What is Graves' disease: symptoms and treatment. I received thyreostatic therapy for a year and a half. I have not taken any drugs for three months and my thyroid function is normal. When can I plan a pregnancy? Leak process

Graves' disease ( diffuse goiter) - this is the name of the most famous and widespread. It is familiar to many of us from a photo from textbooks, which depicts people with a goiter on their neck and bulging eyes.

This is what a diffuse goiter is, it is treated with the help of hormone therapy. Even before its appearance, it was believed that the only way cure Graves' disease - remove part thyroid gland. During the Middle Ages, no one thought at all about how to treat this disease. People with strange eyes were simply burned at the stake, as they were considered sorcerers and witches.

Fortunately, today Graves' disease can be called well-studied. And for its treatment, there are several very effective methods.

Variety this disease can be called nodular colloid goiter.

Causes of the disease

There are many reasons leading to the appearance of this disease. Modern doctors suggest that the greatest role in the occurrence of the disease is played by hereditary predisposition.

In addition, in the past few years, scientists have found that Graves' disease is autoimmune in nature, that is, it is associated with an insufficiency of the immune system. For this reason, it can be put on a par with hepatitis, rheumatism and ulcerative colitis.

The very occurrence of the disease, and to be more precise, the likelihood that a person will get sick with it, is associated with many factors. The first one belongs to mental trauma and infections. When an infection enters the body, defense mechanisms are launched in it, which lead to the fact that the immune system selects the thyroid gland as a target.

Remember that even if you have a predisposition to Graves' disease, this does not mean that you will definitely get it.

Degrees of the disease

The severity of Graves' disease is characterized by how severely affected:

1. Light degree . With it, a decrease in body weight by 10-15 percent, a rapid heartbeat and a decrease in working capacity are noted.
2. Medium. Here, about 20% of body weight is already lost, a person feels high nervous excitability, and the heart beats at about 100-120 beats per minute.
3. severe stage. Signs: strong weight loss, tachycardia, occurrence atrial fibrillation, liver damage, poor circulation and almost complete disability.

Symptoms of the disease

All symptoms, and some of them have already been named earlier, can be divided into 3 main groups:

Goiter, which becomes noticeable even with visual contact. Moreover, how much does not speak about the severity of the disease. That is, in men, the goiter can be enlarged quite slightly and almost not palpable. The enlargement of the gland in them passes due to the lateral parts, which are tightly adjacent to the trachea.

Puffy eyes. Here again, everything is very individual. One will simply have strangely shining eyes, while the other may have deformed eyelids.

Tachycardia is a rapid heartbeat.

These signs can be called characteristic of Graves' disease, but in addition to them, there are also other symptoms that manifest themselves in this disease.

A person suffering from an ailment such as Graves' disease will complain about how he feels general weakness, his irritability increases, sleep is disturbed. In addition, you can notice almost complete heat intolerance and sweating.

Sometimes there are pains of a compressive or stabbing character in the heart. Appetite also increases, but the weight tends to go down. An excess of gland hormones leads to the fact that trembling appears in the fingers, tongue and the whole torso. There is almost fear.

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

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 in the body accumulates increased number hormones that poison him 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, importance It has genetic predisposition. 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 immune system organism, provoking an attack on its own thyroid cells. Some medical devices, the purpose of which is the treatment multiple sclerosis or hepatitis, can also serve as a trigger for thyrotoxicosis, for example, 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 a consensus among specialists about stress as a cause of diffuse toxic goiter no. 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 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. Work is disrupted as nervous system body and cardiovascular system.

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 in front of him, 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?

Exist various techniques treatment. It is important to know that doctors give the most favorable prognosis for a complete recovery with the right method. 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 research, the endocrinologist will write out the dosage of the intake 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 - surgical intervention or another option is the intake of radioactive iodine. Both methods are currently available in Russia within federal quotas, which means free provision help. 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 what more iron the more likely it is to relapse.

