19Feb

Ophthalmopathy in toxic goiter and diagnosis of thyrotoxicosis

Ophthalmopathy for diffuse toxic goiter does not always develop: only a half of patients with a diagnosis of thyrotoxicosis have eyelids.

For example, the symptoms of endocrine ophthalmopathy were clearly manifested in NK Krupskaya.

Before appointing the treatment of endocrine ophthalmopathy, a joint consultation of an ophthalmologist and endocrinologist is conducted.

Diffuse toxic goiter with thyrotoxicosis

A very characteristic symptom of toxic goiter, the so-called ocelli, or ophthalmopathy, which develops in about 50% of patients, nevertheless has no direct relationship to the action of thyroid hormones. It is believed that the antibodies that attack the cells of the thyroid gland can act on the eye muscles, and on the retrobulbar fiber( the fat that is behind the eyeball).It swells and squeezes the eye out of the orbit. The patient feels the pain in his eyes, as if the presence of sand, lacrimation. If the disease is severe, vision can deteriorate sharply.

In order to distinguish the physiological increase in thyroid activity from pathological, a so-called loading test with triiodothyronine is used.

It is based on the fact that in the physiological cases the negative feedback system remains, in the case of the pathology of the iron, it escapes the control of the pituitary gland and does not decrease the productivity in response to the increase in the level of hormones in the blood.

Before the patient is tested, a classical radioiodine uptake test is performed. Then, within 7 days, the examinee takes triiodothyronine at a dose of 100 mg per day, followed by a second test of thyroid radioiodide uptake.

In patients with diffuse toxic goiter, absorption decreases insignificantly, since iron does not respond to an increase in the level of tri-iodothyronine in the blood. In healthy people and with hypothyroidism there is a decrease in the accumulation of radioactive iodine by the thyroid gland by more than 50% of the baseline level.

Endocrine ophthalmopathy: symptoms and treatment

Symptoms. It is usually enough to determine in the blood a high level of thyroid hormones to diagnose thyrotoxicosis.

The absence of nodes in the thyroid gland during palpation and ultrasound and its uniform increase make it possible to distinguish diffuse toxic goiter from toxic adenoma.

With a slight increase in the level of hormones and an erased clinical course of the disease, it can be a physiological enhancement of the thyroid function( often occurs in adolescence during a period of increased growth and the formation of secondary sexual characteristics).In this case, treatment is undesirable, since the body obviously needs high doses of thyroid hormones to complete its maturation.

Treatment. There are 3 main methods of treating toxic goiter with thyrotoxicosis: conservative( drug treatment with special drugs), treatment with radioactive iodine and surgical.

  1. At the first stage prescribe thyreostatic drugs that suppress the activity of the thyroid gland. The treatment is long, it can last from several months to many years. Simultaneously, symptomatic treatment is prescribed, which should compensate for the dysfunction of the central and autonomic nervous systems. If the treatment of diffuse toxic goiter with thyrotoxicosis with thyreostatic drugs is ineffective, they switch to radical methods.
  2. Treatment with radioactive iodine is a method of eliminating an "extra" gland without surgery. Getting into the body, radioactive iodine accumulates by the cells of the thyroid gland, which leads to their death and replacement by connective tissue.
  3. Surgical treatment is indicated in cases of ineffectiveness of conservative treatment, as well as in the presence of a significant increase in the thyroid gland, suspected of a malignant tumor, or a retrosternal goiter. It is possible only after the complete elimination of thyrotoxicosis by medication, otherwise in the operation there is a high risk of complications on the heart.

The most common complication of radical treatments is hypothyroidism. In such cases, lifelong replacement therapy with thyroid hormones is required.