Diffuse toxic goiter ( Graves ' disease, Graves' disease ) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Endocrine Diseases

diffuse toxic goiter (Graves 'disease, Graves' disease) - a disease characterized by widespread increase in the thyroid gland and its persistent excessive production of hormones that cause the violation of all kinds of metabolism and energy, as well as the functions of the various organs and systems.

most often occurs because of autoimmune processes in the body.Autoimmune diseases develop immunity in lesions, in this case to normal healthy cells of the organism immune system produces specific cells (antibodies) damaging them.In Graves' disease produces abnormal protein, which "forces" the thyroid gland to work more intensively.

Historical information about the opening of the thyroid gland and its hormones

Thyroid zhelezav because of its on-surface position was known to the ancient Egyptians, the frescoes of which, according to E. Rene contain the image of the deity Thoth with signs of goiter and hypothyroidism.The first literary description of the body, has come down to us, it belongs to K. Ga

len.The name given to iron 1656g.T. Warton for the similarities with the shield.It is known that even the medieval Arab physicians knew about the extreme increase in the volume of the thyroid gland - craw - and successfully used radio operators complete or partial removal of the prostate - not later than the XI century (Abul-Qasim).Endocrine glands function at first suspected more TWKing (1836), and has proven - by removal of experimental and organ transplants - P.M.Shiff (1884).

1884.our compatriot N.A.Bubnov first tried to allocate from the gland hormones.

1850.A.Shaten in the middle of the formulated hypothesis about the origin of crop due to lack of iodine in the body.

1895.T.Koher iodine proved effective in the treatment of hypothyroidism.

1895.A.Magnus-Levy began to objectively investigate the thyroid function and proved its role in the metabolism of hormones.

1896.E.Baumanom it has been found that iodine is included in the composition of thyroid hormones in patients with endemic goiter contains little iodine.

1919.E. .Kendall floor chill iodine-containing thyroid hormone in crystalline form and gave him the name of thyroxine.

1926 - 1927.KRHerington with Soave tori established its structure and synthesized.Then M. Gross showed that iron is synthesized and triiodothyronine, hormonal activity is higher.

Understanding diffuse toxic goiter

The disease is the most well known among the population as Graves' disease and no wonder, because the first one it discovered and studied in 1840, was Basedow.

-Diffuse toxic goiter - widespread enlarged thyroid gland with symptoms of hyperthyroidism (hyperthyroidism).

most often occurs because of autoimmune processes in the body.Autoimmune diseases develop immunity in lesions, in this case to normal healthy cells of the organism immune system produces specific cells (antibodies) damaging them.In Graves' disease produces an abnormal protein, which "forces" the thyroid gland to work more intensively.

Increased production of thyroid hormones leads to increased nutrient decay, resulting in increased energy expenditure leading to weight loss, feelings of heat, intensified urination, until dehydration.

Iron at a given lesion is increased (sometimes significantly), thick consistency.If a strong increase can be observed signs of compression of adjacent organs (patients may experience a feeling of suffocation).

prevalence of diffuse toxic goiter

not unimportant role played by genetic predisposition to diffuse (popular) toxic goiter .The researchers suggested that the development of the disease can play the role of a genetic component, but, nevertheless, found no one size fits all patients Graves' disease genetic disorder that would indicate a genetic origin of the disease.Perhaps it affected several genes, and the manifestation of symptoms occurs at the negative impact of the environment.

Diffusion toxic goiter is more common in women than in men, about 8 times.It develops mainly in middle age (between 30 and 50 years), and is not uncommon in adolescents, young people, pregnancy, menopause, in people over 50 years.

Symptoms of diffuse toxic goiter

disease can occur with acute or gradual increase in symptoms.The main features are the enlargement of the thyroid gland, eye symptoms (primarily exophthalmos - bulging eyes), palpitations.In addition, patients complain of increased mental excitability, causeless anxiety, insomnia, sweating, trembling fingers or the entire body, frequent stools, weight loss, muscle weakness.

On examination, patients observed some behaviors: fidgeting with a lot of unnecessary movements, hasty speech, sometimes sick, not finishing the thought goes to discussions of other issues.While maintaining or even increased appetite in patients showed a significant decrease in the subcutaneous fat layer, sometimes amounting to severe exhaustion.The skin is warm, smooth and moist to the touch.Some patients have a common pigmentation (skin color in a darkish hue) of the skin, the most common pigment deposition occurs in the eyelids.Hair soft and thin head.

As the thyroid gland, which are confirmed by palpation (feeling) of the body, increasing the degree of distinction:

  1. enlarged thyroid palpated weakly;
  2. enlarged thyroid gland is clearly visible when swallowing;
  3. «thick neck" due to noticeable goiter eyes;
  4. pronounced goiter;
  5. huge goiter.

most common increase of 1 and 2 degrees.

thyroid disorders manifested by the following symptoms:

  • Eye symptoms.

The most common symptoms of Graves' disease include bilateral uniform expansion of the optic fissure, which creates the impression of a surprised look;Shtelvaga symptom - a rare flashes;lifting the upper eyelid, ptosis (dehiscence) of the lower eyelid, an incomplete closure of the eyelids - a symptom Graefe;exophthalmos - exophthalmia (bulging eyes).Most often it is uniform, but may also be asymmetrical or concern only one eyeball.In severe exophthalmos may cause inflammation of the cornea (the transparent sheath eyes), ulcers (long-term healing tissue damage) of the cornea, which can endanger vision.You may also experience swelling of the eyelids due to edema, which can also lead to compression of the optic nerve and the eyeball, which in turn leads to disruption of the visual field, increased intraocular pressure, pain in the eyes and even blindness.The patient may also complain of dryness and feeling of sand in the eyes or chronic conjunctivitis (inflammation of the mucous membrane of the century) due to incomplete closure of the eyelids.

