What is diffuse toxic goiter? What to do when the thyroid gland has gone crazy or all about diffuse toxic goiter. Why can hyperthyroidism develop in newborns?
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In the practice of endocrinologists, diffuse toxic goiter is considered one of the most common diseases.
This disease is difficult to treat, and achieving a positive result takes a long time.
This article will discuss how to treat diffusely toxic goiter and which methods are most effective.
- Elimination of manifestations of thyrotoxicosis.
- Normalization of thyroid hormones in the blood.
- Achieving remission for many years, and ideally for life.
Treatment options for diffuse toxic goiter:
- with the help of medications;
- use of folk remedies;
- through surgical intervention.
Each treatment option is selected by a doctor, depending on the specific case of the disease, taking into account all indications and contraindications. Each endocrinologist relies on his own preferences in treating the disease, based on his own experience. Doctors may prefer different methods of treatment, but the essence of the treatment should be the same.
Drug treatment
Treatment with medications takes a long time, and its effectiveness is questionable. Yes, positive results from such treatment can be observed after a month, but most often relapses occur after stopping the medication. Despite the low effect of treatment, it is often started with it at the initial stage of the disease. This is the most commonly used method.
Derivatives of Imidazole and Thiouracil
They are also called thyreostatics. These drugs block the functioning of the thyroid gland, which reduces the production of T3 and T4. Medicines include: Thiamazole, Carbimazole, Mercazolil, Propicil, Tyrozol.
Treatment of diffusely toxic goiter with thyreostatics is divided into two phases:
- Achieving euthyroidism, for which Thiamazole (up to 60 mg per day) or Propicil (up to 150 mg per day) is prescribed. Reception continues for a month.
- Maintaining euthyroidism. For this purpose, Thiamazole (up to 20 mg per day) or Propicil (up to 100 mg per day) is prescribed. The appointment lasts for one and a half years.
Eutirox (up to 50 mcg per day) can be added to this treatment. The drug is taken for 1.5 years.
Euthyrox can be taken only when the euthyroid state has been fully achieved!
Eutirox is prescribed to prevent the possibility of developing drug-induced hypothyroidism. Thanks to Eutirox, excessive hypofunction of the thyroid gland can be prevented.
Treatment of diffusely toxic goiter in the second stage can be carried out as monotherapy with thyreostatics. In this case, Eutirox is not prescribed. In this case, the dose of the thyreostatic agent should be reduced: Propicil to 50 mg per day, Thiamazole to 5 or even 10 mg.
In previous years, doctors prescribed their patients a daily dose of this drug in 4 divided doses. That is, the drug should be taken every 6-8 hours. Currently, taking multiple tablets throughout the day has become considered incorrect, since there are no differences in the effectiveness of treatment between single and multiple doses.
Of course, it is more convenient for the patient to take thyreostatics once a day for a year and a half than to do it every 8 hours. Yes, and it turns out more economical.
The use of iodine preparations is under strict restrictions at the moment.
When treating patients with such drugs for a long time, an increase in the thyroid gland was observed in the absence of compensation for thyrotoxicosis in sufficient quantities.
The use of iodine preparations is only occasionally allowed for self-treatment.
For self-treatment of mild to moderate thyrotoxicosis, lithium carbonate may be prescribed at the discretion of the physician. This drug, which is 300 mg tablets, is recommended at 900-1500 mg per day. The exact dose depends on the symptoms.
Beta blockers can eliminate the symptoms of thyrotoxicosis. These symptoms are sweating, anxiety, tachycardia, etc. Such symptomatic treatment of thyrotoxicosis is sometimes necessary. These drugs can eliminate the unpleasant symptoms of the disease. Thyrostatics would not be able to eliminate the symptoms in a short time, and they would need at least 8 days.
After the clinical manifestations of diffuse toxic goiter have been eliminated, beta-blockers should be stopped. Today, two types of adrenergic blockers are used: selective and non-selective.
Did you know that if diffusely toxic goiter is left untreated, a thyrotoxic crisis can occur, which can be fatal? Follow the link for detailed information about Graves' disease.
How to treat diffusely toxic goiter with folk remedies
One of the methods of treating diffuse toxic goiter using folk remedies is the use of iodine. Recommendations for use: before going to bed, smear iodine on your heels and put on socks so that the bed linen does not get dirty. The iodine is consumed by the next morning. If iodine has stopped being absorbed, this means that the body has enough iodine and treatment can be stopped.
