The thyroid gland is the largest endocrine organ in our neck, located in front of the trachea and close to the breastbone. It weighs 20-30 grams. It stimulates the secretion of thyroid hormones. It is not normally palpable.
Goiter is an enlargement of the thyroid gland. Enlargement of the thyroid gland may or may not cause changes in thyroid hormone levels. Goiter, which is an enlargement of the thyroid gland, can have many causes.
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The main causes of goiter are:
- Iodine deficiency in daily foods
- autoimmune diseases
- Graves
- Hashimoto
- Cigarette
- genetic diseases
- Medicines
- Lithium
- iodides
- Interferon-alpha
- Radiation
- inflammation
The most common cause of diffuse toxic goiter is autoimmune diseases such as Graves’ disease. It is seen up to 10 times more frequently in women than in men. Although it is usually seen between the ages of 30-50, it can be seen at any age.
Diffuse toxic goiter patients have diffuse growth, in which the follicular cells in the thyroid gland increase, the intermediate thyroglobulin colloid decreases.
Graves’ disease is also one of the causes of diffuse toxic goiter, and not all cases of diffuse toxic goiter are Graves’ disease. In diffuse toxic goiter disease, there is diffuse enlargement of the thyroid gland without nodules. Bleeding increased. The capsule is taut and flattened. Lymphocyte cells are increased in the thyroid tissue. An increase and enlargement can be seen in all cell types of the thyroid gland. Therefore, it can also be confused with Graves’ disease or thyroid carcinomas. In fact, these diseases can be seen together in some patients.
Symptoms of diffuse toxic goiter:
Since diffuse toxic goiter is diffuse enlargement of the thyroid gland, thyroid hormone levels may increase due to increased activity of the enlarged thyroid gland. Patients may experience symptoms of hyperthyroidism. They may experience weight loss, heat intolerance, tremor, irritability, fatigue, palpitations, anxiety disorders, nausea, diarrhea, vomiting, frequent stools, and shortness of breath. In addition, eye disorders such as edema and enlargement of the eyes, strabismus, excessive watering and dilation of the eyes may develop due to excessive increase in thyroid hormones. Skin thickening and darkening of the eyes can also be seen around the eyes. Even menstrual irregularities can be added to the table in some patients.
Diffuse toxic goiter can have symptoms caused by an overgrowth of the thyroid gland. There may be shortness of breath, neck pain, hoarseness and difficulty swallowing.
Diagnosis of diffuse toxic goiter:
Thyroid hormones are usually first examined in all patients with suspected thyroid disease. TSH, T3 and T4 levels are evaluated. In addition, thyroid ultrasonography or thyroid radioactive iodine uptake evaluation can be performed. TSH receptor antibodies can also be examined. In addition, comprehensive evaluation with other examination and imaging methods may be required. Diffuse toxic goiter is a disease that requires detailed evaluation in order to differentiate it from other thyroid diseases that cause thyroid hormone increase and nodular goiter diseases that cause enlargement of the thyroid gland.
Treatment of diffuse toxic goiter:
After the diagnosis of diffuse toxic goiter, the selection of the most appropriate treatment depending on the patient’s condition, concomitant diseases and tolerability depends on the evaluation of the physician.
Diffuse toxic goiter treatment should be based on the underlying disease. Treatment of thyroid carcinomas will differ from the treatment of Graves’ disease or Hashimoto’s disease, which is the most common. In cases of diffuse toxic goiter, drug therapy, radioactive iodine (I-131) therapy or surgical treatment alternatives can be evaluated.
Antithyroid drugs containing propylthiouracil, thiamazole and carbimazole can be used for drug treatment of diffuse toxic goiter. Propylthiouracil is the drug of choice most often. Although tiamazole is the drug of first choice in Graves’ disease, it is not used in the first trimester of pregnancy. Antithyroid drug therapy requires close follow-up and the risk of recurrence is high in the first year after discontinuation of therapy. At the same time, liver and hematological side effects due to drugs can be seen.
Radioactive iodine-131 ablation therapy is also a frequently used treatment method. It is not applied to pregnant women, breastfeeding women and those with severe thyrotoxicosis. Close follow-up is required after this treatment. In addition, radiation-induced thyroiditis may develop.
The most successful treatment method for diffuse toxic goiter is surgical total thyroidectomy. Side effects may occur due to surgery.
Diffuse toxic goiter can cause symptoms and problems related to the side effects of hyperthyroidism in the long term. In advanced cases, it can cause serious problems in the eyes and heart. However, in advanced ages, these symptoms may appear less pronounced or may be confused with malignancies.