Thyroid diseases (thyroid gland) occupy a leading place after diabetes among endocrine pathologies. The concept of goiter is collective, because it is a whole group of diseases with an increase in size, but with different etiologies. Enlargement of the gland (struma) can be observed both with increased and reduced functioning.
How to distinguish the goiter of other enlargements? When swallowing, it will move up and down.
Goiter with hyperthyroidism occurs 10 times more often than hypothyroid. It is always persistent and never dissolves on its own. Pathology in women occurs almost 10 times more often than in men, usually in 20-40 years. This is due to the fact that in the work of the male body there is much more stability. And the body of women continually undergoes hormonal changes: menarche, gestation, childbirth, lactation, menopause…
The term itself speaks of the similarity of goiter with that of birds. They have a special expansion of the esophagus, in which food accumulates, and the neck is expanded in this place.(pelicans, for example). Nothing accumulates in the thyroid gland, but the tissues grow. The term was introduced by the Swiss naturalist A. Haller in the 18th century.
Essence of disease
Changes in the thyroid gland with goiter are not inflammatory in nature and do not belong to tumors. The normal volume of the thyroid gland in women is 15-20 ml, in men - 18-25 ml. Any excess of these figures is considered a struma. The thyroid gland grows throughout puberty, then stabilizes, and gradually begins to atrophy in old age.
Types of goiter
It can arise and exist as a primary disease, it can also be secondary, that is, against the background of an already existing etiology.
According to the functionality, goiter can be with hypo-, hyperfunction of the gland or euthyroid. There are also endemic goiter (with iodine deficiency) and sporadic. In the second option, the cause remains unclear.
According to the morphology, goiter is nodular, diffuse and mixed.
If there are only 2 nodes in the thyroid gland, it is already considered multinodular. This pathology occurs in every second patient.
With diffuse goiter, the gland is uniformly hypertrophied, with an uneven increase, the nodes are usually the culprits. In the latter case, the level of hormones is normal.
According to the effects of hormones on the body goiter is divided into toxic and non-toxic. The first is characterized by a toxic effect on the entire body.
Factors
All predisposing factors are exogenous and endogenous.
Exogenous:
- iodine deficiency, lack of selenium, zinc and molybdenum;
- bad ecology, radiation, ultraviolet;
- injuries;
- taking drugs that block iodine transport;
- constant lack of sleep;
- bad habits;
- infections;
- hypothermia and vasospasm with them;
- intense exercise.
Endogenous:
- heredity;
- gender;
- decreased immunity;
- stress and nervous overload;
- hormone imbalance;
- autoimmune processes;
- diseases in the gland itself (inflammation, formation, functional disorders in the form of an increased amount of colloid);
- obesity;
- other endocrine pathologies;
- malnutrition and eating foods with nitrates and pesticides;
- pathologies in the parathyroid glands or pancreas;
- work in the chemical industry.
The development of goiter of the 2nd degree of the thyroid gland is affected by the composition of water - the presence of a high percentage of calcium s alts, urochrome, nitrates, etc. in it. All of them significantly impede the absorption of iodine. With its shortage, diffuse goiter appears in 90% of cases.
Classification of goiter by degrees
There are two such classifications. Since 1955, the gradation of O. V. Nikolaev has been used and practiced until the advent of ultrasound. Since 1992, the WHO classification has been used abroad.
Nikolaev's gradation is still used today due to its practicality, details and the correct choice of tacticstreatment. It deals with 6 degrees of goiter:
- 0 degree - there is no clinic, there are only changes in the analyzes;
- 1 degree - there are no visual and clinical changes, the node is detected only by probing;
- 2 degree of goiter of the thyroid gland - the entire thyroid gland is completely palpated and the isthmus is noticeable when swallowing;
- 3 degree - the front surface of the neck is changed visually;
- 4 degree - thick neck and hanging goiter;
- 5 degree - giant goiter, there is a compression syndrome, very rare.
In the systematization of WHO, there are 3 stages of thyroid enlargement. Therefore, all degrees after 2 are classified as 2, which makes it difficult to diagnose and choose treatment. There is no clear differentiation.
In this classification, there are 3 degrees:
- 0 degree - there are no visual changes, but the gland is palpable. Its shares do not exceed the size of the distal phalanx of the patient's thumb. Areas of hypertrophy are found on biopsy.
- 1 degree - the size of the thyroid lobes is larger than the distal phalanges. They are determined only by probing, not visually.
- 2 degree of goiter - the neck is deformed, and the patient can feel the changes in the gland on his own.