Some people use a frog for treatment, although this may seem strange.
The essence of the treatment is as follows: turn the frog with its back and bring it to your lips, then take three deep breaths (similar to inhalation).
Then turn the frog on its stomach and repeat inhaling three times.
The disease may well recede after a couple of months of such treatment.
The next method of treating diffuse toxic goiter is to use figs. There are known cases of cure of stage 2 disease, when it was possible to do without surgical intervention. To carry out one course of treatment you will need about 4 kg of figs. You need to put 3 large figs in a container and pour boiling water over them overnight. Let it infuse all night, and in the morning you should drink the resulting remedy, as well as eat one berry. One more berry should be eaten before lunch and dinner. This must be done every day until 4 kg of figs are gone.
The use of tincture of walnut partitions also shows good results in the treatment of the disease. There was a case when expensive drugs did not help a woman cope with a stage 3 disease. She was given advice to try using tincture of walnut partitions.
Recipe: 1 glass of partitions is filled with 2 glasses of vodka. The resulting tincture should be taken in the morning, one tablespoon a couple of hours before finally waking up. That is, after taking a spoonful of tincture, you should continue to lie down and sleep. Six months later, the woman had an ultrasound, which showed that the size of the thyroid gland had decreased significantly and the nodes had resolved. Now the woman undergoes this course of treatment every six months and does not experience a return of the disease.
Another case of healing with iodine. The woman had a goiter, the cause was an insufficient amount of iodine in the body.
One day it was necessary to apply a mesh of iodine to the left thigh and right forearm, and the next day, vice versa: to the right thigh and left forearm. It was recommended to repeat the treatment as iodine was absorbed.
In the first days, iodine was absorbed quite quickly; it was necessary to apply a mesh of it every day. Then the absorption of iodine occurred a little slower, and it was necessary to apply it once every two to three days, then even less often. This treatment was carried out for a year, and then the woman went to see an endocrinologist. The doctor took the patient off the register because the disease had subsided.
Self-treatment does not replace contacting a specialist. Before taking medications or carrying out treatment with traditional methods, you should consult an endocrinologist. The doctor will prescribe the correct treatment and select the required dosage for the patient.
Surgical intervention
Surgical intervention in the treatment of diffusely toxic goiter is prescribed in cases where it reaches a large size, a severe form of thyrotoxicosis is present, drug treatment has been unsuccessful, there is intolerance to thyrotoxic drugs, relapses are regularly repeated, etc.Before going for surgery, the patient is prepared with thyrotoxic drugs in combination with corticosteroids, as well as beta blockers.
The main clinical indicators of a person’s readiness for surgery are considered to be a decrease in tachycardia, weight gain, normal blood pressure, as well as a normal psycho-emotional state.
During the operation, the thyroid gland is almost completely removed.
Only areas of tissue on which the parathyroid glands are located are left.
Preparing the patient for surgery and observing all the details of the surgical intervention guarantee a favorable course of the postoperative period and a positive outcome of the operation.
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Thyrotoxicosis is a condition in which thyroid hormones are persistently elevated and intoxication of the body occurs. Easily imitates health symptoms of thyrotoxicosis in women, which are difficult for a doctor with little experience to diagnose. The presence of excess levels of hormones in the blood aggravates normal processes in the body, disrupting normal metabolism in the body and in the excretory system.
How to recognize the first disruptions in the body caused by an increase in the concentration of thyroid hormones in order to promptly begin correction and treatment of the pathology. The first symptoms of thyrotoxicosis in women, which appear gradually and implicitly, sometimes causing admission to the cardiology and gastroenterology department of the hospital.
Reliably suggesting problems with the thyroid gland is a problem even for a doctor.
The range of signs and symptoms that the patient presents with is extensive:
- Complaints of sudden weight loss, even with a normal appetite and amount of food consumed.
- The appearance of attacks of tachycardia (rapid heartbeat). The pulse rate reaches 100 beats per minute, and an irregular heartbeat (arrhythmia) may occur.
- The patient notes an increase in appetite without changing lifestyle or daily routine.
- Unreasonable nervousness, increased anxiety, irritability.
