Diffuse euthyroid goiter is not a specific disease, but includes a number of pathologies affecting the thyroid gland. The disease is often the result of a lack of iodine, is visible to the naked eye and is easily palpable on palpation. Diffuse euthyroid goiter ICD-10 code has E 04.0. The disease can take several different forms:
- non-toxic goiter with one pathological node;
- multinodular non-toxic goiter;
- diffuse nontoxic euthyroid goiter;
- unspecified nontoxic goiter;
- other specified varieties of non-toxic goiter.
The disease requires an accurate diagnosis through examination, testing and other necessary manipulations.
What kind of disease is this?
Diffuse non-toxic euthyroid goiter is a pathological enlargement of the thyroid gland, which is easily palpable, visible to the naked eye and has a non-toxic origin. At the same time, the function of the organ does not change significantly,the amount of hormones produced remains at the same level and the external form of the gland is adaptive.
If a nodular type of the disease is diagnosed, it means that nodes appeared on the gland in a single or multiple quantity. It is depending on their growth that the final diagnosis is made.
Often a patient goes to the doctor because of a cosmetic defect, which is quite difficult to hide even under clothes. Also, a person may be disturbed by a feeling of squeezing and heaviness in the neck. The specialist makes the final diagnosis based on the collected history, laboratory tests and external examination.
Causes of disease
Diffuse euthyroid goiter is a consequence of iodine deficiency. It has been proven that for the normal functioning of the thyroid gland per day, an adult should consume at least 150 micrograms of this trace element. Food is considered the main route of intake of the substance, and a certain amount enters the body with water and air. Therefore, in places of residence where there is a lack of iodine in water and ambient air, a disease called diffuse euthyroid goiter occurs much more often. Sometimes the starting point for the development of pathology is thiocyanates and flavonoids.
In all other cases, the diagnosed goiter is classified as a sporadic variety, but the reasons for its occurrence have not yet been fully clarified by specialists. However, there is a fairly plausible version that most doctors adhere to. It is believed that the most likelysporadic goiter occurs due to a lack of enzymes involved in the formation of thyroid hormones, which is caused by a birth defect.
Provoking factors
Diffuse euthyroid goiter, of course, is a consequence of a lack of iodine in the body. However, the factors provoking the onset of the disease may be the following:
- smoking and alcohol abuse;
- long-term use of various drugs;
- work requiring contact with harmful substances (chemical industry, x-ray rooms);
- excess calcium in the body and malfunction of the parathyroid glands;
- pregnancy.
Nodular euthyroid diffuse goiter can develop against the background of frequent inflammation of the thyroid tissue. Such a pathology appears as a result of the growth of cells in the affected organ. Reasons can also be:
- Autoimmune reactions occurring in the patient's body.
- Cervical osteochondrosis, which causes obstructed outflow of lymph.
Many experts believe that age-related changes can also cause the growth of nodes.
Classification of goiter
Symptoms of the disease will differ, depending on the nature of the pathology and its progression. According to the WHO classification, the following degrees of the disease are distinguished:
- 0 degree. The size of the organ is within the normal range, there are no clinical data indicating the presence of pathology, but already inside the body beganchanges occur that require adjustment.
- Diffuse euthyroid goiter of the 1st degree. The doctor can already detect some enlargement of the thyroid gland during palpation. Also, only some parts of the organ can undergo a change in size. However, with the usual anatomical position, goiter is difficult to suspect.
- Diffuse euthyroid goiter grade 2. Changes in the thyroid gland are already visible to the naked eye and in the standard position of the neck.
Symptoms of the disease will be considered further, because the clinical picture in each case will be different.
First degree pathology
Diffuse euthyroid goiter of the 1st degree is manifested by rather meager symptoms, because there is no lack of hormones characteristic of a he althy gland. However, patients may complain of some enlargement of the thyroid gland, which is sometimes noticeable on close examination of the neck. At the same time, patients rarely feel real discomfort.
Goiter of the second degree
Diffuse-nodular euthyroid goiter of the 2nd degree can already manifest itself in violations of the function of swallowing and breathing. This situation occurs due to compression of the growing gland of the trachea and esophagus. At the same time, the quality of life of the patient drops sharply. The cosmetic defect is also present to a fairly pronounced degree.
When the disease is of the second degree, complications often occur, expressed in the growth of the superior vena cava and hemorrhage in the tissue of the affected organ. Euthyroid goiter 1 degree in the absence of treatment quicklypasses into the next stage, while the disease will progress if the therapy is not competent, and transform into a nodular variety or toxic.