  • Cardiovascular symptoms.

Tachycardia (rapid heartbeat) - one of the most common symptoms of the given system.Pulse rate ranges from 90 to 120 beats per minute, and in severe cases, and up to 150 patients develop chronic heart failure (a malfunction of the heart), accompanied by swelling of extremities, ascites (accumulation of fluid in the abdominal cavity), skin edema (anasarca).

  • Symptoms of the digestive system.

patients there is an increase in appetite.Due to the increase of motor function of the intestine quite often develop diarrhea (diarrhea);rarely is nausea and vomiting.There is a violation of the liver may develop cirrhosis (chronic inflammation of the liver).

  • Neurological symptoms.

most prominent symptoms are irritability and reactivity, general restlessness, a kind of restlessness.In patients with marked shivering fingers (especially at arm's length), headache, muscle weakness (difficulty getting up from a chair or squatting).

  • Endocrine symptoms.

In severe clinical picture of the disease is manifested most dramatically decrease the function of sexual glands and the adrenal cortex may accede diabetes.In premenopausal women may be reducing the number and frequency of menstruation (oligomenorrhea).In patients with marked weight loss up to exhaustion, heat intolerance.

  • dermatological symptoms.

for patients with Graves' disease is characterized by change and also on the part of the skin in the form of the following changes: increased sweating, the destruction of the nails, erythema (limited area of ​​skin discoloration), edema in the legs.

  • Dental symptoms.

most common multiple dental caries, periodontal disease is much less common.

symptoms of thyrotoxic crisis

When tireotoksicheskom Stroke patient's consciousness is stored, it is strongly excited (subject to hallucinations and delusions).Predecessors of crisis can be muscle weakness, lack of dynamics, apathy.

patient's face becomes red color, his eyes opened wide, rare flashes.

The flow crisis at first accompanied by profuse sweating, which is later replaced by dry skin due to the pronounced dehydration and it becomes hot and reddened.Language and dry mouth, amid which are cracked.

manifestations on the part of the digestive system in the form of abundant indomitable diarrhea, possible spills abdominal pain, liver enlargement, leading to the development of jaundice (hepatitis).

body temperature reaches 41-42 degrees, the pulse becomes quickened, with the broken rhythm.There is a significantly higher systolic and lower diastolic blood pressure, heart failure may develop.

Content thyroid hormone significantly increased.

Causes and risk factors of diffuse toxic goiter

reason diffuse toxic goiter not fully understood, the basis of the development of this disease is the leading role of immune system disorders (collection of organs and cells that protect our body from the harmful effects).

most often occurs because of autoimmune processes in the body.Autoimmune diseases develop immunity in lesions, in this case to normal healthy cells of the organism immune system produces specific cells (antibodies) damaging them.In Graves' disease produces an abnormal protein, which "forces" the thyroid gland to work more intensively.

development of autoimmune processes is possible in the presence of inheritance, the impact of neuropsychiatric factors and long-term chronic foci of infection in the body.Very often Graves' disease occurs in patients with chronic angina, viral infections, with the introduction of radioactive iodine.

risk of diffuse toxic goiter increased in patients with diabetes, hypoparathyroidism, vitiligo, and of course with a hereditary predisposition ..

Complications of diffuse toxic goiter

most severe, life-threatening complication of toxic goiter patient is thyrotoxic crisis (thyrotoxic coma).

Factors contributing to the development of the crisis:

  • Untreated hyperthyroidism for a long time;
  • Severe trauma;
  • Increased physical activity;
  • Any surgery;
  • Infectious Diseases;
  • toxic goiter treatment with radioactive iodine, as well as surgical treatment of the disease, if there was not enough medical compensation.

tireotoksicheskom Stroke When there is an excessive intake of thyroid hormones in the blood and toxic heavy defeat of the cardiovascular system, liver, nervous system and adrenal glands.

Diagnostics diffuse toxic goiter

If you have not put so difficult characteristic clinical diagnosis of Graves' disease.It confirmed by laboratory tests of blood on the quantitative content of thyroid hormones in it (there will be a increase in the level of thyroxine and triiodothyronine and decreased thyroid stimulating hormone).The blood is also seen increasing amounts of iodine-related protein and lowering cholesterol (a fat-like substance is essential for our body, but in moderation).

thyroid also examined by radioactive iodine, thus iodine is observed enhanced absorption.

If you have symptoms of hyperthyroidism the thyroid gland is not detectable, it is possible its atypical location, then spend radioisotope scanning, which allows you to determine the size, shape and location of the body.But we should remember that the symptoms of hyperthyroidism are observed not only in diffuse toxic goiter, but also in the thyroid, thyroid tumor, nodular and mixed goiter, with prostate cancer.

Treatment of diffuse toxic goiter

Treatment should be conducted in a peaceful environment;you need to establish a normal sleep of the patient.Power must be complete, with an increased amount of protein and vitamins.The treatment may be medication, using radioactive iodine, and in severe forms of the disease surgery.

When medication is prescribed antithyroid drugs: iodine drugs, thiouracil derivatives and imidazole, sedatives, drugs potassium.

radioiodine therapy is the same as in hyperthyroidism.

absolute indication for surgical treatment (surgery on the thyroid gland) are allergic reactions, the large size of goiter (enlarged thyroid gland higher than 3 degrees), pronounced symptoms of cardiovascular disease.

operation is performed only when the medical compensation in order to avoid the development of thyrotoxic crisis in the postoperative period.