Struma, or goiter, is a pathological enlargement of the thyroid gland due to the growth of its tissues. This condition is not a separate disease, but refers to the symptoms of various ailments. They are united by the fact that they are all connected with the thyroid gland. With further growth, it takes gigantic dimensions, which leads to squeezing of neighboring organs and tissues. Against this background, a violation of the hormonal function of the gland. In order to prevent the development of complications, it is necessary to study in more detail the causes of the development of goiter, methods of its diagnosis and treatment.
What is a goiter of the thyroid gland
The metabolism in the human body is controlled by the thyroid gland. If you have problems with this organ, irritability, drowsiness, fatigue, and mood swings arise. Problems with the gland are more relevant for women of mature age, but they are also found in men. One of them is goiter. It is an enlargement of the thyroid gland. Pathology develops due to iodine deficiency in the body. Women suffer from it 5 times more often. Strum consists of a set of fibrous scars formed in the tissues of the thyroid gland.
The most common type of goiter is endemic. It develops due to a lack of food and water of iodine, as a result of which an insufficient amount of this microelement enters the body. The list of other causes can be divided into 2 groups: hypothyroidism, hyperthyroidism. The first disease develops as a result of a decrease in hormone production due to:
- genetic disorders in the treatment of hormones by the endocrine gland (cretinism),
- the use of strumogenic products, such as cassava,
- taking certain medications.
Hypothyroidism is characterized by hair loss, dry and pale skin, decreased appetite, brittle nails. The opposite disease is hyperthyroidism. With it, thyroid hormones are produced in excess. Strum in case of hyperthyroidism can cause:
- oncology of the thyroid gland,
- Graves disease.
The pathogenesis of malignant and benign endocrine gland tumors has not yet been precisely studied. Medicine only determines that, as a result of the action of unfavorable factors, the cells of an organ begin to divide uncontrollably. As a result, their number increases and a tumor is formed. In this process, thyroid-stimulating hormone and some substances that lead to gene mutations are involved. To the list of causes of goiter can also add:
- bad ecology,
- hereditary predisposition
- deterioration of the internal organs after 50 years,
- chronic diseases
- pituitary adenoma,
- thyroid tuberculosis,
- puberty in adolescence,
- hormonal abnormalities during pregnancy and menopause,
- stagnation of lymph or blood
- bad habits,
- psycho-emotional overload.
The peculiarity of the pathology is that at an early stage it may be asymptomatic. Only over time, the front part of the neck begins to bulge and bulge in the area of the Adam's apple. This occurs when the node reaches 1-2 cm. When the gland is felt on the front surface of the neck, seal areas are felt. Normally, the organ is elastic and uniform. As it progresses, the tumor begins to squeeze the adjacent organs. As a consequence, the following symptoms appear:
- discomfort in the heart,
- fighting cough
- difficulty swallowing
Goiter with excessive and insufficient production of thyroid hormones is accompanied by various symptoms.Against the background of the development of hypothyroidism, the patient complains of:
- daytime sleepiness and sleep disturbance at night,
- decrease in sexual desire
- low body temperature
- failure of the menstrual cycle
- a sharp increase in body weight
When hypothyroidism can often disturb SARS, colds, pneumonia, bronchitis. In patients with hyperthyroidism, i.e. excessive hormonal activity, there is a different clinical picture. Symptoms with an excess of hormones are as follows:
- tachycardia more than 100 beats per minute for no apparent reason
- protrusion of the eyeballs
- constant arousal
- hand tremor
- weight loss with the same appetite,
- fever without symptoms of an infectious disease.,
- sweat palms.
When lifting the patient's hands, blueing and puffiness of the face, dizziness or fainting may be observed. Growing nodes begin to compress the esophagus and trachea, which surround the thyroid gland. This causes a number of characteristic symptoms, such as:
- difficulty breathing
- voice change
- asthma attacks
For women with struma, the development of hypotension is characteristic - low blood pressure. In the heart area there is a feeling of constriction. As the pathology develops, shortness of breath, drowsiness, nausea, abdominal distention, and a decrease in craving for the usual food join. At later stages, memory problems appear, body weight increases, and weakness appears. A characteristic symptom for women is irregular menstruation, which can result in miscarriage or infertility.
Types of thyroid goiter
According to the place of origin goiter is divided into endemic and sporadic. The first is observed only in areas where food and water do not contain enough iodine. These include India, Brazil and some regions of Egypt, USA, Switzerland, Russia. Sporadic species does not depend on the area of residence. Struma has several more classifications. The next sign to highlight its species is its location. According to him goiter is:
- Ring-shaped. Covers the trachea in a ring.
- Dystopic Affects the root of the tongue or additional thyroid lobe.
- Partially located behind the sternum. Some of the goiter may descend here.
- Standard located. Covers only the lobes of the thyroid gland.
The name “goiter” is taken from the designation in birds of their expanded esophagus. At them it serves as a sedimentation tank for food. Just outwardly, the birds goiter also looks enlarged. This is observed in humans with this pathology. Depending on the morphology of the goiter is:
- Diffuse. Nodes in this form are absent. Pathology is a uniformly and uniformly enlarged tissue.
- Knotted. Presented by enlarged gland sites. Nodular goiter is characterized by an uneven proliferation of tissues and is noted more often with benign hyperplasia and cancer.
- Cystic. Like the previous form, it causes a non-uniform increase in tissue, but this process occurs due to colloidal formations inside the thyroid itself.
- Mixed. In this form, there are changes characteristic of different types of goiter. Mixed goiter of the thyroid gland is more likely to occur with Grave's disease.
According to another classification, several degrees of development of the struma are distinguished. They are determined depending on the results of palpation of the thyroid gland. The following degrees of its increase are distinguished:
- Zero. On its background, the size of the body is normal, there is no goiter.
- The first. An increase is observed in one or both lobes of the thyroid gland. Visually, changes are not observed. They can only be detected by palpation.
- The second. An increase in the organ is visible to the naked eye even in the case of the physiological location of the neck. Abnormalities can be detected during palpation.
Based on the analysis of case histories of patients with goiter, experts were able to identify several possible complications. Most of them develop as a result of mechanical effects of the tumor on the surrounding tissues and organs, including the trachea, blood vessels, nerve fibers, and internal organs. As complications can occur:
- spilled form of bronchitis,
- dry cough,
- circulatory disorder,
- full aphonia
- malignant tumors
- thyroid cancer,
- tumor hemorrhage,
- strumites - inflammatory processes in the thyroid gland,
- common sepsis.
First of all, the doctor examines the patient's neck in order to probe the area of the thyroid gland and determine the extent of its damage. After palpation, in case of suspected the presence of goiter, additional laboratory and instrumental examinations are prescribed. The list of required procedures includes:
- Blood test for hormone levels. Check the ratio of hormones TSH, T3, T4 and thyroglobulin. When struma there is a violation of their balance.
- Analysis of urine. Identifies the beginning of the development of pathological changes. Abnormalities in thyroid activity are indicated by increased iodine excretion rates. The analysis is sensitive to food containing iodine, so the change is prescribed for the morning time and spend on an empty stomach.
- Fine needle aspiration biopsy. This procedure precedes the treatment of nodular goiter. It is optional and helps determine which tumor is benign or malignant.
- Electrocardiogram. Detects cardiac abnormalities that are characteristic of hypothyroidism.
- Chest X-ray. Pre-esophagus contrasted. The procedure itself is indicated for patients with multiple nodes or a large jet.
- Ultrasound. Instrumental method that helps to establish the form of the development of pathology - diffuse, nodal, mixed.
- Computed and magnetic resonance imaging. Needed in severe cases and suspected cancer.
How to treat goiter
There are different methods of dealing with this problem. The main method is hormone replacement therapy. Its basic principles are as follows:
- It is necessary to eliminate the deficiency of thyroid hormones.
- The average course duration is at least one year. Treatment ends when the normal size of the thyroid gland returns.
- Further therapy consists of taking iodine preparations that support the work of the organ.
Treatment of multinodular goiter of the thyroid gland with its benign hyperplasia and hyperthyroidism is carried out only at a normal level in the blood of thyroid hormone. In this case, it is possible to use drugs of radioactive iodine or other methods of therapy. If the level of thyroid hormone is not normal, then first take the means to reduce its production. With malignant tumors resort to surgical treatment. After surgery, they also take hormones throughout their lives.
Depending on the cause and nature of the pathology, drugs from different groups are prescribed. At the time of their reception, the state of the gland is constantly observed in dynamics. When hypo-and hyperfunction using certain drugs. In the first case, these are funds that are aimed at increasing the hormones produced: Levothyroxine, Tireote. When hyperthyroidism, on the contrary, use drugs that block excessive secretion of hormones: Mercazolil, Propylthiouracil.
Additionally, patients are prescribed products containing iodine, for example, Iodtirox. Before taking certain medications should study them in more detail. The list of frequently used tools includes:
- Levothyroxine. Based on levothyroxine sodium. Additionally it contains talc, magnesium stearate, milk sugar, kollidon, calcium phosphate. The drug is a thyroid hormone indicated for replacement therapy.It is used in hypothyroidism, after resection, in autoimmune thyroiditis, Graves disease. The dose is 50-100 mcg. Dale pass on maintenance therapy - 125-250 mcg. The drug is contraindicated in hyperfunction of the thyroid gland, cardiovascular diseases, diabetes, malabsorption syndrome, adrenal insufficiency. After taking the pill, itching and rash on the skin, thyrotoxicosis, brain pseudotumor may occur. Plus Levothyroxine is approved for use during pregnancy, so it can be included in the treatment of thyroid goiter in women during this period.
- Mercazolil. Contains tiamazol - a substance that blocks peroxidase. It is an enzyme involved in thyronin iodization in thyroid tissue. Mercazolil interferes with the synthesis of hormones, therefore it has an antithyroid effect. Indications for use: diffuse struma, thyrotoxicosis, radioiodine therapy, nodular goiter. It is necessary to take the medicine after meals 5 mg 3-4 times every day. After remission after 1-1.5 months after 5-10 days, the dose is reduced by 5-10 mg. Contraindications include lactation, granulocytopenia, severe leukopenia, pregnancy, severe liver pathology. Among the side effects are allergies, thrombocytopenia, aplastic anemia, urticaria, drug fever, periarteritis, vomiting, kidney function disorder. Advantages of Mercazolil: elimination of tachycardia, normalization of hormonal levels.
- Yodtirox. Contains levothyroxine sodium and potassium iodide. The action consists in replenishing the thyroid hormone deficiency, increasing the basal metabolism, replenishing the iodine deficiency in the body. Iodtirox is indicated in the case of hypothyroidism, prevention of recurrent stroma. The initial dose is 0.5 tablets daily. The drug is not used for thyrotoxicosis, acute myocardial infarction, autonomic thyroid adenomas, Düring herpetipical dermatitis, individual hypersensitivity to iodine. Side effects are only allergies, which is considered a plus Yodtiroksa.
An important condition for the success of therapy is the observance of a special diet. With thyrotoxicosis, it is aimed at restoring metabolic disturbances and covering energy costs. With diffuse goiter, an increased caloric intake is required by increasing the amount of proteins, carbohydrates and fats. The focus of the diet is on the use of permitted foods and the exclusion of harmful ones. The latter include:
- simple carbohydrates, including pasta, honey, jam, sweets, white flour cakes, pastries),
- animal fats - dairy products, semi-finished meat products, pies, sausages,
If thyroid function decreases, the diet should include fewer calories and fat. This is necessary for weight loss, because with hypothyroidism it increases. Against the background of hyperthyroidism, a dietary intake with an increase in calories is necessary, but in the afternoon you should not prefer fatty foods. In general, nutrition involves:
- the use of large quantities of fruits and vegetables, necessarily - figs,
- switch to seafood (sea bass, salmon, saury, tuna, mussels, shrimp),
- use in the diet of sea kale,
- frequent meals of lean beef and eggs,
- an increase in the diet of dairy products,
- frequent use of fatty fish.
