Excess hormones thyroid gland leads to an increase in the body's need for oxygen and increased heat production.

Many symptoms of thyrotoxicosis are similar to those due to irritation of the sympathetic nervous system. Such symptoms include hand tremors, sweating, tachycardia, and anxiety.

Cardiovascular disorders

From the outside of cardio-vascular system An excess of thyroid hormones is manifested by the following symptoms:

• an increase in systolic and a decrease in diastolic blood pressure;
• attacks of atrial fibrillation;
• with a long course of the disease, heart failure may occur.

On auscultation of the heart, the heart sounds are loud, and a systolic murmur may be heard at the apex of the heart.

The following changes may be present on the electrocardiogram:

• sinus tachycardia;
• atrial fibrillation;
• high voltage of teeth;
• two-phase or negative wave T.

Changes in skin, hair, subcutaneous fat

Due to advanced education heat in such patients may increase body temperature. Persons with thyrotoxicosis complain of constant feeling heat. The skin feels warm and moist to the touch. Skin hyperpigmentation may appear in folds and areas of high friction (elbows, neck, lower back).

Local hair loss (alopecia) may be detected on the scalp. If liver damage occurs, itching of the skin occurs, which can be suspected by traces of scratching on the skin.

Due to increased basal metabolism, patients lose weight and the subcutaneous fat layer decreases.

Gastrointestinal symptoms

Patients with thyrotoxicosis note an increase in appetite (decreased appetite can be observed in older people). Diarrhea, enlarged liver, and possibly jaundice also develop.

At laboratory research blood serum is determined by an increase in activity alkaline phosphatase and aminotransferases.

Changes in the muscular and skeletal systems

Muscle volume may decrease, develop muscle weakness. In rare cases, peripheral muscular paralysis can occur, lasting from a few minutes to several hours. The cause of such paralysis is potassium deficiency.

An excess of thyroid hormones is also reflected in bone tissue. Children experience accelerated growth. And in adults, osteoporosis develops due to a decrease in protein content in bone tissue. Osteoporosis contributes to back and bone pain.

Symptoms of pathology of the central nervous system

Excess thyroid hormones leave their mark on the psyche. Such patients are excitable, irritable, restless, they have difficulty concentrating, and they sleep poorly.

Sexual dysfunction

In women, excess thyroid hormones lead to problems menstrual cycle, infertility.

In men, thyrotoxicosis manifests itself as gynecomastia (increased mammary glands, subcutaneous fat deposited according to the female type). Also decreasing sexual desire and potency.

If patients have previously had impaired carbohydrate (glucose) tolerance, then excess thyroid hormones can cause diabetes mellitus. Clinical manifestations of the latter will be thirst and polyuria (increased volume of urine excreted).

Eye symptoms

With thyrotoxicosis, the palpebral fissures are widened, it seems that such a person is angry, surprised or scared. There is an increased shine in the eyes.

The following symptoms are identified from the eyes:

• Stellwag's symptom - rare blinking;
• Jellinek's sign - pigmentation of the eyelids;
• Moebius symptom – the convergence (convergence) of the eyeballs is impaired;
• Graefe's symptom - if you ask the patient to look down, you can see a section of sclera between the upper eyelid and the iris, which should not normally be there;
• Kocher's sign - when looking up, a section of the sclera is visible between the lower eyelid and the iris;
• Delrymple's sign is the appearance of a strip of sclera between the iris and the upper eyelid when looking straight ahead.

With thyrotoxicosis, exophthalmos develops (protrusion of the eyeball outward).

Patients complain of a feeling of “sand in the eyes,” pain in the eyeballs, photophobia, and lacrimation.

Excessive production or intake of thyroid hormones into the body with medications is called thyrotoxicosis. This condition has varying degrees of severity. Severe thyrotoxicosis poses a threat to the patient's life.

The clinical picture of the disease depends on many factors. It matters what pathology led to the increase in hormone levels, the age of the patient, accompanying pathologies and heredity.

Symptoms of thyrotoxicosis are most pronounced in young patients. The main cause of severe excess of thyroid hormones is diffuse toxic goiter.

In old age, with nodular goiter and chronic thyroiditis, thyrotoxicosis often has mild manifestations. This condition may remain undiagnosed for a long time.

