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Diffuse toxic goiter (Graves disease): causes, extent, treatment

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Diffuse toxic goiter is an autoimmune damage to the thyroid gland. Autoimmune diseases are caused by improper work of immunity. The aggression of the body’s defense system is directed not at bacteria or viruses, but at its own cells. Autoimmune diseases include type 1 diabetes, lupus erythematosus, glomerulonephritis, rheumatoid arthritis and many other diseases. Usually an autoimmune reaction leads to the destruction of some kind of cells, reducing the function of the organ.

Graves' disease is distinguished from other autoimmune diseases by the atypical effect of antibodies. They not only do not destroy the cells of the thyroid gland, but, on the contrary, have a stimulating effect on them. The reason for this unusual effect is in the antibodies themselves, more precisely at the point of their application. In diffuse toxic goiter, thyroid stimulating hormone (TSH) receptors located on thyrocytes cause autoimmune aggression. These are protein structures that are located on the surface of the thyroid cells. Normally, they are connected to TSH, which produces and secretes the pituitary into the blood. This tropic hormone is a signal from the central endocrine organs, causing the thyroid gland to produce more hormones. Thus, antibodies to the TSH receptors, combined with the object of their aggression (receptor), act as the thyroid-stimulating hormone itself, increase the production of thyroid hormones.

Symptoms of diffuse toxic goiter

Diffuse toxic goiter most often affects women from 30 to 50 years. Symptoms consist of signs of an autoimmune reaction and hyperthyroidism. Autoimmune damage is manifested in the enlargement of the thyroid gland, damage to the adrenal glands, eyes, skin, adipose tissue, muscles. When examining a patient, a thickening of the neck is revealed, this area is painless when feeling, and the gland tissue is elastic. In half of the cases there is eyelid edema, tearing, double vision, exophthalmos. Dark-colored dark spots may appear around the eyes and on the palms. The skin on the front of the lower leg may thicken. Developed severe muscle weakness. Hyperfunction of the thyroid gland is associated with an excess of thyroid hormones (thyroxin and triiodothyronine). It is manifested by increased metabolism in the body, disorders of the nervous, cardiovascular systems, the gastrointestinal tract. Patients develop sweating, constant feeling of heat, low-grade body temperature. Many patients lose weight, although their appetite is preserved or even increased. Typical crying, irritability, sleep disturbance. There is tremor in the whole body and especially in the hands. Disturbed heart palpitations, interruptions in the work of the heart, increased blood pressure. Also often there are pains in the abdomen, frequent stools, enlarged liver.

There are 3 severity of thyrotoxicosis: mild, moderate and severe. The degree depends on the loss of body weight and the severity of damage to the cardiovascular system. With a mild patient loses less than 10% of the weight, the pulse does not exceed 100 per minute. The average degree of severity is manifested by a loss of body weight up to 20%, the pulse is 100-120 per minute. If the weight falls by more than 20%, and the heart rate becomes more than 120, then it is customary to talk about severe thyrotoxicosis.

Diagnosis of diffuse toxic goiter

Hormonal examination and ultrasound examination of the thyroid gland are of fundamental importance for diagnosis. An increase in the concentration of thyroid hormones and a decrease in TSH are usually detected. Ultrasound reveals an increase in the volume of the thyroid gland, a decrease in tissue echogenicity and an increase in the vascular pattern. If there is such a possibility, a radioisotope study is carried out. Iodine isotopes (131, 123) and technetium (99m) are used. Affected thyrotoxicosis of iron quickly accumulates radioactive elements. When scanning revealed an increase in the size of the body, increased capture of the isotope, its uniform distribution in the tissue. When scanning revealed an increase in the size of the gland, increased capture of the isotope, its uniform distribution in the tissue. The most modern diagnostic method is the determination of specific antibody titers in the blood. If an increased content of antibodies to TSH receptors is detected, then the diagnosis of diffuse toxic goiter is beyond doubt.

Principles of treatment of diffuse toxic goiter

There are three main methods of treatment: medical, surgical, radioisotope. In Russia, the first two methods are more often used.

Drug treatment used independently and as a preparation for radical treatment. Conservative therapy is carried out with the help of thionamides, which block the synthesis of thyroid hormones. Schemes with simultaneous appointment of thionamides and levothyroxine are not currently popular. Drugs are prescribed for a long time (up to 2 years). The success of conservative therapy is achieved only in 30% of cases. To assess remission, it is possible to use an analysis of antibody titer to TSH receptors. Thyrostatics are canceled after 1-1.5 years if antibodies in the blood are no longer detected.

Indications for surgical treatment are a large volume of the thyroid gland, the presence of symptoms of compression of the surrounding tissues, the recurrence of thyrotoxicosis after withdrawal of the tablets, an allergy to thionamides. Subtotal resection of the thyroid gland or the removal of organ tissue is usually performed. The operation should be performed on the background of the normal content of hormones in the blood, that is, after the patient's drug preparation.

