Thyrotoxic goiter: causes and treatment

Thyrotoxic goiter is a chronic thyroid disease of autoimmune origin. This is accompanied by an increase in the secretion of thyroid hormones, which, accordingly, affects the condition of the whole organism. As the disease develops, 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 Basedova disease in honor of a German doctor who first described her symptoms.

Unfortunately, many adult patients face similar problems. And, of course, they immediately begin to look for information about what a diffuse thyrotoxic goiter is and why it arises. What symptoms should I pay attention to? What methods of treatment can the patient expect? What are the possible consequences of the disease? Answers to these questions will be useful to many readers.

Diffuse toxic goiter: general information about the disease

Naturally, in the first place, it is worth talking about what is thyrotoxic goiter. The pathogenesis of the disease becomes clear if one understands the basic functions of the thyroid gland.

The thyroid gland is the gland of internal secretion, consisting of the left and right lobes, connected by an isthmus. The work of this body is of great importance, because it is here that important hormones such as thyroxine and triiodothyronine are synthesized. These biologically active substances regulate almost all the stages of metabolism in the human body, ensure normal growth, regulate energy metabolism. In addition, specific thyroid cells synthesize the hormone calcitonin, which provides a normal exchange of calcium in the body, 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, thyroid is the most blood-supplying organ in the human body.

Thyrotoxic goiter is an ailment that is accompanied by hypertrophy of the gland tissues, as well as increased secretion of thyroid hormones. Their excess increases the metabolic reactions in the body, which leads to its exhaustion. In this case, the nervous and vascular system is most affected.

According to statistics, women in the age of 20 to 50 years are most susceptible to this disease. Thyrotoxic goiter in men is also possible, but it is much less common.

What are the causes of the development of the disease?

Why develop diffuse toxic goiter? The causes of the disease, unfortunately, are not fully understood. It is only known that the ailment is of an autoimmune nature. For one reason or another, the human immune system begins to produce specific antigens that attack the cells of the thyroid gland.

The mechanism of occurrence of such failures in the body has not been studied enough. 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 the family who suffer from thyroid dysfunction, then the probability of developing goiter is higher for you).
• Risk factors include hormonal failures, including a disruption in the functioning of the hypothalamic-pituitary system.
• The uncontrolled use of iodine drugs promotes an increased synthesis of thyroid hormones.
• The disease can be caused by strong permanent stress, mental trauma.
• Risk factors include diabetes mellitus.
• Severe, protracted infectious diseases deplete the immune system, which can disrupt its normal functioning.
• 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 of the following:

• An easy form of goiter - pathological disorders in other organs of the endocrine system are absent, cardiac arrhythmias are not observed, patients complain of neurotic symptoms;
• The average form of the severity of the disease, it is accompanied by tachycardia, palpitations, and rapid weight loss (up to 10 kg per month);
• Heavy 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 lesion of the thyroid gland, there are:

• Diffuse goiter - small lesions are evenly distributed across the tissues of the whole organ;
• Nodal thyrotoxic goiter - there are several large lesions, in the place of which seals (nodules) are formed;
• Mixed form combines both nodular and diffuse lesions of the thyroid gland.

In addition, there is also a so-called aberrant thyrotoxic goiter. In this case, we are talking about the lesion of ectopic thyroid tissue located along the course of the thyoglossal duct (a similar deviation is associated with a violation of embryogenesis). It is worth noting that the defeat of aberrant tissues is considered extremely dangerous, since 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 the increase in the level of hormones shchitovidki affects the work of almost all systems and organs. Nevertheless, most often patients complain of neurotic disorders and heart problems.

Disorders from the cardiovascular system are expressed by tachycardia. Even at rest, the heart rate may increase to 120-130 beats per minute. Patients note that sometimes they feel their own heartbeat in the chest, stomach, head and even limbs. As the disease progresses, the systolic pressure increases, and the diastolic pressure, on the contrary, decreases. Patients also experience increased respiratory rate, increased propensity to pneumonia. In the absence of therapy, thyrotoxicosis can lead to severe myocardial dystrophy.

Catabolic syndrome - another violation, which is accompanied by diffuse goiter (thyrotoxic). Symptoms of it - is, in the first place, a sharp loss of weight against a background of increased appetite. Sometimes patients lose 10-15 kg in 1-2 months. In addition, there is general weakness of the body, increased secretion of sweat, 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, the eyelid, which appears as the disease progresses. By lowering the lower and lifting the upper eyelids do not close completely, the eyeballs protrude. A patient with neglected thyrotoxicosis is easy to notice - his face acquires a constant expression of fright and surprise. Due to the fact that the eyelids do not close completely, the person suffers from the dryness of the conjunctiva and the constant sensation of "sand in the eyes". A chronic complication is chronic conjunctivitis. Ophthalmic tissues gradually expand, periorbital edema occurs, which leads to squeezing of the eyeball and nerve endings, partial or complete loss of vision.

Excess hormones shchitovidki affects the functioning of the nervous system. Patients can note increased irritability, anxiety, aggressiveness, tearfulness, sudden mood changes, problems with concentration, in a word, some kind of mental instability. The signs of the disease include depressive conditions, sleep disorders. In more mild cases, people experience a small 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 violations are possible:

• As the disease develops, patients experience a decrease in bone density due to the washing out of calcium and phosphorus;
• Severe forms of the disease are accompanied by the development of adrenal insufficiency, which is visually manifested in hyperpigmentation of the skin;
• The disturbances on the part of the digestive system are not excluded, including abdominal pain, vomiting, unstable stools, and in more severe cases - toxic hepatosis and cirrhosis;
• In men with hormonal disorders, erectile dysfunction and gynecomastia may develop;
• Changes are possible on the part of the female reproductive system, including ovarian dysfunction, menstrual irregularities, development of fibrocystic mastopathy;
• To the signs of the disease can be attributed vitiligo, as well as darkening of the skin in the field of natural folds, hair loss, weakening of nails;
• An increase in the size of the thyroid gland is also possible, but it is not necessary - many patients have severe forms of thyrotoxicosis at normal thyroid size; Nevertheless in 20-30% of cases there is an increase in the size of the gland, the appearance of the "goiter" itself, which can lead to the squeezing of the trachea, the sensation of a foreign body in the throat.

