Causes and symptoms of Graves' disease: treatment methods. Graves' disease (Graves' disease, diffuse toxic goiter) Graves' disease develops with a deficiency

The German scientist Karl Adolf von Basedow in the 19th century, based on similar signs, identified a severe thyroid disease in four of his patients, indicating its symptoms.

This disease was named Basedova. In modern practice, it is more often called diffuse toxic goiter.

And in some countries, the disease bears the name of the Irish doctor Graves, who, like Bazedov, made a description of the symptoms of the disease in the 19th century.

Graves' disease is a form of thyrotoxicosis. In this disease, the thyroid gland produces thyroid hormones in excess. For the normal functioning of all body systems, much less is required. The gland itself greatly increases in size. Among patients with this diagnosis, the majority are girls and women under 45 years of age. In older people, goiter is diagnosed very rarely.

In a person suffering from Graves' disease, the immune system mistakes the cells of his body for enemies and fights against them. Antibody proteins are actively produced, which accelerate the synthesis of thyroid hormones.

Diffuse toxic goiter is a consequence of a combination of certain internal factors with negative environmental factors. The immune response, to which a person has a genetic predisposition, appears due to exposure to external stimuli.

Graves' disease is an endocrine disease that is caused by more than one factor.

Graves' disease occurs in the following conditions:

psychological trauma, stressful situations, emotional stress;
diseases caused by pathogens entering the body;
colds of the nose and throat;
head injuries;
smoking, including passive smoking, drinking alcohol.

However, until now, indications of the causes of Graves' disease are only assumptions. The etiology of the disease is still an open question.

The mechanism of development of the disease is as follows. AT-rTSH - antibodies to the thyroid-stimulating hormone receptor (TSH) are formed. They activate this receptor, triggering cascades of enzymatic reactions inside cells.

The reactions enhance the process of iodine uptake by thyroid cells, which causes the release of a large amount of thyroid hormones and intensive division of thyroid epithelial cells (thyrocytes). As a result, symptoms of thyrotoxicosis are observed, which are the main clinical manifestations of diffuse toxic goiter.

Signs

Thyrotoxicosis is manifested by the following symptoms (we will designate them in development, from the very beginning of the disease to its severe degree):

mood instability;
increased sweating;
tremor of fingers;
causeless loss of up to 10 percent of weight;
the heart beats at a rate of more than 100 beats per minute;
sleep disturbance;
causeless restlessness;
neurasthenic;
disruptions in the menstrual cycle;
decreased sex drive;
problems with potency;
strong feeling of stuffiness;
a person loses more than 10 percent of his weight;
pulse per minute – from 120 beats;
performance is impaired;
inability to concentrate or remember anything;
tearfulness;
trembling of the whole body.

Signs of inflammation of the thyroid gland of an autoimmune nature, which the doctor notices during the examination:

A loud noise is heard above the gland using a phonendoscope (the inflamed organ is supplied with blood more intensely than a healthy one);
when palpating the thyroid gland, the doctor identifies the isthmus of the organ by touch;
ophthalmopathy is observed (in 95 percent of all cases of diffuse toxic goiter);
on the legs - pretibial myxedema (in 10 percent of cases of Graves' disease).

Signs of ophthalmopathy (from mild to severe):

eyes shine;
the patient cannot completely close his eyelids, because the fatty tissue of the eyes is swollen.
inflammation of the mucous membrane of the eyes;
exophthalmos, i.e. “bulging” of the eyeballs;
atrophy of the eye muscles.

Signs of pretibial myxedema are swelling and redness of the skin on the legs, itching.

Signs that the goiter is compressing surrounding tissues:

dry cough;
dyspnea;
swelling and redness of the face;
difficulty swallowing food.

Thyroid dysfunction can lead to the development of such a dangerous disease as we will discuss on our website.

Treatment methods for diffuse toxic goiter are reviewed.

No one is immune from Graves' disease, but preventing the disease will reduce the chances of a dangerous pathology occurring. Follow the link to read in detail about preventive measures.

Symptoms

The symptoms of Graves' disease are not the same at different stages of the disease. In addition to changes that are noticeable visually (movement of the eyeballs forward, thickening of the neck), many internal pathological changes occur in the body. Their symptoms are individual.

At first, the development of diffuse toxic goiter is latent, that is, it is not noticeable either to others or to the patient himself.