- Tremor of the limbs, especially manifested in trembling of the hands and fingers.
- The appearance of perspiration without physical activity.
- Menstrual irregularities.
- Increased sensitivity to heat.
- Changes in intestinal function, increased peristalsis, the appearance of constipation and flatulence.
- Enlargement of the thyroid gland. When palpating with their own hands, patients feel a change in volume and the appearance of swelling at the base of the neck.
- The skin becomes thin and takes on a gray tint.
- The patient complains of restless and sensitive sleep, including persistent insomnia.
- Increased fatigue, impotence, muscle weakness and apathy.
- Hair becomes weak. Easily break and fall out.
In elderly patients, the symptoms are vague, they often complain of an increase in heart rate, heat intolerance and increased fatigue when performing normal daily activities. Beta blocker medications, which older women take to normalize blood pressure, can mask many of the signs of hyperthyroidism.
There is a high probability that eye problems, so-called ophthalmopathy, may occur. If the patient smokes, the symptoms worsen. In this disorder, the eyeballs protrude beyond the sockets and the tissues and muscles swell. The eyes look bulging and bulging. The mucous surface is prone to dryness, and it is difficult for the patient to fix her gaze on close objects.
The symptoms of Graves' ophthalmopathy can be determined by the following signs:
- protruding eyeballs;
- red, swollen eyes;
- lacrimation;
- discomfort in one or both eyes;
- photosensitivity;
- blurred vision or double vision.
Causes of changes in the body
Causes of thyrotoxicosis include:
- Diffuse toxic goiter– refers to systemic autoimmune diseases, and is characterized by the production of stimulating autoimmune antibodies to TSH receptors.
- Multinodular toxic goiter– the development of the disease occurs if there has been a long-term iodine deficiency in food and the environment. During the period when the disease lasts for a long time, the TSH concentration decreases and T3 and T4 increase. In this case, we can claim clinically obvious thyrotoxicosis.
- Pregnancy– thyrotoxicosis during the period of bearing a child most often develops against the background of diffuse toxic goiter. Due to hormonal changes in the body, an exacerbation of thyrotoxicosis may occur, which will lead to thyrotoxicosis.
- Toxic thyroid adenomas– both manifest and subclinical thyrotoxicosis causes imply hormonally active neoplasms. A toxic adenoma can be detected in a previously non-toxic thyroid nodule. When studying the pathogenesis, it becomes clear that excess production of hormones occurs autonomously, by adenoma tissues, which cannot be regulated by TSH. It is noteworthy that with subclinical thyrotoxicosis, the symptoms of the disease are not typical or are absent altogether.
- In case of selective resistance of the pituitary gland to thyroid hormones– a condition caused by the lack of negative feedback between the pituitary and thyroid hormones. Not accompanied by pituitary tumors.
- The main causes of thyrotoxicosis are thyroiditis. With this type of disease, inflammation of the thyroid tissue and destruction of thyrocytes occurs. A large amount of hormones enter the blood from the destroyed gland cells. The most common causes of thyrotoxicosis are postpartum thyroiditis, subacute thyroiditis, and various forms of autoimmune thyroiditis.
Note! The occurrence of thyrotoxicosis is possible not only in cases of autoimmune inflammation of the thyroid gland, but also in cases of infectious damage.
- Ovarian tumors, secreting thyroid hormones, as well as hormonally active large metastases of follicular thyroid cancer are also causes of thyrotoxicosis.
- Overdose of various medications, as well as means for hormone replacement therapy, is the cause of medical thyrotoxicosis. This happens in cases where doctors prescribe excessively large dosages, or patients voluntarily take larger amounts of the drug in order to increase the effect and speed of treatment.
The weight of the gland is only a few grams, but its role is so great that it manages to orchestrate the entire body. Your health and metabolic process depend on it.
It produces two main hormones, the first is thyroxine (T4), the second is triiodothyronine (T3). Every cell of the body falls under their influence, they maintain the normal rate of use of fats and carbohydrates. Controlling body temperature is also not possible without their participation.
Calcitonin produced by the thyroid gland regulates the concentration of calcium in the blood. Hormones affect heart rate and protein production.
A variety of conditions cause hyperthyroidism. Autoimmune disorders are the most common cause. Antibodies stimulate the thyroid gland to produce too much hormone.
