Enlarged Thyroid - Causes, Symptoms, Extent And Treatment Of Enlarged Thyroid

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Causes, symptoms, extent and treatment of an enlarged thyroid gland

The thyroid gland is an organ belonging to the endocrine glands. It is located on the front of the neck and consists of two lobes located on the sides of the trachea and connected by an isthmus. The size of each lobe is approximately 3 × 2 × 1.5 cm. The thyroid gland of a newborn child weighs 2-3 g, an adult - 12-25 g. The normal volume of the thyroid gland is within 25 ml in men and 18 ml in women.

The connective tissue of the thyroid gland contains follicles, the cells of which (thyrocytes) produce thyroid iodine containing hormones: triiodothyronine (T3) and thyroxine (T4). These hormones are involved in the regulation of fat, protein and carbohydrate metabolism, the functioning of the gastrointestinal tract, cardiovascular, nervous and reproductive systems. Normally, the thyroid gland is practically invisible.

Content:

• What is an enlarged thyroid
• Causes of an enlarged thyroid gland
• Symptoms of an enlarged thyroid gland
• Test to determine the level of iodine in the body
• Thyroid enlargement
• What is the threat of an enlarged thyroid gland?
• Diagnostics of the enlarged thyroid gland
• Treatment for an enlarged thyroid
• Prevention of an enlarged thyroid gland

What is an enlarged thyroid

An enlarged thyroid gland is a clinical symptom of a number of diseases of this organ with various etiologies. Popularly, an enlarged thyroid gland is usually called a "goiter", because in this case a noticeable convex formation appears on the neck, similar to a bird's goiter.

The most common cause of goiter is a decrease in gland function due to a deficiency of iodine entering the body (hypothyroidism). Severe hypothyroidism is diagnosed in 2–5% of the Russian population, minor symptoms are observed in another 20–40%. In women, thyroid pathology occurs 5 times more often than in men, young people suffer from this less often than the elderly. Often, hypothyroidism remains undetected, since its symptoms such as a general decrease in vitality, lethargy, chilliness, fragility and hair loss, etc. are not specific, but can be signs of many diseases.

Causes of an enlarged thyroid gland

Common causes of thyroid enlargement include:

• Deficiency in food and water of iodine and some other microelements (fluorine, selenium);
• Poor environmental situation, when toxic substances from the environment enter the body, which affects the functioning of the thyroid gland;
• The presence in the blood of inhibitors of the synthesis of thyroid hormones, which include sulfonamides, aminosalicylic acid, resorcinol. It is believed that substances that interfere with the production of thyroid hormones are found in turnips and soy products;
• Hypovitaminosis (vitamin D deficiency);
• The presence in the body of certain bacterial infections that suppress the activity of the thyroid gland;
• Chronic stress;
• Lack of physical activity;
• Congenital hereditary predisposition;
• Pathologies of the pituitary gland and hypothalamus, hormones of which regulate and control the function of the thyroid gland.

The above reasons can lead to the development of one of three syndromes characterized by an enlarged thyroid gland:

• Hypothyroidism An insufficient amount of iodine in the diet leads to insufficient production of thyroid hormones, as a result of which the thyroid gland begins to work intensively and grow in size. Hypothyroidism is primary and secondary. Primary, due to dysfunction of the thyroid gland itself, secondary is associated with pathologies of the pituitary and hypothalamus, with a deficiency of thyroid-stimulating hormone produced by the pituitary gland.
• Hyperthyroidism. In this case, an excess amount of thyroid hormones is produced, exceeding the norm. The reason for this may be Basedow's disease (diffuse toxic goiter), thyroiditis (inflammation of the thyroid gland), various tumor neoplasms of the gland itself, the pituitary gland and the hypothalamus. With hyperthyroidism, metabolic processes in the body are accelerated.

• Euthyroidism. With this pathology, the thyroid gland is enlarged, but the level of hormones in the blood is not changed according to the test results. With the help of compensatory mechanisms, the body copes with iodine deficiency: thyroid-stimulating hormone is produced by the pituitary gland in an enhanced mode, thereby supporting the function of the thyroid gland. Euthyroid goiter often develops during puberty, pregnancy, or postmenopause.