However, already at this stage one can suspect Basedow’s disease based on some features of the person’s behavior and condition:

behavior instantly changes from aggressive to apathetic;
profuse sweating;
hands are shaking;

In the acute stage of the disease, the following symptoms appear:

The size of the thyroid gland is large, the goiter becomes visually noticeable, especially when a person swallows food;
constant feeling of hunger;
large loss of body weight;
“bulging” eyes, shiny eyes;
poor eyesight;
swelling of the eyelids;
if the patient looks down, strips of white sclera are visible above the corneas;
headache;
insomnia;
frequent loose stools;
abdominal pain that gets worse after eating;
tachycardia;
hypertension;
a violation of fat metabolism, in which the process of absorption of carbohydrates in the body deteriorates (the onset of diabetes mellitus);
disruptions in the reproductive system (menstrual cycle disorders in women, decreased potency in men).

Exophthalmos

Changes in the body at an advanced stage of the disease:

the patient blinks very rarely;
the eyeballs are strongly pushed forward;
blindness;
loss of teeth;
impotence in men, early cessation of menstruation in women;
ischemia;
destruction of nails;
swelling of the legs;
dystrophy of internal organs.

A dangerous complication of Graves' disease is thyrotoxic crisis. Its symptoms:

the patient's body temperature exceeds 40 °C;
severe and sharp pain in the head;
incoherence of speech;
hallucinations;
fear, anxiety for no reason;
increased physical activity is quickly replaced by an apathetic, lethargic state;
psychoses;
frequent loose stools;
vomit;
abdominal pain;
loss of consciousness or coma is possible.

Thyrotoxic crisis can be caused by sudden cessation of treatment with thyroid-stimulating blockers.

Diagnosis of diffuse toxic goiter

If the disease has entered the second stage of development, its symptoms are clearly expressed, and there are no difficulties with diagnosing Basedow’s disease. It is possible to identify the disease at the very beginning of its development only through research conducted in laboratory conditions.

With Graves' disease, the level of thyroid hormones in the blood is increased, and thyroid-stimulating hormones are decreased. In most cases, the test shows that there is more T3 in the blood than T4.

But in some cases of the disease with high T3, the thyroxine level remains normal.

If the increase in T3 and T4 is small, but the doctor suspects thyrotoxicosis, TRH is prescribed, i.e., the administration of rifathiroin, a drug containing thyrotropin-releasing hormone.

If TSH does not increase, this confirms that the patient has Graves' disease.

In medical practice, there were cases when, with elevated levels of T3 and T4, an increased level of thyroid-stimulating hormones was also observed. This was due to the fact that hyperthyroidism was caused by a pituitary adenoma that produces TSH.

Immunofluorescence diagnostics reveals 4 types of antithyroid antibodies in the blood. These antibodies are markers of thyroid pathology.

The biological method reveals how active thyroid-stimulating immunoglobulins (TSIs) are. If the TSI level does not decrease after drug therapy, the patient is prescribed surgical treatment.

Radioisotope diagnostics, once popular, are now rarely used because hormone levels can be measured. The basis of the radioisotope method is the ability of the thyroid gland to absorb iodine. 131I is introduced into the body, after 2 hours the rate at which it is absorbed by the gland is measured, after a day - the amount of iodine accumulated by the organ, after three days - the rate of decline.

Goiter on ultrasound

Hyperthyroidism is indicated by the absorption of iodine by the gland above 13% 2 hours after its administration, and accumulation after 24 hours should normally not exceed 34%. Scintigraphy of the thyroid gland makes it possible to find out the size of the organ, its shape, determine whether there are nodes, etc. The study identifies areas of tissue that capture isotopes.

Ultrasound. The echogenicity of the gland and its volume are determined. In Graves' disease, the echogenicity of the thyroid gland is reduced.

If a patient has many chronic diseases or there are malfunctions in only one system (gastrointestinal tract or cardiovascular system), it can be very difficult to differentiate Graves' disease. We need an integrated approach to diagnosis: taking into account symptoms and the results of all studies.

Treatment

Operation

Surgery is performed when the goiter becomes very large and puts pressure on the trachea or esophagus.

Surgery is also indicated if the overgrown thyroid gland has descended behind the sternum, if Graves' disease is complicated by atrial fibrillation, or if drug treatment has been ineffective.

Drug treatment

Drug therapy is prescribed at all stages of goiter development.

Cytostatics play the main role in drug treatment.

These include “Merkazolil”. The maximum dose of medication per day should not exceed 60 milligrams, and at the initial stage of the disease - 30 milligrams.

After some time, the patient is transferred to the minimum daily dose of Mercazolil (2.5 milligrams), which he must take every day for a year. The drug can be discontinued by the attending physician after 6 months if there have been no exacerbations of the disease during this period.

Medicines containing iodine are prescribed by an endocrinologist only for individual indications. Potassium chlorate is usually used, which prevents iodine from entering the thyroid gland.

With complex therapy, it is possible to prescribe drugs that block beta-adrenergic receptors (Anaprilin, Obzidan, etc.). They normalize heart function. Medicines with corticosteroids are used, for example, Prednisolone, Hydrocortisone.

