Toxic diffuse goitre (Graves’-Basedow’s disease) is a disease marked by the thyroid gland’s hyperplasia and hyperfunction. The disease may be prompted by hereditary factors, infections, intoxications, psychemical traumas, etc. The foundation of pathogenesis is a disturbance of immune “supervision” resulting in the formation of autoantibodies as a stimulating factor causing the gland’s hyperfunction, hyperplasia and hypertrophy. Of significance here is changed the sensitivity of tissues to thyroid hormones leading to a disturbance of metabolism between them.
Clinical manifestations are dictated by a surplus of thyroid hormones affecting different kinds of metabolism, organs and tissues. Patients complain of irritability, weepiness, hyper erethism, insomnia, flaccidity, fatigue, sweating, hands and body tremors. Patients lose weight despite the good appetite (limosis). Young patients, on the contrary, may gain weight (“fat” Basedow). The thyroid gland is diffusely enlarged, there being no relationship between its enlargement and seriousness of thyrotoxicosis. Changes in the eyes are as follows – bilateral exophthalmia (no trophic disturbances), restricted movement of the eyeballs, Greffe symptom (the upper eyelid lags behind the eyeball when looking down), Dalrymple symptom (wide opening of the palpebral fissure), Mobius symptom (weakness of convergence), and Kocher’s symptom (retraction of the upper eyelid when shifting one’s gaze).