Sunday, January 15, 2006

hyperthyroidism (Graves disease, thyrotoxicosis, Basedow's disease, and exophthalmic goiter)

Hyperthyroidism is a common chronic disorder that is caused by an excessive secretion of thyroid hormone. Twenty percent of hyperthyroid patients are over the age of 60. Symptoms of hyperthyroidism include anxiety, insomnia, sweating, tremors, palpitations, tachycardia, heat intolerance, diarrhea, weight loss, muscular weakness, and angina. Some people with hyperthyroidism have exophthalmos (protrusion of the eyeball). There are several types of medical and surgical treatment available for hyperthyroidism. Antithyroid drugs are used to block the production of thyroid hormone. This group is the initial therapy for all severely toxic patients and is preferred therapy for young adults. There is a 20 percent to 25 percent chance of remission after one to two years of treatment. This drug group includes propylthiouracil, methimazole, and radioactive iodine. The effects of these drugs will not be noticed until the excess thyroid hormone in the thyroid gland has been secreted into the blood stream. This will take several weeks. The complications of antithyroid drugs include rash, fever, hepatitis, and agranulocytosis. Radioactive iodine (I-131) may be administered to a patient with hyperthyroidism to destroy the hyperplastic thyroid tissue by radiation. The dose of I-131 is based upon the weight of the person's thyroid gland, age, clinical symptoms, and the emanations from the gland as shown on a geiger counter. The side effects include nausea, vomiting, malaise, and fever. Radioactive iodine was thought to cause cancer; however, it has not been demonstrated in extensive studies. Hypothyroidism may be a possible delayed complication of I-131 treatment. Therefore a person should remain under medical supervision long after this treatment. Radioactive iodine is the preferred definitive therapy for people over 20, those who relapse after surgery, and those who cannot tolerate antithyroid drugs or refuse surgery. Within eight to nine weeks of the first dose of I-131, the person will begin to notice a remission of the symptoms.
Surgery (thyroidectomy) is another choice of treatment. It is the preferred treatment for children or adolescents who cannot tolerate antithyroid drugs or those who relapse after one or two years on antithyroid drugs. The possible side effects of a thyroidectomy include the immediate surgical and anesthetic risks, hypoparathyroidism, voice injury, and permanent hypothyroidism.
Since I-131 treatment is so effective, surgery is usually performed only on malignant thyroid disease, on people under 35, and on pregnant women.
Roger, C. S. and McCue, J. D. Managing Chronic Disease. Oradell, N. J.: Medical Economics Co. Inc .. 1987.
Scherer, J. C. Introductory Medical-Surgical Nursing. Philadelphia: J. B. Lippincott Co., 1982.

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