for symptomatic patients (e.g., for tachycardia or murmur)
Nursing Implementation:
- Educate patient that hypothyroidism is generally not reversible
- Assess medication compliance with oral thyroid replacement or suppression
- History of thyroid disorders does not increase or decrease risk of incidence
- Consider collaborative management with endocrinologist, especially if the patient is hyperthyroid, particularly if a thyroid scan is needed
RED FLAGS:
- Swelling of thyroid gland causing compromised airway
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