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Causes, symptoms, extent and treatment of multinodular goiter

Italian Renaissance artists often depicted in his paintings of women with enlarged thyroid gland, apparently, in that distant time — the phenomenon was so common that was the norm.

Also in the past decades, there has been a steady increase in the incidence of thyroid pathologies.

Among endocrine diseases occurrence they approach diabetes. The reason for such high rates is a poor environment, poor quality food and lack of iodine in water and food.

The content of the article:


What is a multinodular goiter?

A multinodular goiter is a disease, which unites all entities in the thyroid gland in the form of nodes, having different origin, structure and size more than 10 mm.

Nodes can be of different nature:

  • Follicular;
  • Cystic;
  • Colloid and others.

In some instances there is a combination of several types of nodes in one patient.

Depending on the structural changes in the structure of the gland, multinodular goiter divided into 3 types:

  • Hub: diagnosed with non-uniform increase in the thyroid gland, which is caused by its excessive activity.

  • Diffuse: occurs when a uniform growth of gland tissue, indicating the decrease of its secretory function.
  • Mixed: quite rare and is called "endemic nodular goiter". In this case, the thyroid gland is irregularly enlarged, but some of its parts retain uniformity.

If more than two nodes larger than 1 cm in diameter, is recommended puncture of the thyroid gland. The vast majority of detected thyroid nodules are benign. As a rule, these tumors do not affect its function and in such development of the disease talking about eutireoidnom multinodular goiter. Only 5% of the discovered nodes turn out to be malignant.

The mechanism of cancer malignant and benigntumors different. Tumor nodules are formed by rapid abnormal division of one of the cells of the gland due to the damage to her genetic code. Malignant nodes do not replace the healthy cells of the gland and penetrate between them. In benign pathological process, the node grows and compresses surrounding tissue.

In Russia the disease occurs in 12% of the population, while in women 4 times more often than men. The probability of disease increases with age, peak detect multinodular goiter at the age of 45-60 years.

Despite the fact that the presence of nodes in the thyroid gland may not influence its normal work, the disease requires mandatory treatment. In some cases, ignoring this problem is a threat to life.


The symptoms of multinodular goiter

Multinodular goiter may for many years does not affect the function of the thyroid gland, and the patient feels discomfort and complaints. Until the node reaches the size of 1-2 cm in diameter, apparently see it, is problematic. In this course of the disease nodes are often found during routine inspections on the ultrasound machine. If time does not pay attention to this problem, over time, may develop hyperthyroidism, or an overactive thyroid.

Clinic when a multinodular goiter is reminiscent of toxic diffuse goiter, but there is no ophthalmopathy and myxedema. The patient may be concerned about excessive sweating, irritability, deterioration of General health with increasing outdoor temperature, frequent palpitations, and hypertension. Sometimes the patient may complain of tingling in the heart and in the blades, as well as increased appetite, constant thirst, diarrhea and weight loss. In addition, there is tremor of the fingers on the hands, tongue and body. At night, these people are haunted by the feeling of heat, they are characterized by fear and anxiety. Against the background of these symptoms is greatly reduced potency and libido.

Sometimes the thyroid gland grows and takes irregular shape, which does not only the doctor but the patient. Usually by this time the iron is so big that compresses nearby organs. In this case, the change of voice, difficulty in swallowing, breathing, a feeling of compression or choking in the neck, especially clearly get this feeling in the supine position.

You can owntry to detect the node on the thyroid gland. Healthy iron is smooth and elastic, if the probe detects dense areas – it may be nodes. Usually they are not connected with skin, and movable on swallowing.

A multinodular goiter, which apparently does not manifest itself, is detected during the examination on the ultrasound machine. Then prescribe hormonal examination and, if necessary, the study of cells of the node. The result of these analyses depends on the purpose of further treatment.


Degree multinodular goiter thyroid

When expressed signs of goiter thyroid disease divided into 3 degrees:

  • 1 degree multinodular goiter. By external examination and palpation of the thyroid gland manifestation of multinodular goiter is missing. For the diagnosis of disease and confirmation of diagnosis studies using other methods.
  • 2 degree multinodular goiter. There has been some increase in cancer, which is determined only by palpation, in the external examination of changing its size not determined.
  • Grade 3 multinodular goiters. A significant growth of thyroid tissue that becomes evident not only by palpation but also by external examination of the patient.

