Diffuse toxic goiter( Based's disease, Graves' disease) - Causes, symptoms and treatment. MF.

Diffuse toxic goiter( Bazed disease, Graves disease) is a disease characterized by a widespread enlargement of the thyroid gland and persistent excess production of its hormones, which causes disruption of all kinds of metabolism and energy, as well as the functions of various organs and systems.

Most often occurs due to autoimmune processes in the body. Autoimmune diseases develop with immunity damage, in this case, to normal cells of a healthy organism, the immune system produces specific cells( antibodies) that damage them. With Based's disease , an abnormal protein is produced that "causes" the thyroid to work more intensively.

Historical information on the discovery of the thyroid gland and its hormones

The thyroid gland, because of its surface position, was known even to the ancient Egyptians, whose frescoes, according to E. Rene, contain images of the deity Thoth with signs of goiter and hypothyroidism. The first literary description of this organ, which has come down to us, belongs to K. Galen. The name of the gland was given in 1656.T. Warton for resemblance to the shield. It is well known that medieval Arab doctors already knew about the extreme degree of thyroid enlargement in the volume - the

- goiter and successfully applied the complete or partial removal of the gland - no later than the eleventh century( Abul-Kazim).Endocrine functions in the gland were first suspected by T.U.King( 1836), and proved - by the experimental removal and transplantation of the organ - by P. M. Shiff( 1884).

1884g.our compatriot NA Bubnov was the first to try to separate hormones from the gland tissue.

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

1895g. T. Koher proved the effectiveness of iodine in the treatment of hypothyroidism.

1895g. A. Magnus-Levy began to objectively study the functions of the thyroid gland and proved the role of its hormones in the metabolism.

1896g. E. Bauman found that iodine is a part of thyroid hormones and that patients with endemic goiter contain little iodine.

1919g. E. Kendall received iodine-containing thyroid hormone in crystalline form and gave him the name thyroxine.

1926 - 1927.K.R.Harrington and co-authors established its structure and synthesized it. Then M. Gross showed that triiodothyronine is also synthesized in iron, the hormonal activity of which is higher.

General information about diffuse-toxic goiter

This disease is most known among the population, as Basedova disease and it is not surprising, because the first who discovered and studied it in 1840, was Bashedov.

Diffusive-toxic goiter is a common enlargement of the thyroid gland with symptoms of thyrotoxicosis( hyperthyroidism).

Most often occurs due to autoimmune processes in the body. Autoimmune diseases develop with immunity damage, in this case, to normal cells of a healthy organism, the immune system produces specific cells( antibodies) that damage them. With Based's disease, an abnormal protein is produced that "makes" the thyroid gland more intense.

Increased production of thyroid hormones leads to increased disintegration of nutrients, resulting in increased energy expenditure, which leads to weight loss, the appearance of a feeling of heat, increased urination, down to dehydration.

The iron in this lesion is increased( sometimes significantly), of a dense consistency. With a strong increase, there may be signs of compression of neighboring organs( patients may feel suffocated).

Prevalence of diffuse-toxic goiter

A hereditary predisposition to diffuse ( common) toxic goiter plays an important role. The researchers suggested that the genetic component may play a role in the development of the disease, but, nevertheless, there was not found any genetic violation for common to all patients, which would indicate the genetic origin of the disease. It is possible that several genes are affected, and symptomatic manifestations occur when the environment is adversely affected.

Diffusive-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, during pregnancy, menopause, in people over 50 years old.

Symptoms of diffuse-toxic goiter

The disease can occur acutely or with a gradual increase in symptoms. The main signs are an increase in the thyroid gland, eye symptoms( primarily exophthalmos - eye bulging), palpitations. In addition, patients complain of increased mental excitability, unreasonable anxiety, sleep disturbances, sweating, trembling of fingers or whole body, frequent stools, weight loss, muscle weakness.

When examining patients, some features of behavior are noted: fussiness with a lot of unnecessary movements, hasty speech, sometimes the patient, without finishing the thought, proceeds to discuss another issue. With preserved or even increased appetite, the patients notice a significant decrease in the subcutaneous fat layer, sometimes reaching a severe depletion. The skin is warm, smooth and moist to the touch. In some patients, widespread pigmentation( skin color in a darkish shade) of the skin is noted, the most frequent deposition of the pigment occurs in the eyelid region. Hair on the head is thin and soft.

As the thyroid gland increases, which are confirmed by palpation( palpation) of the organ, the degrees of increase are different:

1. an enlarged thyroid gland is palpable slightly;
2. an enlarged thyroid gland is clearly visible on swallowing;
3. "thick neck", caused by a noticeable for the eye goiter;
4. marked goiter;
5. goiter is huge.

The most common increase in 1 and 2 degrees.

Thyroid disorders are manifested by the following symptoms:

• Eye symptoms.

The most common symptoms of Based's disease include: a bilateral, uniform widening of the eye gap, which gives the impression of a surprised look;Stewwag's symptom is a rare flashing;the rise of the upper eyelid, the lowering of the lower eyelid, the incomplete closure of the eyelids, a symptom of Gref;exophthalmos - eyedrops( bulging eyes).More often it is uniform, but it can also be asymmetrical or touch only one eyeball. In severe form of exophthalmia, inflammation of the cornea( a transparent envelope of the eye), ulcers( long-lasting non-healing tissue damage) of the cornea that may pose a threat to vision is possible. There may also be a swelling of the eyelids due to swelling, which can also lead to compression of the optic nerve or eyeball, which in turn leads to impairment of the visual fields, increased intraocular pressure, eye pain and even complete blindness. The patient may also complain of dryness and a feeling of sand in the eyes or chronic conjunctivitis( inflammation of the mucous membrane of the eyelid) due to incomplete closure of the eyelids.

