Thyrotoxic goiter is a chronic disease of the thyroid gland of autoimmune origin. This disease is accompanied by an increase in the secretion of thyroid hormones, which, accordingly, affects the state of the whole organism. As the disease progresses, the tissues of this endocrine organ begin to hypertrophy - the gland increases in size. By the way, in medicine, this ailment is also known under the term Basedow's disease in honor of the German doctor who first described its symptoms.
Unfortunately, many adult patients face similar problems. And, of course, they immediately begin to look for information about what is diffuse thyrotoxic goiter and why it occurs. What are the symptoms to look out for? What treatments can the patient expect? What are the possible consequences of the disease? The answers to these questions will be useful to many readers.
Diffuse toxic goiter: general information about the disease
Of course, firstturn, it is worth talking about what constitutes thyrotoxic goiter. The pathogenesis of the disease becomes clear if you understand the basic functions of the thyroid gland.
The thyroid gland is an endocrine gland, consisting of the left and right lobes, connected by an isthmus. The work of this organ is of great importance, because it is here that such important hormones as thyroxine and triiodothyronine are synthesized. These biologically active substances regulate almost all stages of metabolism in the human body, ensure normal growth, and regulate energy metabolism. In addition, specific cells of the thyroid gland synthesize the hormone calcitonin, which ensures normal calcium metabolism in the body and prevents the development of osteoporosis.
The work of the gland is regulated by the hypothalamic-pituitary system according to the feedback principle. By the way, the thyroid gland is the most vascularized organ in the human body.
Thyrotoxic goiter is an ailment that is accompanied by hypertrophy of gland tissues, as well as increased secretion of thyroid hormones. Their excess enhances metabolic reactions in the body, which leads to its depletion. At the same time, the nervous and cardiovascular systems suffer the most.
According to statistics, women aged 20 to 50 are most susceptible to this disease. Thyrotoxic goiter in men is also possible, but much less common.
What are the reasons for the development of the disease?
Why does diffuse toxic goiter develop? Causes of the diseaseunfortunately not fully explored. It is only known that the disease has an autoimmune nature. For one reason or another, the human immune system begins to produce specific antigens that attack the cells of one's own thyroid gland.
The mechanism of occurrence of such failures in the body is not well understood. Nevertheless, scientists were able to identify several risk factors that contribute to the onset of the disease:
- There is a hereditary predisposition (if you have people in your family who suffer from thyroid diseases, then you are more likely to develop goiter).
- Risk factors include hormonal disruptions, including impaired functioning of the hypothalamic-pituitary system.
- Uncontrolled use of iodine preparations contributes to increased synthesis of thyroid hormones.
- The disease can be triggered by strong constant stress, mental trauma.
- Risk factors include diabetes.
- Severe, lingering infectious diseases deplete the immune system, which can disrupt its normal function.
- According to statistics, thyrotoxic goiter is twice as likely to be diagnosed in smokers.
Unfortunately, not in every case, the doctor can accurately determine the cause of thyrotoxic goiter.
Thyrotoxic goiter: classification
There are several classification systems for this disease. Depending on the severity, they are distinguished:
- mild form of goiter - pathologic althere are no disturbances in other organs of the endocrine system, no cardiac arrhythmias are observed, patients complain of neurotic symptoms;
- moderate form of the disease, it is accompanied by tachycardia, heart palpitations, as well as rapid weight loss (up to 10 kg per month);
- severe form, which is accompanied by a large loss of body weight, exhaustion of the body, functional disorders of the heart, liver and kidneys.
Depending on the characteristics of the thyroid gland, they are distinguished:
- diffuse goiter - small lesions are evenly distributed throughout the tissues of the entire organ;
- nodular thyrotoxic goiter - there are several large lesions in the place of which seals (nodules) form;
- mixed form combines both nodular and diffuse thyroid lesions.
In addition, the so-called aberrant thyrotoxic goiter is also distinguished. In this case, we are talking about the defeat of ectopic thyroid tissues located along the thyroglossal duct (such a deviation is associated with a violation of the processes of embryogenesis). It should be noted that damage to aberrant tissues is considered extremely dangerous, as it often leads to malignant degeneration of nodes and the development of cancer.
Diffuse goiter (thyrotoxic): photos and symptoms
Naturally, an important point for many patients is the clinical picture of the disease. So what disorders are accompanied by thyrotoxic goiter?Symptoms of the disease can be different, because an increase in the level of thyroid hormones affects the work of almost all systems and organs. However, most often patients complain of neurotic disorders and heart problems.
