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Diffuse toxic goiter of the thyroid gland

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What is the diffuse toxic goiter?

Diffuse toxic goiter is a pathological condition caused by increased production of thyroid hormones diffuse thyroid tissue, and leads to poisoning these hormones – hyperthyroidism.

Etiology and pathogenesis

This condition relates to autoimmune diseases. Progression of the disease is polygenic, that is, multivariate way. Among the causes of graves ' disease allocate psychological injury, traumatic brain injury, diseases of the nasopharynx, infectious and inflammatory diseases, heredity. In patients with diffuse toxic goiter is the development of antibodies that damage thyroid cells. Because of the violations she starts to produce a large number of thyroid hormones.

In most cases of diffuse toxic goiter affects women. The disease affects them in 8 times more often than males. The average age, which accounts for the peak of the disease from 30 to 50 years. However, there are cases when a goiter develops in other age groups: adolescents, expectant mothers and those women who entered into menopause. Graves ' disease – pathology common, affects one out of 100 people.


Symptoms diffuse toxic goiter

At the initial stage of the disease does not manifest itself. With the development of the pathological process, the mass of the thyroid gland starts to increase. Instead 20 ga body weighs 50 g. because Of this neck from the front side is formed convex. Moreover, growing both lobes of the thyroid gland evenly.

Other symptoms of diffuse toxic goiter are the following:

  • The person have difficulty taking food and water;

  • The patient complains of a feeling of constant pressure in the neck;
  • Due to compression of the larynx, the breathing becomes more noisy;
  • When a person is lying, shortness of breath;

  • the Patient suffers attacks of vertigo;

  • You receive a goiter that is visible to the naked eye;
  • Eyeball increase in size and protrude from the orbits. This is due to autoimmune inflammation, and swelling of the surrounding tissues. With the eyes wide open, too shiny. It was the symptoms from the side the eye often appears before other symptoms of the disease and gives the opportunity to suspect the development of diffuse toxic goiter;

  • Against the background of changes in the eyeball of the patient developing chronic conjunctivitis;

  • A severe form of the disease causes the development of fatty liver and cirrhosis;

  • Heart rate exceeds 120 beats per minute. Increased blood pressure, the patient complains of stitching pain in region of heart. Among other cardiac irregularities may appear arrhythmia, extrasystole, heart failure;

  • The skin becomes edematous, covered with a crust. To the touch it is warm and moist;

  • Often observed in patients with graves ' disease vitiligo;

  • The patient begins to notice at hair loss;

  • Destroyed nails develops erythema, feet can swell;

  • Increases sweat glands, against which people suffer from excessive sweating;

  • The patient's appetite increases, but he's actively throwing his weight about, as all metabolic processes are accelerated;

  • Body temperature all the time slightly increased: from 37 to 37.5 degrees. However, no accompanying inflammatory processes are not observed;

  • The patient suffers from multiple caries;

  • Hands and the patient's head trembling;

  • There is a tendency to often recurrent pneumonia;

  • People fussy, overly irritable, anxious;

  • Men on the background of the disease develop impotence, decreased attraction to the opposite sex;

  • In women, deviations in the menstrual cycle, sometimes periods are delayed for a longer period and are absent for more than six months;

  • Often patients sufferfrom diarrhea, sometimes, but rarely, nausea and vomiting;

  • Patients complain of sudden attacks of muscular weakness.

Symptoms similar to the symptoms of such diseases as hyperthyroidism. But with diffuse toxic goiter has three characteristic features: the protrusion is formed on the neck, a pronounced exophthalmos, and sometimes swelling of the skin in the legs.


Causes of diffuse toxic goiter

The causes that provoke the development of diffuse toxic goiter, the following:

  • The hereditary factor. Often the disease occurs in the family;

  • Insufficient intake of iodine from food and drink. It is necessary for normal functioning of the thyroid gland. When it is small, there is a rise in the number of thyrocytes;

  • Belonging to the female sex. It was established that women suffer from diffuse goitre more than men. This is due to hormonal changes in the body. We are talking about the period of carrying a child, breast-feeding, about the entry into menopause. Adversely affect health and cause diseases can abortion and hormonal contraception, used alone;
  • The intake of iodine without medical supervision, as well as work in places of its production and active use. The overabundance of this element in the body is no less dangerous than the lack of it;

  • Autoimmune conditions, which include scleroderma, rheumatoid arthritis, diabetes. On the background of the failure of the immune system may be affected, the thyroid gland, the disease is included in the total immune response;

  • The age of 40 years is another factor that increases the risk of developing the disease. Most often it manifests when the human immune system is strong and active;
  • Prolonged stress, psychological traumas, leading to nervous exhaustion, the cause of the disease. Against this background, disrupted nervous regulation, which is important for the normal functioning of the gland;
  • All the factors affecting the reduction of immune forces: hypothermia, bad habits, increased physical activity;

  • Surgical manipulation of the thyroid gland. Once a remote node can become the impetus for the growth of the tissues of the body.