This is a modern method of treating struma, shown when its volume exceeds 40 ml. The procedure helps to destroy the tumor cells. This occurs as a result of the decay of radioiodine in the human body to xenon and radioactive gamma and beta radiation. Each has certain properties:
- Beta-radiation is limited by the depth of penetration, therefore it acts only within the thyroid.
- Gamma particles reveal the localization of metastases.
The effect of radioiodine therapy appears after 2-3 months. The method is similar to surgical removal of the thyroid gland.Iodine isotopes are introduced into the body in the form of gelatin capsules. Their patient is given in the hospital. Then they wait for the radiation to reach the level of the established norm. After that, the patient is sent home. Thyroid gland cells accumulate iodine and die. This method is also used after removal of the thyroid gland to prevent recurrence of the disease. Advantages of radioiodine therapy:
- health safety
- no stitches after surgery and pain,
- good alternative to surgery.
This is the name given to the treatment with leeches, which produce particular active substances. They help the body to adapt to the changing conditions of internal and external factors. Hirudotherapy is an alternative to hormone treatment. Medical leeches fill the endocrine gap, regulate hemostasis and the immune system. The result is normal physiological hormone production. Other benefits of hirudotherapy:
- lowering blood pressure
- improving systemic and capillary blood flow,
- pain relief
- sucking thrombus,
- anti-inflammatory effect
- Improving the nutrition of tissues with oxygen.
Each leech is used once. After the procedure, they are destroyed to prevent the risk of transmission between patients. The course of hirudotherapy is 10 sessions. Leeches set at certain points on the type of acupuncture. Although this method is effective, it has a number of contraindications, including:
- malignant process
- age up to 7 years
- hemorrhagic diathesis,
- leech allergy,
- the period after cesarean
The main indication for surgery is the ineffectiveness of conservative therapy. The list of specific cases in which thyroid surgery is necessary includes:
- frequent relapses with constant medical treatment,
- node size more than 3 cm
- squeezing of adjacent tissues and organs
- neck deformation
- abnormal cells detected by biopsy.
Before the operation, preparation is carried out for 1-3 months. At this time, normalize the level of hormones with medication. Against this background, the patient is prescribed to follow a diet that includes more protein foods and vitamins. The operation itself is performed under general anesthesia. The patient is removed large nodes or areas of potential danger. If the case is neglected, the doctor resects one of the thyroid lobes.
If the operation was successful, the patient will be discharged home a week later. The first couple of days you need to take only liquid food. To prevent complications, exercise therapy and breathing exercises are recommended. As for the hormonal background, then after surgery it is important to quickly restore it. It happens like this:
- After some time, the patient is tested.
- Most have a decrease in thyroid activity.
- To restore the hormonal background, the patient is prescribed life-long replacement therapy.
- Calcium supplements are also prescribed, because the thyroid function of calcitonin is reduced.
- Twice a year, the patient undergoes ultrasound and donates blood for hormones again.
Self-medication only folk remedies is unacceptable. Alternative medicine can only act as an auxiliary method while taking medicine. In addition, you should consult with your doctor about the prescriptions used. This is due to the fact that without research the patient cannot determine how the hormonal system functions. Most popular methods involve the use of prepared means inside.
For the treatment of many diseases used bee products. Their use for the thyroid is due to the composition. A popular combination is honey and walnuts, which insist on alcohol. This remedy is washed down with a glass of milk to help iodine absorption.Honey can be mixed with juice of 10 lemons and 10 minced garlic cloves. Means from them accept 10 days of insisting. The course of treatment should last 8 weeks.
Useful is and beeswax. It contains chitosan, antioxidants, heparin. The first substance is especially necessary for the thyroid gland. It activates the activity of the body, inhibits the growth of neoplasms in it. As a result, thyroid functions are restored, slags and radioactive substances are removed, which helps to reduce the size of the stream. The bee primor is effective regardless of the presence of iodine deficiency. Use this product according to the following recipes:
- Take 30 g of dead bees, chop them into mush. Next, pour half a liter of water and bring to a boil. The tool must be braised on low heat for half an hour. Next, the broth is allowed to cool, filtered and sent for storage in the refrigerator. There he can stay no more than 14 days. To receive daily take a tablespoon of broth. It is better to take before bedtime. The course lasts 21 days.
- For a glass of bee Podmore, take 2 times more good quality vodka. Mix everything, pour into a dark bottle. Insist about 2-4 weeks. Shake the bottle once every three days. Take tincture on a tablespoon regardless of the use of food. The procedure can be carried out for 3 months.
Hawthorn herb reduces the manifestations of thyrotoxicosis and hyperthyroidism. This plant helps to strengthen the thyroid gland. Hawthorn is used in the form of decoctions and infusions. The herb is used in recipes and in conjunction with other plants. As an example of this tool, you can use the following recipe:
- Take 30 g of valerian, 20 g of mint, 50 g of hawthorn fruit, 25 g of motherwort.
- Grind all vegetable raw materials, grind to a state of homogeneous slurry.
- Mix, put in a container that is stored in the refrigerator.
- To prepare the broth, pour 25 g of raw material with boiling water and leave for half an hour, wrapping it with a towel.
- Next, strain the tool with a small strainer.
- Divide the liquid into 2 portions, consume them throughout the day.
The use of this plant is practiced in the nodular form of the stream. In the spring, you can simply eat 2 leaves of celandine daily. When there is no fresh raw material, you should use the recipe for infusion. It will require celandine and vodka or alcohol. The tool is prepared according to the following instructions:
- Take a sterilized liter jar.
- Fill it with half crushed celandine.
- Top down fill the can with vodka.
- Infuse for 2 weeks, periodically shaking the container.
- Take the first day 2 drops, diluted in 50 ml of water.
- Next, add 4 drops already. Then daily increase their number by 2 to reach the level of 16 drops.
- Keep the final dose for a month.
- Next, take a 10-day break.
- Repeat the treatment course, starting right away with 16 drops.
Grass can also be used topically. To do this, the juice of celandine smears the surface of the neck or make compresses with it. Another recipe for this plant:
- Skip the leaves of celandine through the meat grinder.
- Through a double cheesecloth squeeze juice from the resulting mass.
- Pour it into the bottle, close the lid.
- Leave for a week in a dark place. Periodically release gas from the bottle.
- Take the juice for 15 minutes before a meal at 0.5 cups a course of 2 months.
What is goiter?
Goiter is an enlargement of the thyroid gland. In itself, the name "goiter" is taken from the designation of the region of the enlarged esophagus in birds. It is also called goiter and is a kind of settler for food.
Such a disease is most common in countries where there is an iodine deficiency (however, it can also be caused by a high iodine content while taking iodine preparations). Women are prone to this disease 5 times more often than men.The knots formed are nothing but a multitude of fibrous scars that are formed in the tissues of the thyroid gland.
The thyroid gland (thyroid gland) is a center for controlling the metabolism in the human body. She is often called a health guard, so she behaves accordingly if a person has any problems with her: irritability, mood swings, fatigue and drowsiness are possible.
Thyroid problems are more common in women in adulthood, but for men this problem is quite relevant.
The thyroid gland is one of the most important organs of our body. Despite its scanty size and weight (about 20 grams), it is truly a generator of vital energy. No wonder doctors call it a "working bee." The thyroid gland produces thyroxine, triiodothyronine, and these are exactly the substances without which the body’s production of the necessary energy is almost impossible. Moreover, this energy is directed to the work of all human systems and organs.
The thyroid gland also regulates heart activity, brain activity, muscle tone ("muscle armor"). This is the guardian of health. In women, hormonal adjustment takes place with age - before and after the onset of menopause. Therefore, the thyroid gland is very sensitive during this period, quickly responding to stress, weakening of the immune system, infection, deficiency or excess of iodine. Due to the fact that pathological activation of antibodies occurs that counteracts healthy cells, with age, the woman's body is more exposed to autoimmune diseases. These antibodies reduce thyroid function. As a result, weakness, memory deterioration, swelling, weight gain, dry skin, brittle hair, muscle aches and cramps, and constipation are observed.
Video: Live great! What is diffuse toxic goiter?
All over the world endemic goiter should be considered the most common. It is caused by a deficiency of iodine in food. In countries where iodized salt is used, the goiter Hashimoto is most often formed, the alternative name of which is autoimmune thyroiditis.
Other reasons can be divided into two conditional blocks:
Genetic disorders in the treatment of endocrine gland hormones (for example, cretinism),
Use as a meal of strumogenic products, for example, cassava,
Side effects after the use of drugs.
Symptoms of hypothyroidism - hair loss, dry and pale skin, brittle nails, thinning eyebrows, loss of appetite, weight gain. In diseases of the thyroid gland, speech slows down, memory deteriorates, almost constant drowsiness appears, the menstrual cycle is lost. It does not necessarily have all these symptoms, usually two or three, but they are expressed more clearly.
Diffuse toxic goiter, known as Graves' Disease,
Thyroiditis (active inflammatory processes),
Hyperthyroidism is an increased hormone production by the thyroid gland. The satellites of this disease are insomnia, general weakness, irritability, rapid heartbeat, excessive sweating. Suffering from this disease may have a good appetite, but at the same time lose weight. In addition to all this - high blood pressure, an increase in the eyeballs, trembling in the hands (tremor).
Classification of thyroid diseases
It is possible to classify diseases of the thyroid gland by a variety of signs, the first of which is etipathogenetic. It determines the factors and mechanisms of formation. According to this trait, endemic (characteristic only for a certain type of terrain) and sporadic goiter are distinguished. The first is observed in geographical areas endemic in the goiter, and the second, respectively, in all the others.
According to morphology, diffuse, nodular and mixed (diffuse-nodular) goiter are distinguished. By location:
Partially located behind the sternum,
Dystopian, consisting of embryonic type of bookmarks (for example, goiter of the root system of the tongue or an additional thyroid lobe).
Also goiter is distinguished by the degree of increase. According to the WHO (World Health Organization) classification, it is possible to distinguish three types:
At the first stage there is no increase, at the second - the goiter may be palpated, but it is not visible at the usual position of the neck, and at the third - it is not only groped, but also visible with the naked eye.
A more detailed classification by magnification was proposed by O.V. Nikolayev, in accordance with her, the disease goes through the following stages without the necessary treatment:
First degree - the thyroid gland is palpable,
The second - the thyroid gland is visible,
The third - a significant thickening of the neck,
The fourth - a change in the shape of the cervical spine,
Fifth - a huge goiter.
Symptoms of thyroid goiter
At the initial stages, patients may not notice even the slightest manifestations of goiter. The formation of this disease over time provokes an obvious bulging or swelling of the neck in its front part (in the area of the Adam's apple). The enlarged endocrine gland also begins to put pressure on the trachea, nerve endings and blood-type vessels, which are located nearby. Diffuse goiter, visually, is identified by a uniform increase in the thyroid. If we talk about the nodal varieties, then, more often, it is much stronger on one side of the larynx. That is, in this case not only uneven, but also non-uniform increase is expressed.
Impacts on those organs that are located nearby may have the following signs:
A rapidly progressive change of voice, accompanied by hoarseness,
Asthma attacks at night,
Difficulty swallowing food
Dizziness, severe heaviness in the head.
With the presented neoplasm, which is accompanied by hypothyroidism, an atypical form of pneumonia, bronchitis or ARVI can be formed. In addition, most often in women, there is hypotension, painful and just unpleasant sensations, similar to constriction, in the region of the heart. All this as the progression of the disease is aggravated by shortness of breath, a decrease in the usual craving for any food, bloating, nausea and drowsiness. At the final stages, memory deteriorates and weight increases, despite all problems with the gastrointestinal tract.
The male sex on the soil is not enough ratio of iodine in the blood is a decrease in sexual desire, destabilization of sexual function. For women, such changes as menstrual irregularities are characteristic, which, in turn, turns out to be a catalyst for infertility and miscarriages.
With varieties of goiter, such as Bazedov disease or benign thyroid hyperplasia, symptoms such as:
Decreased total body weight
Protrusion of the eyeballs
Progressive tremor in the upper limbs.