Disorders of the cardiovascular system are expressed by tachycardia. Even at rest, the heart rate can increase to 120-130 beats per minute. Patients note that they sometimes feel their own heartbeat in the chest, abdomen, head, and even limbs. As the disease progresses, systolic pressure increases, while diastolic pressure, on the contrary, decreases. Patients also experience increased respiration and increased susceptibility to pneumonia. If left untreated, thyrotoxicosis can lead to severe myocardial dystrophy.
Catabolic syndrome is another disorder that accompanies diffuse goiter (thyrotoxic). Its symptoms are, first of all, a sharp weight loss against the background of increased appetite. Sometimes patients lose 10–15 kg in 1–2 months. In addition, there is a general weakness of the body, increased sweating, as well as a violation of thermoregulation. Even at low temperatures, patients often complain of a feeling of heat. In the evening, a periodic increase in body temperature to subfebrile values is possible.
Thyrotoxic goiter is also accompanied by ophthalmopathy, namely bulging eyes, which appears as the disease progresses. Due to the lowering of the lower and the rise of the upper eyelids, the eyelids do not close completely, the eyeballsbulge out. A patient with advanced thyrotoxicosis is easy to notice - his face acquires a constant expression of fear and surprise. Due to the fact that the eyelids do not close completely, the person suffers from dryness of the conjunctiva and a constant feeling of “sand in the eyes”. A common complication is chronic conjunctivitis. Periorbital tissues gradually grow, periorbital edema occurs, which leads to compression of the eyeball and nerve endings, partial or complete loss of vision.
Excess thyroid hormones also affect the functioning of the nervous system. In patients, increased irritability, anxiety, aggressiveness, tearfulness, sudden mood changes, problems with concentration, in a word, some kind of mental instability can be noted. Signs of the disease include depression, sleep disturbances. In milder cases, people have a fine tremor of the fingers. As the disease progresses, the volume of muscles decreases, and therefore it is difficult for the patient to actively move.
Against the background of thyrotoxic goiter, other disorders are possible:
- as the disease progresses, patients experience a decrease in bone density due to the leaching of calcium and phosphorus;
- severe forms of the disease are accompanied by the development of adrenal insufficiency, which is visually manifested in skin hyperpigmentation;
- disturbances in the digestive system are not excluded, including abdominal pain, vomiting, unstable stools, and in more severe cases, toxic hepatosis and cirrhosis;
- men with hormonal disorders can developerectile dysfunction and gynecomastia;
- possible changes in the female reproductive system, including ovarian dysfunction, menstrual irregularities, development of fibrocystic mastopathy;
- signs of the disease include vitiligo, as well as darkening of the skin in the area of natural folds, hair loss, weakening of nails;
- an increase in the size of the thyroid gland is also possible, but not at all necessary - many patients experience severe forms of thyrotoxicosis with normal thyroid size; nevertheless, in 20-30% of cases, there is an increase in the size of the gland, the appearance of the actual "goiter", which can lead to compression of the trachea, the appearance of a sensation of a foreign body in the throat.
What complications can the disease cause? Thyrotoxic crisis
As you can see, if left untreated, this disease affects almost all organ systems, leading to the development of heart failure, cirrhosis of the liver, and adrenal dysfunction.
However, there is another dangerous complication that diffuse toxic goiter can lead to. Thyrotoxic crisis is an acute condition that usually develops on the background of improper therapy or after surgery.
The earliest signs of a crisis are fever (sometimes body temperature rises sharply to 40 degrees), excessive sweating, emotional lability. Sometimes disorders of the central nervous system are more pronounced - mildanxiety is replaced by aggression and a pronounced manic syndrome.
The consequences of a thyrotoxic crisis include rapid progression of congestive heart failure, vascular collapse, pulmonary edema, coma. In about 30-40% of cases, the crisis ends in the death of the patient. That is why it is so important to diagnose thyrotoxic goiter in time. Its symptoms are a reason to immediately consult a doctor.
Modern diagnostic methods
Only after a thorough examination, the doctor can make a diagnosis. Moreover, differential diagnosis of simple and thyrotoxic goiter is needed.
In fact, even after an external examination, a specialist may suspect the presence of hyperthyroidism. Based on this, the patient is prescribed further tests. Ultrasound examination can detect diffuse enlargement of the thyroid gland and changes in its echogenicity.
