Diffuse toxic goiter (Graves' disease): causes, degrees, treatment. Description of thyrotoxicosis by Adolf von Basedow. Conservative treatment of Graves' disease

Graves' disease is a type of hyperthyroidism that occurs mainly in women (7 times more often than in men) and most often manifests itself during the 3rd-4th decade of life. The disease is characterized by goiter, eye and skin lesions, but all three manifestations do not always occur together.

Causes of Graves' disease

There is a known familial predisposition to Graves' disease. Important role genetic factors play a role in the pathogenesis of the disease.

Hyperthyroidism occurs as a result of stimulation of thyroid-stimulating hormone receptors by autoantibodies to these receptors, the so-called thyroid-stimulating immunoglobulins. Excessive stimulation leads to an increase in the synthesis and secretion of thyroid hormones, as well as an increase in thyroid gland.

The reasons for the formation of autoantibodies to thyroid-stimulating hormone receptors are unknown, but it is assumed that infectious and environmental factors, as well as stress-induced immunosuppression, underlie this mechanism. The causes of Graves' disease manifestations in the skin and eyes are also unknown. Perhaps these manifestations are the result of a cross-reaction of thyroid-stimulating immunoglobulins with thyroid-stimulating hormone receptors on fibroblasts in the orbit and in the dermis. This interaction triggers the production of numerous cytokines and the synthesis of glycosaminoglycans by fibroblasts. Changes associated with the accumulation of glycosaminoglycans and tissues are clinically manifested by skin changes and ophthalmopathy.

Symptoms of Graves' Disease

Graves' disease often presents for the first time in various common symptoms and signs of thyrotoxicosis. Hypertension, heart failure and exacerbation may be detected, especially in elderly patients with accompanying illnesses of cardio-vascular system.

Manifestations of Graves' disease

• Anxiety
• Excessive sweating
• Fatigue
• feeling hot ( poor tolerance heat)
• Frequent defecation
• Irritability
• Menstrual irregularities
• heartbeat
• Shortness of breath or feeling short of breath
• Weight loss
• Energetic and strong pulse
• Elevated systolic pressure
• Fine silky hair
• Fine tremor of hands and tongue
• Hyperkinesia
• hyperreflexia
• Onycholysis
• Weakness of the skeletal muscles of the upper shoulder girdle
• Wide palpebral fissure, backlog upper eyelid from the iris of fixing the gaze on an object slowly moved down
• Tachycardia
• Warm moist smooth skin

The thyroid gland in Graves' disease is usually diffusely enlarged, and its consistency may vary from soft to firm. Noise or vibration may be felt over the gland, indicating increased vascularization. Often on palpation, an enlarged pyramidal lobe is determined.

Patients with Graves' disease may have eye socket changes (orbitopathy), including exophthalmos and proptosis. These changes can lead to complications ranging from mild hyperemia (with chemosis, conjunctivitis, and periorbital swelling) to corneal ulceration, neuritis ophthalmic nerve, atrophy optic nerve, exophthalmic ophthalmoplegia. Rapidly progressive exophthalmos is called malignant exophthalmos. Graves' disease also affects the extraocular muscles, leading to inflammation, muscle enlargement and subsequent fibrosis, dysfunction, and sometimes diplopia.

Skin lesions associated with Graves' disease usually appear on the dorsum of the feet or in the pretibial region as raised, thickened, hyperpigmented areas (" Orange peel"). Such lesions may be accompanied by itching and dense swelling.

Diagnosis of Graves' disease

Laboratory and instrumental research

In Graves' disease and other forms of thyrotoxicosis, there are elevated levels freely circulating T4 and T3, with an undetectable concentration of thyroid-stimulating hormone. Sometimes, only an increase in T3 concentration is detected. This condition is called T3 thyrotoxicosis. At radioisotope study Graves' disease is characterized by diffusely increased uptake of a radioisotope by the thyroid gland.

Differential Diagnosis

The presence of thyrotoxicosis, goiter and ophthalmopathy is considered an actual sign of Graves' disease. When a patient has a combination of such symptoms, radioisotope scanning is indicated only in rare cases.

A symmetrical goiter, especially if there is noise above it, is most characteristic of Graves' disease, although occasionally the causes of such manifestations can be a thyroid-stimulating hormone-secreting adenoma, as well as conditions associated with trophoblastic stimulation of the thyroid gland ( hydatidiform mole and choriocarcinoma). Palpation of a single nodular formation may indicate toxic adenoma, while multiple nodules suggest a multinodular goiter. Sensitive to palpation thyroid in patients who have undergone viral disease, suggests subacute thyroiditis. The absence of a palpable thyroid gland indicates an exogenous supply of thyroid hormones (artificial thyrotoxicosis) or, much less frequently, an ectopic source of thyroid hormone production (ovarian goiter).

