Author: Kathleen Pace Murphy, PhD, MS, GNP-BC

Key Points

Hypothyroidism is a deficiency of thyroid hormones.

Approximately 9.6 million Americans have hypothyroidism (Carroll, 2009).

Hypothyroidism is more common in women than in men (Carroll, 2009).



Hypothyroidism is common in older adults and increases with age. Hypothyroidism often presents subtle,, non-specific symptoms. (The American Thyroid Association, 2012).

There are four types of hypothyroidism:



Contributing factors to hypothyroidism may be:

During your review of the system, ask the patient if they are experiencing:
During physical exam, pay particular attention to the following: 
General: Weight gain and bradycardia
HEENT: Dull expression, swollen face, periorbital edema, decreased auditory acuity, swollen tongue, hoarseness, enlarged thyroid gland (goiter), glandular atrophy and thyroid nodules.
CV: Bradycardia, LV hypertrophy, mild hypotension or diastolic hypertension, decreased heart sounds.
Respiratory: Bradypnea, diminished vital capacity and total lung capacity, dyspnea
Abdominal: Hypoactive bowel sounds and abdominal bloating
MSK: Swollen hands, swollen feet and leg edema
NEURO: Dementia, paranoid ideation, slow delayed reflexes and cerebellar ataxia
PSYCHE: Depression
SKIN: Dry skin, pale, course dry hair, brittle nails, hair loss, and temporal thinning of eyebrows


Differential diagnosis for hypothyroidism includes:
Diagnostic tests to order if you suspect hypothyroidism include:





Agency for Healthcare Research and Quality (2010). Thyroid function tests: Diagnoses and monitoring of thyroid function disorders in adults. Retrieved from:

http://www.guideline.gov/content.aspx?id=38907&search=hypothyroidism Last accessed November 1, 2013. Carroll, P. (2009). Hypothyroid disease. Evidence –based nursing monographs. Retrieved from http://www.nursingconsult.com/das/news/body/206944645-2/ebnm/0/214405/1.htm Last accessed June 23, 2010.

DeLong, M.F. (2012). Thyroid dysfunction. CME Resource. Retrieved from www.NetCE.com June 23, 2010.

The American Thyroid Association. (2012). Thyroid Disease in the Older Patient. Retrieved from http://www.thyroid.org/patients/patient_brochures/older_patient.html. Last accessed November 1, 2013.