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Diffusion toxic craw

Diffusion toxic craw (Bazedov's disease, Greyvs's disease) – the disease caused by a hypertrophy and hyperfunction of a thyroid gland, which is followed by development of a thyrotoxicosis. It is clinically shown by hypererethism, irritability, weight loss, heartbeat, perspiration, short wind, subfebrilny temperature. A characteristic symptom – pucheglazy. Leads to changes from cardiovascular and nervous systems, to development of heart or nadpochechnikovy failure. A threat for life of the patient is posed by tireotoksichesky crisis.

Diffusion toxic craw

Diffusion toxic craw (Bazedov's disease, Greyvs's disease) – the disease caused by a hypertrophy and hyperfunction of a thyroid gland, which is followed by development of a thyrotoxicosis. It is clinically shown by hypererethism, irritability, weight loss, heartbeat, perspiration, short wind, subfebrilny temperature. A characteristic symptom – pucheglazy. Leads to changes from cardiovascular and nervous systems, to development of heart or nadpochechnikovy failure. A threat for life of the patient is posed by tireotoksichesky crisis.

The diffusion toxic craw carries the autoimmune nature and develops owing to defect in immune system at which there is a development of antibodies to receptors of TTG making the continuous stimulating impact on a thyroid gland. It leads to uniform growth of tireoidny fabric, hyperfunction and increase in level of the tireoidny hormones produced by gland: T3 (triyodtironina) and T4 (tiroksin). The thyroid gland increased in a size is called a craw.

Excess of tireoidny hormones strengthens reactions of the main exchange, exhausts energy stocks in an organism, necessary for normal activity of cages and fabrics of various bodies. Are most susceptible to a condition of a thyrotoxicosis warmly – vascular and central nervous systems.

The diffusion toxic craw develops mainly at women from 20 to 50 years. At advanced and children's age arises quite seldom. So far the endocrinology cannot precisely answer a question of the reasons and mechanisms of start of the autoimmune reactions which are the cornerstone of a diffusion toxic craw. The disease quite often comes to light at the patients having hereditary predisposition which is implemented under the influence of many factors of external and internal environment. Emergence of a diffusion toxic craw is promoted by infectious and inflammatory diseases, mental injuries, organic damages of a brain (craniocereberal injuries, encephalitis), autoimmune and endocrine violations (functions of a pancreas, a hypophysis, adrenal glands, gonads) and many others. Almost twice the risk of development of a craw increases if the patient smokes.

Classification

The diffusion toxic craw is shown by the following forms of a thyrotoxicosis, regardless of the sizes of a thyroid gland:

  • easy form - with prevalence of complaints of neurotic character, without violation of a warm rhythm, tachycardia with ChSS no more than 100 . in min., lack of pathological malfunction of other endocrine glands;
  • average weight - loss of body weight within 8-10 kg a month, tachycardia with ChSS more than 100-110 is noted. in min.;
  • severe form - loss of weight at the level of exhaustion, signs of functional violations from heart, kidneys are shown, a liver. It is usually observed at it is long not a lecheny diffusion toxic craw.

Symptoms

As tireoidny hormones are responsible for performance of a set of physiological functions, the thyrotoxicosis has various clinical manifestations. Usually main complaints of patients are connected with cardiovascular changes, manifestations of a catabolic syndrome and an endocrine ophthalmopathy. Cardiovascular violations are shown by the expressed tachycardia (tachycardia). Feelings of heartbeat at patients arise in a breast, the head, a stomach, in hands. ChSS at rest at a thyrotoxicosis can increase to 120-130 . in min. At average weight and heavy forms of a thyrotoxicosis there is an increase systolic and decrease in diastolic arterial pressure, increase in pulse pressure.

In case of the long course of a thyrotoxicosis, especially at patients of advanced age, the expressed miokardiodistrofiya develops. It is shown by violations of a warm rhythm (arrhythmia): premature ventricular contraction, fibrillation of auricles. Subsequently it leads to changes of a myocardium of ventricles, developments of stagnation (peripheral hypostases, to ascites), to a cardiosclerosis. Breath arrhythmia is noted (increase), tendency to frequent pneumonia.

Manifestation of a catabolic syndrome is characterized by sharp weight loss (on 10-15 kg) against the background of the increased appetite, the general weakness, gipergidrozy. Violation of thermal control is shown that patients with a thyrotoxicosis have feeling of heat, do not freeze at rather low surrounding temperature. At some elderly patients evening can be observed subfebrilitt.

Development of changes from eyes (an endocrine ophthalmopathy) is characteristic of a thyrotoxicosis: expansion of eye cracks due to raising of an upper eyelid and omission lower, an incomplete smykaniye a century (a rare blinking), (pucheglazy), gloss of eyes. With a thyrotoxicosis the person gets expression of a fright, surprise, anger from the patient. From behind an incomplete smykaniye a century patients have complaints to "sand in eyes", dryness and chronic conjunctivitis. Development of periorbitalny hypostasis and growth of periorbitalny fabrics squeeze an eyeball and an optic nerve, cause defect of a field of vision, increase in intraocular pressure, eye pain, and sometimes total loss of sight.

