Graves' disease - symptoms and causes, visual manifestations. What is Graves' disease? What causes Graves' disease?

Increased activity thyroid gland leads to its growth diffuse tissue, characterized by significant (goiter), as well as agitation nervous system and strengthening of general metabolic processes leading to changes in all organs and systems of the human body.

Graves' disease occurs in 1 in 100 representatives of humanity, which makes it quite common. At the same time, Graves' disease develops in women many times more often than in men. And its main signs begin to appear between the ages of 30 and 50 years. However, children and adolescents can also suffer from this disease.

Causes of the disease

The causes of Graves' disease have not yet been fully studied by specialists. In their opinion, the fundamental factor is heredity, transmitted in various ways.

The disease occurs due to an erroneous function immune system, which begins to rapidly produce antibodies that destroy its own cells. IN in this case It has been proven that the immune system of people suffering from Graves' disease produces an abnormal protein that causes the thyroid gland to become active.

There are other factors leading to the development of this disease.

Female. Doctors have noticed that the disease is most often transmitted through one generation to female family members. That is, if a grandmother suffered from Graves’ disease, it is passed on to her granddaughter.
Frequent inflammatory and viral diseases, in which disturbances in the functioning of the immune system occur. The medications used to treat them also have a significant impact on the development of the disease.
Other diseases associated with dysfunction of the immune and endocrine systems, including diabetes, vitiligo, hypoparathyroidism.
Impaired liver and adrenal function.

It was also noticed that the disease very often develops in people who have suffered neuropsychic shocks. Its development is also influenced by various infections, for example, tuberculosis, which causes toxic damage to the thyroid gland.

Symptoms of the disease

Characteristic external manifestation Graves' disease is bulging eyes (exophthalmos). This is the first sign indicating the progression of the disease. This feature you can see in the photos of some famous personalities. They clearly have a thickening in the neck area, the cause of which is the growth of the thyroid gland.

The hormones produced by the thyroid gland perform many important physiological functions.

For this reason, the symptoms of Graves' disease manifest themselves in various ways.

From the cardiovascular system, there are disturbances in the heart rate, as well as their rhythm and consistency (arrhythmia), increased heart rate (tachycardia), as well as a persistent increase in blood pressure. Due to impaired blood flow, the heart experiences significant overload, as a result of which sick people experience shortness of breath and chest pain.
Endocrine manifestations, expressed in increased metabolic processes. This factor leads to the fact that a sick person quickly loses weight, despite increased appetite and usual diet. In women, the menstrual cycle is disrupted, and in some cases, menstruation stops completely.

Dermatological manifestations associated with increased sweating, changes in the structure of the nail plates with their subsequent destruction. In such people, capillaries dilate, which leads to redness of the skin. And 5% of patients develop edema skin and subcutaneous tissue.
Neurological problems associated with hand tremors, especially in an extended position. People experience general weakness and fatigue, headaches, anxiety and restlessness. As a result of the disease, sleep is disturbed and tendon reflexes increase.

Disruption of the digestive system. Increased metabolism leads to the fact that the food eaten does not have time to be digested and absorbed, as a result of which diarrhea develops. Very rarely, the disease may be accompanied by nausea and vomiting.
Violation of the functions of the visual organs. Characteristic feature of this disease is “thyroid eye disease”, which is expressed in the rise upper eyelid and lowering of the lower one. In some cases, the eyelids are unable to close when closing the eyes. In advanced cases, people with Graves' disease are unable to blink. Because of this, the mucous membrane of the eyes becomes very dry. Sick people have visual field defects and increased intraocular pressure. As a result, visual acuity gradually decreases, leading to blindness.

Dental manifestations, expressed in multiple caries.
- exactly this dangerous condition arising as a result of a complicated course of the disease.

Stages of the disease

Graves' disease is a disease that occurs in several stages.

