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Diffuse toxic goiter: causes, symptoms and treatment, the degree of DTZ

This name is usually denoted as one of the most serious endocrine diseases in humans, which can be compared in severity and degree of disorders produced only with diabetes mellitus.

What it is? Diffuse toxic goiter of the thyroid gland (DTZ) is a disease characterized by hypersecretion of thyroid hormones over the entire surface of the thyroid gland (as opposed to nodular goiter) and capable of toxic damage to all organs.

According to the international classification of diseases of the 10th revision, (ICD - 10), DTZ belongs to the section of endocrine diseases, section IV, and has the code E 05.

For the first time, the disease was described in sufficient detail in detail by the Irish physician Robert Graves in the first quarter of the 19th century, and since then, diffuse toxic goiter is sometimes called “Graves disease”.


Causes DTZ

Diffuse toxic goiter

The causes of diffuse toxic goiter (etiology) are diverse, so the disease is considered multifactorial. The most frequent reasons for the occurrence of DTZ are the following:

  • genetic predisposition (along the line head of the histocompatibility system);
  • stress and neuroses that trigger hormone production;
  • smoking. It is smoking 10 or more cigarettes per day that doubles the risk of goiter development;
  • the presence of another endocrine pathology increases the risk of DTZ: diabetes mellitus, disorders in the adrenal system;

The pathogenesis of toxic goiter begins with an imbalance between the activity of the immune response and its focus on its own tissues. In this case we are talking about the occurrence of an autoimmune process, in which the thyroid tissue is damaged.

Then begins the infiltration of gland tissue with lymphocytes, which secrete antibodies against thyrocytes and thyroglobulin - the tissues of the thyroid gland. Of great diagnostic importance are the resulting "stimulating antibodies" to the thyroid stimulating hormone receptor.

Interestingly, in most autoimmune diseases, the immune system blocks the body, reduces the production of its hormones. If a diffuse toxic goiter of any degree is detected, then the thyroid gland is not blocked, but, on the contrary, is stimulated for the secretion of an excessive amount of active substances.

As a result, diffuse hypertrophy (enlargement of the gland) occurs, and lymphocytes that have received information about the structure of the thyroid gland can cause disturbances at the periphery, for example, in the tissue, behind the eyeball, or in the connective tissue of the lower leg, with the development of retrobulbar endocrine ophthalmopathy or tibial myxedema.

Effects of thyroid hormones

In addition, hormones of the gland (thyroxin and triiodothyroxin), which begin to be produced uncontrollably, have the following systemic effects:

  • Lipolysis (the use of fat and its removal from the depot, followed by combustion);
  • Fever (hyperthermia);
  • Increase oxygen uptake and breakdown of starches;
  • Increased absorption of glucose;
  • Cardiac contractions increase, blood pressure rises.

As you can see, all effects are aimed at increasing the exchange rate, DTZ "accelerates and sharpens" life, temperature, pressure.

Diffuse toxic goiter 1 \ 2 \ 3 degrees

Diffuse toxic goiter degree

The degree of diffuse toxic goiter reflects the severity and functional reversibility of the disorder. It is known that the most prominent embodiment of DTZ is a condition called thyrotoxicosis.

Morphologically, the thyroid hormones hardest affect the cardiovascular and nervous systems, since these structures are the most sensitive.

That is why the most convenient classification for doctors is by degrees: diffuse toxic goiter 1, 2, 3 degrees. Of course, the severity of the disease is not always so strong that it was possible to deliver even the first degree of DTZ.

In this case, they focus not on complaints, but on quantitative indicators: the level of hormone concentration, pulse numbers, blood pressure, and other indicators reflecting the severity of the condition. It is these studies that are necessary in the military medical examination to determine the category of fitness for military service.

In addition, the severity of the condition may reflect the condition of the goiter, when it interferes with swallowing and is visible with the simple eye, or even changes the shape of the neck.

In total, there are 5 degrees of enlargement of the gland, from the palpatory definition of the gap between the lobes, to a very pronounced tumor on the neck.

Signs and symptoms of diffuse toxic goiter

symptoms of diffuse toxic goiter

The signs and symptoms of diffuse toxic goiter are associated with the many effects of thyroid hormones, therefore they are very diverse.

The main symptomatic groups are distinguished:

Cardiac (increased heart rate, extraordinary contractions - extrasystoles, increased blood pressure). One of the most important damaging factors is high pulse pressure - the difference between the systolic and diastolic index.

