Non-toxic multinodular goiter is a symptom of thyroid disease, which can be seen by its increase. The cause of the disease can be thyroiditis, iodine deficiency, autoimmune diseases. The treatment includes pharmacotherapy, in some cases surgery is necessary.
What is non-toxic multinodular goiter (E 04.2)?
Non-toxic multinodular goiter is a disease that involves an increase in the volume of the thyroid gland with the presence of nodes without changing its function (the levels of hormones produced in it remain normal). The disease is diagnosed by ultrasound. The diagnosis is confirmed by the doctor, even if it is only a single node, without increasing the volume of the entire gland.
Non-toxic nodular goiter in populations with a normal iodine supply is about 5.3% among women and 0.8% in men.
Classification and coding of multinodular non-toxic goiter according to ICD-10
To systematize data on diseases according to their type and development, the International Classification of Diseases of the 10th revision (ICD-10) has been created. This classifier helps the doctor and patient to quickly make an accurate diagnosis and choose a more effective course of treatment. Non-toxic multinodular goiter in ICD-10 has the code E 04.2.
Separation of the disease by degrees:
- The first degree - visually and with palpation, changes in the thyroid gland are not determined. Nodes smaller than 10 mm can only be detected by ultrasound.
- The second degree - there are changes in the gland, which are detected during palpation and ultrasound.
- Third degree - diagnosed by a doctor visually. Visible swelling of the neck is visible, often more enlarged on the right side. The patient experiences discomfort associated with the formation of nodes.
Separation by the number of nodes formed:
- nodular goiter - one encapsulated node formed in the thyroid gland;
- multinodal type - multiple encapsulated changes that are clearly separated from each other;
- conglomerate nodal type - several encapsulated nodes welded together, form a conglomerate;
- diffuse-nodal type - diffuse increase in one or more nodes.
Causes of the disease
In areas with an adequate iodine supply to the diet, the main cause of nodules in the thyroid gland is a genetic predisposition, while in areas with iodine deficiency, the causes of disease symptoms can vary. It could be:
- iodine deficiency in nutrition;
- genetic predisposition;
- the effects of chemicals and sex hormones;
- smoking;
- ionizing radiation;
- thyroiditis;
- autoimmune diseases.
Some chemical compounds negatively affect the absorption of iodine by the body. They are found in green vegetables, such as Brussels sprouts and cauliflower, soy, turnip and peanuts. Due to their unfavorable composition, these products are inappropriate for diseases of the thyroid gland, especially in raw form. Heat treatment reduces the amount of volatiles contained in vegetables by about a third.
Symptoms and Diagnosis
Non-toxic nodular goiter remains an asymptomatic disease for a long time. Patients only in some cases feel an enlarged thyroid gland or nodes in the parenchyma. Complaints on their part usually appear only when a significantly enlarged gland begins to put pressure on the respiratory tract or esophagus, causing difficulty in breathing and swallowing food.
A multinodular non-toxic goiter of the thyroid gland is diagnosed on the basis of the results of the examination performed by the doctor during the first visit, ultrasound data and the level of hormones in the blood serum. Basic hormone tests include in this case the determination of TSH and hormones T3 and T4.
In any case, a biopsy of the thyroid gland (thin aspiration biopsy) is indicated with suspicion of a nontoxic multinodular goiter , since there is a high risk of developing cancerous formations. The procedure is carried out under ultrasound control.
If the disease is suspected by a primary care physician, he will refer the patient to a specialist in thyroid disease - an endocrinologist who will decide on further treatment.
Treatment methods
The main goal of the treatment of non-toxic multinodular goiter is to normalize the function of the healthy part of the gland parenchyma and to prevent the appearance of other changes for the worse.
Therapy of the disease includes:
- Monitoring the development of a patient's disease in dynamics.
- Reducing the size of the gland with radioactive iodine. This method is used only with small nodes and with the ineffectiveness of other types of treatment.
