Diffuse toxic goiter is an autoaggressive disease, which is characterized by increased production of thyroid hormones and an increase in the size of the gland as a result of rapid cell reproduction. In another way, this disease is called hyperthyroidism, or the disease of Graves, Graves, Perry, Flayani. Most often, this pathology is diagnosed in women.
Etiology and pathogenesis
Genetic predisposition plays a major role in the development of hyperthyroidism. Often the disease is transmitted through the generation. The following factors provoke the occurrence of pathology:
- stress situations;
- chronic viral infections;
- frequent sore throats;
- other diseases of the endocrine system - hypoparathyroidism, Addison's disease, diabetes mellitus.
Heredity is confirmed by the fact that half of the patient's relatives have bloodantithyroid antibodies, and in 15% this pathology was identified and confirmed. It is important that not the disease itself is genetically transmitted, but only a predisposition to it. Thus, the leading role in the pathogenesis of diffuse toxic goiter is assigned to genetic predisposition, as well as provoking factors, due to which the information embedded in the genes is developed. Due to the malfunction of the immune system, a mutation occurs in T-lymphocytes, and they, acting on the tissue of the gland, perceive its antigens as foreign. In addition, T-killers are able to independently damage the organ, exerting a toxic effect on the thyroid gland. T-lymphocytes through B-cells, which synthesize antithyroid antibodies, can manifest an indirect effect on the glandular tissue. The latter stimulate the organ as a result of binding of thyroid-stimulating hormone receptors to thyrocytes, i.e., cells of the thyroid gland. With the development of diffuse toxic goiter, the function of the central regulators of the immune response (T-lymphocytes) is impaired.
Different classifications
The doctor determines the size of the thyroid gland using palpation and visual examination of the patient. According to the WHO classification, since 1994, the following degrees have been distinguished:
- 0 - goiter is not visually visible and cannot be palpated;
- 1 - the goiter is palpable, but visually, when the neck is in a natural position, it is not visible;
- 2 - goiter can be easily detected visually and palpation.
According to another classification (according to Nikolaev), there are such degrees of diffuse toxic goiter:
- 0 - not palpable and no gland is determined;
- I - palpation can determine the isthmus of the thyroid gland, it is visually visible;
- II - lateral lobes can be detected by palpation, during swallowing it is visually easy to see the goiter;
- III - visually visible thick neck;
- IV - the gland is enlarged, as a result of this, deformation of the shape of the neck is noticeable;
- V - the thyroid gland reaches an especially large size.
In addition, several degrees can be distinguished according to the severity of the disease:
- Easy. Signs of pathology are manifested by increased nervous excitability, absent-mindedness, insomnia, tearfulness. Quite often, low performance is observed. First of all, the cardiovascular system suffers. The number of heartbeats per minute increases to one hundred. The individual begins to lose weight.
- Average. Symptoms of diffuse toxic goiter, described with a mild degree, are aggravated. Tremor joins the existing disorders. Continued weight loss despite excellent appetite. The individual experiences severe sweating, weakness. The stool is disturbed, a pain syndrome appears in the abdomen, which does not have a clear localization.
- Heavy. The work of vital systems and organs fails. Psychoses are possible. The patient has a complete exhaustion of the body.
Another classification is known, according to which the course of the disease is distinguished:
- Subclinical - symptoms are erased, the diagnosis is made based on the results of the studyblood for hormonal substances.
- Manifest - has a pronounced clinic. Thyroid-stimulating hormone in the blood is not determined, the concentration of thyroid hormone substances is overestimated.
- Complicated - mental disorders are added. The work of the cardiovascular and other important systems is disrupted. The individual is diagnosed with a critical underweight.
Laboratory diagnostic methods
Use laboratory and instrumental methods to diagnose "diffuse toxic goiter". A blood test to determine free T3 (triiodothyronine) and T4 (thyroxine), as well as TSH (thyrotropin) is the main test. A high concentration of the first two hormones and a low rate of the latter is characteristic of this pathology. In addition, tests for antibodies to thyroglobulin and thyroid peroxidase are prescribed. As additional research methods are carried out:
- Scintigraphy, or radioisotope study of the thyroid gland, in which the functions and structure of the thyroid gland are studied.
- Ultrasound, which provides information about the structure of the organ.
- MRI is prescribed to diagnose the ophthalmopathy that is present in this disease.
In addition, when diagnosing diffuse toxic goiter (ICD-10 assigns code E05.0 to it), the functions of the kidneys, liver and other organs necessary for the appointment of adequate therapy are determined.
