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