- Pharmacological treatment is the main method of treatment of multinodal non-toxic goiter of the 2nd degree. It is carried out with preparations containing sodium levothyroxine. Its effect is to suppress thyroid hyperfunction and prevent further growth of the nodular conglomerate, causing the patient to worsen.
- Surgery - removal of altered areas of the gland.
The main indications for deciding on interventional treatment are:
- suspected malignant disease - thyroid cancer;
- large nodes that inhibit the respiratory tract and esophagus, making breathing and swallowing of food difficult.
An additional treatment method is alcohol destruction, which leads to necrosis. Such treatment should also lead to a significant reduction in the mass of nodules. The procedure should be carried out after the precise exclusion of cancer. Unfortunately, the method is burdened with the risk of side effects, such as speech impairment. Cons of therapy include the need to repeat the procedure and its pain.
Disease Monitoring
Decision-making on conservative treatment requires high accuracy and thoroughness from both the attending physician and the patient. With non-invasive treatment, regular mandatory monitoring of the patient’s thyroid gland is required, performed at the endocrinology clinic. The frequency of control depends on the severity of the disease and the risk of cancer.
Initially, for approximately 2 years, a patient with multinodal nontoxic goiter of the 1st degree should visit an endocrinologist every six months. Compulsory endocrinological control applies not only to patients under observation, but also to postoperative and patients after another kind of treatment, for example, after ethanol injection.
The profile of control tests is similar to that during diagnosis and consists of hormonal laboratory tests (TSH and thyroid hormones), palpation by a doctor, and ultrasound. In the event of an abnormal result of a basic analysis, the doctor may decide to conduct a second biopsy.
In addition to the planned follow-up examinations, the patient should immediately inform the doctor of a deterioration in health, for example, the appearance of high fever of unknown origin, swollen lymph nodes, or a sudden noticeable enlargement of the thyroid gland.
Surgery
Thyroid surgery (stumectomy, thyroidectomy) is usually only one of the stages of treatment of multinodal non-toxic goiter. The decision on its necessity is made by the doctor after a series of specialized studies (cytology, ultrasound) and after a conversation with the patient.
Indications for thyroid surgery:
- large goiter (nodular, parenchymal), which inhibits the respiratory tract or causes an adverse cosmetic effect (even if normal thyroid function is maintained);
- the presence of a malignant tumor;
- the development of the disease, despite the use of appropriate drugs.
The thyroid gland is located on the neck and consists of two petals (right and left) connected to each other by a thin strip of glandular tissue. Depending on the decision of the doctor, only part or the whole gland can be removed.
How does thyroid surgery work?
The operation is performed under complete anesthesia and takes about two hours. The recovery period of the patient in the hospital takes about 7-10 days.
After the operation, the most important thing is to remain under the constant supervision of an endocrinologist. This will help to avoid unwanted complications. After surgery, hypoparathyroidism may occur, caused by a decrease in gland size, or hoarseness (this usually disappears in a period of 6 to 12 months). The scar remaining after the operation should be in the form of an arch about 10 cm long. It is usually not visible, because the seams disappear very quickly.
Complications after thyroid surgery
Complications after thyroid surgery are rare. Most often among them are:
- laryngeal nerve damage;
- parathyroidectomy;
- postoperative bleeding;
- allergic reactions after drug administration;
- inflammatory complications;
- damage to neighboring organs;
- air embolism.
Nutrition Tips
Applying the right diet is critical to health, and in addition, it enhances the effects of the therapy that the patient undergoes. Therefore, many nutritionists recommend eating foods high in iodine - seafood, crustaceans and iodized salt.
Products that inhibit thyroid activity include many types of vegetables, including broccoli, Brussels sprouts and cauliflower, spinach, turnips, beans, and mustard. Avoid foods such as refined sugar, milk, wheat, caffeinated drinks, and alcohol.
Thyroid disorders can be caused by the accumulation of acids in the body. This, in turn, causes metabolic problems. The key point here is the elimination of acidic foods from the diet, which will affect the regulation of pH and will support the work of all internal organs.