The first stage can take decades to develop. It is characterized by a mild degree of damage and practically does not worsen the patient’s quality of life. Its only manifestations are a slight increase in heart rate up to 100 beats per minute, as well as a body weight deficit of no more than 10%.
The second stage is characterized by moderate severity, in which persistent arterial hypertension with an increase in heart rate above 100 beats per minute. In this case, the body weight deficit increases to 20%.
The third stage is the most severe, since in this case almost all body systems are affected. The heart of such patients experiences enormous stress, and therefore contracts at a rate of more than 120 beats per minute. As a result, a person, even when at complete rest, absorbs 80% more oxygen than a healthy person of similar build. Patients lose a lot of weight, resulting in their body weight deficit exceeding 20%.

ABOUT mild violation The following signs may indicate thyroid function:

redness of the eyes and watery eyes;
sparkle of eyes;
distortion of visual perception, expressed in doubling of objects;
fear of light and feeling as if sand had been poured into the eyes;
swelling of both legs with pronounced dystrophic changes, accompanied by itching.

If the goiter is large or located too low, compression of the vessels, esophagus and trachea occurs. The following signs indicate this factor:

and suffocation;
swelling and darkening of the facial skin;
Difficulty with swallowing solid food.

Diagnosis of the disease

An endocrinologist can recognize Basedow's disease during the initial examination of the patient. To confirm the diagnosis, the doctor prescribes a diagnostic set of measures:

blood test for the content of hormones, which include,;
immunological studies, which determine the presence of antibodies to the receptor thyroid-stimulating hormone;
In rare cases, a thyroid scan is performed.

Diagnosis, including ultrasound examination, shows changes in the structure of the thyroid gland. If there are violations, this organ darkens and becomes heterogeneous. Also, blood flow in the thyroid tissues increases significantly.

Diagnosis involves scanning the thyroid gland to determine its ability to take up iodine. This method used when suspected. With Graves' disease, iodine uptake by the gland is enhanced, and with thyroiditis, on the contrary, it is reduced.

Therapeutic measures

When choosing a treatment method for Graves' disease, the doctor is guided by the patient's gender, age and physical features. Also special attention deserves women's desire to have children in the future. If there is no such need, she can be prescribed any treatment option.

There are three treatment options:

conservative;
surgical;
radioiodine therapy.

The most popular is conservative or medicinal method. It involves prescribing cytostatic drugs to sick people to prevent further growth of diffuse thyroid tissue.

This treatment can reduce heart rate, increase body weight, eliminate hand tremors and abnormal sweating, and also normalize arterial pressure. In addition to cytostatic drugs, patients will need to take other hormonal drugs, as well as drugs that eliminate other manifestations of the disease, for ½-2 years.

Surgical solution and radioactive iodine therapy

Surgical intervention consists of, which leads to a decrease in its activity. In this case, surgical intervention is used only if the patient has allergic reactions on, or if drug treatment does not bring the desired results.

One of the latest ways treatment of thyroid diseases is during which radioactive iodine is introduced into the patient’s body. Accumulating in the body, this substance destroys both patients and healthy cells thyroid gland, which significantly reduces its activity.

Features of treatment for pregnant women

Treatment of pregnant women is complicated by the possibility of influence medications for the fruit. At existing disease women are advised to use protection until they pass full course treatment.

If pregnancy occurs, it is preserved by continuing the course of treatment using medications in minimal dosages, which avoids a deficiency of thyroid hormones in the fetus.

After giving birth, a woman can breastfeed her baby and continue treatment. In this case, the child should be under the close attention of a pediatrician who monitors the condition of his thyroid gland.

After adequate treatment, the quality of life of patients improves significantly. The only exceptions are patients who have undergone surgery to remove part of the thyroid gland. In this case, it may develop.

Adjusting lifestyle and nutrition helps to avoid relapse of the disease in the future. Such people are not recommended to be in direct sunlight, including sunbathing and visiting a solarium. The use of drugs and products containing iodine, including iodized salt, is contraindicated for them.

