May 25. World thyroid day

Much has been said and written about the thyroid gland. Health to her! 🙂

Especially in the light of the development of preventive medicine, now “many know how to treat” the thyroid gland, but all of them, as a rule, write about hypothyroidism (lack of hormones) and its correction. But, almost no one writes about hyperthyroidism and its varieties (an excess of hormones with a sharp increase in T4 and T3, a decrease in TSH), in this case there are few “willing to diagnose and treat.”

Hyperthyroidism, or diffuse toxic goiter, or toxic adenoma, or Hashi toxicosis, or subclinical hyperthyroidism (these are not identical concepts, completely different diagnoses)! The most difficult to control and treat at the same time, DTZ (diffuse toxic goiter), is prone to multiple relapses, resulting in an operation, or RIT, is very clearly clinically expressed, it is difficult to confuse with something:

manifested by constant sinus tachycardia-palpitations,
the appearance of extrasystoles, atrial fibrillation !!!!
appear – tearfulness, increased excitability, emotional lability, movements become fussy, tremor of the fingers of outstretched arms is noted – Marie’s symptom, as well as tremor of the whole body;
weight drops sharply
MC in women increases in frequency after 14-20 days
the temperature rises to subfebrile numbers
eye symptoms appear – bulging, “sand in the eyes” and so on.
I have long wanted to write about the clinical varieties of DTZ.

How diverse this diagnosis is. Now DTZ began to undergo a change in the clinical course. , its course often deviates from the classical.

Age and sex characteristics of DTZ.
DTZ occurs: in adults and children (more often in girls),
in women, more often than in men, in the elderly – it is extremely rare (!)
During pregnancy, the debut of DTZ is casuistic, but it occurs (associated with impaired immunity). I’ve met a couple of times. After generic exacerbation of DTZ is often, but the debut is a rarity, I had to meet.
There are family forms of DTZ (described in the literature, I have not met)
Depending on the prevalence of symptoms, forms of DTZ:
cardiovascular form; (tachycardia, atrial fibrillation), often (!!!) gastrointestinal form; (diarrhea, earlier, even in infectious diseases wards, patients used to get into infectious diseases wards), often occurs (!!!)
neuropsychic form;
subfebrile form; (where the leader of the symptoms would be an increase in temperature – a great rarity !!!)
adynamic (a person, on the contrary, becomes inactive, and not fussy), this is an untypical form (!), I have met such a course of DTZ, it rarely happens; earlier, one more form was distinguished – hypogenital (but this, apparently, this form was still in the era before the invention of Mercazolil, now the reproductive system almost “does not suffer” from DTZ;);
I would single out – an edematous form, in patients in the onset of DTZ – relapses of pretibilal myxedema (swelling of the ankle, quite pronounced), and Dz DTZ is not immediately given. Confused with CHF and kidney disease.
DTZ and weight.
Distinguish –
the usual form of thyrotoxicosis with moderate weight loss (depending on the severity of thyrotoxicosis;
lipodystrophic with weight loss of the upper part of the body, and the fullness of the lower part of it; DTZ with obesity (met such forms too !!).
DTZ with tachycardia (rapid pulse),
with normosystole
and bradyarrhythmia (rare pulse !!).
DTZ with ophthalmopathy
and without ophthalmopathy. (damage to the periocular tissue and muscles) .It is a separate very complex topic. I will write an article.
DTZ in combination with AIT,
DTZ in combination with nodular goiter
DTZ in combination with thyroid cancer
DTZ by severity
Light – heart rate 80-120 / min, weight more walking no more than 5 kg, weak hand tremor
Moderate severity – heart rate 100-120 per min, weight loss up to 10 kg, increase in pulse pressure (m / u upper and lower blood pressure, a difference of more than 50 mm Hg is a sign of the development of cardiac muscle pathology)
Severe degree – heart rate above 120, weight loss of more than 10 kg, atrial fibrillation and AHF and other polished insufficiency may vary, the patient is disabled !!
DTZ by type of feature debut:
sublichkesky (T4sv and T3sv norm, only TSH is reduced)
manifest (T3sv and T4sv are increased, TSH is sharply reduced)
complicated (T3sv and T4sv are increased, TSH is sharply reduced) + complications: atrial fibrillation, heart failure, tyrogenic relative adrenal insufficiency, dystrophic changes in parenchymal organs, psychosis, severe underweight,
thyrotoxic crisis !!! – an urgent (life-threatening) clinical syndrome, which is a combination of severe hyperthyroidism with thyrogenic adrenal insufficiency. Clinically: extensive hyperthyroidism syndrome, severe mental anxiety up to psychosis, motor hyperactivity, alternating with apathy and disorientation, hyperthermia (up to 40C, pain in the area) heart, abdominal pain, nausea, vomiting, acute heart failure, hepatomegaly, thyrotoxic coma.
DTZ by the degree of thyroid enlargement
0 degree (WHO) – the thyroid gland is palpable, no more than the distal phalanges of 1 fingers
1 degree – the size of the lobes is larger than the distal phalanges of 1 fingers
2 degree – the thyroid gland is actively visible and on palpation is large.
DTZ depending on the predominant hormone:
T3 – thyrotoxicosis (it proceeds and is treated harder !!!)
T4 – thyrotoxicosis
In combination with other pathology:
DTZ with cystic drift (rare !!)
DTZ with chorionepithelioma (rare !!)
TTZ in TSH-producing adenoma (very rare !!)