In a number of countries in the first place goes radioisotope treatment. Its contraindications: pregnancy, breastfeeding, severe eye damage. Two types of therapy are applied: one-time and fractional-extended. Iodine isotope is always used (131). The dose depends on the volume of the thyroid gland. The advantages of radioisotope treatment are the absence of scars, the risk of bleeding, damage to the recurrent nerves during surgery.

The first mention of Graves disease

The first disease that shook Europe was described in 1835 by doctor Robert Graves. He combined the oppressed state, inadequacy in actions, showdowns and family disassembly with one concept - thyrotoxicosis (otherwise - Graves' disease, diffuse toxic goiter). The principle of the manifestation of the disease is the development of antibodies by the body, which provoke the hyperactive activity of the thyroid gland due to the transformations that occur, and the thyroid hormones also have a negative effect.

There are several factors that cause antibodies. One of the versions assumes the existence in patients of "erroneous" receptors in relation to the thyroid-stimulating hormone of the pituitary (TSH), which are determined by the immune system as foreign bodies. Or, directly, the immune system itself has a defect that prevents the containment of protection against its own cells. Also, the formation of antibodies can be the result of a disease.

Sources of problems

The reasons for the occurrence of Graves disease are ambiguous. Among them are the following:

  • Hereditary factor.
  • Lack of iodine in the body.
  • Unfavorable environmental conditions.
  • Stressful situations.
  • Diseases of ENT organs.
  • Traumatic brain injury.
  • General infectious diseases.

Most often, terrain with a lack of iodine in the atmosphere is the reason why the population appears massively diffuse toxic goiter. The extent to which the disease is classified depends on the size of the formation and signs of damage:

  • 1 degree. The visually enlarged thyroid gland is not excreted, but it is palpable.
  • 2 degree. The thyroid gland can be noticed while swallowing.
  • 3 degree. The thyroid gland in connection with its own deformation changes the external structure of the neck.
  • 4 degree. Goiter excretion.
  • 5 degree. A very hard stage in which there is a heavy goiter, and the thyroid gland squeezes the adjacent organs.

Graves disease most often affects women between the ages of 30 and 50. This is due to the physiological specifics of the organism subjected to repeated loads (pregnancy, labor, breastfeeding). Taking into account the hereditary nature of the disease, it is very important to timely detect hyperthyroidism in a pregnant woman, whose treatment will be to normalize the hormonal level by using special drugs that do not penetrate the placental barrier, which will not affect the formation of the thyroid gland in the unborn child.

The course of the disease

By its symptoms, Graves disease manifests itself in signs of an autoimmune reaction and an extremely active function of the thyroid gland. In other words, there is a certain arsenal of hormones that, as needed, enter the follicle, which is a collection of thyroid cells. The possible action of unfavorable factors provokes the release of the hormone thyroxin, which causes hyperthyroidism, the treatment of which requires complex therapy. Getting into the blood through the inflamed thyroid gland, reaching a significant concentration in it, thyroxin causes the first manifestations of the disease, in this case, called subacute thyroiditis.

It is possible the occurrence of toxic adenoma, which is a self-acting node that produces the hormones T3 and T4. The reason for the appearance in this case is a sharp increased intake of iodine in the body with a long-existing deficit of this trace element.

Signs of illness

Graves' disease, whose symptoms affect the whole body, was described by doctor Adolph von Baseedov, which gave her another name: Basedow's disease. Characteristic signs of a problem are the following:

  • Neck thickening, painless when palpating, as well as the presence of goiter, which can manifest itself as a solid formation or in the form of individual nodes (multinodular goiter).
  • Rapid pulse and tachycardia. It is expressed by a strong heartbeat, agitation and insomnia. There is also dyspnea, which is the reason for the frequent erroneous diagnosis of asthma.
  • Eyelid edema, double vision, lacrimation.
  • Exophthalmos (protrusion of the eyeball). It is observed in almost half of the carriers of this disease. The patient has a pronounced puzeglazy, with redness and moisture inherent in the organs of vision, and swelling for eyelids.
  • Enlarged liver, increased stools, abdominal pain.
  • The appearance of dark pigment spots on the palms of the hands and around the eyes.
  • Sweating and constant feeling of heat, even at low temperatures, caused by flushes of blood in the upper body (to the neck and face).
  • The skin of patients is always moist and hot to the touch.
  • Changes in mental character, manifested in signs such as fussiness, irritability, nervousness, anxiety, sometimes reaching the point of aggression. Drastic changes in mood: from a state of celebration and bliss to a deep depression. Weeping. Autoimmune diseases, the symptoms of which are so vividly expressed, require immediate medical attention.
  • Tremor (fractional hand tremor), clearly visible on outstretched fingers.
  • High risk of osteoporosis and various fractures associated with an excess of thyroid hormones, which decrease the supply of phosphorus and calcium in the bone tissue.
  • Significant weight loss with increased appetite.
  • Irrepressible feeling of thirst, excessive urination and diarrhea.
  • The strengthened hair loss at their fragility and fragility.