Hyperthyroidism, with the exception of iodine-induced hyperthyroidism, is characterized by increased accumulation of the radiopharmaceutical on radioisotope scanning. Conversely, thyroiditis caused by excessive release of thyroid hormone depots is characterized by low rates radiopharmaceutical accumulation (usually<1%). У пациентов с эктопической тиреоидной тканью, как при яичниковом зобе, отмечается повышенное накопление радиофармпрепарата в области яичников.

Treatment of Graves' disease

All patients with Graves' disease require treatment with antithyroid drugs. Sometimes thionamides are used as first-line drugs to induce remission. In other cases, they are used for short-term therapy to manage the symptoms of the disease before being treated with radioactive iodine preparations or before surgery.

Conservative treatment

Therapy with thionamides

Propylthiouracil (PTU), methimazole, and β-adrenergic antagonists (β-blockers) are effective in the treatment of Graves' disease. b-Adrenergic blockers are used as adjuvants because they reduce many of the clinical manifestations of excessive sympathetic stimulation—tremor, palpitations, and anxiety.

In general, with the susceptibility of the patient, thionamides can very effectively stop hyperthyroidism.

In groups of children, adolescents and patients with small goiters and mild hyperthyroidism, spontaneous recovery is most characteristic when treated with thionamide drugs alone. It is noted that with longer treatment with thionamide drugs, prolonged remissions are more common. Therefore, most experts recommend taking thionamide drugs for at least 1 year.

Radioisotope therapy

Radioisotope therapy has been used to treat hyperthyroidism since the 1940s, and is the preferred treatment of choice by many for the treatment of elderly patients with Graves' disease. The method is also used for the treatment of toxic multinodular goiter and single (solitary) toxic adenomas, as well as for the ablation of residual thyroid tissue or malignant cells after subtotal thyroidectomy. Radioisotope therapy is absolutely contraindicated during pregnancy, as it can lead to fetal hypothyroidism.

When preparing patients for radioiodine therapy, thionamide preparations are prescribed, which reduces the level of thyroid hormones. After taking thionamide preparations, radioisotope therapy is carried out for 4-5 days, prescribing sodium iodide (131I) orally.

Although the goal of radioiodine therapy is to achieve a euthyroid state, hypothyroidism often develops as a result of treatment, depending on the dose. Based on the results of a year of follow-up of patients after radioisotope therapy, it was found that permanent hypothyroidism is detected in at least 50% of patients receiving high-dose therapy, while the results of a 25-year follow-up show that permanent hypothyroidism after low-dose therapy is observed in at least 25% of patients . Therefore, all patients treated with 131I require long-term follow-up. There is currently no evidence that radioiodine therapy increases the risk of developing thyroid cancer.

Surgical treatment

The main goal of surgical treatment is to eliminate hyperthyroidism by reducing the volume of functioning thyroid tissue. The amount of glandular tissue left is determined based on the volume of the enlarged gland.

Indications for Graves' disease

Since radioisotope therapy cannot be carried out during pregnancy, surgical treatment is indicated for all pregnant women with intolerance to thionamide drugs or if it is impossible to control hyperthyroidism by medication. Surgical treatment is also indicated for other patients with intolerance to thionamide drugs or radioiodine therapy, with large goiter that causes compression of the airways or dysphagia, or when patients choose surgical treatment instead of conservative therapy.

Preoperative preparation

Preparation of a patient with thyrotoxicosis for planned surgical treatment begins with the appointment of thionamide drugs until a euthyroid state is achieved, or at least until the symptoms of hyperthyroidism are controlled before surgery. β-blockers are used to reduce signs and symptoms associated with adrenergic stimulation. 7-10 days before the operation, potassium iodide is administered orally in the form of a saturated solution or Lugol's solution (contains 7 mg of iodine in one drop).

Patients requiring emergency thyroidectomy are treated for 5 days with betamethasone (0.5 mg every 6 hours), iopanoic Θ acid (500 mg every 6 hours), and propranolol (40 mg every 8 hours) before surgery. It has been proven that this dosing regimen allows safe and effective prevention of postoperative thyroid storm.

Operation technique

In most cases, thyroidectomy can be performed through a low transverse cervical incision (Kocher's approach). The skin, together with the subcutaneous muscle, is separated upwards to the top of the thyroid cartilage, downwards to the sternoclavicular joints and laterally to the inner edge of the sternocleidomastoid muscles.

