This name refers to one of the most serious endocrine diseases of a person, which can be compared by the severity of the course and the degree of impairment only with diabetes mellitus.
What is it? Diffusive-toxic goiter of the thyroid gland( DTZ) is a disease characterized by hypersecretion of thyroid hormones by the whole surface of the thyroid gland( in contrast to nodular goiter), and capable of toxic damage to all organs.
According to the International Classification of Diseases of the 10th revision,( ICD-10), DTZ belongs to the section of endocrine diseases, section IV, and has code E 05.
For the first time, the disease was described in detail by the Irish physician Robert Graves in the first quarter of the 19th century, andSince then, sometimes diffuse toxic goiter is called "Graves' disease."
Contents
- 1 The causes of DTD
- 1.1 Effects of thyroid hormones
- 2 Diffusive toxic goiter 1 \ 2 \ 3 degrees
- 3 Symptoms and symptoms of diffuse toxic goiter
- 4 Diagnosis of DTD
- 5 Treatment of diffuse toxic goiter, preparations
- 6 Prevention
Reasons for DTZ
Causes of diffuse toxic goiter( etiology) are diverse, so the disease is considered multifactorial. The most frequent reasons for the occurrence of DTZ are the following:
- hereditary predisposition( by the head of the histocompatibility system);
- stress and neuroses, which provoke the production of hormones;
- smoking. It is the smoking of 10 or more cigarettes a day that increases the risk of developing goiter twice;
- increases the risk of developing DTZ the presence of another endocrine pathology: diabetes mellitus, disorders in the adrenal system;
The pathogenesis of toxic goiter begins with an imbalance between the activity of the immune response and its directionality to its own tissues. In this case, we are talking about the occurrence of an autoimmune process, in which thyroid tissue is damaged.
Then begins the infiltration of the glandular tissue of the lymphocytes, which secrete antibodies against thyrocytes and thyroglobulin-thyroid gland tissues. A great diagnostic value is formed by the "stimulating antibodies" to the thyroid-stimulating hormone receptor.
It is interesting that in most autoimmune diseases the immunity system blocks the organ, reduces the production of its hormones. In the event that a diffuse toxic goiter of any degree is detected, the thyroid gland is not blocked, but, on the contrary, it is stimulated by the secretion of an excessive amount of active substances.
As a result, diffuse hypertrophy( enlargement of the gland) arises, and lymphocytes that receive information about the structure of the thyroid gland are capable of causing disturbances at the periphery, for example, in the fiber, behind the eyeball, or in the connective tissue of the lower leg, with the development of retrobulbar endocrine ophthalmopathy or tibial myxedema.
Effects of thyroid hormones
In addition, hormones of the gland( thyroxine and triiodothyroxine), which begin to be uncontrolled, have the following systemic effects:
- Lipolysis( the use of fat and its removal from the depot, followed by combustion);
- Increased body temperature( hyperthermia);
- Enhance oxygen uptake and starch decomposition;
- Increases glucose absorption;
- Cardiac contractions are gaining, blood pressure rises.
As you can see, all effects are aimed at increasing the speed of exchange, DTZ "accelerates and sharpens" life, temperature, pressure.
Diffuse toxic goiter 1 \ 2 \ 3 degrees
Degree of diffuse toxic goiter reflects the severity and functional reversibility of the disorders. It is known that the most striking manifestation of DTZ is a condition called thyrotoxicosis.
Morphologically, thyroid hormones most harm the cardiovascular and nervous system, as these structures are the most sensitive.
That's why the most convenient classification for doctors is in degrees: diffuse toxic goiter 1, 2, 3 degrees. Of course, not always the severity of the disease is so strong that it was possible to put even the first degree of DTZ.
In this case, they focus not on complaints, but on quantitative indicators: the level of hormone concentration, pulse numbers, blood pressure and other indicators that reflect the severity of the condition. It is these studies that are necessary for military medical examination to determine the category of fitness for military service.
In addition, the severity of the condition can reflect the state of goiter, when it prevents swallowing and is visible to the simple eye, or even changes the shape of the neck.
In total, there are 5 degrees of enlargement of the gland, from the palpation of the interval between lobes, to a very pronounced tumor on the neck.
Signs and symptoms of diffuse toxic goiter
Signs and symptoms of diffuse toxic goiter are associated with a variety of effects of thyroid hormones, because they are very diverse.
The main symptomatic groups are distinguished:
Cardiac ( heart palpitations, extraordinary contractions - extrasystoles, increased blood pressure).One of the most important damaging factors is high pulse pressure - the difference between the systolic and diastolic index.