Video: first symptoms of thyroid problems that should not be ignored:
Causes of goiter
Factors that directly affect the formation of goiter should be considered in more detail. This results from the fact that damages of an endocrine gland, as well as their reasons, can be the most different.
As noted earlier, the main cause provoking the emergence of endemic toxic goiter is iodine deficiency in the body. Its insufficient quantity is explained by the absence of the compound represented in specific territories. This is the reason that causes a decrease in the secretory degree of activity.
In addition, some of the negative effects on her work are due to the poor ecology of the environment. Thus, substances of toxic origin, which are in the human body from the outside, are able to suppress the functioning of the endocrine system and slow down the degree of activity of the thyroid gland.
An endemic goiter can also form with relatively little use of products, in the list of components of which iodine is included. We are talking about fish, fruits and milk.
In the event of the occurrence of Grave's disease, or toxic goiter of diffuse origin, the endocrine gland is affected by specific antibodies. They are produced by the human body and are an integral part of immune protection on their own tissues. In this case we are talking about the structure of the thyroid gland.
If we note the most important factors in the development of a nodular goiter, then it is necessary to single out:
Endocrine gland adenoma,
Neoplasms of oncological origin.
With such lesions, there is a progressive violation of the process of cell division, as well as their differentiation. This can be triggered by a radiological background, toxic substances from a toxic point of view, and also be of a genetic nature.
Goiter in children
Separately, you need to talk about goiter in children, because it is the most common iodine deficiency disorder. In most cases, a diffuse form of the disease is formed.
According to WHO research, over the past 10 years, the incidence of goiter in childhood has increased by 6% and is equal to at least a quarter of children's endocrinological diseases combined. Such high rates are associated with improper nutrition, as well as unfavorable environment. In 30% of cases, goitre in childhood was diagnosed after 14 years and beyond.
The characteristic signs of goiter are associated with a more intense degree of severity. In addition, only in children the disease is often complicated by the formation of specific endemic cretinism. This form is characterized by a delay of not only intellectual, but also physical development, as well as disorders of the central nervous system.
Test to determine the level of iodine in the body
There are three most accurate and easily implemented test for determining the ratio of iodine in the body:
Test 1. The first of these is as follows: you need to take the standard (3 or 5% iodine). With it, you need to draw a grid on your own body - preferably in the evening, when physical activity will be completed. Special attention should be paid to the lower abdomen, as well as the hips. After the absolute drying of iodine should go to bed. So, if in the morning it turned out that the grid had “gone” at least by half, then the iodine content in the body is obviously insufficient. If the shade of the grid lasted more than 12 and even more than 24 hours, then it means that there is some surplus of iodine, which should also be fought.
Test 2. The second test is as follows - it is necessary to dip a cotton swab in a solution of alcohol-type iodine. After that, apply iodine containing a grid to any area of the body, in addition to the endocrine gland itself. On the next day you should carefully consider this place. If no trace of iodine is left, it means that the body needs it, but if, on the contrary, the picture remains, there is no shortage.
Test 3. And finally, the third, much more accurate testing. For its implementation, before going to bed, apply three strips of iodine solution to the skin in the forearm area. This should be done consistently: first, a thin line, then a little thicker, and then the most thick. If in the morning it was found that the first line disappeared, it means that everything is normal with the iodine ratio.
If the first two are not visible, then you should pay close attention to your health. In the same case, if there is not a single strip left, it is possible to talk about an obvious iodine deficiency. What are the treatments for goiter endocrine gland?
Timely recognition of symptoms will be the key to successful treatment, which will help in the shortest possible time to cope with the disease. So, when there are signs of an increase in goiter, you need to contact an endocrinologist. Appealing to him is very important, because any other specialists can simply refer to overwork.
The main method of treatment of goiter should be considered hormone replacement therapy. For this purpose, a variety of active derivatives of tyrosine are used. This is explained by the fact that they are characterized by the physiological parameters of those hormones that are produced by the endocrine gland. It is extremely important to choose not just an adequate dosage of the drug, but also one that will not lead to negative results. Treatment, the periodic use of drugs, very often must continue until the end of life. It is recommended not to forget about controlling the ratio of hormones.
Hypofunction of the thyroid gland is also amenable to adjustment due to hormonal therapy. Much more complicated is the hyperfunction. So, if there is a real danger of the formation of a tumor of any origin or complications of the cardiovascular type, then there is a sense to resort to surgical intervention (it will be described later). This will change the situation for thyroid hypofunction. In turn, this will enable easier and more accessible adjustments due to hormonal therapy.
In a more severe form of hypofunction of the endocrine gland, a person may fall into a coma. Hyperfunction is also characteristic of the fact that a toxic crisis can be fatal. In this regard, it is necessary to adhere to a strict diet and the receipt of the necessary ratio of iodine in the body. In this case, the unconditional is the need to consult a specialist and testing for the amount of iodine in the body. After all, as you know, a large amount of iodine also adversely affects the thyroid gland.
Operation and Radioactive Iodine
Surgical intervention on this organ is extremely difficult, because the endocrine gland contains a significant number of blood vessels. This makes the operation much more problematic. However, in some cases, it is indispensable, therefore, surgery for goiter is one of the most commonly used methods of treatment.
Thus, local anesthesia is administered and large nodal or potentially dangerous areas are removed. In the most difficult and neglected cases, one of the thyroid lobes can be removed. This, in turn, can also trigger hypo-or hyperthyroidism. However, even with resection of one or several nodes, there is a need for medical recovery.
An alternative treatment for the thyroid gland is to use radioactive iodine. This solution is used to destroy endocrine gland tissue. To find the optimal dosage is extremely difficult. For this, additional groups of analyzes are also conducted. At the same time, in the first year, hypothyroidism begins to form in 25% of people. However, radioactive iodine is a unique tool, which has no analogues to date. What are the preventive methods for goiter detection?
Goiter prevention can be carried out in three variants and be mass, group and individual. The most effective is the first method, for its implementation in those products that one person consumes in one way or another, add a small amount of iodine. We are talking about the usual cooking, but iodized salt.
The advantages of this method are that such a product is very inexpensive, but the effect of this effect is obvious. According to the WHO, as a result of such prevention, the formation of goiter is reduced by 20% every year.Other products are used for prophylactic mass iodization, for example, bread or water.
Prevention of goiter according to the group type implies the use of drugs in which iodine is found by persons in the risk category for a similar diagnosis. These are, first of all, children and teenagers who are in such institutions as kindergartens and schools.
The physiologically closest means are potassium iodide, which is available in a wide variety of dosages and is used according to a specific algorithm. Foods that contain iodine can also be used for such prophylaxis.
A separate category of risk group in relation to the formation of goiter are women who are at any gestational age. They have the highest need for this component - 200 micrograms per day. In this regard, it is necessary to carry out individual prevention. In addition, even at the planning stage of pregnancy, the future woman is recommended identification of thyroid status.
Prevention of goiter on an individual type also implies the use of drugs with iodine. The required dose is determined individually and depending on the age category. Without a preliminary visit by an endocrinologist, such prevention is undesirable for people who have a history of endocrine gland problems.
Many people believe that the need for iodine per day will be compensated by a special diet that contains some products. However, this is not 100% true, because to compensate for the already established deficit, significant changes in diet are necessary. Secondly, such changes are quite expensive. In addition, the use of iodine simply must be strictly dosed. After all, any fluctuations: from oversupply to deficiency are fraught with significant problems with the endocrine gland and health in general.
Thus, endocrine gland goiter is one of the most common health problems. This condition is practically not amenable to absolute cure, because it requires constant prevention and use of iodine. That is what will help to maintain optimal livelihoods and health.
Education: Diploma RSMU them. N. I. Pirogov, specialty "General Medicine" (2004). Residency at the Moscow State University of Medicine and Dentistry, diploma in "Endocrinology" (2006).
What is goiter and its varieties
Triiodothyronine (T3) and thyroxine (T4) basically have 3 or 4 (hence the numbers in the title) of iodine atom. With a deficiency of this element, the thyroid gland produces less hormones, and this affects primarily the central nervous system, a person feels weak, tired, or with an excess of them, on the contrary, irritability.
All organs suffer from imbalance, as the metabolism is disturbed. The thyroid gland itself suffers, and the result is the formation of nodules in it or its increase in size.
Goiter is an enlargement of the thyroid gland due to pathological changes occurring in it, the formation of tumors or nodes. This is a disease that affects all aspects of life.
There may be many reasons for the increase in thyroid gland and the formation of goiter, and depending on them there are different types of this pathology.
So, geographically, goiter can be:
- Endemic, when an enlargement of the thyroid occurs, which is characteristic only for a certain locality.
- Sporadic - this is all other species that occur regardless of geographic location.
The enlargement of the thyroid gland is divided according to the classification of Nikolaev on the degree:
- First degree: iron is felt on palpation.
- Second degree: you can see an enlarged thyroid gland.
- Third degree: significant neck thickening.
- Fourth: change the shape of the cervical spine.
- The fifth degree involves a huge goiter.
When considering the structure of the thyroid gland secrete:
When classifying goiter by location on the neck, there are:
- standard goiter, covering only thyroid lobes,
- ring-shaped, ringing trachea,
- dystopic, exciting root of the tongue or additional thyroid lobe.
In addition, a goiter can be benign when it grows very slowly, and is malignant.
Test for the presence of iodine in the body. In the evening you need to apply (with a cotton swab) alcoholic iodine solution 3 bands: the thinnest, medium and thick. Let them dry and then go to bed. If after 12 hours a thin band disappears - this is the norm, if two disappear - a preventive iodine intake is needed. With the disappearance of all three bands should immediately go to the doctor: your body iodine is not enough.
Symptoms of thyroid enlargement
At the first degree of goiter, the symptoms are washed away, and the patient attributes them to overwork or slight indisposition. These manifestations are associated with hyperthyroidism, in which hormone production increases significantly, or hypofunction, when the body suffers from a lack of T3 and T4.
Among the first symptoms are observed:
- irritability or, conversely, lethargy,
- constant fatigue, dizziness, heaviness in the head,
- constriction of breathing, his difficulty
- voice changes, hoarseness, hoarseness,
- cough, dry and scratching throat,
- suffocation at night
- difficulty swallowing food.
Tip! When these symptoms occur, you need to contact an endocrinologist, since the therapist may attribute them to other diseases.
The most effective treatment of the initial stage of goiter is recognized, and it is very difficult to detect it. Therefore, it is important to carefully consider their own health and the health of loved ones.
The iodine net applied to the skin is clearly visible after 24 hours - this means that there is an excess of iodine in the body. An appeal to an endocrinologist is necessary: too much iodine is as harmful as its deficiency.
Features of the manifestation of the disease in men and women
Goiter in women is 5 times more common than in men. Climacteric women are most susceptible to this disease.
Among the symptoms of goiter in women, there is more often a decrease in pressure, weakness, and rapid fatigue. Goiter is characterized by frequent acute respiratory viral infections, bronchitis, pneumonia, there is a feeling of constriction in the region of the heart, chest pain.
At the second degree of an increase in the thyroid gland, shortness of breath appears, later the appetite disappears, drowsiness arises, and digestive disorders and abdominal discomfort torment. Women are characterized by menstrual irregularities, miscarriages, infertility.
The 4th and 5th stages of goiter are characterized by symptoms such as weight gain and memory impairment.
Council Individual prophylaxis with iodine-containing preparations is carried out only after consulting an endocrinologist.
In men, sexual desire decreases to the full impotence.
Other symptoms characteristic of enlargement of the thyroid gland are manifested in men as well as in women.
The presence of goiter 3 degrees adversely affects the ability to become pregnant. In this case, it is impossible.
Pregnancy and iodine deficiency
Among all population groups, pregnant women need the most iodine. They need 200 mg per day. T4 deficiency due to iodine-poor diet in the first trimester of pregnancy can lead to the development of congenital fetal defects.
