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INTRODUCTION Toxic goiter, also called exophthalmic goiter, hyperthyroidism, thyrotoxicosis, or Graves' disease, for the Irish physician

Robert James Graves, is caused by an excess of thyroxine secretion. The cause of the excessive secretion is obscure. In some cases it may result from excessive stimulation by the pituitary gland. The symptoms of toxic goiter may include a rapid heartbeat, tremor, increased sweating, increased appetite, weight loss, weakness, and fatigue. Some patients have eye problems, such as staring or protrusion. Toxic goiter is commonly treated with radioactive iodine, which is taken up by the gland and destroys the cells by irradiation. Drugs also can be used to suppress hormone production, or most of the toxic goiter can be removed surgically. Thyroid hormones stimulate the metabolism of cells. They are produced by the thyroid gland. The thyroid gland is located in the lower part of the neck, below the Adam's apple. The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly formed by two wings (lobes) and attached by a middle part (isthmus). The thyroid gland removes iodine from the blood (which comes mostly from a diet of foods such as seafood, bread, and salt) and uses it to produce thyroid hormones. The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3) representing 99.9% and 0.1% of thyroid hormones respectively. The hormone with the most biological activity (for example, the greatest effect on the body) is actually T3. Once released from the thyroid gland into the blood, a large amount of T4 is converted to T3 - the more active hormone that affects the metabolism of cells. Diet must include caloric intake to meet the energy expenditure of the hypermetabolism. High iodine-containing substances, such as kelp, should be avoided. Toxic goiter can occur in all ages, but it is rare in children younger than 10 years and unusual in elderly persons. The peak incidence is in third and fourth decades. In late childhood, the incidence rate is 3 per 100,000 in girls and 0.5 per 100,000 in boys. Prevalence studies show a rate of 2.7% in women and 0.23% in men.

Our group chose Mrs. X as our patient who has Toxic Goiter because we want to recognize the pathophysiology and the course of the disease in general. The group believes that this case will enable us to broaden our knowledge regarding this unfamiliar case and be able to provide each member sufficient data regarding Toxic Goiter, its signs and symptoms and treatment process; this will also enable us to familiarize our selves with the different nursing interventions related to this disease in order to enhance our skills as future nurses. This case study will serve as a learning experience for us and our patient because this will help us to further understand how the disease works and the different nursing interventions that we can apply. The importance of this study is to develop nursing actions that will surely give us a background which will help us in the future; this will also lead us to a broader understanding of the case that will enhance our knowledge further.

Objective; General: This study done by group 3 of BSN 2b aims to present to all the details about toxic goiter or hyperthyroidism, its causative factors, its damage to the human physiology, and its underlying complications if left untreated. This can be achieved through research, with the use of the patients hospital records, article references and other materials, and through interviewing the patient during hospitalization, also to formulate a complete and comprehensive definition of the diagnosis. This study also aims to understand the medical principles that accompany toxic goiter. With this, we hope this will lead to insights to appropriate nursing care and management that a patient with the same such ailments will need in the future. Specific: Establish a good interpersonal therapeutic relationship with the patient as well as her family and significant others. Formulate an introduction related t the condition being studied, which includes implication to nursing practice, research and education

Obtain patients data of the patients physical condition as well as her overall body system functioning. Assess patients background, such a medical history and family structure as well as its function that could have affected the patients current health status Assess the condition of the client through physical examination using caphalocaudal approach. Discuss the human anatomy and physiology of the systems involves in the disease process of our client. Trace the pathophysiology of the disease from the possible cause. Identify the symptoms, predisposing factors that contribute to the present illness of the client. Determine various laboratory and diagnostic examination use in relation to the disease with its corresponding nursing intervention. Research the medications administered to the patient, Identify the different medical and nursing management that was carried out to the patient. Make appropriate nursing care plans for the patient. Health teachings that must be given to the patient Determine clients prognosis on the disease Present all the reference used in the case study.

Medication The patient orally takes medications such as ferrous sulfate for blood loss, which patient responded para sa dugo, padugang sa dugo, and Ascorbic Acid which its a supplement, and was being taken for cough and cold as stated by the patient. Ferrous sulfate and ascorbic acid were being taken for only once a day. The PHO or Public health officer is the healthcare provider of the patient.