If the body is severely depleted, it is supported by anabolic agents with steroids.

Radioactive iodine

To suppress the activity of the thyroid gland, treatment with radioactive iodine is prescribed. This substance is absorbed by the gland, accumulates in it, and radioactive radiation partially kills this organ.

Thus, despite hyperstimulation by antibodies, the organ cannot produce hormones in excess.

After such treatment, the patient must take the hormones that the thyroid gland synthesizes for the rest of his life, since the normal functionality of the gland cannot be restored after radioactive therapy.

The proliferation of thyroid tissue of the thyroid gland provokes a condition such as. If you notice the symptoms of a pathological process in time, you can avoid a dangerous pathology.

Graves' disease is fraught with dangerous complications. You can read about the prognosis of Basedow's disease.

Folk remedies

The effect of traditional medicine is possible at the first stage of development of Graves' disease. You should consult your doctor about using an alternative treatment method.

Popularly, thickening of the neck is treated with infusions, the recipes of which are written below:

Thyme infusion. The potion is prepared as follows: a tablespoon of dry thyme is brewed with boiling water in a volume of 200 ml. Close the pan tightly and wait 20 minutes until the plant releases its beneficial properties to the water. After straining, drink the infusion three times a day.
Herbal tea to strengthen the body. Make a mixture of approximately equal amounts of motherwort, peppermint leaves, valerian roots and 2 tablespoons of hawthorn berries. A tablespoon of the mixture is brewed with boiling water and filtered after 30 minutes. The infusion should be drunk half a glass twice a day before meals. The course is 30 days, then rest is 10 days, and again a month of treatment.

The simplest method of treating Graves' disease is irradiation of the thyroid gland with radioactive iodine: the patient drinks water with a very small amount of this substance added to it, and the healing process begins.

However, such therapy is not indicated for everyone. For example, it cannot be performed on pregnant women: iodine will enter the baby’s body.

The method of treatment is selected by the doctor individually in each specific case of the disease.

Important conditions for recovery for any degree of development of diffuse toxic goiter are a calm environment, the patient’s confidence that he will recover, proper nutrition with a predominance of dairy products.

Video on the topic

The thyroid gland is involved in the functioning of many systems, since it influences the metabolic processes of various types in the body. The appearance of diseases in the organ leads to disturbances in other systems, which significantly worsens the state of health. Graves' disease is not considered common (every hundred people are affected), but it causes complications if it is not diagnosed and treated. The cause is indicated in the form of immune system failures.

Other names for Graves' disease include:

Diffuse toxic goiter.
Graves' disease.
Flayani's disease.
Perry's disease.

The site defines Graves' disease as an autoimmune disease that provokes a significant enlargement of the thyroid gland and excessive production of thyroid hormones, which develops symptoms of hyperthyroidism. This leads to systemic disruptions. It is more common among the female half of humanity.

The following types of Graves' disease are distinguished:

Mild degree, which is marked by minor changes in health: weight loss up to 10%, heart rate does not exceed 100 beats per minute.
The average degree, which is marked by noticeable changes in the form of weight loss up to 20%, increased blood pressure and an increase in heart rate of more than 100 beats per minute.
Severe degree, which significantly affects health in the form of weight loss of more than 20%, damage to other systems and organs, increased heart rate of more than 120 beats per minute.

What are the causes of Graves' disease?

The main reason for the development of Graves' disease is considered to be disturbances in the immune system. What reasons provoke these violations? Factors leading to immune failures are:

Diabetes mellitus, vitiligo, Addison's disease, hypoparathyroidism and other autoimmune diseases.
Genetic predisposition.
Administration of radioactive iodine.
Chronic infectious diseases in the body. Thus, Graves' disease is often provoked by chronic tonsillitis and viral infections.
Neuropsychiatric disorders.
Traumatic brain and mental injuries.

These factors can lead to a disorder of the immune system, which will begin to produce antibodies to TSH, which will force the thyroid gland to produce more hormones, leading to the development of thyrotoxicosis.

When the immune system is damaged, antibodies begin to be produced that react against normal thyroid cells. It, in turn, begins to produce hormones in excess, which lead to disturbances in metabolic processes and excessive energy expenditure. The gland itself begins to increase in size and become dense. This leads to compression of neighboring organs, which causes a feeling of suffocation.

Is there a predisposition to diffuse toxic goiter?

One of the factors is called genetic predisposition. However, scientists have not yet found reliable evidence of this. This is just an assumption that helps explain the appearance of the disease. It is believed that Graves' disease is a consequence of mutations of several genes that are activated at the moment when the body begins to be influenced by favorable negative factors.