The degree of diffuse toxic goiter

The degree of development of the disease depend on the severityof toxicity caused by hormones produced by the thyroid gland. They also stem from the size of the body. There are three degrees of the disease with characteristic symptoms.

1 the degree of diffuse toxic goiter

First degree is actually fairly easy, as it is the initial stage of the disease. At this time, the patient complains of increased nervous excitability, begins to lose weight. The loss of body weight in an average of 15%. Markedly increased heart rate, the first signs of tachycardia. Human performance is reduced. The goiter is not increased and is not visible during the inspection.

The reason for going to the doctor often be sudden changes of the skin. Enhanced pigmentation, increased sweating.

2 the degree of diffuse toxic goiter

Symptoms with the development of the disease is increasing. This degree is characterized by marked nervous excitability. Continued loss of body weight, it can reach 20%. Signs of tachycardia increase. Patient complains of chronic fatigue, the efficiency is further reduced. Goiter is not yet visible, but the doctor feels the thyroid gland with palpation. Often there is a lack of blood circulation. Visually you may notice a slight goiter that when a person makes swallowing. Exophthalmos is already quite pronounced. Periodically in patients are formed swelling in the legs, mainly in the evening.

3 the degree of diffuse toxic goiter

The last, and heaviest, in terms of therapy and condition of the patient the degree of development of the disease the third. In addition to nervous excitability, a person loses the ability to work. The final stage of diffuse toxic goiter characterized by severe loss of body weight and serious violations of the cardiovascular system. On the background of the disease develop atrial fibrillation, heart failure.

Often affects the liver, there is a pronounced muscular weakness. Comes to the fact that the patient becomes difficult to get up from his chair. The tendon reflexes are increased. At this stage, the patient may lose vision.

The goiter increases in size, becomes noticeable even to the layman. The neck can be deformed, edema in this area.


Complications of diffuse toxic goiter

The disease is dangerous the complications:

  • There are lesions of the cardiovascular system, in particular, the development of"thyrotoxic heart". The symptoms of this condition: heart failure, angina, sinus tachycardia. Moreover, the rapid heartbeat does not depend on physical activity, not decreasing in the night time;

  • Developing hypertension, can be formed by the heart disease;

  • A serious complication from the blood – the emergence of thyrotoxic hepatosis. This condition threatens to develop into cirrhosis and cause the death of the patient;

  • Pathology is complicated by attacks of muscle weakness, in some cases developed paralysis;

  • Thyrotoxic crisis is a serious complication of diffuse goiter, threatening the patient's life. Uncommon, in most cases with severe course of the disease. In this production of hormones increases sharply, which causes the formation of severe hyperthyroidism. The person is conscious, in the initial stages of a crisis he is very fussy, often aggressive. Psychosis may be replaced by an abrupt lethargy, inactivity, you may have headaches severe intensity. Then the heart rate increases dramatically, it becomes spasmodic, increases blood pressure, quickens breathing. The person strongly sweats, the body temperature increases, may reach 41 degrees. Often there is vomiting, yellowing of the skin. Completion of thyrotoxic crisis is often the loss of consciousness and coma. Treatment should be carried out only in a hospital environment, assistance should be provided as quickly as possible. The lethal outcome when the crisis occurs in 50% of cases.


Diagnosis of diffuse toxic goiter

When clinical manifestations of diffuse toxic goiter pronounced, the diagnosis is not complicated. Such symptoms as low body weight, a pathological condition of the skin and nails, increased heart rate and increased blood pressure, allow the doctor to make an assumption about the presence of hyperthyroidism. If there is ophthalmopathy, the diagnosis is almost obvious.

To confirm, the following types of surveys:

  • A blood test for hormones. To avoid biases, it is necessary to conduct laboratory research. The test results indicate an increase in the number in the body of thyroid hormones by reducing the number of TSH. To conduct the study carried out blood sampling for determination of hormone levels (hormone and thyroid hormones);

  • Immunofermentnyi analysis. In order to distinguish diffuse toxic goitre from similar conditions, is carried out immunofermental analysis, which allows to determine the presence of antibodies to TSH, thyroglobulin and thyroid peroxidase;

  • Ultrasound. The patient is also advised to undergo thyroid ultrasound. It will allow to determine the presence of a diffuse increase of the body, changing its structure;

  • Scintigraphy. A method such as scintigraphy, gives you the opportunity to know the volume and shape of the body. Moreover, the method allows to detect areas of active diffuse gland tissue;

  • Also, the doctor examining the reflexes of the patient;

  • Radiodiagnostics recently used less and less. This method is based on the introduction into a vein of the patient isotopes of iodine and measuring their concentration a day later using a special camera;

  • Conducting x-ray examinations are appropriate when craw reaches the impressive size and compresses the esophagus. The picture is taken in two projections, it demonstrates a pattern of changes in the lymph nodes and gives a possibility to detect the narrowing of the organs of the neck;

  • Biopsy. When the doctor discovers a seal and the secondary nodes, the patient is sent for fine-needle aspiration biopsy. The procedure allows to exclude or confirm thyroid cancer and the increase in lymph nodes.