Medical monitoring of the functioning of the thyroid gland, the production of hormones during this period is very strict. It is necessary that the pregnant woman received the right amount of iodine with food or with additional treatment.
What is dangerous iodine deficiency for children
The occurrence of endemic goiter in children, and today it is about 25% of all childhood diseases of the endocrine system, entails the development of endemic cretinism. For adults, this is uncharacteristic, and in children, goiter is accompanied by growth retardation, physical and intellectual development.
The most common form of goiter in children is diffuse goiter.
Why does goiter appear?
Scientists believe the main cause of the formation of goiter is a lack of iodine in the body. The deficiency of this element occurs when a small amount of iodine-containing products in the diet. In many geographic regions in the soil of iodine is not enough, therefore, it is small in the water.
Another reason for the formation of goiter is heavy metal poisoning (diffuse goiter), as well as a number of other factors of poor ecology.
Among the causes of nodular goiter formation are:
- genetic predisposition
- pituitary tumors,
- thyroid adenoma,
- oncologic neoplasms.
Thyroid goiter treatment involves several options:
- With an insignificant increase in the thyroid gland, when hormone production is slightly reduced, hormone replacement medication is administered. Such therapy is used for life after surgery to remove the lobe of the thyroid gland, or after therapy with radioactive iodine. In fact, treatment with hormonal drugs is the main treatment for goiter of the thyroid gland.
- Nodular goiter is treated surgically. There may be a resection of nodes or a damaged lobe, if one lobe is damaged by a diffuse goiter, it is also removed. This is a complex operation, since there are many blood vessels in the area of the thyroid gland.
If tumor resection is not possible, radioactive iodine treatment is performed. Today it is a unique procedure, there are no substitutes for it. In many cases, it leads to hypofunction of the gland, and then requires constant correction of hormonal levels with the help of medicines.
The hormones produced by the thyroid gland are involved in the most important biochemical processes in the body. Without them, the implementation of metabolism, the functioning of the nervous system. Disruption of the thyroid gland leads to the appearance of heart disease and other organs. Consequences of hormonal disruption is the breakdown of the reproductive system, the occurrence of cancer. One of the typical manifestations of functional failure is an increase in the volume of the organ and the appearance of goiter.
There are endemic and sporadic goiter.
Characteristic of geographic areas in which there is a shortage of iodine in water and food. The causes of the disease can be:
- contamination of natural water bodies with substances that prevent the absorption of iodine in the body (nitrates, chromium and calcium compounds),
- lack of water and food zinc, copper, selenium and other elements that contribute to the absorption of iodine and the formation of thyroid hormones,
- poor sanitary and hygienic conditions and unfavorable social conditions causing infectious diseases,
- the traditional predominance in food of foods with a high content of strumogenic substances that block iodine absorption by the thyroid gland, as well as a shortage in the diet of foods containing iodine (fish, fruit),
- congenital thyroid dysfunction.
Occurs in people living in areas where natural violations of iodine content is not observed. The causes of the emergence of diseases can be unfavorable ecology, abuse of hormonal and some other drugs, genetic predisposition to diseases of the thyroid gland.
Goiter can be triggered by emotional stress or physical overload.In addition, the sporadic goiter of the thyroid gland is formed during the development of diseases associated with the violation of the structure of its tissues (adenomas, tumors, tuberculosis). The cause of autoimmune thyroid abnormalities can be a congenital disorder of the immune system, as well as infection.
Goiter occurs in both children and adults of both sexes. In women, this pathology is much more common than in men, due to the fact that the hormones are unstable. The ratio of hormones they change repeatedly during the month. Sharp jumps in the level of various hormones occur during adulthood, during pregnancy, after childbirth, with the onset of menopause.
If iodine deficiency was observed in the mother during pregnancy, the child may develop a congenital goiter, and a lack of thyroid hormones T3 and T4 in the body is formed.
Note: In children, there is such a pathology as atrophy, or shrinkage of the thyroid gland. At the same time, the level of thyroid hormones is extremely low, as a result of which dementia (cretinism) develops.
Another reason for the formation of congenital goiter may be the appearance of a dermoid cyst on the neck (during the period of the formation of organs, a cavity is formed containing particles of germinal tissues: adipose, bone and hair).
Degrees of goiter development
The severity of symptoms distinguish the following degrees of pathology:
- increase in goiter unnoticed,
- external manifestations are absent, but an increase in the volume of the gland is found on palpation,
- goiter is visible to the naked eye, it is also detected by touch.
There are several types of pathology: diffuse goiter (with a uniform proliferation of thyroid tissue), nodular (with the formation of individual nodes) and mixed.
With the development of nodular goiter, neck thickening may be asymmetrical if it is formed only on the right or left lobe of the thyroid gland. But a two-way defeat is also possible.
Overgrown follicles of the thyroid gland can be dense in structure. But in most cases they are filled with a viscous liquid - a colloid (the so-called diffuse, nodular or mixed "colloid" is formed). This kind of pathology is the most innocuous, since it does not lead to malignant degeneration of cells.
By location are distinguished:
- normal goiter,
- partially over the sternum,
- located in the form of a ring.
Located in the area of the root of the tongue and the extra lobe of the thyroid goiter is called dystopic.
Symptoms of various types of pathology
Goiter symptoms appear after increasing its size, when it begins to put pressure on neighboring tissues. Metabolic disorders lead to fluid retention in the tissues and the occurrence of edema in the neck and sternum. Possible increase in body temperature. At the same time there are difficulties when breathing, swallowing, turning the head, a dry cough appears, the voice becomes hoarse. Pinching the blood vessels leads to dizziness.
Pathological conditions of the body, leading to the formation of thyroid goiter, are divided into the following types: hypothyroidism, hyperthyroidism and euthyroidism.
This is a condition that occurs due to insufficiently active production of thyroid hormones. At the same time, metabolic processes in the body slow down. As a result, a person becomes obese, puffy, there is mental and physical inhibition.
There are also symptoms such as weakness, chronic fatigue, drowsiness, constant desire to warm up. Observed dry skin, hair loss.
A characteristic symptom is apathy, low blood pressure, slow pulse, arrhythmia, and heart failure. There may be fainting. In women, the production of sex hormones is reduced, amenorrhea occurs.
An example of such a pathology is Hashimoto thyroiditis.The disease has an autoimmune nature. The cells that are supposed to produce hormones are destroyed by their own immune system.
Increased hormone production, abnormal acceleration of metabolism lead to a dramatic weight loss of a person and depletion of the nervous system. A similar condition occurs in such autoimmune diseases as “toxic goiter” (Basedow's disease), “Riedel's fibroplastic goiter”, as well as in benign tumors (thyroid adenomas). In hyperthyroidism, there is increased blood pressure, increased heart rate, irritability and agitation. A characteristic sign is hand shake. Patients complain of increased urination. Women have hot flashes (hot flashes, alternating with chills and sweating).
Basedow's disease - a dense lump arises in the neck. Eyeballs become convex by increasing their size. Blinking is extremely rare. Blindness due to damage to the optic nerve is possible.
Riedel's fibroplastic goiter. The destruction of cells by lymphocytes leads to the proliferation of the connective tissue of the thyroid gland and the formation of a very dense asymmetrically located fibrous goiter (it is called "iron").
Adenoma. Pathological growth of tissues occurs in a limited area, due to which a one-sided seal appears on the neck.
The growth of thyroid tissue does not affect the production of hormones, but its increase leads to the formation of nodes. This is a borderline condition; a subsequent decrease or increase in thyroid hormone levels may occur. Typical symptoms are the formation of outgrowths on the neck, uncontrolled weight gain, irritability, change in voice, feeling of a lump in the throat.
At the initial stage of goiter formation, iodomarin and potassium iodide preparations help to eliminate iodine deficiency.
With an excess of thyroid hormones in the body, therapy with thyreostatic drugs is suppressed, which suppress the production of thyroid hormones. Timazol, propylthiouracil are used.
With a shortage of hormones, L-thyroxin and eutirox, which are synthetic analogues of thyroid hormones, are prescribed. The dose of drugs is selected individually and is constantly adjusted in accordance with the results of blood tests for hormones (T3 and T4). Such drugs are taken for years, and sometimes for life.
One of them is the destruction of the tissues of the gland with the help of radioactive iodine. In this way, hormone production is reduced and hyperthyroidism is eliminated. The method is used in the treatment of thyrotoxicosis, diffuse toxic goiter and cancer.
The second method is the surgical removal of part or all of the thyroid. After surgery, life-long medication is necessary to maintain the level of thyroid hormones, as well as calcium in the body.
Goiter during pregnancy
The goiter of the thyroid gland in women during pregnancy leads to the appearance of serious complications of its course, affecting the development of the fetus and the process of delivery.
Lack of iodine leads to disruption of the formation of the placenta, which provides the body with oxygen and nutrients. The child may have dwarfism, deafness, mental retardation. He may be born dead.
Consequences for the very future mother may be hypertension, heart failure, the appearance of edema, premature birth due to detachment of the placenta, the appearance of uterine bleeding during and after childbirth.
When the goiter mild possible correction of hormone levels with drugs. In more complex cases, surgical removal of goiter is sometimes performed at the 14th week of pregnancy.If a moderate and severe form of the disease occurs, termination of pregnancy is recommended, since treatment with high thyroid hormones is extremely harmful for the development of the fetus.
Video: How thyroid affects the female reproductive system
Pathological changes in the tissues of the thyroid gland can trigger a change in hormonal levels. Grade 1 diffuse goiter is one of these conditions. If the disease is caught in the early stages, the therapy will be more successful, because the functions of the thyroid gland are not yet disturbed. The classification of this disease, the causes and methods of treatment are described in detail in the information below.
Hypertrophy of the thyroid gland is called the common term - goiter. Depending on the reasons activating its increase, we can talk about the risks for the patient. Despite the prevalence of such diseases, and in fact in the endocrinology of the goiter of the thyroid gland takes the "honorable" second place after diabetes, the nature of the origin is almost unknown.
Features of the disease:
- Women are more likely to get sick. On average, there are almost eight times more female patients than men.
- The appearance of goiter is attributed to autoimmune diseases.
- The age group of risk is from 30 to 50 years. Diagnosis in childhood and in the elderly is much less common.
- To provoke a disease can insufficient intake of iodine in the body, as well as its excess.
- There is a genetic predisposition of the appearance of thyroid abnormalities.
- Acquired goiter may occur with improper treatment and hormonal medications.
- Increasingly, there is an increase in endocrine system disorders due to congenital organ failure.
Despite such widespread prevalence, it is not serious to treat thyroid disease. The functions of all internal organs are impaired, which gradually appear more and more as the disease develops.
How goiter affects the functions of the systems:
- Endocrine disorders. Decrease or sharp weight gain, failure in the menstrual cycle in women. Men may experience decreased libido and potency problems.
- Nervously somatic manifestations. Chronic fatigue syndrome, decreased performance and problems with sleep - all this suggests possible problems with the thyroid gland. In the late stages of goiter, a tremor of the extremities, anxiety and disturbances in the central nervous system can be observed.
- Heart rhythm problems. Such problems begin with irregular tachycardia, gradually developing into heart failure.
- Ophthalmic disorders. Periorbital edema develops, leading to "swelling" of the eyeball (one of the characteristic signs in the later stages), as well as incomplete closure of the eyelids.
- Respiratory system. As the thyroid gland grows in size, breathing difficulties may occur, shortness of breath and pain when swallowing appear.
Goiter is a common name for various painful conditions in which the thyroid gland is abnormally enlarged, which is often well marked and causes considerable aesthetic inconvenience to a sick person. Pathology is often associated with a deficiency or excess of iodine.
Women are more susceptible to it, which is often associated with age-related hormonal changes (men get sick five times less often). When the goiter in the body, nodes are formed from fibrous tissue, in rare cases they can be malignant.
- in the world it is registered more often than other pathologies of the thyroid gland, which is caused by a deficiency of the necessary microelements for synthetic activity, the organ increases, trying to capture as much iodine from the blood as possible. In those countries where all the salt used is iodized, it is characteristic to diagnose autoimmune pathologies that are the cause. The main factors for thyroid enlargement are shown in the table below.
