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Causes, symptoms, diagnosis and treatment of endemic goiter

Endemic goiter is a chronic disease of the thyroid gland, characterized by increase in size (goiter), as well as a violation of its function due to iodine deficiency.

According to the statistics given by the world health organization, more than 750 million people living in areas with iodine deficiency are goiter and different degrees of functional insufficiency of the gland. 42 million of them are diagnosed with acquired mental retardation.

The most unfavourable on the iodine content in the environment in the Russian Federation the Republic of Karelia, and the valleys of the Siberian rivers, the Volga and the Caucasus.

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The symptoms of endemic goiter

Clinical picture of endemic goiter of the thyroid gland to form the following groups of symptoms:

  • Local symptoms (from the cancer);
  • Symptoms associated with impaired synthesis of thyroid hormones;
  • Symptoms of lesions of other organs and systems.

Local symptoms

Local symptoms of endemic goiter include:

  • The most important local symptom of endemic goiter is the increase in thyroid volume. In the initial period of the disease in the examination can not notice and only during the palpation of the study, identifies the enlarged lobes and isthmus. Over time due to the continuous growth of the gland it becomes visible when viewed and plotted as tumor formation in the neck front of the trachea.

  • The patients themselves are beginning to notice that it's hard to wear clothes with high collars, sleep on my stomach.
  • Also a common symptom of goiter is the feeling of the pressure of a foreign body in the trachea and the throat, difficulty swallowing.
  • In some cases, the gland reaches such a size that can compress the surrounding tissue, causing vascular and respiratory failure.
  • Enlarged gland becomes dense texture. Auscultationvessels over the phonendoscope are heard vascular noise.

Symptoms associated with impaired synthesis of thyroid hormones

Endemic goiter occurs in the background hypofunction of the thyroid gland synthesizes hormones on the basis of organic iodine.

Thyroid hormones are triyodtironin and tetrajodtironina. They regulate protein, carbohydrate, mineral, fat and heat exchanges, the reproductive, nervous and other systems.

Deficiency of these hormones may develop the following clinical symptoms:

  • From the of carbohydrate metabolism: impaired glucose utilization in the glycogen of the liver. As a result of sugar entering the body, follow the path of lipogenesis formation of both external and visceral (around the organs) fat.
  • Side protein metabolism: the shift from anabolic to catabolic direction. This reduces the amount of muscle tissue and, consequently, muscle strength.

  • Fat metabolism: increase in not only deposits on the body, but increasing the amount of fatty substances occurring in the blood – cholesterol, triglycerides, fatty acids, and lipoproteins of low and very low density. With increasing concentration there is a risk of formation of atherosclerosis, angina and outcome of myocardial infarction.

  • Peripheral and Central nervous system: reduction of all types of activity, confusion, drowsiness, loss of memory and ability to perceive information.
  • Cardiovascular system: reduction in the frequency and force of heart contractions, chest discomfort, sensation of pressure on the heart, interruptions in its work.
  • Musculoskeletal system: increased excretion of calcium from the bones - brittle bones and stunted growth (in children), muscle weakness, retarded physical development.
  • Heat exchange: the decline in the production of heat – continuous feeling of coolness, cold extremities.
  • Reproductive system – infertility in men and women, spontaneous abortion and fetal abnormality, birth of children with body weight more than 4,500 g.

The causes of endemic goitre

As mentioned above, the cause of endemic goiter is iodine deficiency in the human body.

Iodine deficiency can be acute, in this casethe body mobilizes all compensatory potential and, with the imminent resumption of iodine, the thyroid gland returns to a state of euthyroid (normal operation) and damage to other organs does not occur.

In chronic iodine deficiency, the situation is much more complicated. In response to reduced intake of this element is hypertrophy, that is increase thyrocyte cells, synthesizing hormones. By increasing the volume of the cells of the gland and enhance their work for some time stabiliziruemost relatively normal amount of hormones produced by. But after a while it becomes inevitable that they fibrosis and the formation of knots.

Prolonged iodine deficiency alone hypertrophy of the thyroid cells is not enough. They not only increase in size, but strongly divided. Thus, increased fibrogenesis cells becomes significantly more so, there are preconditions for the development of diffuzionnogo goiter.

Topic: Test to determine the level of iodine in the body

The thyroid gland with the increasing lack of iodine goes through several stages of changes of its structure: diffuse euthyroid goiter, then multinodular euthyroid goiter and, in the end, goiter multinodular toxic.

The most common causes of iodine deficiency

  1. The reasons for the relative failure:

    • Some medications that stimulate the excretion of iodine from the body;
    • Diseases of the digestive tract, accompanied by malabsorption;
    • Reception of enterosorbents;
    • Chronic renal failure, accompanied by increased excretion of iodine;
    • Congenital anomalies of the gland (aplasia or hypoplasia);
    • Transitory conditions involving iodine deficiency, Pregnancy, infancy, puberty, and intense physical work and constant psycho-emotional activity.

  2. The reasons for the absolute failure:

    • Insufficient intake of iodine from food;
    • Insufficient intake of iodine with water.

