Diffuse toxic goiter is a disease characterized by an enlarged thyroid gland and an increase in its function as a result of an attack by its own immune system. As a result, a complex of symptoms due to the toxic effects of thyroid hormones on various organs and systems develops.
The prevailing age of diffuse goiter is 20-50 years. The predominant gender is female.
The main factor in the development of the disease is an inherited defect of immunity, which leads to the production of special proteins – autoantibodies that bind to receptors on the thyroid cells – this causes an increase in the gland and stimulation of the production of thyroid hormones. In some cases, diffuse toxic goiter develops after acute infectious diseases, stress effects.
Complaints of general weakness, increased irritability, nervousness and mild excitability, sleep disturbance, sweating, poor tolerance to elevated environmental temperatures, palpitations, and sometimes pain in the region of the piercing or constricting heart, increased appetite and, despite this, weight loss, diarrhea.
Disorders of cardiovascular activity in diffuse goiter are manifested in the form of increased heart rate (pulse even during the night’s sleep more than 80 per minute), increased systolic and lower diastolic blood pressure, arrhythmia attacks. The vessels of the skin are expanded, and therefore it is warm to the touch, moist. In addition, some patients show vitiligo, darkening of skin folds, especially in areas of friction (neck, lower back, elbow, etc.), urticaria, scratches (itching of the skin, especially when attaching a liver lesion), loss of skin is observed hair.
Expressed trembling fingers. Sometimes hand shake is so pronounced with diffuse goiter that patients hardly manage to fasten buttons, the handwriting changes and the sign of “saucer” is characteristic (when an empty cup is in a hand, a rattling sound is produced on the saucer as a result of a fine hand shake).
Disturbances on the part of the nervous system are manifested by irritability, anxiety, increased excitability, changeable mood, loss of ability to concentrate attention (the patient quickly switches from one thought to another), sleep disorders, sometimes depression, and even mental reactions.
In diffuse toxic goiter in most cases there are characteristic changes (luster of the eyes, etc.) from the side of the eyes. The eyes are dilated, giving the impression of an angry, surprised or frightened look.
Diagnosis of diffuse goiter is carried out by an endocrinologist. The patient is primarily sent to study the basal level of TSH using highly sensitive techniques. The concentration of TSH in diffuse toxic goiter is usually low (<0.1 mU / l). Concentration of T3 and T4, on the contrary, is increased. Possible subclinical diffuse toxic goiter, in which the level of T3 and T4 is saved, and TSH is reduced.
An immunological study is performed. With its help, antibodies to TSH are determined.
Instrumental methods are also used. The patient may be given an ultrasound scan of the thyroid gland, scintigraphy, CT and MRI, if necessary.
The drug of choice for patients with diffuse toxic goiter is Tiamazole . The drug is prescribed in the amount of 30-40 mg for two doses. In most cases, within 4-6 weeks, it is possible to achieve an euthyroid state in 90% of patients. On an ongoing basis, the drug in large doses is not accepted, over time they go to a maintenance dosyroku.
Soothing preparations are widely used (bromine, valerian, etc.).
For moderate and severe forms of diffuse goiter, vitamins (A, C, B1, B2 B12, B15), cocarboxylase , ATP, calcium preparations are used.
Indications for surgical treatment of diffuse goiter are large sizes of goiter (45 ml and more), intolerance to mercazole , recurrence of the disease after drug therapy, retrovoranny location of goiter.
Diet with diffuse toxic goiter:
- sufficient content of proteins, fats and carbohydrates;
- replenishing the lack of vitamins (fruits, vegetables) and mineral salts (milk and milk products as a source of calcium salts);
- limit the products and dishes that excite the nerve system (strong tea, coffee, chocolate, spices).
With diffuse toxic goiter, the prognosis is favorable. In more than 60-70% of patients, remission occurs under the influence of mercazole . Often remission occurs alone or as a result of non-specific therapy.
Numerous works published in 1920–40 show that under the influence of treatment, which can now be considered as non-specific (spa treatment, physiotherapy, balneotherapy, etc.), 80-90% were in remission. This can be explained by the indirect influence (immunomodulating action) of the listed factors on the immune system and the restoration of the immune- nerve-hormonal relationship.