Diseases of the thyroid gland (thyroid gland) occupy a leading place after diabetes among endocrine pathologies. The concept of goiter is collective, because it is a whole group of diseases with an increase in size, but with a different etiology. The enlargement of the gland (struma) can be observed both with increased and with reduced functioning.
How to distinguish goiter of other magnifications? When swallowing, it will move up and down.
Goiter with thyroid hyperfunction occurs 10 times more often than hypothyroid. It is always persistent and by itself never dissolves. Pathology in women occurs almost 10 times more often than in men, usually in 20-40 years. This is because in the work of the male body there is much more stability. And the body of women is constantly undergoing hormonal changes: menarche, gestation, childbirth, lactation, menopause ...
The term itself speaks of the similarity of goiter to that of birds. They have a special expansion of the esophagus, in which food accumulates, and the neck in this place is enlarged (pelicans, for example). Nothing accumulates in the thyroid gland, but the tissues grow. The term was introduced by the Swiss natural scientist A. Galler in the XVIII century.
Essence of the disease
Changes in the thyroid gland with goiter are not inflammatory in nature and do not apply to tumors. The normal thyroid volume in women is 15-20 ml, in men - 18-25 ml. Any excess of these numbers is considered a struma. The thyroid gland grows throughout puberty, then stabilizes, and already in old age gradually begins to atrophy.
Types of Goiter
It can arise and exist as a primary disease, it can be secondary, that is, against the background of an already existing etiology.
By functionality, goiter happens with hypo-, hyperfunction of the gland or euthyroid. The goiter is also endemic (with iodine deficiency) and sporadic. In the second option, the cause of the occurrence remains unclear.
According to morphology, goiter is nodular, diffuse and mixed.
If there are only 2 nodes in the thyroid gland, it is already considered multinodular. Such a pathology occurs in every second patient.
With diffuse goiter, the iron is hypertrophied uniformly, with an uneven increase, the nodes are usually the culprits. In the latter case, the level of hormones is normal.
According to the effects of hormones on the body, goiter is divided into toxic and non-toxic. The first is characterized by toxic effects on the whole organism.
Factors
All predisposing factors are exogenous and endogenous.
Exogenous:
- iodine deficiency, lack of selenium, zinc and molybdenum;
- poor ecology, radiation, ultraviolet;
- injuries
- taking medications that block the transport of iodine;
- constant lack of sleep;
- bad habits;
- infections
- hypothermia and vasospasm with them;
- intense physical activity.
Endogenous:
- heredity;
- gender affiliation;
- decreased immunity;
- stress and nervous overload;
- imbalance of hormones;
- autoimmune processes;
- diseases in the gland itself (inflammation, education, functional disorders in the form of an increased amount of colloid);
- obesity;
- other endocrine pathologies;
- eating disorders and the use of foods with nitrates and pesticides;
- pathology in the parathyroid glands or pancreas;
- work in the chemical industry.
The composition of water affects the development of goiter of the 2nd degree of the thyroid gland - the presence of a high percentage of calcium salts in it, urochrome, nitrates, etc. All of them significantly complicate the absorption of iodine. With its lack in 90% of cases, diffuse goiter appears.
Classification of goiter by degrees
There are two such classifications. Since 1955, the gradation of O.V. Nikolaev was used and practiced until the appearance of ultrasound. Since 1992, the WHO classification has been applied.
Graduation of Nikolaev and today is applied because of its practicality, details and the correct choice of treatment tactics. It examines 6 degrees of goiter:
- 0 degree - there is no clinic, there are only changes in the analyzes;
- 1 degree - there are no visual and clinical changes, the node is detected only by probing;
- 2 degree goiter of the thyroid gland - the entire thyroid gland is palpated completely and an isthmus is noticeable when swallowed;
- 3 degree - the front surface of the neck is visually changed;
- 4 degree - thick neck and drooping goiter;
- Grade 5 - goiter of gigantic proportions, there is a syndrome of compression, is very rare.
The WHO systematization distinguishes 3 stages of thyroid enlargement. Therefore, all degrees after 2 are attributed to 2, which complicates the diagnosis and choice of treatment. There is no clear differentiation.
In this classification, there are 3 degrees:
- 0 degree - no visual changes, but the gland is palpated. Its shares do not exceed the size of the distal phalanx of the patient’s thumb. Areas of hypertrophy are detected by biopsy.
- 1 degree - the size of the thyroid lobes is greater than the distal phalanges. They are determined only by palpation, not visually.
- Grade 2 goiter - the neck is deformed, and the patient can feel the changes in the gland independently.
