Causes, symptoms, diagnosis and treatment of goiter
- What is a goiter?
- Classification of thyroid diseases
- Symptoms of a thyroid goiter
- The causes of goiter
- Diagnostics of the thyroid goiter
- Test to determine the level of iodine in the body
- Treatment methods
- Goiter prevention
What is a goiter?
Goiter is an enlarged thyroid gland. The name "goiter" itself is taken from the designation of the area of the enlarged esophagus in birds. It is also called goiter and is a kind of food sump.
This disease is most often found in countries where there is an iodine deficiency (however, it can also be caused by a high iodine content against the background of the use of iodine preparations). Women are affected by this disease 5 times more often than men. The nodes formed are nothing more than a multitude of fibrous scars that form in the tissues of the thyroid gland.
The thyroid gland (thyroid gland) is the center of metabolic control 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 in our body. Despite its meager size and weight (about 20 grams), it is truly a generator of vital energy. No wonder doctors call her a "working bee". The thyroid gland produces thyroxine, triiodothyronine, and these are precisely the substances without which the production of the necessary energy by the body is practically impossible. Moreover, this energy is directed to the work of all systems and organs of a person.
The thyroid gland also regulates the activity of the heart, brain activity, muscle tone ("muscle armor"). This is the guardian of health. In women, hormonal changes occur with age - before and after menopause. Therefore, the thyroid gland is very sensitive during this period, reacts quickly to stress, weakening of the immune system, infections, deficiency or excess of iodine. Due to the fact that there is a pathological activation of antibodies that oppose healthy cells, with age, a woman's body is more exposed to autoimmune diseases. These antibodies decrease thyroid function. As a result, there is weakness, deterioration in the quality of memory, swelling, weight gain, dry skin, brittle hair, muscle pain and spasms, and constipation.
Video: Life is great! what is diffuse toxic goiter?
Worldwide, endemic goiter should be considered the most common. It is caused by iodine deficiency in food. In countries where iodized salt is used, Hashimoto's goiter is most often formed, the alternative name of which is autoimmune thyroiditis.
Other reasons can be divided into two conditional blocks:
- Genetic abnormalities in the processing of hormones by the endocrine gland (eg, cretinism);
- The use of strumogenic products as food, for example, cassava;
- Side effects after using medicines.
Symptoms of hypothyroidism are hair loss, dry and pale skin, brittle nails, thinning eyebrows, decreased appetite, weight gain. With diseases of the thyroid gland, speech slows down, memory deteriorates, almost constant sleepiness appears, the menstrual cycle gets confused. At the same time, the presence of all these symptoms is not necessary, usually two or three, but they are more pronounced.
- Toxic goiter of a diffuse type, known as Graves' disease;
- Thyroiditis (active inflammatory processes);
- Oncology of the thyroid gland.
Hyperthyroidism is an increased production of hormones by the thyroid gland. Companions of this disease are insomnia, general weakness, irritability, heart palpitations, excessive sweating. A person suffering from this disease may have a good appetite, but lose weight. Plus to all this - high blood pressure, enlargement of the eyeballs, tremors in the hands (tremors).
Classification of thyroid diseases
Thyroid diseases can be classified according to a variety of criteria, the first of which is etipathogenetic. It determines the factors and mechanisms of formation. On this basis, endemic (characteristic only for a certain type of area) and sporadic goiter are distinguished. The first is observed in geographic areas endemic for goiter, and the second, respectively, in all others.
According to morphology, diffuse, nodular and mixed (diffuse-nodular) goiter are distinguished. By location:
- Standardly placed;
- Partially located behind the sternum;
- Dystopic, consisting of embryonic anlages (for example, goiter of the root system of the tongue or an accessory lobe of the thyroid gland).
Also, goiter is distinguished by the degree of increase. According to the classification of WHO (World Health Organization), it is possible to distinguish three types:
- Zero degree
- First degree
- Second degree.
At the first stage, there is no increase, at the second stage, it is possible to palpate the goiter, but it is not visible in the normal position of the neck, and at the third stage, it is not only groped, but also visible with the naked eye.
A more detailed classification by the degree of increase was proposed by O. V. Nikolaev, according to 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 is a significant thickening of the neck;
- The fourth is a change in the shape of the cervical spine;
- The fifth is a huge goiter.
Symptoms of a thyroid goiter
At the initial stages, patients may not notice even the slightest manifestations of goiter. The formation of this ailment over time provokes a clear bulging or swelling of the neck in its front part (in the Adam's apple). The enlarged endocrine gland also begins to press on the trachea, nerve endings and blood vessels that are located nearby. Diffuse goiter, visually, is identified by a uniform increase in the thyroid gland. If we talk about the nodal variety, then it, most often, is much more enlarged on one side of the larynx. That is, in this case, not only uneven, but also non-uniform increase is expressed.