Most often, the disease manifests itself in women aged 30-50 years. It is behind them that bulging eyes are noted. However, the disease can occur in young girls, pregnant women or women during menopause. According to statistics, for every 8 sick women there is 1 sick man.

What are the symptoms of the disease?

Graves' disease manifests itself quickly and acutely, or its symptoms increase gradually. The following signs of the disease are identified:

Ophthalmic:

Stellwag's sign is rare blinking.
Inflammation of the cornea.
The effect of a surprised look is the widening of the palpebral fissure.
The appearance of ulcers on the transparent membrane.
Incomplete closure of eyelids.
Sensation of sand and dryness in the eyes.
Graefe's sign is a rise of the upper eyelid and drooping of the lower eyelid.
Exophthalmos - bulging eyes. It occurs both uniformly and unilaterally.
Chronic conjunctivitis.
Compression of the eyeball or nerve by swelling, which leads to pain in the eyes, impaired visual field, complete blindness, and increased intraocular pressure.

Digestive:

Diarrhea.
Liver dysfunction.
Increased appetite.
Vomiting with possible nausea.

Cardiovascular:

Ascites.
Swelling of the limbs.
Tachycardia.
Swelling of the skin - anasarca.
Chronic heart failure.

Endocrine:

Heat intolerance.
Sudden weight loss.
Decreased functioning of the gonads and adrenal cortex.

Neurological:

Muscle weakness.
Fussiness.
Increased excitability.
Headache.
Motor restlessness.
Trembling fingers.
General reactivity.

Dental:

Periodontal disease.
Multiple caries.

Dermatological:

Erythema.
Increased sweating.
Darkening of hair.
Swelling of the legs.
Nail destruction.

With diffuse toxic goiter, not all of the above symptoms may appear, but only some of them.

What complications arise?

Thyrotoxic crisis is the most severe and dangerous complication that can develop after Graves' disease. It can be recognized by high blood pressure, vomiting, rapid heartbeat, fever up to 41°C, excessive irritability and coma. The patient may die if he is not hospitalized and does not receive medical care.

Thyrotoxic crisis occurs suddenly under the influence of:

Heart attack.
Stress.
Treatment with radioactive iodine.
Physical fatigue.
Infectious diseases.
Overdose of synthetic hormones after removal of part of the thyroid gland.
Any surgical intervention.
Abruptly stopping the use of medications that controlled the production of thyroid hormones.

If a complication develops, then a huge amount of thyroid hormones are released into the blood, which disrupt the functions of the liver, nervous and cardiac systems, and adrenal glands.

How to diagnose and treat Graves' disease?

Symptoms are the first diagnostic indicators that Graves' disease has developed. However, this is confirmed by other procedures, after which treatment is prescribed.

Diagnostic measures are:

Study of the effect of radioactive iodine on the gland.
Blood test.
Palpation of the gland, which is enlarged.
Radioisotope scanning.
Reflexometry.
Thyroid biopsy.
Enzyme immunoassay blood test.
Ultrasound of the gland.
Thyroid scintigraphy.

Treatment is carried out by normalizing the daily routine and nutrition:

Creating a favorable and calm environment.
Ensuring nutrition.
Getting adequate sleep.
Taking vitamins.

Doctors prescribe drug treatment, which consists of taking antithyroid drugs, potassium supplements and sedatives. Radioiodine therapy and surgical intervention are also prescribed in case of an allergic reaction to iodine, severe symptoms of heart failure and an increase in goiter of more than the 3rd degree.

Is it possible to recover from Graves' disease - forecasts

A person should not ignore the presence of the disease, since negative forecasts are possible in the form of:

Muscle weakness.
Hyperthyroidism.
Heart attack.
Paralysis.
CNS lesions.
Stroke.
Skin hyperpigmentation.
Cardiovascular failure.
Thyrotoxic crisis.

With timely treatment, Graves' disease can be completely eliminated. Fluids, sedatives, vitamins, and nutrients may be prescribed to help maintain health.

What is this disease?

Graves' disease is an endocrine disease caused by an excess of thyroid hormones. It is characterized by overproduction of the hormone thyroxine, an enlargement of the thyroid gland (goiter) and numerous changes in all body systems. Basedow's disease most often begins between the ages of 30 and 40; people with a family history of thyroid defects are especially often affected.

With treatment, most people can lead a normal life. However, an acute attack of the disease, called thyrotoxic crisis, can lead to the development of life-threatening diseases (heart, liver and kidney failure). See WHAT HAPPENS DURING A THYROTOXIC CRISIS.

What are the causes of Graves' disease?

Hereditary predisposition and a defect in the immune system play a role in the development of Graves' disease. Graves' disease is sometimes combined with disorders of iodine metabolism and other endocrine diseases (for example, diabetes, thyroiditis and hyperparathyroidism).

