A Case of Graves' Disease Occurring after Subacute Thyroiditis / 대한내과학회지

Graves' disease following subacute thyroiditis is uncommon. Some patients in these cases showed positive for thyroid antibody only transiently in the resolving phase. However, Graves' disease can rarely be caused by the presence of antibodies after subacute thyroiditis, although the pathophysiology of this is unclear. A 40-year-old woman presented with anterior neck pain and swallowing difficulty. Thyroid function testing showed reduced thyroid-stimulating hormone (TSH) and elevated free thyroxine levels. A thyroid scan revealed decreased uptake in the bilateral thyroid gland. The patient was initially diagnosed with subacute thyroiditis and treated with steroids. Five months later, thyroid function testing showed recurrent hyperthyroidism with positive conversion of TSH receptor antibody, indicating Graves' disease. Since then, she needed the long-term methimazole treatment. In summary, we herein report a case of Graves' disease occurring after subacute thyroiditis.

Extent of Knowledge on the Disease and Learning Needs of Patients with Systemic Lupus Erythematosus / 기본간호학회지

This study was conducted between October 1, 1998, and December 31, 1998, in order to provide basic data to develop better self-management educational programs for systemic lupus erythematosus (lupus) patients. In the study, the extent of each patients knowledge on the disease and their learning needs about it were examined for 100 lupus inpatients and outpatients at the Kangnam St. Marys Hospital. Data were collected by using questionnaires to those patients. Frequencies, percentage, average, standard deviation, t-test, ANOVA, and Duncans multiple range test were examined through the SAS program. The result of study follows: 1) The average score of patients knowledge on the disease was 15.7 (range, 7-20; standard deviation, 2.74). Subjects scored higher as far as the extent of their knowledge in the following categories : management of daily life, diet, characteristics of the disease, risk factors, and medication. Two categories shared the highest percentage of correct answers: 99% of subjects correctly identified that fatigue and stress aggravate symptoms of lupus and symptoms of lupus vary among individuals in range and type. However, when subjects were asked if patients should get a regular examination by an ophthalmologist every 4-6 months while they are on medication to treat rashes, lupus can be completely cured, and contraceptives that include a female hormone (estrogen) are good as contraceptive methods, the percentages of correct answers were low (32%, 31%, and 20%, respectively). In terms of subjects knowledge about the disease by their general characteristics, single subjects had more knowledge about the disease than married subjects did (t=2.14, p=0.0353). The extent of knowledge also varied by monthly income (F=4.96, p=0.0097). Those with more formal education had more knowledge about lupus than those who had less formation education did (t=2.95, 0.0039). Additionally, those who were satisfied with their education about the disease had better knowledge about it than those who were dissatisfied with their education did (t=2.71, p=0.0090). 2) The extent to which lupus patients wanted to be educated about the disease was, on average, 64.5 (range, 46-75; standard deviation, 7.91). Areas for which patients requested education are listed here in order : risk factors, sexual lives and patients associations. Patients who had been hospitalized demonstrated wanting more education than those who had not been did (t=3.73, p=0.0003). The extent to which they wanted the information was different by the number of educational sessions they had (F=3.98, p=0.0249). In conclusion, the results above would be considered when the education programme is planned for SLE patients.

Emotional State and Compliance with a Medical Regimen of the Patients with Systemic Lupus Erythematosus / 성인간호학회지

This descriptive study was conducted between October 1, and December 31, 1998 in order to provide basic data for understanding the emotional states of patients with systemic lupus erythematosus and their compliance with a medical regimen. Data was collected by using questionnaires administered to 100 lupus inpatients and outpatients at the Kangnam St. Mary's Hospital. Frequencies, percentage, average, standard deviation, t-test, ANOVA, Duncan's multiple range test, Pearson correlation coefficients, and stepwise multiple regression were applied to the data using the SAS program. The results of study are summarized below. The mean compliance score was 91.21. The highest compliance score was found in "risk factor management", followed by "taking medicine", "follow-up care", "daily life management", "stress management", "diet", "activity and rest" in that sequence. The mean depression score was 43.58. 24% for subjects who showed more than mild depression. The compliance score of depressed subjects was significantly lower than that of the subjects without depression. The mean score of anxiety was 44.01. 36% for subjects who had scores lower than 40 points, 37% for those between 41-50 points, and 27% for those with more than 51 points. As for compliance scores according to anxiety levels, the compliance scores for those with anxiety scores of below 40 significantly higher than that of those of the above 51 group. There was a negative correlation between compliance and depression and between compliance and anxiety. In addition, a strong positive relationship was found between depression and anxiety. The major variable affecting compliance was anxiety, accounting for 13.6%. We concluded that when we care for the patients with lupus, we have to consider the outcomes of this study because emotional status affects the lupus patients' compliance. In addition, it is necessary to develop nursing interventions in order to alleviate the lupus patient's depression and anxiety.