Symptoms of the disease at the first degree
The disease may be accompanied by the appearance of hypothyroidism or hyperthyroidism. In this case, the signs of diffuse-nodular euthyroid goiter may be as follows:
- apathy, depression, lethargy and physical inactivity;
- increased susceptibility to infectious pathologies;
- nausea and appetite disturbances;
- decrease in normal body temperature;
- dry skin;
- Children are stunted;
- hair loss;
- disruptions in the menstrual cycle;
- decreased libido and complete impotence.
However, the disease can be expressed in different ways, depending on how the gland behaves. In this case, the symptoms are considered with a decrease in its function. If the organ begins to pathologically actively produce hormones, then the following symptoms in the patient are possible:
- insomnia and irritability;
- rise in normal body temperature;
- exophthalmos;
- palpitations;
- weight loss with increased appetite.
Signs of disease of the second degree
If in the first degree of euthyroid goiter of the thyroid gland, the symptoms are expressed only in general well-being and changes in the body, then in the second degree, mechanical signs of pathology are added. The gland grows strongly and begins to compress the esophagus. The patient complains of a sensation of a lump in the throat, which does notpasses and leads to failures in swallowing. The process also involves the respiratory organs, in particular the trachea. The result is:
- characteristic hoarse voice;
- frequent incessant cough;
- difficulty breathing that progresses as the disease progresses;
- suffocation.
There is also a sore throat because the thyroid nodules grow rapidly. At the same time, they begin to become inflamed, which threatens to bleed. In the absence of nodes, palpation is usually not painful.
If euthyroid goiter of the thyroid gland occurs with the formation of nodes, then they are visible on examination and look like bumps at the base of the neck. A "mixed goiter" can also be diagnosed when the size of the organ is significantly enlarged and there are areas of swelling.
Diagnostic Methods
To make a diagnosis, the endocrinologist will perform the following manipulations:
- Palpation of the affected organ. Thus, the doctor will be able to assess the degree of the problem, to understand what the real increase in the gland is. It can be local, affecting only its individual sections, and general, affecting the entire organ as a whole.
- After a digital examination and the data obtained, the patient receives a referral for an ultrasound scan. As a result, a more accurate visualization of the detected pathology can be obtained. The diagnosis according to ICD-10 "diffuse euthyroid goiter" is made upon detection of an increase in the organ in men up to 25 mm and in women up to 18 mm. If foundformations, even less than 1 cm in circumference, then a diagnosis of "multinodular" or "nodular goiter" is made, depending on their number.
- If the ultrasound data showed the presence of formations of more than 1 cm in circumference, as well as with established diffuse goiter of any nodes, then an aspiration fine-needle biopsy is prescribed. Such manipulation is necessary to exclude the cancerous nature of the disease.
Scintigraphy may sometimes be indicated. The procedure is important for making an accurate diagnosis, but is not always necessary. With its help, it is possible to determine the nature of the pathology.
The procedure is as follows:
- an isotope of iodine is administered intravenously;
- with its uniform distribution, a diffuse enlargement of the thyroid gland is placed;
- if cold, hot or warm areas are detected, then this indicates nodular formations;
- if the node shows excessive activity, then the zone is hot (treatment is required immediately);
- a warm nodule indicates optimal hormonal activity and characterizes the presence of nodular euthyroid goiter.
Laboratory blood tests may also be used. If the hormone levels are normal and there is an increase in the production of thyroglobulin, then this indicates a lack of iodine. Additionally, radiography and tomography are used for suspected goiter of the second degree.
How is the disease treated?
Treatment of diffuse euthyroid goiter involves the use ofdrug therapy, the use of radioactive iodine and surgery. Of course, any competent doctor will always try to get by with conservative methods. It should be understood that only strict indications lead to surgical intervention and an operation is never performed without evidence.
Used drugs
The disease requires treatment by an endocrinologist. In this case, the doctor can go in different ways:
- use suppressive therapy:
- apply iodine therapy;
- prescribe combination treatment.
If iodine preparations are used, the maximum duration of treatment cannot exceed six months. It is noted that after that the size of the affected organ is reduced by at least a third. Sometimes a complete cure and the achievement of a normal size are recorded. The daily dosage of iodine medications is usually 100 to 200 micrograms. The treatment regimen is selected based on the collected history and the age of the patient.