Table 1. Why goiter is formed:
|Title||The reasons||Characteristic signs of pathology|
|, inflammatory processes and cancerous tumors.||Sleep disturbance, arrhythmias, acceleration of the pulse, high blood pressure, fatigue, weakness, disturbance of the usual emotional background, irritability, increased sweating, weight loss (without reducing food intake), eye eyes, hand tremor.|
|Genetic pathologies (cretinism and others), an excess of strumogenic products (for example, cabbage slows down the absorption of iodine), the iatrogenic effect of certain medications.||Dermatological problems (dry skin and its derivatives, brittle nails and hair, thinning eyebrows), loss of appetite, but at the same time a person gains weight, fatigue, drowsiness, decreased mental activity, women have menstrual failures.|
Note. When hypothyroidism of the above symptoms, as a rule, there are only a few strongly pronounced (usually 2 or 3 characteristic signs).
The thyroid gland, in the presence of the causes indicated in Table 1, begins to increase in size, areas with diverse synthetic activity are formed in its functional tissue, which leads to the formation of nodes.
At the beginning of the formation of the pathogenesis in no way manifests itself. As the disease progresses, the thyroid gland begins to grow and bulge, with a noticeable characteristic protrusion in the neck area around the neck.
Goiter begins to compress the esophagus, trachea, nerve cords, which causes the appearance of specific signs:
- choking, shortness of breath,
- change in voice reproduction, hoarseness and hoarseness appear,
- a cough that is not associated with colds,
- difficulty in swallowing
- headaches, dizziness, heaviness in the head, which is associated with hypoxia due to the weakening of blood flow to the brain and incomplete filling of the lungs with inhaled air.
Note. If it is seen that the protrusion is formed uniformly, then it is most likely a diffuse goiter. With nodal forms on the one hand, the deformation will be greater.
If goiter is caused by insufficient synthetic activity of the thyroid gland, then the development of diseases of the upper and lower respiratory tract, such as bronchitis or pneumonia, is not excluded. The representatives of the weaker sex have a decrease in blood pressure, a feeling of rawness or pressure in the heart area, a delay in menstruation, and the risk of miscarriage or inability to become pregnant increases. In men, libido and potency decreases, and erection problems may occur.
Consider separately the symptoms of each type of goiter:
- Symptoms of toxic goiter of the thyroid gland which is diffusely associated with an excessive level of thyroid hormones in the blood, which is expressed in endocrine ophthalmatoma, tachycardia, increased blood pressure, palpitations in the throat or chest, increased heart rate, arrhythmia. Also, with DTZ, there is a sharp loss of weight, appetite increases, weakness, muscle wasting, there is a constant sensation of heat. Symptoms of thyrotoxic goiter also appear on the face - it has an angry or frightened appearance, swollen eyelids, conjunctivitis, decreased visual acuity, pain in the eyes. The skin is hot and wet, hair is brittle and strongly fall out.
In addition, with diffuse toxic goiter, anxiety and irritability, fussiness, mood swings, acceleration of thought processes, depression and insomnia are observed. With a more severe course of the disease, tremor occurs, speech and writing deteriorate, tendon reflexes increase. With an excess amount of thyroxin, calcium and phosphorus are washed out of the bones, which leads to the destruction of bone tissue and osteopenia, pain in the bones and deformation of the fingers like “drumsticks” appear.
The function of the gastrointestinal tract undergoes pain in the abdomen, diarrhea, nausea and vomiting, fatty degeneration of the liver.On the part of the reproductive system in women, the menstrual cycle is disturbed, fibrocystic mastopathy develops, fertility decreases, erectile dysfunction and gynecomastia are observed in men.
- Endemic goiter - symptoms are not associated with hormonal activity, since with endemic (diffuse non-toxic) goiter, the function of the thyroid gland does not change. The disease is manifested by weakness, headaches, chest discomfort. As the goiter grows, there is a feeling of squeezing around the neck, breathing and swallowing become difficult, shortness of breath, reflex coughs, and sore throat appear.
- Goiter Hashimoto - Symptoms may not appear for a long time. This autoimmune pathology eventually leads to the development of hypothyroidism, therefore, the symptoms depend not only on the enlarged thyroid, but also on its reduced function. As the disease progresses, weakness appears, it increases and changes the shape of the thyroid gland. There is a feeling of discomfort in the neck area, due to squeezing of the blood vessels and adjacent organs, shortness of breath is present, slight coughing, feeling of a lump in the throat, swallowing is disturbed. In addition, there is a decrease in memory, deteriorating skin condition, hair becomes more dull and brittle, abundantly fall out. The sexual inclination decreases, in men the potency is disturbed, in women there are malfunctions of the menstrual function. Also marked swelling of the face, and especially the eyelids, cheeks and mouth. Due to the disturbed metabolism a sharp weight gain occurs, chilliness is constantly felt, the tendency to constipation increases.
- Colloid goiter - no symptoms appear at all for quite a long time, especially if the nodules with a colloid are small. With further development of the disease, there is pressure in the neck area, it becomes difficult to swallow, a sore throat appears, breathing is disturbed, and the voice changes. If the goiter squeezes blood vessels or nerves, there is pain in the head and dizziness. If there are many nodes and their sizes are more than 1 cm, then the contours of the neck are deformed and the patient can feel the nodes with his own hands.
- Symptoms of mixed goiter they are manifested by a change in voice, asthma, difficulty in swallowing, a feeling of a lump in the throat and a sore throat, a feeling of heaviness in the head. In addition to these symptoms, others may be present, depending on whether the thyroid function is increased or decreased.
- Symptoms of nodular goiter of the thyroid gland non-toxic both single-node and multi-node mainly consist in manifestations, which causes increased due to the nodes of iron. Extremely rare non-toxic nodular goiter is accompanied by mild symptoms of hypothyroidism. There is difficulty in breathing and swallowing, a feeling of coma in the throat, sore throat, and a change in voice. Chilliness increases, a person becomes slower and more inhibited, the menstrual cycle in women is disturbed, and the libido in men decreases. The skin becomes drier, body temperature decreases, slight swelling is observed.
- Single-node or multi-node toxic goiter - the symptoms are almost identical. The only difference is the number of nodules in the thyroid gland. Most often, if a toxic nodular goiter occurs, the symptoms may not appear for a long time. With an increase in nodes, the contours of the neck are deformed, it becomes difficult to breathe and swallow food. In addition, irritability increases, capriciousness and apathy arise. Sharply reduced weight, quickened heart rate, arrhythmia appears. The condition of hair and nails also worsens, the skin becomes moist and hot. Important! If a multinodular goiter of the thyroid gland occurs, symptoms of endocrine ophthalmopathy are absent.
With nodular toxic goiter, an increase in sweating is observed, sleep is disturbed, appetite increases, and limb tremor can also be observed.
Reasons for education
The factors that negatively affect the activity of the thyroid gland can be very diverse.
The main ones are as follows:
- natural iodine deficiency,
- adverse environmental factors of the environment,
- disruptions in the endocrine system
- autoimmune processes
- toxin poisoning
- radiation exposure.
Important. The main reasons for the formation of nodular goiter are adenomas and thyroid cancer, when the cells divide intensively, which is a health risk. In this case, cancer pathologies are effectively treated (especially in the early stages), so do not delay the diagnosis, the price of which is not high.
This disease has an autoimmune nature and is caused by defects in the immune system.
Predisposing factors to the appearance of DTZ can be:
- burdened hereditary history,
- irradiation of the neck and / or head,
- infectious and inflammatory diseases,
- endocrine pathologies,
- frequent stressful situations
- injuries and diseases of the brain.
Colloid goiter occurs if the outflow of colloid from the follicles in the thyroid gland is disturbed.
Factors that can contribute to the development of colloid goiter include:
- insufficient intake of iodine in the body,
- age over 40 years
- burdened heredity
- radiation exposure
- toxic effects of various substances
- strong psychological trauma and stress
- frequent hypothermia and infectious diseases.
Mixed goiter is a disease in which the thyroid gland increases in size evenly, but with the formation of nodes in it.
Mixed goiter appears due to:
- genetic predisposition
- poor environmental conditions
- living in the endemic regions of the country
- the presence of chronic infections
- autoimmune processes in the body,
- insufficient intake of vitamins and minerals from food.
Nodular toxic goiter
With nodular toxic goiter in the receptor mechanism of the cellular structures of the nodes there is a sharp decrease in sensitivity to TSH.
Factors predisposing to this pathology can be:
- iodine deficiency in the body,
- mineral and vitamin deficiencies
- exposure to radiation,
- intoxication with various substances
- frequent exposure to stress.
The probability of a surgical intervention is not excluded. The traces of the operation, provided that modern technologies are used, are hardly noticeable, and the price of services is relatively low. The procedure is widely used in medical practice.
The indications for its conduct can be the following circumstances:
- detection of malignant neoplasm in the structure of thyroid tissues,
- the presence of large nodes or cysts,
- an intense increase in neoplasm for a short time,
- discomfort and pressure on adjacent tissues,
- aesthetic aspects of the problem.
The operation is carried out through a small incision in the neck or by opening the trachea zone in case of inaccessibility of the organ.
There are several options for further manipulation:
- knot removal - a modified part of the organ is cut,
- partial resection - removal of one lobe of the thyroid while maintaining the second half and the isthmus,
- thyroidectomy - complete removal of the thyroid and parathyroid glands, which is necessary when detecting malignant processes in the tissues.
In cystic goiter, a simpler solution to the problem is possible - by puncture, a colloid is pumped out of the cyst, without extensive invasive manipulations.
Consequences and risks
Since predominantly the pathology is benign in nature, it does not carry significant risks to the life of the patient. However, the problem cannot be ignored, since the proliferation of altered tissues will continue.Such a phenomenon is fraught with not only problems in aesthetic terms, which is important for women, but can also be harmful to health.
The increase in goiter occurs in several stages, which in medicine are divided into degrees from 0 to 5. The last stages are characterized by a significant increase in thyroid gland.
At this time, the body exerts significant pressure on adjacent tissues: vessels, nerve endings, esophagus and trachea, vocal cords. As a result, discomfort occurs, the voice changes, it becomes difficult to swallow, and asthma attacks become more frequent.
In addition, it is necessary to normalize the functioning of the body and restore the balance of hormones. In rare cases, it is possible that a benign neoplasm will degenerate into cancer.
It consists in informing the population about the likelihood of developing pathology, measures for its prevention and characteristic signs. It is considered the most effective to add microscopic doses of potassium iodide to the products of mass consumption, for example, to salt (typical packaging is presented in the photo), bread and mineral waters. The advantage of this approach is that the cost is low, and this (according to WHO) reduces the overall incidence by 20%.
Group goiter prevention
In this case, people at risk are shown using drugs containing potassium iodide. As a rule, this practice is common in educational institutions. Recommend to use similar medicines to children, adolescents and women (pregnant, in menopause and after menopause). Last it is important to confirm the identification of thyroid status.
Individual goiter prevention
Therapy is selected by the endocrinologist for each patient according to indications and needs.
As a rule, these are people:
- who are in the early stages of the disease,
- with a significant risk of their occurrence,
- have received counseling therapy.
Thyroid goiter is a frequent pathology in endocrinological practice. It is better to prevent the disease than to treat it. To finally get rid of it is quite a problematic task, so the importance of prevention in this case is difficult to overestimate.
It should be understood that it is not always possible to adjust the amount of iodine with the help of nutrition. Compensating for a pathological micronutrient deficiency (when diagnosing it) only with the help of a diet is expensive and not always possible, because it is thus difficult to observe the necessary dosages. It is better to use drugs and undergo regular check-ups with your doctor.