A sad example of the defeat of the immune system is the comrade and wife of V.I. Lenina - Nadezhda Konstantinovna Krupskaya. Basedow's disease with a black stroke crossed out the life of this woman, tragically traversing her fate. The manifestation of the disease was expressed in the bug-eyed and lack of ability to know the joy of motherhood.

The degree of damage to the thyroid gland

According to the degree of severity of the Bazedov disease, the causes of which are mainly due to hereditary factors and poor environmental conditions, there are 3 types: mild, moderate and severe, differing in weight loss, presence of goiter and degree of damage to the cardiovascular system.

  • Mild degree It is characterized by a loss of 10% of body weight and a pulse of about 100 beats per minute, as well as a decrease in efficiency and concentration. A person is characterized by rapid fatigue, tachycardia and slight weight loss.
  • Average. With weight loss of up to 20% of the total body mass and pulse from 100 to 120 beats per minute, pronounced emotional excitability is observed.
  • Hard stage. It is characterized by malfunctions in the functioning of the cardiovascular system, disability, impaired liver function and mental problems. Weight loss exceeds 20%, and the pulse rolls over 120 beats.
  • Critical. All indicators reach the limit mark with a complete loss of efficiency and a serious condition of the body.

Diagnostics

Graves' disease (diffuse toxic goiter), diagnosed by an endocrinologist, is a dangerous disease. The initial stage of identifying the problem involves the method of palpation of the thyroid gland with its further ultrasound. In parallel, the patient is required to donate blood for analysis to determine the amount of thyroid stimulating hormone, thyroxin and triiodothyronine. Be sure to conduct an electrocardiogram to identify violations of the heart. In the diagnosis of the disease, it is important to conduct a hormonal examination, which determines the degree of concentration of thyroid hormones and a decrease in TSH. No less informative is the analysis of the state of the thyroid gland, which reveals its increase in volume. If possible, a radioisotope study is also recommended.

Autoimmune diseases, the symptoms of which affect all systems of the body, require complex and long-term treatment, and the chances of a full recovery are 50%.

Ways to eliminate the disease

Graves' disease, the treatment of which is carried out in three ways, absolutely cannot be treated on its own in order to avoid the appearance of complications. Therapies are as follows:

  • Medicamentous. It is used as an independent treatment and as a preparation for radical therapy. The fight against the disease occurs through the use of thyreostatic drugs. These include such as "Mercazole", "Propitsil", "Tyrozol". Suppressing the functionality of the thyroid gland, with proper observance of the dosage, they help relieve the symptoms of the disease. The use of large amounts of the drug can only exacerbate the developing hypertension. Treatment, for example, means "Mercazole" at the initial stage involves 3-fold intake of 2 tablets per day, which is 30 mg. The effect of the drug will appear approximately after 2-3 weeks. It is necessary to take it before the onset of euthyroidism, that is, the return to the state of thyroid standard (TSH) and thyroid hormones (T3 and T4). Further, the dose required to reduce to 10 mg per day. In parallel, the treatment includes sedatives that improve sleep, as well as relieve irritability and nervousness ("Tazepam", "Nozepam") and beta-blockers, which suppress the negative effect of an excess amount of hormones ("Trazikor", "Anaprilin" and "Atenolol") .
  • Thyrodectomy (or carving of part of the thyroid gland). The factors responsible for its implementation are the large size of the thyroid gland, the existing symptoms of compression of the surrounding tissues, as well as the recurrence of thyrotoxicosis after discontinuing the pill. The operation is performed after drug therapy on the background of the normal content of hormones in the blood.
  • Radioiodine therapy, which occupies a priority place in comparison with the methods described above. The essence of the treatment is the seizure of the thyroid gland, which has the property of accumulating iodine, a radioactive drug that deprives it of the possibility of producing excess hormones. Most often assigned to patients with contraindications for surgical treatment, as well as older people, on whom thyreostatics have not had the desired effect. With this type of treatment, two methods of treatment are used: one-time and fractional-extended, whose names speak for themselves. Before conducting radioisotope treatment, the patient is injected into a state of iodine deficiency, which leads to the rapid uptake of radioiodine. In this case, the isotope of iodine (131) is constantly used, the dosage of which depends on the size of the thyroid gland. Contraindications to the use of this method are severe eye damage, pregnancy and breastfeeding. The advantage of radioisotope treatment is the absence of scars, the meager risk of possible bleeding and injury to the recurrent nerves during surgery.

Thyrotoxicosis at a young age

Even children are subject to thyrotoxicosis, and the exact reasons for its occurrence have not been identified. Предполагается, что это может быть обусловлено воздействием инфекционных заболеваний либо следствием хронического тонзиллита.Overheating in the sun, parental alcoholism, mental and physical injuries, heredity - factors that can cause Graves disease. The manifestation of the disease is expressed in tearfulness, instability of mood, irritability, tics (uncontrolled movements of the muscles of the face, head and hands). The first sign of diffuse toxic goiter is a rapid heartbeat, at which the pulse rate reaches 90 beats per minute. There may be a delay in the sexual development of a teenager.

Treatment of diffuse toxic goiter in children requires long-term (from 1.5 to 3 years) continuous intake of thyreostatics - medicines, normalizing the function of the thyroid gland.