The goiter can be diffuse, when the thyroid gland is enlarged evenly, and nodular, with local autonomous formations in the gland. In the latter case, against the background of iodine deficiency, some thyrocytes come out of the regulatory influence of thyroid-stimulating hormone produced by the pituitary gland, which is accompanied by the formation of nodes in the gland tissue. Nodular goiter is more common in people over 50.

Also, depending on the causes of the occurrence, the enlargement of the thyroid gland is subdivided into endemic and sporadic goiter. The appearance of endemic goiter is due to a lack of iodine in the environment: in food, soil, etc. Sporadic goiter develops in people living in regions with a sufficient amount of iodine. Like endemic, it can be diffuse or nodular, as well as mixed. In this case, the provoking factors can be poor ecology, exposure to radiation, unfavorable heredity, and taking certain medications.

Symptoms of an enlarged thyroid gland

Common symptoms of thyroid dysfunction are:

• Weight change in the direction of increase or decrease in the absence of changes in the volume and diet;
• Heart rhythm disorder;
• Progressive hair loss;
• Thermoregulatory disorders: chills or a feeling of heat;
• Fatigue, constant fatigue;
• Increased irritability, sleep disorder;
• Menstrual irregularities in women and problems with potency in men;
• Vision problems;
• Nausea, vomiting, gastrointestinal disorders (constipation, diarrhea).

As mentioned above, dysfunction of the thyroid gland can take two forms: its decrease (hypothyroidism), characterized by a low level of thyroid hormones, and excessive activity (hyperthyroidism or thyrotoxicosis), manifested in the excessive production of hormones. Depending on this, the symptoms of an enlarged thyroid gland may vary.

Symptoms of hypothyroidism:

• An increase in body weight due to a slowdown in metabolic processes in the body;
• Dryness, fragility and hair loss;
• Tendency to chilliness, chills, poor cold tolerance;
• Swelling of the face and eyelids, as well as limbs;
• Decreased appetite;
• Dry mouth;
• Slowing heart rate: pulse below 60 beats per minute;
• Decrease in blood pressure;
• Nausea, vomiting, constipation, flatulence;
• Increased blood cholesterol;
• General weakness, lethargy, drowsiness;
• Difficulty breathing, hoarseness, hearing impairment;
• Depression, depressed mood;
• Headaches;
• Dryness, flaking, pallor, or yellowness of the skin;
• Tingling in the hands;
• Violation of the menstrual cycle in women;
• Signs of anemia;
• Memory impairment, decreased performance.

Hyperthyroidism symptoms:

• Weight loss with adequate nutrition and increased appetite;
• Acceleration of heart rate: pulse more than 90 beats per minute;
• Increased blood pressure, shortness of breath;
• Thinning hair and brittle nails, early gray hair;
• Poor heat tolerance and increased sweating;
• Skin moisture, in some cases - violations of its pigmentation;
• Feeling thirsty, frequent urination;
• Gastrointestinal disorders: vomiting, diarrhea, constipation;
• Muscle weakness and fatigue;
• Hand tremor;
• Vision problems: photophobia, lacrimation, development of bulging eyes;
• Sexual dysfunction;
• Increased excitability, nervousness, irritability, anxiety, fear;
• Sleep disorder.

Usually only some of the listed symptoms are observed. In old age, severe symptoms may be absent altogether. Hearing impairment with hypothyroidism occurs due to swelling of the Eustachian tube. With euthyroid goiter (when the content of hormones in the blood is within the normal range), the leading complaint is a cosmetic defect, a feeling of discomfort and heaviness in the neck. A significant enlargement of the gland can put pressure on nearby blood vessels and organs. When the trachea is squeezed, coughing, shortness of breath appear, when the esophagus is squeezed, difficulties and painful sensations when swallowing food, especially hard food. There is discomfort when wearing scarves and high-collared clothing.

With inflammation of the gland or hemorrhage in the nodular goiter, pain appears in the neck area, the temperature rises, the goiter begins to rapidly increase in size.

Symptoms related to the nervous system are almost always observed. The person becomes irritable, nervous, quick-tempered, prone to mood swings. In hyperthyroidism, this is accompanied by increased physical activity and aggression. A common symptom is a small tremor of the fingers, which increases with stretching the arms. Children have tics - violent movements of the muscles of the face and limbs.