Thyrotoxicosis syndrome occurs in 1 out of 100 adults in our country. In women, its prevalence is 10 times higher than in men and is equal to 2%.

"Targets" of thyroid hormones

Thyroid hormones have a variety of effects on the human body. All organs and systems are sensitive to thyrotoxicosis.

The most severely violated:

• metabolism;
• activity of the nervous system;
• function of the heart and blood vessels.

Symptoms of thyrotoxicosis occur during the manifest stage of the disease. During this phase of the disease, blood tests show a drop thyroid-stimulating hormone and an increase in the level of thyroid hormones (thyroxine, triiodothyronine).

Metabolic disorders

Thyrotoxicosis affects thermoregulation. The body produces more thermal energy from the calories received from food. Body temperature rises slightly. Analyzes reveal an acceleration of metabolism.

At high level thyroid hormones, the need for daily calorie content food. The patient begins to eat more food than usual. But even in the background good appetite body weight does not increase. Most often, gradual weight loss is observed. In severe thyrotoxicosis, patients lose more than 10% of their weight.

The metabolism of carbohydrates changes. In the liver, the processes of glucose synthesis are enhanced. Hepatocytes produce it from their own reserves (glycogen), fat deposits and from nutrients food. The concentration of glucose in the blood increases, sometimes reaching the level characteristic of diabetes mellitus. Such a violation carbohydrate metabolism is temporary and goes away after correction of the hormonal status.

The metabolism of proteins and fats also changes under the influence of thyrotoxicosis. Of these chemical elements the body receives energy by gradually using it up. The patient is losing weight muscle undergoes atrophy.

Thyrotoxicosis and central nervous system

High concentrations of thyroid hormones in the blood affect the functioning of the brain. The patient develops mental disorders varying degrees expressiveness.

In mild cases, changes are limited emotional lability, tearfulness, finger tremor, fussiness and insomnia. The patient appears to be constantly in the manic phase of a cyclic disorder. He has many ideas, desires, plans. A patient with thyrotoxicosis is constantly acting. But the effects of its work are almost invisible. This is due to the fact that the disease reduces concentration and determination.

IN severe cases thyrotoxicosis can lead to psychosis. Patients experience agitation, anxiety, and increased aggressiveness. Hallucinations may appear.

Cardiovascular problems

Thyrotoxicosis increases the sensitivity of the heart and blood vessels to the stimulating influence of adrenal catecholamines.

The first symptoms of the disease may be a rapid pulse. In addition, signs of thyrotoxicosis are different kinds arrhythmias, and arterial hypertension. Excess thyroid hormones deplete the heart muscle. In severe cases it develops characteristic lesion myocardium. Patients experience swelling, shortness of breath, severe weakness. These manifestations indicate the onset of heart failure.

Laboratory signs of thyrotoxicosis

When examining patients with thyrotoxicosis syndrome, a characteristic combination of laboratory signs is observed.

In addition to an imbalance of thyroid hormones, it is noted:

• increase in the number of red blood cells in the blood;
• reduction of total cholesterol and atherogenic index;
• increased blood sugar on an empty stomach and after exercise;
• increase in the concentration of glycated hemoglobin.

On the ECG, at the first signs of myocardial damage, tachycardia and deviation to the left are detected electrical axis heart, high R wave. Long-term thyrotoxicosis causes dystrophy of the heart muscle. In this case, the ECG shows a decrease in the voltage of the R and T waves, and signs of ventricular overload and coronary insufficiency appear.

Eye symptoms

Some thyroid diseases are combined with endocrine ophthalmopathy. Eye symptoms confirm the diagnosis of diffuse toxic goiter, less often – chronic autoimmune thyroiditis.

Endocrine ophthalmopathy is based on inflammation of the fatty tissue of the orbit. Swelling, sclerosis, muscle damage, optic nerve, the eyeball is caused by special antibodies. These substances are produced by our own immune system person.

Most important symptoms eye damage due to thyrotoxicosis:

• exophthalmos;
• wide opening of the palpebral fissure;
• sparkle of eyes;
• rare blinking;
• double vision when looking at a close object;
• eyelid lag when looking up or down.

Eye symptoms of thyrotoxicosis decrease with correction of thyrotoxicosis. But heavy endocrine ophthalmopathy requires separate specific treatment.