Examination plan for endemic goiter
Hello! Six months ago, I was examined for thyroid problems (there were complaints), I did an ultrasound and I donated blood for hormones. According to the results, the endocrinologist diagnosed me with an endemic goiter, said Jodomarin for 1-2 months to drink, and then come back for another examination. Then I did not get an appointment. Now I feel good, no complaints. I continue to take iodine preparations - as I understand it, this is the standard treatment for goiter: what tests to pass to me now, to make sure that the thyroid is all right.
Hello! Unfortunately, you did not specify the exact results of the initial survey. Nevertheless, to control the endocrine status, I would advise you to repeat the tests for TSH and T4 St., as well as undergo an ultrasound of the thyroid gland.
Analyzes at DTZ
For several months now I have noticed that the character has changed not for the better: everything irritates me, sometimes there are real flashes of rage. Often I can not fall asleep, scrolling through the thoughts of the event for the day. I also became very thin, my face was sharpened, my hands were shaking. What could it be? The wife says that this is due to the thyroid. How can I check?
Hello! Based on your complaints, you can assume that you have a diffuse toxic goiter: tests for this pathology must include determining the level of TSH, free T4 and antibodies to rTTG.
- a group of diseases of the thyroid gland, occurring with the development in it of voluminous nodules of different origin and morphology. A nodular goiter may be accompanied by a visible cosmetic defect in the neck, a feeling of compression of the neck, and symptoms of thyrotoxicosis.Diagnosis of nodular goiter is based on palpation, ultrasound of the thyroid gland, thyroid hormone indicators, fine-needle puncture biopsy, scintigraphy, x-ray of the esophagus, CT scan or MRI. Treatment of nodular goiter may include suppressive therapy with thyroid hormone drugs, radioactive iodine therapy, hemithyroidectomy or thyroidectomy.
Symptoms of nodular goiter
In most cases, nodular goiter has no clinical manifestations. Large nodules present themselves as a visible cosmetic defect in the neck - a noticeable thickening of its front surface. In a nodular goiter, the enlargement of the thyroid gland occurs predominantly asymmetrically.
As the nodes grow, they begin to squeeze the adjacent organs (esophagus, trachea, nerves and blood vessels), which is accompanied by the development of mechanical symptoms of the nodular goiter. The compression of the larynx and trachea is manifested by the sensation of a “lump” in the throat, constant hoarseness of the voice, increasing difficulty in breathing, prolonged dry cough, and attacks of breathlessness.
Compression of the esophagus leads to difficulty swallowing. Signs of compression of blood vessels may be dizziness, noise in the head, the development of the syndrome of the superior vena cava. Soreness in the area of the site may be associated with a rapid increase in its size, inflammatory processes or hemorrhage.
Usually, in case of a nodular goiter, the function of the thyroid gland is not disturbed, however, deviations towards hyperthyroidism or hypothyroidism can occur. With hypofunction of the thyroid gland, there is a tendency to bronchitis, pneumonia, SARS, pain in the heart, hypotension, drowsiness, depression, gastrointestinal disorders (nausea, loss of appetite, flatulence). Characterized by dry skin, hair loss, a decrease in body temperature. Against the background of hypothyroidism in children, growth and mental development can be observed, in women - menstrual disorders, spontaneous abortions, infertility, in men - decreased libido and potency.
Symptoms of thyrotoxicosis with nodular goiter are prolonged subfebrile condition, trembling hands, insomnia, irritability, constantly feeling hunger, weight loss, tachycardia, exophthalmos, etc.
Treatment of nodular goiter
The treatment of nodular goiter is approached differentially. It is believed that the special treatment of nodular colloidal proliferative goiter is not required. If the nodular goiter does not violate the function of the thyroid gland, is small in size, does not pose a threat of compression or a cosmetic problem, then with this form, the patient is under dynamic observation by an endocrinologist. A more active tactic is shown if the nodular goiter detects a tendency to progress rapidly. Treatment may include the following components:
- Drug therapy. When nodular goiter can be applied suppressive therapy with thyroid hormones, therapy with radioactive iodine, surgical treatment. Suppressive therapy with thyroid hormones (L-T4) is aimed at suppressing TSH secretion, which can lead to a decrease in the size of the nodules and the volume of the thyroid gland in diffuse goiter
Prognosis and prevention
In case of nodular colloid euthyroid goiter, the prognosis is favorable: the risk of developing compression syndrome and malignant transformation is very low. With functional autonomy of the thyroid gland, the prognosis is determined by the adequacy of the correction of hyperthyroidism. Malignant tumors of the thyroid gland have the worst prognostic prospects.
In order to prevent the development of an endemic nodular goiter, mass iodine prophylaxis (consumption of iodized salt) and individual iodine prophylaxis of people at risk (children, adolescents, pregnant and lactating women) is indicated, which consists in taking potassium iodide in accordance with age dosages.
Symptoms of thyroid goiter
Signs of goiter have their own characteristics, and the symptoms are often vague and misleading.
Consider several major manifestations of the disease:
- Changes the color of the skin. The skin becomes yellow, the shade is present on an ongoing basis, which causes discomfort.
- Ophthalmic manifestations are observed. This is a characteristic look, reminiscent of surprise. “Bulging eyes” is another characteristic sign of goiter. Often, patients with a similar diagnosis suffer from inflammatory eye diseases.
- The psycho-emotional state of a person is violated. There are problems with sleep, brings memory, frequent changes of mood change a person's behavior. If obsessive dreams worry for a certain time, then you should consult with an endocrinologist.
- Women may complain of cycle instability. That is, menstruation are long and abundant, or scanty and short.
- Weight problems. It is believed that metabolic disorders are accompanied by weight gain. But often patients complain that they cannot recover and rapidly lose weight. It is also worth considering as a sign of goiter.
- Symptoms may be associated with the work of the digestive system. With violations of metabolic processes in the body are concerned about constipation, pain in the stomach.
- The heart rhythm changes as well, and there are irregularities in the liver. Against the background of which irreversible changes in the body begin, atherosclerosis develops.
- Another manifestation of the disease is considered characteristic tremor of the limbs, eyelids. Often there is tremor of the whole body.
Specific symptoms associated with an increase in organ:
- feeling of suffocation
- pain in the neck and submandibular glands,
- trouble breathing, shortness of breath.
An increase in the size of the thyroid gland leads to the fact that the lobes of the organ squeeze the soft tissues, disrupting the vascular permeability. There is a feeling of suffocation, lack of air. Because of the pressure on the tissues and blood vessels pain. These symptoms are considered key at diagnosis.
Patients are also concerned that the changes have affected the appearance. The neck increased in size, asymmetry or deformation of this part of the body appeared.
By degree of increase
If the disease is not associated with disruption of the endocrine organs, then there is no non-specific symptoms. The patient notes only an increase in the front wall of the neck.
As the disease progresses, the following symptoms begin to bother:
- There is pain in the neck, lymph nodes in the submandibular region.
- When the goiter "grows", there are problems with breathing.
The body squeezes the esophagus, disrupts the process of swallowing food.
- In the process of breathing, a specific sound appears, changes can affect the voice.
If the thyroid gland acquires gigantic dimensions, then the front wall of the neck bulges, it deforms, is disturbed by pain, problems with breathing and swallowing. While eating, a feeling is created that a person chokes on food.
By functional activity
Disorders in the thyroid gland entails certain consequences, they are associated with the production of hormones.
Disruption of the enzyme production process is accompanied by functional problems. Such states have received the following classification:
- If the production of the hormone is not disturbed, then we are talking about euthyroidism, a condition in which the thyroid gland is functioning in a “normal mode”.
- Hypothyroidism is a condition in which there is an insufficient amount of enzymes produced. Moreover, the lack of hormones is persistent and can negatively affect the human condition.
- Thyrotoxicosis is a condition in which hyperfunction of the organ is observed. The condition has several forms of development and is often considered a consequence of the increase in thyroid size.
Pathogenesis (what is happening?) During goiter:
In any form of iodine deficiency, thyroid hormone deficiency occurs, which stimulates the pituitary gland through feedback. The level of TSH in the blood increases, the thyroid function is activated, its cell proliferation increases.
Increased thyroid volume provides greater uptake of iodine from the blood and increased synthesis of hormones. In this way, the exchange of iodine and thyroid hormones in the body can be restored.
Therefore, an adequate adaptation response to primary exogenous iodine deficiency can be realized by enhancing the function of the gland and / or increasing its size.
Indeed, in the foci of iodine deficiency in most people diffuse hyperplasia of the I – II degree thyroid occurs, and the seizure of iodine that enters the body increases to 40 .. .50%.
In cases where functional thyroid hyperplasia does not ensure the proper synthesis of thyroid hormones, a further increase in thyroid occurs - goiter occurs.
In the structure of diffuse hyperplasia of the thyroid gland, foci of enhanced proliferation (nodular goiter germ) may appear or the colloid compartment may be disturbed (colloid cysts are formed).
Other things being equal, women are more likely to have goiter, because they have more complex hormonal relationships, especially those related to pregnancy and lactation. By the way, during pregnancy, even in areas with a sufficient iodine content in nature, there is always a diffuse increase in the thyroid gland to II and even III.
Endemic goiter is a disease of the regional pathology that occurs in certain biogeochemical regions, which are characterized by primary or secondary iodine deficiency.
The main signs of endemic goiter:
- A disease that constantly affects a significant number of people in a given area.
- The disease affects children, women and men more or less evenly, including nodular goiter.
- In this area, there should be cases of chronic insufficiency of the thyroid function: micsedema, cretinism.
- In severe endemic goiter can occur in domestic animals.
The severity of the endemic focus of goiter is determined by the Lenz-Bauer index and the MG index. Kolomiytsevoy.
Lenz-Bauer index - the ratio of the frequency of goiter in men and women:
When the index is from 1: 1 to 1: 3 - severe endemic focus,
When the index is from 1: 3 to 1: 5 - endemic focus of moderate severity,
With the index 1: 5_ 8 - a light endemic focus.
Index MG Kolomiytseva: quotient from percentage
correlation of functional hyperplasia to true goiter:
If the index is up to 2 - a severe endemic focus,
When the index is from 2 to 4 - endemic focus of moderate severity,
With an index of more than 5-6, a light (weak) endemic focus.
Epidemic goiter is a rare form of goiter that occurs more often in areas with exogenous iodine deficiency as an epidemic outbreak among people of closed collectives (military units, orphanages, ITK camps). Epidemic outbreak can occur within 6_8 weeks, sometimes it develops over 2_3 years. In the overwhelming majority of cases, the cause of an epidemic goiter is intestinal infections, chronic toxic effects of various substances, unfavorable sanitary and hygienic conditions, severe hypovitaminosis, malnutrition and water supply.
Sporadic goiter develops in cases where endogenous iodine deficiency occurs, the causes of which are discussed above.
In accordance with the Swiss classification, there are five degrees of thyroid size.
0 - the thyroid gland is not visible and can not be felt
I- palpable isthmus thyroid, but thyroid is not visible
II - the thyroid is noticeable when swallowing, easily palpable
III - the thyroid gland is significantly enlarged, visible to the eye when viewed in the form of a "thick neck."
IV - pronounced goiter, deforming the neck, which destroys its configuration
V - giant goiter, squeezes the neck organs with breathing and swallowing.
In euthyroid goiter, patients note, as a rule, a cosmetic defect and a feeling of awkwardness when moving in the neck. Examination and palpation of the thyroid gland allows you to detect various forms of goiter.
In hypothyroid goiter, isolation is observed, a constant feeling of coldness, slowness of movements, increased drowsiness, decreased working ability, interest in life.
Objectively: patients answer questions at a slower pace, the skin is dry, sometimes scaly, there is swelling of the face, hands, feet, moderate bradycardia. On palpation of the thyroid gland most often found nodal or mixed forms of goiter.
In hyperthyroid goiter, the patients are agitated, vanity-loving, verbose, make a lot of complaints: irritability, tearfulness, unfair attitude from others, poor sleep, increased perspiration, and a sensation of elevated temperature. Despite the large number of complaints, the general condition, as a rule, does not suffer.
On examination, patients with asthenic physique are tender, moist skin. Reflexes somewhat elevated. Situational tachycardia, instability of mood is noted.
