Diffuse euthyroid goiter: degrees, symptoms and treatment
Diffuse euthyroid goiter( DEZ) is hypertrophy and hyperplasia of the thyroid gland.The changes are compensatory, and do not lead to dysfunction of this endocrine organ.The process of biosynthesis and content in the blood of T3 and T4 correspond to the norm.
Severe symptoms are generally not observed.With a significant increase in thyroid gland, it may be a cosmetic defect.In some cases, patients complain of a feeling of constriction or a lump in the throat.
Note: in men has a normal gland volume of 25 ml, and in women it is 18 ml.Parameters are specified during ultrasonic scanning.Hyperplasia is said, if the indicators go beyond this framework.
Diffuse goiter is endemic and sporadic.An endemic variety is characteristic of regions where low iodine content is present in the environment.The sporadic form develops against the background of the normal consumption of this trace element;Its exact causes are not finally clarified.Table of contents: Classification Reasons Clinical symptomatology Diagnosis Treatment and prognosis Measures to prevent diffuse euthyroid goiter
Several forms of euthyroid goiter are distinguished in clinical practice:
- is diffusive-nodal or mixed.
According to WHO classification, 4 degrees of hyperplasia of the thyroid gland are considered:
- 0 - the thyroid gland is not detected during examination and palpation, and dimensions within the anatomical norm;
- 1 - the gland is palpated, but the size of the lobes is not greater than the extreme phalanx of the thumb of the patient;
- 2 - both lobes and an isthmus of the endocrine organ are well probed, but the gland is visible only when the head is tilted back;
- 3 - "thyroid gland" is greatly increased, ie, there is a goiter.
The leading factor in the development of ESD( up to 95% of cases) is the inadequate supply of iodine with water and food, i.e., alimentary.
Please note: is diagnosed in almost 13% of the world's population according to statistical studies conducted by the World Health Organization, thyroid disorders due to iodine deficiency.
Daily intake of iodine( in μg):
- up to 2 years - 50;
- 2-6 years - 90;
- 6-11 years old - 120;
- from 12 years - 150.
The most frequently diagnosed ESD in young patients is from 20 to 35 years.This condition is more often detected in women. The human need for iodine increases significantly with active growth and hormonal reorganization( in the pubertal period, as well as during pregnancy and lactation).
Compensatory hypertrophic and hyperplastic processes in the thyroid gland are necessary to maintain the normal level of production and the release of thyroid-stimulating hormones - triiodothyronine and thyroxine( T3 and T4).The basic adaptation mechanisms are the enhanced capture of iodine ions, the decrease in the formation of iodide in the kidneys and the use of the microelement present in the body for the synthesis of T3 and T4.
The lack of a vital element, thus, is compensated, but hypertrophy of epithelial cells of the thyroid gland( thyrocytes) develops.
Against the background of iodine deficiency, autocrine growth factors( epidermal, fibroblastic and transforming) are activated.From them depends not only the growth of thyrocytes, but also the effect of TSH on the gland.
Other factors contributing to hyperplasia:
- chronic foci of infection:
- excessive psychoemotional stress;
- nicotine dependence;
- reception of some pharmacological agents;
- diseases of the gastrointestinal tract causing iodine malabsorption;Excessively high levels of calcium in the
- lack of cobalt, manganese copper and other trace elements.
It is believed that hereditary factors are of some importance.
Among the probable causes of sporadic ESD are congenital and acquired disorders from the enzyme systems involved in the synthesis of thyroxine and triiodothyronine.
Diffuse euthyroid goiter is characterized by an almost asymptomatic course, since there is no dysfunction of the gland.
Possible manifestations include:
- increased physical and mental fatigue;
- dysphagia( violation of the act of swallowing due to the goitre of neighboring areas);
- feeling of lack of air( with compression of the trachea).
In many cases, the only complaint of patients is a cosmetic defect with a significant hyperplasia of the gland.
Significant growth of tissues can cause compression of the esophagus, trachea, as well as nerves and blood vessels .In some cases, development of the syndrome of the inferior vena cava is possible, for which the outflow of venous blood from the upper part of the trunk is characteristic.Sometimes hemorrhages in the tissue of the gland are diagnosed."Shchitovidka" in a number of cases becomes inflamed;Develops strumite, the symptomatology of which resembles the manifestations of thyroiditis in subacute form.
Against the backdrop of DEZ, a nodular or toxic form of pathology can develop.