DTZ
Diffuse toxic goiter of the thyroid gland of the 2nd degree (DTZ) is more common from 20 to 40 years. The effect of nodes is toxic. In 85% of cases, DTZ is accompanied by gland hyperfunction in the form of thyrotoxicosis.
The mechanism for the development of such a goiter is that when there is a lack of iodine, which the thyroid gland uses to produce its own hormones, it begins to actively seek and absorb it (even if it does so little). For this purpose, she has to increase her size. This is a kind of adaptive reaction of the gland.
In addition to such a mechanism, diffuse toxic goiter of the 2nd degree of the thyroid gland often occurs as a result of the development of gene mutations and autoimmune processes. It can develop as a result of taking levothyroxine (drug thyrotoxicosis).
Diffuse goiter of the thyroid gland of the 2nd degree or hyperthyroidism is a disease of residents of iodine-deficient areas.
Clinical picture of goiter with hyperfunction
It can be diffuse or nodular, but always toxic. All manifestations of toxic goiter of the thyroid gland of the 2nd degree are associated with an acceleration of metabolism.
Changes in the central nervous system:
- mood swings and tearfulness;
- nervousness and fussiness;
- irritability and insomnia;
- tendon reflexes are increased, muscle weakness;
- adynamia and osteopenia.
Changes in the cardiovascular system:
- heart palpitations (pulse 120-130);
- increased pressure, pulsation of the jugular veins;
- atrial fibrillation, dyspnea and the development of insufficiency;
- tendency to thrombosis;
- myocardial dystrophy.
From the gastrointestinal tract:
- against the background of rapid weight loss increases appetite;
- increased metabolism leads to an acceleration of intestinal motility, which causes diarrhea;
- heat intolerance, subfebrile condition, hyperhidrosis, a feeling of constant heat;
- later, the symptoms of exophthalmos necessarily join, the eyelids cease to fully close, due to which other eye symptoms are added (there are only 10 of them);
- conjunctivitis and pain in the eyes occur, vision deteriorates;
- Mari's symptom is characteristic (tremor of fingers or toes - indicates damage to the peripheral nervous system);
- the symptom of the telegraph pole is trembling of the whole body.
On the part of hair and skin:
- alopecia, brittleness and damage to nails;
- skin is hot to the touch and velvety;
- places of skin friction darken.
Reproductive system damage:
- cycle disorders, malfunction of the ovaries;
- decreased potency and erection in men, gynecomastia;
- kidneys can be affected with the development of renal failure.
Mechanical symptoms:
- the front side of the neck hurts and enlarges;
- hoarseness of voice;
- a feeling of soreness and a lump in the throat;
- shortness of breath and bouts of dry cough;
- dizziness.
Toxic diffuse-nodular or multinodular goiter of the thyroid gland of the 2nd degree is characterized by a rather rapid growth of nodes to a size of more than 3 cm.
In advanced cases, after the 3rd degree, the treatment is only surgical. The enlarged part of the thyroid gland is removed, only 5 g is left for it to function, and it was not necessary to drink hormones for life.
But you need to know that the operation of diffuse nodular goiter of the thyroid gland of the 2nd degree does not guarantee the exclusion of relapses that can occur in 10% of cases.
Goiter with hypothyroidism
Diagnosed much less often. At the 2nd degree, hypertrophy is uneven, asymmetric. Symptoms do not appear immediately; for several years there has been no clinic.
With hypothyroid goiter of the thyroid gland of the 2nd degree, symptoms and manifestations are due to a sharp slowdown in metabolism:
- progressive weight gain in parallel with reduced appetite;
- weakness, constant chilliness due to increased sensitivity to cold;
- decreased vision and hearing;
- cephalgia;
- lethargy, weakness and fatigue;
- slowing down speech and movements, memory loss;
- impotence in men and lack of libido in women, infertility and miscarriages;
- the skin is flabby, dry, light spots appear on them due to a decrease in the production of melanin;
- hair falls out;
- broken nails;
- limbs and face become swollen - the cheeks are thick, the eyes are narrow;
- tongue and lips are thick;
- on the lateral surfaces of the tongue - prints of teeth;
- slow metabolism leads to constipation and flatulence, nausea;
- bradycardia and hypotension;
- tendency to colds.
In severe cases, edema is observed throughout the body - myxedema. I want to sleep during the day, no sleep at night. The mood is depressive. Hypothyroidism in children threatens with mental retardation.
Euthyroid goiter
It can occur with any pathology of the gland. It makes up 50-70% of all visits to the endocrinologist. With nodular goiter in the gland there is one or more nodes. Hormones are produced normally, metabolism is normal, but abnormalities can be found in the gland tissue. In the clinic, mainly mechanical symptoms are detected.