The cause of the appearance of antibodies cannot be determined; the influence of microbes is assumed, which aggravate the patient’s condition and provoke further development of the disease.
Some reasons for the development of thyrotoxicosis:
- excessive presence of iodine;
- thyroiditis (inflammation of the thyroid gland) leads to the leakage of T3 and T4 from the gland;
- benign changes in the thyroid gland or pituitary gland;
- ovarian tumor;
- excess T4 entered into the body as part of dietary supplements or medications.
Symptoms of changes in the body
Increased concentrations of T4 and T3 trigger an excessively high metabolic rate - hypermetabolism. The thyroid gland increases in size. Visible changes under the skin can be symmetrical or unilateral.
The woman cannot concentrate, has difficulty sleeping, and is often nervous due to the appearance of inexplicable obsessive fears. Excitability and irritability accompany the patient almost all the time. Older women are prone to depression, lethargy and fear of social contacts.
Weakness and increased fatigue occur as a reaction to intoxication with thyroid hormones. Ordinary loads: moderate-intensity walking, cleaning the apartment or small physical work becomes an overwhelming task for a woman. Fatigue is often accompanied by vomiting and attacks of nausea.
On the neck, a visual manifestation of the disease is possible - goiter, an increase in the volume of the neck. The patient may experience discomfort when swallowing, difficulty breathing, and a change in voice timbre to hoarseness.
Danger signs
You should pay attention to the symptoms that require immediate help and medical supervision:
- dizziness;
- loss of consciousness;
- confused, uneven breathing;
- Irregular heart rhythm.
Thyrotoxicosis is dangerous due to a condition such as atrial fibrillation. Arrhythmia can lead to stroke and congestive heart failure.
Excess thyroid hormones negatively affect the cardiovascular system. Patients are at risk of hypertrophy, hyperfunction, cardiac dystrophy and cardiosclerosis.
In addition, eye symptoms are characteristic of thyrotoxicosis.
These include:
- Graefe's symptom in thyrotoxicosis is that the outer eyelid lags behind eye movements. The reason for this is the increased tone of the muscles responsible for the movements of the eyelids. White flat sclera is visible. When the pupil moves, the eyeball moves with it.
- Delrymple's sign - accompanied by wide open palpebral fissures, which is why the face takes on a surprised or angry expression.
- Stellwag's symptom is characterized by infrequent blinking.
- Exophthalmos is excessive protrusion of the eyeballs.
- Ekroth's sign is swelling of the upper eyelids.
- Rosenbach's symptom - at the moment when the eyes are somewhat closed, tremor of the eyelids occurs.
- Kocher's sign in thyrotoxicosis means that the eyelids move to the lower or upper edge of the orbit, exposing the sclera. The degree of displacement varies - from barely noticeable to complete exposure of the cornea.
- Jellinek's sign – significant darkening of the skin and hyperpigmentation occur in the eyelid area.
Exacerbation
Thyrotoxic crisis is a serious complication that occurs during exacerbation.
Several factors contribute to the onset of a crisis:
- stress or psychological trauma;
- physical stress;
- non-compliance with medications;
- surgical intervention.
During the attack, the patient is in serious condition. Acute heart failure, high blood pressure, fever, and vomiting are noted.
Forms of the disease
Thyrotoxicosis is divided into three forms according to the level of its course:
- Lightweight. There is noticeable weight loss and mild tachycardia. The dysfunction occurs in the thyroid gland, other organs are not affected.
- Average. The patient notes severe weight loss and an increase in heart rate to 120 beats per minute. Tachycardia is present regularly. Digestive disorders occur.
- Heavy. Not only the thyroid gland is affected, other organs are also involved. It develops with prolonged disruption of the gland, lack of timely identification of the problem and lack of adequate therapy.
The formation of toxic diffuse goiter, excess iodine and thyroid hormones supplied from outside are the causes of the development of forms of thyrotoxicosis.
Diagnostic principles
The doctor can suggest signs of thyrotoxicosis in women based on a visual examination of the patient and her complaints. To confirm suspicions, a diagnosis of the functioning of the thyroid gland is carried out.
The main indicator of changes is a deviation from the norm in the content of hormones in the blood serum. Thyrotoxicosis is characterized by a decrease in TSH levels; the hormones T3 and T4, on the contrary, are increased.
