NURS 700 Advanced Nursing Theory

Response to question 1.

The thyroid disorder mainly can be of two types. One is hyperthyroidism and another one is hypothyroidism. Hyperthyroidism mainly refers to the increased rerelease of thyroid hormone. In addition, the increase release is mediated by the hypothalamus, anterior pituitary and as well as by the thyroid gland itself. The whole process is happened in a chain wise process. Increased  release of  Thyroid releasing hormone ( TRH) from hypothalamus stimulates the secretion of Thyroid stimulating hormone( TSH) from the anterior.TSH then reaches to thyroid gland by the blood  circulation and helps in secretion of Trihydrothyronine ( T3) and tetrahydrothyronine( T4) or thyroxin (Fliers et al.,2015).In hyperthyroidism the level of unbound thyroid hormone in circulation is increased. Due to several defects like tumor or other problems like receptor problem can lead to the condition. Increased level of TRH causes more secretion of TSH in the pituitary level and this will cause more production of T3 and T4 (Vissenberg et al.,2015).The negative feedback mechanism is also unable to regulate the secretion of T3 and T4. The production of thyroid-stimulating immunoglobulin (TSI), which stimulates the TSH receptor more in the thyroid gland, will cause more growth and secretion of thyroid gland. The enlarged thyroid gland produces more thyroid hormone and causes the hyperthyroidism. In this condition, basal metabolic rate becomes very high due to the increased rate of degradation of carbohydrate, fat protein. Increased thyroid level helps in increasing the sympathomimetic action, which ultimately results in goiter disease, which is a symptom of hyperthyroidism (Mullur, Liu & Brent, 2014).On the other hand hypothyroidism is caused due to the underactivity of the thyroid gland. This condition can be due to the abnormal functions of hypothalamic-pituitary axis or due to the genetic disorders. Lack of iodine in the body can cause under development of the thyroid gland. Along with this lack of production of thyroid, stimulating hormone will alter the hypothalamus-pituitary axis and as a result, there is less production of T3 and T4.This ultimately results in a ceased thyroid gland. The inhibition of T3 and T4 synthesis is the crucial cause of hypothyroidism (Fekete  & Lechan, 2013).

Response to question 2.

The thyroid disorder patients’ face several social, psychological and as well as emotional issues. The main social issues that are faced by a patient of thyroid disorder is the social misconception about the disease. One of the important medication of thyroid disorder is the radioactive iodine (RAI). People have the misconception that with this treatment, the person will developed radioactivity in his body and that makes the patient more anxious about the diseased condition. Another social factor that the patient of thyroid disorder often faces that they are not given any respect and honor  due to their adverse health condition ,which affect the patients badly (Goel et al.,2017).The emotional and psychological  factors that are associated with this disease mainly are anxiety,depression,irritability, restlessness. In the endocrine system, there are various glands and hormones and as well as neurotransmitter, that helps in maintaining the homeostasis of hormonal level in our body. This homeostasis is responsible for the mood and anxiety and other psychological factors in our system. During the thyroid disorder, not only the thyroid hormone  level alters, but along with this simultaneously all other endocrine systems are also affected and cause alteration in other hormone levels those are responsible for maintaining stable mode. So when assessing the thyroid disorder, the other hormonal level should also be considered. The one of the most important reasons of mode swings, anxiety, and depression is the lack of essential nutrient in the diet of a thyroid patient. The completely psychological process is accomplished by a cascade of reaction and thyroid hormone is a key factor in that chain. Therefore, alteration in thyroid hormone level will cause those psychological problems to occur. Thyroid hormone is associated with the secretion of neurotransmitters like serotonin and noradrenergic and they are responsible for maintenance of stable mode. In studies, it is seen that increased level of T3 in hyperthyroidism increases the level of serotonin in the cerebral cortex and along with this in hypothyroidism condition; lowered level of serotonin is reported. Alteration in the serotonin level also disrupts the hypothalamus-pituitary axis and finally results in alteration in the concentration of thyroid hormone in the body. Moreover serotonin is directly associated with mode swing, depression, anxiety.So alteration in level of serotonin will cause the psychological and emotional alteration in a thyroid disorder patient (Ittermann et al.,2015).