With increased nervousness, bromine, motherwort, valerian, soothing herbs and Novopassit are prescribed to the patient. If the disease is severe, then tranquilizers.

A pronounced puchagliosis is treated with hormonal drops ("Dexamethasone") or glucocorticoid hormones ("Prednisolone").

When eliminating a disease, it is very important to follow a diet rich in proteins and to limit salt and fluid, if there is a pronounced bee-eyed. Children are not treated with radioactive iodine. Surgical intervention is possible only with a large goiter and advanced form of the disease.

Possible complications

Graves' disease (Basedow's disease) can be fraught with the following complications:

  • The appearance of diabetes mellitus, which is caused by a decrease in insulin production in the body, which provokes an increase in blood glucose concentration.
  • Violation of the menstrual cycles in women, up to their absolute disappearance.
  • Decreased libido and potency in the stronger sex.
  • Myocardial dystrophy. Manifested in violation of the rhythm of breathing and heartbeat (in arrhythmias), it causes the transformation of the ventricular myocardium, persistent pneumonia and cardiosclerosis.
  • Catabolic syndrome. It is expressed by drastic weight loss with increased appetite, excessive sweating (hyperhidrosis), disruptions in body temperature conditions (sensation of heat even at very low temperatures), raising the body temperature to 38 degrees in the evening.
  • Osteopenia With prolonged use of the drug "Thyroxin" is the leaching of phosphorus and calcium from the bone tissue of the body, which reduces the strength of bones and causes joint pain.
  • Endocrine ophthalmopathy. There is an increase in the palpebral fissures due to the lowering of the lower eyelid and raising the upper one. As a consequence, there is an incomplete connection, which causes the occurrence of pucheglasia (exophthalmos). Along with this, the patient suffers from persistent conjunctivitis, increased intraocular pressure and reduced visual acuity.
  • Proximal myopathy. It is expressed in weakness of the muscles, reduction in the size of the muscles of the limbs, which complicates and makes the process painful, requiring some effort: raising from the chair or squatting.
  • Thyrotoxic crisis characterized by significant accumulation of thyroid hormones in the blood. And for several hours, their level can grow several times. Thyrotoxic crisis affects almost all systems and organs. Combining the symptoms of adrenal insufficiency and thyrotoxicosis in severe form, is expressed in the manifestation of nervous excitability, reaching a state of psychosis or to hallucinations. There is a violation of consciousness, which causes a loss of coordination in space. Also manifested a violation of orientation, fever, nausea, vomiting, respiratory failure, a sharp rise in blood pressure and tachycardia with a pulse of up to 200 beats per minute. The skin may acquire yellowness and be characterized by hyperpigmentation.

The slightest signs indicating a diffuse toxic goiter in the body, the causes of which are due to various negative factors, should be an incentive to seek timely medical care. It is strictly impossible to self-medicate, excluding any advice from friends and relatives about taking iodine tincture or wearing beads from amber!

Preventive actions

Disease prevention involves a set of measures:

  • Proper nutritional choices with a high iodine content in foods.
  • Regular preventive examination (2 times a year) at the doctor with an examination of the thyroid gland using ultrasound. This is especially true for people who have experienced Graves' disease earlier.
  • Exclusion of exhausting physical labor and significant loads.
  • The use of vitamin complexes.
  • Reception warm (not contrast) soul.
  • Narzan baths, carefully dosed.
  • Creating a favorable psychological and emotional climate at work and in the family.

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 to the cells of the endocrine organ, but do not destroy it, but over-stimulate activity.

This is due to the production in the blood of antibodies to the TSH receptor - thyrotropic hormone. Due to the constant stimulation of the thyroid gland tissue expands, provoking the formation of goiter, the level of the hormones T3 (thyroxin) and T4 (triiodothyronine) increases.

Such pathological processes affect many systems of the body, often causing comorbidities.

It has been observed that women aged 20-40 suffer from Graves disease 8 times more often than men, and this is largely due to the physiological features of the organism. In elderly people and babies, Graves disease is extremely rare.

The pathogenesis has not yet been fully studied, and doctors can not give an exact answer to the question why this disease occurs. Nevertheless, thanks to a number of studies, specialists were able to find out that the following factors affect the development of Graves disease:

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

Thyroid hormones affect many physiological processes occurring in the human body, so changes in the endocrine organ can manifest themselves in different ways, reflected in disorders of the central nervous system, heart and blood vessels, and visual organs.

In some patients, the development of this disease is a consequence of the impact of several negative factors.

In the overwhelming majority of cases, it is not possible to identify the true cause of the development of Graves disease, even after carrying out the necessary research.

Symptoms of Graves Disease

Thyroid hormones affect many physiological processes occurring in the human body, so changes in the endocrine organ can manifest themselves in different ways, reflected in disorders of the central nervous system, heart and blood vessels, and visual organs.

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

  • exophthalmos (pucheglaziye),
  • a sharp decrease in body weight on the background of increased appetite,
  • fast fatiguability,
  • increased sweating, frequent sensation of heat,
  • finger tremor
  • unstable work of the central nervous system (irritability, aggression, tearfulness, tendency to depression),
  • arrhythmia, tachycardia.

