Diffuse toxic goiter (Graves disease) - Overview of information

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Last reviewed: 19.06.2018

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Diffuse toxic goiter (Graves 'disease, goiter, Graves' disease) is the most common thyroid disease that occurs due to increased production of thyroid hormones. In this case, as a rule, there is a diffuse increase in its size. The disease is more common among the urban population aged 20 to 50 years, mainly in women.

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The cause of diffuse toxic goiter

Currently, diffuse toxic goiter (DTZ) is considered as an organ-specific autoimmune disease. Its hereditary nature is confirmed by the fact that family cases of goiter are observed, thyroid antibodies are detected in the blood of relatives of patients, a high incidence of other autoimmune diseases among family members (type I diabetes, Addison's disease, pernicious anemia, myastenia gravis) and the presence of specific HLA antigens (HLA B8, DR3). The development of the disease often provokes emotional stress.

The pathogenesis of diffuse toxic goiter (Graves' disease) is caused by a hereditary defect, apparently by a deficit of T-lymphocyte suppressors, which leads to mutation of the forbidden clones of T-lymphocyte helper cells. Immunocompetent T-lymphocytes, reacting with autoantigens of the thyroid gland, stimulate the formation of autoantibodies. The peculiarity of immune processes in diffuse toxic goiter is that autoantibodies exert a stimulating effect on cells, lead to hyperfunction and hypertrophy of the gland, whereas in other autoimmune diseases, autoantibodies exert a blocking effect or bind an antigen.

Diffuse toxic goiter (Graves disease) - Causes

Symptoms of Basid's disease

The pathogenesis of clinical symptoms is due to the influence of excess thyroid hormones on various organs and systems of the body. The complexity and multiplicity of factors involved in the development of thyroid pathology determine the variety of clinical manifestations of the disease.

In addition to cardinal symptoms such as goitre, eyelashes, tremors and tachycardia, patients, on the one hand, have increased nervous excitability, tearfulness, fussiness, excessive sweating, a feeling of heat, small temperature fluctuations, unstable stools, swelling of the upper eyelids, increased reflexes. They become uncomfortable, suspicious, excessively active, suffer from sleep disturbances. On the other hand, adynamia is often observed, sudden attacks of muscle weakness.

Diffuse toxic goiter (Graves disease) - Symptoms

Diagnosis of diffuse toxic goiter

With sufficient severity of clinical symptoms, the diagnosis is beyond doubt. A correct and timely diagnosis is assisted by laboratory tests. Diffuse toxic goiter is characterized by an increase in the basal level of thyroid hormones and a decrease in TSH. Usually the basal level of T 3 is increased to a greater extent than the T 4 level . Sometimes there are forms of the disease, when T 3 is higher, and thyroxine, common and free, within the limits of normal vibrations.

In doubtful cases, when T 3 and T 4 are elevated insignificantly and there are suspicions of thyrotoxicosis, it is useful to conduct a test with rifatiorone (TRH). The absence of an increase in TSH with the introduction of TRH confirms the diagnosis of diffuse toxic goiter.

Diffuse toxic goiter (Graves disease) - Diagnosis

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Treatment of diffuse toxic goiter

Currently, there are three main methods for treating diffuse toxic goiter: drug therapy, surgical intervention - subtotal resection of the thyroid, and treatment with radioactive iodine. All available methods of therapy for diffuse toxic goiter result in a decrease in the elevated level of circulating thyroid hormones to normal numbers. Each of these methods has its own indications and contraindications and should be determined for patients individually. The choice of method depends on the severity of the disease, the size of the thyroid gland, the age of patients, concomitant diseases.

Diffuse toxic goiter (Graves disease) - Treatment


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