Endemic goiter is an enlargement of the thyroid gland, which is caused by an iodine deficiency in the body. A he althy volume of the gland, as a rule, in women does not exceed 20 cm3, and in men - 25 cm3. In the presence of a goiter, it is larger than the given dimensions. According to statistics recently cited by the World He alth Organization, over seven hundred million people who live in iodine-deficient areas suffer from endemic goiter (ICD-10 code - E01.0).
They have varying degrees of functional insufficiency of the gland. Forty-two million are diagnosed with an acquired form of mental retardation. The most unfavorable territories in terms of iodine content in the environment in our country are the Republic of Karelia, the Volga region, the Caucasus and the Siberian river valleys.
Views
Endemic goiter is differenttypes, for example:
- Euthyroid type. At the same time, the thyroid gland is enlarged in size, but the normal level of hormones is maintained.
- Hypothyroid type. Such a goiter is combined with hypothyroidism, and in addition, with reduced thyroid function.
- Hyperthyroid type. Such a goiter is characterized by excessive work of the gland.
In addition to the above forms, there are also:
- Development of diffuse goiter, in which the thyroid gland enlarges evenly.
- Multinodular endemic goiter. With the development of such a goiter, nodes of denser tissue are present in the mass of the gland.
- Development of a mixed goiter, when, in parallel with a diffuse increase, individual nodes can be felt in the thyroid gland.
Directly in its localization goiter is unilateral or bilateral. Next, we will find out what are the main causes of this pathology, and also consider the degree of the disease.
Degrees of endemic goiter
Most often distinguished:
- 0 degree - no goiter.
- I degree - goiter is felt on palpation, but not visually detected.
- II degree - goiter is determined visually and on palpation.
To determine the exact size of the thyroid gland, the patient is prescribed an ultrasound, which also reveals the shape of the goiter.
Endemic goiter: pathogenesis of the disease
As mentioned above, the cause of endemic goiter is primarily iodine deficiency in the human body. Iodine deficiency is, for example, acute. In such a case, the body will collect all itscompensatory possibilities and, as soon as the supply of iodine resumes, the normal functioning of his thyroid gland will be returned to the person, due to which any damage to other organs will not occur.
Against the background of the development of chronic insufficiency of such an important element as iodine, the situation is much more complicated. As a response to a reduced intake of iodine, as a rule, there is an increase in thyrocytes, which synthesize hormones. Due to the increase in the volume of these cells of the gland and the strengthening of their work, a relatively normal amount of the required hormones will be stabilized for a short time. But after some time, the process of their fibrosis will become inevitable and nodes will begin to form. Not everyone knows the pathogenesis of endemic goiter.
Against the background of prolonged iodine deficiency, hypertrophy of thyrocytes alone is not enough. They can not only increase in size, but also intensively divide. As a result, there are a lot of fibrosing cells in the body, and this, in turn, means that there are prerequisites for the further formation of diffuse nodular goiter.
The causes of endemic goiter are that the thyroid gland, against the background of the development of an increasing iodine deficiency, goes through several stages of changing its structure. Goiter first becomes diffuse euthyroid, then multinodular euthyroid, and eventually multinodular toxic.
The most common causes of pathology
Endemic thyroid goiter appears due to lack ofiodine.
The most common causes of iodine deficiency are:
- Taking certain medications that stimulate the excretion of iodine from the body.
- The appearance of diseases of the digestive system, which are accompanied by a violation of the absorption of substances necessary for the body.
- Use of enterosorbents.
- Development of chronic renal failure, which is accompanied by increased excretion of iodine.
- The appearance of congenital anomalies of the gland in the form of aplasia or hypoplasia.
- The presence of transient conditions that are accompanied by iodine deficiency. An example of such conditions is pregnancy along with childhood, puberty and intense physical activity. In addition, regular psycho-emotional stress also affects.
- Insignificant intake of iodine from food.
- Low intake of iodine from water.
- The presence of an energy imbalance.
- Development of chronic hypoxia.
When discussing the causes that provoke the development of endemic goiter, one should consider in more detail the lack of this element in everyday food. Most of the inhabitants of our country have almost no fresh seafood with fish in their diet. In addition, few people think about using iodized s alt for cooking.
Of course, taking only iodized s alt will not fully compensate for an iodine deficiency. This is due to the fact that iodine is a very volatile substance, which quickly disappears from the structure of s altcrystals due to the air entering them. In this regard, it is necessary to store s alt not in s alt shakers, but in glass or metal jars that are tightly closed with a lid.
Eating a significant amount of cauliflower, and in addition, beans and turnips threatens the development of iodine deficiency. This is due to the fact that these products contain too many goitrogenic substances that provoke excessive growth of thyroid tissue.
Thus, iodine deficiency primarily occurs due to the following factors:
- Insufficient iodine content in the environment, as well as in drinking water. Such regions include the middle zone of Russia, the Urals, Altai and the Caucasus.
- Unbalanced diet, against the background of which not enough fish, seaweed, dairy products, buckwheat and oatmeal are eaten.
- The systematic use of certain drugs that block the absorption of iodine.
- The presence of a hereditary predisposition along with a genetic defect in the production of thyroid hormone.
Now consider how the presence of endemic thyroid goiter in patients is manifested.
Symptomatics
Symptoms of goiter primarily depend on the functions of the thyroid gland. Especially often, patients may complain of the following sensations:
- The appearance of weakness.
- Presence of low physical endurance.
- Discomfort in the heart area.
- The appearance of headaches.
Such symptoms canappear even at an early stage of the disease. With the subsequent growth of the thyroid gland, patients may experience the following signs:
- The appearance of a feeling of squeezing in the neck.
