Toxic diffuse goiter (Graves’ disease)

Description of Ligos

This is the most common cause for the thyroid gland to produce an excessive amount of the hormone thyroxine. Toxic goiter can occur at any age, but it most commonly affects individuals aged 20-40, with women being affected five times more often than men. The development of the disease is believed to be influenced by a genetic predisposition and an autoimmune process (antibodies are produced against the thyroid gland, stimulating it to produce hormones). It is thought that an autoimmune response can be triggered by an excess of iodine, viral or bacterial infection, stress, or discontinuation of glucocorticoid therapy.

Symptoms

The symptoms characteristic of the disease include: a goiter in the neck area – without nodules, with increased blood flow, increased heart rate, psychomotor agitation (increased nervousness, insomnia, fine tremor of the outstretched fingers). In women, there may be menstrual cycle disturbances. Additionally, Graves’ disease is characterized by weight loss, increased bowel movements, elevated blood glucose concentration, increased sweating, warm and moist skin, heat intolerance, muscle weakness, and hair loss.

In 50% of cases, there are eye manifestations, such as grittiness (as if there were sand in the eyes), redness, pain, a feeling of pressure, impaired eye movement, protrusion, and swelling around the eyes.

Skin changes are not uncommon – thickening in the shape of the fingers and toes. Dermopathy – swelling and redness of the shins and feet.

Diagnosis

Hormones are tested – thyroid-stimulating hormone (TSH), thyroxine 4 (T4), triiodothyronine 3 (T3), antibodies against thyroid peroxidase (anti-TPO). Thyroid ultrasound is performed (enlarged thyroid gland, increased blood flow), scintigraphy (intense radionuclide accumulation is determined).

Treatment

The goal of treatment is to achieve euthyroidism (i.e., normalize hormone levels). Medications such as thioamides (methimazole, propylthiouracil) are prescribed. Additionally, beta-blockers are prescribed to reduce tachycardia (high heart rate). Also, vitamin supplements, antioxidants, liver-protecting drugs, iodides (especially when preparing for thyroid surgery) may be prescribed.

Treatment with radioactive iodine (highly effective) may be used, or surgical treatment may be applied when malignancy is suspected or when pressure symptoms due to goiter enlargement occur.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology