Etiology and pathogenesis

Hyperthyroidism - over-secretion of thyroid hormones, causing the acceleration of many processes in the body. This is one of the most common hormonal diseases. Most often, the development of hyperthyroidism occurs between the ages of 20 and 50. Women suffer from hyperthyroidism. Sometimes the predisposition to hyperthyroidism is inherited. The way of life does not matter.

With excessive secretion of thyroid hormones, many of the processes in the body receive additional stimulation, which leads to their acceleration. Approximately 3 of the 4 cases, the disorder arises due to the sample of graves - an autoimmune disorder, in which the body's immune system produces antibodies, damaging the tissue fabric, leading to the increased secretion of its hormones. Graves's disease is inherited, it is believed that we can talk about its genetic basis. In rare cases, hyperthyroidism can be associated with other autoimmune diseases, especially with skin disease and blood disease (malignant anemia).

Symptoms

For hyperthyroidism, the following symptoms are characterized:

Weight loss, despite elevated appetite and increased food intake;

Rapid heartbeat, often accompanied by arrhythmia;

Tremor (trembling) of hands;

Too warm, wet skin, as a consequence of increased sweating;

Bad heat tolerance;

Anxiety and insomnia;

Increased intestinal activity;

The formation of a tumor on the neck caused by an increase in the thyroid gland;

Muscle weakness;

Menstrual cycle disorder.

In patients with hyperthyroidism caused by Greiva's disease, Puchglasie can also be observed.

Diagnosis and treatment

In suspected the development of hyperthyroidism, a blood test should be made, allowing to determine elevated level thyroid hormones in the blood and the presence of antibodies, damaging the tissue of the thyroid gland. If a tumor is tamed in the field of the thyroid gland, a radionuclide study should be passed to check the gland for the presence of nodules.

To reduce the level of thyroid hormones, there are three main treatments. The most common of them is to use. This method is used in the treatment of hyperthyroidism caused by graves disease. The method is aimed at suppressing the secretion of thyroid hormones. Treatment radioactive iodom It is the most effective method in the formation of nodules in the thyroid gland. The course consists of doses of radioactive iodine used by the patient in the form of a solution. Iodine accumulates in the thyroid gland, destroying it.

Many patients are completely recovered by treatment. Nevertheless, the recurrence of hyperthyroidism is possible, especially in patients with graves disease. When conducting surgical treatment Or treatment with radioactive iodine the remaining part of the thyroid gland may not cope with the development of a sufficient number of hormones. Thus, after treatment, it is very important to regularly check the level of hormones.

Simple nonsense toxic goiterwhich can be diffuse or nodal, is non-torrent thyroid hypertrophy without developing the state of hyperthyroidism, hypothyroidism or inflammation. The reason is usually unknown, but it is believed that this may be the result of a long-term hyperstimulation by thyroid-stimulating hormone, most often in response to iodine deficiency (endemic colloid goiter) or reception of various nutritional components or drugs inhibiting the synthesis of thyroid hormones. Except for cases of pronounced iodine deficiency, the function of the thyroid gland is normal and patients are asymptomatic, is determined noticeably increased, dense thyroid. The diagnosis is established on the basis of clinical examination data and laboratory confirmation of the normal function of the thyroid gland. Medical events Aims to eliminate the leading cause of the disease, in the case of the development of too large goiter, it is preferable to surgical treatment (partial thyroidectomy).

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Code of the ICD-10

E04.0 non-toxic diffuse goiter

Causes of simple non-toxic goiter (eutheroid goiter)

A simple non-toxic goiter is the most common and typical reason for increasing the thyroid gland, most often revealed in a pubertal period, period of pregnancy and in menopause. The reason for the present time is not clear in most cases. Specific reasons - established defects of products of thyroid hormones in the body and iodine deficiency in certain countries, as well as eating food containing components, overwhelming the synthesis of thyroid hormones (so-called zobogenic food components, such as cabbage, broccoli cabbage, cauliflower, manica). Other known causes are due to the use medicinal preparationsreducing the synthesis of thyroid hormones (for example, amiodarone or other iodine-containing drugs, lithium).

The iodine deficiency is rarely found in North America, but remains the main cause of the serve epidemic around the world (called endemic goiter). There are compensatory low rates of TSH, preventing the development of hypothyroidism, but TSH-stimulation itself speaks in favor of non-toxic nodal goiter. Nevertheless, the true etiology of the majority of non-toxic gobles found in the regions where iodine is unknown.

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Symptoms of simple non-toxic goiter (euticide goiter)

Patients may have an anamnesis of the small intake of iodine into the body with food or high content in the food of the zobogenic components, but in North America, this phenomenon is rare. On the early stages Increased thyroid gland is usually soft and smooth, both shares are symmetrical. Multiple nodes and cysts can develop later.

The accumulation of radioactive iodine of the thyroid gland is determined, scanning and determining the laboratory indicators of the thyroid function (T3, T4, TSH) are determined. In the early stages, the accumulation of radioactive iodine the thyroid gland can be normal or high with a normal scintigraphic picture. Laboratory indicators are usually normal. The antibodies to the tissue of the thyroid gland are determined to identify differences with thyroidite Hashimoto.

