Diffuse toxic goiter is a visible and / or palpable enlargement of the thyroid gland, formed by an attack of antibodies to thyrocytes. Treatment of persistent hyperfunction of thyrotoxicosis or hyperthyroidism of 1 and 2 degrees is selected based on the causes of exposure: nodal degeneration or inflammation.

The prevalence of DTG

Toxic diffuse goiter is characterized by a uniform and nodular pathology of the thyroid gland. More often there is a single hyperfunctioning node of 1/2 degree.

The presence of a family predisposition indicates the influence of genetic components. No single genetic defect has yet been found that indicates the monogenetic characteristics of the disease that determine effective treatment. The assumptions are based on the creation of a complex complex of several genes, combined with unknown factors from the external environment.

Toxic diffuse goiter (1, 2 degrees) progresses in female and male representatives at an average age of 30-50 years (more often in women). Often, treatment is required at an earlier period, during pregnancy and menopause.

Causes, classification and manifestations

Inherited defects immune system contribute to the production of protein elements - autoantibodies that form a connection with the receptors of thyroid cells. As a result, there is an acceleration of the growth of hormones of the 2nd degree.

Classification

Correctly organize treatment, it is possible with a competent determination of the presence of the disease and the degree of increase:

• 0 - no goiter
• l - parameters of shares greater than the distal phalanx thumb. The goiter is palpable, but not noticeable.
• II - goiter of the 2nd degree is palpable and has a pronounced shape.

Manifestations

Diagnosis and treatment

1 and 2 degrees are diagnosed by endocrinologists. Thyrotoxicosis syndrome is confirmed by the main indicators:

Treatment types

Toxic node 1/2 degree is caused by malfunctions of the immune system. Eliminating the symptoms of thyrotoxicosis allows you to fundamentally solve the problem with the growth of hormones. Modern endocrinologists consider 3 types of treatment:

Medical impact

Toxic goiter is treated with drugs (thyreostatics) contained in Mercazolil, Tyrosol and Propicil. They contribute to the destruction of hormonal defects.

To obtain the desired effect, it will take 1-1.5 years of therapy. At the first stages, the use of a large dose of drugs will be required, the normalization of the level of free T3 and T4 indicates a decrease in the dose of thyrostatic to the maintenance stage. Reception rates vary within 10 - 15 mg per day. Compliance with all recommended aspects will affect the blocking of thyroid hormone production.

The task of doctors is to provide treatment according to the principle of blocking and substitution. Such an event requires the parallel administration of artificial thyroid hormones (L-thyroxine). They replace the destroyed ones in a given volume. The daily norm of eutiroks is 75-100 mcg.

During the use of drugs can not be avoided side effects. The most pronounced is the increase in size - the goiter effect. In the blood, the level of platelets and leukocytes decreases. The liver is negatively affected, AST and ALT are elevated. Symptoms in the form of an allergic reaction, headache, diarrhea, and menstrual irregularities are characteristic.

Important! Drug treatment does not eliminate the original cause of the disease. The recurrence rate reaches up to 70%, which is due to the level of symptoms.

Surgical intervention

Therapy radioactive iodine or surgical exposure due to the development of hypothyroidism with repeated relapses. Regardless of the method: surgical removal or slow destruction with radioactive iodine, the progressive growth of hormones stops.

At the same time, the formation of hormones vital for the body is excluded. Such patients become hostages of hormone replacement therapy. Artificial hormones do not provide a complete replacement for those produced by the thyroid gland.

Computer reflexology

A safe and effective effect affects the preservation of the thyroid gland and the restoration of its functions without the use of thyreostatics. The peculiarity of the method is to stimulate the proper functioning of the body with the production of the necessary hormones in the optimal volume. The immune system of the body is restored, the symptoms and the cause of inflammation are eliminated. Reduction in the recurrence rate reaches up to 10%.

Computer reflexology acts as a guarantor of the main factors indicating healthy condition thyroid gland.

Diffuse toxic goiter (Perry, Basedow, Graves, Flayani disease) is an autoimmune pathology in which the overgrown thyroid tissue produces an excessive amount of hormones, leading to poisoning of the body (thyrotoxicosis).