Bibliography

Pinsky, S.B. Diagnosis of thyroid diseases / S.B. Pinsky, A.P. Kalinin, V.A. Beloborodov. - L.: Medicine, 2005. - 192 p.
Rudnitsky, Leonid Diseases of the thyroid gland. Pocket guide / Leonid Rudnitsky. - M.: Peter, 2015. - 256 p.
Sinelnikova, A. 225 recipes for thyroid health / A. Sinelnikova. - M.: Vector, 2013. - 128 p.
Sinelnikova, A. A. 225 recipes for thyroid health: monograph. / A.A. Sinelnikova. - M.: Vector, 2012. - 128 p.
Uzhegov, G.N. Thyroid diseases: Types of diseases; Treatment with traditional medicine; Medical / G.N. Uzhegov. - Moscow: Russian State University for the Humanities, 2014. - 144 p.
Khavin, I.B. Diseases of the thyroid gland / I.B. Khavin, O.V. Nikolaev. - M.: State Publishing House of Medical Literature, 2007. - 252 p.

⚕️Melikhova Olga Aleksandrovna - endocrinologist, 2 years of experience.

Deals with the prevention, diagnosis and treatment of organ diseases endocrine system: thyroid gland, pancreas, adrenal glands, pituitary gland, gonads, parathyroid glands, thymus gland etc.

Graves' disease refers to a pathology of the endocrine system, which affects the thyroid gland with an increase in the production of its hormones. This disease is also called diffuse toxic goiter. This disease is characterized by its predominant development in women, on average 8 times more often than in men. The main manifestations of this pathology are symptoms of excessive increases in the hormones thyroxine and triiodothyronine - thyrotoxicosis.

In various medical literature you can find such names as Graves', Flajani's or Perry's disease. These names of doctors, in different time described the symptoms, also called diffuse toxic goiter.

Mechanism of development of Graves' disease

The thyroid gland is a barrier organ. This means that from the moment of its laying in the period intrauterine development of the fetus, it is delimited from the immune system by a special barrier. If this barrier is damaged, the immune system identifies the tissues and cells of the thyroid gland as foreign and begins to produce antibodies against them. This leads to their damage, partial death and the development of inflammation. In toxic goiter, the thyroid tissue reacts to the attack of the immune system by proliferation (increase in number) and increase in the functional activity of glandular cells, which ultimately leads to hyperfunction of the entire gland and an increase in the level of thyroid hormones in the body, which are responsible for basic metabolism and cause a number of physiological effects. Morphological changes in the gland are characterized by its uniform increase ( diffuse process) or the development of lesions.

Causes (etiology)

Two main causative factors lead to the development of an autoimmune process with damage, inflammation and hyperfunction of the thyroid gland - increased activity of the immune system with excessive production of antibodies to the body's own tissues and a violation of the thyroid barrier with the possibility of access of cells of the immune system to its cells. Increased immune activity is hereditary factor. Defective genes responsible for functional state immune system and leading to an increase in its activity are inherited from parents to children. Several factors lead to disruption of the integrity of the thyroid barrier:

The most basic causative factor is a hereditary predisposition. Damage to the thyroid barrier accelerates the development of Graves' disease.

Genes responsible for regulating the activity of the immune system in relation to thyroid gland, are localized on the sex X chromosome (the female genotype contains two X chromosomes). This may explain the higher incidence of Graves' disease in women.

Symptoms of Graves' disease

Toxic goiter most often occurs in women between 20 and 40 years of age. It is characterized by two groups of symptoms - local (local) changes and symptoms of increased levels of its hormones. Local signs of pathology include:

The manifestations of increased levels of thyroxine and triiodothyronine, which include:

Exophthalmos (bulging eyes) is a characteristic symptom of Graves' disease, the development of which is associated with hypertrophy (increase in volume) of the tissues around the eyeball. This may cause pain in the eyes and increased intraocular pressure.
Mental changes - anxiety, emotional instability (sudden mood swings), irritability, bad dream, fussiness, features of choleric temperament appear.
Autonomic dysfunction is a change in the functional activity of the autonomic part of the nervous system, which manifests itself excessive sweating, periodic nausea and vomiting.
Weight loss with a normal diet indicates an increased metabolism, in which fats quickly “burn out.” These disorders are also characterized by inhibition of the synthesis of various protein structures, which leads to hair loss, increased fragility and brittleness of nails.
Changes in the functioning of the heart and blood vessels are manifested by arrhythmia (irregular heartbeat), tachycardia (increased heart rate), and increased systemic blood pressure.