In case of endemic zob, whey TSH can be slightly elevated, and serum T3 - on the lower boundary of the norm is either slightly reduced, but the level of T3 in serum is usually normal or slightly elevated.

Treatment of simple non-toxic goiter (euticoid goiter)

In regions with iodine deficiency, salt iodization is used; oral or intramuscular purpose of iodine oil solutions annually; Water iodization, chub or the use of animal feed (foose) reduce cases of the development of iodine deficient goiter. Reception should be excluded in food of bogged components.

In other regions, the suppression of the hypothalammopofizar zone by thyroid hormones, blocking TGG products (hence and stimulation of the thyroid gland) is used. TTG-suppressive doses of L-thyroxine, necessary for its complete suppression (100-150 μg / day orally, depends on the level of serum TG), are particularly effective in young patients. The purpose of L-thyroxine is contraindicated in individuals of the elderly and senile age, with non-toxic nodal zobs, since these goiter types are rarely reduced in size and may contain areas with autonomous (non-TG-dependent) function, in this case the reception of L-thyroxine can lead to development of hyperthyroid status. Patients with large-sized zobs often require surgical treatment or purpose of radioiodterepia (131-I) in order to reduce the size of the gland sufficient to prevent the development of breathing difficulties or swallowing or problems associated with cosmetic correction.

It's important to know!

The vascularization of the thyroid gland can be estimated during color streaming and pulsed dopplerography. Depending on the clinical problem (diffuse or focal disease of the thyroid gland) the purpose of the study may be a quantitative assessment of the vascularization of the thyroid gland or the definition of its vascular structure.

Such a nosological unit as nodal goiter, the code on the ICD 10 of which, respectively, from E00 to E07, is not one disease, but clinical syndrome. It combines a sufficiently varied form and the structure of the formation in the field of thyroid gland. Most often, pathological changes in the structure of the body are caused by a disadvantage of iodine intake into the patient's body.

The disease is usually endemic. It is noted that in certain territories among the population, the incidence rate may exceed the figure of 40%. Most often women are sick in the age group of 40 years and more. If we talk about characteristic symptomatic manifestations, then they may be absent with the easiest pathological process. With more severe course The nodal goiter can manifest itself in the form of a variety of dysfunctions of this organ, as well as symptoms of compression of the surrounding organs and tissues.

If we talk about the structure of such an endocrine organ of a person, like thyroid gland, then first of all we will define that it consists of follicular cells. Each such cell is a microscopic ball, which is filled with a specific - keloid fluid. When developing the pathological process, the follicle increases in size, forming the so-called node. The neoplasm can only be represented by one node or form from a large amount of modified follicles. This is the so-called diffuse nodal goiter.

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If we talk about the reason for the development of such pathological changes in the field of thyroid gland, it until now is not yet established. As mentioned above, most specialists bind the formation of the pathological change in follicles with a lack of admission to the human body of iodine. This theory is based on that, according to statistical data in areas with low content of this chemical element In water and food products, the incidence among the population is large in the nodal goiter. However, how to explain what such pathology is often detected in sufficiently prosperous in the content of iodine areas?

According to another theory of the disease (classification code corresponds to the column E07) develop as a result of an increase in load on the thyroid gland. As a rule, this is due to the violation of the robots of the entire human body. What factors can provoke an increase in the size of follicles and will form cystic education on their basis?

1. Hereditary predisposition to the violation of the work of the endocrine system.
2. Environmental factors. This include increased radiation, water pollution and air products of industrial enterprises.
3. Various immune violations or human diseases.
4. Long stressful situations.
5. Age changes in tissues forming the thyroid gland can also contribute to the development of this pathology.

The difficulty of determining the cause that caused such a goiter (ICD 10 defines as E01-07) is due to the fact that there is no one, but several adverse factors on the patient's body. However, regardless of the determining factors, symptomatic manifestations of pathology are always the same.

Clinical picture

In the early and uncomplicated stages of the pathological process, without special research, it is almost impossible to determine the presence of nodal goiter. There are no special specific complaints from the patient. Diagnosis In this case, you can randomly, for example, as a result of the thyroid survey with an ultrasound. On the screen, the doctor states the presence of knots or cysts in body tissue.

Only at the later stage of the patient will pay attention to the change in the contours of the neck due to the growing cystic education. Such a disease got the name of eutheosis. The absence of clinical symptoms is due to the fact that the products of hormones in this case are not violated. The patient will mainly disturb the appeared cosmetic defect. Only in some cases there may be unpleasant squeezing sensations in the throat area.

The most severe symptomatic manifestations are the diffuse goiter. By clinical flow It is very similar to thyrotoxicosis. When a doctor is polling, the patient presents the following complaints:

1. There are unpleasant sensations in the throat area. Sometimes it is just a sense of pressure, but may also be painful.
2. The patient complains about difficulties with food swallowing.
3. At the pressure of cystic education, complaints appear on the trachea.
4. Changes in the work of the cardiovascular system can be revealed, for example, in the form of greetings and arrhythmias. This symptomatic manifestation will have an additional code in the history of the patient's disease.
5. The patient notes that he lost in weight without certain reasons.
6. The work of the sweat glands increases.
7. Skin covers can be very dry.
8. The patient marks an increased nervousness or, on the contrary, is inclined to depression.
9. A process of memorizing a large amount of information can be broken.
10. Sometimes there are complaints on intestinal dysfunctions or constipation.