Women aged 30-50 suffer from the disease 8-10 times more often than men. Depending on the symptoms, they are different forms ailment. Consider the features of the course and direction of therapy for diffuse toxic goiter 1 degree.

There are several classifications of diffuse toxic goiter. Most often, the technique developed by O.V. Nikolaev in 1955. When determining the degree of the disease, the ability to palpate the gland and appearance neck.

Classification according to Nikolaev:

• 0 degree - the gland is not palpable and not visible visually;
• 1 - palpable, but not visible, when swallowing, you can see the isthmus;
• 2 - palpable, visible when swallowing;
• 3 - the neck is thickened due to a significant increase in the gland;
• 4 - the goiter is clearly visible, it changes the shape of the neck;
• 5 - the goiter reaches a gigantic size and compresses the trachea, esophagus and neck vessels.

To clarify the degree of goiter, an ultrasound scan is performed, which shows the parameters of the gland. Normal organ volume: for women - up to 18 ml, for men - up to 25 ml.

This classification reflects only the size of the goiter of the 1st degree. To assess the patient's condition, another technique is used, based on determining the severity of thyrotoxicosis symptoms:

• mild form (subclinical) - it is characterized by changes in the psycho-emotional state, increased heart rate, weight loss;
• medium (manifest) - with it, a detailed picture of the disease is observed;
• severe - accompanied by the appearance of complications.

The choice of tactics for the treatment of Basedow's disease is largely determined not by the size of the thyroid gland, but by the level of its functional activity, that is, the severity of thyrotoxicosis.

Diffuse goiter 1 degree - what is it?

The diagnosis of "diffuse toxic goiter of the 1st degree" indicates that the thyroid gland is enlarged evenly and slightly. The doctor can feel it, but visually it is invisible. As a rule, this state of the body corresponds to mild form thyrotoxicosis, but not necessarily. In some cases, a small growth of the gland leads to severe poisoning of the body with thyroid-stimulating hormones.

Manifestations of diffuse goiter with mild thyrotoxicosis:

• decrease in working capacity;
• increase in nervous excitability;
• tachycardia about 100 beats per minute;
• weight loss by 10-15% against the background of increased appetite;
• hand tremor.

Symptoms of diffuse toxic goiter 1 degree with overt thyrotoxicosis:

• tachycardia 100-120 beats per minute;
• increase in pulse pressure;
• weight reduction by 20%;
• psycho-emotional disorders - irritability, aggressiveness, sudden mood swings, fussiness, insomnia;
• muscle weakness, trembling of the whole body, hyperactivity of tendon reflexes;
• diarrhea;
• heat intolerance, sweating;
• swelling of the legs;
• destruction of nails;
• violations menstrual cycle.

An obligatory sign of Basedow's disease is ophthalmopathy:

• uplift upper eyelid and omission of the lower;
• exophthalmos (bulging eyes);
• swelling and proliferation of tissues around the eyes;
• discomfort in the eyes, decreased vision.

The classic triad of symptoms of toxic goiter is an increase in the thyroid gland, exophthalmos and tachycardia. Pathological signs progress within 6-12 months.

The main reason

The cause of Basedow's disease is the genetic characteristics of the immune response, which are inherited.

The predisposition to the disease is realized under the influence of external prerequisites.

The main ones are:

• psychological stress, emotional overload;
• infectious and inflammatory diseases;
• brain injury;
• bad habits, in particular smoking.

The described factors lead to a violation of immunological tolerance, and autoreactive lymphocytes begin to be synthesized in the body, which impregnate the tissues of the thyroid gland.

Unlike other autoimmune pathologies in toxic goiter, an antibody attack does not lead to the destruction of the target organ, but to its stimulation: the synthesis of thyroid hormones is triggered, and the growth of thyroid cells is activated. In addition, immune inflammation occurs in the tissue near the eyes and on the front surface of the legs.

The diagnosis of "nodular goiter" is not taken seriously by everyone, however, such a doctor's conclusion should alert and become a reason for contacting an oncologist. You can read more about the nature of this disease by following this link.

Possible Complications

Without treatment, thyrotoxicosis with toxic goiter of the 1st degree can lead to serious disorders in the work of the heart, central nervous system and liver.