If thyrotoxicosis syndrome is not provoked autoimmune process, then eye symptoms do not occur. Endocrine ophthalmopathy is absent in multinodular toxic goiter, an iatrogenic condition (introduction synthetic hormones), subacute thyroiditis and other diseases.

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High levels of thyroid hormones cause a disease called thyroid hormone intoxication. In some cases, the disease is also called hyperthyroidism. Some of the characteristic symptoms of this disease are Graefe's and Kocher's symptoms.

general information

In a patient with thyrotoxicosis, large quantity thyroid hormones than required for normal functioning body. As a consequence, the effects that hormones cause in in good condition, are significantly enhanced, for example, the metabolic rate increases significantly.

As the disease progresses, no matter how much patients overeat, they only end up losing weight. Those suffering from the disease also report diarrhea and constant thirst. The thermoregulation of the body is also disrupted, changes appear in the central nervous system and cardiovascular systems.

Also, this disease leads to an increase in the body's need for oxygen; the patient's body produces more heat than necessary.

As a result, symptoms such as hand tremors, restlessness, heavy sweating and many others. There are also problems related to the eyes.

Most common eye symptoms

Most often, eye symptoms in thyrotoxicosis are associated with impaired facial muscles and eye movement. The most pronounced protrusion of the eyeballs or exophthalmos. In most cases, only unilateral protrusion is observed.

The reason lies in the work autonomic system and an increase in the tone of the muscles that move the eyes, as well as an increase in the volume of fat and adjacent tissues. As a result, stagnation, increased pressure and swelling form in the eyelids. If the mentioned symptoms are observed, you should definitely.

However, the eye symptoms of the disease are not limited to this alone. Among others, the following can be noted:

• Stellwag's symptom: the patient blinks very rarely;
• Dalrymple's sign: the palpebral fissures are widely dilated, the patient seems constantly surprised;
• Graefe's symptom: when the eye moves, the outer eyelid lags, which is associated with increased tone of the muscles responsible for this movement. On closer observation, stripes of sclera can be seen;
• Moebius symptom: the convergence of the eyeballs is impaired, the patient cannot fix his gaze on close objects, this is due to the increased tone of the oblique muscles, which is higher than that of the rectus muscles;
• Kocher's sign: the eyelid moves down or up, towards one of the ends of the orbit, during which the sclera can be seen exposed. This symptom, depending on the severity, can occur completely unnoticed or expose the cornea;
• Jellinek's symptom: the skin on the eyelids darkens and becomes stained;
• Brown's symptom: the eye does not narrow when laughing;
• Ekroth's sign: noticeable swelling upper eyelid;
• Wilder's sign: during movement eyeball twitches, makes noticeable stops;
• Patients with bulging eyes may have problems with tear production. In the process, due to the inability to close your eyes, inflammation of the cornea begins.

In severe or even medium degree eye damage, the patient begins to see double, and visual acuity rapidly decreases. At the same time, these symptoms do not always appear; even in the most severely ill patients they may be absent, so the disease cannot be assessed solely on their basis.

Features of exophthalmos

Perhaps no other symptoms of thyrotoxicosis occur as often as exophthalmos. The exact reasons for its development are currently unknown; scientists have only a number of hypotheses.

Possible causes of eye symptoms

Based on animal experiments, it was found that extracts of the anterior pituitary gland administered to a subject caused not only hyperthyroidism, but also exophthalmos.

Unfortunately, clinical observations It was not possible to establish an exact correspondence: with diffuse toxic goiter, TSH hypersecretion always occurs, but exophthalmos occurs only in isolated cases. Latest Research allow us to suspect that the reason lies in some “exophthalmic factor,” a substance associated with TSH, but so far unknown to science.

In some cases, exophthalmos in patients turns out to be one-sided. This is one of the proofs of the fact that bulging eyes are far from completely determined by the exophthalmic factor.

Scientists believe that the overwhelming role in this case is played by the vegetative nervous system, which was also confirmed experimentally.

Using animals as an example, researchers have found that exophthalmos occurs when the cervical sympathetic nerves are irritated in animals. In this case, the immediate cause of the disease becomes:

• increase in tone oculomotor muscles;
• increase in the volume of retrobulbar tissue;
• connective tissue and fat;
• the pressure rises sharply, stagnation and swelling are observed in the eyelids.