Monotherapy with the use of iodine preparations does not require the calculation of an individual dosage and does not cause side effects. However, the effect of such therapy is somewhat weaker than with the appointment of a suppressive technique. More suitable as a preventive measure after surgery to avoid relapse. In addition, monotherapy gives the greatest effect in the treatment of patients not older than 40 years. Then the degree of effectiveness decreases according to the increase in age.
Suppressive method
If there is no improvement with iodine alone, orIf the patient is older, then the most optimal would be the use of a suppressive technique. A synthetic analogue of the hormone produced by the thyroid gland, levothyroxine sodium, is used. Its advantage is the quickly achieved effect. However, when canceled, relapse is diagnosed in almost 100% of cases.
Combination treatment
To avoid relapses when using only levothyroxine sodium, the doctor often resorts to a combined method of treatment. This is the only way to quickly achieve results and avoid a recurrence of the situation with the overgrowth of the thyroid gland.
Surgery
There are absolute and relative indications for surgery. If a nodular goiter is diagnosed, then, of course, it is necessary to decide on an intervention for:
- pronounced nodes that are easy to remove surgically;
- formations that compress the trachea and larynx and create the risk of suffocation;
- detection of hemorrhages in nodes;
- tumor degeneration of formations.
If the nodes are small enough in size, do not cause inconvenience or there are a lot of them, then the indications for the operation are considered relative. In this case, there are risks of an early relapse after surgery and incomplete removal of all nodes. The specialist usually prefers to wait until the nodes grow to a size where they are easy to visualize and remove.
It should be understood that the disease itself does not imply a mandatorysurgical intervention. The operation is necessary only in emergency cases, when the growths begin to compress the respiratory organs, which leads to a threat to life. Usually, the intervention is carried out urgently, and the operation involves the removal of not only the nodes themselves, but also that part of the thyroid gland that compresses the trachea and esophagus.
How is the operation going?
Surgical intervention consists in resection of the organ, and a total or subtotal technique can be used. The surgeon leaves the organ only if there is a good chance of recovery. Otherwise, there is no point in a saving operation, because recurrences are most often recorded with incomplete removal of nodes, which is possible with a sufficient number of them.
According to the same indications as surgery, he is being treated with radioactive iodine. However, this technique does not always allow for the complete destruction of the node. As practice shows, under favorable conditions, education can decrease in size by only 80%. The essence of therapy is that under the influence of iodine, the tissues of the node and the thyroid gland itself are destroyed. Moreover, the effect can be seen only after 3-5 months of treatment. Often the method is used in order to avoid recurrences after surgery, as well as in case of detection of thyroid cancer. However, absolute contraindications to the use of radioactive iodine should also be taken into account. These include pregnancy and breastfeeding.
Alternative Medicine
Diffuse euthyroid goiter has indications for alternative treatment. Howeverit must be understood that folk remedies therapy in no case can replace the prescribed medications or help to avoid surgery. But we can safely say that using an alternative technique, you can significantly increase the effect of the prescribed treatment.
Herbal infusions
With goiter, the following decoctions are excellent for reducing the size of the gland and stabilizing its function:
- from calendula flowers (half a glass up to 4 times a day):
- from strawberry leaves (a glass 3 times a day);
- from the root of wild mallow (you need to drink 500 ml of infusion during the day);
- from Baikal skullcap (a tablespoon 3 times a day).
Before drinking any decoction, it is important to get the approval of a specialist.
What is the forecast?
Diffuse non-toxic euthyroid goiter with properly prescribed treatment has a very encouraging prognosis. And it doesn’t matter if the pathology is nodular or diffuse. A lethal outcome is recorded in very rare cases, and the cause of death is not the goiter itself, but compression of neighboring organs and asphyxia. The quality of life of patients who are seen by a doctor and receive appropriate treatment does not change significantly either.
Drug therapy helps to correct the size of the gland. If a diffuse goiter without nodes is diagnosed, then the disease can be cured by almost 100% using only medications. Of course, in some part of the patients, the formation of nodes is fixed, which require a different treatment tactic and additional control by a specialist.
Diffuse euthyroid goiter grade 2 and army
If a conscript has a goiter, the medical commission will send him for surgical treatment. However, this does not mean that the operation is mandatory. This decision is discussed with the attending physician. In the future, events may develop differently.
If the operation did not help or the conscript refuses it, then he becomes unfit for military service. If there are no clinical manifestations, then a call is possible. Everything is decided on an individual basis and only on the basis of the conclusion of the commission. A delay is always given for the duration of treatment. Also, a person can receive a category that exempts from service in peacetime, but does not serve as a basis for exemption from conscription during military operations.