This disease of the thyroid gland can lead to a serious complication - thyrotoxic crisis. It is characterized by a sharp and significant increase in hormone levels. Most often it can be triggered by operations performed for diseases such as nodular goiter or thyroid adenoma.

Sometimes the first manifestations of Graves' disease may only be sleep disturbances and weight loss. Therefore, if such symptoms appear, it is not advisable to delay a visit to the endocrinologist.

Diagnostics

The appearance of characteristic symptoms serves as the basis for further examination, the purpose of which is to determine the severity of structural changes in the thyroid gland and the degree of increase in the level of its hormones. To do this, the following studies are performed:

All these studies allow us to determine the severity pathological process and prescribe appropriate appropriate treatment.

Treatment

Once a diagnosis of Graves' disease has been made, treatment can be carried out using several main therapeutic approaches, which include:

Carrying out radioiodine therapy and surgical treatment is possible only in a specialized medical hospital under the constant supervision of doctors.

Each of these methods of treating Graves' disease has its own characteristics. The most radical is surgical removal. But the operation itself is quite dangerous and can lead to the development of a thyrotoxic crisis.

The further prognosis depends on how to treat the thyroid gland and the timeliness of starting therapeutic measures. Basically it is favorable, the disease is transferred to a controlled state. With surgical treatment, a long-term absence of relapse is possible. To prevent pathology, it is important to avoid exposure to provoking factors on the body.

Graves' disease is common throughout the world and is a severe autoimmune disease, ranking second after hypothyroidism. It is difficult to treat and often recurs, so it is recommended to contact a specialist at the first sign. The disease has other names: diffuse toxic goiter, Graves' disease. In ICD 10, the disease is coded E05.0.

What is Graves' disease

The disease occurs due to increased activity of the thyroid gland. Under its influence, disturbances occur in both the nervous system and body tissues, which leads to a severe deterioration in human health.

The etiology of the disease is not fully understood. Most often it occurs between the ages of 30 and 40. During this period, the body may malfunction, which leads to the appearance of this serious illness. Numerous studies have confirmed that this disease develops in those people who have a family history of various pathologies thyroid gland. However healthy people those with good heredity can also get it. Moreover, deviations are more common in women than in men.

Can diffuse toxic goiter occur in children? Yes maybe. Such cases do occur. According to research, it can appear between the ages of 10 and 15 years, but there have been cases of diffuse toxic goiter even in infants. In girls, the disease occurs 7-8 times more often than in boys.

Causes

Graves' disease occurs due to an overactive thyroid gland. The thyroid gland enlarges, producing more hormone than normal. The main reason This process is that the immune system of a sick person produces special antibodies, due to which the thyroid gland begins to actively function. For this reason, the concentration of hormones in the blood increases greatly.

So far, scientists do not know why such autoimmune disruptions occur in the body. There are several different theories. One argues that the immune system is defective. Therefore, a person cannot contain the immune response that acts against him. In addition, there is a theory about the presence of incorrect receptors in the body, which the immune system does not accept, defining them as foreign. It is also believed that this disease develops due to iodine deficiency.

The following reasons lead to the progression of the disease:

heredity;
hormonal disorders during pregnancy and the postpartum period;
deterioration of the environmental situation;
stress and depression;
chronic diseases.

In addition, diseases of the pituitary gland can provoke the development of pathology, radiation therapy, diabetes mellitus, diseases of viral origin.

The exact causes of the disease have not yet been fully identified, but it has been proven that acute form develops as a result severe stress, which was transferred shortly before the onset of the disease. Stress is a trigger for the development of pathology.

Symptoms of Graves' disease

The signs of this disease in both men and women are similar to those characteristic of thyrotoxicosis, therefore it is not always early stage a correct diagnosis can be made. There is a malfunction in the patient's body various systems. The patient may notice that his pulse has become faster, sweating has become too active, and diarrhea has appeared.

