Lecture Notes: Graves Disease

Overview

• Presenter: Sah, Register Nurse RN
• Part of an NCLEX review series on the endocrine system, focusing on the thyroid.
• Previous videos covered hypo and hyperthyroidism.
• This session covers Graves Disease: causes, signs and symptoms, and nursing interventions.
• Quiz available on registernurse.com to test knowledge on Graves Disease.

Definition

• Graves Disease is an autoimmune condition causing hyperthyroidism.
• Characterized by excessive production of thyroid hormone.

Basics of the Thyroid Gland

• Located near the trachea, below the Adam's apple.
• Butterfly-shaped and produces thyroid hormones T3 and T4.
• Works with the hypothalamus and anterior pituitary gland in a negative feedback loop.
• Hypothalamus releases Thyrotropin-Releasing Hormone (TRH).
• Anterior pituitary releases Thyroid Stimulating Hormone (TSH).

Pathophysiology of Graves Disease

• Body produces Thyroid Stimulating Immunoglobulin (TSI), mimicking TSH.
• Leads to overproduction of T3 and T4.
• Excess T3 and T4 affect metabolism and sympathetic nervous system activity.

Effects of T3 and T4

• Increase calorie burning.
• Affect cell replacement rate, digestion speed.
• Stimulate sympathetic nervous system, increasing alertness and reflexes.
• Raise body temperature, heart rate, and blood pressure.
• Aid in brain development.

Signs and Symptoms

• Common symptoms of hyperthyroidism: weight loss, heat intolerance, increased heart rate, high blood pressure, diarrhea, irritability.
• Unique symptoms for Graves Disease:
  • Protruding eyeballs (exophthalmos).
  • Goiter due to thyroid gland overstimulation.
  • Pretibial myxedema: red, swollen skin on lower legs and feet.

Nursing Interventions

• Monitor vital signs: heart rate, blood pressure, weight.
• Ensure a high-calorie diet.
• Maintain a cool, quiet environment to manage overactive sympathetic nervous system.
• Educate on medications and treatments.

Medications and Treatments

Anti-thyroid Medications

• Methimazole (Tapazole)
  • Preferred due to fewer side effects, except in first trimester of pregnancy.
• Propylthiouracil (PTU)
  • Used in first trimester of pregnancy.
  • Risk of liver failure; monitor liver enzymes.
• Watch for agranulocytosis and thrombocytopenia.
• Patient education: do not stop abruptly, take at same time daily, avoid iodine-rich foods, no aspirin, watch for hypothyroidism signs.

Beta Blockers

• Used to manage tachycardia and high blood pressure.
• Not recommended for patients with asthma or diabetes due to risk of masking hypoglycemia symptoms.

Radioactive Iodine

• Given to destroy thyroid tissue over time.
• Not for pregnant or nursing patients.
• Potential side effects: taste changes, nausea, swollen glands.

Thyroidectomy

• Surgical removal of the thyroid gland.
• Monitor for thyroid storm and hypocalcemia post-surgery.
• Ensure respiratory safety post-surgery due to potential swelling.

Conclusion

• Important to understand the signs, symptoms, and treatment of Graves Disease.
• Additional resources and quizzes available on the website.