The autoimmune theory states that the cause lies in thyroglobulin, which turns into an antigen. Proponents of another theory suggest that the cause is a violation of the outflow of lymph into thyroid gland. The exact reason has not yet been established.

Development and complications of Gefen eye syndrome

Quite often, euthyroid exophthalmos is family character. As a consequence, many relatives also develop thyrotoxicosis as a result. What is characteristic is that the disease itself in this case is not necessarily accompanied by other symptoms, especially weight loss. On the contrary, in isolated cases there was weight gain.

Experts believe that the reason for this lies in the simultaneous damage to diencephalic formations.

Histological studies show infiltration by plasma cells and macrophages, as well as edema. Over time, swelling appears in muscle fibers. There is also a loss of striations and homogenization, accompanied by an increase in size up to tenfold.

The degree of development and speed of the disease can vary widely. IN in the rarest cases development turns out to be lightning fast, in some cases it can drag on for several years. Other symptoms include:

• pain behind the eyes;
• increased tearfulness;
• sensation as if sand and the like were in the eyes.

During the process, it swells first upper eyelid. Swelling of the lower one occurs only when it is severe, and then the changes also affect the temples and eyebrows.

Among the symptoms of mucosal hyperemia, one should also highlight an increase in swelling, which leads to chymosis and ectropion of the lower eyelid. Over time and the development of thyrotoxicosis, the mucous membrane gradually dries out and ulcers form on it. The frequency of exophthalmos in thyrotoxicosis can reach values ​​from 10 to 40%.

Treatment of eye symptoms of thyrotoxicosis

Prevention and treatment of Graefe's symptom in thyrotoxicosis, as well as others eye symptoms most often pathogenetic.

Prevention is surgical treatment thyrotoxicosis. There are a number of important nuances here:

• If there are signs of exophthalmos, then large doses of imidazole-based medications are prohibited from the very beginning. Otherwise, there is a risk of exophthalmic factor and increased TSH secretion;
• Once a euthyroid state is achieved, doctors prescribe treatment with thyroid hormones. In this case, it is necessary to carefully monitor the pulse rate, which should not cross the physiological limit of 100 beats;
• in the process of development of exophthalmos as mucopolysaccharides accumulate in the retrobulbar space, gamma therapy and glucocorticosteroids are often used.

Regression of exophthalmos in thyrotoxicosis may not occur. Most often this is due to the advanced stage of the disease. Too much connective tissue and fat manages to accumulate in the retro-orbital space. In this case conservative treatment will not show adequate effectiveness and all that will remain is an operation during which orbital decompression will be performed.

The thyroid gland is small, but very important organ a person on whose work many processes depend. Its main function is the production of hormones that promote metabolism in the body. If their quantity exceeds the norm, the metabolization processes are sharply accelerated, and symptoms of thyrotoxicosis appear. In 75% of people, this condition develops against the background diffuse goiter. Familiarize yourself with the pathogenesis of thyrotoxicosis, causes, and main symptoms in children and adults.

If a person easy stage, i.e. subclinical thyrotoxicosis, it occurs without obvious clinical symptoms. In moderate and severe forms, you can see characteristic external signs: enlarged palpebral fissure, bulging eyes, hyperpigmentation of the eyelids. In addition, there are internal symptoms syndrome: hypertension, elevated temperature, rapid pulse, tachycardia. Nervous system disorders, weakness, sleep disturbances, and noticeable surges in T3 and T4 hormones often occur. Due to the loss of protein and vitamin deficiency in thyrotoxicosis, vitamin deficiency occurs.

Nodules in the thyroid gland

Small lesions often go unnoticed because they are not accompanied by pain or other symptoms. Nodules in thyrotoxicosis are altered tissue of the thyroid gland, often forming along its edges. If there are several neoplasms, multinodular toxic goiter or a non-toxic form of thyrotoxicosis is diagnosed. If the seals have big sizes, a person feels a lump in his throat. Multiple neoplasms in thyrotoxicosis are usually benign.

