Assignment: Hypothyroidism In Older Adult Populations Essay

Assignment: Hypothyroidism In Older Adult Populations Essay

Assignment  Hypothyroidism In Older Adult Populations Essay

 

Demographics

Hypothyroidism is characterized by increased levels of thyroid-stimulating hormone (TSH) and decreased circulating thyroid hormones tri-iodothyronine (T3) and thyroxine (T4). TSH levels naturally increase with aging with over 97% of patients above 80 years having a TSH range of between 6.3-7.5 mIU/L while the reference range is between 0.27-4.20mIU/L (Calsolaro et al., 2018). It is more dominant in the elderly population, with 2-30% of older adults having some degree of hypothyroidism. In the United States, the condition’s prevalence in women above 60 years of age is at a rate of 5.9% and in men is 2.4% (Calsolaro et al., 2018). According to the American Thyroid Association, females are five to eight times more likely to have thyroid dysfunctions than males. Besides, one in eight women will have a thyroid condition in her lifetime (Hennessey & Espaillat, 2015).

Pathophysiology

The hypothalamic-pituitary-thyroid axis governs the secretion of thyroid hormones and dysfunction in one of the organs causes reduced T3 and T4 production. Under normal physiologic processes, the thyroid gland secretes a daily amount of 100-125 nmol of T4 as well as negligible small levels of T3. T4 is converted to T3, which is the active thyroid hormone (Hennessey & Espaillat, 2015). Moreover, the prevalent cause of hypothyroidism among the elderly population is chronic autoimmune thyroiditis, commonly referred to as Hashimoto thyroiditis, which results from the immune system attacking the thyroid gland (Razvi, 2019). Other causes include medications such as lithium, atrophy of the thyroid gland due to aging, iodine deficiency, surgical and medical procedures on the neck region. Also, aging is characterized by a decreased iodine absorption and a reduced sensitivity of thyroid gland to TSH, resulting in a reduced thyroid hormone production.

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Clinical Manifestations

The symptoms of hypothyroidism include: fatigue, muscle pain, weakness in the extremities, joint pain, loss of appetite, hair

loss, blurred vision, decreased hearing, constipation, depression and mental confusion (Hennessey & Espaillat, 2015). The clinical presentations of hypothyroidism are mostly atypical in the elderly population, and they may have few or none of the symptoms until the condition becomes severe (Razvi, 2019). Furthermore, the symptoms may be mistaken for the aging process or other medical conditions. The major early symptoms in the elderly are depression, apathy, significant weight loss, and a fourth of the patients with the condition experience constipation.

Morbidity and Mortality

Hypothyroidism has various systemic effects since thyroid hormones play a role in the process of oxygen consumption, production of heat, synthesis, and absorption of glucose in the body. Low levels of circulating thyroid hormones result in decreased heart contractility, cardiomegaly, pericardial effusion, and reduced cardiac output  (Hennessey & Espaillat, 2015). The effects on the cardiovascular system result in heart failure, renal failure, and hypotension. Failure to appropriately treat hypothyroidism in geriatric patients can lead to coma and death. Thus, hypothyroidism is associated with increased risks of cardiac mortality.

Evaluation and Management

The goal of medical management in hypothyroidism is to correct the metabolic state and lower morbidity by supplementing or through thyroid hormone replacement (TRH). Generally, the condition is managed with a daily administration of levothyroxine (LT4), and the achievement of a normal TSH level can take months as the hypothalamic-pituitary axis readapts (Ruggeri, Trimarchi & Biondi, 2017). An elderly patient should first be evaluated for the body mass index, etiology, and severity of the condition and the presence of cardiac disease.  In geriatric patients, TRH should be initiated with low dosages of LT4 12.5-25 mcg PO qid and the dose should be gradually increased after 4-6 weeks to avoid neurological and cardiovascular side effects (Ruggeri, Trimarchi & Biondi, 2017). For instance, elderly patients with a known coronary artery disease may experience angina if initiated with the normal dosage of HRT of 300 mcg/day, and it may result in heart failure and arrhythmias. Furthermore, after the dose has been stabilized, the patients should be evaluated for signs of overtreatment such as palpitations, nervousness, atrial fibrillation, tachycardia, tremors, insomnia, and angina.

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Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource