How to identify Basedow's disease without tests?

The thyroid gland is an organ that controls many vital processes in the body. When the thyroid gland is damaged by some disease, its function is disturbed, and this manifests itself throughout the body. The most common pathology of the thyroid gland – diffuse toxic goiter, which is also called Graves' disease – Basedow, Pari's disease.

Graves' disease. Mechanism of the development of the disease

Graves' disease develops against the background of the production of antibodies to the TSH receptor. Clinically, this is manifested by a widespread lesion of the thyroid gland and the development of thyrotoxicosis syndrome.

Graves' disease refers to multifocal diseases that are realized with a genetic predisposition against the background of the environment. Some scientists are considering the theory of molecular mimicry between thyroid antigens, retrobulbar tissue, a number of stress – proteins and antigens of bacteria.

In the pathogenesis of diffuse toxic goiter, the main role belongs to the synthesis of antibodies to the TSH receptor and its stimulating effect on TSH. This brings it into an active state, and the process of intracellular systems (cAMP and phosphoinositol cascades) is launched, which stimulate the uptake of iodine by gland cells, the synthesis and release of thyroid hormones, and the proliferation of thyrocytes. This is how the thyrotoxicosis syndrome develops, which is the main one in the clinical picture of Basedow's disease.

A triad of symptoms in the clinical picture of Basedow's disease

The clinical symptoms of Graves' disease are manifestations of thyrotoxicosis and consist of the main triad of symptoms – goiter, tachycardia and bulging eyes.

Endocrine ophthalmopathy. In some cases, eye changes are among the first manifestations of toxic goiter. There is a pronounced exophthalmos, which sometimes has an asymmetrical character, as well as lacrimation, diplopia when looking up, swelling of the eyelids, a feeling of sand in the eyes.

If such symptoms are found in a patient, it is possible to make an unmistakable diagnosis with the determination of the etiology, since among the diseases that are accompanied by thyrotoxicosis, such eye symptoms occur only in Graves' disease.

Complaints – sweating, poor tolerance to high temperatures, mental lability, hand tremor, fatigue, diarrhea, polyuria, oligoamenorrhea, decreased libido.

Objectively – atrial fibrillation, sinus tachycardia (often observed in people over 50 years of age). Hot moist skin, fine tremor, onycholysis, palmar erythema, onycholysis, urticaria, diffuse alopecia, muscle weakness, myopathy. Eye symptoms are visible to the naked eye. Gynecomastia can also occur with Graves' disease.

Specific Features – increased incidence of other autoimmune diseases, lymphadenopathy, thymus enlargement, diffuse goiter.

Thyroid tests that will indicate diffuse toxic goiter

TSH levels are low in thyroid lab tests. If the concentration of T3 or T4 is increased, this indicates overt thyrotoxicosis. If these hormones are within normal limits – this indicates a subclinical course of goiter.

The most informative for the diagnosis of Basedow's disease is the determination of the antibody titer to the TSH receptor. The level of antibody titers can help in deciding on the advisability of conservative therapy: the higher the titer – the lower the likelihood of successful conservative treatment and stable remission.

Normochromic or iron deficiency anemia is often detected in a clinical blood test. In a biochemical blood test, a decrease in the level of cholesterol, triglycerides, an increase in transaminases, alkaline phosphatase, hyperglycemia and hypercalcemia are determined.

To confirm the diagnosis, ultrasound and thyroid scintigraphy, as well as an ECG are performed. If necessary, a fine-needle biopsy of the thyroid gland is performed.

Basedow's disease is treated in 3 stages: conservative treatment, surgical treatment and radioactive iodine therapy.

During treatment, it is worth limiting the use of products that contain iodine, eliminating caffeine, alcohol and heavy physical exertion. If a small increase in the volume of the gland without nodes is detected, long-term conservative therapy is possible, which is very likely to lead to a stable remission. In case of relapse, thyreostatics are prescribed.

If Basedow's disease is detected, the patient should regularly monitor the level of hormones, taking tests every six months.