Uncontrolled use of drugs containing iodine and stress can contribute to the development of Graves' disease. Surgery, infections, toxicosis of pregnancy, diabetic ketoacidosis, as well as improper treatment can cause a thyrotoxic crisis.

MORE ABOUT THE DISEASE

What happens during a thyrotoxic crisis

Thyrotoxic crisis is a complication of Graves' disease. Signs and symptoms of a crisis: excessive irritability, high blood pressure, rapid heartbeat, vomiting, fever up to 41.1 o and coma. If urgent measures are not taken, the patient may die.

Thyrotoxic crisis develops suddenly. It can be triggered by stress caused by injury, surgery or infection.

Predisposing factors:

insulin-dependent low blood sugar or diabetic ketoacidosis;

heart attack;

blood clot in the lungs;

abrupt cessation of taking medications that block the production of thyroid hormones;

initiation of radioactive iodine treatment;

preeclampsia;

overdose of synthetic thyroid hormone after removal of part of the thyroid gland.

What are the symptoms of the disease?

Classic symptoms of the disease are goiter (enlarged thyroid gland), nervousness, poor heat tolerance, weight loss despite increased appetite, sweating, diarrhea, tremors and rapid heartbeat.

Another classic symptom of Graves' disease is bulging eyes, but there are cases when it is absent (see CHANGES IN APPEARANCE CAUSED BY Graves' DISEASE).

How is the disease diagnosed?

Diagnosis of Graves' disease usually does not cause difficulties. If your doctor suspects you have Graves' disease, he or she will review your medical records, examine you, and order routine laboratory tests. An ultrasound may show changes in the eyes caused by Graves' disease.

How is this disease treated?

The main methods of treatment are taking medications that block the synthesis of thyroid hormones and radioactive iodine, as well as surgical removal of part of the thyroid gland. The choice of treatment method depends on the size of the goiter, the causes of the disease, the age of the patient, the woman’s desire to have children and the possibility of surgical intervention.

Drug therapy

Drug therapy is used to treat children, young people, pregnant women, and those who refuse surgery and cannot take radioactive iodine. Propylthiouracil and mercazolil are used, which block the synthesis of thyroid hormones. Although symptoms disappear 4-8 weeks after starting therapy, treatment must be continued for 6 months to 2 years. To prevent side effects (such as increased heart rate), many people are prescribed Inderal at the same time.

Pregnant women are prescribed minimal doses of medication to minimize the risk of developing thyroid hormone deficiency in the fetus. Since the condition of patients usually deteriorates after childbirth, young mothers should be monitored. If the mother receives the medicine in minimal doses, she can continue to breastfeed the baby, provided that the baby's thyroid function is checked periodically.

Another commonly used treatment is radioactive iodine 131, which is given in a single dose orally. This method is preferable for those who do not plan to have children.

MORE ABOUT THE DISEASE

Changes in appearance caused by Graves' disease

Graves' disease affects the functioning of many organs.

Nervous system

Concentration of attention worsens, overexcitability, nervousness, emotional instability, mood swings, trembling fingers, and uncertainty of movements are noted.

Eyes

The eyeballs protrude forward, sometimes the conjunctiva, retina or eye muscles become inflamed, double vision and tearing may appear.

Leather

Painful, raised, itchy plaques may appear on the skin; nodules are sometimes noted.

Hair and nails

Hair becomes thin, soft, turns gray early, and falls out more than usual; nails break easily and separate from the nail bed.

Heart and blood vessels

Rapid heartbeat, full, fast pulse, enlarged heart, arrhythmia (especially in older people) and sometimes heart murmurs.

Lungs

Shortness of breath on exertion and at rest.

Digestive system

Nausea and vomiting, increased bowel movements, soft stools or diarrhea, enlarged liver, decreased appetite.

Muscles and bones

Weakness, fatigue, loss of muscle mass, possible paresis and swelling.

Reproductive system

In women - infrequent or absent menstruation, reduced fertility, increased risk of miscarriage; in men - abnormal enlargement of the mammary glands; in both sexes - decreased sexual desire

Surgery

Removing part of the thyroid gland reduces its ability to produce hormones. Surgery is indicated for people with a severely enlarged thyroid gland, the hyperactivity of which is restored after drug treatment, who refuse treatment with iodine 131 or have contraindications to it (see QUESTIONS THAT ARE MOST FREQUENTLY ASKED ABOUT SURGERY).

After surgery and radioiodine treatment, many people develop an underactive thyroid gland, so they need to be under medical supervision for a long time, sometimes years after treatment.

CONVERSATION WITHOUT INTERMEDIARIES

Questions most often asked about surgery

I know that the thyroid gland is located next to the ligaments. Will removing part of the thyroid gland affect my voice?

