Graves’ disease is an autoimmune disease that leads to a generalized overactivity of the entire thyroid gland (hyperthyroidism). It is the most common cause of hyperthyroidism in the United States. It is named after Robert Graves, an Irish physician, who described this form of hyperthyroidism about 150 years ago. It is 7-8 times more common in women than men. Show
WHAT IS THE THYROID GLAND?The thyroid gland is a butterfly-shaped endocrine gland that is located in the lower front of the neck. The thyroid makes thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormones help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working appropriately. WHAT CAUSES GRAVES' DISEASE?Graves’ disease is triggered by a process in the body’s immune system, which normally protects us from foreign invaders such as bacteria and viruses. The immune system destroys foreign invaders with substances called antibodies produced by blood cells known as lymphocytes. Sometimes the immune system can be tricked into making antibodies that cross-react with proteins on our own cells. In many cases these antibodies can cause destruction of those cells. In Graves’ disease these antibodies (called the thyrotropin receptor antibodies (TRAb) or thyroid stimulating immunoglobulins (TSI) do the opposite – they cause the cells to work overtime. The antibodies in Graves’ disease bind to receptors on the surface of thyroid cells and stimulate those cells to overproduce and release thyroid hormones. This results in an overactive thyroid (hyperthyroidism). WHAT ARE THE SYMPTOMS OF GRAVES' DISEASE?
HOW IS THE DIAGNOSIS OF GRAVES' DISEASE MADE?The diagnosis of hyperthyroidism is made on the basis of your symptoms and findings during a physical exam and it is confirmed by laboratory tests that measure the amount of thyroid hormones (thyroxine, or T4, and triiodothyronine, or T3) and thyroid-stimulating hormone (TSH) in your blood (see the Hyperthyroidism brochure). Clues that your hyperthyroidism is caused by Graves’ disease are the presence of Graves’ eye disease and/or dermopathy (see above), a symmetrically enlarged thyroid gland and a history of other family members with thyroid or other autoimmune problems, including type 1 diabetes, rheumatoid arthritis, pernicious anemia (due to lack of vitamin B12) or painless white patches on the skin known as vitiligo. The choice of initial diagnostic testing depends on cost, availability and local expertise. Measurement of antibodies, such as TRAb or TSI, is cost effective and if positive, confirms the diagnosis of Graves’ disease without further testing needed. If this test is negative (which can also occur in some patients with Graves’ disease), or if this test is not available, then your doctor should refer you to have a radioactive iodine uptake test (RAIU) to confirm the diagnosis. Also, in some patients, measurement of thyroidal blood flow with ultrasonography may be useful to establish the diagnosis if the above tests are not readily available. HOW IS GRAVES' DISEASE TREATED?The treatment of hyperthyroidism is described in detail in the Hyperthyroidism brochure. All hyperthyroid patients should be initially treated with beta-blockers. Treatment options to control Graves’ disease hyperthyroidism include antithyroid drugs (generally methimazole [Tapazole®], although propylthiouracil [PTU] may be used in rare instances such as the first trimester of pregnancy), radioactive iodine and surgery. Antithyroid medications are typically preferred in patients who have a high likelihood of remission (women, mild disease, small goiters, negative or low titer of antibodies). These medications do not cure Graves’ hyperthyroidism, but when given in adequate doses are effective in controlling the hyperthyroidism. If methimazole is chosen, it can be continued for 12-18 months and then discontinued if TSH and TRAb levels are normal at that time. If TRAb levels remain elevated, the chances of remission are much lower and prolonging treatment with antithyroid drugs is safe and may increase chances of remission. Long term treatment of hyperthyroidism with antithyroid drugs may be considered in selected cases. If your hyperthyroidism due to Graves’ disease persists after 6 months, then your doctor may recommend definitive treatment with either radioactive iodine or surgery. If surgery (thyroidectomy) is selected as the treatment modality, the surgery should be performed by a skilled surgeon with expertise in thyroid surgery to reduce the risk of complications. Your doctor should discuss each of the treatment options with you including the logistics, benefits and potential side effects, expected speed of recovery and costs. Although each treatment has its advantages and disadvantages, most patients will find one treatment plan that is right for them. Hyperthyroidism due to Graves’ disease is, in general, controllable and safely treated and treatment is almost always successful. WHAT WILL BE THE OUTCOME OF TREATMENT?If you receive definitive treatment for your Graves’ hyperthyroidism (such as radioactive iodine or surgery), you will eventually develop hypothyroidism (underactive thyroid). Even if you are treated with antithyroid drugs alone, hypothyroidism can still occur. Your doctor will check your thyroid function tests frequently to assess thyroid function following treatment. When hypothyroidism occurs, you will need to take a thyroid hormone tablet once a day at the right dose (see Hypothyroidism brochure). OTHER FAMILY MEMBERS AT RISKGraves’ disease is an autoimmune disease and has a genetic predisposition. However, no specific gene has been identified for screening to date. What is the outcome of Graves disease?If left untreated, Graves' disease can lead to heart rhythm disorders, changes in the structure and function of the heart muscles, and the inability of the heart to pump enough blood to the body (heart failure). Thyroid storm.
What is the goal of treatment for a patient with Graves disease?The goals of treatment of Graves' disease are to control symptoms efficiently and restore euthyroidism. Antithyroid drugs, radioiodine and surgery all effectively restore euthyroidism but have potentially serious side effects.
Which nursing intervention would be included in the plan of care for a patient with a diagnosis of hypothyroidism?Nursing interventions for a patient with hypothyroidism include the following: Promote rest. Space activities to promote rest and exercise as tolerated. Protect against coldness.
Which action does the nurse take to provide improved care for a patient with hyperthyroidism?Nursing Management. Monitor vital signs, especially heart rate and blood pressure (both increase in hyperthyroidism). Ask if the patient has chest pain (Due to increased heart work). Listen to the heart for murmurs.. Obtain ECG (atrial arrhythmias may occur in hyperthyroidism). Teach the patient to relax.. |