Another characteristic symptom is changes in the work of the cardiovascular system. An increase in the function of the thyroid gland is accompanied by tachycardia, a decrease - by bradycardia. Often these signs precede visual enlargement of the gland. Shortness of breath with hyperthyroidism is usually associated not with cardiac activity, but with a constant feeling of heat. An increase in systolic (upper) pressure is typical, while diastolic (lower) pressure can remain normal. With prolonged hyperthyroidism and untreated, there is a risk of osteoporosis.

An overactive thyroid gland is always accompanied by severe sweating of the whole body. The skin becomes thin, moist, prone to redness, itching is possible. Muscle weakness mainly affects the muscles of the arms and shoulder girdle.

Endocrine ophthalmopathy, which is a consequence of autoimmune damage to the thyroid gland (Graves disease), is considered a characteristic feature of diffuse goiter. In the early stages of the process, dry eyes, photophobia, and swelling of the eyelids are noted. In the future, there is a protrusion of the eyeballs and a limitation of their mobility, exophthalmos (incomplete closure of the upper and lower eyelids) may develop.

How to identify an enlarged thyroid gland?

The normal size of the thyroid gland is 25 ml in men and 18 ml in women. With the development of diseases, the volume of the gland increases, since it begins to work in an enhanced mode, producing an excess amount of hormones or trying to maintain their production at the required level.

If you put your hand in front of the neck so that the thumb is on one side of the cartilage, and the other four are on the other, then you can feel a soft formation. This is the thyroid gland. Normally, its length is equal to the length of the extreme phalanx of the thumb (on which the nail is located). The gland should have a soft and elastic consistency and move with the cartilage during swallowing movements. If it seems that the size of the gland is larger, and its structure is too dense, or local nodules are found in it, then it is recommended to visit an endocrinologist for an examination.

Test to determine the level of iodine in the body

You need to take the usual 3-5% iodine and, using a cotton swab, apply an iodine net to any part of the body (except for the thyroid gland) at night. This could be the ribcage, lower abdomen, or thigh. If by morning the mesh disappears or becomes completely pale, this indicates an iodine deficiency. If the color of the mesh remains practically unchanged during the day, this indicates an excess of iodine in the body.

You can make this test more accurate. Before going to bed, apply three lines on the forearm with iodine solution: thin, slightly thicker and thick. If the first line disappears by morning, then everything is normal with the iodine content in the body. If two thicker ones disappear, it is recommended to check the thyroid gland. If there are no traces left on the skin, there is a clear lack of iodine.

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Thyroid enlargement

Normally, the thyroid gland is not visually noticeable and practically cannot be felt.

The simplest classification of goiter size is used by the World Health Organization (WHO) and includes three degrees of thyroid enlargement:

• Zero degree: there is no goiter, the gland is palpable, the sizes of the lobes correspond to the length of the nail phalanges of the thumbs;
• First degree: enlargement of the gland is palpable, but the goiter is not visually noticeable in the normal position of the head;
• Second degree: the goiter is palpable and visible to the eye.

In Russia, the most common classification of Professor O. V. Nikolaev.

According to this classification system, there are five stages of goiter development, each of which has its own clinical signs:

1. First degree: The thyroid gland is not visually changed, changes are not palpable, but at the time of swallowing, an isthmus is visible connecting the lobes of the gland.
2. Second degree: The lobes of the gland are well palpated and visible during swallowing. At the same time, the outlines of the neck remain the same.
3. Third degree: The goiter and the isthmus of the gland become clearly visible, the neck thickens, but this does not cause any pronounced physical discomfort.
4. Fourth degree: The goiter continues to grow, the outlines of the neck change greatly, the contours of the lobes of the gland are drawn on it, visible even in a state of immobility and rest.
5. Fifth degree: The goiter becomes large and begins to squeeze nearby organs: the trachea, esophagus, blood arteries, vocal cords, which may be accompanied by shortness of breath, difficulty in chewing and swallowing, a feeling of heaviness in the chest, headaches, and voice changes.

The most accurate determination of the size of the thyroid gland allows ultrasound, since during a visual examination, errors are possible, which depend on the development of the cervical muscles, the thickness of the fat layer, and the location of the gland. Its value is calculated by the formula:

Volume of one lobe = (length) × (width) × (thickness) × 0.48.

Then the volume indicators of the two shares are summed up. The dimensions of the isthmus are not of significant diagnostic value.

What is the threat of an enlarged thyroid gland?

