What is Goiter?
Goiter is a clearly defined increase in the thyroid gland, to a greater or lesser extent, deforming the contours of the neck.
Causes of Goiter
The main cause of goiter is iodine metabolism.
Possible causes of iodine deficiency in the body:
- exogenous: primary, secondary.
Primary exogenous iodine deficiency in the body arises in cases where the soil of the area contains little iodine and the plants that grow on these soils contain it in insufficient quantities. Accordingly, with plant food and animal products, not 100 … 200y, but about 20 ..50y iodine enters the body.
Secondary exogenous iodine deficiency occurs when the soil contains a normal amount of iodine, but at the same time there are conditions that inhibit the absorption of its plants.
So, peaty soils are rich in iodine, however, it is firmly fixed with plant residues, does not become soluble and is not absorbed by plants.
Prevents plants from assimilating iodine with a high content of iron, manganese, cobalt, sodium fluoride, humic compounds, nitrates and other salts in the soil.
A special role is played by sanitary and hygienic and social living conditions of people.
Thus, the content in the soil of iodine is only a prerequisite for the normal content of iodine in food products of the area. Under certain conditions, severe secondary exogenous iodine deficiency may occur.
Endogenous iodine deficiency occurs in cases when iodine coming from the external environment is not used properly.
As stated above, any abnormalities in the intestinal absorption function can lead to iodine deficiency.
Chronic intoxication of any origin (chronic suppurative processes, chronic tonsillitis, antritis, frontitis, otitis, etc.) sharply inhibit the function of the thyroid gland. Chronic colitis, especially aggravated by extremely long-term use of sulfa drugs, leads to impaired iodine uptake by thyroid cells.
Chronic abnormal liver function can lead to an iodine metabolism disorder in the body.
Naturally, the layering of natural iodine deficiency factors that violate its assimilation by plants or the human body, aggravates the exchange of iodine, violates adaptation processes (iodine circulation), contributes to the development of goiter.
Pathogenesis during Goiter
In any form of iodine deficiency, thyroid hormone deficiency occurs, which stimulates the pituitary gland through feedback. The level of TSH in the blood increases, activation of the thyroid function occurs, its cellular proliferation increases.
Increased thyroid volume provides greater uptake of iodine from the blood and increased synthesis of hormones. In this way, the exchange of iodine and thyroid hormones in the body can be restored.
Therefore, an adequate adaptation response to primary exogenous iodine deficiency can be realized by enhancing the function of the gland and / or by increasing its size.
Indeed, in the foci of iodine deficiency in most people diffuse hyperplasia of the I – II degree thyroid occurs, and the seizure of iodine that enters the body increases to 40 .. .50%.
In cases where functional thyroid hyperplasia does not ensure the proper synthesis of thyroid hormones, a further increase in thyroid occurs – goiter occurs.
In the structure of diffuse hyperplasia of the thyroid gland, foci of enhanced proliferation (nodular goiter germ) may appear or the colloid division may be disturbed (colloid cysts are formed).
Other things being equal, women suffer from goitre more often because they have more complex hormonal relationships, especially those related to pregnancy and lactation. By the way, during pregnancy, even in areas with a sufficient content of iodine in nature, there is always a diffuse increase in the thyroid gland to II or even III.
Endemic goiter is a disease of the regional pathology that occurs in certain biogeochemical regions characterized by primary or secondary iodine deficiency.
The main signs of endemic goiter:
- A disease that constantly affects a significant number of people in a given area.
- The disease affects children, women and men more or less evenly, including nodular goiter.
- In this area, there should be cases of chronic insufficiency of the thyroid function: micsedema, cretinism.
- In severe endemic goiter can occur in domestic animals.
The severity of the endemic focus of goiter is determined using the Lenz-Bauer index and the index MG Kolomiytsev.
Lenz-Bauer index – the ratio of the frequency of goiter in men and women:
- with the index from 1: 1 to 1: 3 – severe endemic focus;
- with the index from 1: 3 to 1: 5 – a medium endemic focus;
- at index 1: 5 to 8 – light endemic focus.
