What happens in the thyroid gland
The thyroid gland uses iodine as a building material for hormones that regulate metabolism. With a lack of iodine, the production of hormones decreases, the pituitary gland in response increases the secretion of TSH, and under its influence, gland cells divide more actively. This is how a diffuse goiter is formed - a uniform increase in the organ. Over time, growth becomes uneven and nodes appear; Some of them cease to be regulated and begin to independently produce hormones. Then a long-term goiter without symptoms can suddenly turn into thyrotoxicosis, especially in older people.
- Diffuse goiter - uniform increase
- Nodular and multinodular goiter
- Functional autonomy of nodes
- Hypothyroidism with severe deficiency
- Retrosternal location of large goiter
Causes and risk factors
The main reason is the low iodine content in the diet, which is typical for mountainous areas and areas far from the sea. The need for iodine increases during adolescence, pregnancy and breastfeeding, so it is during these periods that goiter is detected more often. Smoking, monotonous diet, rare consumption of seafood and refusal of iodized salt increase the deficiency. Some substances in foods and medications interfere with the absorption of iodine, but if you get enough iodine, this does not matter. Heredity determines how easily a person develops knots.
- Lack of iodine in diet and water
- Pregnancy and breastfeeding
- Adolescence and growth period
- Smoking
- Avoiding iodized salt
- Hereditary predisposition
- Monotonous diet without fish and seafood
Symptoms
At an early stage, there are usually no complaints, and an enlarged gland is noticed by chance during an examination or ultrasound. As they grow, thickening of the front surface of the neck appears, discomfort when fastening the collar, and a feeling of a lump when swallowing. A large or retrosternal goiter puts pressure on the trachea and esophagus: shortness of breath on exertion, coughing, difficulty swallowing, and sometimes hoarseness occur. If the function of the gland is impaired, either signs of hypothyroidism are added - drowsiness, chilliness, swelling, constipation - or thyrotoxicosis with palpitations, sweating and weight loss.
- Thickening of the neck, noticeable knot
- Feeling of lump and pressure in the throat
- Difficulty swallowing, coughing
- Dyspnea on exertion, worse when lying down
- Drowsiness, chilliness, dry skin with hypothyroidism
- Palpitations and sweating with thyrotoxicosis
Diagnostics
The doctor examines and feels the neck, after which he prescribes an ultrasound of the thyroid gland: it shows the volume of the organ, the presence and size of nodes, their structure and signs that require attention. Be sure to check TSH, in case of deviations - free T4, and to exclude autoimmune thyroiditis - antibodies to thyroid peroxidase. Nodes over one centimeter and suspicious according to ultrasound are punctured with a thin needle under ultrasound control to exclude a malignant process. In case of large or retrosternal goiter, the condition of the trachea and respiratory function are assessed.
- Examination and palpation of the thyroid gland
- Ultrasound with volume measurement and description of nodes
- TSH, if abnormal - free T4 and T3
- Antibodies to thyroid peroxidase
- Fine needle aspiration biopsy of nodes
- Assessment of tracheal compression in large goiter
Treatment and prevention
In children, adolescents and young adults with diffuse goiter, iodine preparations are usually prescribed in a physiological dose, and the iron is gradually reduced. If the effect is insufficient or the function is reduced, hormonal therapy is added under the control of TSH. In elderly people with multinodular goiter, iodine preparations are prescribed cautiously due to the risk of starting autonomous nodes. A large goiter with compression of the neck organs, suspicion of a malignant process and a pronounced cosmetic defect are indications for surgery. Prevention is simple and effective: constant use of iodized salt, and for pregnant and lactating women - iodine preparations as prescribed by a doctor.
- Iodine preparations in age doses
- Hormonal therapy according to indications and under TSH control
- Caution with iodine for nodular goiter in the elderly
- Surgery for compression of the neck organs
- Observation with ultrasound at the time prescribed by the doctor
- Iodized salt in everyday nutrition
- Additional iodine during pregnancy and lactation as prescribed by a doctor