In order to get rid of bulging, in most cases, prescribe the drug prednisone. The choice of treatment method depends on gender, age, symptoms, comorbidities and analysis indicators. Applies strictly individual approach to every patient, which is why it is so important not to self-medicate. Doctors recommend taking monthly pills while taking the pills. additional analysis blood to control the level of platelets and leukocytes.

Graves' disease is an endocrine disease characterized by enlargement of the thyroid gland due to increased output hormones.

This disease is also called Graves' or diffuse toxic goiter.

Mostly, women under the age of 40 suffer from pathology.

Signs of the onset of the disease

Graves' disease is indicated by a reduced level of thyroid-stimulating hormone in the blood, as well as increased amount thyroxine.

This means that the production of these hormones by the thyroid gland occurs autonomously and is not controlled by the pituitary gland.

The problem is caused by diffuse toxic goiter. In order to confirm the diagnosis, antibodies must be found in the blood that affect the functioning of the gland.

Experts distinguish 3 degrees of the disease:

1. A mild degree proceeds with an increase in heart rate up to 100 beats / min. and slight weight loss. There is also a slight change in the work of the nervous system.
2. The average degree proceeds with an increase in heart rate up to 120 beats / min. and more marked weight loss. There is a change in the boundaries of the heart. The patient suffers from impaired performance.
3. A severe degree is characterized by an increase in heart rate of more than 120 beats / min., Significant exhaustion. The patient has liver damage, the appearance of heart failure, arrhythmias. The nervous system is severely affected. The person becomes disabled.

Clinical picture

Graves' disease affects almost all organs and systems. Increased production of thyroid hormones leads to weight loss, fever, frequent urination, dehydration.

The disease is characterized by: increased peristalsis, increased acidity of the stomach. In women, there is a violation of the menstrual cycle.

In male patients, there is a noticeable decrease in potency. Moderate and severe degrees of the disease lead to infertility.

The long course of Graves' disease leads to exophthalmos and osteoporosis. At the onset of the disease, trembling of the fingers, increased sweating, periodic increase heartbeat, drastic changes in a mood.

Patients may notice the appearance of anxiety, irritability. There are complaints about bad dream, deterioration in attentiveness.

Often, the patient complains of stuffiness. Even with good nutrition noticeable thinness appears.

Treatment Methods

Graves' disease is treated with medicines. The doctor prescribes first high doses, which then gradually decrease.

At proper treatment the symptoms of the disease go away within two months, but therapy should continue even after the disappearance of all signs and last up to six months, and sometimes up to two years.

During pregnancy, a sick woman is prescribed the minimum dosage of drugs.

After childbirth, a woman should be constantly monitored by an endocrinologist.

With maintenance therapy, breastfeeding is allowed.

During this period, reception vitamin complexes, sedatives.

It is forbidden to use iodized salt and foods rich in iodine in the diet. Doctors do not recommend sunbathing.

Endocrinologists prescribe the drugs Mercazolil and Methylthiouracil. The doctor selects the dosage, and then changes it individually, depending on the severity of the symptoms.

Blood tests are done every two weeks.

Along with antithyroid drugs, b-blockers, glucocorticoids, sedatives and preparations containing potassium.

Immunomodulating therapy suppresses the antibodies that lead to goiter. With the help of b-blockers, the load on the heart decreases, the heart rate decreases and blood pressure normalizes.

If treatment with drugs does not bring the desired effect, therapy is used radioactive iodine.

This method is not carried out for people planning children, since radioactive iodine damages thyroid cells, which impairs its functioning.

With no effect on drug treatment, as well as the appearance adverse reactions for these drugs, surgery, the purpose of which is to remove part of the gland.

Intervention does not eliminate the causes of the disease. The operation is not performed when:

• mild degree diseases;
• slight enlargement of the gland;
• severe violation of cerebral circulation;
• with a recent heart attack;
• after an infectious disease;
• the presence of concomitant severe pathologies that can lead to death during surgery.

Possible Complications

Left untreated, Graves' disease can lead to complete infertility.

