Case Study on Diffuse Toxic Goiter

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 thyroxin secretion. The cause of the excessive secretion is obscure. In some cases it may result from excessive stimulation by the pituitary gland. 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. Regarding morphology, goiters may be classified either as the growth pattern or as the size of the growth: Growth pattern Uninodular (struma uninodosa) - can be either inactive or a toxic nodule Multinodular (struma nodosa) - can likewise be inactive or toxic, the latter called toxic Diffuse (struma diffuse), with the whole thyroid appearing to be enlarged. Size Class I - palpation struma - in normal posture of the head, it cannot be seen; it is only found by palpation. Class II - the struma is palpative and can be easily seen. Class III - the struma is very large and is retrosternal; pressure results in compression marks.

*The disease is named for Robert Graves who in 1835 first identified the association of goiter, palpitations, and exophthalmos.*

Nursing Management Monitor for S&S of thyrotoxicosis Provide calm, cool environment Protein and calorie diet Teach S&S of hypothyroidism, which may occur with treatment Give eye care (drops, patches) prn Thyrotoxicosis: Hypothermia blanket, oxygen, propranolol, propylthiouracil, iodine. Treatment 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. Radioactive Iodine Therapy. The goal of radioactive iodine therapy is to destroy the overactive thyroid cells. Almost all the iodine that enters and is retained in the body becomes concentrated in the thyroid gland.

Struma nodusa (Grad II)

Struma Grad III