Auxiliary measures for diagnosis are:
- Ultrasound, which gives the doctor the necessary information about the condition of the thyroid gland and changes in its size;
- scintigraphy (scanning) using radioactive iodine;
- biopsy of the thyroid gland using a thin needle.
The doctor needs an analysis to determine the level of antibodies to the structural elements of the thyroid gland and thyroid-stimulating hormone receptors. Computer diagnostics or MRI helps to obtain a clear and complete picture.
In rare cases, secondary thyrotoxicosis is determined if a pituitary adenoma is detected. In this case, TSH is released into the blood in excess quantities, the thyroid gland is constantly stimulated with the release of thyroxine and triiodothyronine.
Helping a patient
Relieving the severity of the symptoms of thyrotoxicosis is the primary task for the doctor. The arsenal of help includes medications that are prescribed to the patient for daily use. They quickly normalize a woman’s condition and gradually correct the main health problems.
Thyrostatic drugs suppress the stimulation of the thyroid gland and promote normal levels of hormones in the blood. The patient must follow the instructions. A woman should take medications constantly, as well as visit an endocrinologist for a preventive examination and tests.
Additionally, the doctor prescribes medications to compensate for disturbances that have occurred in the nervous system and the functioning of the hypothalamus.
The administration of radioactive iodine solves the problem of thyroid pathologies. The incoming iodine accumulates in the organ and destroys its cells.
With this type of treatment, a complication is possible - hypothyroidism. When dead cells are replaced by connective tissue, the function of the thyroid gland decreases, so the patient is doomed to take thyroid-stimulating drugs for life.
The question of surgical treatment is considered in the absence of effect from conservative therapy. Thyrotoxicosis symptoms in women are more than serious; it is unacceptable to ignore them, as well as to postpone a visit to the doctor.
In the second half of pregnancy, as a rule, the woman’s condition improves. This is due to the fact that as a result of physiological immunosuppression occurring in a given period of time in the body, the level of thyroid-stimulating immunoglobulins decreases.
However, it should be noted that in most cases, starting from the twenty-eighth to thirtieth week of pregnancy, a woman develops manifestations of heart failure due to circulatory disorders, tachycardia and an increase in circulating blood volume.
Diffuse toxic goiter can cause the following complications in a pregnant woman:
- increased blood pressure ( increase in systolic pressure and decrease in diastolic);
- preeclampsia ( a condition of a pregnant woman characterized by high blood pressure, the presence of protein in the urine and edema);
- heart failure;
- late toxicosis;
- increased risk of miscarriage;
- premature birth;
- premature placental abruption;
- postpartum hemorrhage;
- thyrotoxic crisis.
- various developmental defects;
- stillbirth;
- intrauterine growth retardation;
- low weight;
- embryonic and neonatal ( first month of baby's life) hyperthyroidism.
- severe irritability and nervousness;
- severe fatigue;
- increase in body temperature ( up to 37 – 38 degrees);
- severe sweating;
- increased heart rate;
- dyspnea;
- limb tremor ( more often than hands);
- weight loss ( with preserved or increased appetite);
- exophthalmos;
- an increase in the size of the thyroid gland.
The dose of the drug prescribed to a woman should be low. This is necessary in order to prevent the development of hypothyroidism ( decreased production of thyroid hormones) and goiter in the fetus.
In addition, a pregnant woman may be prescribed sedatives to normalize her psycho-emotional state, as well as antihypertensive drugs to lower blood pressure.
What is diffuse nodular toxic goiter?
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Diffuse nodular toxic goiter means the following:
- diffuse– uniform increase in organ size;
- nodal– formation of nodules in the tissue;
- toxic– excessive production of thyroid hormones ( negatively affects human health);
- goiter– enlargement of the thyroid gland.
- zero– the gland is of normal size and not palpable ( pathology can be detected only through laboratory and instrumental studies);
- first– there is no visual enlargement of the thyroid gland, but nodular formations are palpable;
- second– diffuse nodular goiter is visually identified and palpated.
- irregular and irrational nutrition ( insufficient iodine intake from food);
- living in an area with low iodine content;
- hereditary predisposition;
- autoimmune diseases;
- psycho-emotional stress.
