Graves, Robert James
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Graves, Robert James(grāvz)
Other findings include palpitations, nervousness, heat intolerance, sweating, frequent defecation, insomnia, menstrual irregularities, tremor, and weight loss despite increased appetite.
The clinical signs and symptoms (goiter, proptosis) in the setting of elevated thyroxine levels and a suppressed thyroid-stimulating hormone are diagnostic.
Drugs that limit the thyroid gland's output of thyroid hormone are effective. The thyroid gland may be removed surgically, or it may be inactivated with radioactive iodine (131I) therapy. Beta-adrenergic blockers are prescribed to manage tachycardia and peripheral effects of excessive sympathetic nervous system activity.
The patient is helped to cope with related anxiety and is encouraged to minimize emotional and physical stress and to balance rest and activity periods. A quiet environment is provided or encouraged. A high-calorie, high-protein diet of six meals a day is recommended to treat increased protein catabolism. Body weight and vital signs are monitored, along with serum electrolyte and glucose levels. The patient is taught comfort measures to deal with elevated body temperature and GI complaints (abdominal cramping, frequent bowel movements); safety measures to protect the eyes from injury, including moistening the conjunctiva frequently with isotonic eye drops and wearing sunglasses to protect the eyes from light; and appropriate administration and safety procedures for iodide therapy, beta-blocker therapy, and propylthiouracil and methimazole therapy, as prescribed. If the patient is being maintained on propylthiouracil or methimazole, potential side effects of the medications are reviewed with the patient, including the importance of having blood counts done periodically to detect blood dyscrasias. Special instructions are provided for therapeutic use of radioactive iodide (pretherapy and posttherapy medication restrictions; care with and disposal of expectorated saliva and of urine that remain slightly radioactive for 24 hr, vomitus for 6 to 8 hr; need to drink fluids in large quantities for 48 hrs after therapy; and, if discharged less than 7 days after therapy, avoiding close contact with children and sleeping in the same room with others until 7 days after therapy).
The patient is prepared physically and psychologically for surgery if planned; postoperative care specific to thyroidectomy is provided. Regular medical follow-up is needed to detect and treat hypothyroidism, which may develop 2 to 4 weeks after surgery and after radioactive iodine therapy. The patient is advised of the possible need for lifelong thyroid hormone replacement therapy and should wear or carry a medical identification tag and keep a supply of medication with him or her at all times.
The underlying hyperthyroidism must be treated. The patient should sleep with the head of the bed elevated. Methylcellulose eyedrops and diuretics will help to relieve eye discomfort. If the condition is severe and progressive, surgical decompression of the orbit will be required to treat impaired retinal function and exposure keratopathy.