Causes and signs of illness
Hormonal imbalance contributes to the development of the disease duringpregnancy, breastfeeding, menstruation or menopause. Among the main reasons provocateurs are:
- traumatic brain injury;
- mental disorders;
- genetic predisposition;
- bad environment;
- autoimmune response of the body;
- bad environment;
- infections of a viral nature.
The main cause of diffuse toxic goiter is considered to be a violation of the immune system. Symptoms of pathology or the classic clinical picture are bulging eyes, goiter and palpitations. On the part of organs and systems important for normal life, signs of pathology appear:
- fast metabolism;
- hot weather intolerance;
- excellent appetite, but there is a sharp weight loss;
- diarrhea;
- disease;
- tremor of the body and limbs;
- fatigue;
- general weakness;
- insomnia;
- body swelling;
- arrhythmia;
- heart failure;
- tachycardia;
- belly enlargement;
- hyperactivity of motor reflexes;
- temperature increase;
- oral candidiasis;
- excessive sweating;
- brittle nails.
The male has erectile dysfunction, breast enlargement. Symptoms of diffuse toxic goiter in the female are infertility, menstrual cycle failure and severe pain in the lower abdomen,fibrocystic mastopathy. On the part of the organs of vision, there is an increase in intraocular pressure, conjunctivitis, a feeling of sand in the eyes, incomplete closure of the eyelids, rare blinking, lagging of the lower eyelid from the eyeball.
Complications and their treatment
Excessive production of hormonal substances by the thyroid gland has a negative impact on all organs and systems of the individual's body. Complications of diffuse toxic goiter include:
- Thyrotoxic crisis is a particularly severe consequence of the disease, which poses a real threat to life. Fortunately, today this disease is rare due to the latest methods of examination and treatment of patients. The development of the crisis is not fully understood, but there are several hypotheses. According to one of them, it occurs due to an increase in free triiodothyronine and thyroxine. On the other - because of the increased sensitivity of the body to adrenaline, norepinephrine, dopamine. The provocateur of the disease is stress or an infectious process. Symptoms characteristic of thyrotoxicosis are increasing. The crisis develops suddenly. The individual takes a forced position, the so-called frog posture, speech is disturbed, the dermis becomes moist and hot to the touch, the heart rate increases per minute to 130 beats. Urgent medical manipulations involve detoxification of the body, the introduction of beta-blockers, hormones, thyreostatics. In order to reduce psychomotor agitation, drugs of the barbiturate group, opioid analgesics are used. The urgent measures taken should be aimed atcompensation for acute insufficiency of the adrenal cortex, neutralization of thyroid hormonal substances, decreased activity of the sympathoadrenal system, elimination of metabolic disorders.
- Endocrine ophthalmopathy. The cause of this thyroid complication is relatively related, but it lies in an autoimmune attack on the eye tissues and muscles that are behind the eyeballs. Thus, the source of damage is the same as in the case of diffuse toxic goiter. At the same time, the eyes protrude strongly forward, they are also called bulging. The clinical picture develops in stages. Initially, changes affect only one eye, with further progression, the other is also affected. After some time, exophthalmos occurs. In severe lesions, the optic nerve suffers, which is a direct threat to vision. Complex therapy is shown. With untimely or incorrect treatment, the pathological process becomes irreversible.
- Pretibial myxedema. This complication is rare. It is manifested by itching, redness, swelling and thickening of the dermis tissues on the anterior surface of the lower leg. As a therapy, hormonal agents for topical use are prescribed.
In addition, the progression of hyperthyroidism can lead to the following consequences:
- atrial fibrillation;
- pulmonary edema;
- psychosis;
- heart failure;
- osteoporosis;
- toxic hepatosis;
- adrenal insufficiency;
- myopathy;
- diabetes;
- blood clotting disorder.
Alternative medicine recipes
Treatment of diffuse toxic goiter with folk remedies is recommended at the first stage of the disease. The following recipes serve as an addition to the main traditional therapy:
- Ripe chokeberry berries are mixed with honey or sugar in a 1:1 ratio, insisted in a cold place for seven days. Take daily on an empty stomach 40 grams, which is equivalent to two tablespoons without a slide.
- A sea s alt compress is applied to the thyroid gland for 55 days, of which 27 times the procedure is done daily, then every other day.
- Young willow leaves fill a three-liter saucepan, add water, put on fire and evaporate until a jelly-like sediment is obtained. The resulting mixture is smeared on the goiter for four months before bedtime.
- Every evening, an iodine mesh is applied to the goiter area. If traces of iodine are visible in the morning, the procedure is stopped.
