Diagnosis of diffuse toxic goiter


  • Laboratory determination of hormones
  • Thyroid-stimulating hormone
  • The total thyroxine
  • Determination of antibodies to thyroglobulin
  • Instrumental methods

  • Graves' disease - an autoimmunedisease caused by excessive secretion of thyroid hormones and manifested diffuse enlargement of the thyroid gland. The main manifestations of the disease is a smooth, velvety, moist skin, tremor of fingers, sclera vascular injection (cloudy or "red-eye"), witnessed a rapid heartbeat, lack of pulse shortening inspiratory and alone. The thyroid gland is uniformly increased, elastic, often without knots.

    Laboratory determination of hormones

    The initial examination of patients with toxic goiter is necessary to determine hormone levels:

    • thyroid stimulating hormone (TSH)
    • thyroglobulin
    • total thyroxine (T4 total, tetraiodothyronine general, Total Thyroxine, TT4)
    • free thyroxine (rarely free triiodothyronine)
    • determination of antibodies to thyroglobulin
    • thyroid peroxidase and thyroid-stimulating hormone receptor

    Thyroid-stimulating hormone

    Thyroid hormone is produced in the pituitary gland toincrease of the iodine in the plasma cells of the thyroid gland. Under the influence of the hormone tiroetropnogo the synthesis of the major thyroid hormones - thyroxine and triiodothyronine.

    The indications for purpose of analysis:

    • Detection of latent hypothyroidism
    • Control study in detecting hypothyroidism (for life 1 - 2 times / year)
    • Control study in detecting diffuse toxic goiter (1.5 - 2, 1 - 3 times / month)
    • Delayed mental and sexual development in children
    • Goiter
    • cardiac arrhythmias
    • myopathy
    • Idiopathic hypothermia
    • Depression
    • Alopecia
    • Infertility
    • Amenorrhea
    • Impotence and decreased libido
    • hyperprolactinemia

    Preparation for the study: on the eve of the research necessary to exclude physical activities (athletic training), alcohol intake and smoking.

    The total thyroxine

    Diagnosis of diffuse toxic goiterTotal thyroxine produced by the thyroid glandunder the influence of the pituitary hormone tiroetropnogo. Most tsirkuliruyuscheego thyroxine in the blood is associated with proteins, and biological effects has only the free part of the hormone.

    Under the influence of total thyroxine increases speedbasal metabolism, increased heat production and oxygen consumption in all tissues of the body except the brain tissue, which increases the body's need for vitamins, stimulates the synthesis of vitamin A in the liver, decreases the concentration of cholesterol and triglycerides in the blood, accelerate protein turnover.

    The indications for purpose of analysis:

    • Decreased or increased level TTG
    • Goiter
    • The clinical picture of hypothyroidism or tirotoksikoza

    Preparation for the study: For 2 - 3 days before the study excluded receiving iodine-containing preparations, for 1 month - thyroid hormones, unless otherwise stated endocrinologist. Taking blood should be carried out prior to the study, using contrast media. On the eve of the research necessary to eliminate physical exertion and stress. Immediately before taking blood patient should be at rest for at least 30 min. Blood is taken on an empty stomach.

    Determination of antibodies to thyroglobulin

    Thyroglobulin - iodinated protein from whichformed thyroid hormones (thyroxine and triiodothyronine). Antibodies to thyroglobulin are an important parameter for the detection of autoimmune thyroid diseases such as Hashimoto's disease, atrophic autoimmune thyroiditis, Graves' disease.

    Hashimoto thyroiditis patients the level of antibodies in the treatment process, usually decreases, but may be fluctuating course with a period of about 2 - 3 years.

    Determination of antibodies to give terioglobulinythe ability to predict thyroid dysfunction in patients with other autoimmune endocrine diseases and family members with hereditary autoimmune diseases. Children born to mothers with high titers of antibodies to thyroglobulin, for life may develop autoimmune thyroid disease that requires classification of these children at risk.

    The indications for purpose of analysis:

    • Newborns (high-Tg antibodies in the mother)
    • Chronic thyroiditis in adults (Hashimoto)
    • Differential diagnosis of hypothyroidism
    • Goiter
    • Diffuse toxic goiter (Graves' disease)
    • Heavy swelling shins (peritibialnaya myxedema)

    Survey Preparation: Not required.

    In addition, a study carried out in basal metabolism, absorption of radioactive iodine by the thyroid gland, iodine levels associated with proteins.

    Instrumental methods

    The last group of methods is less informative andrecent years, little used. From instrumental methods using ultrasound, which allows to detect an increase in cancer and the presence of nodes.

    Ultrasonography (US) thyroidgland - a method that allows to see the breast tissue, its structure, the pathological formation in it. In diffuse toxic goiter determined by diffuse enlargement of the thyroid gland. If the reason tirotoksikoza other, the US will make a differential diagnosis with nodular and multinodular thyroid gland formations.

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