These symptoms, in the end, deplete the contractility of the myocardium, heart failure is formed, which is manifested by cardiac asthma, edema, including portal hypertension and ascites;

Metabolic disorders are associated with increased basal metabolism. Patients are exhausted, they have all the time "wolf hunger." Due to hyperthermia, body temperature can rise to 37, 5 degrees. As a result of this, and complete “rampant hormones” in women, menstruation is disrupted or stopped.

Ophthalmic or ophthalmopathy symptoms: a bug-eyed (Graves' disease), incomplete closure of the eyelids, which leads to the development of dry eyes, the appearance of "sand sensation" and the development of conjunctivitis. A pronounced periorbital edema develops.

In the case that the edematous fiber compresses the vessels and the optic nerve, even complete blindness can develop.

Neurological symptoms with severe thyrotoxicosis do not allow the patient to perform work, and often serve as a reason for entering the disability: severe hand tremor and staggering, revitalization of tendon reflexes until clonus appears, severe headache, weakness, insomnia, anxiety, hot temper, tearfulness.

In addition to the above symptoms of diffuse toxic goiter, there may be severe sweating, a change in the nail plates, the appearance of edema in the legs, diarrhea due to the acceleration of food movement through the intestines. In special, severe cases, thyrotoxic crisis occurs, which is stopped in the intensive care unit.

Doctors are particularly worried about diffuse toxic goiter and pregnancy. The classification of this condition can be different: for example, the diagnosis of goiter could be made before pregnancy, or it appeared after fertilization by unknown autoimmune mechanisms.

Both in the first and in the second case, the risk of miscarriage and miscarriage at an early stage with severe hormonal disorders is high.

The greatest chances of a healthy child being born to that expectant mother who had a diagnosis of DTZ was made before pregnancy and was given the necessary treatment.

Diagnosis of DTZ

Diagnosis of diffuse toxic goiter in typical cases is not difficult and consists of:

  1. Patient complaints;
  2. Data inspection and palpation of the neck;
  3. Determining the level of thyroid-stimulating and thyroid hormones, establishing the factor of their excess and the appearance of specific symptoms, first of all - cardiac, neurological and eye.

Ultrasonography of the thyroid gland and biopsy followed by histological determination of the cellular composition are also in demand.

Analysis of similar conditions, or the differential diagnosis of diffuse toxic goiter is carried out with those diseases that can simulate the main signs (symptoms) from any side:

  • neurosis and menopause;
  • myocarditis, heart defects, rheumatism;
  • tuberculosis (leading to malnutrition);
  • cancer of the thyroid gland, producing excess hormones.

Treatment of diffuse toxic goiter, drugs

Treatment of diffuse toxic goiter

The treatment of any disease is etiotropic (directed at the cause), pathogenetic and symptomatic - relieving the patient from painful complaints. When diffuse toxic goiter treatment are reduced to the following principles:

  • Blocking the synthesis of hormones and their release from the gland - Mercazole;
  • For adequate replenishment of hormone levels during the "blocking" treatment with mercazole, L-thyroxine is prescribed;
  • After treatment with thyreostatics, surgical treatment of diffuse toxic goiter is possible (for example, almost complete removal or subtotal resection of the gland);
  • The use of a radioactive isotope of iodine is considered one of the main methods of treatment of DTZ abroad.

Diffuse nodular toxic goiter may be complicated by a thyrotoxic crisis — a difficult condition for life caused by the sudden release of blood by a large number of hormones with the development of the following symptoms:

  • The most acute tachycardia, hypertensive crisis, which is replaced by a drop in pressure, a decrease in urine output, as well as cardiac rhythm disturbances, shortness of breath, heart failure.

Complications of diffuse toxic goiter, in addition, may be symptomatic: cachexia, progressive amaurosis (blindness), myocardiodystrophy, violation of swallowing due to compression of the neck with goiter.


Prevention of diffuse toxic goiter, as with many other diseases, consists of the following activities:

  • prevention of colds, hardening;
  • stress management;
  • maintaining motor activity, positive emotions;
  • iodine intake with food (iodized salt);
  • preventive visits to an endocrinologist and an annual hormone test;

In any case, the thyroid gland is a very important formation: both a deficiency and an excess of hormones are harmful to health and can lead to disability.

Therefore, you should not neglect the examinations, and do not be lazy to once again look in the mirror to assess the contours of your own neck, if you become disturbed by insomnia, tachycardia, irritability, temperature rises and weight loss.

Take care of yourself and be healthy!


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