DTZ
Diffuse toxic goiter of the thyroid gland of the 2nd degree (DTG) occurs more often from 20 to 40 years. The influence of nodes is toxic. In 85% of cases, DTG is accompanied by hyperfunction of the gland in the form of thyrotoxicosis.
The mechanism for the development of such a goiter is that with a shortageiodine, which the thyroid gland uses to produce its hormones, it begins to actively seek and absorb it (at least what is so little received). For this purpose, she has to increase her size. This is a kind of adaptive reaction of the gland.
In addition to this mechanism, diffuse toxic goiter of the 2nd degree of the thyroid gland often occurs as a result of the development of gene mutations and autoimmune processes. It can develop as a result of taking levothyroxine (medicated thyrotoxicosis).
Diffuse goiter of the thyroid gland of the 2nd degree or hyperthyroidism is a disease of residents of iodine-deficient areas.
Clinical picture of goiter with hyperfunction
It can be diffuse or nodular, but always toxic. All manifestations of toxic goiter of the thyroid gland of the 2nd degree are associated with an acceleration of metabolism.
Changes in the CNS:
- mood swings and tearfulness;
- nervousness and fussiness;
- irritability and insomnia;
- tendon reflexes increased, muscle weakness;
- adynamia and osteopenia.
Changes in the cardiovascular system:
- palpitations (pulse 120-130);
- increased pressure, jugular pulsation;
- atrial fibrillation, shortness of breath and development of insufficiency;
- prone to thrombosis;
- myocardial dystrophy.
Gastrointestinal side:
- appetite increases amid rapid weight loss;
- increased metabolism leads to fasterintestinal motility, which causes diarrhea;
- heat intolerance, subfebrile condition, hyperhidrosis, constant feeling of heat;
- later the symptoms of exophthalmos necessarily join, the eyelids cease to close completely, due to which other eye symptoms are added (there are only 10 of them);
- conjunctivitis and pain in the eyes occur, vision deteriorates;
- symptom of Marie is typical (tremor of the fingers or toes - indicates damage to the peripheral nervous system);
- telegraph pole symptom - trembling of the whole body.
Hair and skin side:
- alopecia, brittleness and damage to nails;
- skin feels hot and velvety;
- skin friction spots darken.
Reproductive system damage:
- cycle disorders, ovarian failure;
- reduced potency and erection in men, gynecomastia;
- kidneys may be affected leading to kidney failure.
Mechanical symptoms:
- front of neck hurts and enlarges;
- hoarse voice;
- feeling of itching and a lump in the throat;
- shortness of breath and bouts of dry cough;
- dizziness.
Toxic diffuse-nodular or multinodular goiter of the thyroid gland of the 2nd degree is characterized by a rather rapid growth of nodes up to a size of more than 3 cm.
In advanced cases after the 3rd degree, treatment is only surgical. The enlarged part of the thyroid gland is removed, only 5 g is left for it to function, and it was not necessary to drink hormones for life.
Butyou need to know that the operation of diffuse nodular goiter of the thyroid gland of the 2nd degree does not guarantee the exclusion of relapses, which can occur in 10% of cases.
Goiter with hypothyroidism
Diagnosed much less frequently. At the 2nd degree, hypertrophy is uneven, asymmetric. Symptoms do not appear immediately, for a number of years there is no clinic.
With hypothyroid goiter of the thyroid gland of the 2nd degree, the symptoms and manifestations are due to a sharp slowdown in metabolism:
- progressive weight gain in parallel with reduced appetite;
- weakness, constant chilliness due to increased sensitivity to cold;
- vision and hearing loss;
- cephalgia;
- lethargy, weakness and fatigue;
- slowing down speech and movements, memory loss;
- impotence in men and lack of libido in women, infertility and miscarriages;
- skin is flabby, dry, light spots appear on them due to a decrease in melanin production;
- hair falling out;
- nails break;
- the limbs and face become swollen - cheeks are thick, eyes are narrow;
- tongue and lips are thick;
- on the lateral surfaces of the tongue - prints of teeth;
- slow metabolism leads to constipation and flatulence, nausea;
- bradycardia and hypotension;
- prone to colds.
In severe cases, swelling is observed throughout the body - myxedema. During the day you want to sleep, at night - no sleep. The mood is depressive. Hypothyroidism in children threatens with mental retardation.
Euthyroid goiter
It can occur whenany pathology of the gland. It makes up 50-70% of all visits to the endocrinologist. With nodular goiter, the gland has one or more nodes. Hormones are produced normally, metabolism is normal, but abnormalities can be found in the tissue of the gland. The clinic reveals mainly mechanical symptoms.