Most prefer to divide the infrahyoid muscle vertically in the midline and separate it from the thyroid capsule using a blunt technique and lateral traction. After the detection of the upper pole of the thyroid gland, with care - so as not to damage the external branch of the laryngeal nerve - the superior thyroid artery and vein are ligated throughout. The release of the upper pole allows you to mobilize the lateral and posterior surfaces of the thyroid lobe and identify the inferior thyroid artery to the side of the gland.

The recurrent laryngeal nerve is found medially near the capsule of the gland at the point of intersection with the inferior thyroid artery. From this point, the recurrent laryngeal nerve is carefully traced to pass through the cricothyroid membrane, where it separates from the overlying thyroid gland. In the same zone, the upper parathyroid glands can be detected. As a rule, they are formations up to 1 cm in diameter, located at the intersection of the inferior thyroid artery and the recurrent nerve. Every effort must be made to preserve the parathyroid glands.

From this moment of the operation, it is safe to treat the lower and posterior venous branches of the thyroid gland. The isthmus of the gland is crossed between the clamps and the lobe of the thyroid gland is directly separated from the underlying trachea. If there is a pyramidal lobe located anterior to the trachea and larynx, it should be removed, as it can cause relapse of hyperthyroidism.

Patients with Graves' disease most often undergo bilateral subtotal resection of the thyroid gland. Such an operation requires repeating the steps described above on the opposite side. An alternative variant of the operation is a lobectomy on one side and a subtotal resection on the opposite side (Dunhill operation), in which a slightly larger piece of tissue remains, but it is much easier to carry out subsequent treatment.

Operation complications

Due to slight swelling due to tracheal intubation, signs of nerve damage may not be noticed immediately after extubation, but this is suggested by the deterioration of the patient's voice in the next 12-24 hours after surgery. Intraoperatively, to prevent such a complication, it is useful to stimulate the recurrent nerve with a special stimulator and palpate the contraction of the muscles of the larynx. If the patient develops hoarseness after surgery, the surgeon must ensure that nerve conduction is not impaired. If the external branch of the laryngeal nerve is damaged, the patient may experience rapid fatigue when talking and a slight change in voice, especially at high notes. Such damage can be critical for singers and public speakers. Therefore, every effort must be made during surgery to clearly identify and preserve the nerves, since the location of the nerves near the vascular thyroid pedicle contributes to such injuries. Transient nerve paresis occurs in 3-5% of patients. Restoration of nerve function in this case requires from several days to 4 months. Complete nerve damage occurs in 1% of cases or less.

When the parathyroid glands are damaged or excised, hypoparathyroidism develops. During the operation, it is necessary to isolate these glands and make every effort to preserve their blood supply, which in 30% of patients is carried out directly from the capsule of the thyroid gland. In case of violation of the blood supply to the parathyroid glands or when they are removed along with the thyroid gland, it is important to perform their autotransplantation. Transient hypoparathyroidism after thyroidectomy occurs in 3-5% of patients. Such a condition in the immediate postoperative period requires the appointment of vitamin D3 preparations and maintenance therapy with calcium preparations. Permanent hypoparathyroidism occurs in less than 1% of patients.

In the postoperative period, the patient needs close observation for early detection of bleeding or airway obstruction. In patients with progressive hematomas, increasing pain sometimes leads to hoarseness and the rapid development of symptoms of airway obstruction, stridor, and respiratory depression. If bleeding is suspected, it is necessary to remove the stitches, open the wound and immediately evacuate the hematoma (if necessary, right in the ward). Sometimes airway obstruction occurs as a result of subglottic or supraglottic edema. Treatment is conservative - inhalation of humidified oxygen and intravenous administration of corticosteroids.

Graves' disease (or diffuse toxic goiter) belongs to the group of endocrine autoimmune pathologies that affect the thyroid gland. For certain reasons, the thyroid tissue produces aggressive cells (antibodies), leading to diffuse damage to the tissue of the glandular organ, to the formation of seals and increased production of hormones.

This disease was studied and thoroughly described by the American George Graves (1835). In Russia, this pathology is often called Basedova in honor of the German practitioner Karl Adolf von Basedow (1840).

The process of hypertrophy and hyperfunction of the thyroid gland leads to the development of thyrotoxicosis, that is, to hormone intoxication. Pathology ranks first among endocrine diseases.

According to statistical studies, women are more often ill than men. Age for this pathology is also of great importance, apparently, this is due to puberty or a decline in the hormones of the reproductive system.

It is the age from 18 to 43 years that is acceptable for the development of diffuse toxic goiter. The pushing factor is iodine deficiency in drinking water.

Thyrotoxicosis is common in Russia in iodine-deficient regions such as the North Caucasus, the Urals, Altai, the Volga region and the Far East. Lack of iodine in water bodies exists in the northern part of the Russian Federation and Siberia.