A serious consequence of the disease can be; thyrotoxic coma associated with severe liver intoxication, disruption of the nervous system, deterioration of the heart and adrenal glands.

This consequence is a threat to the life of the patient. Often it is promoted by: severe nervous shock, excessive physical exercise, infectious diseases.

Thyrotoxic coma can lead to surgical intervention and treatment with radioactive iodine, if medical compensation is not carried out in the right amount.

Preventive measures

To prevent the onset of Graves' disease, healthy lifestyle life, support and strengthen the immune system.

Important to treat in a timely manner viral infections and exacerbations chronic diseases. You should also avoid stress, sunbathe less. After 30 years it is recommended to pass regular examination at the endocrinologist.

Graves' disease is damage to the thyroid gland as a result of excessive production of hormones.

The severe course of this disease can lead to complete disability and even to thyrotoxic coma. Timely treatment will help prevent dangerous consequences.

The doctor will tell you about Graves' disease in the video.

Diffuse toxic goiter(other names for this disease are Graves' disease , Graves' disease ) - this is pathological process, which is characterized by an increase thyroid gland diffuse nature while the patient has symptoms.

Officially diffuse-toxic goiter was first described by the Irish Robert James Graves(1835), and German Karl Adolf von Basedow(1840). It is their names that are called in modern medicine it's a disease.

The reasons

This disease is autoimmune in nature. Its main feature is increased function thyroid gland ( hyperthyroidism ). Gradually, the size of the thyroid gland increases, and it produces much more thyroid hormones than with normal operation. It is generally accepted that the main mechanism of the autoimmune process in patients with diffuse toxic goiter is the production of special ones by the immune system. As a result, the human thyroid gland is constantly overactive. The consequence of this is an increase in the concentration of thyroid hormones in the patient's blood.

Why Graves' disease leads to the appearance of such antibodies, scientists have not yet determined exactly. There is a theory that patients Graves' disease there are “wrong” TSH receptors in the body. It is their immune system that defines a person as "strangers". There is also a version that the main reason why a person suffers from diffuse toxic goiter is the presence of a defect in the immune system. As a result, human immunity is not able to contain the immune response directed against tissues. own body. Modern physicians are engaged in research aimed at determining the role different types microorganisms for disease development.

In addition, the causes of Graves' disease leading to its progression are stress , infectious diseases , mental trauma .

Symptoms

Graves' disease in humans is expressed by signs characteristic of thyrotoxicosis. Symptoms of Graves' disease are determined by the fact that in the patient's body there is an acceleration of all metabolic processes. He has a rapid pulse, diarrhea is often observed, and sweating is very active. There is also stimulation of the nervous system, which leads to the fact that a person becomes very irritable, sometimes his hands tremble. A patient who develops Graves' disease does not tolerate heat and sun very well.

Often, in the presence of appetite, the patient loses weight, since the food that enters his body does not keep up with compensating for the too rapid breakdown of proteins. In addition, the large amount of hormones that the thyroid gland produces causes too rapid breakdown of nutrients, which, in turn, leads to high energy costs. But in patients with young age often body weight increases, although there are signs of increased metabolism. Increased urination that occurs with this disease often leads to dehydration. That is why the treatment of Graves' disease should be timely and correct.

Often with Graves' disease it is noted endocrine ophthalmopathy , which is typical for . The most common ophthalmopathy different severity develops with diffuse toxic goiter. In most cases, both eyes are affected, and the signs of this disease, as a rule, develop along with the main symptoms of diffuse toxic goiter. But sometimes ophthalmopathy develops earlier or later than thyroid disease.

Increased production of thyroid hormones leads to changes in behavior, mood changes, there is a strong touchiness, depression. Sometimes phobias develop, and a condition may also occur periodically. Sleep disorders accompany very frequent awakenings, disturbing dreams.

Later, the patient has goiter - Tumor-like enlargement of the gland, which is visible to the naked eye. In this case, there is swelling on the surface of the neck in front, which the doctor easily notices upon examination.

