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Diffusion toxic craw (Bazedova an illness, or Greyvs's illness) — the disease caused by supersecretion of thyroid hormones diffusion (not nodal) tissue of a thyroid gland. Hyperfunction of a thyroid gland is caused by impact on it of the special antibodies possessing tireostimuliruyushchy action.
Now the diffusion toxic craw is considered as genetically caused, autoimmune disease caused by formation of specific anti-thyroid antibodies. Hereditary character of a disease is confirmed by family "accumulation" of a craw, association with some antigens of the HLA system (B8, DR3, DW3), detection of antibodies to a thyroid gland at relatives of patients.
Disturbances of an immunogenesis are connected with hereditary deficit of function of T-suppressors that leads to formation of the forbidden clones T-helperov promoting synthesis of anti-thyroid antibodies. Their population of a geterogenn. At the same time two groups have the greatest pathogenetic value.
• A LATS factor (long act thyroid stimulator) — the antibodies which are agonists of receptors to thyritropic hormone of a hypophysis (TTG), i.e. strengthening function of a thyroid gland.
• GSI (growth the stimulating immunoglobulins) — the antibodies which are agonists to the receptors of an insulinopodobny growth factor of the I type and/or somatomedin C localized in a thyroid gland.
Other classes of antibodies, in particular, possessing blocking and/or antagonistic impact on receptors to TTG, antibodies to peroxidase of a thyroid gland, thyreoglobulin of microsomal fraction, a nuclear component, are found at a diffusion toxic craw less often and , as a rule, in a smaller caption.
As at a diffusion toxic craw thyrotrophin receptors are under the continuous stimulating influence of a LATS factor, regulatory influence of TTG on a thyroid gland is lost and there is an uncontrolled development of excess amount of its hormones. The thyrotoxicosis, as a rule, followed by growth of a thyroid gland develops. By the principle of negative feedback thyroid hormones suppress development of TTG in a hypophysis and its level in blood decreases.
Hormones of a thyroid gland increase sensitivity of receptors of a sympathetic nervous system to influence of catecholamines that affects, mainly, functioning cardiovascular (tachycardia, increase of arterial pressure) and the central nervous system (alarm, irritability, a sleep disorder, a small tremor).
The catabolic effect of thyroid hormones is shown by loss of body weight, muscular weakness, feeling of heat and other symptoms.
In 18-20% of cases at a diffusion toxic craw there is an ophthalmopathy which represents independent autoimmune inflammatory process in oculomotor muscles and fabrics of an orbit. At the same time development of a diffusion toxic craw and an ophthalmopathy not necessarily happens in parallel. The ophthalmopathy can be observed as against raised, and normal or reduced function of a thyroid gland.
The illness occurs both at young people, and at elderly people, however women at the age of 20 — 50 get sick more often. Development of a clinical picture can be provoked by a trip to the district with hot climate, a severe psychoemotional stress (divorce, death of the relative), childbirth, operational treatment, a heavy infection, a craniocereberal injury.
Symptoms of a diffusion toxic craw
Complaints from cardiovascular system are most often noted. Heartbeat disturbs patients, as a rule, at night, and in case of a ciliary arrhythmia the feeling of dying down and interruptions in cardiac performance appears. It should be noted that sometimes at objective existence of disturbances of a rhythm patients subjectively do not feel them.
Quite often patients pay attention to decrease in body weight, and appetite can be kept or is even increased.
In certain cases muscular weakness becomes the leading complaint (patients cannot carry out or carry out hardly an exercise stress, usual for them: care of the child, cleaning of the apartment, cooking, etc.). It is characteristic, but emergence of weakness in legs (difficultly to enter the tram, to walk upstairs) with further development of the general weakness is not obligatory in the beginning.
Emergence of feeling of an internal shiver (symptom of "a cable column"), tremblings of hands which interferes with performance of small and exact work or leads to handwriting change is considered typical. Occasionally in hard cases the large, wide tremor can appear.
Often sick are disturbed by feeling of heat, perspiration though body temperature does not increase. Because of constant feeling of heat patients with a diffusion toxic craw wear very easy clothes even in a cold season, easily take cover during a dream, badly transfer warm and hot weather.
Complaints from the central nervous system are noted: alarm, irritability, tearfulness, sleep disorders, decrease in intellectual working capacity.