Some patients may experience negative changes in the digestive, reproductive, and respiratory systems. In Graves' disease, an enlargement of the thyroid gland occurs, 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 is individual and depends on the severity of the course of the disease and the characteristics of the patient.

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 the restoration of thyroid function. For this purpose, preparations based on thiamazole (Mercazole, Tyrosol) and propylthiouracil (Propitsil) are used.

Drug administration for Graves' disease is carried out only according to the prescription of a specialist and under his control, since careful monitoring of the reaction of the patient’s body is necessary.

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

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

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 the restoration of thyroid function.

The effectiveness of conservative therapy reaches about 35%. Often, after the end of antithyroid medication, the disease develops again.

If drug treatment does not work, the patient is shown a resection of the thyroid gland.

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

Before the operation, an obligatory medical preparation of the body is carried out using thyreostatics. Otherwise, in the postoperative period, the patient may experience a thyrotoxic crisis. After removal of the gland, the patient is forced to take hormone preparations for life.

Radiation therapy (radio therapy) is a good alternative to surgical intervention. Today, this method is considered the most effective and safest way to treat Graves disease. During the procedure, the patient ingests radioactive iodine in the prescribed dosage for some time, as a result of which the affected cells of the thyroid gland are destroyed and its function is inhibited.
Read more about thyroid radio radio therapy in this article >>

If drug treatment does not work, the patient is shown a resection of the thyroid gland.

The treatment takes place under the supervision of a physician 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 with the use of a radioactive iodine isotope 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 a complete loss of efficiency and death.

The most dangerous consequence of Graves disease is a 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 (radio therapy) is a good alternative to surgical intervention. Today, this method is considered the most effective and safest way to treat Graves disease.

Among other complications of Graves disease are:

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

The likelihood of severe consequences of Graves disease increases several times with a long course of the disease without appropriate therapy.

The likelihood of severe consequences of Graves disease increases several times with a long course of the disease without appropriate therapy.

Since Graves disease is accompanied by impaired metabolic processes, the patient must follow a special diet aimed at regular replenishment of nutrients in the body. The diet should contain a large amount of vitamins and amino acids, and the basis of the diet should be carbohydrate foods. To normalize the weight of the energy value of food must be increased by 30% compared with the usual diet.

People suffering from Graves disease are good foods that are high in fiber (fruits, berries, vegetables), seafood, cereals (rice, buckwheat, oatmeal), yolks of chicken eggs. Meat is better to choose lean, while it should be cooked, stew, bake, cook for a couple, but do not fry. The same applies to all other dishes.

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

If you can not fill the deficiency of nutrients with the help of diet correction, you should consult with your doctor about taking vitamins.

People suffering from Graves disease are good foods that are high in fiber (fruits, berries, vegetables), seafood, cereals (rice, buckwheat, oatmeal), yolks of chicken eggs.

Prevention

Specific measures to prevent the development of Graves disease does not exist.

Reducing the risk of pathology will help to maintain a healthy lifestyle, adherence to proper nutrition, timely treatment of other diseases and avoidance of stressful situations.

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

Causes of Base disease

The main cause of Graves disease is the disruption of the normal functioning of the immune system. Also, for the appearance of the disease, a genetic mutation must be observed initially in the body, which, under the influence of external factors (infection, severe stress and excitement, an excess of sunlight), triggers the disease mechanism. In the case of Graves' disease, the organism begins to perceive thyroid hormones as a foreign substance that must be eliminated, and it produces antibodies to the thyroxin receptor and triiodothyronine. This process has a stimulating effect on the thyroid tissue, which produces much more hormones than necessary. In the end, an overabundance of thyroid hormones poisons the human body, leading to thyrotoxicosis.

The main reasons that can cause the emergence of diffuse toxic goiter include:

  • Unfavorable genetics,
  • Abrupt change of diet and living conditions
  • Work increased harmfulness
  • A large amount of solar radiation.

Recently, due to ecology, the number of those suffering from Grave's disease has increased significantly. Seven-eight times more often women suffer from this disease than men. In regions where there is a strong iodine deficiency, the incidence is even worse.

Symptomatology of Grave Disease

This disease is distinguished by specific symptoms that affect most organs and body systems:

  • Endocrine disorders. Patients observe weakness, fatigue, muscle activity is markedly reduced, there is a strong tremor in the hands. Heat and sweat are constantly felt, skin is hot and moist, blood rushes to the upper part of the body and face. A common symptom of Grave's disease is an enlarged thyroid gland.
  • Skin and hair. The skin is swollen, there is hyperemia due to a rush of blood, there is a strong itching. Hair becomes thinner and starts to fall out.

  • Nervous system. The following symptoms are observed: aggressiveness, nervousness, tearfulness, mood swings from euphoria to depression, sleep disturbances.
  • Digestive and excretory systems. Despite the fact that with Graves' disease a strong appetite arises, patients, on the contrary, begin to lose weight, sometimes up to ten to twenty percent of the initial weight. This is due to enhanced metabolism. At the same time, there are severe diarrhea, which can be a cause for hospitalization, as well as severe thirst and frequent abundant urination.