Over the past 5 years, there has been a slight shift towards an increase in the incidence. This fact is explained by the following: an increased level of toxic substances in the air, soil or water, constant stressful situations, the use of fast food and products containing a large amount of preservatives and group E substances, an increased background radiation and frequent solar perturbations.

Etiopathogenesis of the disease

Graves' disease can be associated with a number of pathologies that cause genetic mutations in the form of clone or killer cells. Autoimmune aggression destroys one's own thyroid tissue, the main target of which is thyroid-stimulating hormone (TSH) receptors.

They function as recognizers of pituitary and hypothalamus hormones. It is they who affect the quantitative reproduction of TSH, and their antibodies disrupt the balance of production and contribute to excessive stimulation and an excessive increase in thyroxine and triiodothyronine.

As a result of these actions, intoxication begins in the body with damage to organs and systems. An autoimmune reaction leads to the development of goiter and ophthalmopathy. To start a pathological chain for the production of clones that destroy their own tissue, certain conditions are needed.

List of causes contributing to the development of toxic goiter:

• hereditary factor;
• Chronic infectious and viral diseases;
• Stress of any etiology;
• Traumatization of the skull;
• throat pathology;
• Neoplasms of benign and malignant etiology;
• Blood diseases;
• Radiation sickness;
• Poisoning with pesticides;
• Infectious and inflammatory processes in the body.

Risk factors for the development of autoimmune diffuse goiter are multiple sclerosis, leukemia, diabetes mellitus, type B and C hepatitis, as well as pregnancy, anemia, and a reduced immune system. Medicinal substances (Insulin, Interferon Alpha, Leukeran) and procedures (radiation and radioisotope therapy) used in a schematic therapeutic tactic of these pathologies can provoke Basedow's disease.

As for the pregnant condition of a woman: during the gestation of the fetus, autoimmune reactions may occur, perceiving the fetus as a "foreign invasion", the primary reaction begins with the thyroid gland.

Symptomatic picture

Graves' disease, whose symptoms begin with a change in size of the gland and a feeling of a foreign body in the throat, begins with complaints of unbearable irritability and cardiac arrhythmia.

Full list of symptoms:

The description of a disease unknown in the 19th century belongs to the American doctor Robert Graves. Inadequate behavior, depression, groundless clarifications and suspicions he named (later received the name or Graves' disease).

The thyroid gland becomes ill due to the increased activity of its cells, producing hormones necessary for normal functioning. She suffers from the negative effects of her cells, mistakenly taking them for alien ones, and fights against them. This process turns into - thyroiditis, which leads to the same increase in the thyroid gland.

The body produces antibodies that affect the ongoing changes in the increase in the active activity of the thyroid gland, which has a negative effect on it by thyroid hormones. Antibodies in the body arise for various reasons.

In patients, the existence of receptors is observed, the thyroid-stimulating hormone of the pituitary gland recognizes them as erroneous, and the immune system detects them as foreign bodies. Or the immune system is susceptible to a defect that does not protect its own cells. After suffering a disease, in some cases the body reacts with the appearance of antibodies.

Factors provoking thyrotoxicosis

Various factors provoke Graves' disease. They are like this:

• heredity;
• stress;
• lack of iodine in the body;
• environmental pollution;
• ENT diseases;
• head injury;
• infections of a different nature that affect the body.

The appearance of Graves' disease is often found in places where there is an acute lack of iodine.

The degree of thyrotoxicosis disease

Signs that determine the degree of the disease:

• I degree - the thyroid gland is palpable, although outwardly not noticeable.
• II degree - when swallowing, an enlarged thyroid gland is noticeable.
• III degree - deformation of the thyroid gland affects the change in the appearance of the neck.
• Grade IV - goiter is prominent.
• Grade V - a severe goiter protrudes, other tissues are pressed by the thyroid gland.

Very often, Graves' disease affects women under 50 years of age. The female body, due to physiological characteristics, has loads: pregnancy, childbirth, lactation period. Graves' disease is inherited, and it is important to identify the onset of the disease. Treatment of thyrotoxicosis in a woman will occur by bringing the level of hormones to a normal state with special drugs. These drugs do not penetrate the placenta, and the baby will form a thyroid gland without disturbances.

Symptoms of thyrotoxicosis

The symptoms of Graves' disease are determined through an autoimmune reaction and the functional activity of the thyroid gland. Part of the special hormones, if necessary, fills the follicle, which consists of thyroid cells. With negative manifestations, ejection occurs, a hormone that provokes. Treatment is prescribed complex. The inflamed thyroid gland brings thyroxine into the blood, when a high concentration is reached, it causes the onset of the manifestation of the disease -.