The impact on those organs that are located nearby can be manifested by the following symptoms:
- Difficulty breathing
- Rapidly progressive change in voice, accompanied by hoarseness;
- Asthma attacks occurring at night;
- Pounding cough;
- Difficulty swallowing food
- Dizziness, great heaviness in the head.
With the presented neoplasm, which is accompanied by hypothyroidism, an atypical form of pneumonia, bronchitis or ARVI may form. In addition, most often in women, hypotension occurs, painful and simply unpleasant sensations similar to constriction in the region of the heart. All this, as the disease progresses, is aggravated by shortness of breath, a decrease in the habitual craving for any food, bloating, nausea and drowsiness. In the final stages, memory worsens and weight increases, despite all the problems with the gastrointestinal tract.
In males, on the basis of an insufficient ratio of iodine in the blood, there is a decrease in sexual desire, destabilization of sexual function. Women are characterized by changes such as menstrual irregularities, which, in turn, are a catalyst for infertility and miscarriages.
With varieties of goiter such as Basedow's disease or benign thyroid hyperplasia, symptoms such as:
- Long-term maintenance of elevated body temperature;
- Decrease in total body weight;
- Bulging of the eyeballs;
- Permanent hunger;
- Exhausting insomnia;
- Sporadic irritability;
- Progressive trembling in the upper limbs.
Video: the first symptoms of thyroid problems that should not be ignored:
The causes of goiter
The factors directly affecting the formation of goiter should be considered in more detail. This is due to the fact that the lesions of the endocrine gland, as well as their causes, can be very different.
As noted earlier, the main reason that provokes the appearance of endemic toxic goiter is iodine deficiency in the body. Its insufficient number is explained by the lack of the presented connection in specific territories. This is precisely the reason that causes a decrease in the secretory degree of activity.
In addition, some negative impact on its work is associated with the poor ecology of the environment. So, substances of toxic origin, which appear in the human body from the outside, are able to suppress the functioning of the endocrine system and slow down the degree of thyroid activity.
Endemic goiter can also form with relatively little consumption of products, the list of components of which includes iodine. We are talking about fish, fruits and milk.
In the case of Graves' disease, or a toxic goiter of diffuse origin, the endocrine gland is exposed to 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 highlight:
- Endocrine gland adenoma;
- Oncological neoplasms.
With such lesions, progressive disturbances in the process of cell division, as well as their differentiation, are noted. This can be provoked by a radiological background, substances dangerous from a toxic point of view, and also have a genetic character.
Goiter in children
Separately, it is necessary to talk about goiter in children, because it is the most common iodine deficiency disease. In the overwhelming majority of cases, a diffuse form of the disease is formed.
According to WHO studies, 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 an inappropriate diet, as well as an unfavorable environmental situation. In 30% of cases, goiter 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 most 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.
Diagnostics of the thyroid goiter
As part of the diagnosis of goiter, laboratory-type blood and urine tests are used. The blood of a person with any clinical signs of neoplasm is tested for the ratio of hormones such as TSH, T3, T4 and thyroglobulin. The diagnosis is determined based on the fact that those who are faced with the presented type of ailment usually have an imbalance in thyroid hormones and an increased thyroglobulin ratio. At the same time, the data on the excretion of iodine in the urine remain reduced.
Ultrasound should be considered an instrumental method for diagnosing the formed goiter. Thanks to him, it is possible to accurately establish the form of development of the disease, for example, it is diffuse or nodular goiter. With the help of radioisotope scanning, the functional state of the endocrine gland is determined and assessed.
With the nodular type of endemic goiter, as an additional examination measure, specialists resort to a biopsy of the gland. This makes it possible to determine the nature of the disease. So, it can be benign or malignant.
If, as a result of palpation, suspicions of thyroid goiter arise, in order to make a definite diagnosis, identify the etiology and stage of development of the disease, such mandatory examinations should be consistently carried out as:
- Take a blood test for the ratio and level of hormones (it is recommended to take the test several times within two to three months from the start of treatment);
- Examination of tendon-type reflexes for a while;
- Ultrasound of the thyroid gland.
Test to determine the level of iodine in the body
There are three most accurate and easily feasible tests for determining the ratio of iodine in the body:
- Test 1. The first of them is as follows: you need to take a standard (3 or 5% iodine). With its help, you need to draw a grid on your own body - preferably in the evening, when physical activity is over. Particular attention should be paid to the lower abdomen as well as the thighs. After the iodine is completely dry, you need to go to bed. So, if in the morning it turned out that the mesh was "gone" at least by half, then the iodine content in the body is obviously insufficient. If the shade of the mesh lasted more than 12 and even more than 24 hours, then this suggests that there is some excess of iodine, which should also be fought.
- Test 2. The second test is as follows - you need to dip a cotton swab in an alcohol-type iodine solution. After that, apply iodine-containing mesh to any area of the body, except for the endocrine gland itself. The next day, you need to carefully consider this place. If there are no traces of iodine left, then it is necessary for the body, but if, on the contrary, the pattern remains, then there is no deficit.