Index MG Kolomiytseva: the quotient from the percentage of functional hyperplasia to the true goiter:
- if the index is up to 2 – severe endemic focus;
- when the index is from 2 to 4 – an endemic focus of moderate severity;
- with an index of more than 5-6 – light (weak) endemic focus.
Epidemic goiter is a rare form of goiter that occurs most often in areas with exogenous iodine deficiency as an outbreak of people among closed groups (military units, orphanages, camps of ITC). Epidemic outbreak can occur within 6_8 weeks, sometimes it develops over 2_3 years. In the overwhelming majority of cases, the cause of an epidemic goiter is intestinal infections, chronic toxic effects of various substances, unfavorable sanitary and hygienic conditions, severe hypovitaminosis, malnutrition and water supply.
Sporadic goiter develops in cases when endogenous iodine deficiency occurs, the causes of which are discussed above.
In accordance with the Swiss classification, there are five degrees of thyroid size.
0 – the thyroid gland is not visible and can not be felt
I – the isthmus of the thyroid gland is palpated, but the thyroid gland is not visible
II – the thyroid is noticeable when swallowing, easily palpable
III – the thyroid gland is significantly enlarged, visible to the eye when viewed in the form of a “thick neck.”
IV – pronounced goiter, deforming the neck, violating its configuration
V – giant goiter, squeezes the neck organs with respiratory and swallowing disorders.
In euthyroid goiter, patients usually notice a cosmetic defect and feeling of awkwardness when moving in the neck. Examination and palpation of the thyroid gland allows you to detect various forms of goiter.
When hypothyroid goiter is observed isolation, constant feeling of cold, slowness of movement, increased drowsiness, reduced working capacity, interest in life.
Objectively: patients answer questions in slow motion, the skin is dry, sometimes scaly, there is swelling of the face, arms, legs, moderate bradycardia. On palpation of the thyroid gland most often found nodal or mixed forms of goiter.
When hyperthyroid goiter patients are excited, fussy, verbose, make a lot of complaints: irritability, tearfulness, unfair attitude from others, poor sleep, excessive sweating, feeling of fever. Despite the large number of complaints, the general condition, as a rule, does not suffer.
On examination, patients with asthenic physique are tender, moist skin. Reflexes somewhat elevated. Situational tachycardia, instability of mood is noted.
1. Conservative, as a rule, is used for diffuse goiter, or for mixed (nodular) with absolute contraindications to the operation:
- balanced diet;
- improvement of sanitary and hygienic conditions;
- rehabilitation of foci of chronic infection;
- normalization of intestinal function and liver;
- normalization of iodine metabolism in the body: anti-stress 1 tablet per day (1 mg of potassium iodide);
- if necessary, the appointment of thyroid hormones 25 … 100 mg per day; thyreocomb 0.5-1 table. in a day; on 0.5-1 tab. per day, thyroidin, triiodothyronine.
2. Surgical treatment of goiter.
Indications for surgery:
- nodular and mixed goiter with all degrees of thyroid enlargement;
- diffuse goiter, stage III, not amenable to conservative therapy.
- diffuse goiter IV and V stages.
The nature of surgical interventions:
- Share resection, possible bilateral
- Mass – use in the foci of exogenous iodine deficiency iodized salt containing 25 g of potassium iodide per 1 ton.
- Group (children, school groups, military units) with the help of anti-strumin (a tablet contains 1 mg of potassium iodide), 1 tablet per week.
- Individual – among the people who arrived in the area with iodine deficiency used anti-platinum 1-2 tablets per week.
- Along with specific prevention, elimination of aggravating factors is extremely important, which include a number of social and sanitary measures (improvement of living conditions, complete balanced nutrition, prevention of vitamin deficiencies, sanitary culture of the population, the fight against intestinal infections, etc.).
- Pronounced goiter, deforming the neck, violating its configuration.
- Giant goiter, squeezes the neck organs with respiratory and swallowing disorders.