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Endemic goiter - A condition in which a person is substantially increased thyroid, thereby changing the shape of its neck. The disease develops as a result of state iodine deficiency . Often, the disease affects people who live in regions where there is a lack of this element in the environment.
Causes of endemic goiter
Human endocrine system, namely the operation Thyroid It determines its normal development and growth. Because of the constant shortage Iodine in the body tissue of the gland gradually grow and function of the gland affected. Thus, the main reason for which the patient develops endemic goiter is insufficient intake of iodine in the body of the patient.
Experts identify several factors that contribute to the development of this disease in children and adults. First of all, the symptoms often appear in patients who have a hereditary tendency to endemic goiter. Also, a higher risk of developing the disease in people with genetic defects biosynthesis thyroid hormones .
There is a clear manifestation of the disease and the dependence of the human environment. If he is constantly drinking water contaminated nitrates . urochrome And having too much of humic substances, Calcium , The absorption of iodine is difficult, and gradually the patient goitre 1 degree. The same thing happens if the environment and the food there is a low content of microelements manganese . Zinc . molybdenum . Selena . cobalt . Copper . In this case, important disease prevention, which involves restocking of iodine in the body.
The occurrence of endemic goiter maybe people who are appointed by the treatment of drugs that block the transport of iodide into the thyroid gland. It periodate . potassium perchlorate . There are also a number of drugs that disrupt the organification iodine in the thyroid gland itself.
The cause of this disease can become infectious and inflammatory processes, infection with worms, ignoring the rules of sanitation and hygiene in the home. These factors reduce the compensatory function of the thyroid gland, resulting in disrupted blood levels of thyroid hormones.
Iodine deficiency
Iodine in humans is involved in the biosynthesis of thyroid hormones - thyroxine and triiodothyronine . As it enters the body with food, water, air. Thus the basic requirement for this trace - about 90% of the daily requirement - provided by the food.
In medicine, to distinguish between absolute and relative iodine deficiency. Absolute failure develops due to insufficient iodine in water and food. The relative failure - the result of diseases that provoke iodine malabsorption in the intestines, as well as medication, birth defects in the synthesis of the thyroid gland thyroid hormones.
Symptoms
In medicine differs diffuse . nodular and mixed goiter. With the development of diffuse goiter the patient noted an increase in the thyroid gland, which occurs at regular intervals. With nodular goiter iron formed nodes. If manifested mixed crop , The patient has diffuse enlargement of the prostate, and thus there are detected the individual nodes. Varies unilateral goiter When a share is affected gland, and reversible If two parts are affected. If we evaluate the function of the thyroid gland man, are the following forms: euthyroid . hyperthyroid and hypothyroid goiter. Most often diagnosed in euthyroid goiter.
Sometimes the crop can be placed atypical: in the chest, around the trachea. Also found lingual, sublingual form layout.
Depending on the severity of thyroid goiter determined by extent of disease. In this case, the main clinical feature is the size of the thyroid gland. If the 0 degree thyroid gland is not visible and can not be determined at a palpation, then the last 5 degrees, thyroid enlargement is so pronounced that it compresses the nearby organs. This causes serious symptoms and triggers the development of complications.
Colloidal goitre can not provoke any symptoms, however an increase in cancer is still going on. As a consequence, develop symptoms associated with it pressure on nearby organs.
When thyroid goiter grows, it gradually increased its pressure on the esophagus and the trachea, because of which complicates the process of swallowing and breathing. The pressure in the neck area man more clearly felt in the supine position. If compressed the trachea, the patient may suffer from periodic asthma attacks and a dry cough.
Due to the compression of the neck veins disrupted the process of circulation. As a result, the veins dilate blood vessels of the neck and chest. Symptoms in this case manifested a sense of tension in the head, when a person bends over. The person becomes puffy.
In addition, the disease provokes congestion in the pulmonary circulation. As a result, says the so-called "goiter heart", that is, increase and broaden his right departments. In view of the pressure on the nerves goiter patient notes hoarseness, dilated pupils, sweating violation. At the same time the treatment of individual symptoms no results.
In general, the symptoms of the disease depends on the size and shape of the crop, and also on how the presently thyroid. Already at euthyroid goitre patients often complain about the manifestation of general weakness, severe fatigue, recurrent headaches, discomfort in the heart.
Complications
The most severe complication is hypothyroid goiter cretinism That develops in childhood. In this state the expressed hypothyroidism Sharp lag in child physical and mental development.
