DiagnosisTo diagnose Graves' disease, your doctor may conduct a physical exam and check for signs and symptoms of Graves' disease. He or she may also discuss your medical and family history. Your doctor may also order tests including: Show
TreatmentThe treatment goals for Graves' disease are to stop the production of thyroid hormones and to block the effect of the hormones on the body. Some treatments include: Radioactive iodine therapyWith this therapy, you take radioactive iodine (radioiodine) by mouth. Because the thyroid needs iodine to produce hormones, the thyroid takes the radioiodine into the thyroid cells and the radiation destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink, and symptoms lessen gradually, usually over several weeks to several months. Radioiodine therapy may increase your risk of new or worsened symptoms of Graves' ophthalmopathy. This side effect is usually mild and temporary, but the therapy may not be recommended if you already have moderate to severe eye problems. Other side effects may include tenderness in the neck and a temporary increase in thyroid hormones. Radioiodine therapy isn't used for treating pregnant women or women who are breast-feeding. Because this treatment causes thyroid activity to decline, you'll likely need treatment later to supply your body with normal amounts of thyroid hormones. Anti-thyroid medicationsAnti-thyroid medications interfere with the thyroid's use of iodine to produce hormones. These prescription medications include propylthiouracil and methimazole (Tapazole). Because the risk of liver disease is more common with propylthiouracil, methimazole is considered the first choice when doctors prescribe medication. However, propylthiouracil is the preferred anti-thyroid drug during the first trimester of pregnancy, as methimazole has a slight risk of birth defects. Pregnant women will generally go back to taking methimazole after the first trimester. When these two drugs are used alone without other treatments, a relapse of hyperthyroidism may occur at a later time. Taking either drug for longer than a year may result in better long-term results. Anti-thyroid drugs may also be used before or after radioiodine therapy as a supplemental treatment. Side effects of both drugs include rash, joint pain, liver failure or a decrease in disease-fighting white blood cells. Beta blockersThese medications don't inhibit the production of thyroid hormones, but they do block the effect of hormones on the body. They may provide fairly rapid relief of irregular heartbeats, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea, and muscle weakness. Beta blockers include:
Beta blockers aren't often prescribed for people with asthma because the drugs may trigger an asthma attack. These drugs may also complicate management of diabetes. SurgerySurgery to remove all or part of your thyroid (thyroidectomy or subtotal thyroidectomy) also is an option for the treatment of Graves' disease. After the surgery, you'll likely need treatment to supply your body with normal amounts of thyroid hormones. Risks of this surgery include potential damage to the nerve that controls your vocal cords and the tiny glands located adjacent to your thyroid gland (parathyroid glands). Your parathyroid glands produce a hormone that controls the level of calcium in your blood. Complications are rare under the care of a surgeon experienced in thyroid surgery. You'll need to take thyroid medication for life after this surgery. Treating Graves' ophthalmopathyMild symptoms of Graves' ophthalmopathy may be managed by using over-the-counter artificial tears during the day and lubricating gels at night. If your symptoms are more severe, your doctor may recommend:
Graves' ophthalmopathy doesn't always improve with treatment of Graves' disease. Symptoms of Graves' ophthalmopathy may even get worse for three to six months. After that, the signs and symptoms of Graves' ophthalmopathy usually become stable for a year or so and then begin to get better, often on their own. Lifestyle and home remediesIf you have Graves' disease, make your mental and physical well-being a priority:
For Graves' ophthalmopathyThese steps may make your eyes feel better if you have Graves' ophthalmopathy:
For Graves' dermopathyIf the disease affects your skin (Graves' dermopathy), use over-the-counter creams or ointments containing hydrocortisone to relieve swelling and reddening. In addition, using compression wraps on your legs may help. Preparing for your appointmentYou'll probably see your primary care doctor first. You may be referred to a specialist in disorders of hormone function and the endocrine system (endocrinologist). If you have Graves' ophthalmopathy, your doctor may also recommend that you see a doctor who has trained in eye disorders (ophthalmologist). Here's some information to help you get ready for your appointment, and what to expect from your doctor. What you can do
Preparing a list of questions can help you make the most of your time with your doctor. For Graves' disease, some basic questions to ask your doctor include:
What to expect from your doctorYour doctor is likely to ask you a number of questions. Be prepared to answer the following:
When assessing a client with hyperthyroidism the nurse should expect the client to exhibit?Hyperthyroidism may manifest as weight loss despite an increased appetite, palpitation, nervousness, tremors, dyspnea, fatigability, diarrhea or increased GI motility, muscle weakness, heat intolerance, and diaphoresis.
What information is most important for the nurse to include when teaching a patient with hypothyroidism about drug therapy with levothyroxine?Nursing considerations
Teach patients about the many drug interactions with levothyroxine and about the importance of establishing a daily routine to help maintain even hormone levels. Levothyroxine should be taken on an empty stomach with water, at least 1 hour before eating.
Which signs and symptoms should the nurse expect to exhibit from a patient with hypothyroidism?Symptoms and signs of hypothyroidism may include weight gain, sleepiness, dry skin, and constipation, but lack of these symptoms does not rule out the diagnosis. To make this diagnosis in the elderly patient, a doctor often needs a high index of suspicion.
What medication would the nurse anticipate for the treatment of hypothyroidism?Levothyroxine is a thyroid replacement drug used to treat hypothyroidism.
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