It is customary to distinguish three degrees of severity of the disease. If, with a mild degree of thyrotoxicosis, there are moderate symptoms, then with severe thyrotoxicosis in a person, the heartbeat increases, weight loss reaches the degree catechism , the person suffers from weakness. If the disease is not treated in time, it is possible to develop thyrotoxic crisis .

Diagnostics

If you suspect the development of Graves' disease, you should consult an endocrinologist for a consultation. The basis for a comprehensive diagnosis is the presence characteristic symptoms. In the course of the research, laboratory analysis blood to determine the amount of thyroid hormones, as well as the titer of classical antibodies and the iodine-accumulative function of the thyroid gland. If the doctor visually determines that the thyroid gland is enlarged, the patient undergoes an ultrasound scan.

Another study that is practiced with suspicion of diffuse toxic goiter much less frequently is a fine-needle biopsy of the thyroid gland. The specialist takes cells from the thyroid gland using a thin needle for this. The cells are then examined under a microscope. Such a procedure is advisable if the doctor detects a nodular formation in the gland that is easily palpable, or its size is more than 1 cm in diameter.

In the process of diagnosis, the patient should be aware that the enlargement of the thyroid gland does not depend on the severity of the degree of the disease.

Treatment

To date, there is no specific specific method therapy of those processes that lead to the development of the disease. Diffuse toxic goiter should be treated in such a way as to reduce the signs of thyrotoxicosis. Initially, the treatment of diffuse toxic goiter involves taking a thyreostatic drug, which is selected by the attending physician. In the process of receiving such medication the symptoms of the disease in many patients become less pronounced. Drugs that reduce the production of thyroid hormones must be prescribed to children and young people under 25 years of age. Such drugs are also used to treat patients at an older age, and they must also be taken to reduce the symptoms of the disease before surgery.

However, the main problem in this case is the fact that immediately after the withdrawal of such a drug, a relapse of the disease is often noted, both in adults and in children. If there is a relapse, then the patient is prescribed an operation in which part of the gland is removed. This operation is called a thyroidectomy. Except traditional operation destruction of gland cells is practiced with the help of radioactive iodine .

The patient takes radioactive iodine in capsules. The dose of the drug depends on the size of the goiter. Gradually, iodine accumulates in the cells of the thyroid gland, which leads to their death. Before taking iodine, the patient stops taking antithyroid drugs. After treatment with radioactive iodine, the symptoms of the disease disappear after a few weeks. In some cases, assigned re-treatment. Sometimes the function of the thyroid gland is suppressed completely. Despite the fact that such treatment seems relatively simple and convenient, it is rarely used for the treatment of children and young people. Doctors are wary of the possibility harmful effect such treatment on the body as a whole. Although the use of this method for about forty years did not reveal a harmful effect on other body systems.

The attending physician also takes into account the fact that, as a rule, improves the condition of a patient who has a mild disease. However, sometimes in a pregnant woman, the condition, on the contrary, worsens.

Symptoms of the disease are also effectively reduced by drugs from another group - beta-blockers. They are able to block the impact too a large number hormones secreted by the thyroid gland, on the body, but do not act directly on the thyroid gland.

Surgical treatment is practiced when too large sizes goiter, as well as in the absence of effect after taking medication. Thyroidectomy is performed in a hospital, after which hospitalization continues for several more days.

The doctors

Medications

Prevention

To prevent the development of Graves' disease, you must observe correct image life without stress. It is very important for women to follow these rules at a time when the risk hormonal disruptions increases. Patients with Graves' disease should not be exposed to the sun, swim in the sea, take hydrogen sulfide baths. You should always try to maintain peace of mind, periodically visit sanatoriums with specialized treatment. The patient's diet should be high in calories, large quantity carbohydrates. It is important to limit animal proteins in the diet, and also rarely consume those foods that have an exciting effect on the body (tea, coffee, spicy dishes and etc.). It is worth eating foods containing iodine: sea ​​kale, seafood, vegetables and fruits.