Sometimes a toxic adenoma is observed - this is an independent node, the action of which is produced by the hormones T3, T4. Rapid saturation of the body with iodine after a long deficiency of this trace element is the cause of this disease.

Description of thyrotoxicosis by Adolf von Basedow

Graves' disease was studied and new signs were identified by the doctor Adolf von Basedow, after which it still began to be called:. Symptoms of the disease are manifested as follows:

• The neck thickens, the goiter is visible as a holistic formation or having separate nodes;
• Intense palpitations, insomnia, tachycardia and rapid pulse occur.
• There is shortness of breath, in which asthma is diagnosed.
• Swelling of the eyelids, double vision, frequent lacrimation.
• Protruding eyeballs - exophthalmos. It can be seen in half of the patients who have this disease. The patient clearly manifests bulging eyes, accompanied by moisture and redness, and swelling is characteristic of the eyelids.
• The liver increases, stool becomes more frequent, frequent pains in the abdomen.
• Noticeable pigmentation appears around the eyes and on the palms.
• Increased sweating, hot even in cold weather.
• Skin moist and hot on contact;
• Mental changes are manifested - aggressiveness, restlessness, nervousness. Changes in mood are noticed: from gaiety to depression. With such vivid symptoms, emergency medical attention is needed.
• A tremor is noticed, fractional trembling is clearly visible on outstretched fingers.
• Osteoporosis develops, the risk of fractures increases - this refers to an excess of hormones that affect the decrease in calcium and phosphorus in the bones.
• Appetite increases, but significant weight loss is noticed.
• I want to constantly drink, frequent diarrhea and urination.
• Hair becomes brittle and brittle, actively fall out.

Graves' disease did not spare Nadezhda Konstantinovna Krupskaya, hitting her immune system. In appearance, bulging eyes were clearly expressed, and she could not become a mother.

Graves' disease stages

The main causes of Graves' disease or Graves' disease are: heredity and a polluted ecological environment, there are 3 stages of the disease:

• Easy stage - increased heart rate per minute up to 100 beats, decreased efficiency, absent-mindedness, increased fatigue, weight loss, tachycardia.
• The middle stage - weight loss by 20%, increased heart rate per minute up to 100-120 beats, increased nervousness.
• Severe stage - failures in the cardiovascular system and liver, loss of working capacity, mental problems, weight decreases by more than 20%, pulse beats per minute increase to 200.

Diagnostic methods

An endocrinologist diagnoses Graves' disease. The onset of the disease is determined in the region of the thyroid gland, and then an ultrasound is prescribed. A blood test is also needed to determine the levels of thyroxine, thyroid-stimulating hormone, triiodothyronine. To detect cardiac pathologies, an electrocardiogram is necessary.

An important factor for diagnosing the body is a hormonal examination that helps determine the degree of accumulation of thyroid hormones. You can get enough information about the disease by conducting an analysis that detects changes in the volume of the thyroid gland. In case of urgent need, a radioisotope study is carried out.

The treatment of Graves' disease is long and complicated, because all body systems are affected, the chance of complete remission is 50%.

Features of Graves' disease therapy

• Medical. It is used in two cases: as an independent treatment for Graves' disease, and as a preparation for more complex therapies. Thyrostatic drugs are used. The correct use of the dose helps to relieve the symptoms of the disease. Drug overdose will lead to aggravation of hyperthyroidism. Together with these drugs, treatment requires taking sedatives that promote good sleep and relieve nervous excitability, and beta-blockers that reduce the negative effect of excess hormones.
• Thyroidectomy. With an increased size of the thyroid gland, squeezing the tissues around, a part of it is cut out. This treatment is used when symptoms return after stopping the pills. The operation is done after bringing the hormones back to normal through medication therapy.
• . This method, which affects Graves' disease, consists in the fact that the thyroid gland, which can store iodine, takes a radioactive drug that takes away the ability to produce excess hormones. This method of treatment is used for patients with contraindications to surgical interventions and for elderly people who have not been helped by medications. Graves' disease therapy is carried out in two ways: one-time and fractionally extended. First, the patient is brought to a state of iodine deficiency - this contributes to the rapid penetration of radioisotope iodine, it is dosed depending on the state of the thyroid gland. This method of treatment should not be used with severe bulging eyes, pregnancy and lactation. The positivity of this method of treatment is that there are no scars, there is almost no bleeding, and the recurrent nerves are not injured.

Thyrotoxicosis in children

Graves' disease is observed in children, the real causes are still unknown. Doctors have suggested that the disease occurs due to various infections or chronic ENT diseases.