At significant increase in a thyroid gland sick or surrounding can pay attention to change of a shape of a neck, emergence of a craw.
The chair at patients with a thyrotoxicosis becomes frequent to 3 ~ 4 times a day, becomes kashitseobrazny.
Especially it is necessary to pay attention to the complaints characteristic of an ophthalmopathy. Complaints to feeling of raspiraniye behind eyes, dacryagogue, "feeling of sand" in eyes, an exophthalmos, in hard cases — doubling in eyes, decrease in visual acuity are possible.
At survey of the patient smooth, warm, velvety, wet skin, the small tremor of fingers of hands well noticeable at a pulling of hands with thumbs up (Mari's symptom), especially, comes to light if the doctor fixes a forearm of an outstretched arm of the patient. Coloring of skin pink, is sometimes noted a xanthopathy a century.
Occasionally the specific damage of skin caused by adjournment in it a large amount of acid mucopolysaccharides owing to an immune inflammation — a so-called pretibialny myxedema meets. Usually skin of a front surface of shins, feet is surprised. She becomes edematous, reinforced, reminds an orange peel, but purple or brown-red color. Hair on an affected area coarsen. Emergence of an itch is possible.
Constant tachycardia over 90 beats/min, lack of an urezheniye of pulse on a breath, at rest is characteristic of a diffusion toxic craw and during a dream. Arterial pressure is, as a rule, increased, mainly at the expense of the systolic pressure while diastolic can be lowered.
In initial stages of a disease of limit of relative cordial dullness remain normal, at development of a thyrocardiac myocardial dystrophy moderately extend as at the expense of auricles, and ventricles. Cardiac sounds a long time remain sonorous.
The I tone on a top can even be increased, emergence of systolic noise is possible further. Emergence of a ciliary arrhythmia demonstrates existence of considerable dystrophic changes of a myocardium and often is followed by heart failure.
The thyroid gland at patients is evenly increased, elastic, is more often without nodes. An important symptom is the vascular noise listened over a thyroid gland.
From eyes the symptoms connected directly with increase of level of thyroid hormones — a thyrotoxicosis, and caused by an autoimmune ophthalmopathy come to light.
So, the increase of a sympathetic tone which is available against a thyrotoxicosis leads to the fact that the tone of the muscle of Müller lifting an upper eyelid and innervated by a sympathetic nerve also raises. For this reason there are following symptoms: emergence of a white strip of a sclera between edge of an upper eyelid and edge of a cornea at the movement of an eyeglobe up (Kokher's symptom); the same is at the movement of an eyeglobe down (a symptom Gref); broad disclosure of a palpebral fissure (Delrimpl's symptom); gloss of eyes (Krause's symptom) and some other. Diagnostic value of the specified symptoms is rather small as often they can occur at patients with vegetative neurosises and even sometimes at healthy people.
Möbius's symptom — disturbance of convergence of eyeglobes owing to weakness of eye muscles is more important (as private manifestation of the general muscular weakness). This symptom often meets at a thyrotoxicosis and is much more rare at other diseases, for example, than high degree of a myopia.
The autoimmune ophthalmopathy proceeds with increase in volume of retrobulbar cellulose and damage of eye muscles that leads to the progressing exophthalmos at the expense of a protrusion of eyeglobes forward, and also to disturbance of movements of eyeglobes (look paresis up, disturbance of verkhnebokovy movements). At survey the exophthalmos, usually a little asymmetric, but bilateral, an injection of vessels of scleras in combination with hypostasis and an infiltration a century, conjunctivitis is noted. Hypostasis of retrobulbar cellulose can cause a prelum of an optic nerve and a vascular bundle. At a considerable exophthalmos eyelids completely are not closed that can lead to drying of a cornea with the subsequent ulceration and infection.
Clinical picture at men and persons ill with a diffusion toxic craw
In general heavier fast-progressing course of a disease, often refractory to conservative therapy is characteristic of men. To their thicket the expressed ophthalmopathy is observed. Though patients with a diffusion toxic craw of men quite often completely have no complaints to heartbeat tachycardia is less expressed, the heavy myocardial dystrophy meets to a bowl.
At advanced age often there is no essential enlargement of the thyroid gland, seldom there is an exophthalmos. Defeat of cardiovascular system — a ciliary arrhythmia and the progressing heart failure can be the only display of an illness.