Classification of disease

If we talk about the most frequently used in medical practice under this pathology of classifications, then are used to be based on the characteristic of the degree of increasing body. An example is the classification proposed by Dr. O.V. Nikolaev. Unlike the ICD 10, it does not use encodings, but simply in the history of the disease, the degree of increasing thyroid gland is indicated:

1. The zero degree of pathology is characterized by the lack of obvious disorders of the form and size of the body. Even palpator research will not help make a diagnosis. The patient has characteristic complaints.
2. At the first degree of cosmetic defects in the neck, there is no, however, when you feel the doctor may notice some increase in the thyroid gland. It is during this period that the first functional disorders In the work of the body.
3. If the thyroid gland is clear enough at the act of swallowing, then the patient put the second stage of the disease. During this period, the organ is easily palpable. The patient begins to complain about periodically emerging difficulties in swallowing or breathing.
4. The code of the third degree of this pathology is exhibited in the case when the patient iron is so increased that it changes the usual neck contour. In a patient, during this period, all major symptomatic manifestations of the disease can be identified.
5. When the symptomatic manifestations and the presence of a significant cosmetic defect in the neck of the neck, the fourth degree of illness is posed.
6. The fifth degree is the most severe. Iron in this case grows up to large sizes, which leads to the compression of regional organs and tissues. Violated the work of most organs and systems.

There is a classification and according to the ICD 10. It is based not only on symptomatic manifestations, but also takes into account the causes of the development of the disease. At the same time, 3 types of illness are distinguished:

1. Endemic goiter, which was formed due to the lack of iodine.
2. The non-toxic form of goiter, and the presence of one or more nodes is distinguished.
3. Thieterotoxicose form of pathology.

Medical events

Experts believe that easy form Nodal goiter therapy, as a rule, is not needed. The patient's health is observed. And only in the presence of intensive growth, the cyst can be selected tactics of treatment. In this case, the question of which method is used to use, conservative or operational.

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In the case of the choice of conservative, or, in other words, the drug method, the patient is prescribed medications capable of suppressing increased production of hormones with this iron. In addition to this, iodine preparations can be appointed.

Operational treatment is shown in a significant increase in the cyst, for example, if the patient has a diffuse toxic goiter of severe. Surgical technique In this case, it is designed to remove the resulting cyst. This removes part of the affected gland (share or half gland). When identifying malignant neoplasses, all thyroid glands can be removed depending on the lesion area.

The International Statistical Classification of Health Conditions and Problems is a document developed under the guidance of WHO to ensure a single approach to methods and the principles of disease treatment.

Once at 10 years it is revised, changes and amendments are made. To date, there is an ICD-10 classifier, which makes it possible to determine the International Protocol for the treatment of one or another disease.

Principles of classification of endocrine diseases

Class IV. E00 - E90. Diseases of the endocrine system, nutrition disorders and metabolic disorders, also includes diseases and pathological states of the thyroid gland. Nonzology code according to the ICD-10 - from E00 to E07.9.

• Congenital iodine deficiency syndrome (E00 - E00.9)
• Sound diseases associated with iodine deficiency and similar states (E01 - E01.8).
• Subclinical hypothyroidism due to iodine deficiency (E02).
• Other forms of hypothyroidism (E03 - E03.9).
• Other forms of non-toxic goiter (E04 - E04.9).
• Thyrotoxicosis (hyperthyroidism) (E05 - E05.9).
• Thyroiditis (E06 - E06.9).
• Other diseases of the thyroid gland (E07 - E07.9).

All these nosological units are not one disease, but a number of pathological conditions that have their own characteristics - both in the causes of the occurrence and in the methods of diagnosis. Consequently, the protocol of treatment is determined by the totality of all factors and taking into account the severity of the state.

Disease, its causes and classic symptoms

Initially, we remember that the thyroid has a special structure. It consists of follicular cells, which are microscopic balls filled with a specific liquid - keloid. Due to pathological processes, these balls begin to grow in size. It is because of what character is the growing, whether it has an impact on the production of hormone hormones, and developing disease will depend.

Despite the fact that the diseases of the thyroid gland are diverse, often the causes of their occurrence of similarity. And in some cases, it is definitely not possible to establish it, since the mechanism of action of this gland is still not fully studied.

• Heredity is called the fundamental factor in the development of pathologies of the domestic secretion.
• Environmental impact is an unfavorable environmental situation, radiological background, iodine deficiency in water and food products, food chemistry, additives and GMOs.
• Diseases of the immune system, violation of metabolic processes.
• Stresses, psycho-emotional instability, chronic fatigue syndrome.
• Age changes associated with hormonal rearrangements of the body.