It shouldn't. You may notice some hoarseness for a few days after surgery. However, permanent voice changes are very rare.

Could there be other dangerous consequences?

The risk is very low. But you need to know about dangerous symptoms so that you can quickly take measures to eliminate them. After surgery, you may experience bleeding, infection, or difficulty breathing, which you should immediately notify your doctor about. There is also a very small risk that the nearby parathyroid gland, which is involved in regulating calcium balance, will be affected.

After having my thyroid removed, will I need to take medication?

This depends on a number of reasons. If you have all or most of your thyroid gland removed, you will need to take thyroid hormone medications because your body can no longer produce them. If you have enough healthy thyroid remaining, you won't need to take medication.

Other treatments

Treatment of ophthalmopathy that develops as a result of Graves' disease may involve local use of medications; in other cases, large doses of corticosteroids are required. People with protruding eyes may require radiation therapy using an external source of radiation or surgery to relieve the pressure when pressure on the optic nerve increases.

Thyrotoxic crisis is relieved with medications that suppress the synthesis of thyroid hormones, Inderal is prescribed intravenously, a steroid and a drug containing iodide. Maintenance therapy consists of prescribing nutrients, vitamins, sedatives, and fluids.

Graves' disease is a diffuse inflammation of the thyroid tissue caused by an autoimmune lesion. Other names of the pathology: diffuse toxic goiter, Flajani's disease, Graves' disease. In 1840, this disease was first described in detail by Karl von Basedow. The term Basedow's disease is used in those countries where the influence of German medicine is still strong.

Causes of the disease

Graves' disease develops due to a breakdown of the body's immune defenses. Instead of fighting viruses and bacteria, lymphocytes begin to produce antibodies against thyroid cells.

Autoimmune aggression can be triggered by various factors. The causes of Graves' disease have not been fully studied. It is known that the prevalence of pathology is much higher among young people aged 20–40 years. Most of the patients are women.

Graves' disease may be caused by:

previous viral infection;
hormonal disorder;
emotional stress;
excessive insolation (solarium, sunlight);
traumatic brain injury.

Hereditary burden also affects the incidence of Graves' disease. The disease itself is not passed on from generation to generation. But if there are people in the family who have suffered from any autoimmune pathologies, then the risk of Graves’ disease increases.

Mechanism of disease development

Graves' disease is an atypical autoimmune disease. For a long time, inflammation not only does not destroy the affected organ, but even maintains its functional activity at an excessive level.

The target of antibodies in this pathology is a special structure of thyroid cells - a receptor for thyroid-stimulating hormone. The disease is accompanied by activation of the receptor. The result of this is the stimulation of thyroid hormone production.

Thyroxine and triiodothyronine are released into the blood in quantities up to 3-5 times higher than normal. Such levels of thyroid hormones almost completely block the secretion of thyroid-stimulating hormone from the pituitary gland.

In addition, antibodies to the thyroid-stimulating hormone receptor stimulate an increase in the number of thyroid cells and their hypertrophy. Graves' disease is almost always accompanied by an increase in the volume of thyroid tissue. In most cases, a goiter is visible upon examination.

Autoimmune damage to the thyroid gland may be accompanied by endocrine ophthalmopathy (eye damage) and pretibial myxedema (swelling of the legs).

Symptoms of the disease

Symptoms of Graves' disease can be divided into three groups:

signs of thyrotoxicosis;
signs of autoimmune damage;
signs of mechanical compression of surrounding tissues.

Each patient has a unique combination of symptoms with a predominance of one or another sign of Graves' disease.

Increased thyroid function occurs in 100% of cases of Graves' disease.

There are three degrees of thyrotoxicosis:

light;
average;
heavy.

Mild thyrotoxicosis is characterized by:

moderate loss of body weight (0-5%);
heart rate (pulse) less than 100 beats per minute;
mild neurogenic and psychogenic symptoms.

Patients may be bothered by slight emotional lability, sweating, and trembling in the fingers. Functionality has been preserved. Physical activity can be tolerated without shortness of breath. At this stage, patients sometimes do not seek medical help, but are treated with folk remedies.

Moderate thyrotoxicosis is associated with:

pronounced weight loss (5–10% of body weight);
heart rate 100–120 per minute;
strong changes in the activity of the nervous system.

Patients do not tolerate physical activity well, suffer from insomnia, nervousness, and irritability. They are constantly hot and stuffy even in cool rooms.

Severe thyrotoxicosis is diagnosed if:

the patient loses more than 10% of body weight;
pulse is more than 120 beats per minute;
changes in the mental sphere and nervous system are critical.

