Causes, symptoms, stages and treatment of euthyroid goiter
Content:
- What is euthyroid goiter?
- Symptoms of a euthyroid goiter
- Causes of euthyroid goiter
- Types of euthyroid goiter
- Stages and diagnosis of euthyroid goiter
- Treatment for euthyroid goiter
- Prevention of euthyroid goiter
What is euthyroid goiter?
Euthyroid goiter is a group of endocrine pathologies affecting the thyroid gland. In contrast to toxic and other forms of goiter, EZ (euthyroid goiter) is much less dangerous. The term "euthyroid" itself indicates the absence of changes in the intensity of secretion of specific thyroid hormones. Therefore, in this form, neither hypo- or hyperthyroidism symptoms will be observed.
EZ is the most common disease among other types of goiter. According to statistics, the incidence rate is about 50-70% of all cases of visits to an endocrinologist. The main categories subject to the pathological process are school-age children, adolescents (8-14 years old), as well as older young people (15-21 years old).
The overwhelming majority of patients are female (about 70-80%), which is explained by the increased need of the female body (especially during the period of active development) for thyroid hormones and a tendency to frequent changes in hormonal levels.
It is important to keep in mind that euthyroid goiter over time can turn into another disease and become toxic, or even lead to a malignant process, etc.
Symptoms of the euthyroid goiter of the thyroid gland
As already mentioned, the functions of the thyroid gland in euthyroid goiter are not impaired or slightly impaired. Pronounced symptomatology is absent in the first stages of the development of the disease, later it is mechanical in nature. Biochemical symptoms are scanty or not observed either.
Mechanical symptoms appear with the growth of organ tissues, when the goiter is already palpable. As the pathology develops further, the compression of the adjacent organs increases.
Among the typical symptoms of euthyroid goiter are:
- Chronic paroxysmal cough that cannot be stopped. Its occurrence is due to irritation of the tracheal wall.
- Shortness of breath, in the later stages of goiter formation - choking. It is associated with compression of the trachea by an overgrown formation. Observed in the later stages.
- Burning, tickling sensation in the throat.
- Difficulty swallowing.
- Hoarseness or hoarseness of the voice. If the tissues of the thyroid gland grow even more - loss of voice.
- Soreness in the neck is possible. However, the patient rarely complains of pain.
- "Thick Neck". With this symptom, the overgrown thyroid gland changes the shape of the neck, it becomes like a bird. Pathology takes the form of a pronounced cosmetic defect.
Symptoms are nonspecific, typical for any form of goiter. Build up gradually. Since the disease itself does not develop rapidly, the entire complex of symptoms can appear years after the onset of the disease.
At the 3rd-5th stages of goiter formation, slight manifestations of hypothyroidism (decreased secretion of triiodothyronine and thyroxine) may be observed. Their occurrence is extremely rare.
In general, the intensity of the symptomatic manifestations of this group is much lower than with other forms of goiter.
Causes of euthyroid goiter of the thyroid gland
The causes of goiter in general and euthyroid goiter in particular are not fully understood. The reason why, with the same development of the pathological process, in some cases, severe functional disorders in the work of the thyroid gland develop, in others, only diffuse and nodal changes without disturbances in the intensity of secretion are not fully understood.
Presumably, the following factors play a special role in the mechanism of EZ formation:
- Stagnant inflammatory processes in the thyroid gland itself and surrounding tissues (for example, chronic osteochondrosis, etc.). In response to the focus of inflammation, the organ begins to increase the number of cells for the purpose of protection, and since this process is not associated with a lack of substances necessary for the synthesis of specific hormones, secretion is not impaired.
- Lack of elements necessary for the production of active substances. These include, first of all, iodine and selenium. Slightly less important are cobalt, manganese, etc. In order to "catch" and convert more substances, the thyroid gland begins to grow. As soon as the compensatory function is reached, growth stops. In this case, the thyroid gland continues to work as needed, without producing either excess or deficiency of substances.
- Rare autoimmune diseases. EZ also includes the so-called Hashimoto's goiter, in which the immune system attacks the thyroid cells and destroys the iodine-containing compounds.
- Genetics. Although the disease itself is not inherited, the predisposition and characteristics of the immune and endocrine systems are directly related to genetic factors. Therefore, in children whose parents suffered from one form or another of goiter, the risk of developing pathology is higher. The absence of thyroid problems in the genetic line, however, does not guarantee that a goiter will not appear in a person.
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Environmental factors. The higher the content of toxic substances in the environment, the more significant the negative impact on the thyroid gland. It is especially dangerous to be in areas with an increased radiation background, since free radicals contribute to the development of mutant thyrocyte cells.
- Bad habits. Drug and nicotine addiction affects the thyroid gland by interrupting the normal secretion of hormones. The thyroid gland can respond to this with diffuse and nodular changes.
- Hormonal changes and surges. Women are most susceptible to them during the period of peak activity of the body: pubertal period, period of gestation and lactation, postmenopause. During such periods, the risk of developing not only EZ, but also toxic goiter is high.