Thyroid pathologies cause disorders of all types of metabolism: protein, carbohydrate, fat; negatively affect the activity of the nervous and cardiovascular systems.

Lack of treatment can lead to serious and life-threatening consequences:

• An enlarged thyroid gland puts pressure on nearby organs, which is accompanied by impaired blood circulation, respiratory and swallowing processes;
• On the part of the cardiovascular system, cardiac arrhythmias (tachycardia, bradycardia, arrhythmia), surges in blood pressure occur;
• On the part of the nervous system, imbalance appears, an inability to control one's emotions, a tendency to depressive states;
• A large goiter itself is a major cosmetic defect;
• With hyperthyroidism (thyrotoxicosis), a complication such as a thyrotoxic crisis (a sharp release of a large amount of thyroid hormones into the bloodstream) is possible. In this case, immediate hospitalization is required, since a severe crisis can be fatal.

Diagnostics of the enlarged thyroid gland

The main procedures required to make a diagnosis include:

• Medical examination. The endicrinologist listens to complaints and palpates the organ. With superficial palpation, the overall size of the gland and the nature of the increase (diffuse or nodular) are determined. With deep palpation, the consistency of the organ (soft or dense), soreness, pulsation (normally pain and pulsation are absent), mobility are analyzed. A healthy thyroid gland is soft, mobile, has a uniform consistency and a smooth surface, there is no adhesion to the surrounding tissues.
• Blood test for hormones. To diagnose pathologies of the thyroid gland, the level of thyroid-stimulating hormone (TSH), hormones T4 and T3 is detected. Thyroid stimulating hormone is produced by the pituitary gland and regulates thyroid function. A high concentration of this hormone indicates its decreased function. The thyroid's own hormones, thyroxine (T4) and triiodothyronine (T3), are mainly found in the blood in a bound state and depend on serum proteins. The hormonal activity of the thyroid gland is determined by the concentration of free T3 and T4. However, in general, an increased level of thyroxine and triiodothyronine is observed with hyperfunction of the gland (hyperthyroidism and thyroiditis), a decreased level - with hypothyroidism.
• Ultrasound of the thyroid gland. An ultrasound examination determines the size of the gland, the degree of enlargement, the absence or presence of nodules.

Find out more: Ultrasound of the thyroid gland - preparation, what shows what is the norm?

If nodes larger than 1 cm in diameter are detected in the thyroid gland, additional studies may be prescribed:

• Puncture biopsy. It is carried out if a tumor is suspected. In this case, a cytological and histological analysis of the cells of the tissue removed from the seal in the gland is done.
• Magnetic resonance imaging and computed tomography. These methods are more informative than ultrasound. The location, size, contours, structure of the thyroid gland, the density of the existing nodes are assessed.
• Radioisotope research (scanning). With its help, the size and shape of the organ, the activity of the nodules are determined. It is believed that, based on the results of this method, one can assume the presence or absence of a malignant process in the gland.
• Study of the absorption of radioactive iodine by the thyroid gland (used in rare cases).

General studies and analyzes are also assigned:

• General blood analysis;
• General urine analysis;
• Biochemical blood test to determine the level of bilirubin, liver enzymes, urea, creatinine, serum proteins, etc.;
• Determination of cholesterol levels: with hyperfunction of the gland, cholesterol is usually lowered, with hypofunction - increased. However, high cholesterol levels can be caused by many other diseases (the most informative use of this indicator when making a diagnosis in children);
• Chest X-ray. With a large goiter and its retrosternal location, X-rays can reveal the degree of enlargement of the gland, assess the state of the esophagus and trachea;
• Electrocardiogram, etc.

In each case, diagnostic methods are selected individually, depending on the history and the characteristics of the pathology.

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Treatment for an enlarged thyroid

With timely and adequate treatment, it is possible to reduce the gland to its natural size and restore its normal function. The first priority is to normalize thyroid hormone levels.

The restoration of the thyroid cells themselves is essential for a healthy thyroid gland. Modern means - peptide bioregulators - can help to restore damaged cells. To improve the function of the thyroid gland, a peptide bioregulator, Tyramine, has been developed. Components for Tyramine, obtained from the thyroid glands of cattle, they are a complex of proteins and nucleoproteins that have a selective effect on the cells of the thyroid gland, which helps to restore its function.