What complications can cause the disease? Thyrotoxic crisis

As can be seen, in the absence of treatment, this disease affects almost all organs, leads to the development of heart failure, cirrhosis, and adrenal disorders.

Nevertheless, there is another dangerous complication, to which a diffuse toxic goiter may result. Thyrotoxic crisis is an acute condition, which usually develops on the background of incorrect therapy or after surgery.

The earliest signs of a crisis are fever (sometimes body temperature rises to 40 degrees), increased sweating, emotional lability. Sometimes disorders of the central nervous system are more pronounced - slight anxiety is replaced by aggression and pronounced manic syndrome.

The consequences of thyrotoxic crisis include rapid progression of congestive heart failure, vascular collapse, pulmonary edema, and coma. Approximately in 30-40% of cases, the crisis ends with the patient's death. That is why it is so important to diagnose thyrotoxic goiter in time. Symptoms of it - this is an occasion 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. Therefore, the patient is given further tests. Ultrasound can detect a diffuse increase in the thyroid gland and a change in its echogenicity.

Differential diagnosis of simple and thyrotoxic goitre necessarily includes a blood test for the level of thyroid hormones and thyroid-stimulating hormone of the pituitary gland. There are also immunoenzyme assays that allow to detect the presence of specific antibodies to thyroglobulin, thyroid peroxidase and TSH receptors in the blood (this is proved by the presence of an autoimmune process).

An informative study is scintigraphy of the thyroid gland, which allows you to accurately determine the volume and shape of the organ, the presence of nodal formations in it, and also to find out the volume of functional tissues in which hormones are actually synthesized.

Medication

What if the patient has thyrotoxic goiter diagnosed? Treatment directly depends on the stage of development of the disease, the disorders present, the severity of thyrotoxicosis.

Speaking of drug therapy, it includes the use of antithyroid drugs, in particular Mercazolil, Tyrozola, Metizol, and Propitsila. These drugs stop the processes of the synthesis of hormones in the tissues of the thyroid gland.

In addition, the introduction of molecular iodine or its salts on the principle of a negative bond blocks the production of pituitary hormones, which stimulate the activity of the thyroid gland. Naturally, such treatment should be carried out exclusively under the supervision of a doctor.

Since thyrotoxicosis is accompanied by cardiovascular disorders, patients are recommended to take beta-blockers, which restore the heart rate, 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, anticonvulsant and antipsychotic drugs.

At a risk of developing thyrotoxic crisis, hormonal drugs, namely glucocorticosteroids, are introduced into the treatment regimen, which prevent the sudden development of adrenal insufficiency.

Surgical methods of treatment

The operation is prescribed to patients who develop a disease quickly or have been diagnosed at later stages, and drug therapy does not produce any results. Indications for surgical intervention is a strong increase in thyroid gland.

Naturally, complete removal of the thyroid gland is impossible, because the absence of thyroid hormones will entail total changes in the work of the body. That is why doctors perform a partial resection of the organ, while retaining a small area of glandular tissue. Thus, hormones are still synthesized, but in less quantity.

Cases of relapse after surgery are possible. For greater safety before and after surgical intervention, conservative therapy is performed, and sometimes treatment with radioactive iodine.

Treatment with radioactive iodine and its features

It is possible to fight the disease with the help of radioactive iodine. The fact is that the radioactive substance introduced into the body is much more quickly absorbed by the tissues of the thyroid gland and, radiating beta rays, destroys the functional cells of the organ. In their place, connective tissue is formed, unable to produce hormones.

This is a rather aggressive treatment regimen, which can lead to such consequences as hypothyroidism, toxic hepatitis, acute inflammation of the thyroid gland. That is why he is appointed only in extreme cases. Indications for such therapy are severe forms of the disease, exacerbations after surgery, as well as inefficiency of drug treatment.

Projections for patients

Diffuse thyrotoxic goiter - the disease is extremely dangerous. In the absence of treatment, this ailment gradually leads to the depletion of the body, mental abnormalities, cardiovascular insufficiency and the patient's death.

On the other hand, for people who have been treated, the predictions are quite favorable. With the help of medications, it is possible to restore the normal functioning of the thyroid gland and the natural hormonal background. As shown by statistical studies, after the termination of therapy, the patient's cardiomegaly gradually regresses, and the sinus rhythm is restored. Naturally, it is recommended to avoid taking medications and products containing large doses of iodine.

As for surgical treatment, after the operation, people often develop hypothyroidism, which requires a certain drug correction.

Are there methods of prevention?

Unfortunately, today many people are faced with a diagnosis of "thyrotoxic goiter". The case history, causes and possible complications, effective methods of treatment are important points for each patient. On the other hand, it is not a secret for 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, then it is recommended to visit the endocrinologist's office at least twice a year. The earlier the disorder is diagnosed, the easier it will be to correct the patient's condition.

It is very important to undergo treatment in time for any infectious diseases. And, of course, a healthy lifestyle, including the lack of constant stress, physical activity, proper nutrition, will positively affect the condition of not only the thyroid gland, but all the body systems.