- Presence of difficulty in swallowing and breathing.
- Appearance of dry cough.
- The occurrence of asthma attacks.
It is interesting to note that the diffuse type of goiter is the most common form. Women get it four times more often than men. This is primarily due to the increased need of women for the hormones of this gland during puberty, and in addition, during pregnancy.
It should be borne in mind that the recommended doses of iodine preparations should be as follows:
- 50 mcg is the norm for babies.
- 90 mcg should be taken by children under the age of seven.
- 120 mcg is the norm for children ages seven to twelve.
- 150 mcg should be taken by adults.
- 200 mcg should be consumed by pregnant and lactating women.
Figures and facts
About two hundred million people on the planet suffer from this pathology. It is called one of the most common disasters of people. Ninety percent of all goiter cases are caused by iodine deficiency. The incidence of goiter among children has increased by six percent over the past ten years. Today, this frequency is approximately twenty-five percent of all childhood endocrinological diseases.
The pathogenesis of endemic goiter shouldknow everyone.
Complications
The disease can give various complications. These typically include:
- The presence of a goiter. This is a condition in which the vessels that depart from the heart are compressed. This can cause the heart to expand on the right side.
- Presence of compression of the esophagus and trachea.
- The appearance of hemorrhages in the thickness of the thyroid gland.
- The occurrence of inflammation of the gland.
- Development of malignant degeneration of the thyroid gland.
To prevent complications of endemic goiter, timely diagnosis is necessary.
Diagnosis of pathology
An instrumental method for diagnosing goiter is ultrasound. Thanks to this study, the form of the disease is established, which may be diffuse or nodular.
In the case of the presence of nodes, sonoelastography can be prescribed - a study that allows you to determine the density and elasticity of nodular formations. This makes it possible to find out what the nature of the pathology is: benign or malignant. For the same purpose, an additional biopsy of the thyroid gland is performed. Among other things, to clarify the diagnosis, the level of hormones such as TSH and T4 is checked. In patients with this type of disease, as a rule, the balance of thyroid hormone is significantly disturbed. In turn, the rate of excretion of iodine in the urine is reduced. But the initial stage of the examination is primarily palpation. This method allows you to do the following:
- The size of the shares of the diseased organ is determined.
- The clarity of the border with surrounding tissues is assessed.
- The consistency of the gland is estimated. At the same time, the doctor pays attention to such signs as compaction, softening, nodular formations and their approximate size.
- The condition of the lymph nodes is assessed along with the presence of lymphangitis.
In addition to palpation, a very informative, and at the same time accessible method is, as already noted, ultrasound, which provides the following information:
- Exact width, thickness and height of the beats.
- Isthmus size.
- Complete information about the structure of the organ, and in addition, about its homogeneity.
- Presence of a nodule and its exact dimensions.
- The degree of volume of individual shares. It also turns out the total volume of the thyroid gland.
- The condition of the surrounding tissue.
What is the treatment for endemic goiter?
Treatment of disease
In the case of a slight increase in the gland, it is often enough just a few courses of potassium iodide, and in addition, diet therapy with foods that are rich in iodine. Treatment of goiter complicated by hypothyroidism primarily involves hormone replacement therapy.
Treatment of a goiter that is nodular at an advanced stage usually requires surgery.
At the postoperative stage, patients undergo hormone replacement therapy. From folk remediesseaweed powder is recommended. It is taken in a teaspoon at night and washed down with water. The course of therapy is from twenty to thirty days.
Prevention of endemic goiter is equally important.
Diet as a measure of prevention
People are recommended the following diet to prevent endemic goiter:
- Eating seafood in the form of shrimp, squid and mussels.
- Using seaweed and other seaweed in the diet.
- Eating sea boiled fish up to three times a week.
- The use of fermented milk drinks in the diet, especially those containing bifidobacteria. Thus, you should drink two glasses of such drinks a day.
- Use medium-fat cottage cheese up to three times in seven days.
- Eating nuts of all kinds up to 50 grams per day.
- Adding seeds of all kinds to food.
- The use of dried fruits in the diet in the form of raisins, dried apricots, apricots, figs, prunes, apples and pears.
- Use cranberries, lingonberries, wild strawberries, gooseberries, black currants, viburnum, red ashberry and so on.
- The use of vegetables in the diet in the form of carrots, cabbage, beets and raw pumpkin.
- Eating greens such as onions, horseradish, celery, etc.
- Reception of freshly squeezed juices from vegetables, berries or fruits.
- Reception of drinks from rosehip, dandelion root or hawthorn.
- Drinking mineral or spring water.
- Using 50 grams of honey in the diet.
Otherways to prevent goiter
Prevention of endemic goiter is divided into mass, group and individual type:
- Mass preventive methods consist in the production of iodized s alt, bread and confectionery, which must contain this element. In addition, television is promoting the control of iodine content in products.
- Group prevention is carried out mainly in risk groups, namely in children's institutions, schools, secondary and higher educational institutions. In addition, attention is paid to pregnant women. This primarily includes conducting explanatory conversations along with controlled distribution of iodine preparations, for example, Antistrumine, Iodomarin and Yodokomba.
- As for individual prevention, it consists in the use of foods that are rich in iodine. It is very important to take iodine supplements for people who are at risk, as well as for those who live in endemic regions.
How to prevent endemic goiter in children? Mixed-fed babies need 90 micrograms of iodine daily. Pregnant women, children and adolescents need up to 200 micrograms per day. In addition to taking appropriate drugs, it is important to follow a diet that should be based on a sufficient iodine content in food.
