NR 503 Week 6 Assignment-Epidemiological Analysis-Chronic Health Problem

For this paper, I will discuss a chronic health disease called Hashimoto’s thyroiditis. I will define, describe, describe signs and symptoms, and describe disease statistics. I will provide current surveillance methods and mandated reporting processes related to the disease. I will conduct a descriptive epidemiology analysis of the health condition, including what, who, where, when, and why. I will explain how the disease is diagnosed and current national guidelines. I will review a screening test’s sensitivity, specificity, predictive value, and cost. I will provide a plan of how a nurse practitioner will address this chronic health condition and give three specific interventions.

Background and Significance

 Hashimoto’s thyroiditis is also known as chronic lymphocytic or chronic autoimmune thyroiditis. It is an autoimmune disorder where cell and antibody-mediated immune processes destroy the thyroid cells (Mincer and Jialal, 2021). The thyroid is found in the lower front of the neck and is responsible for making thyroid hormones (American Thyroid Association, 2022). The hormones produced are excreted in the blood and carried to other tissues. (American Thyroid Association, 2022). In Hashimoto’s thyroiditis, antithyroid antibodies begin to attack the thyroid tissue and lead to fibrosis (Mincer and Jialal, 2021). This leads to a decrease in the hormone production and leads to hypothyroidism. Laboratory results will show an elevated thyroid-stimulating hormone (TSH) with normal to low free thyroxine (fT4) levels (Mincer and Jialal, 2021). In the early course of the disease, the patient may have signs, symptoms, and laboratory findings of hyperthyroidism or normal values due to the irregular destruction of the thyroid gland cells (Mincer and Jialal, 2021). Signs and symptoms of the disease may vary depending on the person. Common symptoms include goiters, tiredness, brittle nails, puffy face, joint pain, problems with memory or concentration, muscle weakness, weight gain, sensitivity to temperatures, depression, hair/skin changes, rapid heart rate, weight loss, tremors, anxiety (John Hopkins Medicine, 2022).

Hashimoto’s thyroiditis is estimated to have an incidence rate of 1.3% based on 5,000 children aged 11-18 years (Lee, 2022). According to Mincer and Jialal (2021), the incidence rate is estimated at 0.8 per 1000 per year in men and 3.5 per 1000 per year in women. Table 1 reflects these rates. In the Appalachian region, the incident rate of Hashimoto’s thyroiditis can be as high as 65 (Lee, 2022). The Colorado Thyroid Disease Prevalence Study included 25 862 adults (Lee, 2022). Of those adults, there was a 9.5% prevalence of elevated TSH in symptomatic and asymptomatic adults, with the higher percentage being women (Lee, 2022).

Table 1	Incidence rate
Female	3.5 per 1,000
Male	0.8 per 1,000
Age 11-18	1.3 per 5,000

Surveillance and Reporting

 There is evidence to support annual surveillance. Initially, patients started on oral medications should be seen by their practitioner for 6-8 weeks (Lee, 2022). This visit will need to include laboratory studies to monitor the TSH level in the body (Lee, 2022). Patients receiving treatment without dosage adjustment for hypothyroidism should receive annual laboratory thyroid function testing (Mincer and Jialal, 2021). Hashimoto’s thyroiditis is a life-long disorder with no cure (Mincer and Jialal 2021). It can impact other laboratory studies. There is a need for evaluation of symptoms as well as laboratory studies to monitor for things such as anemia (Lee, 2022). There is no mandated reporting for Hashimoto’s thyroiditis.

Epidemiological Analysis

In the United States, Hashimoto’s thyroiditis is the most common cause of hypothyroidism (American Thyroid Association, 2022). There is a 10:1 ratio for female-to-male (Mincer and Jialal, 2021). Most diagnoses are between the ages of 30 and 50 (Mincer and Jialal, 2021). The peak age for men is approximately 10-15 years later than for women (Lee, 2022). Women are estimated to be 10-15 times more likely to develop Hashimoto thyroiditis than men (Lee, 2022). At the same time, no gene that carries Hashimoto’s thyroiditis has been found, but it does tend to run in families (John Hopkins Medicine, 2022). It is the most common cause of hypothyroidism in the United States (Mincer and Jialal, 2021).