Thyromegaly

This is a very common pathology, characterized by an excessive increase in size of the organ - it is visible to the naked eye and can be palpated. More accurate results are visible on ultrasound. How enlarged the organ is is determined using special tables. In women, the volume may vary depending on the cycle and the presence/absence of pregnancy, but in normal conditions it should not exceed 25 ml. For men, the size is stable and should also not be more than 25 ml.

If you do nothing, glandular tissue nodes are formed that can induce the appearance cancer cells. As the thyroid gland enlarges, the following signs of thyrotoxicosis appear:

• soreness when palpated;
• thickening of the neck;
• the formation of a huge “collar”;
• dyspnea;
• dry cough;
• compression of surrounding organs;
• feeling of heaviness in the chest.

Increased TSH

We are talking about increasing the thyroid-stimulating hormone of the pituitary gland. With hypothyroidism, little T3 and T4 are produced, and to normalize their amounts in the body, the synthesis of thyrotropin increases. Biochemical analysis blood shows a high titer of antibodies to TSH receptors. If a patient is diagnosed with a diffuse-toxic or nodular goiter, then free T3 is increased.

How to reduce TSH with thyrotoxicosis? Its amount will decrease as soon as the concentration of thyroid hormones reaches normal level. To compensate for the deficiency of T3 and T4, only medications are prescribed. These can be “Eutirox”, “L-thyroxine”. To prevent an excess of synthetic drugs, hormonal tests need to be carried out periodically.

Eye symptoms of thyrotoxicosis

If you look at photos of people suffering from autoimmune syndrome, you might think that they are scared or shocked by something. This expression on their face is given by the characteristic symptoms of thyrotoxicosis syndrome:

Wide eye opening.

The eyeballs protrude (exophthalmos).

The upper eyelid is swollen.

When the eye drops, the upper eyelid lags behind. Graefe's symptom in thyrotoxicosis occurs due to increased muscle tone.

When closed, the eyelids tremble.

Thyrotoxic ophthalmopathy (characterized by swelling of the conjunctiva, eyelids, lacrimation, bulging eyes, pain, pain, feeling of sand).

Rare flashing.

When you quickly change your gaze, areas of the sclera are exposed (Kocher syndrome).

Arterial hypertension

It is characterized by a stable increase in blood pressure, which is sometimes not accompanied by any symptoms. Sometimes a person experiences dizziness, pain, and a sensation of spots flashing before the eyes. Because of this disorder, the kidneys, heart, brain, blood vessels suffer, heart attacks, strokes, visual impairment and other complications are possible.

Other signs of Graves' disease

One of clinical manifestations thyroiditis – damage to the cardiovascular system as a result of excess thyroid hormones. Violations manifest themselves in the form of rapid heartbeat, extrasystole, high pulse pressure. Older people often develop heart failure. Manifest thyrotoxicosis is additionally characterized by increased tone of the sympathetic nervous system, impaired microcirculation, and increased glycolysis.

Another symptom of thyrotoxicosis is dysfunction gastrointestinal tract. The signs are pronounced and are often paid attention to when diagnosing the syndrome. When thyrotoxicosis relapses, symptoms reappear. Patients complain of:

• attacks of pain;
• mushy frequent stools, diarrhea;
• loss of appetite;
• vomiting;
• increased or decreased acidity.

Often with thyrotoxicosis, especially in moderate and severe forms of the syndrome, the liver suffers. The organ greatly increases in size, jaundice appears varying intensity. Studies show functional liver failure. If a person experiences fatty diarrhea, this may indicate severe defeat pancreas.

Features of symptoms of increased thyroid function

Thyrotoxicosis has some genital and age characteristics. It mainly affects women from 20 to 50 years old. This is due to the fact that they often have a violation of the relationship between the functions of the hypothalamic-pituitary system and the gonads. Read more about other features of the symptoms of thyrotoxicosis in women, men and children.

Among women

Symptoms of the syndrome in women:

• irregular menstrual cycle;
• severe pain in the lower abdomen (especially in nulliparous women);
• general weakness;
• nausea, vomiting;
• “cotton” legs;
• fainting;
• increased hair loss.