Often, symptoms of thyroid diseases also have a general trend:

• feeling of discomfort in the neck, compresses, difficulties in swallowing;
• weight loss without changing the diet;
• violation of the sweat glands - can observe excessive sweating or dryness of the skin;
• sharp change of mood, depression exposure or excessively nervousness;
• reducing the severity of thinking, memory deterioration;
• complaints of the work gastrointestinal tract (constipation, diarrhea);
• failures in the work of the cardiovascular system - tachycardia, arrhythmia.

All these symptoms should suggest that it is necessary to consult a doctor - at least a plot therapist. And he, having conducted primary research, if necessary, will send to the endocrinologist.

Some diseases of the thyroid gland are less common due to various objective and subjective reasons. Consider those that are most common according to statistics.

Types of thyroid pathologies

Cyst thyroid gland

Little size benign tumor. It is believed that the cyan can be called an education that exceeds 15 mm. in diameter. All that below this border is the expansion of the follicle.

This is a mature benign tumor, which many endocrinologists are classified as a cyst. But the difference is that the cavity of the cystic formation is filled with Keloid, and adenoma is epithelial cells of the pin.

Autimmune thyroiditis (AIT)

The thyroid disease characterized by inflammation of its tissue caused by a violation of the work of the immune system. Due to this malfunction, antibodies are produced, which begin to "attack" own cells thyroid glands, saturated with leukocytes, which causes inflammatory processes. Over time, its own cells are destroyed, cease to produce the desired number of hormones and the pathological state occurs, referred to as hypothyroidism.

Eutheriosis

This is a practically normal state of the thyroid gland, in which the function of producing hormones (TSH, T3 and T4) is not violated, but there are already changes in the morphological state of the organ. Very often, such a state can proceed asymptomatic and lasting all his life, and a person will not even suspect the presence of a disease. Specific treatment This pathology does not require and often detected by chance.

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Nodal goiter Code on the ICD 10 - E04.1 (with a single node) - a neoplasm in the thicker of the thyroid gland, which can be both harsh and epithelial. The unit node is rarely formed and indicates the beginning of the process of neoplasms in the form of multiple nodes.

Goiter multicoral

Multi-melanoma goiter MKB 10 - E04.2 is an uneven increase in the thyroid with the formation of several nodes that can be as cystic, the same and epithelial. As a rule, this type of goiter is characterized by increased activity of the internal secretion body.

Diffuse Goob.

It is characterized by uniform growth of the thyroid gland, which affects the decrease in the secretory function of the organ.

Diffuse toxic goiter is an autoimmune disease for which the diffuse increase in the thyroid glands and the persistent pathological development of an excessive amount of thyroid hormones (thyrotoxicosis).

This increase in the size of the thyroid gland, which does not affect the production of the normal number of thyroid hormones and is not the consequence of inflammation or neoplastic formations.

Disease of thyroid disease caused by iodine deficiency in the body. There are euticoid (increasing the size of the organ without affecting the hormonal function), hypothyroid (reduction of hormone products), hyperthyroid (increase in hormone products) endemic goiter.

An increase in the size of the organ, which can be observed both in a sick person and in healthy. The neoplasm is benign and is not considered a tumor. Specific treatment does not require until the moment changes in the body or an increase in education.

Separately, it is necessary to mention such a rare disease as the thyroid hypoplasia. This innate disease, which is characterized by the underdevelopment of the body. If this disease occurs during the life, it is called the thyroid atrophy of the thyroid gland.

Thyroid cancer

One of the low-prolonged pathologies, which is detected only through specific diagnostic methods, as the symptomatics is similar to all other diseases of the threshold.

Diagnostic methods

Almost all pathological neoplasms are rarely discarded in a malignant form (thyroid cancer), only with very large sizes and late treatment.

For diagnostics use such methods:

• medical examination, palpation;
• analysis of the titer of antibodies to the tissue tissue
• ultrasonic examination of the pin;
• hormone analysis;
• if necessary, a thin game biopsy.

In some cases, treatment may not be required at all if the size of the neoplasms is very small. The specialist is simply observing the state of the patient. Sometimes neoplasms are spontaneously resolved, and sometimes rapidly begin to increase in size.

Most effective ways of treatment

Treatment can be conservative, that is, drug. Preparations are prescribed in strict accordance with laboratory studies. Self-treatment is unacceptable, since the pathological process requires control and correction of a specialist.

If there are clear indications, operational measures are carried out when a part of the organ is removed, which is subject to the pathological process, or the entire organ.

The treatment of autoimmune diseases of the pin has several differences:

• medical - aims to destruction surplus hormones;
• treatment with radioactive iodine or operation - leads to the destruction of the gland, which entails hypothyroidism;
• computer reflexotherapy is designed to restore the work of the gland.

Diseases of the thyroid gland, especially in the modern world, the phenomenon is quite common. If you turn to a specialist in time and carry out all the necessary therapeutic measures, you can significantly improve the quality of life, and in some cases completely get rid of the disease.

The concept of nodal goiter in the ICD 10 revision

This nosological unit relates to the class of diseases of the endocrine system, nutrition disorders and metabolic disorders (E00-E90), a block of thyroid disease (E00-E07).