- Prepare a tincture of walnut partitions, which should be drunk two hours before waking up, 15 ml for a month, then a 30-day break. If necessary, continue the course.
Diffuse toxic goiter: clinical guidelines
This is a special document that is issued at regular intervals and is designed for practicing doctors. Clinical guidelines contain the most up-to-date information, proven in practice on the following issues:
- diagnostics;
- treatment;
- rehab;
- prevention.
This document defines the algorithm of actions in the management of the patient. The doctor is given the right to choose methods of diagnosis and treatment, depending on the individual characteristics of the individual, his gender, age, as well as the course of the pathology. Currently, in practical medicine, the methods of therapy described in the clinical guidelines are used. Diffuse toxic goiter is recommended to be treated in three ways:
- conservative;
- surgical;
- radioactive iodine.
For each species, the level of evidence is given and comments are provided, which set out detailed treatment regimens and necessary examinations. In addition, side effects and complications arising from therapy are described. A special section is highlighted in the document, which indicates the requirements that are mandatory for the doctor, their fulfillment affects the outcome of the disease, in particular diffuse toxic goiter.
Conservative treatment
Designed to eliminate the manifestations of the disease. The use of tablet dosage forms allows you to achieve results after a month from the start of treatment. However, after the individual stops taking them, relapses occur. Several groups of drugs are used in therapy:
- Thyrostatics - "Propicil", "Merkazolil". They block the function of the gland, as a result, the synthesis of hormonal substances decreases. Treatment of diffuse toxic goiter with these drugs helps to normalize the functioning of the thyroid gland. Additionally, the drug "Eutiroks" is prescribed to prevent the occurrence of drughypothyroidism. In order to maintain the functions of the gland, monotherapy is carried out using small doses of thyreostatics.
- Beta-blockers and glucocorticoids are prescribed as symptomatic therapy in the presence of concomitant pathology (tachycardia, hypertension, palpitations, ophthalmopathy, osteoporosis) that accompanies the underlying disease.
Patients receive drug therapy for a year and a half.
Surgical treatment
This method is considered highly effective, but is fraught with various complications. The indication for this type of therapy is:
- moderate and severe disease;
- no result from other treatment;
- thyrotoxic adenoma;
- nodal and retrosternal forms;
- relapses;
- compression of the esophagus and trachea by goiter;
- childhood;
- first and second trimester of pregnancy;
- presence of complications in the form of atrial fibrillation.
Contraindication for surgery:
- diffuse toxic goiter complicated by mental illness;
- severe concomitant pathology of the kidneys, lungs and heart.
Before surgery, patients are prescribed the drug "Mercazolil" in order to normalize thyroid hormones, reduce toxic symptoms and prevent exacerbation of thyrotoxicosis after surgery. During the operation, the thyroid gland is removed almost completely. Only the areas where the parathyroid glands are located remain.
The use of radioactive iodine
When treating diffuse toxic goiter with this method, an isotope of radioactive iodine I-131 is injected into the patient's body, which affects the gland with gamma and beta rays, damaging its cells. As a result, the synthesis of hormonal substances is reduced. Treatment is carried out in stationary conditions. During therapy, it is recommended to limit iodine-containing foods.
Indications for this treatment:
- old age;
- severe side effects or intolerance to conservative therapy;
- refusal of the patient from the operation;
- impossibility of surgical intervention;
- development of postoperative thyrotoxicosis.
Contraindication to the use of radioactive iodine is:
- pregnancy;
- breastfeeding;
- retrosternal goiter;
- childhood;
- diseases of the blood, kidneys.
Can diffuse toxic goiter be cured?
Prognosis in the absence of treatment is extremely unfavorable. The patient develops serious complications, the disease progresses. With the normalization of the thyroid gland, the prognosis is good. In the case of surgical treatment of the disease, there is a high probability of the formation of hypothyroidism, in which metabolic processes slow down in the body of the individual. The reason for this phenomenon lies in the insufficient production of hormonal substances (triiodothyronine and thyroxine). Patients are advised to exclude foods and medicines containing a high concentration of iodine, as well as to reduceminimize exposure to direct sunlight.
Prevention measures include:
- Maintaining and strengthening the immune system, which includes hardening, regular walking, doing gymnastic exercises.
- Compliance with the diet. Include in your diet foods that contain animal and vegetable protein, raw vegetables and fruits.
- Exclusion of stress, as it plays a leading role in the development of pathology. In some cases, the doctor may recommend taking herbal sedatives.
- Timely treatment of viral infections.
There is no specific prevention of diffuse toxic goiter. To prevent pathology, dispensary observation by an endocrinologist in a polyclinic at the place of residence is indicated.