Signs such as weakness, drowsiness, nausea are nonspecific and are characteristic of both thyrotoxicosis and the period of pregnancy. Before prescribing treatment, it is recommended to study hormone levels in women at risk. If you do not take thyreostatics during thyrotoxicosis, the prognosis is unfavorable - a destructive form develops in the future. Important: thyrotoxicosis during pregnancy is not a contraindication for continuing pregnancy.

In men

Thyrotoxicosis in men is accompanied by enlarged mammary glands, emotional instability, and loss of concentration. Characteristic symptom– decreased potency, which can result in infertility. With thyrotoxicosis, the size of the thyroid gland in men rarely exceeds grade 3. Endocrine ophthalmopathy is often observed. Compared to women, men have rare cases of tachycardia.

In children

Hyperthyroidism in children is rare and usually develops with early age due to disturbances in the functioning of the thyroid gland. At puberty, complaints from the nervous system are noted: sleep disturbances, increased excitability, low performance. In addition, the disease is characterized excessive sweating, tremors of hands, eyelids, tongue, headaches. One of permanent signs thyrotoxicosis – tachycardia.

Even with increased appetite Children are losing weight before our eyes. They often suffer from diarrhea and dyspeptic disorders. Eye symptoms are present, but they are not as severe as in adults. One of distinctive manifestations syndrome in children exceeding actual growth rates. In most children, the thyroid gland is diffusely enlarged.

Find out what are the signs of heart failure in men.

Video about the symptoms of diffuse toxic goiter

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on individual characteristics specific patient.

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EYE SYMPTOMS OF DIFFUSE TOXIC GOITER arise as a result of complex neurohormonal disorders, the mechanism of which is not fully disclosed. They usually appear with diffuse toxic goiter.

Ocular symptoms of diffuse toxic goiter (GSDT3) mainly consist of exophthalmos and are associated with impaired conjugal movements of the eyeballs (Mobius sign) and facial muscles caused by myasthenia of the facial muscles and extraocular muscles, damage to the nuclei oculomotor nerves.

• Of the many GS DT3 takes the leading place Exophthalmos(E).

There are a number of hypotheses explaining the reasons for its development, but none of them is able to reveal the entire mechanism of this process. It has been experimentally established that extracts of the anterior lobe of the pituitary gland, in particular TSH, administered to an animal, in addition to hyperthyroidism, cause exophthalmos. However, clinical observations show that with diffuse toxic goiter, when hypersecretion of TSH occurs in almost all cases, exophthalmos is observed in a few. It is known that in hypothyroidism, TSH secretion increases significantly, but exophthalmos does not develop. Research recent years showed that the factor causing exophthalmos is not TSH itself, but a substance found with it, called "exophthalmic factor". It is assumed that this factor is not produced to the same extent in all patients with thyrotoxicosis.

In practice it is often observed unilateral exophthalmos. This fact indicates that bulging eyes are not completely determined by the exophthalmic factor. In all likelihood, the autonomic nervous system, in particular the sympathetic, plays a certain role in this, which has been confirmed experimentally: when the cervical sympathetic nerves are irritated, exophthalmos occurs in animals. The immediate cause of exophthalmos is an increase in the tone of the extensors of the oculomotor muscles, an increase in the volume of retrobulbar tissue, in particular, acidic mucopolysaccharides (increasing the hydrophilicity of tissues), fat and connective tissue. It leads to sharp increase intraorbital pressure, to stagnation in the eyelids and their swelling.

There are a number of other theories.
For example, according to autoimmune theory, thyroglobulin can become an antigen and, coming into contact with thyroidin together with B-lymphocytes , is fixed on the cell membranes of the extracular muscles, causing their damage with the subsequent development of edema of the retrobulbar tissues.

Exophthalmos is explained and violation of lymphatic drainage in the thyroid gland, which is followed by lymphostasis and swelling of the extraocular and retrabulbar tissues. Along with swelling of the retrabulbar and intrabulbar tissue, the tone of the oculomotor nerves and muscles is disrupted, which leads to disruption of conjugate movements of the eyeballs. Often observed in individuals who do not suffer from thyrotoxicosis.