Goiter may not lead to visible enlargement of the thyroid gland or provoke its significant growth, in which it occupies the whole of the neck and even going down behind the sternum.

Causes of multinodular goiter

The exact cause of the disease is not fully understood, but insufficient dietary intake of iodine has a significant impact on the development of the pathological process.

In addition, aggravating factors can be the following:

  • Disruption of the Central nervous system;

  • Diseases of the liver and digestive system;

  • Psychological strain;
  • Overload associated with adaptation;
  • Inhibition of humoral immunity;
  • Radiation exposure;
  • Harmful working conditions;
  • Frequent inflammatory processes in the thyroid gland;
  • Long-term use of certain medications;
  • Irrationalfood;
  • Genetic predisposition to the disease.

The right treatment depends on understanding of the processes occurring in the thyroid gland. When iodine deficiency decreases the secretory activity of the organ and gland starts decreasing the production of thyroid hormones, which stimulate its activity. The signal about the lack of hormones reaching the brain, and the pituitary gland begins active secretion of the hormone TSH, thyroid-stimulating. Under the influence of hormones of pituitary gland thyroid cells are actively dividing, causing the gland grows in size. This can be called the compensatory response to iodine deficiency. Thus, the body seeks to independently increase the volume of the thyroid gland in order to effectively take from the blood the necessary quantity of iodine and other substances.

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

In the case when the body's need for thyroid hormones is reduced, accumulates in the gland colloid. Clinically it is manifested as the formation of a voluminous goiter. Inside it's filled with follicles that contain colloid substance. In re-needs of the body in an increased concentration of hormones of the thyroid tissue re-grow. Such wave-like processes can be observed for several years, this leads to multinodular goiter.

The female body is more susceptible to hormonal pathologies from the thyroid gland due to hormonal fluctuations during pregnancy, menopause and monthly during menstruation. The negative impact is able to provide increased secretion of specific hormones triiodothyronine and tetraiodothyronine in women.

Another important factor affecting the occurrence of goitre are internal autoimmune process. With the decline of humoral immunity in the blood appear specific substances of protein nature, which intensifies the confrontation of the organism to its own thyroid hormones. Such as the unfavorable external environment often leads to a significant decrease in the activity of the thyroid gland (hypothyroidism), which ultimately can cause cancer.

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Treatment multinodular goiter

Methods treatment multinodular goiter determined according tofrom causes that generated it. According to endocrinologists not all types of this disease require treatment. In some cases, doctors recommend to regularly monitor the condition of the gland and in the case of active dispersal of nodes to apply the methods of therapy. With the right approach of the doctor, and the patient's compliance with all required maintenance rules, he can live with this disease for several decades and not need surgical intervention. Treatment multinodular goiter can be both conservative and surgical.

L-thyroxine. Conservative therapy is prescribed to patients with high or low levels of thyroid hormones in the blood. In hypothyroidism treatment L-thyroxine dose set according to results of the analysis depending on the level of TSH. The dosage and duration of its use, pick up only individually. Typically, the reduction of goiter has been observed after 6-8 months of regular intake. Sometimes you need a longer therapy, which can last up to two years. After completion of the course of treatment prescribed drugs containing iodine during the year, for the prevention of disease.

The thyreostatics. Increased production of thyroid hormones provides thyreostatics, suppressing its activity, and drugs that speed up the metabolism of these hormones within the body. In addition, assigned a combination of drugs, which is composed of iodine. It is necessary for the iodination of tyrosine in the thyroid gland and slowing down the synthesis of TSH, which stops growth goitre. Such therapy is used in the early stages of the disease and in preparation for surgery.

When eutireoidnom multinodular colloid goitre drugs are not assigned due to the fact that the active components of these funds are not able to affect these formations. Therefore, if time does not determine the origin of the pathological process, the treatment of conservative methods will be meaningless and will not bring results.

Radioactive iodine-131. As therapy of the disease successfully used the introduction to the thyroid gland of radioactive iodine-131. This isotope causes cell death of the host. This procedure allows us to treat a point on the tumor while surrounding healthy tissues remain intact. Subsequently, the iron acquires its normal volume, the reduced size of the nodes or there is complete disappearance.

General preventive measures in the case of thyroid cancer include healthy lifestyle, dietary diversity and normalized physical activity. Increased consumptioniodine-containing products and complex of vitamins is necessary only after consultation with your doctor.