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secondPPTTSH.pptxThyroid-Stimulating Hormone
Importance of TSH
To evaluate thyroid gland function related to the primary cause of hypothyroidism and assess for congenital disorders, tumor, cancer, and inflammation
Normal/Abnormal Results
Elevated TSH levels combined with decreased thyroxine (T4) levels indicate hypothyroidism and thyroid gland dysfunction.
Decreased TSH and T4 levels indicate secondary congenital hypothyroidism and pituitary hypothalamic dysfunction.
Normal TSH level and a depressed T4 level may indicate
Hypothyroidism owing to a congenital defect in T4-binding globulin
Transient congenital hypothyroidism owing to hypoxia or prematurity.
Increased TSH
A decrease in thyroid hormone levels activates the feedback loop to increase production of TSH
Congenital hypothyroidism in the neonate
Ectopic TSH-producing tumors (lung, breast)
Primary hypothyroidism (related to a dysfunctional thyroid gland)
Secondary hyperthyroidism owing to pituitary hyperactivity
Thyroid hormone resistance
Decreased TSH
An increase in thyroid hormone levels activates the feedback loop to decrease production of TSH
Excessive thyroid hormone replacement
Graves disease
Primary hyperthyroidism
Secondary hypothyroidism (related to pituitary involvement that decreases production of TSH)
Tertiary hypothyroidism (related to hypothalamic involvement that decreases production of TRH)
Factors that Affect Results
Failure to let the filter paper sample dry may affect neonatal screening test results
Drugs and hormones that may increase TSH levels include amiodarone, benserazide, erythrosine, flunarizine (males), iobenzamic acid, iodides, lithium, methimazole, metoclopramide, morphine, propranolol, radiographic agents, TRH, and valproic acid.
Drugs and hormones that may decrease TSH levels include acetylsalicylic acid, amiodarone, anabolic steroids, carbamazepine, corticosteroids, glucocorticoids, hydrocortisone, interferon-alfa-2b, iodamide, levodopa (in hypothyroidism), levothyroxine, methergoline, nifedipine, T4, and triiodothyronine (T3)
Patient Care/teaching
Before the procedure is performed, plan to review the steps with the patient
Address concerns about pain, and explain that there may be some discomfort during the venipuncture.
Patient education is key to obtaining the patient’s cooperation in following directions, and providing an explanation for the purpose of the procedure is an important part of this process
Inform the patient that this study can assist in evaluating thyroid function
Perform the venipuncture
Recognize anxiety related to test results and answer any questions or address any concerns voiced by the patient or family.
Pertinent Nursing Diagnoses
Anxiety r/t increased stimulation, loss of control
Diarrhea r/t increased gastric motility
Constipation r/t decreased gastric motility
Insomnia r/t anxiety, excessive sympathetic discharge
Imbalanced nutrition: less than body requirements r/t increased metabolic rate, increased gastrointestinal activity
Risk for injury: eye damage: risk factor: protruding eyes w/o sufficient lubrication
Risk for overweight: risk factor: decreased metabolic process
Activity intolerance r/t muscular stiffness, SOB on exertion
Impaired skin integrity r/t edema, dry or scaly skin
Impaired gas exchange r/t respiratory depression
Follow-up Tests That May Be Required
Related tests may include adrenocorticotropin hormone, albumin, antibodies antithyroglobulin, biopsy thyroid, copper, follicle-stimulating hormone, growth hormone, luteinizing hormone, newborn screening, PTH, protein total, RAIU, thyroglobulin, TSI, TBII, thyroid scan, T4, free T4, T3, free T3, and US thyroid