An increased incidence of autoimmune thyroiditis was noted in a twin study when comparing monozygotic to dizygotic twins. Autoimmune thyroiditis was seen in 55% of monozygotic twins compared to 3% in dizygotic twins (Mincer and Jialal, 2021). Based on this information, Mincer and Jialal (2021) concluded that 79% of predisposition is due to genetic factors and 21% to environmental and sex hormone factors. A person with an autoimmune disease such as rheumatoid arthritis, lupus, or type 1 diabetes is at a higher risk for Hashimoto’s thyroiditis (John Hopkins Medicine, 2022). Pregnancy can increase the risk for Hashimoto’s thyroiditis due to changes in the immune system during pregnancy (Mayo Clinic, 2022).

Medications for treating bipolar disorder or other mental health disorders have been linked to Hashimoto’s thyroiditis (National Institute of Diabetes and Digestive and Kidney Diseases, 2022).

Many factors influence the development of Hashimoto’s thyroiditis. There is a correlation between environmental factors such as infection, stress, or radiation exposure (Mayo Clinic, 2022). Overusing iodine in the diet has increased the risk of Hashimoto’s thyroiditis (Mayo Clinic, 2022). Excess radiation exposure has been linked to Hashimoto’s thyroiditis (Mayo Clinic, 2022). Bacterial infections, specifically gastrointestinal, are related to developing Hashimoto’s thyroiditis (Lee, 2022).

Screening and Guidelines

Diagnosis of Hashimoto’s thyroiditis depends on the patient’s signs and symptoms and laboratory results. For diagnostic purposes, a suspected patient may have laboratory studies for TSH, Free T4, T3 levels, and thyroid antibodies (thyroid peroxidase). Serum thyroid-stimulating hormone levels (TSH) show thyroid function and are invariably raised in hypothyroidism due to Hashimoto thyroiditis (Lee, 2022). Free T4 levels are necessary to interpret the TSH level correctly in most cases (Lee, 2022). A low free T4 with an elevated TSH level can confirm the diagnosis of hypothyroidism (Lee, 2022). Levels of T3 and thyroid antibodies are helpful but not necessary for confirming a diagnosis of Hashimoto thyroiditis. 10-15% of patients may have a negative antibody test and still have Hashimoto thyroiditis (Lee, 2022). There may be times when a thyroid ultrasound is ordered. This non-invasive, painless procedure for thyroid enlargement could be related to Hashimoto’s thyroiditis (Lee, 2022).

One screening tool for Hashimoto’s thyroiditis is the thyroid-secreting hormone level (TSH). Levels below 0.1mU/L are low and elevated over 6.5 mU/L (U.S. Preventive Services Task Force, 2004). The high sensitivity of TSH is 98%, and the specificity is 92% (U.S. Preventive Services Task Force, 2004). The positive predictive value of TSH is low in detecting thyroid disease when screening primary care populations and is more often complicated by underlying illness (U.S. Preventive Services Task Force, 2004). Yoo and Chung (2021) report a 95% confidence interval for the healthy population. While it is the ‘gold standard” for thyroid disease, TSH can have false-positive results, as the positive predictive value of a low TSH was 0.24 for hyperthyroidism and 0.06 for hypothyroidism (U.S. Preventive Services Task Force, 2004). The average cost for the TSH level is $25-$58.

