After the Chernobyl accident, the number of people with thyroid diseases is growing exponentially. Air pollution and iodine deficiency in food and water affects the thyroid gland of many people who have a genetic predisposition to thyroid disease. These changes are manifested by some morphological forms. Read more about diseases, diagnosis and treatment regimens for thyroid pathologies at estet-portal.com.
Focal formations in the thyroid gland. Nodular goiter
Nodular (multinodular) goiter – a clinical concept that combines all the processes in which focal formations in the thyroid gland are detected. These formations have a capsule and are determined by palpation or visually, they are characterized by morphological features.
The concept of nodular goiter combines many pathological processes in the thyroid gland. This is a nodular colloid goiter, a hypertrophic form of autoimmune thyroiditis, in which false nodes, follicular adenoma, solitary cyst and thyroid cancer are formed.
Depending on the number of detected nodes, solitary nodular goiter is isolated - with one encapsulated formation, multinodular goiter – upon detection of multiple formations, conglomerate goiter – several formations that are soldered to each other, and a diffuse-nodular goiter – nodes against the background of diffuse enlargement of the gland.
Processes leading to the development of nodular goiter syndrome
Among the reasons for the development of nodular goiter, the main one is iodine deficiency in the body. In the presence of iodine deficiency, cysts filled with cystic fluid can form in the thyroid gland. These cysts are formed as a result of small hemorrhages, degeneration of colloid nodules and hyperplasia of single follicles.
In the presence of iodine deficiency, the thyroid gland is exposed to stimulating factors that ensure the production of the required amount of thyroid hormones. As a result, a diffuse euthyroid goiter is formed. At the same time, individual cells of the gland are more sensitive to such stimulating influences and receive growth advantages. This is how nodes and cysts form in the thyroid gland, and nodular goiter syndrome appears.
Thyroid tumors develop in a different way. Their formation is associated with the presence in the gland of cells that have a high growth potential; they form locally dominant foci. Endogenous growth factors (TSH, IGF-1), mutations of ras-oncogenes take part in the formation of tumors.
Basic methods for diagnosing thyroid diseases
When examining a patient, the first thing to do is to ask about his possible residence in the area of iodine deficiency, & nbsp; to find out the presence of thyroid diseases in relatives (especially medullary cancer), as well as the duration of the existence of goiter, the dynamics of its growth, to find out if there is a connection between the onset of the disease and ionizing radiation. It is also important to pay attention to the patient's voice, ask if it has changed recently, find out if there are any unpleasant symptoms when swallowing food and liquid. It is important not to miss the presence of symptoms of thyrotoxicosis (arrhythmia, increased heart rate, blood pressure, tremor of the limbs, exophthalmos, rapid weight loss).
When examining and palpating the thyroid gland, you can see the pathology by tilting the patient's head back. Palpation of the gland can characterize the density and consistency of the gland. During the examination, the doctor must palpate the lymph nodes in the neck.
In laboratory studies of thyroid diseases, the determination of TSH, free T3 and T4 is important. But the determination of antibodies to gland cells and thyroglobulin in the diagnosis of nodular goiter, according to the recommendations of the association of endocrinologists, is inappropriate.
Calcitonin determination is necessary if the patient's relatives are suspected of having medullary thyroid cancer.
Ultrasound is performed if any pathology of the thyroid gland is suspected.
Scintigraphy of the thyroid gland is done when the diagnosis is differentiated between goiter and other diseases, as well as when the goiter is located retrosternally and ectopic tissues of the thyroid gland are detected.
TAB is a method that is used to exclude malignant pathology of the thyroid gland. MRI and CT, indicated in cases of retrosternal goiter.
Algorithms for the treatment of thyroid diseases depending on the process in it
If present nodular goiter is suspected, a puncture biopsy is performed. The tactics of treating thyroid diseases depend on its results.
- Colloid goiter – observation of the patient, therapy with iodine preparations, suppressive therapy, surgical treatment.
- Autoimmune thyroiditis – observation, substitution therapy.
- Thyroid cancer – surgical removal of part of the gland, radioactive iodine therapy, suppressive & nbsp; therapy with levothyroxine.
- Follicular neoplasia (adenoma) – surgical treatment with an urgent histological examination.
Surveillance means an annual assessment of the functioning of the gland by monitoring the hormones TSH, free T3 and T4. Suppressive therapy is carried out with thyroid hormone preparations in order to reduce TSH. Iodine therapy is effective in diffuse colloid goiter. Potassium iodide is used.
Methods such as ethanol ablation and other minimally invasive methods have not yet been evaluated in long-term studies.
Although hereditary factors and iodine deficiency play a predisposing role in the development of thyroid pathologies, but with frequent stressful situations, both for the psyche and for the body, the chances of manifestations of thyroid diseases increase greatly. After all, the thyroid gland reacts to the smallest changes in the body and controls many processes with its hormones. Therefore, in order to save the thyroid gland, you need to give up bad habits, normalize nutrition and psycho-emotional background. People who have thyroid disorders that need to be monitored should get more rest, spend more time outdoors, and avoid prolonged exposure to direct sunlight.
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