- increased nervousness and irritability;
- sleep disturbance;
- weight loss ( with normal appetite);
- tremor of the limbs or torso;
- tachycardia;
- increased sweating;
- fever.
The severe course of the disease leads to the development of the following symptoms in the patient:
- feeling of pressure in the neck;
- feeling of heaviness in the chest area;
- dry cough;
- dyspnea;
- hoarseness of voice;
- feeling of a lump in the throat;
- attacks of suffocation.
Why can hyperthyroidism develop in newborns?
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Persistent congenital hyperthyroidism in newborns is rare and may be associated with the following reasons:
- mutation of thyroid-stimulating hormone receptors;
- congenital immunity of the pituitary gland ( endocrine gland located in the brain) to thyroid hormones.
- increased anxiety;
- increased respiratory rate;
- increased body temperature;
- pronounced motor activity;
- increase in the size of the liver and spleen ( hepatosplenomegaly);
- poor weight gain;
- exophthalmos ( bulging eyes);
- lymphadenopathy ( swollen lymph nodes);
- enlargement of the thyroid gland.
From the cardiovascular system, a child may experience the following symptoms:
- tachycardia;
- increased blood pressure;
- arrhythmias;
- expansion of the boundaries of relative cardiac dullness.
The diagnosis of congenital hyperthyroidism in a newborn is made on the basis of:
- collection of family history ( it is determined whether the mother has diffuse toxic goiter, whether the woman took thyreostatics during pregnancy);
- carrying out laboratory research ( the level of thyroid-stimulating hormones in the blood is determined);
- conducting instrumental research ( e.g. ultrasound, electrocardiogram).
- early closure of fontanelles;
- mental development disorder;
- increased psychomotor activity;
- growth retardation.
- beta-blockers to correct blood pressure and heart rate;
- sedatives to normalize the child’s psycho-emotional state;
- potassium iodide solution to reduce the production of thyroid-stimulating hormone and normalize the functioning of the thyroid gland;
- antithyroid drugs, which prevent excessive production of thyroid hormones.
Diffuse toxic goiter is an autoimmune disease, the development of which is caused by disturbances in the functioning of the immune system. It is dangerous not so much for its symptoms as for its complications affecting the functions of other vital systems of the body. Treatment of goiter can be either medicinal or surgical; the main thing is not to let the disease take its course, so that it does not turn into serious complications requiring separate therapy.
Doctor holding a stethoscope with arms crossed and copy space
Thyroid dysplasia - what is it?
Diffuse goiter, according to the generally accepted classification, means a uniform increase in thyroid tissue, without clearly defined nodules and other formations. It is considered toxic due to the thyrotoxicosis that occurs against the background of the growth of the thyroid gland, that is, the influence of thyroid hormones on the metabolism in the body.
DTG, or Graves' disease, is accompanied by hyperthyroidism, i.e. increased production of thyroid hormones due to benign proliferation of thyroid tissue with expansion and strengthening of its vascular bed.
Causes and mechanism of development of the disease
A disorder of immune function leading to the development of goiter is the production of antibodies to thyroid-stimulating hormone receptors. They constantly affect the thyroid gland, stimulating it to produce the hormones T3 and T4. This hyperfunction leads to the growth of gland tissue, sometimes to visible sizes. A symmetrical, uniform lump appears on the patient’s neck, from barely visible to protruding forward and to the sides; this is a diffuse goiter. Moreover, the severity of the disease does not depend on the size of the thyroid gland.
An excess of thyroid hormones accelerates metabolic reactions in the body, which consume a lot of energy necessary for the normal functioning of cells and tissues. This negatively affects primarily the patient’s cardiovascular and nervous system. Lack of treatment at this stage also leads to more dangerous consequences - cardiac and/or adrenal failure.
The reasons why a person may develop Graves' disease are still unclear. It is assumed that autoimmune disorders affecting the thyroid gland manifest themselves in a person with a family history who is under the influence of external negative factors. Among them:
- smoking;
- disturbances in the functioning of the endocrine system (dysfunction of the adrenal glands, pancreas and gonads, pituitary gland, etc.);
- infectious diseases;
- mental disorders;
- inflammatory diseases of the brain, traumatic brain injury.
According to statistics, the development of thyrotoxicosis with diffuse goiter is observed mainly in women 20-50 years old.