Other diseases of the group Diseases of the musculoskeletal system and connective tissue:
|Alcaptonuria and Ochronotic Arthropathy|
|Allergic (eosinophilic) granulomatous angiitis (Churg-Strauss syndrome)|
|Arthritis for chronic bowel disease (ulcerative colitis and Crohn's disease)|
|Arthropathy with hemochromatosis|
|Ankylosing spondylitis (ankylosing spondylitis)|
|Kawasaki disease (skin and glandular syndrome)|
|Hemorrhagic vasculitis (Schönlein – Genoch disease)|
|Giant cell arteritis|
|Hypertrophic pulmonary osteoarthropathy (Marie-Bamberger disease)|
|Diffuse (eosinophilic) fasciitis|
|Intermittent hydrarthrosis (intermittent dropsy of the joint)|
|Infectious (pyogenic) arthritis|
|Itsenko - Cushing's disease|
|Intervertebral osteochondrosis and spondylosis|
|Neuralgia of the spinal nerve|
|Thromboangiitis obliterans (Buerger’s disease)|
|Lung apex tumor|
|Acute infectious arthritis|
What is a goiter of the thyroid gland? What it is? If you give a general definition, it will be as follows: an increase in thyroid size, due to various processes. The name “goiter” appeared due to the analogy with the esophagus department in representatives of the birds, which tends to increase in size, since it acts as a store for the found food. It bears exactly that name. Below is detailed information about what is goiter, symptoms and treatment of this pathology.
This pathology is most common in areas poor in iodine, however, the appearance of goiter may be due to an excess of this trace element, due to improper or uncontrolled use of iodine-containing drugs as a treatment. By gender, the disease is more common among the fair sex - about 4 times. Nodes, which are responsible for the increase in the volume of the thyroid gland, are nothing but scar-fibrous changes that form in the structure of the thyroid tissue. A photo.
The thyroid gland is a very important part of the endocrine system. Substances produced by it - hormones - are involved in many processes occurring in the body, including the exchange.Therefore, any violations in its work quickly reflect on the state of the whole organism, which is first of all expressed in such manifestations as excessive irritability, sharp changes in mood, rapid tiredness, insomnia. The most common diseases of the thyroid gland in women appear after menopause, men of mature age are also at risk.
Having a fairly small size and weight (on average, 20 grams), the thyroid gland is a very important element in the system of maintaining a healthy state of the body. As mentioned above, the substances synthesized by it are involved in almost all metabolic processes - energy, fat, and so on.
Here you can add regulation of the heart muscle, the activity of brain activity, maintaining muscle tone and the like. The thyroid gland rightfully bears the title of "guardian of health." Hence the conclusion: any disease of the thyroid gland, including goiter, must be diagnosed in time and started its treatment in time, so that the consequences for the organism do not become irreversible due to these disorders of the thyroid function.
The most common goiter is considered to be an endemic species. It is characterized by a lack of iodine in food, due to the poverty of this surrounding microcell. If everything is in order with the condition of iodine-containing products, the autoimmune variety of goiter, namely goiter, caused by Hashimoto's thyroiditis, an autoimmune thyroid disease, is the most common. The remaining causes of the pathology under consideration are conditionally divided into the following two groups: hypothyroid states and hyperthyroid states of the thyroid gland.
Hypothyroid diseases include:
- Hereditary predisposition to the dysfunction of the hormone-synthesizing properties of the thyroid gland.
- Excess in the diet of so-called strumogennyh products (struma - Latin name of the thyroid gland), whose property is to prevent the production of thyroid hormones.
- Consequences of taking certain medications.
Symptomatology of such conditions includes the violation of the hair structure (their increased fragility and sometimes loss), a violation of the skin (excessive dryness and the acquisition of a pale yellow shade), fragility of the nail plates, lack of appetite, but at the same time sufficiently rapid weight gain. Hypothyroidism is also characterized by worsening of speech functions, impaired memory, constant daytime sleepiness against the background of nighttime insomnia. In women, the cycle of menstruation is disturbed, and in men, libido decreases. Moreover, the appearance of all the symptoms at once sufficiently rare, in most cases there is only two or three, but pronounced.
Hyperthyroid states of the thyroid gland are represented mainly by the following pathologies:
- toxic diffuse goiter, which is better known as Basedow's disease,
- various internal inflammations in the tissues of the thyroid gland (thyroiditis),
- tumors in the tissues of the thyroid gland (both malignant and benign),
The state of hyperthyroidism is characterized by hyperthyroidism, that is, the production of hormones above the norm. Symptoms are expressed by insomnia, general weakness, an abrupt change of mood and often an aggressive reaction to external stimuli, an abnormal heart rhythm, and increased perspiration. Possessing a normal or increased appetite, people suffering from such diseases often lose weight fairly quickly. Here you can add an increase in blood pressure, bulging eyeballs from the sockets, tremor of the lower and upper extremities.
Classification of goiter is carried out on several grounds. One of them is the mechanism of occurrence and the factors preceding it. In this case, endemic and sporadic goiter can be distinguished.In the first case, the pathology is due to the peculiarity of the patient's location (in this case, the low iodine content in the environment, food and water), in the second, the occurrence of goiter does not depend on the territorial location, that is, other factors caused it.
Another type of classification is morphological. On this basis, there are nodular goiter of the thyroid gland, diffuse, and their mixed form, called diffuse-nodular. In addition to the morphological differences, the goiter differs in the area of location: the usual location, partially retrosternal, ring-shaped and distal. The latter type is caused by the appearance of goiter root of the tongue or the pyramidal lobe of the thyroid gland.
All of the above are the forms and types of the goiter of the thyroid gland. Stages of development of pathology have their own "scale". Today, endocrinologists use two types of such classification, adopted by the World Health Organization (three degrees) and developed by the domestic endocrinologist Nikolayev (5 degrees), which is also called practical and is used only in Russia.
WHO classification implies three stages of goiter development: the first, the second and, accordingly, the third. The first stage is not characterized by any noticeable visual changes of the thyroid gland. When the second goiter is already felt on palpation, but is not visible at the normal position of the neck. But the third is caused by both palpation of the pathological state of the thyroid gland and its visibility with the naked eye.
Domestic endocrinologist Nikolaev OV In 1955, he proposed a more detailed classification, which practitioners began to use. This classification involves the passage of goiter in five stages, not counting zero, which means the absence of any changes in the thyroid gland. The zero stage is introduced to compile a correspondence table for two types of goiter classification.
Returning to the development of Nikolaev:
- Stage 1 - changes in the endocrine organ are noticeable on palpation,
- Stage 2 - thyroid changes are visually noticeable,
- Stage 3 - the growth of goiter leads to a "thickening" of the neck,
- Stage 4 - the shape of the neck visually changes (depending on the location of the goiter),
- Stage 5 - the goiter becomes so large that problems begin with nearby organs on which it presses. Also the voice timbre is disturbed, up to its loss.
In the initial stages of the disease, a person may not even be aware of its presence, since the goiter does not manifest itself in any way. The further course of the pathology is characterized by the appearance of a well-marked swelling in the Adam's apple region. Thyroid tissue, in such cases, exerts substantial pressure on the respiratory tract, as well as on nerve endings and blood vessels in the nearby area. If we talk about the nature of the increase, the diffuse type of goiter is caused by a uniform proliferation of thyroid tissue, which is visually reflected as a general increase in the neck or lack of "tuberosity". The nodular type of pathology is characterized by unilateral swelling (on one side of the trachea) and the characteristic heterogeneity of this formation.
When physical exposure of enlarged thyroid tissue to nearby organs may be accompanied by the following symptoms:
- labored breathing,
- violation of the timbre of voice, hoarseness, and in some cases his loss,
- seizures, akin to asthma, manifested mainly during sleep,
- dry cutting cough
- difficulty in swallowing,
- feeling of heaviness in the head and occasional dizziness.
With concomitant hypothyroidism, goiter can cause diseases such as atypical pneumonia, acute forms of respiratory tract infections. In addition, against the background of the pathology can develop diseases associated with low blood pressure.
Perhaps the periodic appearance of discomfort and constriction in the heart. The development of pathology is accompanied by the gradual appearance of shortness of breath, the appearance of indifference to any dishes or foods, problems in the work of the gastrointestinal tract, persistent nausea, and pathological drowsiness. Late stages are characterized by impaired memory and weight gain, with low appetite.
Symptoms include sexual problems. In women, they manifest themselves mainly in violation of the menstruation cycle. In the future, these problems may "result" in the impossibility of having children, and at the stage of pregnancy may lead to its premature termination. Men may suffer from decreased libido and erectile dysfunction.
With the development of toxic diffuse goiter or benign nodular formations (single or multiple), the symptoms can be complemented by the following positions:
- the temperature does not decrease over time,
- weight loss with good appetite
- bulging eyes (exophthalmos),
- constant hunger
- insomnia at night and daytime sleepiness,
- excessive irritability, and sometimes aggressiveness,
- tremor of the upper and lower extremities.
As mentioned above, the main cause of the pathology of a mixed goiter of the thyroid gland is the lack of iodine entering the body. This form of the disease is typical for areas with a low content of this trace element in the environment. As a result, the thyroid gland is not able to produce iodine-containing hormones in the right quantity. Also, the dysfunction of the thyroid gland can also be caused by the negative ecological condition of the area where a person lives or works - substances containing toxins can inhibit the hormone-producing function of the thyroid gland, thereby limiting its activity. Another reason for the emergence of endemic goiter may be a banal deficiency in the diet of iodine-containing products, so it is very important to watch what a person eats.
Autoimmune damage to the tissues of the thyroid gland (Graves' disease, Hashimoto thyroiditis) is caused by the immune system's perception of thyroid cells as targets for attack. In this case, antibodies are produced against the constituent tissues of the body, and this is the reason for the dysfunction of the endocrine organ under consideration. In order to compensate for the lack of hormones, the thyroid gland begins to build up tissue and, accordingly, grow.
All of the above related to diffuse types of pathology.
The main causes of the nodular goiter of the thyroid gland are benign and substandard formations in the tissues of the endocrine organ.
In these cases, violations are observed both in the processes of cell division and in their quality. The appearance of such neoplasms is caused by being found excessively in places of radiation contamination, ingestion of certain substances of a toxic nature into the body, as well as hereditary factors.
Goiter, as a lesion of the thyroid gland, is the most commonly diagnosed endocrine system disease in children. Overwhelmingly, this pathology is diffuse in them.
If you pay attention to the statistics of the World Health Organization, then the value of 6% is indicated as an increasing number of patients-children suffering from pathologies such as goiter in the last ten years. The main reasons for the same statistics are the wrong diet and deteriorating environmental conditions. And almost a third of patients older than 13 years.
The age of patients imposes its own characteristics on the course of the disease, they are expressed in more vivid manifestations of pathology.A delayed treatment can lead to such irreversible consequences as cretinism, a condition in which there is a mental and physical developmental delay of the child, aggravated and disruption of the work of the central nervous system.
Laboratory tests of blood and urine are used as diagnostic studies to determine the presence of a disease of the nodular goiter of the thyroid gland. As part of a blood test, blood levels of free thyroid hormones (triiodothyronine and thyroxin), thyrotropic hormone (TSH), and thyroglobulin, which is a chain of almost ready thyroxine molecules, are found. The broken ratio of these substances indicates the occurrence of pathological processes in the tissues of the thyroid gland. These diagnostic procedures are complemented by ultrasound. It allows with sufficient certainty to determine the shape and type of developing pathology, for example, diffuse, mixed or nodular goiter of the thyroid gland. The functionality of the thyroid gland is determined using radioisotope research. A neoplasm biopsy can be used to determine the nature (benign or substandard) of the detected nodes in endemic goiter.
Mandatory diagnostic procedures with a positive result for palpation will be:
- tests for the above hormones (if followed by treatment, such studies are carried out regularly),
- determining the speed of reflex reactions,
- ultrasound of the thyroid gland.