Differential diagnosis of simple and thyrotoxic goiter necessarily includes a blood test for the level of thyroid hormones and pituitary thyroid stimulating hormone. ELISA tests are also carried out to detect the presence in the blood of specific antibodies to thyroglobulin, thyroid peroxidase and TSH receptors (this proves the presence of an autoimmune process).
An informative study is thyroid scintigraphy, which allows you to accurately determine the volume and shape of the organ, the presence of nodular formations in it, as well as to find out the volume of functional tissues in which, in fact,hormones are synthesized.
Medicated treatment
What to do if a patient is diagnosed with thyrotoxic goiter? Treatment directly depends on the stage of development of the disease, the disorders present, the severity of thyrotoxicosis.
If we talk about drug therapy, then it includes taking antithyroid drugs, in particular Mercazolil, Tyrozol, Metizol, and Propicil. These drugs stop the synthesis of hormones in the tissues of the thyroid gland.
In addition, the introduction of molecular iodine or its s alts into the body on the basis of a negative relationship blocks the production of pituitary hormones that stimulate thyroid activity. Naturally, such treatment should be carried out exclusively under the supervision of a physician.
Since thyrotoxicosis is accompanied by disorders of the cardiovascular system, patients are recommended to take beta-blockers that restore heart rhythm, reduce heart rate, improve myocardial nutrition and normalize blood pressure. Depending on the presence of certain symptoms, the patient may be prescribed sedatives and hypnotics, muscle relaxants, anticonvulsants and antipsychotics.
If there is a risk of developing a thyrotoxic crisis, hormonal drugs, namely glucocorticosteroids, are introduced into the treatment regimen, which prevent the sharp development of adrenal insufficiency.
Surgical treatments
The operation is prescribed for patients who havethe disease progresses rapidly or was diagnosed in the later stages, and drug therapy does not give any results. An indication for surgical intervention is a strong increase in the thyroid gland.
Naturally, the complete removal of the thyroid gland is impossible, because the absence of thyroid hormones will entail total changes in the functioning of the body. That is why doctors perform a partial resection of the organ, preserving a small area of glandular tissue. Thus, hormones are still being synthesized, but in smaller quantities.
Cases of recurrence after surgery are possible. For greater safety, conservative therapy is carried out before and after surgery, and sometimes radioactive iodine treatment.
Radioiodine treatment and its features
You can fight the disease with the help of radioactive iodine. The fact is that the radioactive substance introduced into the body is much faster absorbed by the tissues of the thyroid gland and, emitting beta rays, destroys the functional cells of the organ. In their place, connective tissue is formed that is not able to produce hormones.
This is a rather aggressive treatment regimen that can lead to consequences such as hypothyroidism, toxic hepatitis, acute inflammation of the thyroid gland. That is why it is prescribed only in extreme cases. Indications for such therapy are severe forms of the disease, exacerbations after surgery, as well as the ineffectiveness of drug treatment.
Prognosis for patients
Diffuse thyrotoxic goiter -the disease is extremely dangerous. If left untreated, this disease gradually leads to exhaustion, mental disorders, cardiovascular failure and death of the patient.
On the other hand, for people who have undergone treatment, the prognosis is quite favorable. With the help of medicines, it is possible to restore the normal functioning of the thyroid gland and the natural hormonal background. According to statistical studies, after the end of therapy, the patient's cardiomegaly gradually regresses, and sinus rhythm is restored. Naturally, it is recommended to avoid taking medications and foods containing high doses of iodine.
As for surgical treatment, after surgery, people often develop hypothyroidism, which requires some medical correction.
Are there methods of prevention?
Unfortunately, today many people are faced with the diagnosis of "thyrotoxic goiter". The history of the disease, causes and possible complications, effective methods of treatment are important points for each patient. On the other hand, it is no secret to anyone that the disease is much easier to prevent than to deal with the consequences of the disease.
Unfortunately, there are no specific preventive methods. If you have a hereditary predisposition, it is recommended to visit the endocrinologist's office at least twice a year. The sooner the disorder is diagnosed, the easier it will be to correct the patient's condition.
It is very important to be treated on time for any infectious diseases. And, of course,a he althy lifestyle, including the absence of constant stress, physical activity, proper nutrition, will positively affect the state of not only the thyroid gland, but also all body systems.