Graves' disease affects 1 in about 200 people and is usually more common in women than in men. It is an autoimmune disease and main reason Hyperthyroidism is a condition in which the thyroid gland produces too much hormone. If the disease is diagnosed and treated correctly, remission can be achieved. However, if left untreated, it can lead to serious, even life-threatening consequences, and the approach official medicine treatment can be just as aggressive.

Your thyroid gland produces hormones that control metabolism and regulate extremely important metabolic functions, such as heartbeat, energy level, weight, hair growth, mood, brain function and more. Normally, the thyroid gland receives its instructions from the thyroid-stimulating hormone TSH, which is produced in the pituitary gland. However, in Graves' disease, the body's immune system "revolts" and releases antibodies that attack TSH receptors. As a result, the thyroid gland overworks, producing dangerously high levels of thyroid hormones that feverishly speed up the metabolism.
This may lead to:

• heart palpitations
• weight loss
• insomnia
• shivering (tremor)
• muscle weakness
• high body temperature
• sweating
• anxiety or panic attacks

1. Eliminate gluten (gluten)

– in many people, gluten causes chronic inflammation in the intestine. This causes your immune system, which is already attacking your thyroid, to produce even more antibodies. Worse yet, to the immune system, gluten and the thyroid look very similar in structure to each other, so it often confuses the two, a phenomenon known as molecular mimicry. This means that your immune system attacks your thyroid even more when you eat foods containing gluten.

2. Eat Sea Vegetables

- this is natural source iodine, and they are rich in micronutrients, including copper and zinc. All these nutrients are essential for the proper functioning of the thyroid gland. sea ​​vegetables These are seaweed, wakame, nori/red seaweed, dark red edible seaweed (dulse), and hijiki.

3. Add Selenium

- when the thyroid gland converts iodide to iodine to produce hormones, oxidizing agents (oxidants) are produced that cause an autoimmune reaction. Selenium neutralizes oxidizing agents, and studies show that increasing selenium levels in patients with autoimmune disease thyroid reduces the level of thyroid antibodies. Meat, fish, and shellfish are rich in selenium, so add more of these foods to your diet.

4. Purify the air.

Coal-fired power plants (TPPs) annually release tons of mercury into the atmosphere. Mercury is dangerous to our health for many reasons, but studies have shown that women with high level mercury are more than twice as likely to have antibodies to thyroid gland. You can use a HEPA air filter to remove mercury and breathe safe, clean air; and also, you can purify the air with plants such as aloe vera, crested chlorophytum and bamboo palms.

5. Remove amalgam fillings.

Dentists use amalgam fillings, which contain mercury and release mercury vapor that can enter the bloodstream. If you have amalgam fillings, visit your dentist to discuss the impact they can have on your health and options for replacing them.

6. Relieve stress

Find ways to minimize stress. This is one of the most important changes lifestyle that you can do. Stress renders Negative influence on your immune system and gut, so reducing your stress levels is very, very important in overcoming Graves' disease.

Everyone relieves stress differently, so explore and experiment with what works best for you. Spend some time in prayer or fresh air in nature, get a massage or learn to meditate. Just remember to practice stress relief regularly.

7. Get enough sleep

- sleep, by at least, 8 to 10 hours is needed for correct operation thyroid gland. Turn off your computer at least an hour before bed, dim the lights, read a book or enjoy a cup chamomile tea. Take a shower or bath to wash away the day. A sachet of lavender in the bedroom will also help relax your mind and body for a great night's sleep.

8. Drink herbs

– naturally regulate your thyroid hormones and reduce the symptoms of hyperthyroidism. You can take these herbs in addition to help manage your symptoms while you are treating the underlying causes of your Graves disease.

If you or someone you know is struggling with Graves' disease, don't give up. There are many hidden factors that contribute to disease and they can be difficult to unravel, but thanks to advances in functional medicine and our understanding of how the factors environment affect our health, you can address the underlying causes of your illness and reverse your illness.