Tyramine is recommended for use in case of thyroid dysfunction, hypo- and hyperfunction, tumor processes in the glandular tissue. As a prophylactic agent, Tyramine is advisable to apply to persons living in areas endemic to thyroid diseases.

Hypothyroidism treatment

Thyroid hormone preparations are taken as substitution therapy. These include Levothyroxine sodium, Eutirox, Liothyronine, Triiodothyronine. The dosage is assigned individually according to the results of the examination. Also, these drugs are used for neoplasms in the thyroid gland, as suppressors for diffuse non-toxic goiter, to prevent relapses after removal of part of the gland.

With primary hypofunction and endemic goiter during treatment with hormones, it is necessary to monitor the level of thyroid-stimulating hormone; in secondary hypothyroidism, monitor the level of free T4.

With extreme caution, thyroid hormones should be used by patients with cardiovascular diseases (ischemia, angina pectoris, hypertension) and impaired liver and kidney function. During pregnancy, the need for hormones increases by 30–45%.

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Hyperthyroidism treatment

There are three main methods of therapy for hyperthyroidism: drug treatment, surgical removal of all or part of the gland, and therapy with radioactive iodine, which destroys excess thyroid tissue and nodules.

Medication treatment consists in the use of thyrostatic agents that suppress the excessive activity of the thyroid gland. These include Propylthiouracil, Propicil, Mercazolil, Tiamazole, Tyrozol, lithium preparations. Iodine preparations prevent the release of T3 and T4 from the thyroid gland, suppress their synthesis, the capture of iodine by the gland and the transition of thyroid hormones into an active form. Contraindications to their appointment are severe liver damage, leukopenia, lactation.

Treatment with radioactive iodine is indicated for patients over the age of 40. The difficulty with this method is that it is very difficult to choose the right dosage and predict the reaction of the thyroid gland. There are frequent cases when, after it was possible to normalize the function of the thyroid gland, hypothyroidism begins to develop in the future and maintenance therapy is required.

Surgical intervention is performed in the following cases:

• The presence of nodes in the thyroid gland, the size of which exceeds 2.5-3 cm;
• The presence of cysts over 3 cm in size;
• Thyroid adenoma;
• Retrosternal location of the nodular goiter;
• Suspicion of a malignant tumor.

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Prevention of an enlarged thyroid gland

When living in regions related to iodine deficiency, it is recommended to take iodine preparations, eat foods with a high iodine content, replace ordinary table salt with iodized salt. Iodine preparations must be taken systematically, in courses, and it is better to do this under the supervision of a doctor, since an overdose of iodine is as dangerous as its lack. The elderly with an enlarged thyroid gland and people with nodular goiter should be treated with extreme caution.

Foods rich in iodine:

• Seaweed (dried, frozen, canned);
• A fish;
• All seafood: shrimp, squid, mussels, shellfish;
• Embryos of grains; bread made from low grade flour and bran.

To compensate for the lack of iodine, these products should be eaten regularly, and not from time to time. Prolonged cooking reduces the iodine content of the product.

Also, some vegetables and legumes contain substances that affect the absorption of iodine by the body: they prevent it from entering the thyroid gland or inhibit the activity of enzymes involved in the synthesis of thyroid hormones. These include turnips, rutabagas, radishes, dill, beans.

Nutrition for hypothyroidism

In hypothyroidism, it is recommended to reduce the calorie intake, especially carbohydrates and saturated fat with high cholesterol content. The consumption of protein foods must comply with physiological norms. A proper organization of rest is also necessary, a vacation at sea is useful.

Nutrition for hyperthyroidism

With thyrotoxicosis, the basal metabolic rate is accelerated, which leads to increased energy consumption, therefore, in this case, a high-calorie diet is recommended, in which the content of proteins, carbohydrates and fats should be well balanced. You should give preference to easily digestible proteins, in the first place among which you can put dairy products. Also, dairy products are an excellent source of calcium, the need for which is increased in people with hyperthyroidism.

Of great importance for hyperfunction of the thyroid gland is a sufficient content of vitamins and microelements in food. You should limit the use of foods and drinks that stimulate the cardiovascular system and the central nervous system: strong coffee and tea, chocolate, cocoa, spices, rich meat and fish broths. Better to switch to fractional meals, 4-5 times a day, drink enough water. From drinks, decoctions of rosehip and wheat bran, diluted fruit juices (with the exception of plum, apricot, grape) are useful.

The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist

Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).