What does diagnosis mean?
The thyroid gland produces hormones that regulate metabolism, and their synthesis requires iodine. If there is little iodine intake, the pituitary gland increases the production of TSH, which stimulates the gland; the tissue grows and the volume of the organ increases. As long as compensation works, hormone levels remain normal - this is the euthyroid state. The diagnosis is made by the volume of the gland on ultrasound, taking into account gender and age, and not by sensations. Diffuse goiter is called because the tissue is enlarged evenly, without nodes; When nodules appear, they speak of nodular or mixed goiter.
- Uniform increase in gland volume
- Normal TSH and free T4
- Diagnosis by volume on ultrasound
- Difference from nodular goiter - absence of nodes
- Most often there are no complaints
Reasons
The leading cause in iodine-deficient regions is insufficient iodine intake from the diet. The need increases in adolescence, during pregnancy and lactation, so it is during these periods that goiter is detected more often. Additionally, heredity, smoking and substances that interfere with the uptake of iodine, contained in large quantities of certain foods with a monotonous diet, also influence. Less commonly, enlargement of the gland is associated with autoimmune thyroiditis at the stage of preserved function or with congenital disorders of hormone synthesis. It is important that normal hormones do not exclude the need to find out the cause.
- Lack of iodine in diet
- Increased need during pregnancy and lactation
- Adolescence
- Hereditary predisposition
- Smoking
- Autoimmune thyroiditis with preserved function
- Taking certain medications
Symptoms and complications
A slight increase usually does not manifest itself in any way and is found by chance during examination or ultrasound. With a significant amount of iron, it becomes noticeable in appearance, the neck looks thickened, collars and chains begin to get in the way. Complaints of compression are rare and are associated with pressure on the trachea and esophagus: a feeling of a lump, difficulty swallowing solid food, discomfort when tilting the head back. A long-existing goiter can eventually become nodular, and some of the nodes begin to autonomously produce hormones - then functional autonomy develops with symptoms of excess hormones, especially in the elderly.
- Most often there are no complaints
- Visible thickening of the neck
- Feeling of a lump in the throat
- Discomfort when swallowing and a buttoned collar
- Formation of knots over time
- Possible development of functional autonomy
Survey
The examination begins with examination and palpation of the gland, but the exact volume is determined by ultrasound: it measures the size, evaluates the structure and finds even small nodes. The function is assessed by TSH - this is the main screening indicator; in case of deviations, free T4 and T3 are added. Antibodies to thyroid peroxidase are tested if autoimmune thyroiditis is suspected. Ultrasound-guided puncture biopsy is needed not for diffuse enlargement, but when identifying nodes with warning signs. With a large goiter, assess whether the trachea is compressed.
- Examination and palpation of the thyroid gland
- Ultrasound of the thyroid gland with volume calculation
- TSH as the main indicator of function
- Free T4 and T3 with abnormal TSH
- Antibodies to TPO according to indications
- Fine needle biopsy for suspicious nodes
Treatment and prevention
In children, adolescents and young adults, the basis of treatment is iodine supplementation in doses determined by the doctor; Against this background, the volume of the gland often decreases. Thyroxine preparations are prescribed in individual cases and only by an endocrinologist - taking hormones on your own is dangerous. Elderly patients with long-standing goiter usually do not require active treatment; they are indicated for observation with TSH monitoring and ultrasound. Surgical treatment is considered for compression of the trachea and esophagus, very large sizes and suspicion of a malignant process. Prevention is simple: use iodized salt in your daily diet.
- Iodine preparations in a dose selected by a doctor
- Iodized salt in daily diet
- Monitoring with TSH and ultrasound
- Thyroxine preparations only as prescribed by an endocrinologist
- Quitting smoking
- Surgery for compression and suspected tumor
- Particular attention when planning pregnancy