NR 503 Week 6 Assignment-Epidemiological Analysis-Chronic Health Problem

Plan

The nurse practitioner will have to address this chronic health condition. The three interventions I have selected are educating on decreasing the risk of developing the disease, conducting routine screening for those at risk, and initiating medication management for individuals diagnosed with Hashimoto’s thyroiditis. You will want to do a full history and physical on your patient. It is important to remember that other autoimmune disorders, such as rheumatoid arthritis, type 1 diabetes, or lupus, can increase the risk for the patient (Mayo Clinic, 2022). Palpation of the thyroid will be included in the examination, and the patient will be asked if they have trouble swallowing or breathing, which could indicate that the thyroid is swollen (Mayo Clinic, 2022). Since hypothyroidism can cause a slow heart rate, it will be important to note the patient’s heart rate and do a cardiac assessment. Screening for depression can help in the diagnosis, but it is also important to remember that depression alone does not give a diagnosis of a thyroid disorder. If the patient is already taking certain psychiatric medications, please remember that these medications can put the patient at risk for hypothyroidism.

Discussing the patient’s sexual history is also important, as hypothyroidism can cause a decreased libido (Mayo Clinic, 2022).

Intervention one

My first intervention would be to provide education to patients on steps that can be taken to decrease the risk of Hashimoto’s thyroiditis. Education will include environmental and social exposures such as a diet high in iodine, smoking, stress, virus exposure, and radiation exposure. Education to avoid high-iodine diets, medications, and health-related products should occur (Yoo and Chung, 2021). For example, suppose I have a patient who works in the radiology department in a CT scan. In that case, they should be encouraged to protect their body from radiation from the machines as this can lead to a higher incidence of Hashimoto’s thyroiditis (Mayo Clinic, 2022). Educating the patient on how smoking and stress can strain the immune system and increase the risk of Hashimoto’s is important (Lee, 2022). You can measure the effectiveness of the intervention by asking your patient to name three factors that can increase the risk of developing Hashimoto’s thyroiditis.

Intervention two

My second intervention will be conducting routine screening of those at-risk groups. This will focus on middle-aged individuals, especially females, at higher risk (Mayo Clinic, 2022). This intervention will include going through the signs and symptoms of Hashimoto’s thyroiditis to screen patients. Those patients’ multiple signs will require laboratory testing, including TSH, free T4, T3 levels, and thyroid antibodies (Yoo and Chung, 2021). Signs and symptoms of Hashimoto’s thyroiditis include cold intolerance, pressure in the neck, voice hoarseness, decreased energy, depression, memory/concentration difficulty, hair loss, joint pain, menstrual irregularities, sleep apnea, weight gain, slowed heart rate, and constipation (Lee, 2022). A high TSH and low T4 indicate Hashimoto’s thyroiditis (Mincer and Jialal, 2021). This intervention can be measured for effectiveness by conducting chart audits and using the data to determine how many patients have signs and symptoms, received laboratory studies, and were diagnosed with Hashimoto’s thyroiditis.

Intervention three. My third intervention is disease management with medication. Hypothyroidism is treated mainly with levothyroxine sodium (Mincer and Jialal, 2021). While dosages vary per patient, the standard dose is 1.6-1.8 mcg/kg daily (Mincer and Jialal, 2021). It is recommended that patients over 50 years be started on 25 mcg/day (Mincer and Jialal, 2021). Reevaluations should occur between six and eight weeks (Mincer and Jialal, 2021). You will need to conduct repeat laboratory studies and conduct a physical exam. It is important to know that levothyroxine sodium should not be given with iron or calcium supplements, aluminum hydroxide, or proton pump inhibitors due to their interference with medication absorption (Mincer and Jialal, 2021). It is also important to tell the patient that this medication should be taken early in the morning on an empty stomach for optimum absorption (Mincer and Jialal, 2021).

Conclusion

In conclusion, Hashimoto’s thyroiditis is the inflammation of the thyroid tissue. The thyroid is responsible for producing thyroid hormones. Inflammation can lead to damage and impact hormone production. It is seen more often in women than men. It is the most common cause of hypothyroidism in the United States.