Symptoms and diagnosis of Graves' disease
Symptoms of diffuse toxic goiter can be different, because. Thyroid hormones are involved in many processes in the body. The mild form of the disease causes mainly complaints of tachycardia and mild manifestations of neurosis, without disrupting endocrine functions. Diffuse goiter of moderate severity is manifested by a more noticeable increase in heart rate (up to 110 beats/min) and weight loss (about 8 kg per month).
The severe form into which thyrotoxic goiter often progresses, if not treated in the early stages, demonstrates not only a critical loss of body weight (up to exhaustion), but also functional disruptions in the functioning of vital organs: the liver, heart, kidneys.
In addition to the above signs, the development of a goiter can be suspected based on the following complaints:
- emotional lability: mood variability, exacerbation of emotional reactions, difficulty concentrating, anxiety, irritability, aggressiveness;
- general weakness, gradual weight loss along with an increase in appetite, increased sweating, impaired thermoregulation, sometimes a slight increase in temperature in the evening;
- endocrine ophthalmopathy: “bulging” of the eyes due to changes in the tissues around the eyelids, as a result - incomplete closure of the eyelids, dry eyes, conjunctivitis.
With prolonged absence of treatment, calcium and phosphorus can be washed out of the bones, which is manifested by osteopenia syndrome: a decrease in bone density and a decrease in their mass. The bones begin to ache, the risk of fractures increases, and thyroid acropachy may develop - thickening of the fingertips, the so-called. "drumstick syndrome"
A preliminary diagnosis based on the listed clinical manifestations is clarified through laboratory tests:
- Ultrasound of the thyroid gland - checks the size of the gland, the presence of nodes, the echogenicity of the parenchyma;
- CT and MRI of the eyes - the condition of the tissues and bone walls of the eye orbits, the presence of changes in the extraocular muscles;
- analysis of TSH concentration in blood serum, determination of the predominance of growth in the production of free T3 over T4;
- analysis for antibodies to TSH receptors;
- other blood tests performed for hyperthyroidism.
Treatment of diffuse toxic goiter
The first thing to do if Graves' disease is confirmed is to achieve a steady decrease in the production of thyroid-stimulating hormones to normal. The further treatment strategy will be chosen based on the patient’s condition, his desire, stability of remission and other factors. A favorable outcome of drug therapy is considered to be a decrease in the number of antibodies to TSH, a decrease in the size of the thyroid gland and a smoothing of the symptoms of the disease. If after such a remission a goiter recurs, radiological or surgical treatment is indicated.
Drug treatment of diffuse toxic goiter is based on taking the drugs thiamazole and propylthiouracil. The treatment regimen involves the accumulation of active substances in the thyroid tissue in order to suppress its hormone-producing activity. Normalization of heart rate and blood pressure, disappearance of limb tremors and hyperhidrosis, weight gain to normal - all this means that the dose of medication can be reduced, but the adjustment occurs strictly individually, depending on the condition of each individual patient.
Another non-invasive method for treating diffuse goiter is radioactive iodine therapy. This is an artificially synthesized substance that can accumulate in the thyroid tissue. As radioactive iodine disintegrates, it irradiates the gland, destroying thyrocytes—cells that produce hormones. The result of such therapy is expected within 4-6 months after the introduction of the active substance into the body: hypothyroidism develops, which, if necessary, can be corrected by taking medications.
If the listed methods are ineffective or for some reason are not suitable for a given patient, a decision is made on thyroidectomy - surgical removal of the thyroid gland. In addition, the following are considered indications for surgical intervention:
- the presence of nodes in the gland tissue with signs of malignancy;
- large size goiter;
- severe ophthalmopathy.
The operation also results in hypothyroidism, which is subsequently compensated by taking synthetic hormones T3 and T4. Relapses of the disease are completely excluded.
Prognosis and prevention
In the absence of timely treatment, the prognosis is unfavorable, because Over time, new symptoms appear and increasingly severe complications develop, affecting many organs and systems. If, with diffuse toxic goiter, treatment was able to normalize thyroid function, one can hope for the restoration of heart rhythm and regression of cardiac pathology caused by goiter.
As a preventative measure, constant follow-up is considered for patients who have an enlarged thyroid gland without functional disorders, as well as those who have a family history of Graves' disease.