Talking the nodal goiter, it is important to remember that this concept summarizes the ICD 10 different forms Diseases of the thyroid gland, differing due to the occurrence and morphological characteristics. In other words, these are nodes or neoplasms located in the gland and having their own capsule. The process may be one - or multicolored depending on the quantity. In this case, this disease can cause a visible cosmetic defect, determined by the palpation, or is generally confirmed only with ultrasound diagnostics. Thus, the following morphological types of goiter are distinguished:

• Nodular
• Diffuse
• Diffuse-nodes

Classification

However, the CCB 10 revision still put the formation of not only morphology, but also the causes of the occurrence, allocation:

• Endemic goiter as a result of iodine deficiency
• Non-toxic goble
• Thyredoxicosis

Endemic goiter with iodine deficiency

On ICD 10, this nosological unit belongs to the E01 code. For this pathology is characterized by hyperthyroidism. That is, the activity of the thyroid gland without clinical manifestations Toxic effects of thyroid hormones. About thyrotoxicosis syndrome can be said when pronounced symptoms of intoxication with hormones of the thyroid gland appear.

Etiology

As it is clear from the name the cause of this disease is the deficiency of iodine in the body, with the only difference at which stage the body lacks this element. If the deficit is due to a violation of iodine absorption in the intestines or congenital pathologies of the thyroid gland, in which the mining of the hormone is disturbed is a variant of relative failure. The absolute drawback occurs in endemic areas, where water, soil and food products with critical iodine content.

Pathogenesis

When iodine deficiency decreases the synthesis of hormones T3, T4 and the product of feedback in the hypophysies increases thyreotropic hormonewhich stimulates a hyperplastic reaction in the tissues of the thyroid gland. In the future, the process may become separate, that is, with the formation of a nodal goiter or diffuse. However, the mixed type is not excluded.

Sporadic forms

In ICD 10, the code E04 discusses non-toxic forms of goiter. Scientists still speak about the conventions of the separation of this term on the concept of endemic and sporadic, as the pathogenesis and the reasons for the latter are not fully clarified. In the ICD 10 revision, the non-toxic form is divided into one-member, multi-nominal and diffuse.

Etiology

Genetic factors in the development of sporadic form play not a latter role. The fact that not all the inhabitants of endemic areas develop hyperthyroidism, but a family tends to it with congenital genetic diseases associated with the defect of chromosome X. As a result, a change in the sensitivity threshold to the lack of iodine is possible in the body, as well as thyrotropic stimulation. Classical reasons include a lack of tyrosine amino acids, which is necessary for thyroxine synthesis. Reception of drugs in the composition of having perchlorates, salts of lithium, thiourevine.

Under the code E05 in ICD 10 separately indicated by thyrotoxicosis syndrome. This clinical syndrome is due to the negative effect of an excess TSH. Tireotoxicosis is a consequence of thyroid diseases, namely:

• diffuse toxic zoba
• autoimmune thyroiditis
• excessive admission to the body of iodine drugs or thyroid hormones
• toxic adenoma
• adenoma pituitary gland
• increasing sensitivity to thyroid hormones

Diffuse of the thyroid gland: symptoms and disease manifestations

The article describes the symptoms of diffuse toxic goiter, all the variety of its manifestations, given the concept of the forms of this heavy pathology. Also lists and described the degree of development of the disease with visual photos and video materials.

Heavy chronic endocrine disease- the diffuse goiter of the thyroid gland the symptoms of which proceed almost from all systems human organismHas an autoimmune nature. Its development is associated with the advent of the defect of the immune system, which is manifested in the products of antibodies, directed against TSH receptors, stimulating the work of the thyroid.

The consequence of this is:

1. Uniform growth of thyroid tissue.
2. Hyperfunction of gland.
3. The increase in the concentration of hormones produced by the thyroid house is thyroxine (T4) and triiodothyronine (T3).

Hypertrophied thyroid gland has its own name - goiter.

Etiology and pathogenesis of the disease

This pathology is most often striking women in the age category 20 - 50 years. In children and older people, the diffuse goiter arises very rarely. As for the causes of the disease and mechanisms that launch an autoimmune process, they currently remain for endocrinology a task that has yet to be solved.

While we can only talk about the hereditary predisposition, implemented under the influence of a complex of factors, both internal and external:

1. Mental injuries.
2. Diseases of infectious-toxic nature.
3. Organic lesions of brain structures (injuries, encephalitis).
4. Autoimmune pathologies.
5. Smoking (see thyroid gland and smoking: hazards lie down).
6. Endocrine disorders and so on.

Next, produced with significant excess of thyroid hormones, accelerate the exchange reactions, which leads to rapid exhaustion energy resourceslike fabrics separate organsAnd the whole human body is generally. First of all, the structural elements of the central nervous and cardiovascular systems suffer. Detailed description All stages of development of pathology describes the video in this article.

Classification

In such a disease, as the goiter diffuse, the symptoms are largely dependent on its form and the degree of manifestation. Pathology has several classifications.