There is evidence that with the so-called euthyroid exophthalmos the content of thyroid hormones in the blood, in particular T3, is increased, but without tachycardia and weight loss. It is assumed that exophthalmos is caused by hyperthyroidism, however, the sensitivity of peripheral receptors to them is reduced, and the receptors eye muscles, on the contrary, increased.
Euthyroid exophthalmos often runs in families, and it is not uncommon for individual family members to develop thyrotoxicosis. At the same time, thyrotoxicosis in such individuals is not necessarily accompanied by weight loss; sometimes there is even some obesity, which is most likely due to simultaneous damage to diencephalic formations.

Histologically, edema and cellular infiltration of the retroorbital tissue with lymphocytes, macrophages and plasma cells are initially noted.
Subsequently, the muscle fibers experience swelling, loss of transverse striations, homogenization with an increase in their size up to 10 times with an increase in their contractility.

The speed and degree of development of exophthalmos varies widely from several weeks to a year. Rarely does the development of exophthalmos occur at lightning speed.
Subjective symptoms of exophthalmos are lacrimation, pain behind the eyes, when moving the eyeballs unpleasant feeling sensations of “sand in the eyes”, especially with strained vision, rarely diplopia.
Initially, the upper eyelid swells, and with a pronounced degree, the lower eyelid, temple area, and eyebrow swell. Hyperemia of the mucous membrane causes swelling to progress and leads to chymosis, an edematous shaft is formed around the cornea, and inversion of the lower eyelid. The mucous membrane becomes dry and ulcerated. The frequency of exophthalmos in thyrotoxicosis ranges from 10 to 40%. The degree of protrusion of the eyeballs is determined by an exophthalmometer.

According to its severity, exophthalmos is divided into four degrees:

• 1st degree (light form) - moderate exophthalmos with mild dysfunction of the extraocular muscles. Eye protrusion 15.9+0.2 mm.
• 2nd degree (moderate severity) - moderate exophthalmos with mild dysfunction of the extraocular muscles and mild changes in the conjunctiva. Eye protrusion 17.9+0.2 mm.
• 3rd degree(severe form) - severe exophthalmos with impaired eyelid closure. Pronounced changes in the conjunctiva and the function of the extraocular muscles, mild damage to the cornea, initial symptoms of optic nerve atrophy. Eye protrusion 22.8±1.1 mm.
• 4th degree(extremely severe form) - pronounced manifestation of the above symptoms with the threat of loss of vision and eyes. Protrusion more than 24 mm.

In addition to exophthalmos, a number of eye symptoms characteristic of thyrotoxicosis have been described:

