Goiter diffuse toxic

Diffuse toxic goiter ( Graves-Bazedov's disease) is a disease characterized by hyperplasia and hyperthyroidism of the thyroid gland.

Etiology, pathogenesis. Are hereditary factors, infection, intoxication, mental trauma. At the heart of pathogenesis is the violation of immune "surveillance", leading to the formation of autoantibodies, which have a stimulating effect leading to hyperfunction, hyperplasia and hypertrophy of the gland. Change in the sensitivity of tissues to thyroid hormones and the violation of their metabolism are important. Clinical manifestations are caused by the action of excess thyroid hormones on various types of metabolism, organs and tissues,

Symptoms, course. Patients complain of irritability, tearfulness, increased excitability, sleep disturbance, weakness, fatigue, sweating, hand tremors and trembling of the whole body. Progressive weight loss with saved or even increased appetite. In young patients, on the contrary, an increase in body weight - "fat Basedov" may be noted. The thyroid gland is diffusely enlarged; There is no correlation between the degree of its increase and the severity of thyrotoxicosis. Changes in the eyes: exophthalmos, usually bilateral, without trophic disturbances and movement of the eyeballs, Gref's symptoms (lagging behind the eyeball when looking down), Dalrymple (wide opening of the eye cracks), Moebius (weakness of convergence), Kocher (Retraction of the upper eyelid with a quick glance).

The leading manifestations of thyrotoxicosis include changes in the cardiovascular system - thyrotoxic cardiomyopathy: tachycardia of varying intensity, tachysystolic form of atrial fibrillation (paroxysmal or permanent), in severe cases leading to the development of heart failure. In rare cases, more often in men, paroxysms of atrial fibrillation may be the only symptom of thyrotoxicosis. Characteristic is the large pulse pressure due to an increase in systolic and a decrease in diastolic pressure, an extension of the heart to the left, a strengthening of tones, functional systolic noises above the apex and pulmonary artery, pulsation of the vessels in the neck and abdomen.

There are also dyspeptic phenomena, abdominal pain, in severe cases, an increase in size and a violation of the liver and stomach. Often a violation of tolerance to carbohydrates.

In severe thyrotoxicosis or its long course, symptoms of adrenal insufficiency appear: sharp adynamia, hypotension, hyperpigmentation of the skin.

A frequent symptom of toxic goiter is muscle weakness, accompanied by muscle atrophy, sometimes paralysis of the proximal limb muscles develops. Neurological examination reveals hyperreflexia, anisoreflexia, instability in the Romberg pose.

In some cases, there may be a thickening of the skin on the front surface of the shins and the rear of the feet (preikibial myxedema). Women often develop a menstrual cycle, in men - a decrease in potency, sometimes two- or one-sided gynecomastia, disappearing after the cure of thyrotoxicosis. In the elderly, the development of thyrotoxicosis causes weight loss, weakness, atrial fibrillation, rapid development of heart failure, worsening of the course of IHD. Frequent changes in the psyche - apathy, depression, may develop proximal myopathy.

Distinguish between mild, moderate severity and severe course of the disease. With easy flow, the symptoms of thyrotoxicosis are not clearly expressed, the pulse rate does not exceed 100 in 1 min, weight loss of not more than 3-5 kg. For the disease of moderate severity, there are clearly expressed symptoms of thyrotoxicosis, tachycardia 100-120 per 1 min, weight loss 8-10 kg. In severe course, the pulse rate exceeds 120-140 in 1 min, rapid weight loss, secondary changes in the internal organs are noted.

Cholesterol levels are lowered in the blood, the content of iodine bound to the protein, the level of thyroxine and triiodothyreine are increased; The level of thyroid-stimulating hormone is low. Absorption of 131I and 99T with thyroid gland is high. When reflexometry - shortening the duration of the Achilles reflex.

In doubtful cases, samples with tyroliberin are carried out. The absence of an increase in the thyroid-stimulating hormone level when tyroliberin is administered confirms the diagnosis of diffuse toxic goiter.

Treatment. Apply medicament (thyreostatic drugs, radioactive iodine) and surgical methods. The main thyreostatic drug is mercazolil (30-60 mg depending on the severity of the disease with a gradual transition to maintenance doses of the drug - 2.5-5 mg per day, every other day or every 3 days, the course of treatment is 1-1.5 years) . Complications-allergic reactions (itching, urticaria), leukopenia, agranulocytosis, zobogenic effect. With intolerance the drug is canceled, with leukopenia prescribe prednisolone, leukogen, pentoxyl, sodium nucleate. In the complex treatment of thyrotoxicosis, beta-blockers are also used [anaprilin (obzidan), tracicore] from 40 to 200 mg / day; Corticosteroids (hydrocortisone, prednisolone), tranquilizers (relanium, rudotel, phenazepam), peritol. With significant exhaustion prescribe anabolic steroids (retabolyl, phenobolin, silobolin, methandrostenolone), in some cases insulin (4-6 units before dinner). With circulatory insufficiency, cardiac glycosides (strophanthin, korglikon, digoxin, isolanide), diuretics (triampur, veroshpiron, furosemide), potassium preparations (chloride, potassium acetate). With complications from the liver - Essentiale, corset. Assign also multivitamins, ascorbic acid, cocarboxylase.

In the absence of a stable effect of drug therapy, the development of complications (allergic reactions, leukopenia, agranulocytosis with the administration of mercazolil), as well as in severe thyrotoxicosis, the presence of atrial fibrillation after appropriate preparation is directed to surgical treatment or radioiodine therapy.