Along with signs and symptoms, laboratory results can help diagnose the disease. TSH, free T3, T4, thyroid antibodies, and common laboratory tests. Once a patient has received a diagnosis and is started on medications, reevaluations should occur in 6-8 weeks until the dosage has been therapeutic. It is important to monitor other laboratory results for things such as anemia. My interventions include education on decreasing the risk, identifying signs, forming laboratory studies to determine a diagnosis, and managing medications. Constant reevaluation will be necessary.

References

American Thyroid Association. (2022). Hashimoto’s thyroiditis (lymphocytic thyroiditis). https://www.thyroid.org/hashimotos-thyroiditis/

John Hopkins Medicine. (2022). Hashimoto’s thyroiditis. https://www.hopkinsmedicine.org/health/conditions-and-diseases/hashimotos-thyroiditis

Lee, S. (2022). Hashimoto thyroiditis. Practice Essentials, Background, Etiology. Retrieved from https://emedicine.medscape.com/article/120937-overview#a5

Mayo Clinic. (2022). Hashimoto’s disease. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc20351855#:~:text=Hashimoto%27s%20disease%20is%20the%20most%20common%20cause%20of,your%20thyroid%20function%20to%20help%20detect%20Hashimoto%27s%20disease.

Mincer, D. L. and Jialal, I. (2021). Hashimoto Thyroiditis. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/

National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Hashimoto’s disease. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease#causes

U.S. Preventive Services Task Force. (2004). Screening for thyroid disease: recommendation statement. American Family Physician. 15; 69(10): 2415-2418. https://www.aafp.org/afp/2004/0515/p2415.html

Yoo, W. S., and Chung, H. K. (2021). Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape. Endocrinology and Metabolism, 36(3), 500. https://dx.doi.org/10.3803%2FEnM.2021.1066

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NR 503 Week 6 Assignment-Epidemiological Analysis-Chronic Health Problem

Purpose

The purpose of this assignment is:

1. Integrate knowledge and skills learned throughout the NR503 course
2. Direct application of course objectives utilizing epidemiological analysis of a chronic health problem, along with state and national level

Activity Learning Outcomes

Through this assignment, the student will demonstrate the ability to:

See weekly outcomes from Weeks 1-6.

Requirements:

This paper should clearly and comprehensively discuss a chronic health disease. Select a topic from the list provided by your course faculty.

The paper should be organized into the following sections:

1. Introduction (Identification of the problem) with a clear presentation of the problem and its Significance and a scholarly overview of the paper’s No heading is used for the Introduction per APA current edition.
2. Background and Significance of the disease, to include Definition, description, signs and symptoms, and current incidence and prevalence statistics by state with a comparison to national statistics about the  Create a table of incidence and prevalence rates by your geographic county/city or state with a  comparison to national statistics. Use the APA text for formatting guidelines (tables). This table you create using relevant data should not be a table from another source using copy/paste.
3. Surveillance and Reporting: Current surveillance methods and mandated reporting processes as related to the chronic health condition chosen should be
4. Epidemiological Analysis: Conduct a descriptive epidemiology analysis of the health condition. Be sure to include all 5 W’s: What, Who, Whatever, When, and Why. Use details associated with all W’s, such as the “Who.”

Which should include an analysis of the determinants of health. Include costs (both financial and social) associated with the disease or problem.

5. Screening and Guidelines: Review how the disease is diagnosed and current national standards (guidelines). Pick one screening test (review Week 2 Discussion Board) and review its sensitivity, specificity, predictive value, and
6. Plan: Integrating evidence, provide a plan of how a nurse practitioner will address this chronic health condition after graduation. Provide three specific interventions based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility and are useful?) Note:  Consider primary, secondary, and tertiary interventions and the integration of health policy advocacy efforts. All interventions should be based on evidence – connected to a resource such as a scholarly piece of
7. Summary/Conclusion: Conclude an overview of the key points in each section of the paper utilizing the integration of resources.