Endemic goiter: causes, symptoms, diagnosis, treatment, prevention

Endemic goiter is an enlargement of the thyroid gland that is caused by iodine deficiency in the body. The healthy volume of the gland, as a rule, in women does not exceed 20 cm ³ , and in men - 25 cm ³ . In the presence of goiter, it is larger than the given dimensions. According to statistics recently cited by the World Health Organization, over seven hundred million people who live in iodine-deficient areas suffer from endemic goiter (according to ICD-10, the code is E01.0).

They have varying degrees of functional insufficiency of the gland. Forty-two million people are diagnosed with an acquired form of mental retardation. The most unfavorable territories in terms of iodine content in the environment in our country are the Republic of Karelia, the Volga region, the Caucasus and the valleys of Siberian rivers.

Views

Endemic goiter is of various types, for example:

• Euthyroid type. At the same time, the thyroid gland is enlarged in size, but the normal level of hormones remains.
• Hypothyroid type. Such goiter is combined with hypothyroidism, and in addition, with reduced thyroid function.
• Hyperthyroid type. Such a goiter is characterized by excessive work of the gland.

In addition to the above forms, they also distinguish:

• The development of diffuse goiter, in which the thyroid gland increases evenly.
• Multinodal endemic goiter. With the development of such goiter, nodes of a denser tissue are present in the mass of the gland.
• The development of mixed goiter, when, in parallel with diffuse enlargement, individual nodes can be felt in the thyroid gland.

Directly in its location, the goiter is unilateral or bilateral. Next, we find out what are the main reasons for the appearance of this pathology, and also consider the degree of the disease.

Degrees of endemic goiter

Most often distinguished:

• 0 degree - no goiter.
• I degree - goiter is felt on palpation, but is not visually detected.
• II degree - goiter is determined visually and upon palpation.

To determine the exact size of the thyroid gland, an ultrasound is prescribed to the patient, which also reveals the shape of the goiter.

Endemic goiter: pathogenesis of the disease

As mentioned above, the cause of endemic goiter is primarily iodine deficiency in the human body. Iodine deficiency is, for example, acute. In this case, the body will collect all its compensatory abilities and, as soon as iodine intake resumes, the normal functioning of his thyroid gland will be returned to the person, so that no damage to other organs will occur.

Against the background of the development of chronic insufficiency of such an important element as iodine, the situation is much more complicated. As a response to a reduced intake of iodine, as a rule, there is an increase in thyrocytes, which synthesize hormones. Due to the increase in the volume of these gland cells and the strengthening of their work for a short time, a relatively normal amount of the required hormones will be stabilized. But after some time, the process of their fibrosis will become inevitable and nodes will begin to form. The pathogenesis of endemic goiter is not known to everyone.

Against the background of prolonged iodine deficiency, hypertrophy of thyrocytes alone is not enough. They can not only increase in size, but also divide intensively. As a result of this, there are a lot of fibrosing cells in the body, and this, in turn, means that there are prerequisites for the further formation of diffuse-nodular goiter.

The causes of endemic goiter are that the thyroid gland, against the background of the development of an increasing iodine deficiency, goes through several stages of changing its structure. First, goiter becomes diffuse euthyroid, then multinodular euthyroid, and eventually multinodular toxic.

The most common causes of pathology

An endemic goiter of the thyroid gland appears due to a lack of iodine.

The most common causes of iodine deficiency are the following factors:

• Taking certain medications that stimulate the removal of iodine from the body.
• The appearance of diseases of the digestive system, which are accompanied by impaired absorption of substances necessary for the body.
• The use of enterosorbents.
• The development of chronic renal failure, which is accompanied by increased excretion of iodine.
• The appearance of congenital abnormalities of the gland in the form of aplasia or hypoplasia.
• The presence of transient conditions, which are accompanied by iodine deficiency. Pregnancy along with childhood, puberty, and intense physical activity is an example of such conditions. In addition, regular psycho-emotional stress also affects.
• Minor intake of iodine with food.
• Low intake of iodine with water.
• The presence of a violation of the energy balance.
• The development of chronic hypoxia.

Talking about the reasons that provoke the development of endemic goiter, we should consider in more detail the lack of this element in everyday food. Most of the inhabitants of our country almost never find fresh seafood with fish in their diets. In addition, few people think about using iodized salt for cooking.

Of course, taking only iodized salt will not fully compensate for the iodine deficiency. This is due to the fact that iodine is a very volatile substance that quickly disappears from the structure of salt crystals due to air entering them. In this regard, it is necessary to store salt not in salt shakers, but in glass or metal banks, which are tightly closed with a lid.

Eating a significant amount of cauliflower, and in addition, beans and turnips threatens the development of iodine deficiency. This is due to the fact that these products contain too many strumogenic substances that provoke excessive growth of thyroid tissue.

Thus, iodine deficiency primarily occurs due to the following factors:

• Lack of iodine in the environment, as well as in drinking water. Such regions include central Russia, the Urals, Altai and the Caucasus.
• An unbalanced diet, against which insufficient fish, seaweed, dairy products, buckwheat and oatmeal are eaten.
• The systematic use of certain drugs that block the absorption of iodine.
• The presence of a hereditary predisposition along with a genetic defect in the production of thyroid hormone.

Now we will consider how the presence of endemic goiter of the thyroid gland in patients is manifested.

Symptomatology

Symptoms of goiter primarily depend on the functions of the thyroid gland. Especially often, patients may complain of the following sensations:

• The appearance of weakness.
• The presence of low physical stamina.
• Discomfort in the heart.
• The appearance of headaches.