Note : with hyperplasia in childhood and adolescence, there is a parenchymal goiter.In elderly patients, colloid goiter is more often diagnosed, in which the iron consists of large vesicles with jelly-like contents.
The diagnosis is the task of an endocrinologist.The doctor conducts palpation of the problem area and appoints an echoscopy( ultrasound scan).
Scintigraphy is also shown - a highly accurate diagnostic study on a special tomograph after the introduction of a radioactive isotope.If the hyperplasia is diffuse, then the contrast material is distributed evenly in the tissues, and with the nodular form, the so-called."Warm" and "cold" areas.
If necessary( if ultrasound shows additional nodal formations), a fine needle biopsy of the gland is used, during which a tissue sample is taken for pathomorphological laboratory analysis. Microscopy allows differentiating hyperplasia from malignant neoplasms.
For the verification of the diagnosis of ESD, an evaluation of the level of the thyroid-stimulating hormone of the pituitary( TTG), responsible for the intake of iodine ions from the plasma into the cells of the thyroid gland, is necessary.
Thyroglobulin, triiodothyronine and thyroxine values are of great importance.Euthyroid goiter is characterized by normal T3 and T4 or a slight increase in T3 with a decrease in T4( TTG - within the limits of ).Against the background of iodine deficiency, the level of thyroglobulin in the serum increases.
If there are reasons to suspect the compression of the esophagus with a large goiter, an x-ray examination of the neck region is necessary.
Treatment and prognosis
When detecting diffuse non-toxic goiter, conservative measures are resorted.
There are 3 variants of etiotropic treatment:
- monotherapy with potassium iodide;
- suppressive therapy with levothyroxine( L-T4);
- combined effects of levothyroxine and iodine preparation.
Patients under 40 years of age, children and adolescents are primarily prescribed monotherapy with iodine.With early diagnosis, daily doses of iodine preparations are at least 100-200 mg .There are no side effects, no individual dose selection is required, and the growth of thyrocytes is suppressed very effectively.In most cases, after a course of treatment for 6 months, the thyroid gland decreases in size to an anatomical rate. If there is no positive dynamics, resort to a combined or suppressive technique. Levothyroxine sodium stops the growth of thyrocytes due to influence on TSH.The drug makes it possible to maintain the content of thyroid-stimulating hormone within physiological parameters, which range from 0.1 to 0.4 mIU / L.After the abolition of this pharmacological agent, the resumption of tissue proliferation is not ruled out.It is impossible to exclude the possibility of development of iatrogenic( medicamentous) thyrotoxicosis with insufficiently accurate selection of individual dosage.
The most promising is a combined technique that combines the advantages of monotherapy and suppressive effects.Appointment and withdrawal of drugs can be carried out in stages( depending on the dynamics).
Therapeutic measures do not require hospitalization of the patient;Treatment is carried out on an outpatient basis with supervision by an endocrinologist.
Important: only with very large goiter, strongly compressing adjacent tissue, the question of surgical intervention - resection of lobes.As an alternative, exposure to radioactive iodine is practiced( I-131).This technique allows you to achieve a reduction in the gland in almost 2 times after only one procedure.
The prognosis for complete cure is very favorable;As a rule, conservative treatment can eliminate hypertrophy and hyperplasia.
One of the possible complications is the formation of nodes with functional autonomy.With it there is an increase in secretion of T3 and T4, independent of the thyroid-stimulating hormone and external stimulants.
Persons over 45 years of age who have been diagnosed with diffuse euthyroid goiter should undergo an ultrasound scan of the gland once a year and take tests for TSH. He showed the observation of an endocrinologist in his place of residence.
Measures to prevent diffuse euthyroid goiter
There are 3 types of prevention:
1 - individual;
2 - group;
3 - mass.
Massive prevention of DEZ involves the replacement of regular iodized salt in endemic regions.
Individual measures to prevent hyperplasia of the thyroid gland are the administration of iodine preparations to persons at risk( adolescent puberty, pregnant women, patients undergoing surgery on the gland).
Important: in women during pregnancy and breastfeeding is strongly recommended to increase iodine intake to 200 μg per day.
An important preventive measure is to minimize the factors that lead to the development of diffuse goiter.It is necessary to treat infectious and inflammatory diseases in a timely manner and to sanitize foci of chronic infection.From smoking you need to refuse.
It is important to consume foods that are high in iodine.
- algae( for example - kelp or "sea kale");
- marine fish of any sort;
- fish oil;
- seafood( shrimp, squid, etc.);
- dried apricots;
Vladimir Plisov, medical reviewer