Prolonged uncontrolled exposure to the sun, alcohol addiction of parents, mental or physical nature of injuries, hereditary predisposition - can lead to thyrotoxicosis. Children become whiny with mood swings, and are prone to uncontrollable twitching of the arms, head, and facial muscles. Early signs of Graves' disease - an accelerated heartbeat occurs, the pulse rate per minute is up to 90 beats. In some adolescents with Graves' disease, there may be a suspension of sexual development.

The duration of treatment in children with thyrotoxicosis is up to 3 years, they have to constantly take medications that help the thyroid gland to normalize its work.

During the treatment of Graves' disease, a constant diet enriched with proteins and reducing the intake of salty and sugary drinks is required. Surgical operations are performed only with a greatly enlarged goiter and with advanced disease. Radioiodine therapy for children is not used.

Prevention measures

For the prevention of Graves' disease, simple actions should be performed:

• eat foods containing iodine;
• undergo an examination of the thyroid gland with the help of ultrasound for prevention by a doctor 2 times a year;
• exclude unbearable physical activity for the body;
• support the body intake;
• strive to create favorable relationships in the team and family.

At the first minor signs of Graves' disease, you should immediately contact a medical facility. Self-treatment of Graves' disease is an increased danger, the consequences can be irreversible.

Diffuse toxic goiter is an endocrine disease. In Russia, it is especially often observed among residents of the North-West. In our country, it is customary to call this thyroid disorder a diffuse toxic goiter. The term is common in Germany. In world medical practice, the term Graves' disease is more often adhered to.

Whatever the name, the essence remains the same. Diffuse toxic goiter - . The disease is caused by excessive production of thyroid hormones by diffuse tissue of the thyroid gland. The body does not need so many hormones, which is why there is literally poisoning with them - thyrotoxicosis.

Thus, we can say that everything is to blame for a malfunction in the functioning of the immune system. Synthesized for this reason, antibodies to the thyroid-stimulating hormone receptor begin to act against the patient's own thyroid gland. This process does not lead to destruction, on the contrary, it activates more than before, calling for a greater intensity of hormone production. Under the influence of antibodies, an increased number of hormones accumulate in the body, poisoning it from the inside.

Graves' disease is a concomitant syndrome of hyperthyroidism. It is believed that people between the ages of 30 and 50 are most susceptible to it. However, cases of the disease are not uncommon among adolescents, young and old people.

According to experts, genetic predisposition is important. It has been proven that the hereditary component in many cases is the cause of the disease. Factors that provoke it:

• mental trauma;
• Traumatic brain injury;
• Diseases of the nasopharynx;
• Infectious and inflammatory processes in the body.

Getting from the outside, viruses begin to attack the body's immune system, provoking an attack on its own thyroid cells. Some medications aimed at treating multiple sclerosis or hepatitis may also trigger thyrotoxicosis, such as Interferon-alpha and Interferon-beta. Persons taking these drugs should be especially attentive to the thyroid gland and monitor whether its condition has worsened during the course.

Graves' disease is 8 times more common in women than in men. Maybe it's estrogen, the female sex hormone. This phenomenon has not yet been accurately explained by scientists.

The process of bearing a child also carries the likelihood of developing this disease. In this regard, it is not the pregnancy itself that is dangerous, but the cells of the fetus, which can penetrate the mother. The body of a woman in such a situation can respond to them by damaging the tissues of her thyroid gland.

There is no consensus among specialists about stress as the cause of diffuse toxic goiter. A number of honored scientists believe that during moments of experience, adrenaline and noradrenaline are released into the blood by the adrenal glands. These hormones affect the work of many organs and systems, including the thyroid gland, enhancing its work.

How does the disease manifest itself?

One of the main symptoms of the disease, which is noticeable even far from medicine, is bulging eyes (ophthalmopathy). Bulging eyes become due to scarring of soft tissues. There is a formation of a stable swelling of the muscles responsible for eye movement. Contrary to popular belief, not every Graves disease patient has this symptom. The latest statistics speak of only 30% of all patients with diffuse toxic goiter.

Typical symptoms of diffuse toxic goiter:

• Arrhythmia, rapid pulse and palpitations, tachycardia, hypertension;
• Sudden weight loss, fever, diarrhea;
• Sweating, swelling, brittleness and thinning of the nail plates;
• Tremor, weakness, fatigue, irritability, tearfulness.

According to patients, they are haunted by bouts of causeless crying. They can explode because of the little things and get offended, just as quickly move away. Increased excitability and irritability, anger against the background of weakness and rapid fatigue - these are the first manifestations. The work of both the nervous system of the body and the cardiovascular apparatus is disrupted.