Patients with severe thyrotoxicosis are unable to perform daily activities. Their sleep, memory processes and concentration are disturbed. Patients cry a lot and quickly move from low mood to euphoria and back. Tremors of the torso and head may accompany trembling of the fingers.

Severe thyrotoxicosis may be accompanied by atrial fibrillation, acute psychosis, heart failure, and hepatitis.

Any thyrotoxicosis can cause cycle disruption in women, decreased libido, and impaired potency in men.

Signs of an autoimmune disease

Signs of autoimmune inflammation in the thyroid gland are detected during examination, laboratory and instrumental examination.

On examination, there is an increase in noise over the thyroid gland when listening with a phonendoscope. This symptom is associated with active blood supply to the affected organ.

When you touch the gland, there is a clear increase in the isthmus and lobes in volume, elastic elasticity of the tissue.

Autoimmune damage in Graves' disease is confirmed by the combination of goiter with endocrine ophthalmopathy of varying degrees and pretibial myxedema. These conditions are also provoked by one’s own immunological aggression.

Endocrine ophthalmopathy is an eye disease. In 95% of cases it accompanies Graves' disease. With endocrine ophthalmopathy, autoimmune inflammation affects the fatty tissue of the orbit (retrobulbar). Swelling of this area disrupts the closure of the eyelids, causing conjunctivitis and damage to the eye muscles.

Protrusion of the eye from the socket is called exophthalmos. The degree of exophthalmos is determined by the ophthalmologist. The more pronounced the bulge, the higher the risk of loss of eye function.

Complaints with endocrine ophthalmopathy in mild cases:

lacrimation;
redness of the eyes;
sparkle of eyes;
doubling of objects;
photophobia;
feeling of “sand” in the eyes.

Severe ophthalmopathy causes partial or complete loss of vision, corneal ulceration, and atrophy of the eye muscles.

Pretibial myxedema - local dense swelling of both legs. Dystrophic changes are observed on the skin. Swelling may be accompanied by severe itching.

Signs of compression of surrounding tissues

Mechanical compression of the neck organs is possible with a giant goiter or an atypically located thyroid gland.

In the first case, compression of surrounding tissues occurs if the volume of thyroid tissue is more than 50–100 cm 3 .

An atypical, too low location of the thyroid gland is a substernal goiter. In this case, mechanical compression of the vessels, esophagus and trachea is possible when the total volume of thyroid tissue is more than 30 cm 3.

Symptoms of compression:

cough without phlegm;
suffocation;
>swelling and purple complexion;
difficulty swallowing solid food.

Diagnosis of Graves' disease

The typical course of Graves' disease does not present diagnostic difficulties. Already the initial examination allows you to make a preliminary diagnosis.

hormonal tests (thyroid-stimulating hormone, thyroxine, triiodothyronine);
immunological studies (antibodies to the thyroid-stimulating hormone receptor);
Ultrasound of the thyroid gland;
radioisotope scanning.

Treatment

Treatment of Graves' disease can be conservative, surgical or radiological. The success of drug therapy is higher when the volume of thyroid tissue is small; drugs from the group of thyreostatics (timazol, propylthiouracil and others) are used for treatment. The drugs are prescribed for a long term (1–2 years).

Graves' disease– these are the consequences of improper functioning of the thyroid gland and hormonal imbalance in the body.

The exact causes of this disease and symptoms have not yet been fully established; it is only known that it belongs to the category autoimmune diseases and it most often affects females under the age of 45.

Graves' disease, its symptoms and causes are often referred to as Graves' disease or diffuse toxic goiter.

Reasons

Graves' disease refers to diseases of the endocrine system and, accordingly, its occurrence is directly related to disturbances in the functioning of this system.

In addition, among the possible causes of Graves' disease are:

Cause of Graves' disease in the presence of autoimmune processes and diseases in the human body. Autoimmune diseases are defects of the immune system when the body produces substances that have a detrimental effect on its own cells. With Graves' disease, the same thing happens: lymphocytes produce an abnormal protein, which causes the thyroid gland to produce excessive amounts of thyroid hormones.
Cause of Graves' disease in infectious processes of a chronic nature in the body. Due to such foci, the number of lymphocytes increases, and they affect the functioning of the thyroid gland in the same way as described in the first case. In connection with this fact, Graves' disease often develops in humans against the background of diseases such as diabetes mellitus, chronic tonsillitis, vitiligo, hypoparathyroidism and others.

Cause of Graves' disease in a viral infection.
Cause of Graves' disease in the use of radioactive iodine to conduct any examinations may negatively affect the activity of the thyroid gland.
Cause of Graves' disease in hereditary predisposition the same diseases.
Cause of Graves' disease in mental disorders. Also, emotional disorders and constant nervous shocks in the body lead to frequent surges of adrenaline, which does not have the best effect on the endocrine system as a whole. In medicine, the causes of the development of Graves' disease in absolutely healthy people were observed due to severe shock or stress.