Auxiliary method of diagnosis is computed tomography. If the vessels and the volume of the organ is enlarged, the edges are rough, there are nodes and cyst, the diagnosis is confirmed.

Treatment of diffuse toxic goiter

Therapy disease primarily aims to normalize the level of hormones produced by the gland. To do this, in the Arsenal of doctors there are hormonal and iodine. In some cases, surgical intervention, and the use of radioactive iodine. Determine the method of treatment of a doctor. It depends on a number of factors, in particular, from the stage of the disease, patient's age, other medical conditions etc.

For the treatment of graves ' disease used drugs containing iodine. They allow you to make up for the deficit and stop the growth of the body. However, the receipt of these funds should be conducted under strictmedical supervision, as in diffuse goiter iodine can cause the gland seal and its increase in size.

A tool such as Diyodtirosin, contains the amino acid tyrosine and iodine. Its conversion in the body contributes to the neutralization of excess thyroxine and normalization of the patient's condition. The drug is used if there is insufficient iodine in the body, however, as an independent therapeutic method is rarely used. Shown exchange treatment.

Topic: Test to determine the level of iodine in the body

In order to reduce the number of produced thyroid hormones, thyreostatics drugs used. Such tools include Mitesol, Tyrosol, Tiamazol, Propitsil. A tool such as Merkazolil, prescribed for graves ' disease three times a day the pill cannot be chewed, you should drink plenty of water. If the disease runs hard, shows a gradual increase in dose and after normalization of reduce the dosage every five days. A sound approach to the individual treatment scheme is important in order to avoid complications of the disease.

Cancel antitireoidne of funds is only the disappearance of signs of toxicity, normalization of heart rate, body mass, after elimination of tremor of the extremities. Approach to the treatment of diffuse toxic goiter needs to be determined. Mercazolilum therapy may be initiated at any level of severity of the disease.

The total time of treatment with drugs in this disease is from one to one and a half years. If the drugs cannot be cancelled after this period, the patient is directed either to surgery or to radioiodtherapy. When the patient is experiencing frequent relapses, you cannot treat it Mercazolilum. This can cause the formation of thyroid cancer.

If the disease is detected in women at term of gestation before 12 weeks, it will be necessary to terminate the pregnancy. If the disease has not reached the third degree, the patient is recommended to take antitireoidnye drugs. Doses is minimal. During breast-feeding may only accept Propitsil. If the disease runs hard, shows surgery.

Also for the treatment of goitre often use corticosteroids. They influence the activity of the adrenal glands, metabolism of hormones, and in addition, have immunosuppressive effect.

To reduce anxiety, normalize sleep will help sedatives. The patient is prescribed with this purpose, Phenobarbital, which further affects the level of hormones.

To surgerythere are clear indications:

  • Severe course of the disease;
  • The third stage of goiter with compression of the larynx, and severe cosmetic defect;

  • The impossibility of reception antitireoidne of funds due to allergic reactions;

  • The ineffectiveness of the treatment drugs for six months;

  • Atrial fibrillation;

  • Frequent relapses of the disease.

It is impossible to carry out the operation in kidney disease and the liver and other conditions that are contraindications for General anesthesia. As a rule, will be removed almost the entire organ. The operation is called "thyroidectomy". It is when all the indicators come back to normal. Treatment of postoperative hypothyroidism is with hormone replacement therapy. After 5 days after surgery the patient allowed to go home.

It is important to adhere to the following guidelines:

  • In the early days you cannot eat solid food, to avoid committing the active chewing and swallowing movements. They cause pain and swelling of the laryngeal tissues causes difficulties with swallowing. Therefore, the food should be liquid. A few weeks later, this restriction is removed;

  • Important after removal of the authority to monitor their menu. Diet is essential for maintaining a healthy weight, as it increases the probability of obesity;

  • The diet should include foods rich in proteins and vitamins. Must be present seafood, sea fish;

  • Not without consulting with your doctor take medications containing iodine;

  • It is important to respect the day and rest at least 8 hours a day;

  • After removal of the thyroid gland should avoid being in the sun. However, walking the patient necessary;

  • Once a month during the first year after surgery need to visit an endocrinologist to monitor the status.

Remaining after surgery the scar on the neck the first time will be red and may increase in size. This is a normal condition, and two years later he brighten and become thinner.