  • The cardiovascular system. Heart problems most often represent the main difficulty due to which patients go to the doctor (symptoms such as fast heartbeat, arrhythmia, hypertension are observed).
  • The reproductive system. In women with Graves' disease, menstrual irregularities and irregularities occur, in men - erectile dysfunction, and a decrease in sexual desire and infertility can occur in both sexes.
  • Exophthalmos. The eyeballs bulge and shine unnaturally due to increased tearing, the eye slit is enlarged, the innervation is broken.If Graves disease progresses, then over time the eyelids may stop closing, the cornea may dry out and become covered with sores, the exophthalmos may progress to the point of loss of vision.

It is necessary to carefully monitor which symptoms are more severe, since sometimes they can be a sign not of Grave's disease, but of other non-thyroid diseases.

Conservative Treatment for Grave Disease

It is especially effective in the initial stages of the disease. Its essence lies in the fact that the patient begins to take drugs that slow down the rate of production of thyroid hormones. Such medicines are called thyreostatics and contribute to the rapid improvement of the patient's condition. Symptomatology of thyrotoxicosis is manifested to a lesser extent after a few days. But it is impossible to take such drugs uncontrollably, since this can lead to the appearance of the opposite disease - hypothyroidism, in which the thyroid gland works in a very slow mode.

Therefore, drugs that will help regulate the secretion of thyroid hormones should also be prescribed. An experienced doctor should calculate the dosage individually, based on the degree of symptoms, hormonal levels and other features of the patient. In some patients, remission of Grave's disease can occur by itself without the use of medications, it is important to take this into account.

Surgical treatment of Grave disease

Implies the removal of part of the thyroid gland. Appointed in the event that the conservative method has not had the desired impact. When using a surgical intervention, the manifestations of both thyrotoxicosis and hypothyroidism disappear. In the process of rehabilitation, it is important to conduct replacement therapy, during which the patient takes hormonal substances identical to thyroid hormones. Recovery after surgery is quite long, but this method of treatment allows a person to return to a normal active life without aggravating the manifestations of autoimmune disease.

Iodotherapy

It is used as the most benign method of treatment for Grave Disease. Lugol's solution is prescribed, which must be taken ten to twelve drops in ten to twelve days. After that, there is an improvement in the patient's condition, which is transferred to more effective drugs to complete the therapy of Grave's disease. In our country, this method is used quite rarely, despite the fact that it is considered to be quite effective.

Additionally, you can use popular recipes for the treatment of grave disease. The beneficial effect of some plants on the thyroid gland, which was later confirmed by medical research, was noticed long ago. Among the basic recipes for Grave disease are the following:

  • It is necessary to take in equal quantities oak bark, dried sea kale, oxalic leaves, sandy sedge roots. All the ingredients are mixed, two tablespoons of mixed plants must be poured with two cups of boiling water and insisted in a thermos for two hours. Drink the broth to half a glass three times a day.
  • One tablespoon of the prickly bockelly must be poured with one glass of boiling water, brewed for an hour and drunk half a glass two or three times a day.
  • A tablespoon of Hypericum is poured with a glass of hot water and boiled for ten minutes. After that, the broth is cooled and sip almost a full glass three times a day half an hour before meals.

Folk remedies are not able to cure completely, but will help to improve the general condition of the patient.

You should not think that the Bazedov disease is such a pain, which is impossible to cope with. The main thing is to carefully monitor your body and if any complaints appear, immediately contact a doctor until the disease has gained momentum and has become an incurable pathology.

Etiology and pathogenesis of the disease

Diffuse toxic goiter is associated with certain genetic mutations. The original pathology is manifested under the influence of adverse effects (viral infections, excessive sunlight, stress).

Graves disease is based on autoimmune inflammation. Aggression of the body's own defenses is directed against thyrocytes. The main target in diffuse toxic goiter is the receptor for TSH. This structure is responsible for the perception by the thyroid cells of the influence of the central endocrine organs (pituitary and hypothalamus). In Graves' disease, antibodies to the thyroid-stimulating hormone receptor are produced. They mimic the stimulating effects of the pituitary gland.

The result of this is an excessive increase in the hormonal function of thyroid tissue. Thyroxine and triiodothyronine begin to be produced in a clear excess. A high level of these hormones leads to the development of thyrotoxicosis.

Autoimmune inflammation in the thyroid gland is often combined with similar processes in other tissues. The most common combination is endocrine ophthalmopathy and Graves disease.

The clinical picture of Graves disease

Patient complaints are usually associated with changes in the psychological status and activity of the heart. Patients are disturbed by sleep disturbance (insomnia), anxiety, tearfulness, aggressiveness, irritability, nervousness. On the part of the circulatory system may be increased heart rate, the development of atrial fibrillation, hypertension, shortness of breath, edema, chest pain.