The nervous system is actively stimulated, so the patient becomes irritable and restless. His hands begin to shake periodically, he cannot stand hot weather, since his health deteriorates sharply under the scorching sun.

The person’s appetite remains intact, but the patient begins to lose weight sharply. The food that enters the body does not have time to be properly absorbed. The thyroid gland actively produces hormones and leads to rapid breakdown useful substances. At the same time, young people with increased metabolism experience weight gain. In addition, many people begin frequent urination, which can lead to severe dehydration.

A characteristic symptom This disease is endocrine ophthalmopathy, which is expressed in bulging eyes. In many cases, both eyes are affected. Ophthalmopathy may develop earlier or later than the disease itself.

Excessive activity of thyroid hormones leads to increased irritability, sudden mood swings, despondency and depression. A person becomes touchy and tearful, his sleep and appetite are disturbed, fears and anxiety appear. Mood often changes, which is associated with increased level thyroid hormones.

A goiter appears in the throat area - a tumor on the gland. A swelling appears on the surface of the neck, which the doctor pays attention to when examining the patient.

There are 3 stages of disease development. If she is on initial stage, then the symptoms are mild. If the disease is in an advanced state, then the patient’s well-being deteriorates greatly. The heart begins to work at an increased pace and intermittently, the person gradually loses weight, which leads to weakness and bad work brain

A goiter appears in the throat area - a tumor on the gland; a swelling appears on the surface of the neck, which the doctor pays attention to when examining the patient.

If the disease is not treated in time, a thyrotoxic crisis may develop.

Diagnostics

At the first suspicion of this disease, you should contact an endocrinologist. He will conduct an examination and direct the patient to take a necessary tests. During the study, the amount of thyroid hormones, the presence of antibodies and the organ’s ability to accumulate iodine are determined.

In parallel with this, an ultrasound examination of the gland is prescribed. In addition, if diffuse toxic goiter is suspected, a thyroid biopsy may be necessary. It is carried out using a thin needle, which is used to collect cells. They are then examined under a microscope.

Treatment

Treatment of the disease must be strictly supervised by a doctor.

Under no circumstances should you make your own decisions about the method of therapy. Most often, for this disease, a specialist prescribes thyreostatic drugs. Medicines, aimed at reducing the production of thyroid hormones, can be prescribed to children, adolescents and adults.

Exophthalmos in Graves' disease affects both eyes. Sometimes treatment has a positive effect. If this does not happen, then surgery is recommended.

Quite often, withdrawal of a thyreostatic drug leads to a relapse. If the disease is advanced and cannot be cured in this way, then surgery will be required to remove part of the thyroid gland. This intervention is called a thyroidectomy.

In addition, treatment with radioactive iodine is widely practiced. It causes the destruction of organ cells. The drug is available in capsule form. The required dosage should be calculated by the attending physician depending on the severity of the disease. After such treatment, the disease recedes. This takes several weeks. Sometimes iodine supplementation is required.

Traditional methods of treatment

Treatment of diffuse toxic goiter folk remedies has been practiced for a long time. This treatment is especially effective at the very beginning of the disease. However, all home procedures must be coordinated with an endocrinologist so as not to harm your 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. Graves' 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(eg 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 incorrect treatment may cause 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;

start of treatment radioactive iodine;

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 examine your medical card, will examine you and prescribe the usual laboratory research. Ultrasonography 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 in the treatment of children, people young, pregnant women and those who refuse surgical treatment 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(eg, increased heart rate), many people are prescribed Inderal at the same time.

Pregnant women are prescribed minimal doses of medications 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 medicine in minimal doses, she can continue to breastfeed the baby as long as 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, a soft chair or diarrhea, enlarged liver, loss of appetite.

Muscles and bones

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

Reproductive system

In women - infrequent or absent menstruation, reduced fertility, increased risk miscarriages; in men - abnormal increase mammary glands; in both sexes - decreased sexual desire

Surgery

Removing part of the thyroid gland reduces its ability to produce hormones. Surgical intervention is indicated for people with a severely enlarged thyroid gland, which becomes overactive after drug treatment recovering, refusing treatment with iodine 131 or having contraindications to it (see QUESTIONS THAT ARE MOST ASKED ABOUT SURGERY).