- Test 3. And finally, the third, much more accurate testing. For its implementation, before going to bed, apply three strips with an iodine solution to the skin in the forearm area. This must be done sequentially: first a thin line, then a little thicker and then the thickest. If in the morning it was found that the first line had disappeared, this means that everything is normal with the iodine ratio.
If the first two are not visible, then you should pay close attention to the state of health. In the same case, if there is not a single strip left, it is possible to talk about an obvious lack of iodine. What are the treatments for endocrine goiter?
Timely recognition of symptoms will be the key to successful treatment, which will help to cope with the disease as soon as possible. So, when signs of an increase in goiter appear, it is necessary to consult an endocrinologist. It is very important to appeal to him, because any other specialists can simply refer to overwork.
The main method for treating goiter should be considered hormonal replacement therapy. For this, a wide variety of active tyrosine derivatives are used. This is due to 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 a sufficient dosage of the drug, but also one that will not lead to negative results. Treatment, periodic use of drugs, very often must continue until the end of life. In this case, it is recommended not to forget about controlling the ratio of hormones.
Many diseases (goiter is no exception) are caused by impaired cell self-healing processes. Normally, peptide bioregulators are responsible for this in the body. However, in modern conditions (psycho-emotional tension, malnutrition, poor ecology, etc.), their reserves are rapidly depleted. Russian scientists have developed a peptide bioregulator, Tyramine, specifically to maintain the health of the thyroid gland. The components of Tyramine 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. Tyramine is also recommended for older and elderly people to maintain thyroid function.
The hypofunction of the thyroid gland is also amenable to hormone therapy. The situation with hyperfunction is much more complicated. So, if there is a real danger of the formation of a tumor of any genesis or complications of the cardiovascular type, then it makes sense to resort to surgical intervention (it will be discussed later). This will change the situation for thyroid hypofunction. In turn, this will allow for easier and more affordable adjustments through hormone therapy.
In a more severe form of endocrine gland hypofunction, a person may fall into a coma. Hyperfunction is inherent in the fact that a toxic crisis can be fatal. In this regard, it is necessary to follow a strict diet and the intake of the required ratio of iodine in the body. At the same time, it is unconditional that it is necessary to consult a specialist and take tests for the amount of iodine in the body. Indeed, as you know, a large amount of iodine also adversely affects the thyroid gland.
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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 cannot be done without it, therefore, surgery for goiter is one of the most commonly used treatment methods.
Thus, local anesthesia is administered and large nodular or potentially dangerous areas are removed. In the most difficult and advanced cases, it is permissible to remove one of the lobes of the thyroid gland. It can also, in turn, provoke hypo- or hyperthyroidism. However, even with resection of one or several nodes, there is a need for medical recovery.
An alternative way to treat the thyroid gland is to use radioactive iodine. This solution is used to destroy the tissues of the endocrine gland. Finding the optimal dosage is extremely difficult. For this, additional groups of analyzes are also carried out. Moreover, in the first year, hypothyroidism begins to form in 25% of people. However, radioactive iodine is a unique drug that has no analogues today. What are the preventive methods for detecting goiter?
Goiter prophylaxis can be carried out in three versions and be mass, group and individual. The first method is the most effective; for its implementation, a small amount of iodine is added to those products that each person consumes in one way or another. We are talking about ordinary table salt, but iodized salt.
The advantages of this method are that such a product is quite inexpensive, but the effect of this effect is obvious. According to the WHO, as a result of such prevention, the formation of goiter decreases by 20% every year. For preventive mass iodization, other products are also used, for example, bread or water.
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Prevention of goiter by group type involves the use of preparations containing iodine by persons at risk for such a diagnosis. These are, first of all, children and adolescents who are in institutions such as kindergartens and schools.
The closest physiological means is potassium iodide, which is produced in various dosages and is used according to a specific algorithm. For such prevention, food products that contain iodine can also be used.
A separate category of the risk group for the formation of goiter is made up of women at any stage of pregnancy. They have the highest need for this component - 200 mcg 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 to identify the thyroid status.
Prevention of goiter on an individual basis also implies the use of preparations with iodine. The required dose is determined on an individual basis, as well as depending on the age category. Without a preliminary visit to the endocrinologist, it is undesirable to carry out such prevention for people who have a history of problems with the endocrine gland.
Many people are sure that the need for iodine per day can be compensated for by a special diet that contains certain foods. However, this is not 100% true, because significant dietary changes are required to compensate for an already established deficiency. Secondly, such changes are quite expensive. In addition, the use of iodine simply must be strictly dosed. After all, any fluctuations: from overabundance to deficiency are fraught with significant problems with the endocrine gland and health in general.
Thus, endocrine goiter is one of the most common health problems. This condition is practically not amenable to absolute cure, because constant prevention and the use of iodine are needed. This is what will help maintain optimal vitality and health.
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).