Depending on the increase in the thyroid, the following degrees of the disease distinguish:

1. Zero - the goiter is not.
2. The first goiter is determined by Palparato, but visually not distinguish. The size of the share does not exceed the length of the distal phalanx I finger.
3. The second - goiter is defined both palpatory and visually.

Goiter, depending on the form happens:

1. Diffuse.
2. Nodal.
3. Diffuse-nodal (mixed).

By severity of the process flow:

1. Easy degree.
2. Average.
3. Heavy.

Depending on the functional state Typotka goiter can be:

1. Eutheroid.
2. Hypoterioid.

On localization it can be:

1. Ordinary.
2. Partially progressed.
3. Ring.
4. Distoping from embryo bookmarks.

Symptoms of the disease depends on all the characteristics mentioned in the classification.

Disease manifestations, depending on the severity of the pathological process

Diffuse-toxic goiter, whose symptoms are very diverse, depending on the severity of the process, has the following manifestations:

1. With a light form, neurotic complaints dominate. Tachycardia is observed, but the CSS does not exceed 100 UD / min, without violations of the rhythm. Other glands of internal secretion are not included in the pathological process.
2. With a medium severity, diffuse thyroid gland symptoms has several others, - to tachycardia, exceeding 110 ° C / min, weight loss is added, reaching 10 kg during the month.
3. A severe form is characterized by progressive weight loss, up to cachexia. In addition, the first signs of impaired heart functioning, as well as liver and kidneys appear.

A severe form of development of the disease is usually observed in the absence of treatment of diffuse toxic goiter for a long time, as well as when people are trying to cope with this disease with their own hands.

Features of the manifestation of the eutheroid state

Since the thyroid is functioning at the eutheroid goiter normally, but clinical picture The whole depends on the degree of increasing the gland. The zero degree against the background of preserving the normal health of the organ is absolutely not manifested. As the thyroid sizes increase, its effect on other systems of the body appears and gradually increases.

For example, the euticoid goiter diffuse 1 degree of symptoms has not yet very obvious:

1. Total weakness.
2. Increased fatigue.
3. Headaches.
4. Behind the sternum, in the projection of the heart there are unpleasant sensations.

1. Difficulty breathing.
2. Feeling compression in the neck.
3. Difficulties with swallowing.
4. Sressing the tracheas, leading to the attacks of choking and dry cough.

In order to prevent exacerbation of the state, you should seek timely medical help And do not deal with self-medication. In addition, it should be remembered that the price of treatment is the greater that the disease is launched.

Features of the manifestations of diffuse-noded goiter

In addition to the diffuse goiter, there are also mixed (diffuse and node) and the nodal form. Diffuse goiter is a uniform increase in the thyroid gland, subject to the lack of local seals in the tissues. In node form, pathological assemblies appear in normal structures.

The mixed goiter is a complex of noded formations and diffuse growth. It takes in the structure of the thyroid pathologies one of the first places in the frequency of occurrence.

The first stages of the disease can give scarce symptoms or not to give it at all. But the further progression of the pathological process makes the manifestation of the disease more brighter.

The development of diffuse-nodal beast occurs in three degrees international Classification WHO or five to the Russian:

• Zero degree (I on WHO). Symptoms have no, it is found randomly during the survey of other organs
• First degree (I on WHO). Manifests itself a slight increase in the weight of the patient, an unprecedented decrease in body temperature, chronic fatigue, hypotension.
• Second degree (II on WHO). Manifests problems with swallowing, painful sensations in the head and neck when performing slopes of the body and head. Since diffusely nodal goiter, the symptoms of which are gradually enhanced, continues to grow and increase the products of hormones, the manifestations of hyperthyroidism begin to join, - blood pressure rises, edema, exophthalm, pathological psychomotor reactions, tremor appear. Also, due to the grave of the trachea, the tissues of the thyroid gland is developing shortness of breath.
• Third degree (II on WHO). At this stage of its development, the diffuse nodal goiter of the thyroid gland demonstrates even more pronounced. Suffer from cardiovascular, endocrine and nervous Systems. The shape of the neck is strongly changed. The skin is either dry or mooring, due to the excessive generation of the hormones containing iodine, it appears a reddish tint. From the head of the gastrointestinal tract - diarrhea alternate with constipation. The patient is concerned with pronounced tremor, hypotension, bradycardia to 40 UD / min or tachycardia more than 100 ° C / min. Despite the elevated appetite, patients lose weight. Changing the position of the head feels a sharp attack of suffocation. They are tormented by a permanent shortness of breath.
• Fourth degree (WHO III). It differs from the previous one and the size of the goiter, completely changing the configuration of the neck.
• Fifth degree (III on WHO). It is characterized by the extreme severity of the course of the disease, in which many systems of the human body suffer: endocrine, nervous, digestive, cardiovascular. Sometimes death is possible. The sizes of the goiter are huge, which chinno changes appearance patient. His voice becomes husky or completely disappears. Intellect, memory, reproductive functions are reduced.

Doctors use both varieties of classification, but the Russian is more valuable, since with its help the course of the goiter is described much more.