From nervous system at a thyrotoxicosis mental instability is observed: easy excitability, the increased irritability and aggression, concern and fussiness, changeability of mood, difficulty at concentration of attention, tearfulness. The sleep is interrupted, the depression, and in hard cases - permanent changes of mentality and the identity of the patient develops. Quite often at a thyrotoxicosis the small tremor (trembling) of fingers of outstretched arms appears. At a heavy current of a tiretoksikoz the tremor can be felt on all body and complicate the speech, the letter, performance of movements. The proximal myopathy (muscular weakness) is characteristic, reduction of volume of muscles of the top and lower extremities, to the patient is difficult to rise from a chair, from cards. It is in certain cases noted the raised tendinous reflexes.

At a long thyrotoxicosis under the influence of surplus of a tiroksin there is a washing away of calcium and phosphorus from a bone tissue, the bone resorption (process of destruction of a bone tissue) is observed and the syndrome osteosinging (reduction of bone weight and density of bones) develops. Bone pains are noted, fingers of hands can take a form of "drum sticks".

From digestive tract of patients belly-aches, diarrhea, an unstable chair disturb, it is rare – nausea and vomiting. At a severe form of a disease gradually develops tireotoksicheskiya - fatty dystrophy of a liver and cirrhosis. The heavy thyrotoxicosis at some patients is followed by development of tireogenny (relative) nadpochechnikovy insufficiency, the shown hyperpegmentation of skin and open parts of the body, hypotonia.

Dysfunction of ovaries and violation of a menstrual cycle at a thyrotoxicosis meet infrequently. At women in a premenopauza reduction of frequency and intensity of periods, development of fibrous and cystous mastopathy can be noted. Moderately expressed thyrotoxicosis can not reduce ability to conception and a possibility of approach of pregnancy. The antibodies to TTG receptors stimulating a thyroid gland can be transferred transplatsentarno from the pregnant woman with a diffusion toxic craw to a fruit. As a result at the newborn development of a tranzitorny neonatal thyrotoxicosis is possible. The thyrotoxicosis at men often is followed by erectile dysfunction, a ginekomastiya.

At a thyrotoxicosis skin soft, damp and warm to the touch, at some patients appears vitiligo, darkening of folds of skin, especially on elbows, a neck, a waist, injury of nails (a tireoidny akropakhiya, ), a hair loss. At 3 – 5% of patients with a thyrotoxicosis the pretibialny miksedema (the hypostasis, consolidation and the eritema of skin in a shin and feet reminding an orange-peel and which are followed by an itch) develops.

At a diffusion toxic craw uniform increase in a thyroid gland is noted. Sometimes gland is considerably increased, and the craw can sometimes be absent (in 25-30% of cases). Disease severity is not defined by the craw sizes as at the small sizes of a thyroid gland the severe form of a thyrotoxicosis is possible.

Complications

Thyrotoxicosis the complications: serious defeats of TsNS, cardiovascular system (development of "tireotoksichesky heart"), digestive tract (development of a tireotoksichesky gepatoz). Tireotoksichesky gipokaliyemichesky passing paralysis with the sudden, periodically arising attacks of muscular weakness can sometimes develop.

The course of a thyrotoxicosis a craw can be complicated by development of tireotoksichesky crisis. As the main reasons for tireotoksichesky crisis serve the wrong therapy of a tireostatikama, treatment by radioactive iodine or carrying out surgical intervention, treatment cancellation, and also infectious and other diseases. Tireotoksichesky crisis combines symptoms of a heavy thyrotoxicosis and tireogenny nadpochechnikovy insufficiency. At patients with crisis are noted pronounced nervous excitability up to psychosis; strong motive concern which is replaced by apathy and violation of orientation; fever (to 400C); pains in heart, sinusovy tachycardia with ChSS more than 120 . in min.; breath violation; nausea and vomiting. Vibrating arrhythmia, increase in pulse pressure, increase of symptoms of heart failure can develop. Relative nadpochechnikovy insufficiency is shown by a skin hyperpegmentation.

At development of a toxic gepatoz integuments gain yellowness. The lethal outcome at tireotoksichesky crisis makes 30-50%.

Diagnostics

The objective status of the patient (appearance, body weight, condition of integuments, hair, nails, conversation manner, measurement of pulse and arterial pressure) allows the doctor to assume the available hyperfunction of a thyroid gland. In the presence of obvious symptoms of an endocrine ophthalmopathy the diagnosis of a thyrotoxicosis is almost obvious.