Response to question 3.

Endocrine disorders like thyroid disease is associated with the onset of anxiety and depression in patients. It becomes very important to increase awareness about the psychological aspects of these diseases. Lack in maintaining good quality of life is another reason for developing such kind of problem. Patients are facing difficulties in combatting against such diseases and that is why the rehabilitation process becomes so important in endocrine diseases like thyroid disorders. Rehabilitation process in thyroid disorder is mainly done to attain the best psychological condition, mental stability, social and as well as physical condition. However sometimes hormonal therapy itself fail to recover the hormonal balance in the body and along with this depression and anxiety is also stayed in the body. To combat with this situation, rehabilitation therapy is essential part in medication process of a thyroid disorder patient. As rehabilitation helps to reduce anxiety and depression, it will provide additional support to the pharmacological medication to the medication procedure (Li et al., 2013).Multidisciplinary team can be very important in treatment of a thyroid disorder patient. In a multidisciplinary team, there can be an endocrinologist, histopathologist, oncologist, radiologist, thyroid surgeon and a clinical nurse specialist who is experienced in treating thyroid patients. According to the severity of the disease, the patient can be referred to the histologist for checking the conditions of tissues of thyroid gland. The patient can also be referred to the oncologist to examine whether there is any carcinogenic symptoms or not. However, if the endocrinologist thinks that, surgery is needed then the patient can be referred to the thyroid surgeon (Perros et al., 2014). The communal information of thyroid community is very important in preparing a health teaching paln.However if People with disease joins a community of people with same disease they will no feel alone and this will help in reducing their level of depression and anxiety. From the community the patient can also know about the proper medication strategies (Beck-Peccoz et al., 2013).

References

Beck-Peccoz, P., Lania, A., Beckers, A., Chatterjee, K., & Wemeau, J. L. (2013). 2013 European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. European thyroid journal, 2(2), 76-82.

Fekete, C., & Lechan, R. M. (2013). Central regulation of hypothalamic-pituitary-thyroid axis under physiological and pathophysiological conditions. Endocrine reviews, 35(2), 159-194.

Fliers, E., Bianco, A. C., Langouche, L., & Boelen, A. (2015). Thyroid function in critically ill patients. The Lancet Diabetes & Endocrinology, 3(10), 816-825.

Goel, A., Shivaprasad, C., Kolly, A., Pulikkal, A. A., Boppana, R., & Dwarakanath, C. S. (2017). Frequent Occurrence of Faulty Practices, Misconceptions and Lack of Knowledge among Hypothyroid Patients. Journal of clinical and diagnostic research: JCDR, 11(7), OC15.

Ittermann, T., Völzke, H., Baumeister, S. E., Appel, K., & Grabe, H. J. (2015). Diagnosed thyroid disorders are associated with depression and anxiety. Social psychiatry and psychiatric epidemiology, 50(9), 1417-1425.

Li, S. X., Yan, S. Y., Bao, Y. P., Lian, Z., Qu, Z., Wu, Y. P., & Liu, Z. M. (2013). Depression and alterations in hypothalamic–pituitary–adrenal and hypothalamic–pituitary–thyroid axis function in male abstinent methamphetamine abusers. Human Psychopharmacology: Clinical and Experimental, 28(5), 477-483.

Mullur, R., Liu, Y. Y., & Brent, G. A. (2014). Thyroid hormone regulation of metabolism. Physiological reviews, 94(2), 355-382.

Perros, P., Boelaert, K., Colley, S., Evans, C., Evans, R. M., Gerrard BA, G., … & Moss, L. (2014). Guidelines for the management of thyroid cancer. Clinical endocrinology, 81, 1-122.

Vissenberg, R., Manders, V. D., Mastenbroek, S., Fliers, E., Afink, G. B., Ris-Stalpers, C., … & Bisschop, P. H. (2015). Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Human reproduction update, 21(3), 378-387.