Treatment of diffuse goiter with radioactive iodine

Method of treatment with radioactive iodine yields positive results. For this the patient must ingest capsules or liquid that itcontain. The introduction of the drug through a vein practiced, but rarely.

When the tool gets in the body, it begins to accumulate in the cells of the gland, which causes their death. In place of dead cells formed connective tissue. Studies show that iodine also tends to accumulate in mammary and salivary glands, in the mucous membranes of the digestive tract.

It is noteworthy that the tool is distributed in the body unevenly. One, mostly in the Central part of the gland is destroyed and its peripheral parts continue to function. Moreover, the surrounding body tissue does not suffer from the actions of the isotope.

There are particular therapy:

  • Before starting treatment, it is important to refuse the acceptance of tireostaticheskim. It must be done a few days before the start of intensive exposure to radioactive iodine. If this is not done, the effectiveness of the therapy isotope will be reduced;

  • Not to start treatment during pregnancy;
  • Is a few days before the start of therapy to refuse certain foods. In particular, we are talking about seafood (shrimp, mussels, crab sticks, seaweed, fish, crabs, etc.), as well as from iodized salt. You should avoid foods containing this salt (sausage, cheese, canned food);

  • You can't use foods that are soy-based. Sometimes, the content of iodine is extremely high;

  • Do not eat two hours before the procedure and after less than the same time after ingestion of the capsule;
  • In order to avoid worsening of endocrine ophthalmopathy, which can be triggered by radioactive iodine treatment, appropriate pre-course reception of glucocorticoids;
  • Previously it is necessary to conduct ultrasound of the thyroid gland to determine its size. This must be done in order to accurately calculate the dose of the drug;

  • It is necessary to abandon breastfeeding, if a woman holds the radioactive iodine treatment.

The effectiveness of the treatment by the radioactive isotope of iodine is high. The obtained data indicate that cured 99% of patients. However, until now, the debate continues about the safety of the procedure. It is known that in a short time the iodine decays by half it reduces its activity. This period is 8 days, which means he will not have time to harm other systems of the body and the environment.

The isotope is excreted in the urine. So if it gets on things or bed linen, they must be replaced and wash betterseparately. If in the immediate vicinity there are children under the age of 2 years should avoid contact with them, not less than 9 days. If the work involves contact with the children, you should call in sick for one month after the therapy.

Some scientists theorize regarding the fact that those areas of the thyroid gland, which has been replaced by connective tissue susceptible to the formation of cancerous tumors. Therefore, a clear contraindication to the use of radioactive iodine treatment is the period of carrying a child, lactation, childhood and adolescence and increase in goiter in volumes of more than 40 ml.

As the potential complications after therapeutic programme allocate jodijulieannd development of hyperthyroidism. Moreover, if the symptoms appear immediately after the first dose, most often they pass quickly and unnoticed. When signs of disease occur late, after 5 days of treatment, then the disease will be protracted.

Also during therapy with radioactive iodine can develop thyroid storm, to form retrosternal goiter and cause the inability to use medications containing iodine. Sometimes patients complain of feelings of sore throat, weakness, nausea and loss of appetite. You may experience minor swelling in the respective region of the neck.

Another rule – use of contraceptives after the end of treatment isotope. This should be done for 4 months, to avoid the risk of fertilization and impair the health of the unborn child. It is best to plan pregnancy not earlier than two years after the treatment, because radioactive iodine has the ability to penetrate through the placenta.

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Prevention of diffuse toxic goiter

Comprehensive prevention of disease is the best way to avoid it.

To do this, follow these guidelines:

  • To monitor the condition of the immune system, tempering the body. You should not start immediately dive into the hole. It should begin with rubdowns with a damp towel, gradually moving to more intense changes in temperature by spraying;
  • Diet is important to maintain the gland in normal condition. For this you need to include in the diet of seafood and greens, as they are rich in iodine and othertrace elements;
  • When you add salt to meals, one should use iodized counterpart. It is important to salting already cooked food, as in the heat treatment process, the iodine tends to evaporate;
  • After consultation with a doctor can be in his recommendations a few times a year to take vitamin and mineral supplements rates;
  • Exercise to strengthen the muscles of the neck;
  • Drink at least 2 liters of water per day;

  • Avoid high physical loads and stresses;

  • Try not to be in areas with radiation levels above the established norms;
  • To visit an endocrinologist with a prophylactic purpose. This is especially true for those in the family there were cases of diffuse toxic goiter;
  • Do not use without consulting a doctor iodine-containing preparations;
  • All the necessary readjustment of foci of chronic infection.

If there is no adequate treatment of the disease, the prognosis is unfavorable. LED over time necessarily lead to serious complications, such as heart failure, exhaustion, thyrotoxic crisis.

Most patients respond well to medical treatment, their condition is normalized, heart rate is restored. Surgery often causes subsequent hypothyroidism, hence the importance of taking appropriate means.