At suspicion of a thyrotoxicosis determination of level of tireoidny hormones of a thyroid gland (T3, T4), tireotropny hormone of a hypophysis (TTG), free fractions of hormones in blood serum is obligatory. The diffusion toxic craw should be distinguished from other diseases which are followed by a thyrotoxicosis. Blood define existence of the circulating antibodies to TTG receptors by the immunofermental analysis (IFA), a tireoglobulina (AT-TG) and to tireoidny peroxidase (AT-TPO). Its diffusion increase and change of an ekhogennost (the gipoekhogennost characteristic of autoimmune pathology) is defined by the ultrasonography method of a thyroid gland.

To find functionally active fabric of gland, to define a form and volume of gland, existence in it of nodal educations allows a stsintigrafiya of a thyroid gland. In the presence of symptoms of a thyrotoxicosis and endocrine ophthalmopathy the stsintigrafiya is not obligatory, it is carried out only in cases when it is necessary to differentiate a diffusion toxic craw from other pathologies of a thyroid gland. At a diffusion toxic craw receive the image of a thyroid gland with the increased isotope absorption. Refleksometriya is the indirect method of definition of function of a thyroid gland measuring Achilles tendon reflex time (characterizes peripheral effect of tireoidny hormones – at a thyrotoxicosis it is shortened).

treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

Conservative treatment of a thyrotoxicosis consists in reception of antitireoidny medicines - a tiamazola (merkazolit, , ) and (propitsit) a propiltiouratsil. They can collect in a thyroid gland and suppress production of tireoidny hormones. Decrease in a dose of medicines is carried out strictly individually, depending on disappearance of symptoms of a thyrotoxicosis: normalization of pulse (till 70-80 . in min.) and pulse pressure, increase in body weight, lack of a tremor and perspiration.

Surgical treatment means almost total removal of a thyroid gland (tireoidektomiya) that leads to a condition of a postoperative hypothyroidism which is compensated medicamentally and excludes a thyrotoxicosis recurrence. Indications to carrying out surgery are allergic reactions to the appointed medicines, permanent decrease in level of leukocytes of blood at conservative treatment, a craw of the big size (it is higher than III degrees), is warm – vascular disorders, existence of the expressed zobogenny effect of a merkazolil. Carrying out operation at a thyrotoxicosis is possible only after medicamentous compensation of a condition of the patient for the prevention of development of tireotoksichesky crisis in the early postoperative period.

Therapy by radioactive iodine - one of the main methods of treatment of a diffusion toxic craw and a thyrotoxicosis. This method noninvasive, is considered effective and rather inexpensive, does not cause complications which can develop at a thyroid gland operation. A contraindication to radioiodine therapy is pregnancy and breastfeeding. Isotope of radioactive iodine (I 131) collects in cells of a thyroid gland where begins to break up, providing local radiation and destruction of tirotsit. Radioiodine therapy is carried out with obligatory hospitalization to specialized offices. The condition of a hypothyroidism develops usually within 4-6 months after treatment by iodine.

At presence of a diffusion toxic craw at the pregnant woman conducting pregnancy has to be carried out not only by the gynecologist, but also the endocrinologist. Treatments of a diffusion toxic craw at pregnancy it is carried out propiltiouratsily (it badly gets through a placenta) in the minimum dose necessary for maintenance of quantity of a free tiroksin (T4) on the upper bound of norm or a little above it. With increase in term of pregnancy the need for a tireostatika decreases, and most of women after 25-30 weeks of pregnancy does not accept medicine any more. After the delivery (in 3-6 months) at them the thyrotoxicosis recurrence usually develops.

Treatment of tireotoksichesky crisis includes intensive therapy by high doses of tireostatik (preferably – propiltiouratsily). At impossibility of reception of medicine by the patient independently, it is entered via the nazogastralny probe. Glucocorticoids, b-adrenoblokatory, dezintoksikatsionny therapy (under control of haemo dynamics), a plasma exchange are in addition appointed.

Forecast and prevention

The forecast in the absence of treatment prospect adverse as the thyrotoxicosis gradually causes cardiovascular insufficiency, fibrillation of auricles, organism exhaustion. At normalization of function of a thyroid gland after treatment of a thyrotoxicosis - the forecast of a disease favorable - at most of patients regresses a kardiomegaliya and the sinusovy rhythm is restored.

After surgical treatment of a thyrotoxicosis development of a condition of a hypothyroidism is possible. Patients with a thyrotoxicosis need to avoid insolation, the use of iodinated medicines and foodstuff.

Development of severe forms of a thyrotoxicosis needs to be prevented, making dispensary observation of patients with the increased thyroid gland without change of its function. If the anamnesis indicates the family nature of pathology, under observation there have to be also children. As preventive measures it is important to carry out the all-strengthening therapy and sanitation of the chronic centers of an infection.

Diffusion toxic craw - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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