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Case study: Graves’ disease, post- thyroidectomy

By: Taima Ayasrah

Health Assessment Skill

School of Nursing- the University of Jordan

Prof. Amani Khalil, PhD

November, 2022
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Introduction and Background

Definition

Graves' disease is an autoimmune disorder that primarily affects the thyroid

gland, leading to hyperthyroidism. Named after Sir Robert Graves, who first described

the condition in the 19th century, this disease results from the immune system mistakenly

attacking the thyroid gland, causing it to produce excessive amounts of thyroid hormones.

The primary culprit in Graves' disease is the presence of autoantibodies, specifically

thyroid-stimulating immunoglobulins (TSIs), which mimic the action of thyroid-

stimulating hormone (TSH) (Davies et al., 2020).

Statistical Concerns

The prevalence of Graves' disease varies globally, with estimates suggesting that

it affects approximately 0.5% of the population. Women are more commonly affected

than men, and the onset often occurs between the ages of 30 and 50. The condition can

lead to significant morbidity if left untreated, with potential complications such as

cardiovascular issues, osteoporosis, and thyroid storm, a life-threatening exacerbation of

hyperthyroidism (Chin et al., 2020). As of the most recent statistics available, the

incidence and prevalence of Graves' disease have been on the rise, emphasizing the need

for increased awareness, early detection, and effective management strategies (Wémeau

et al., 2018).

Rationale for being Important for Nursing

Graves' disease presents a significant case of importance to nursing for several

reason including that managing Graves' disease involves a multidisciplinary approach,

and nurses play a crucial role in the ongoing care of affected individuals. Given the
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complexity of the disease, nurses must possess a comprehensive understanding of thyroid

function, autoimmune disorders, and the pharmacological interventions commonly

employed in its treatment. Indeed, nurses are often at the forefront of patient education.

Individuals with Graves' disease require comprehensive information about their

condition, treatment options, potential side effects, and the importance of adherence to

medications. Nurses play a pivotal role in empowering patients to actively participate in

their care and make informed decisions. Based on the best understanding of their disease.

Furthermore, nurses are responsible for closely monitoring patients with Graves'

disease for signs of complications, such as cardiac issues, and managing symptoms

related to hyperthyroidism. This includes addressing anxiety, weight loss, heat

intolerance, and other symptoms that significantly impact a patient's quality of life.

Case details

Laboratory data/diagnostic tests

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Disease related risk factors, health promotion

The patient has been to take a well-balanced diet, including sufficient iodine and

selenium, is essential for patients with thyroidectomy. Nutrition education can help

individuals make informed choices about their diet. My patient is a heavy smoker and

was encouraged to avoid smoking as smoking has been associated with an increased risk

of Graves' disease. Indeed, health promotion campaigns may include information on the

benefits of smoking cessation (Yoshiuch et al., 1998). Further, the patient has received

Education on stress reduction techniques which can be beneficial, as chronic stress is

considered a potential risk factor for Graves' disease (Yoshiuch et al., 1998)..

Treatment Approaches

The patient was undergone a total thyroidectomy (surgical removal of the thyroid

gland) as there was a doctor’s concern about malignancy. Post-surgery, the patient

discharged on beta-blockers (Perpanolol 10 mg x 4) to manage symptoms of rapid heart

rate, tremors, and anxiety. Other medications

She was also advised to have regular follow-up appointments with healthcare

providers for effective management.

Analysis & Discussion for Clinical Case

Graves' disease is an autoimmune disorder where the immune system mistakenly

attacks the thyroid gland, leading to excessive production of thyroid hormones. Common

symptoms include weight loss, rapid heart rate, tremors, heat intolerance, and anxiety.

The patient was presented with Graves' ophthalmopathy including eye-related symptoms
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of bulging eyes and vision changes. Among her, the presence of thyroid-stimulating

immunoglobulins (TSIs) indicated a Graves' disease. The patient was undergone a total

thyroidectomy (surgical removal of the thyroid gland) as there was a doctor’s concern

about malignancy. Patient undergoing a thyroidectomy need to be prepared for the

procedure by providing preoperative and postoperative care including detailed

instructions for the required lifestyle modification and adhering for through life hormonal

replacement therapy with thyroxin 100 mg x1, and regularly monitor the adjust treatment

as necessary. Also, she received education about potential complications, such as

cardiovascular issues and osteoporosis. She has been encouraged to perform self-

monitoring of symptoms and prompt reporting of any changes.

Recent literature have emphasized the importance addressing patient fears and

pre-morbid psychological conditions such as anxiety and fear, increasing patient

knowledge of the disease that results in better insight into the condition, reduces

anxiety, and increases compliance with treatment, evaluating quality of life through using

generic and disease-specific measurement tools. Also, Patient care may benefit from

counseling, support groups, a regular port of call to a nurse specialist, and even disease-

specific psychiatric care when necessary (Lindo et al., 2023).

Conclusion

Graves' disease is crucial in nursing due to its complexity, requiring a

multidisciplinary approach. Nurses play a vital role in ongoing care, necessitating a deep

understanding of thyroid function, autoimmune disorders, and relevant pharmacological

interventions. They are key in patient education, providing comprehensive information

about the condition and treatment. Additionally, nurses monitor for complications and
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manage symptoms, addressing issues like anxiety and weight loss that impact patients'

quality of life.
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References

Chin, Y. H., Ng, C. H., Lee, M. H., Koh, J. W. H., Kiew, J., Yang, S. P., ... &

Khoo, C. M. (2020). Prevalence of thyroid eye disease in Graves’ disease: A meta‐

analysis and systematic review. Clinical endocrinology, 93(4), 363-374.

Davies, T. F., Andersen, S., Latif, R., Nagayama, Y., Barbesino, G., Brito, M., ...

& Kahaly, G. J. (2020). Graves’ disease. Nature reviews Disease primers, 6(1), 52.

Lindo, A., Breikert, A., Lakwijk, P., Lundberg, C., Lunner, K., Johansson, B., &

Nyström, H. F. (2023). Patient needs and care: moves toward person-centered care for

Graves' disease in Sweden. European Thyroid Journal, 12(3).

Wémeau, J. L., Klein, M., Sadoul, J. L., Briet, C., & Vélayoudom-Céphise, F. L.

(2018, December). Graves’ disease: introduction, epidemiology, endogenous and

environmental pathogenic factors. In Annales d'endocrinologie (Vol. 79, No. 6, pp. 599-

607). Elsevier Masson.

Yoshiuchi, K., Kumano, H., Nomura, S., Yoshimura, H., Ito, K., Kanaji, Y., ... &

Suematsu, H. (1998). Stressful life events and smoking were associated with Graves'

disease in women, but not in men. Psychosomatic Medicine, 60(2), 182-185.

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