These symptoms eventually deplete the contractility of the myocardium, heart failure is formed, which is manifested by cardiac asthma, edema, including portal hypertension and ascites;
Metabolic disorders of - are associated with an increase in basal metabolism. Patients are depleted, they have a "wolf hunger" all the time. Because of hyperthermia, body temperature can rise to 37.5 degrees. As a result of this, and full "hormone rash", women are disrupted or stopped monthly. Ophthalmic , or symptoms of ophthalmopathy: ocelli( Graves disease), incomplete closure of the eyelids, which leads to the development of dry eyes, the appearance of "sensation of sand" and the development of conjunctivitis. A pronounced periorbital edema develops.
In the event that the edematous tissue squeezes the vessels and the optic nerve, even complete blindness can develop.
Neurological symptoms in severe thyrotoxicosis prevent the patient from performing work, and often cause disability: marked tremor of hands and swaying, revitalization of tendon reflexes until the appearance of clonus, severe headache, weakness, insomnia, anxiety, hot flashes, tearfulness.
In addition to the above symptoms of diffuse toxic goiter, there may be severe sweating, changes in nail plates, the appearance of edema on the legs, diarrhea due to accelerated food movement through the intestines. In special, severe cases, there is a thyrotoxic crisis, which is stopped in the intensive care unit.
Diffuse toxic goiter and pregnancy are of particular concern to doctors. The classification of this condition may be different: for example, a diagnosis of goiter could be made prior to pregnancy, or occurred after fertilization by unknown autoimmune mechanisms.
Both in the first and in the second case, the risk of miscarriage is high, as well as miscarriage at an early stage with severe hormonal disorders.
The greatest chances for the birth of a healthy child in the future mother, in whom the diagnosis of DTZ was diagnosed before pregnancy and the necessary treatment was prescribed.
Diagnosis of DTD
Diagnosis of diffuse toxic goiter in typical cases presents no difficulties and consists of:
- Patient complaints;
- Data of examination and palpation of the neck;
- Definitions of the level of thyrotropic and thyroid hormones, the establishment of the factor of their excess and the appearance of specific symptoms, in the first place - cardiac, neurological and ocular.
Ultrasound of the thyroid gland is also in demand, and a biopsy followed by a histological determination of the cellular composition.
Analyzing similar conditions, or differential diagnosis of diffuse toxic goiter, is performed with those diseases that can simulate the main symptoms( symptoms) from either side:
- neuroses and menopause;
- myocarditis, heart defects, rheumatism;
- tuberculosis( leading to malnutrition);
- is a cancerous thyroid tumor that produces excess hormones.
Treatment of diffuse toxic goiter, preparations
Treatment of any disease is etiotropic( directed at the cause), pathogenetic and symptomatic - relieving the patient of painful complaints. In case of diffuse toxic goiter, the treatment is reduced to the following principles:
- Blocking the synthesis of hormones and their release from the gland - Mercazolil;
- For adequate replacement of hormones during the "blocking" treatment with Mercazolilum, L-thyroxine is prescribed;
- After treatment with thyrostatics, surgical treatment of diffuse toxic goiter is possible( for example, almost complete removal or subtotal resection of the gland);
- The use of radioactive isotope iodine is considered one of the main ways to treat DTZ abroad.
Diffusive nodal toxic goiter may be complicated by thyrotoxic crisis - a life-threatening condition caused by sudden release of large amounts of hormones with the development of the following symptoms:
- . A sharp tachycardia, hypertensive crisis, followed by a drop in pressure, a decrease in urine output, and heart rhythm disturbances, shortness of breath, heart failure.
Complications of diffuse toxic goiter, in addition, may be symptomatic: cachexia, progressive amaurosis( blindness), myocardial dystrophy, impaired swallowing due to compression of the neck with goiter.
Prevention
Prevention of diffuse toxic goiter, as with many other diseases, consists of the following activities:
- prevention of colds, hardening;
- stress management;
- maintenance of motor activity, positive emotions;
- use of iodine with food( iodized salt);
- preventive visit to a doctor - an endocrinologist and an annual study on hormones;
In any case, the thyroid gland is a very important education: both deficiency and excess hormones are harmful to health and can lead a person to disability.
Therefore, you should not neglect the examinations, and do not be lazy to look again in the mirror to assess the contours of your own neck, if you become disturbed by insomnia, tachycardia, irritability, temperature rises and weight loss.
Watch yourself and stay healthy!