Symptoms are quite specific, it happens that the patient independently puts forward an assumption about the diagnosis. Even if you are sure that you have been affected by Graves' disease, do not try to start treatment without contacting a specialist. We strongly advise you to visit an endocrinologist.

How is the disease diagnosed?

Before starting treatment, the doctor needs to conduct a series of studies. As a rule, the diagnosis includes:

• Blood tests for hormones and antibodies;
• Ultrasound examination of the thyroid gland;
• Thyroid scan.

As for the tests, the indicators of thyroid-stimulating hormone, free triiodothyronine and thyroxine, and the thyroid-stimulating hormone receptor, alanine aminotransferase, aspartate aminotransferase, and bilirubin are important to the endocrinologist. In Graves' disease, a high level of hormones T3 and T4 is observed, it is underestimated and is less than 0.1 μIU / ml, it deviates from the norm upwards.

With Basedow's disease, the structure of the thyroid gland undergoes changes: it becomes heterogeneous, darkened, enlarged. When conducting doplerometry in the tissues, increased blood flow is observed. Scanning is not for every patient.

Usually, the doctor resorts to this method to make sure that he has a diffuse toxic goiter, and not autoimmune thyroiditis. The difference lies in the uptake of iodine by the gland: in Graves' disease, there is an increase in uptake, in autoimmune thyroiditis, it is weakened.

What are the ways of treatment?

There are various methods of treatment. It is important to know that doctors give the most favorable prognosis for a complete recovery with the right method. The tablet technique is the most popular among European and Russian doctors. Thyreostatics are used - this is a group of drugs whose action is aimed at reducing the production of hormones by the thyroid gland, by reducing the uptake of iodine. These include drugs such as propicil, mercazolil, tyrosol and others.

Based on the specific situation, the patient's condition, laboratory and ultrasound data, the endocrinologist will prescribe the dosage individually. On average, the course lasts about one and a half years, after which a second examination is scheduled to compare the indicators. About 35% of patients after the pills say goodbye to the disease forever. The rest will be forced to continue drug therapy again.

With the ineffectiveness of several courses, patients are recommended a more radical method - surgery or another option - taking radioactive iodine. Both methods are currently available in Russia within the framework of federal quotas, which means free assistance. Radioactive iodine is a great alternative to surgery. In America, it is with him, and not with pills, that they begin the treatment of the disease.

The principle is the accumulation of radioactive iodine by the body in the right acceptable dosage for the subsequent destruction of the gland. If the gland tissue is not completely destroyed, a relapse is possible. The effectiveness of treatment with this technique directly depends on the volume of the gland. It is believed that the more iron, the more likely a relapse.

In order to get rid of bulging, in most cases, prescribe the drug prednisolone. The choice of treatment method depends on gender, age, symptoms, comorbidities and test results. A purely individual approach is applied to each patient, which is why it is so important not to self-medicate. Doctors recommend taking an additional blood test every month while taking the pills to monitor the level of platelets and leukocytes.

Graves' disease, also called Graves' disease, or diffuse toxic goiter, is one of the most common pathologies of the thyroid gland. Today, this problem has acquired particular urgency: according to the observations of physicians, for several years now there has been a steady increase in the number of people suffering from this disorder.

The disease is not considered deadly, but the occurrence of this pathology can have serious consequences for the whole body, so the disease requires timely diagnosis and mandatory treatment.

What is Graves' disease

Graves' disease (ICD-10 code E05.0) is a chronic autoimmune disorder in which there is an increase and hyperfunction of the thyroid gland, leading to the development of thyrotoxicosis. In this disease, the body's own defenses show aggression towards the cells of the endocrine organ, but do not destroy it, but overly stimulate activity.

This is due to the production of thyroid-stimulating hormone in the blood. Due to constant stimulation, the thyroid tissue grows, provoking the formation of a goiter, and the level of hormones T3 (thyroxine) and T4 (triiodothyronine) increases.

Such pathological processes affect many body systems, often causing concomitant diseases.

It has been noticed that women aged 20-40 suffer from Graves' disease 8 times more often than men, and this is largely due to the physiological characteristics of the body. Graves' disease is extremely rare in the elderly and toddlers.

The reasons

The pathogenesis is still not fully understood, and doctors cannot give an exact answer to the question of why this disease occurs. Nevertheless, thanks to a number of studies, experts were able to find out that the following factors influence the development of Graves' disease:

• heredity;
• infectious diseases;
• pathology of the respiratory organs;
• endocrine pathologies;
• autoimmune disorders;
• mental trauma;
• smoking;
• iodine deficiency;
• unfavorable ecological situation;
• strong physical and emotional stress.

In some patients, the development of this disease is the result of exposure to several negative factors at once.