How to treat goiter? The first thing to remember is the timely detection of pathology significantly improves the prognosis of the course of the disease, and in some cases it becomes the key to recovery. When the first symptoms or suspected thyroid disease, including goiter, you should immediately contact the endocrinologist, who will prescribe the necessary diagnostic procedures and treatment, if necessary. If thyroid goiter is diagnosed, treatment should be under the strict supervision of the attending physician. As a treatment for the pathology under consideration, two methods can be distinguished: drug and surgery.
The first (drug) involves the use of hormone replacement therapy, which is to take drugs based on artificial thyroxine. In some cases, the use of such therapy becomes a permanent treatment, which will have to continue throughout life. Such drugs are prescribed when the thyroid gland is unable to independently produce the required amount of triiodothyronine and thyroxine. However, it is important to strictly follow the recommendations of the endocrinologist and the dosage, which can be adjusted after each study on the ratio of thyroid and thyroid-stimulating hormones. Excess hormones are as dangerous as their deficiencies.
Drug treatment with radioactive iodine can also be attributed to drug treatment. The task of such therapy is to destroy a certain amount of thyroid tissue or the desired tissue site.
The difficulty lies in the selection of the correct dose of this substance, because with such treatment often have to undergo additional examinations.
The second type of treatment, surgical, is used if there is no other choice besides resection (removal). Distinguish between complete resection and partial, that is, the complete removal of the thyroid gland or only part of it. The most common form of this therapy is when detecting substandard tumors in the tissues of the thyroid gland, with a strong pressure of overgrown thyroid tissues on nearby organs and departments of the circulatory system, also with a strong negative cosmetic defect created by these tissues. The difficulty in this case lies in the huge number of blood vessels in the body of the thyroid gland. Often, after resection, hormone replacement therapy is prescribed.Complete resection implies such a postoperative treatment throughout life.
The thyroid gland is a very important part of the endocrine system. Substances synthesized by it, take part in many archival processes occurring in the human body. Therefore, any violations in its work can lead to very serious consequences, sometimes irreversible. And goiter is no exception. At the first suspicion of having this pathology, it is necessary to immediately consult an endocrinologist to get a competent recommendation and undergo the necessary diagnostic procedures. It should be remembered that in no case can self-medicate - the damage it can cause is incommensurable with the planned effect. Timely diagnosis and treatment under the supervision of a specialist is the key to a speedy stabilization of the situation and subsequent recovery.
Thyroid goiter - what is it? This question can be heard in various parts of the world due to the fairly widespread occurrence of the phenomenon. The thyroid gland can be enlarged for various reasons, but for some areas the level of the disease is such that it is ranked as the rank of regional diseases.
The issue of goiter suddenly rises when a person suddenly discovers that an incomprehensible and frightening formation begins to grow on his throat. Goiter itself is not a disease, but a symptom of a disease that can actually be very dangerous and requires serious attention and treatment.
Features goiter thyroid
Goitre is an increase in the size of an organ, being a sign of a number of its diseases, expressed in functional disorders. This pathology may represent a slight swelling in the area of the Adam's apple, but can grow so that it deforms the neck and puts pressure on other organs.
Goiter of a different type is much more common in women than in men, which is associated with hormonal processes.
The type of goiter manifestation depends on the type of violation of the secretory function of the gland:
- Hypothyroidism: a decrease in secretory function, leading to a decrease in the release of hormones, which causes such effects as attenuation of metabolic processes, edema, obesity, and retardation of the reaction.
- Hyperthyroidism: excessive activation of secretion, accompanied by abnormal acceleration of metabolic processes and leads to weight loss and overload of the nervous system.
- Euthyroidism: normal hormone production, but the growth of goiter is due to the pathological size of the gland itself.
The main types of goiter
What is goiter is determined by the type of thyroid disease. The following main types can be distinguished:
- Endemic goiter: is described by an increase in organ volume and a decrease in the secretion of thyroxin and triiodothyronine, has a characteristic geographical dependence, is common in places where there is a clear lack of iodine in water and foods. The pathogenesis of the disease is due to the fact that iodine in the body is necessary for the production of the necessary hormones and with its acute deficiency it takes much more to siphon blood through itself, and iron reflexively increases the number of cells responsible for the production of this hormone. To correct the situation, the pituitary gland produces thyrotropin, which activates cell division of the organ and increases its volume and mass.
- Thyroiditis (goiter Hashimoto): similar in etiology to diffuse goiter, but refers to hypothyroidism. As a result of the erroneous actions of the immune system, excess leukocytes attack the gland, and fibrous tissue forms at the site of cell death. This type of disease mainly has hereditary causes, but can sometimes be triggered by injuries, infections, cervical inflammations, chronic pharyngitis, iodine anomaly, and toxic pollution of the atmosphere.
- Diffuse toxic goiter: this is a disease that can be attributed to thyrotoxicosis, and an excess of iodine leads to poisoning of the body, triggered by the pathology of the autoimmune system at the genetic level, with infections, head injuries, and nerve shocks.
- Nodular goiter (adenoma of the thyroid gland): the formation of a node as a result of excessive secretion of thyrotropin, as well as impaired functioning of the nerve processes. Cell proliferation leads to poisoning of the body with hormones (thyrotoxicosis).
- Congenital goiter: appears in children, if the mother during pregnancy experienced a significant iodine deficiency or due to genetic predisposition.
- Fibrous thyroiditis (fibroplastic goiter): the thyroid gland grows due to the manifestation of an autoimmune pathology of an inflammatory nature, through the growth of connective tissue from fibrin fibers.
The degree of enlargement of the thyroid gland
In the course of the disease, varying degrees of gland enlargement are observed. In the international classification are the following degrees:
- Grade 0: goiter is not visible and palpable.
- Grade 1: Grade 1 thyroid enlargement is not noticeable, but the isthmus of the gland is palpated.
- Grade 2: Grade 2 goiter is noticeable during swallowing and is easily palpable.
- Grade 3: the gland is enlarged, which visually looks like the effect of a thick neck.
- Degree 4: goiter 4 has a pronounced appearance, the neck configuration is disturbed, the neck is deformed.
- Grade 5: a huge goiter, squeezing the neck, causing trouble breathing and swallowing.
Causes of nodular goiter
Nodular goiter can be a manifestation of such diseases as:
- nodular colloid goiter: the most common nodular formation in the form of an enlarged follicle filled with a viscous colloid,
- thyroid adenoma,
- thyroid cancer: a malignant tumor with the ability of metastasis,
- pituitary adenoma: an increase in thyroid due to an excess of thyrotropin,
- Hashimoto thyroiditis,
- cyst: goiter associated with a dermoid cyst, refers to the congenital form.
These reasons are provoked by a number of internal and external factors: iodine and some other minerals deficiency in water and nutrition, impaired blood and lymph outflow from the gland associated with atherosclerosis, hereditary predisposition, impaired nerve endings in any area of the gland contaminated by the environment ( increased background radiation, nitrite contamination, soil oversaturation with calcium, etc.), psychological stress, head injuries, hormonal rearrangement, reduced immune protection after suffering diseases.
Symptoms and treatment of colloid goiter
Colloid goiter of the thyroid gland is an increase as a result of the filling of the follicles with a colloidal fluid in a volume of more than 18 ml (in women) and 25 ml (in men).
It is possible to distinguish the main forms of colloidal goiter.
- Diffuse colloid goiter: the distribution of colloid throughout the body.
- Nodular colloid goiter: local placement of filled follicles.
- Cystic colloid goiter: accumulation of colloids in a cyst surrounded by an elastic sheath.
The main causes of colloidal goiter are iodine consumption deficiency, age-related abnormalities (after 40 years), female hormonal surges, endocrine organ pathology, increased radiation background, genetic predisposition, nervous stress, infectious and inflammatory diseases, and hypothermia.
Symptoms of colloid goiter
Symptoms begin to manifest from grade 3 of the disease. Goiter in the form of a wide cushion or butterfly visible visually. To the touch, the formation is an elastic growth containing many small bubbles with colloid. Perceived signs: pressure in the neck, problems when swallowing, coughing, hoarseness, foreign body sensation in the throat.Additionally, it can be noted: in hypothyroidism - inhibition of reaction, weakness, constipation, slow heart rate, low temperature, in hyperthyroidism - anxiety, insomnia, increased heart rate, fever.
Thyroid nodes: diagnosis, puncture (biopsy), types, consequences
Thyroid nodes. The reasons
Causes of toxic goiter
Toxic goiter is an enlargement of the thyroid gland in which the body is poisoned with thyroid hormones (thyrotoxicosis). The main causes of this type of disease are:
- pathology of the pituitary gland,
- excessive consumption of iodine-containing drugs and thyroid hormones,
- psychological and hormonal changes in the female body,
- infections (flu, sore throat, tuberculosis),
- head injuries
- psychological stress
- excessive exposure to ultraviolet radiation.
Types and causes of the disease
The main diseases characterized by diffuse character: diffuse toxic species (basedovoy disease), diffuse colloid type, endemic goiter. The following causes lead to such diseases: iodine consumption deficiency, hereditary pathologies, uncontrolled iodine-containing drugs, female hormonal changes, diseases affecting the immune system (diabetes, arthritis, scleroderma), age factor, prolonged stress or nerve shock, surgical operations on the thyroid gland.
The specific symptoms of diffuse goiter include noisy breathing, shortness of breath, appearing in a supine position, dizziness. The main external manifestation is a characteristic convex formation on the front surface of the neck with a uniform growth of both halves.
Treatment of diffuse goiter. In the medical treatment of diffuse goiter, iodine preparations (diiodotyrosine), thyreostatics and antithyroids (mercazole), thyroid hormones (propranolol, anaprilin), sedatives (primidone), steroid hormones - corticosteroids (prednisolone) are prescribed. Surgical treatment is carried out with the development of severe thyrotoxicosis, too large a goiter, the occurrence of complications in the form of atrial fibrillation.
The thyroid gland is the largest in the human body. she participates in all metabolic processes, it is impossible to be healthy without her hormones. But there are also failures in her work when a person has a goiter. Then the question arises - what is goiter, and what consequences for the body can it have?
Goiter is an enlargement of the thyroid gland. It is named so because of its similarity with the expansion of the esophagus in birds, which is also called goiter. Another name for this pathology is struma. This is not a separate thyroid disease, but only one of the symptoms of a whole complex of diseases. In some of them, the lesion is not at all in the thyroid gland. But at the same time, the body sometimes grows to such an extent that it squeezes the organs surrounding the gland, squeezes the neck, interferes with proper breathing. But why does such a state arise, and how is it dangerous for the human body?
Outwardly, they are almost indistinguishable, but in fact there is a big difference between different types of goiter. It can only be determined during the delivery of the analysis for hormones, and only the doctor should be engaged in treatment. Self-treatment can only increase the problem, but will not bring a positive result.
Iron is enlarged if its lobes are larger than the average phalanx of the thumb on a particular person’s arm.
Goitre can appear for several reasons:
- hypothyroidism - when the thyroid function is reduced, hormones are not enough. In this case, the body slows down all metabolic processes, puffiness appears, the rate of reactions slows down, obesity begins, sight and hearing deteriorates. It occurs due to iodine deficiency in the body, poor ecology, hereditary factors.
- hyperthyroidism - reverse effects. There are too many hormones, metabolic processes occur quickly, there is an increased load on the nervous system. One of the most severe forms of hyperthyroidism is Graves' disease.
- euthyroidism - hormones are secreted in a normal amount, but are poorly absorbed by the body. Often this condition occurs during pregnancy.
In hypothyroidism, when iodine lacks in food, the production of thyroid hormones, thyroxine and triiodothyronine, sharply decreases. Iron, they are vital, it seeks to get iodine from the body by increasing its total area. So is the growth of the gland. But the more it becomes, the more iodine it needs, and the more it grows. To break this vicious circle can only be a strong increase in iodine in the body - with food or with medicines. There are also artificial hormone analogues, which, if necessary, are prescribed by an endocrinologist.