Graves' disease affects the appetite. Because of this, many patients increase the daily caloric content of food more than twice. Metabolism and heat energy production are also increased, so patients with diffuse toxic goiter gradually lose weight. In severe cases, weight loss reaches 10–20%.

A characteristic symptom of diffuse toxic goiter is trembling in the hands. Tremor may be barely noticeable. It is enhanced if the patient closes his eyes.

The skin in Grave disease is characterized by constant moisture. Patients sweat even in cold rooms.

The gastrointestinal tract with diffuse toxic goiter is unstable. Patients suffer digestion: there may be heartburn, diarrhea, pain along the intestines.

The reproductive system is also affected by thyrotoxicosis. Symptoms of Graves disease in this area can be considered menstrual dysfunction, infertility, reduced sexual desire.

Prolonged thyrotoxicosis affects mineral metabolism and provokes multiple caries and bone fractures.

Endocrine Ophthalmopathy for Graves Disease

Eye damage in diffuse toxic goiter occurs in more than 50–70% of cases. Endocrine ophthalmopathy is associated with autoimmune lesions of retrobulbar (orbital) adipose tissue. Edema in this anatomical region is extremely dangerous. It causes a bug-eyed, that is, an exophthalmos. The eye moves forward from the orbit, the closing of the eyelids, the activity of the muscular system, and the blood supply to the tissues are disturbed.

The specific symptoms of endocrine ophthalmopathy can be seen when examining a patient. Doctors pay attention to:

  • Dalrymple's symptom (excessive opening of the palpebral fissure),
  • Stelvag's symptom (rare blink),
  • Gref's symptom (delayed upper eyelid when looking down)
  • Moebius symptom (no fixation of a look on a close object), etc.

In extreme cases, endocrine ophthalmopathy can lead to optic nerve damage and blindness. Damage of the eyes and fiber of the orbit with diffuse toxic goiter is amenable to medical treatment (corticosteroids). Cosmetic defect can be eliminated further by a plastic surgeon.

Evidence of Graves Disease

For the diagnosis of the disease, a medical examination, blood tests, ultrasound of the thyroid gland are used. In rare cases, additional radioisotope scanning, cytology, X-rays or computed tomography should be performed.

The main diagnostic criterion for Grave's disease is persistent thyrotoxicosis in the presence of an enlarged thyroid gland.

Thyrotoxicosis in the analyzes confirms the low level of thyroid-stimulating hormone and the high titer of thyroxine and triiodothyronine.

The autoimmune nature of the disease can be proved using tests for antibodies to the TSH receptor. The higher the antibody titer, the greater the severity of inflammation.

On ultrasound, a large amount of thyroid tissue, heterogeneity of its structure and increased blood supply are usually observed.

Treatment of the disease

Treatment of Graves disease begins with thyreostatics. These drugs block the synthesis of hormones in the thyroid gland. Their dose is gradually reduced to maintenance. The duration of the full course of drug treatment is 12-30 months.

The effectiveness of conservative treatment of diffuse toxic goiter is about 30–35%. In other cases, dose reduction and drug withdrawal provoke a relapse of thyrotoxicosis. Such an unfavorable course of Graves disease is an indication for radical treatment.

In order for the operation or radioisotope treatment to be successful, the patient needs careful preparation (examination, correction of hormonal background, therapy of associated diseases).

The outcome of radical treatment is often hypothyroidism. This condition requires constant replacement therapy with synthetic thyroxine.

Factors provoking thyrotoxicosis

Various factors provoke Graves disease. They are:

  • heredity,
  • stress,
  • lack of iodine in the body,
  • environmental pollution,
  • ENT diseases,
  • head injuries
  • infections of various kinds affecting the body.

The appearance of Graves disease is often found in places where iodine is badly needed.

The degree of thyrotoxicosis

Signs that determine the extent of the disease:

  • Grade I - the thyroid gland is palpable, although outwardly not noticeable.
  • Grade II - when swallowing, an enlarged thyroid gland is noticeable.
  • Grade III - deformation of the thyroid gland affects the change in the appearance of the neck.
  • Grade IV - goiter significantly stands out.
  • Grade V - severe goiter, the other tissues crushes the thyroid gland.

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

Symptoms of thyrotoxicosis

Symptoms of Graves disease are determined through an autoimmune reaction and the functional activity of the thyroid gland. Part of the special hormones with a certain need fills the follicle consisting of cells of the thyroid gland. When negative manifestations occurs, the release of thyroxin, a hormone that provokes hyperthyroidism. Treatment is prescribed complex. The inflamed thyroid gland carries thyroxin into the blood, when it reaches a high concentration, it causes the onset of the manifestation of the disease - subacute thyroiditis.

Sometimes there is toxic adenoma - it 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-term deficiency of this trace element causes this disease.