In the vast majority of cases, it is not possible to identify the true cause of the development of Graves' disease even after conducting the necessary studies.

Symptoms of Graves' Disease

The most striking manifestations of Graves' disease in children and adults are:

• exophthalmos (bulging eyes);
• a sharp decrease in body weight against the background of increased appetite;
• fast fatiguability;
• increased sweating, frequent feeling of heat;
• tremor of fingers;
• unstable work of the central nervous system (irritability, aggression, tearfulness, tendency to depression);
• arrhythmia, tachycardia.

Some patients may experience negative changes in the work of the digestive, reproductive, respiratory systems. With Graves' disease, the thyroid gland is enlarged, which causes pain and discomfort when swallowing, and the shape of the neck changes.

Treatment of Graves' disease

There are 3 ways to treat diffuse toxic goiter: conservative, surgical and radioiodine therapy. The choice of a suitable technique occurs individually and depends on the severity of the course of the disease and the characteristics of the patient's body.

If the pathology is not running, then there is a chance to eliminate the endocrine disorder with the help of drug therapy. Conservative treatment is aimed at normalizing the level of thyroid hormones and restoring thyroid function. For this, preparations based on thiamazole (Merkazolil, Tyrozol) and propylthiouracil (Propicil) are used.

Taking medicines for Graves' disease takes place only as prescribed by a specialist and under his control, since careful monitoring of the reaction of the patient's body is necessary.

As the patient's condition normalizes and the symptoms of the pathology are eliminated, the dosage of the drugs used is gradually reduced.

Along with antithyroid therapy, immunomodulating agents are used that restore the body's natural defenses, beta-blockers that prevent the development of complications from the cardiovascular system, and other groups of medications for symptomatic treatment. Since the disease affects the metabolism and the condition of the bone tissue, the patient is advised to eat right and perform strengthening exercises.

The effectiveness of conservative therapy reaches approximately 35%. Often, after the end of taking antithyroid drugs, the disease develops again.

Surgical intervention is also carried out in severe forms of the disease, during pregnancy and lactation, the presence of nodes and a strong increase in the endocrine organ.

Before the operation, a mandatory medical preparation of the body with the use of thyreostatics is carried out. Otherwise, in the postoperative period, the patient may experience a thyrotoxic crisis. After the removal of the gland, the patient is forced to take hormonal drugs for life.

Treatment takes place under the supervision of a doctor in a medical institution. Acute symptoms of the disease after radiation therapy disappear within six months. The risk of re-development of the disease and the occurrence of complications when using the isotope of radioactive iodine is minimized.

Complications

In the absence of proper timely treatment, Graves' disease can adversely affect the vital systems of the body and cause complications of varying severity, up to complete loss of working capacity and death.

The most dangerous consequence of Graves' disease is thyrotoxic crisis.

This is a serious condition, accompanied by many clinical manifestations and can lead to kidney and heart failure, liver atrophy, coma and death. Thyrotoxic crisis requires immediate medical attention.

Radiation therapy (radioiodine therapy) is a good alternative to surgery. Today, this method is considered the most effective and safe way to treat Graves' disease.

Other complications of Graves' disease include:

• decreased visual acuity;
• circulatory disorders in the brain;
• osteoporosis;
• hepatosis;
• diabetes;
• sexual dysfunction in men;
• infertility;
• amenorrhea and other menstrual disorders in women.

Diet

Since Graves' disease is accompanied by a violation of metabolic processes, the patient must follow a special diet aimed at regularly replenishing the supply of nutrients in the body. The diet should contain a large amount of vitamins and amino acids, and carbohydrate food should be the basis of nutrition. To normalize weight, the energy value of meals must be increased by 30% compared to the usual diet.

People suffering from Graves' disease benefit from high-fiber foods (fruits, berries, vegetables), seafood, cereals (rice, buckwheat, oatmeal), chicken egg yolks. It is better to choose lean meat, while it should be boiled, stewed, baked, steamed, but not fried. The same applies to all other dishes.

Patients with Graves' disease are shown fractional meals - at least 5 times a day. Portions should be small, but high in calories.

If it is not possible to compensate for the deficiency of nutrients with the help of diet correction, it is necessary to consult with your doctor regarding the intake of vitamins.

Prevention

There are no specific measures to prevent the development of Graves' disease.

Maintaining a healthy lifestyle, adherence to proper nutrition, timely treatment of other diseases and avoiding stressful situations will help reduce the risk of pathology.

After the age of 30, it is necessary to visit an endocrinologist at least once a year and conduct an examination of the thyroid gland in order to detect possible disorders early, especially in the presence of a genetic predisposition to the development of Graves' disease.