One of the most powerful manifestations of the depletion of thyroid resources is hypothyroidism, which has developed in childhood, is cretinism. It is characterized by a pronounced lag of physical, mental, mental and intellectual development, lowerness, tie-up, slow ripening of bones, in some cases deaf-and-darkness.

Separate syndromes peculiar to diffuse goiter

The defeat of each body system leads to the emergence of specific complaints, in addition, there are a number of individual syndromes characteristic of this disease in hyperthyroidism.

The cardiovascular system

Violation of normal heart and vessels manifests itself:

1. Tachycardia alone (up to 130 ° C / min), in which pulsation is felt in different parts of the body, such as hands, belly, head, chest.
2. Systolic growth arterial pressure and a drop of diastolic.
3. Pronounced myocardiodistrophy (especially in the elderly).
4. Cardiosclerosis.

Violations of the cardiovascular system carry a direct threat to the life of the patient. The struggle against them should be carried out by joint efforts of endocrinologists and cardiologists, and the patients should clearly follow the treatment instructions developed by these specialists.

Catabolic syndrome

The following manifestations are characteristic of it:

1. Sharp altitude (up to 15 kg) when an appetite is increased.
2. Total weakness.
3. Hyperhydrosis.
4. Subfebrile in the evenings (found at the limited number of elderly patients).
5. Temperature regulation.

The last manifestation is characterized permanent sensation Heat, thanks to which the patients are not flawed even with a significantly low ambient temperature.

Activities

Tireotoxicosis leads to endocrine ophthalmopathy, characterized by the following symptoms:

1. Expansion of eye cracks.
2. An incomplete closure of the eyelids leading to the "sand in the eyes", dryness of the mucous side, chronic conjunctivitis.
3. Puchglasium.
4. Shine eye.
5. Periorbital edema in combination with the growth of periorubital tissues.

The last symptom is perhaps the most threatening, because it leads to the squeezing of the eye nerve and eyeballEnhance intraocular pressure, the appearance of pain in the eyes, and even to full blindness.

Nervous system

Thyareotoxicosis primarily leads to mental instability from easy excitability and plasticity to aggressiveness and difficulty concentration.

The disease also leads to other violations:

1. Depression.
2. Sleep disorders.
3. Tremora of different severity.
4. Muscle weakness with a decrease in the volume of muscles of the limbs.
5. Increase tendon reflexes.

With severe forms of thyrotoxicosis, patients may develop sustainable disorders of the patient's psyche and his personality.

Skeleton bones

The lasting course of thyrotoxicosis, with an excess of thyroxine leads to the washing of phosphorus ions and calcium from the bones, which causes:

1. Destruction of bone tissue.
2. Reducing the mass of bones, as well as their density.
3. Bone pain.

Fingers in the hands gradually become similar to "drum sticks".

Gastrointestinal

Disorders of the digestion are expressed in pain syndrome, the instability of the chair up to diarrhea, sometimes nausea and vomit. The severe form of the disease leads to thyrotoxic gapatosis, liver and cirrhosis dystrophy.

Endocrine glands

Since all the components of the endocrine system are interrelated, then disorders of the thyroid glance lead to the failures of the functioning of many other glands.

Adrenal glands may suffer from relative thyreogenic insufficiency, the symptoms of which are:

1. Skin hyperpigmentation (especially in open areas).
2. Hypotension.

Disruption of ovarian work due to thyrotoxicosis is a rather rare phenomenon in which such changes occur:

1. The frequency and intensity of menstruation decreases.
2. Fibrozno-cystic mastopathy develops.

Moderate thyrotoxicosis may not affect the reproductive function of a woman. The threat here in another, - antibodies that stimulate the thyroid gland can pass the transplacent barrier, leading in some cases to the manifestation of newborn transient neonotal thyrotoxicosis.

The sexual sector of men suffers often and is expressed in gynecomastia and erectile dysfunction.

Breath system

In patients with thyrotoxicosis, there is an increase in breathing, as well as a tendency to the development of pneumonia.

Skin Covers

Thyareotoxicosis affects skin condition. It becomes soft, warm and wet. Sometimes vitiligo is developing, skin folds darken, which is especially noticeable in the area of \u200b\u200bthe elbows, neck, loins. The hair falls out, the nails are affected by onchomicosis and thyroid acopacia.

A small number of patients suffers from the pretibial mixedma, which is expressed in the swelling, seal, as well as erythene of the skin in the footsteps and the legs, which are also itchy.

In order for the diffuse goiter to do not reach their later stages and did not start risk not only the health, but also the life of the patient, when the first signs of the disease should immediately appeal to the therapist or endocrinologist.