• Cardiovascular symptoms.

Tachycardia( rapid heartbeat) is one of the most common symptoms on the part of this system. The pulse rate varies from 90 to 120 beats per minute, and in severe cases to 150. Patients develop chronic heart failure( violation of the normal functioning of the heart) accompanied by swelling of the extremities, ascites( accumulation of fluid in the abdominal cavity), swelling of the skin( anasarka).

• Symptoms of the digestive system.

Patients have increased appetite. Due to increased motor function of the intestine, diarrhea( diarrhea) often develops;Occasionally there is nausea and vomiting. There is a violation of the liver, it is possible the development of cirrhosis( chronic inflammation of the liver).

• Neurological symptoms.

The most striking symptoms are increased excitability and reactivity, general motor anxiety, peculiar fussiness. In patients, trembling of the fingers is noted( especially with extended arms), headache, muscle weakness( difficulty in getting up from the stool or squatting).

• Endocrine symptoms.

With a pronounced clinical picture of the disease, the decrease in the function of the sex glands and adrenal cortex is most pronounced, diabetes mellitus may join. Premenopausal women may have a decrease in the number and frequency of menstruation( oligomenorrhea).In patients, weight loss is noted up to exhaustion, intolerance to heat.

• Dermatological symptoms.

Patients with Basoid's disease are also characterized by changes in the skin, in the form of the following changes: increased sweating, nail destruction, erythema( limited area of ​​skin with altered color), edema on the legs.

• Dental symptoms.

The most common is multiple caries, much less often periodontitis.

Symptoms of thyrotoxic crisis

With thyrotoxic crisis, the patient's consciousness is preserved, he is sharply agitated( hallucinations and delirium are possible).The precursors of the crisis can be muscle weakness, lack of dynamics, apathy.

The face of the patient acquires a red color, the eyes are wide open, the flashing is rare.

The flow of the crisis is first accompanied by a profuse sweating, which is then replaced by dry skin due to pronounced dehydration, and it becomes hot and reddened. The tongue and lips are dry, against the background of which they become cracked.

Manifestations from the digestive system in the form of abundant indigestible diarrhea, possible diffuse pain in the abdomen, enlargement of the liver, leading to the development of jaundice( hepatitis).

Body temperature reaches 41-42 degrees, the pulse becomes more rapid, with a disturbed rhythm. There is a high systolic and significantly low diastolic blood pressure, possibly the development of heart failure.

The thyroid hormone content is significantly increased.

Causes and risk factors for diffuse-toxic goiter

The cause of of diffusive-toxic goiter is not completely clear, the leading role belongs to disorders of the immune system( a set of organs and cells that protect our body from harmful effects).

Most often occurs due to autoimmune processes in the body. Autoimmune diseases develop with damage to the immune system, in this case to normal cells of a healthy body, the immune system produces specific cells( antibodies) that damage them. With Based's disease, an abnormal protein is produced, which "causes" the thyroid gland to work more intensively.

The development of autoimmune processes is possible in the presence of heredity, the influence of neuropsychic factors and prolonged chronic foci of infections in the body. Especially often Basedova's disease occurs in chronic angina, viral infections, with the introduction of radioactive iodine.

The risk of developing diffuse-toxic goiter increases in patients with diabetes mellitus, hypoparathyroidism, vitiligo and, of course, with hereditary predisposition.

Complications of diffuse-toxic goiter

The thyrotoxic crisis( thyrotoxic coma) is the most serious, life-threatening complication of toxic goiter.

Factors contributing to the development of the crisis:

• Absence of treatment of thyrotoxicosis for a long time;
• Severe mental trauma;
• Increased physical activity;
• Any surgical interventions;
• Infectious Diseases;
• Treatment of toxic goiter with radioactive iodine, as well as surgical treatment of the disease, if there was insufficient medical compensation.

In thyrotoxic crisis, there is an excessive intake of thyroid hormones into the blood and severe toxic damage to the cardiovascular system, liver, nervous system and adrenal glands.

Diagnosis of diffuse-toxic goiter

In the presence of a characteristic clinical picture, the diagnosis of Graves' disease is not so difficult. It is confirmed by laboratory tests of blood on the quantitative content of thyroid hormones in it( there will be an increase in the level of thyroxin and triiodothyronine and a decrease in the thyroid-stimulating hormone).In the blood, there will also be an increase in the amount of iodine associated with protein and the reduction of cholesterol( a fat-like substance is extremely necessary for our body, only in moderate doses).

The thyroid gland is also examined with radioactive iodine, with increased iodine uptake.

If, in the presence of symptoms of hyperthyroidism, the thyroid gland is not probed, then its atypical location is possible, then a radioisotope scan is performed, which allows determining the size, shape and location of the organ. But it should be remembered that the symptoms of hyperthyroidism are observed not only in diffuse-toxic goiter, but also in thyroiditis, thyroid tumors, nodular and mixed goiter, and in cancer of the gland.

Treatment of diffuse-toxic goiter

Treatment should be conducted in a calm environment;it is necessary to establish a normal sleep patient. The food should be high-grade, with the raised quantity of fibers and vitamins. Treatment can be medicated, with the help of radioactive iodine, and with severe forms of the disease surgical.

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

Radioiodine therapy is the same as for hyperthyroidism.

Absolute index for surgical treatment( operation on the thyroid gland) is allergic reactions, large goiter sizes( thyroid enlargement above 3 degrees), pronounced symptoms of cardiovascular insufficiency.

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