Description of thyrotoxicosis by Adolf von Basedow

Graves' disease has been studied and new signs have been identified by doctor Adolf von Baseedov, after which it was also called: Basedovan disease. Symptoms of the disease are manifested as:

  • The neck thickens, the goiter is seen as a holistic formation or, having separate nodes,
  • There is intense heartbeat, insomnia, tachycardia and rapid pulse.
  • There is shortness of breath at which asthma is diagnosed.
  • Eyelids swell, double eyes, frequent tearing.
  • Protruding eyeballs - exophthalmos. Can be seen in half of patients with this disease. The patient has a bright eyelid that accompanies moisture and redness, and swelling is characteristic of the eyelids.
  • The liver increases, the chair becomes frequent, frequent abdominal pains.
  • There is noticeable pigmentation around the eyes and on the palms.
  • Sweating increases, hot even in cold weather.
  • The skin is moist and hot on contact.
  • Manifested mental changes - aggressiveness, restlessness, nervousness. Changes in mood are noticed: from gaiety to depression. With such vivid symptoms, emergency medical help is needed.
  • A tremor is observed, fractional jitter is clearly visible on the outstretched fingers.
  • Osteoporosis develops, the risk of fractures increases - this refers to an excess of hormones that affect the decrease in calcium and phosphorus bones.
  • Increased appetite, but noticeable significant weight loss.
  • I want to constantly drink, frequent diarrhea and urination.
  • They become brittle and brittle hair, actively fall out.

Bazedov's disease did not spare Nadezhda Konstantinovna Krupskaya, affecting her immune system. In its appearance, the bright-eyed, bright-eyed, and she could not become a mother.

Stage of Grave Disease

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

  • The easy stage is an increase in pulse rate per minute up to 100 beats, a decrease in performance, distraction of attention, increased fatigue, weight loss, tachycardia.
  • The middle stage - losing weight by 20%, increased heart rate per minute up to 100-120 beats, increases nervousness.
  • Severe stage - failures in the cardiovascular system and liver, loss of performance, mental problems, weight is reduced by more than 20%, pulse rates per minute increase to 200.

Diagnostic methods

Endocrinologist diagnoses Graves' disease. The onset of the disease is determined by palpation of the neck in the region of the thyroid gland, and then an ultrasound scan is prescribed. A blood test is also needed to determine thyroxine, thyrotropic hormone, triiodothyronine. To detect cardiac pathologies, an electrocardiogram must be done.

An important factor for the diagnosis of the body is a hormonal examination, which helps to determine the degree of thyroid hormone accumulation. You can get enough information about the disease by conducting an analysis that detects changes in the volume of the thyroid gland. When urgently needed is conducted radioisotope research.

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

Features of the treatment of goiter's disease

Bazedovu disease is not recommended to treat on their own, it is better to do this under the supervision of a doctor. With the disease, three types of therapy are used:

  • Medication. It is used in two cases: as an independent treatment of Graves disease, and as preparation for more complex therapies. Thyrostatic drugs are used. Proper use of the dose helps to relieve the symptoms of the disease. Drug overdose will lead to aggravation of hyperteriosis. Along with these drugs, treatment requires the use of sedatives, which promote good sleep and relieve nervous irritability, and beta-blockers, which reduce the negative effect of excess hormones.
  • Thyrodectomy. With an increased size of the thyroid gland, squeezing the tissue around, its part is cut out. This treatment is applied when symptoms return after taking pills. An operation is performed after the hormones are normalized by means of drug therapy.
  • Radioiodine therapy. This method, which affects Graves disease, consists in the fact that the thyroid gland, which is able to preserve iodine, takes a radioactive drug that takes away the ability to produce extra hormones. This method of treatment is used for patients with contraindications for surgical interventions and for elderly people who were not helped by medicines. Therapy of Graves' illness is carried out in two ways: one-time and fractionally extended. First, the patient is brought to the state of iodine deficiency - this contributes to the rapid penetration of radioisotope iodine, dispense it, depending on the state of the thyroid gland. Do not use this method of treatment with a strong eye-eyed, pregnancy and lactation. The positivity of this method of treatment is that there are no scars left, there is almost no bleeding, no return nerves are injured.

Thyrotoxicosis in children

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

Prolonged uncontrolled exposure to the sun, alcoholic addictions of parents, mental or physical nature of injuries, hereditary predisposition - can lead to thyrotoxicosis. Children become whiny with mood swings, subject to uncontrollable twitching of hands, head and facial muscles. Ранние признаки болезни Грейвса – происходит ускоренное сердцебиение, частота пульса в минуту до 90 ударов. У некоторых подростков при базедовой болезни может отмечаться приостановка полового развития.

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

During the treatment of Graves' disease, a constant diet rich in protein and reducing intake of salinity and sugary drinks is required. Surgical operations are carried out only with greatly increased goiter and with advanced disease. Radio therapy is not used for children.

Preventive measures

For the prevention of geriatric disease, you should perform simple steps:

  • eat foods containing iodine,
  • to undergo a prophylaxis of the thyroid gland 2 times a year with a doctor by ultrasound,
  • exclude excessive physical activity for the body,
  • support the body by taking vitamins
  • strive to create a favorable relationship in the team and family.

At the first minor signs of Graves disease, you should immediately contact a medical facility. Treating a motivated illness alone is an increased risk; the consequences may be irreversible.

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