Included: endemic states associated with iodine deficiency in the environment of both directly and as a result of iodine deficiency in the mother's body. Some of these states cannot be considered true hypothyroidism, but are a consequence of inadequate secretion of thyroid hormones in a developing fetus; There may be a connection with natural zobogenic factors. If necessary, identify the concomitant mental delay use additional code (F70-F79). Excluded: Subclinical hypothyroidism due to iodine deficiency (E02)

• • E00.0 congenital iodine deficiency syndrome, neurological form. Endemic cretinism, neurological form
  • E00.1 Congenital iodine deficiency syndrome, Myxdematous Form Endemic Cretinism: Hypothyroid, Miksdematomatic Form
  • E00.2 Congenital iodine deficiency syndrome, mixed form. Endemic cretinism, mixed form
  • E00.9 Congenital iodine insufficient syndrome. Congenital hypothyroidism due to the lack of iodine BDU. Endemic cretinism BDA
• E01 thyroid diseases associated with iodine deficiency, and similar states. Excluded: Connected iodine deficiency syndrome (E.00-), subclinical hypothyroidism due to iodine deficiency (E02)
  • E01.0 diffuse (endemic) goiter associated with iodine deficiency
  • E01.1 Multi-nose (endemic) goiter associated with iodine deficiency. Nodal goiter associated with iodine disadvantage
  • E01.2 goiter (endemic) associated with iodine deficiency, unspecified endemic goiter BD
  • E01.8 Other diseases of the thyroid gland associated with iodine deficiency, and similar states. Acquired hypothyroidism due to the lack of iodine BD
• E02 Subclinical Hypothyroidism due to iodine deficiency
• E03 Other forms of hypothyroidism.

Excluded: Hypothyroidism associated with iodine deficiency (E00 - E02), hypothyroidism arising after medical procedures (E89.0)

• • E03.0 Congenital hypothyroidism with diffuse goiter. Goiter (non-toxic) congenital: BDU, parenchymal, Excluded: Given congenital goiter with normal function (P72.0)
  • E03.1 Congenital hypothyroidism without goiter. Aplasia thyroid gland (with mycase). Congenital: thyroid atrophy Hypothyroidism BDA
  • E03.2 Hypothyroidism caused by medicines and other exogenous substances
  • E03.3 Post-infectious hypothyroidism
  • E03.4 Atrophy of the thyroid gland (purchased) Excluded: Congenital thyroid atrophy (E03.1)
  • E03.5 Miksdematous Coma
  • E03.8 Other refined hypothyroidism
  • E03.9 Hypothyroidism unspecified. Myxedema BDA
• E04 Other forms of non-toxic goiter.

Excluded: Congenital goiter: BDA, diffuse, parenchymal goiter associated with iodine deficiency (E00 - E02)

• • E04.0 non-toxic diffuse goiter. Netoxic goiter: diffuse (colloidal), simple
  • E04.1 Non-toxic single-mellite goiter. Colloid node (cystic), (thyroid). Non-toxic mononodosis goiter. Thyroid (cystic) knot BDU
  • E04.2 Non-toxic multicate goiter. Cystic goiter BDU. Filotone (cystic) goiter BD
  • E04.8 Other refined forms of non-toxic goiter
  • E04.9 Non-toxic goiter unspecified. Goiter BDU. Nodal goiter (non-toxic) BD
• E05 thyrotoxicosis [hyperthyroidism]
  • E05.0 thyrotoxicosis with diffuse goiter. Exophthalmic or toxic goiter. BDU. Greiva's disease. Diffuse toxic goiter
  • E05.1 Thyareotoxicosis with toxic single-pointed goiter. Thyrotoxicosis with toxic mononodotic goiter
  • E05.2 thyrotoxicosis with toxic multi-nominal goiter. Toxic nodal goiter BDA
  • E05.3 thyrotoxicosis with tireoid tissue ectopia
  • E05.4 Thyareotoxicosis artificial
  • E05.5 Thyroid crisis or coma
  • E05.8 Other forms of thyrotoxicosis. Hypersection of thyroidism hormone
  • E05.9 Thyareotoxicosis is unspecified. Hyperthyroidism BDU. Tireotoxic heart disease (I43.8 *)
• E06. Thyroiditis.

Excluded: Postpartum thyroiditis (O90.5)

• • E06.0 acute thyroiditis. Abscess thyroid gland. Thyroiditis: Pointed, purulent
  • E06.1 Subighteous thyroiditis. Careloit de Kervena, giantheal, granulomatous, unmarried. Excluded: autoimmune thyroiditis (E06.3)
  • E06.2. Chronic thyroiditis with transient thyrotoxicosis.

Excluded: autoimmune thyroiditis (E06.3)

• • E06.3. Autimmune thyroiditis. Tareloit Hasimoto. Hasitoxicosis (transit). Lymphoadomatous goiter. Lymphocytic thyroiditis. Lymphomatous struma
  • E06.4 Medical thyroiditis.
  • E06.5 thyroiditis chronic: BDA, fibrous, rusty, ridel
  • E06.9 Thyroiditis is unspecified
• E07 Other Thyroid Diseases
  • E07.0 Calcitonin hypersecrection. C-cell hyperplasia of the thyroid gland. Hypersection of thyreocalcitonin
  • E07.1 Dormoronal goiter. Family dormriconal goiter. Pendred syndrome.

Excluded: Given congenital goiter with normal function (P72.0)

• • E07.8 Other refined thyroid diseases. The defect of tyrosine-binding globulin. Hemorrhage, heart attack in the thyroid gland.
  • E07.9 Thyroid disease Uncomfortable