  3. Violation of the transfer of iodine from inorganic to organic:

    • The violation of the energy balance;
    • Chronic hypoxia,
    • The binding of iodine strogannymi (zabojnyj) substances.

Let us consider the lack of iodine in the diet. Mostresidents of Russia in the diet are not fresh quality seafood and fish. Also, few people think about buying iodized salt.

Of course, the use of only iodized salt is also not compensate for a deficiency of iodine, especially in view of the fact that iodine is a very volatile substance and rapidly disappears from the structure of salt crystals when you receive them air. It is therefore necessary to store this salt in the salt shakers and vases, in metal or glass jars with tight-fitting lid.

Eating large amounts of colored cabbage, beans, peanut and turnip threaten the development of iodine deficiency, as they contain a lot chromogenic substances that provoke an excessive growth of thyroid tissue.


Extent of endemic goitre

The world health organization has proposed in 1994 the following classification of endemic goiter in degrees, which remains relevant to this day:

  • 0 degree of endemic goiter is characterized by a lack of increase in volume of the thyroid gland; in this case, the volume of each of the shares separately does not exceed the size of the extreme (distal) phalanx of the thumb of the patient.
  • 1 degree – goiter is, it is not seen by the eye in the normal position of the neck of the subject, but well palpated; first degree also include nodules in patients with normal size of its shares.
  • 2 degree – goiter is well palpable and visible in normal neck position of the patient.

Diagnosis of endemic goiter

The initial stage for the identification of endemic goiter is palpation. This method allows you to:

  • To determine the size of the lobes and the isthmus (if it is accessible to palpation);
  • To assess the clarity of the borders with the surrounding tissues;
  • To assess the consistency of the gland: the presence of seals, razmagcheniu, nodular formations and their approximate dimensions;
  • To assess the status of regional lymph nodes, presence of lymphangitis - inflammation of lymphatic vessels, extending from the thyroid and parathyroid glands.

In addition to palpation is very informative, and affordable, method is ultrasound (sonography), which provides the following information:

  • The exact width, thickness and heightshares;
  • The size of the isthmus;
  • Comprehensive data on the structure of the gland, its homogeneity;
  • the presence of nodular formations and their exact dimensions;
  • The volume of individual lobes and total thyroid gland volume;
  • Condition of surrounding tissues.

Determination of the volume of the thyroid gland

The volume is calculated by the following formula:

The volume of one fraction = width * length * thickness * 0,48 (see kV)

The total volume is equal to the sum of volumes of both lobes.

Normal volume of the thyroid gland depending on the age of the person:

Age

The volume of the thyroid gland

6 years

For 4.8 – 5.5 ml

8 years

6.2 – 6.8 oz

10 years

7,7 - 9,1 ml

12 years

10,0 – 11,6 ml

14 years

13,7 – 14,7 ml

16 years

15,2 – 16,1 ml

The diagnosis of goiter in adults is established in excess of the volume of the breast above 18 ml in women and above 25 ml in men.

Additional methods of studying the state of the thyroid gland are:

  • Study the concentration of thyroid hormones in the blood (triyodtironin and tetrajodtironina), and thyroid-stimulating hormone of the pituitary gland, stimulating their synthesis;
  • Excretion of iodine with urine (up to 90% of the iodine taken into the body through the gastrointestinal tract and excreted by the kidneys);
  • Magnetic resonance imaging and computed tomography (used in doubtful cases);
  • Biopsy to exclude malignant neoplasms of the thyroid gland.

Treatment of endemic goiter

Treatment of endemic goitre must be comprehensive and consist of adherence, diet, drug therapy and, in some cases, surgical treatment.

Drug therapy of endemic goiter

Conservative therapy of endemic goiter reduced to the administration of thyroid preparations and preparations of iodine.

In the Russian Federation today, to make up for iodine deficiency approved only two drugs – imbalance and codomain. Iodactiv, so frequently prescribed by pediatricians and Russiantherapists, it contains iodine, which is associated with casein (protein in cow's milk), and therefore practically not absorbed.

0-1 on the stage of goiter and hypothyroidism in the first 6 months is assigned only to the codomain (or imbalance). If no effect, they may be combined with thyroid medications.

If you experience goiter 1st and 2nd degrees of the appointment toreading drugs is mandatory from first day of treatment. They inhibit the production of thyroid stimulating hormone, stimulating the thyroid gland, and reduce it in size. In addition, they reduce the risk of developing autoimmune reactions that often accompany thyroid disorders.

For the treatment of endemic goiter use the following medications:

  • L-thyroxine is a synthetic tetraiodothyronine. The treatment begins with a daily dose of 0.05 mg, gradually increasing it to 0.1-0.2 mg per day during the week.
  • Triiodothyronine is a synthetic analogue of triiodothyronine from the thyroid gland. The initial dose is 20 mg, which increases every 6-7 days.
  • Tireotom Forte – analogue of L-thyroxine. Therapy is started with 20 mg, gradually increasing to 80 mg (2 tablets).