After surgery and treatment with radionuclide iodine, many people develop thyroid deficiency, so they need long time be under the supervision of a doctor, sometimes for 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 measures can be taken to eliminate them more quickly. 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 thyroid, you will need to take thyroid hormone medications because your body will no longer produce them. If you have enough healthy thyroid remaining, you won't need to take medication.

Other treatments

Treatment of ophthalmopathy resulting from Graves' disease may include: local application medications; in other cases, large doses of corticosteroids are required. People with protruding eyes, where pressure on the optic nerve increases, may require radiation therapy using an external radiation source or surgical intervention to relieve pressure.

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, liquids.

Graves' disease is a diffuse inflammation of the thyroid gland, most often the main cause is the appearance of antibodies to the TSH receptor in the body.

The disease develops against the background of a “breakdown” of the immune defense of lymphocytes. Antibodies against thyroid cells begin to be produced; lymphocytes fight not against viruses and bacteria, but against the organ.

Causes of Graves' disease

Unfortunately, everything possible reasons Graves' disease has not yet been studied. Most often, young people aged 20-40 suffer from autoimmune aggression, while women are more often affected by the disease than men.

The main causes of Graves' disease include:

transferred viral infections;
stress;
hormonal disorders;
traumatic brain injuries.

Predisposition to Graves' disease, according to scientists, is inherited genetically. More precisely, the disease itself is not transmitted “from father to son,” but if there are people in a person’s family who have suffered from toxic goiter, the relatives have an increased risk of developing the disease.

Graves' disease is autoimmune disease, which is catalyzed by improper functioning of the immune system. Unfortunately, more often than others, people who have some kind of autoimmune pathology also develop Graves' disease.

Various infections, skull injuries and metabolic stress can also trigger the disease.

Mechanism of development of Graves' disease

The mechanism of development of Graves' disease is the production of antibodies to the TSH receptor, this receptor is located on the surface of thyrocytes - the cells that make up the thyroid gland. Antibodies stimulate the TSH receptor, resulting in excess production of thyroid hormones. When the receptors are activated, the production of thyroid hormones, thyroxine and triiodothyronine is stimulated.

Thyroid hormones are released into the blood in significant quantities from the thyroid gland, which blocks the secretion of thyroid-stimulating hormone in the pituitary gland and stimulates the enlargement of thyroid cells. Uncontrolled growth of thyroid tissue begins, which leads to growth of the thyroid gland - goiter; in 80% of patients, eye damage begins - endocrine ophthalmopathy.

Symptoms of Graves' disease

Conventionally, all symptoms of Graves' disease are divided into three groups:

cardiological (mild, moderate and severe forms).
neurological;
eye symptoms.

According to the organ system, the symptoms of Graves' disease can be represented as follows:

Nervous system. A person suffering from Graves' disease becomes irritable, fussy, and restless. The disease is characterized by involuntary twitching, unreasonable fears, insomnia, problems with concentration.
The cardiovascular system. Typical symptom Graves' disease is an increase in blood pressure, atrial fibrillation. The heart beats faster, characteristic chest pain appears, and ischemic disease, glycosaminoglycans (mucopolysaccharides with amino sugars-hexosamines) are deposited in the valves of the organ, which leads to mitral valve prolapse.
The respiratory organs do not suffer much in Graves' disease. As a rule, patients' breathing increases slightly.
Reproductive system. A characteristic symptom of Graves' disease is dysfunction of the reproductive system. In women, the menstrual cycle is disrupted, in men there is a decrease in potency. The disease often leads to severe and moderate forms of infertility.
Digestive system. With Graves' disease, acidity decreases gastric juice, intestinal motility accelerates, the person suffers from diarrhea. In addition, TSH breakdown products have a detrimental effect on the liver, and the patient develops thyrotoxic hepatopathy.
Eyes. Patients with Graves' disease can be distinguished by their eyes. Wide-open, rarely blinking eyes cause a lot of cosmetic and physical discomfort. Patients suffer from pain, burning in the eyes, and inflammation of the sclera. At running forms the disease develops neuritis optic nerve. In most cases, there is also a lag of the upper or lower eyelid, noticeable when the patient looks up or down.
Skeletal system. Graves' disease, due to the catabolic effect of thyrotoxin, can catalyze osteoporosis.
Nails with Graves' disease become thin, soft and brittle.
Hair. The disease is characterized by patchy hair loss and even total hair loss. In most cases, patients also suffer from loss of eyebrows, hair in the groin areas, and armpits.
Leather. Dilated blood vessels lead to increased moisture and hyperpigmentation of the skin.

