Diffuse Toxic Goiter

Goiter, Diffuse Toxic 

(Basedow’s disease, thyrotoxicosis), a disease characterized by enlargement and intensified function of the thyroid gland and accompanied by the development of toxicosis.

Diffuse toxic goiter develops in connection with increased production of thyroid hormones, higher levels of these hormones in the blood, and disturbance of their metabolism in the tissues. The goiter may be caused by mental traumas, poisoning, infections (especially of the upper respiratory tract; specifically, chronic tonsillitis), and overexposure to the sun in persons not accustomed to a hot climate. It generally develops gradually. It occurs mostly in females, often at puberty and the climacteric. It is manifested by weakness, ready fatigability, dyspnea, tachycardia, display of emotions, irascibility, tremor of the eyelids and limbs, insomnia, poor tolerance for heat, hidrosis, loss of hair, loss of weight despite increased appetite, and diarrhea. The palpebral fissures are often wide open, and exophthalmos and poor convergence of the eyes are frequently observed. Changes are most pronounced in the cardiovascular system: rapid heart beat, elevation of the systolic and lowering of the diastolic blood pressures, and resultant hypertrophy of cardiac muscle. Severe cases are characterized by cardiovascular insufficiency. All forms of metabolism are disturbed: oxygen consumption by the tissues increases, resulting in intensified basal metabolism; accelerated excretion of nitrogen (hyperazoturia), calcium, phosphorus, magnesium, and water; and elevated blood sugar levels (hyperglycemia) that may develop into glucosuria. The functioning of other endocrine glands becomes impaired: the adrenal cortex (hypofunction, in the severe forms), pancreas (insufficiency of the islands of Langerhans), and gonads (disruption of the menstrual cycle and hemorrhage in females; increased libido and potency followed by a sharp decline in both, testicular hypotrophy, and decrease in spermatogenesis in males).

Diffuse toxic goiter is treated by proper work, rest, and sleep arrangements; high-caloric diet with sufficient amounts of vitamins (especially vitamin C); and iodine preparations (Microiod), thyrostatic agents (Thiouracil and Mercazole derivatives), and radioactive iodine (contraindicated for children, pregnant women, and lactating mothers). Surgery is effective.

REFERENCE

Gol’ber, L. M., and V. I. Kandror. “Patologicheskaia fiziologiia shchitovidnoi zhelezy.” In Mnogotomnoe rukovodstvo po patologicheskoi fiziologii, vol. 4. Moscow, 1966.

L. M. GOL’BER