The duration of therapy of endemic goiter these drugs is directly related to the severity of disease and the degree of enlargement of the thyroid gland.

In mild cases the treatment takes 6 – 12 months. Then starts the long-term dispensary observation of the patient with regular monitoring of thyroid size and hormone levels.

Surgical treatment of endemic goiter

In case the thyroid gland does not involve a violation of differentiation of its cells (malignancy), we performed a partial resection.

The indications for such operation are:

  • Much enlarged gland, compressing blood vessels, nerves, trachea;
  • The presence of a single solid node (cold) in adolescence;
  • Autonomous adenoma;
  • The recurrence of goitre.

In the case of suspected adenocarcinoma – a malignant tumor, the thyroid gland is removed completely or spend a Subtotal resection.

Radionuclide therapy of endemic goiter

In extreme cases, with frequent relapses, failure of medicinal and surgical treatment, and in old age conducted radionucleide therapy, which slows cell division and inhibits the growth of cancer.

It is very important not to forget about the presence of chronicpathology in a patient with goiter. This is especially true of diseases of the digestive system, accompanied by a malabsorption syndrome – malabsorption. In such cases, the dose of iodine several times greater than doses for patients with normal absorption of substances from the intestines.

Diet

So in 90% of cases of endemic goiter by just the lack of iodine in the body through the digestive tract, diet is one of the key elements in the treatment of this disease.

Daily requirement of iodine of a healthy adult is 140 to 150 mcg, children – 100-120 mcg and infants – 50mcg.

In the food should be consumed the following foods rich in organic iodine:

  1. Potatoesbaked in the oven, contains a single tuber up to 60 µg of iodine, which is more than a third of the daily requirement.

  2. Prunes – one fruit contains about 3 mg of iodine.

  3. Cranberry– 20-30 berries completely cover the daily needs.

  4. Seafood:

    • cod contains 99 mcg of iodine in 85 grams;
    • shrimp – 35 mcg per 100 grams;
    • lobster – 90 mcg per 100 grams;
    • tuna – 17 micrograms per 85 grams;
    • dried seaweed provides the body with up to 2500% of the daily requirement of iodine, because 7 grams contains 4500 mg.

  5. Turkey breast baked in the oven, contains 35 micrograms of iodine per 100 grams.

Iodine in small amounts is contained in milk, natural yogurt, chicken eggs, bananas, strawberries, and sea beans.

Exclude for the period of treatment from your diet is foods with strogannymi properties: broccoli, cabbage, cauliflower, turnips, radishes, lettuce, corn, beans.

Mode

In this situation, you should stick to this lifestyle during which providing all the needs of the organism requires the development of a large number of thyroid hormones. It is necessary to limit physical activity, eliminating heavy physical and emotional loads, climate change, long flights, change of routine and bad habits.

Definitely need to protect itself from the natural (see "Diet") and industrial chromogenic substances.

Industrial strumogennoe are:

  • Insecticides - chemical compoundsused to kill insects;
  • Herbicides – chemicals designed to kill weeds, widely used in agriculture;
  • Fungicides – chemicals to combat fungal diseases affecting plants;
  • Halogenated organic compounds used in the chlorination of drinking water, wastewater, and cooling of various power units;
  • Phthalic esters which are used in the automotive industry, construction and furniture manufacture;
  • Tiozionat – substances contained in cigarette smoke, competes with the thyroid for iodine capture.

On topic: Effective recipes of folk medicine for Goiter


Reminder to patient with endemic goiter

  • Follow a diet. Limit the use of products that stimulate the increase of the thyroid gland. Maximum type products, rich in organic iodine (see "Diet").
  • Stick to a healthy lifestyle. Reduce the severity physical exercise, but do not remove it completely. Give preference to the morning gymnastics, walking, yoga.
  • Ditch unhealthy habits, especially Smoking, as tobacco smoke contains strumigenys.
  • Take regular iodine preparations and thyroid hormones. Preferred admission in the morning.
  • Please think of all the recommendations of your doctor, regularly come to him for inspection.

  • Pay close attention to the sensations of the body. Describe in detail the points that bother you doctor (attacks palpitations or, conversely, bradycardia, neck pain, weakness, etc.) and try to identify the causes of their appearance.


Prevention of endemic goiter

Prevention of endemic goitre divided by the mass, group and individual:

  • Mass preventive measures consist in the production of iodized salt, iodized bread and confectionery, as well as propaganda to control the level of iodine in the diet on television and radio.

  • Prevention group is held in high-risk groups: organized groups of children and preschools, schools, technical secondary and higher educational institutions as well as withpregnant and lactating women. This includes the following explanatory conversation, and, according to doctor's recommendations, the controlled distribution of iodine preparations (Antistrumin, codomain, Iodosorb).

  • Individual prevention is to eat foods rich in iodine and taking iodine in high-risk groups in endemic areas.

Children on mixed feeding in case of feeding not adapted formula milk daily need 90 micrograms of iodine. Pregnant women, children and teenagers – 200 mg per day.