Taken together, these negative factors directly affect the formation of euthyroid goiter.
Types of euthyroid goiter of the thyroid gland
Depending on the nature of the changes in the thyroid gland, EZ is subdivided into three types:
- Diffuse.
- Nodal.
- Diffuse nodal.
Diffuse EZ is characterized by a gradual, uniform increase in thyroid tissue. No nodules are formed on the tissues.
With nodular euthyroid goiter, as the name suggests, thyroid tissue grows unevenly. The organ is covered with one (single-nodular goiter) or several nodes (multinodular form), which grow independently. Moreover, the thyroid gland itself does not increase in size or increases only slightly.
Diffuse-nodular EZ is characterized by the simultaneous course of these two processes: the thyroid gland increases its mass (diffuse changes) and at the same time, independent formations develop on the body of the organ, growing separately. These can be colloidal nodes, cystic structures, etc.
Stages and diagnosis of euthyroid goiter of the thyroid gland
According to the international classification, there are three stages of EZ:
- 0: the goiter is not palpable and not visible to the eye.
- 1st: goiter is felt on superficial palpation and is visible to the eye when swallowing.
- 2nd: the goiter is visible with the naked eye in the normal position of the neck and is easily palpable
Diagnostics of the euthyroid goiter
To determine the type of goiter and the nature of the process, various instrumental and laboratory methods are used:
- Palpation. Palpation allows you to establish the presence of the process and determine its stage, but does not give information about the type of goiter. It is possible to determine hypo- and hyperthyroidism only in the 2-3rd stage of the disease, when the goiter is already visible to the naked eye. However, palpation makes it possible to identify the onset of the disease in time and send the patient for diagnostic procedures to clarify the diagnosis.
- Analysis of venous blood for specific substances, such as triiodothyronine (T3), thyroxine (T4), TSH and thyroglobulin. With euthyroid goiter of any kind, hormonal indicators will be normal, and globulin will be below the established norm.
- Ultrasound examination of the thyroid gland. The most accessible and simple diagnostic method. At the same time, it is not so easy to identify EZ; a careful assessment of the echogenicity of the gland, its structure and size is required.
- Biopsy. Fine needle puncture is used to determine the composition of the contents of the nodes.
- Radioisotope research. The introduction of radioactive iodine preparations makes it possible to assess the functional capabilities of the thyroid gland, as well as the nature of its formations (nodes).
- Analysis of venous blood for the presence of antibodies to thyroglobulin and other specific substances. This study is important to exclude autoimmune diseases in which iodine-containing compounds and thyroid cells are destroyed. Such as Hashimoto's thyroiditis.
It is possible to correctly diagnose euthyroid goiter by identifying simultaneously two parallel factors:
- Normal thyroid hormone levels.
- Diffuse and / or nodal changes in the organ.
Therefore, the main role in the diagnosis is played by ultrasound and hormonal tests.
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Treatment of euthyroid goiter of the thyroid gland
The correct diagnosis plays a huge role, since the treatment of goiter without functional disorders of the thyroid gland is fundamentally different.
To eliminate the disease, they resort to conservative methods, and in case of insufficient efficiency, they also resort to operational ones.
In the early stages, the disease does not require treatment. The pathological process can stop itself. If the disease progresses, in the vast majority of cases, conservative treatment is sufficient.
Since the hormonal background in euthyroid goiter is normal, the use of thyroid hormone preparations is strongly discouraged. They should only be resorted to if violations are observed.
Usually, treatment consists of:
- Taking iodine preparations to compensate for iodine deficiency, or to smooth out negative factors;
- Diet and lifestyle adjustments.
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If hypothyroid disorders are observed, it is recommended to take levothyroxine or its analogues.
There are no absolute indications for surgical intervention, but in medical practice, there are reasons for which an operation is prescribed:
- A goiter is a significant cosmetic defect. In this case, its elimination is not required without fail.
- Goiter is a threat to the patient's life. This happens if the formation interferes with nutrition and breathing, and also squeezes the surrounding organs. In this case, delays can lead to serious complications, up to and including death.
- There are nodules over a centimeter in size. In this case, a biopsy is performed and, with a confirmed malignant nature of the nodes, an operation is prescribed.
Surgery is a last resort.
Prevention of euthyroid goiter of the thyroid gland
The main preventive measure is the consumption of foods with a high iodine content. Risk groups (adolescents, pregnant and lactating women, older women) should also take iodine preparations in addition to consuming iodized products. Thus, euthyroid goiter differs from other types in the absence of functional disorders. To diagnose it, an integrated approach and special care of a specialist are required. The effectiveness of treatment depends on the literacy of diagnosis. An incorrect diagnosis can cause irreparable harm to the patient's health, since thyroid hormone preparations prescribed for other forms of goiter have serious side effects, but they are powerless to help here. The treatment is based on conservative methods; surgical intervention is resorted to only if there is a threat to the patient's life. Preventive measures include correction of diet and lifestyle, giving up bad habits. Consumption of foods rich in iodine is especially important. |
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).
