Diffuse toxic goiter (Graves ' disease, Bazedov's disease)

• What is Graves ' disease, or diffuse toxic goiter?  

An autoimmune disease caused by excessive production of thyroid hormones by diffuse thyroid tissue, which leads to poisoning of the body with these hormones — hyperthyroidism (thyrotoxicosis).

Among the causes of Graves ' disease, hereditary factors, infections, intoxication, mental trauma, etc. are important.

• What are the symptoms of Graves ' disease?

An increased hormonal background causes a serious blow to the nervous system, resulting in a feeling of anxiety to the patient, frequent dizziness, headaches, irritability. A common disorder is insomnia.

From the gastrointestinal tract, the disease is manifested by nausea and diarrhea. Accompanying thyroid disorder, damage to the sex glands causes impotence in men and menstrual disorders in women. Graves ' disease often causes changes in the skin, expressed in increased sweating, erythema (redness) and edema.

On the part of the cardiovascular system, this is a violation of the heart rhythm, an increase in blood pressure, which can lead to hypertension, severe pain in the heart area.

Various ophthalmopathies (eye lesions) are also often the result of a disorder of the thyroid gland. Patients are characterized by bulging eyes and an increase in their size, as well as noticeable swelling of the eyelids. The blood supply to the eye is disrupted, which leads to the development of various inflammatory processes, a decrease in visual acuity, and in severe cases to vision loss.

The appearance of goiter indicates the presence of Graves ' disease with a significant degree of probability, but in itself is not an unambiguous indication, since the appearance of goiter can be a symptom of other diseases. On the other hand, the absence of signs of thyroid enlargement makes the presence of Graves ' disease unlikely, but does not rule it out. 

How is Graves ' disease diagnosed? First of all, a blood test is performed to determine the amount of thyroid hormones produced by the thyroid gland.

The second part of the examination is an ultrasound examination of the thyroid gland.

When the diagnosis is doubtful, an analysis of thyroid cells is performed to clarify it. Cells are taken using a thin needle directly from the thyroid gland under the control of ultrasound (fine needle aspiration biopsy).

Radioisotope testing of the thyroid gland with iodine is also a reliable method for diagnosing Graves ' disease. In the presence of the disease, there is an increased absorption of iodine by the cells of the thyroid gland. Radioisotope testing is particularly common if the thyroid gland is atypical and is not palpable during a routine examination.

• How is Graves ' disease treated?

Apply the drug method (thyrostatic drugs).  The main drug is Mercazolil, which is taken continuously for 1.5-2 years.  The dosage of the drug is selected strictly individually, which is subsequently adjusted, depending on blood tests. It is necessary to conduct a clinical blood test every 10-14 days (with maintenance therapy with mercazolil-1 time per month).

Patients in whom conservative therapy of Basedova disease has proved ineffective, radical treatment is recommended – surgical intervention or treatment using radioactive iodine.

The operation is performed only when the state of drug compensation is reached, since otherwise a thyrotoxic crisis may develop in the early postoperative period.

Detection of the disease at an early stage allows you to avoid or minimize many complications associated with a violation of the thyroid gland.

Diagnosis and treatment of thyroid diseases should take place with the participation of an endocrinologist and a surgeon in a specialized department.