• Abadi symptom (1842-1932, France) - spasms of the muscles that lift the eyelid.
• Ballet symptom (1888) - partial or complete immobility of one or more external muscles of the eye without damage to the internal muscles.
• Burke's symptom - expansion and pulsation of retinal vessels.
• Bella symptom - deviation of the eye upward and outward with active closing of the palpebral fissure.
• Boston symptom (1871 - 1931, American doctor) - jerky, uneven lag of the upper eyelid when moving the gaze down.
• Botkin's symptom (1850) - fleeting widening of the palpebral fissures when fixing the gaze.
• Brahma symptom. During laughter, the eyes remain wide open, but in healthy people the palpebral fissures narrow significantly.
• Govena's symptom - jerky constriction of the pupil of one eye when the other is illuminated.
• Goldziger's symptom - hyperemia of the conjunctiva.
• Graefe symptom (1823-1870, German ophthalmologist). The patient is asked to follow with his gaze the finger that the examiner moves in front of his eyes (at a distance of 30 - 40 cm) from top to bottom, and with the other hand the doctor supports the patient’s head so that he cannot move it. With a positive symptom, the upper eyelid is delayed and does not keep up with the downward movement of the eyeball. As a result, a strip of conjunctiva opens between the upper eyelid and the limbus of the cornea. This symptom is the result increased tone muscle that lifts the upper eyelid.
• Griffth's symptom - lag of the lower eyelid when looking closely at an object located at eye level.
• Dalrymple's symptom (1804 - 1852, Scottish ophthalmologist). When vision is fixed on an object located at the level of the pupils, the palpebral fissures open wide. At the same time, areas of the sclera that are normally covered by the upper and lower eyelids are revealed. Caused by paresis of the circular muscles of the eyelids.
• Gifford's symptom (1906, Britain). Due to thickening and increased muscle tone, the upper eyelid turns out with great difficulty.
• Jellinek's symptom (1187, Austrian doctor) - pigmentation of the skin of the eyelids. Considered a sign of adrenal insufficiency.
• Geoffroy's symptom (1844-1908, French doctor). When looking up, wrinkles do not form on the forehead: asthenia of the frontal muscles.
• Zatlera symptom - weak squinting.
• Zenger-Entrout symptom - pillow-shaped swelling of the eyelids.
• Ibn Sina symptom - retroocular resistance with exophthalmos.
• Knisa symptom - anisocoria.
• Cowan's symptom - vibration of the pupils.
• Kocher's symptom (1841 -1917, Swiss surgeon). The patient follows the finger of the person being examined, moving it in front of his gaze from bottom to top. With a positive symptom, the sclera, normally located under the upper eyelid, is exposed and becomes visible. The symptom is caused by a faster displacement of the upper eyelid than the eyeball, due to an increase in its tone.
• Levi's symptom. Dilation of the pupil when the conjunctiva is exposed to a weak solution of adrenaline.
• Mobius symptom (1880). When the finger is quickly moved from the lateral side to the middle, the eyeball does not keep up with the movement of the finger and transient strabismus occurs. Convergence disorder is caused by weakness of the rectus intrinsic muscles of the eye.
• Mina symptom - delay of the eyeballs behind the movement of the eyelids during stare.
• Nisa symptom - uneven pupil dilation.
• Popovasymptom (USSR) - spasmodic movement of the upper eyelid when looking from top to bottom.
• Reprev-Melikhov symptom (USSR) - characterized by the angry look of patients.
• Rosenbach's symptom (1851-1907, German, doctor) - trembling of the eyelids when they close.
• Snellensymptom (1834-1908. Dutch ophthalmologist) - a buzzing sound heard with a phonendoscope over eyes closed. Characteristic of thyrotoxic exophthalmos.
• Spector's symptom - soreness of the points of attachment of the oblique muscles to the sclera with initial exophthalmos.
• Stasinsky symptom - injection of the cornea in the form of a red cross.
• Topolyansky's symptom (USSR) - hyperemia of the conjunctiva in the form of a “red cross”.
• Wilder's symptom. If the eyeball is in a state of extreme abduction and begins to move towards the center, its displacement occurs in steps, with stops.
• Stellvaga symptom (1869, Austrian ophthalmologist) - retraction of the upper eyelid in combination with rare blinking due to decreased sensitivity of the cornea.
• Ekrot's symptom - swelling of the upper eyelid.
• Jaffe symptom - the inability to wrinkle the forehead, as with Geoffroy’s symptom, is due to a decrease in the tone of the frontal muscles.

Not all ocular symptoms of thyrotoxic goiter are detected in the same patients with thyrotoxicosis; they are more common symptoms Gre fe, Kocher, Dalrymple, associated with dysfunction of the upper eyelid, Jaffe symptoms And Geoffroy, symptomatic We Rosenbach, Shtelvag, associated with neurogenic factors, and, finally, Mobius, Wilder, caused by ocular convergence disorder.

TREATMENT OF EYE SYMPTOMS OF THYROTOXICOSIS.

Treatment of eye symptoms is mainly pathogenetic.
Prevention of exophthalmos involves timely treatment thyrotoxicosis.

• If there are signs of exophthalmos, large doses of drugs should not be used from the very beginning. imidazole, which can lead to hypersecretion of TSH, an exophthalmic factor.
• In the future, when reaching a euthyroid state, you should long time assign thyroid hormones (T 4, Tz) in such a way that the pulse rate does not cross the physiological boundaries - 100 beats per minute.
• During the development of exophthalmos, when mucopolysaccharides accumulate in the retrobulbar space, good therapeutic effect provide glucocorticosteroids And gamma therapy (6000 rad) hypothalamic-pituitary region from three fields, as well as retro-orbital with simultaneous administration in large doses With thyroid hormones up to 40-80 mg per day or by administration hydrocortisone into the orbital space for 10-12 days, 30-40 mg daily in each orbit.

Regression of exophthalmos often does not occur in cases where it has been for a long time, during which a lot of fat and connective tissue accumulate in the retro-orbital space. In these cases, conservative treatment is not effective. An operation has been proposed - decompression of the orbit by expanding it in three spatial directions.