Similar symptoms can occur even at an early stage of the disease. With the subsequent growth of the thyroid gland, the following symptoms may be observed in patients:

• The sensation of compression in the neck.
• Presence of difficulty swallowing and breathing.
• The appearance of dry cough.
• The occurrence of asthma attacks.

It is interesting to note that the diffuse type of goiter is the most common form. Women get them four times more often than men. This is primarily due to the increased need for women in the hormones of this gland during puberty, and in addition, during pregnancy.

It should be borne in mind that the doses of iodine preparations, according to the recommendations, should be as follows:

• 50 mcg are the norm for infants.
• 90 mcg should be taken by children under seven years of age.
• 120 mcg is the norm for children from seven to twelve years old.
• 150 mcg should be taken by adults.
• 200 mcg should be consumed by pregnant and lactating women.

Facts and Figures

About two hundred million people on the planet suffer from this pathology. She is called one of the most common disasters of people. Ninety percent of all goiters are caused by iodine deficiency. The prevalence of goiter among children over the past ten years has increased by six percent. Today, this frequency is about twenty-five percent of all childhood endocrinological diseases.

The pathogenesis of endemic goiter should be known to everyone.

Complications

Ailment can give various complications. These usually include:

• The presence of goiter. We are talking about a condition in which the vessels that leave the heart are compressed. This can lead to expansion of the heart on the right side.
• Presence of compression of the esophagus and trachea.
• The appearance of hemorrhages in the thickness of the thyroid gland.
• The occurrence of inflammation of the gland.
• The development of malignant degeneration of the thyroid gland.

To prevent complications of endemic goiter, it is necessary to undergo a timely diagnosis.

Pathology diagnostics

The instrumental method for diagnosing goiter is ultrasound. Thanks to this study, a form of the disease is established, which may be diffuse or nodular.

If there are nodes, sonoelastography can be prescribed - a study that allows you to determine the density with elasticity of nodular formations. This makes it possible to find out what the nature of the pathology is: benign or malignant. For the same purpose, a thyroid biopsy is additionally performed. In addition, the level of such hormones as TSH and T4 is checked to clarify the diagnosis. In patients with this type of disease, as a rule, the balance of thyroid hormone is significantly impaired. In turn, the rate of iodine in the urine is reduced. But the initial stage of the examination is primarily palpation. This method allows you to do the following:

• The size of the shares of the diseased organ is determined.
• The sharpness of the border with surrounding tissues is assessed.
• The consistency of the gland is evaluated. In this case, the doctor draws attention to such signs as compaction, softening, nodular formations and their approximate size.
• The condition of the lymph nodes along with the presence of lymphangitis is assessed.

In addition to palpation, a very informative, and at the same time accessible method is, as already noted, an ultrasound scan that provides the following information:

• Exact width, thickness and height of lobes.
• The size of the isthmus.
• Full information about the structure of the body, and in addition, about its homogeneity.
• The presence of nodular formation and its exact size.
• The degree of volume of individual shares. The total volume of the thyroid gland is also found out.
• The condition of the surrounding tissue.

What is the treatment for endemic goiter?

Disease treatment

In the case of a slight enlargement of the gland, often only a few courses of potassium iodide are enough, and in addition, diet therapy with products that are rich in iodine. Treatment of goiter, complicated by hypothyroidism, primarily involves hormone replacement therapy.

Treatment of goiter, which is in a nodular form at a late stage, usually requires surgical intervention.

In the postoperative phase, patients undergo hormone replacement treatment. From folk remedies, it is recommended to use powder from seaweed. It is taken by teaspoon at night and washed down with water. The course of therapy is from twenty to thirty days.

Prevention of endemic goiter is no less important.

Diet as a preventive measure

The following diet is recommended for people to prevent the occurrence of endemic goiter:

• The use of seafood in the form of shrimp, squid and mussels.
• Use in the diet of seaweed and other seaweeds.
• Eating marine boiled fish up to three times a week.
• The use of fermented milk drinks in the diet, especially those containing bifidobacteria. Thus, you should drink two glasses of such drinks a day.
• Eating cottage cheese of medium fat content up to three times every seven days.
• Eating nuts of all kinds up to 50 grams per day.
• Adding seeds of all kinds to food.
• Use of dried fruits in the diet in the form of raisins, dried apricots, apricots, figs, prunes, apples and pears.
• The use of cranberries, lingonberries, wild strawberries, gooseberries, black currants, viburnum, red mountain ash and so on.
• Use of vegetables in the diet in the form of carrots, cabbage, beets and raw pumpkins.
• Eating greens, for example, onions, horseradish, celery and so on.
• Reception of freshly squeezed juices from vegetables, berries or fruits.
• Reception of drinks from rose hips, dandelion or hawthorn root.
• The use of mineral or spring water.
• Use in the diet of honey at 50 grams.

Other ways to prevent goiter

Prevention of endemic goiter is divided into mass, group and individual type:

• Mass prophylactic techniques consist in the production of iodized salt, bread and confectionery, which should contain this element. In addition, television is promoting the control of iodine in foods.
• Group prevention is carried out mainly in risk groups, namely in children's institutions, schools, secondary and higher educational institutions. In addition, attention is given to pregnant women. This primarily includes conducting explanatory conversations along with the controlled distribution of iodine preparations, for example, Antistrumin, Iodomarina and Yodokomba.
• As for individual prevention, it consists in the use of foods that are rich in iodine. It is very important to take iodine preparations by people who are at risk, as well as those who live in endemic regions.

How to prevent endemic goiter in children? Babies who are breast-fed daily need 90 micrograms of iodine. Pregnant women, children, and adolescents require up to 200 micrograms per day. In addition to taking appropriate drugs, it is important to follow a diet, which should be based on a sufficient iodine content in food.