Signs of nodular colloid goiter of the thyroid gland of the 2nd degree with normal hormone production are manifested as follows:
- when the size of the node is more than 3 cm, there is a feeling of discomfort in the neck;
- dysphagia;
- sore throat;
- shortness of breath and shortness of breath;
- paroxysmal dry cough;
- a feeling of a foreign body in the throat;
- a change in the timbre of the voice due to pressure on the vocal cords;
- pain and a change in the appearance of the neck.
There is no gender difference. Colloidal goiter is never reborn.
Nodular goiter SCHZHZH
Nodular colloid goiter occupies 90% of the appearance of nodes in the thyroid gland. It contains thyroglobulin. With nodular goiter, the follicles begin to grow. This is expressed in an increase in them colloid - a viscous fluid, due to which the name arose.
With nodular goiter of the thyroid gland, the concentration of T3 (triiodothyronine) increases, overgrown follicles that produce the hormone give this. The causes of goiter are associated with a lack of iodine. Colloidal goiter of the thyroid gland of the 2nd degree can also be accompanied by a decrease or increase in the production of thyroid hormones and the corresponding symptoms described above.
Diagnostics
In addition to a general examination, the doctor needs to palpate the gland.
Typically, a diagnosis of goiter of the thyroid gland of the 2nd degree involves:
- Ultrasound of the thyroid gland;
- chest x-ray;
- gland scintigraphy;
- much less often MRI or CT;
- blood for TSH, T3 - one of the simplest and most informative tests;
- determination of antibodies ATPO;
- TAB - fine needle biopsy.
More often in practice, ultrasound and blood hormones are enough to make a diagnosis.
Complications
Goiter creates not only a cosmetic defect, it causes lesions with the development of arrhythmias and heart failure, increases the formation of blood clots, causes intellectual and mnemonic disorders, hepatosis. Hemorrhage may occur in the parenchyma of the gland itself, its inflammation (strumit).
The most serious complication is thyrotoxic crisis, in which the outcome is often fatal. The incidence rate is 20% with thyrotoxicosis. Malignization of nodes is very rarely possible.
Therapeutic measures
Symptoms and treatment of goiter of the thyroid gland of the 2nd degree are always interconnected, i.e., the tactics of therapy depend on the initial cause, degree of goiter, age, etc.
With goiter of the 2nd degree, antihypertensive drugs, sedatives are prescribed. In order to normalize the production of thyroid hormones, thyreostatics are used. There are a lot of them - Mitezol, Tyrozole, Carbimazole, Tiamazole, Propitsil, etc. Merkazolil is used more often because it gives results for any degree of hyperthyroidism. Dosage is individual. The course of treatment is from 3 months to six months.
How to treat goiter of the thyroid gland of the 2nd degree?
Therapy also depends on the severity of the mechanical symptoms. If there is only a slight increase, then you can usually limit yourself to iodine preparations and diet. With hypofunction, synthetic hormones are prescribed for life.
If drug treatment of goiter of the thyroid gland of the 2nd degree is ineffective, the organ is removed promptly with subsequent hormone therapy.
With the effects of goiter, such as arrhythmias, beta-blockers (Anaprilin) are prescribed. These drugs reduce the frequency of tachycardia, reduce the minute volume of pumped blood and pressure.
Eye disorders are treated with corticosteroids, most often with the course of Prednisolone with a gradual dose reduction. The course is 2-3 months. The effect is noted if treatment of eye symptoms is started up to 6 months from the onset of their onset. Otherwise, connective tissue develops around the eyes, and bulging eyes will require surgery.
Radical Therapies
The operation is prescribed only after normalization of the analyzes. Intervention takes place under general anesthesia. A very small part of the gland is left, which takes on all the work or the entire organ is removed.
Rehabilitation is a few weeks. Nodular toxic goiter lends itself very well to RYT - the use of radioactive iodine. Radioiodine is able to completely destroy the affected tissue (follicular cells) of the thyroid gland. With the right dose, the size of the knot can be reduced by 80%.
Prevention
Endemic goiter is relatively easy to prevent. The simplest method is iodized salt. It is added after cooking.
An important place in prevention is given to healthy lifestyle. It is necessary to exclude stress, any overwork, to establish proper nutrition. Strengthening the immune system is required.
With poor heredity, a person should be registered with an endocrinologist, even if there are no symptoms of damage. Analyzes are given every 3-4 months.
In the presence of pathology, patients should protect themselves from stresses of any kind: douche with cold water (only warm), contrast showers, mud therapy, heavy physical exertion are strictly prohibited. All these procedures are stressful for the body, and the thyroid condition will only worsen. For the same reason, long trips and change of climatic zones are prohibited.