Signs of nodular colloid goiter of the thyroid gland of the 2nd degree with normal hormone production are as follows:
- when the knot size is more than 3 cm, there is a feeling of discomfort in the neck;
- dysphagia;
- sore throat;
- shortness of breath and difficulty breathing;
- paroxysmal dry cough;
- feeling of a foreign body in the throat;
- changing the timbre of the voice due to pressure on the vocal cords;
- pain and changes in the appearance of the neck.
There is no gender difference. Colloidal goiter never regenerates.
Nodular goiter of the thyroid gland
Nodular colloid goiter accounts for 90% of the appearance of nodes in the thyroid gland. It contains thyroglobulin. With nodular goiter, the follicles begin to grow. This is expressed in an increase in the colloid in them - a viscous liquid, due to which the name arose.
With nodular goiter of the thyroid gland, the concentration of T3 (triiodothyronine) increases, this is given by overgrown follicles that produce the hormone. The causes of goiter are associated with a lack of iodine. Colloidal goiter of the thyroid gland of the 2nd degree may also be accompanied by a decrease or increase in the production of thyroid hormones and the corresponding symptoms described above.
Diagnosis
Besides the general examination to the doctorit is necessary to palpate the gland.
Usually, the diagnosis of grade 2 thyroid goiter implies:
- Ultrasound of the thyroid gland;
- chest X-ray;
- gland scintigraphy;
- much less often MRI or CT;
- blood for TSH, T3 is one of the simplest and most informative tests;
- determination of antibodies ATPO;
- FNA - fine needle biopsy.
More often in practice, ultrasound and blood hormones are enough to make a diagnosis.
Complications
Goiter creates not only a cosmetic defect, it causes lesions with the development of arrhythmias and heart failure, increases the formation of blood clots, causes intellectual and mnestic disorders, hepatosis. There may be a hemorrhage in the parenchyma of the gland itself, its inflammation (strumitis).
The most severe complication is thyrotoxic crisis, which is often fatal. The frequency of occurrence is 20% with thyrotoxicosis. Very rarely, malignancy of the nodes is possible.
Treatment measures
Symptoms and treatment of grade 2 thyroid goiter are always interrelated, i.e. treatment tactics depend on the initial cause, degree of goiter, age, etc.
With goiter of the 2nd degree, antihypertensive drugs, sedatives are prescribed. In order to normalize the production of thyroid hormones, thyreostatics are used. There are a lot of them - "Mitezol", "Tyrozol", "Carbimazole", "Tiamazol", "Propicil", etc. They are used more often than others"Mercazolil" because it gives results in any degree of hyperthyroidism. The dosage is individual. The course of treatment is from 3 months to six months.
How to treat grade 2 thyroid goiter?
Therapy also depends on the severity of mechanical symptoms. If there is only a slight increase, then you can usually limit yourself to iodine preparations and diet. With hypofunction, synthetic hormones are prescribed for life.
If medical treatment of grade 2 thyroid goiter is ineffective, the organ is removed promptly followed by hormone therapy.
With such consequences of goiter as arrhythmias, beta-blockers ("Anaprilin") are prescribed. These drugs reduce the frequency of tachycardia, reduce the minute volume of pumped blood and pressure.
Ocular disorders are treated with corticosteroids, most often with a course of "Prednisolone" with a gradual dose reduction. Course - 2-3 months. The effect is noted if the treatment of eye symptoms is started before 6 months from the onset of their onset. Otherwise, the connective tissue around the eyes will develop and the bulge will require surgery.
Radical treatments
The operation is prescribed only after the normalization of the analyzes. The intervention takes place under anesthesia. A very small part of the gland is left, which takes over all the work or the entire organ is removed.
Rehabilitation is a few weeks. Nodular toxic goiter is very goodlends itself to RJT - the use of radioactive iodine. Radioiodine is able to completely destroy the affected tissues (follicular cells) of the thyroid gland. With the right dose, nodule size can be reduced by up to 80%.
Prevention
Endemic goiter is relatively easy to prevent. The easiest method is iodized s alt. It is added after cooking.
An important place in prevention is given to he althy lifestyles. It is necessary to eliminate stress, any overwork, to establish proper nutrition. Strengthening the immune system is required.
With poor heredity, a person should be registered with an endocrinologist, even if there are no symptoms of a lesion. Tests are taken every 3-4 months.
In the presence of pathology, patients should protect themselves from stress of any kind: it is strictly forbidden to pour cold water (only warm), contrast showers, mud therapy, heavy physical exertion. All these procedures are stressful for the body, and the condition of the thyroid gland will only worsen. For the same reason, long trips and changes in climate zones are prohibited.