The above reasons are, rather, assumptions about Graves’ disease. In most patients with Graves' disease, the cause of its occurrence cannot be reliably determined. It can be noted that one proven fact still exists - The acute form of Graves' disease occurs due to mental or emotional stress.

The fact that women are more susceptible to Graves' disease is explained by the fact that the fairer sex has a more developed hormonal system and it is also most susceptible to various stresses (pregnancy, menopause, etc.)

Excess body weight– the cause is the occurrence of Graves’ disease. The greater the weight, the greater the load on the body as a whole and on its individual systems. This condition of Graves' disease is especially dangerous when the pancreas cannot cope with the production of special enzymes. In this case, the extraction of microelements from food and their absorption is significantly limited, and the body begins to experience a lack of them.

Symptoms

The onset of Graves' disease does not manifest itself as anything special. Therefore, a person may not even suspect that he is sick at first.

The primary symptoms of Graves' disease include:

Symptoms of frequent mood swings and sleep disorders;
Symptom of increased sweating in Graves' disease;
Symptoms of fussiness of movements and tremors of the limbs;
Symptom of increased heart rate.
Thickening of the thyroid gland without pain.
Usually there is a decrease in a person’s weight, but on the contrary, there may be a sharp increase in weight.
A symptom of darkening of the skin to darker shades with Graves' disease.
The occurrence of dense edema in the lower extremities.

From the gastrointestinal tract the following symptoms are observed: diarrhea,
nausea and vomiting, liver problems.
Nails become brittle and brittle, they peel off and become yellowish. Hair becomes very thin, breaks and falls out profusely.
In the sexual sphere Negative signs such as decreased libido, disruptions in the menstrual cycle in women, and inability to conceive are noticeable. Men may experience impotence. Such symptoms are associated with low production of hormones by the adrenal cortex.

Degrees of the disease

Main degrees of Graves' disease:

Diagnosis and consequences of the disease

Making an accurate diagnosis of Graves' disease in this case is not too difficult. The doctor is quite capable of determining the presence of this autoimmune disease by the patient’s appearance and his characteristic behavior. However, to clarify the diagnosis of Graves’ disease and the causes of its occurrence, a number of measures are carried out:

A blood test is required. If it contains an increased amount of iodine, triiodothyronine and thyroxine, then this confirms the presence of Graves' disease. The concentration of cholesterol in the blood is significantly reduced in this case.
Radioisotope scan of the thyroid gland carried out to determine its exact size and location. This study is necessary because it is necessary to exclude the presence of tumors in the thyroid gland and other diseases in it.
Ultrasound examination The thyroid gland is also indicated for diagnostic purposes of Graves' disease.

The consequences of Graves' disease are quite complex. As the disease progresses, the thyroid gland increases in size, which leads to significant thickening of the neck. This is visible even to the naked eye to any person. Sometimes it can grow so much that it looks like a tumor formation

Thyrotoxic crisis - This is one of the most severe consequences of Graves' disease. It occurs due to a huge release of thyroid hormones and poisoning of the body with them. A crisis is dangerous because of its suddenness and, in the absence of emergency medical care, can even lead to the death of the patient. A crisis of Graves' disease can occur due to the following reasons:

Causes of severe mental or physical stress, stressful situation;
The cause is a heart attack;
Due to extensive inflammation in the body;
Due to abrupt withdrawal of thyroid-stimulating drugs.

Treatment

The method of treating the symptoms of Graves' disease is determined only by the attending physician. This will depend on the causes, symptoms, degree of the disease, the size of the goiter itself, the age group of the patient, the need to preserve reproductive function (for women), and the possibility of surgical intervention.

As a rule, treatment of the symptoms of Graves' disease is carried out either with medication or surgery.

Drug therapy is aimed at reducing thyroid production. Treatment of symptoms of Graves' disease differs in its duration: even if the symptoms smooth out after 2-3 months of treatment, treatment should be continued from six months to two years. If surgery is still indicated, then in its process part of the thyroid gland will be removed. This is also done to reduce the production of hormones in Graves' disease. But this method cannot eliminate the very cause of the disease.

Treatment of symptoms of Graves' disease is also indicated during the patient's pregnancy: in this case, of course, the dosage of prescribed medications will be significantly reduced. The same applies to the period of breastfeeding. Naturally, the woman must be under constant medical supervision..

A method like one-time oral administration of radioactive iodine has been widely used in the treatment of Graves' disease. The disadvantage of this treatment for Graves' disease is that it is suitable only for those patients who are no longer interested in preserving reproductive function.