Mild thyrotoxicosis is diagnosed with a moderate decrease in body weight, weak neurogenic and psychogenic symptoms, increased heart rate. Average degree is associated with strong changes in the activity of the nervous system, patients complain of constant feeling heat, do not tolerate physical activity well.

Severe thyrotoxicosis is diagnosed if the patient loses more than 10% of body weight, his pulse is more than 120 beats per minute, and changes mental state become uncontrollable.

Due to the enlargement of the thyroid gland, a feeling of constriction and lack of air may appear. Typically, these symptoms develop gradually.

Diagnosis of Graves' disease

An endocrinologist may suspect the disease during the initial examination, but additional examinations are prescribed to confirm the diagnosis:

hormonal tests - TSH, fT4, fT3;
Ultrasound of the thyroid gland;
immunological studies - Ab to the TSH receptor;
radioisotope scanning - scintigraphy of the thyroid gland.

Treatment of Graves' disease

There are three possible treatment methods for Graves' disease - conservative, surgical and radiological.

According to established tradition, in Russia, when Graves' disease is detected, the patient is treated with medication. The average treatment period is no more than 2 years. In Europe and the United States, radioactive iodine is most often the first line of treatment. In our country there is a catastrophic shortage of centers for treatment with radioactive iodine; therefore, patients are most often treated with medication or sent for surgery. Drug treatment used for small volumes of thyroid tissue. Antithyroid drugs are prescribed, for example, tyrosol or mercazolil. Such drugs suppress excessive activity of the thyroid gland.

The treatment program also includes:

Glucocorticoids (eg, cortisol) - hormonal drugs;
Anti-inflammatory drugs to reduce the severity of Graves' disease;
Immunomodulators to suppress active synthesis of autoantibodies;
β-blockers are prescribed to reduce the load on the patient's heart, lower blood pressure and calm the patient.

If drug therapy is ineffective, the patient is offered surgical treatment. Surgical treatment implies complete removal thyroid gland. It is important to note that thyroid surgery should only be performed in a specialized center by an endocrinologist surgeon.

Prognosis for Graves' disease

At timely treatment The prognosis for Graves' disease is favorable. At severe forms thyretoxicosis, heart defects, arrhythmias and other advanced irreversible changes in the heart area are unfavorable.

Relapses of Graves' disease are rare, usually occurring in 5-40% of children. The most difficult treatment is observed when the patient has already developed ophthalmopathy, since when the symptoms are relieved, this disease can intensify. Fortunately, eye damage due to Graves' disease is becoming less and less common these days.

Doctors consider the main complications of Graves' disease to be:

endocrine disorders - irregular menstrual cycles, hypercalcemia, early pubertal development or its delay;
eye diseases - in approximately 3% of cases, a severe form of ophthalmopathy is observed in patients. A special therapeutic course is prescribed.
Increased bone fragility due to hyperthyroidism. During treatment, the bone mass is corrected.

Where to go?

Of course, Basedow's disease is an unpleasant illness: the patient experiences bad feeling, changes “cosmetically”, many patients panic, suspecting alarming symptoms. But don’t worry so much, it’s important to diagnose the disease in time and prescribe competent treatment. Under no circumstances should Niv contact folk medicine, find an experienced endocrinologist and follow all the doctor’s instructions.