Complications observed in endemic goiter when the thyroid gland is greatly increased. This is the aforementioned "goiter heart", which marks the hyperactivity of the right heart. Bleeding may occur in the parenchyma of the thyroid gland and, consequently, its calcification. Another chance of complications - inflammation in the modified goiter thyroid tissue. In some cases, a malignant degeneration of the modified cancer. This complication is more common in nodular goiter.
Diagnostics
Despite the presence of visible signs, treatment of endemic goiter is conducted only after a clear definition of the diagnosis. First of all, the patient is assigned an overall analysis of blood and urine. Be sure to define the content of blood T4 . Ts . thyrotropin . thyroglobulin . High concentrations in the blood thyroglobulin suggests iodine deficiency. It is also determined daily urinary iodine excretion .
Informative method is ultrasound gland, which can detect areas of fibrosis, thyroid enlargement. This information allows to diagnose diffuse goiter of the thyroid gland. Moreover, detected by ultrasound can even diffuse goiter of 1 degree.
When nodular ultrasound makes it possible to identify the sites and their features. In the process of diagnostics performed radioisotope scanning of the thyroid gland, in some cases, it is expedient to puncture Biopsy .
To determine whether there is compression of the esophagus in patients with large goiter is assigned to X-ray of the esophagus.
Treatment
Treatment goiter assigned depending on what degree of thyroid enlargement occurs in a patient. An important point is also expressed by the human cancer. If there is a slight increase in cancer and goiter diagnosed first degree, the patient is assigned to intermittent treatment Potassium iodide As well as regular inclusion in the diet of foods with essential iodine.
If the patient has reduced function of the thyroid gland, the therapy must include the reception of synthetic analogues of thyroid hormones or combined preparations ( levothyroxine . tireotom ). An important aspect in this treatment is to control the level of thyroid hormones in the blood. Acceptance of these drugs can not only eliminate the symptoms of thyroid deficiency, but also to reduce its increased activity.
If a patient diagnosed with thyroid nodular goiter, then necessarily it carried out regular monitoring of the patient. Several times a year an assessment of thyroid function, determined to show symptoms of the disease. Surgical intervention is indicated to the patient in the event that he is diagnosed multinode goiter thyroid, and thus significantly increases the iron itself and compresses the surrounding organs. Initially, however, the doctor decides whether it is possible in a particular case, conservative treatment of nodular goiter. Thus, using a needle physician may hold draining nodules filled with fluid.
Surgery is indicated when the nodules are malignant cells, then drain again soon accumulates fluid, difficult breathing or swallowing process. After the surgery appointed reception of thyroid hormones in order to avoid a recurrence of the disease. He practiced as a popular treatment of goitre, but we can not take any action without consulting with your doctor.
Toxic goiter is an autoimmune disease, the development of which increases production of thyroid hormones. As a result, the poisoning organism occurs. Prescribe treatment, the doctor will take into account the cause of the disease. The patient in this case is assigned to a therapy drug-tireostatikami Or illustrated surgery. It is also important to adjust the diet of patients with toxic goiter.
Practiced as treatment radioiodine Which destroys the thyroid tissue. This tactic useful if education is not malignant, but there is a tendency to develop hyperthyroidism. Also, radioactive iodine therapy is used in multiple formations.
If nodular goiter changes its size does not occur, the patient shows only observation.
Prevention
In medicine are two types of prevention of endemic goiter - mass and individual .
As a mass prevention practice of adding table salt potassium iodate . We are talking about salt iodization in which one ton of salt is added from 20 to 40 g of potassium iodate. Consumers should remember that iodized salt can not be stored longer than the period of which is specified on the product packaging. Indeed, over time there is a destruction of iodine salts. Also, they are destroyed when the salt is stored in a damp place. It is important to salt all meals a salt after cooking, as iodine evaporates during heating. Sometimes practiced iodization of bakery products.
Methods individual prevention indicated in patients who have been made surgery on the thyroid gland. Preventive measures are needed in those regions where there is a high risk of endemic goiter. Also, they practiced against people who regularly work with strumogennymi substances .
Experts define general advice regarding nutrition. It is important to include in the diet of foods high in iodine. This fish, a variety of seafood, seaweed, persimmons, walnuts.
When predisposition to diseases of the thyroid gland is to eat vitamin-products: infusion of rose hips currants, strawberries, cherries, strawberries. Very useful chokeberry and apples.
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