Possible complications:

• tachycardia above 120 beats per minute;
• atrial fibrillation;
• chronic heart failure;
• change in the psyche;
• muscle dystrophy, exhaustion of the body;
• liver damage;
• disability;
• osteoporosis (decrease in bone density);
• clouding of the cornea, squeezing optic nerve, loss of vision.

A life-threatening complication of Basedow's disease is thyrotoxic crisis. It can occur with improper treatment of goiter, after surgery, or as a result of an infectious disease.

The condition is characterized by a sharp increase in the symptoms of thyrotoxicosis, high fever, clouding of consciousness. Without urgent care, the risk of death is high.

Diagnostic studies

The main diagnostic methods for diffuse goiter are:

• examination of the neck and palpation of the thyroid gland;
• scintigraphy - obtaining a two-dimensional image of an organ using an emission computed tomograph after the introduction of a radioactive isotope into the patient's body;
• blood test for hormone and antibody levels.

Ultrasound of the thyroid gland with diffuse goiter of the 1st degree, it demonstrates its slight increase, hypoechogenicity (reduced density), homogeneity and absence of structural changes.

Scintigraphy is carried out in order to differentiate Basedow's disease from other pathologies of the thyroid gland. With toxic goiter, the tissue of the organ is characterized by increased absorption of the isotope.

Lab tests with thyrotoxicosis, they show a decrease in pituitary thyroid stimulating hormone (TSH) against the background of an increase in triiodothyronine (T3) and / or thyroxine (T4), as well as a high concentration of antibodies to TSH receptors.

When making a diagnosis, take into account external signs and the main indicators - weight, condition of the skin, nails, reflexes, pulse, pressure. But a clear sign of diffuse toxic goiter of any degree is ophthalmopathy.

goiter therapy

Treatment of diffuse toxic goiter of the 1st degree is carried out by conservative methods: antithyroid drugs or radioactive iodine.

To suppress the synthesis of hormones are used:

• drugs based on thiourea - thiamazole, mercazolil;
• means with propylthiouracil - propycil, PTU.

These substances are heated up in the cells of the body and inhibit the production of thyroid peroxidase, an enzyme that is involved in the production of thyroxine and triiodothyronine.

The dosage is determined individually. For example, for Mercazolil, the following scheme can be used:

• initial dose - 30-40 mg per day;
• maintenance - 10-15 mg per day.

A decrease in the amount of the drug is possible with the normalization of the pulse, body weight, pressure and the disappearance of tremor.

In addition, once every 14-30 days, tests are carried out for the level of hormones. The average duration of treatment is 6 - 24 months.

Additionally, in Graves' disease, sedatives, potassium and beta-blockers are used (to neutralize disorders in the work of the heart and blood vessels).

Radioactive iodine therapy for diffuse goiter is rarely practiced. It is indicated with an increase in the symptoms of thyrotoxicosis against the background of treatment with thyreostatics. The essence of the method is the introduction of a radioactive isotope of iodine into the body in the form of oral capsules. The substance accumulates in the cells of the thyroid gland and decomposes, emitting beta and gamma rays, which destroy the overgrown thyrocytes.

In case of allergy to thyreostatics, a persistent decrease in leukocytes and serious disorders in the functioning of the cardiovascular system, an operation is performed to remove part of the thyroid gland. It is preceded by medical stabilization of the patient's condition.

Preventive measures

Since toxic goiter is caused by a genetic defect, measures for its primary prevention have not been developed.

If there was a family history of the disease, it is possible to prevent an autoimmune reaction in the following ways:

• timely treat infectious and inflammatory pathologies;
• lead healthy lifestyle life;
• control the state of the thyroid gland;
• avoid stressful situations;
• strengthen immunity;
• not be exposed to insolation;
• do not take iodine-containing drugs on their own.

It is advisable to observe the same measures for all patients with an enlarged thyroid gland.

The first degree of diffuse toxic goiter is the initial stage of a dangerous thyroid disease. Without therapy, it leads to the development of severe poisoning of the body with thyroid hormones. In the case of timely seeking help, the prognosis for the course of the pathology is favorable: with the help of drugs, it is possible to normalize the function of the gland, metabolic reactions in the body and the work of the heart.

Thyroid disease is a common pathology that affects the functioning of the body as a whole. At the same time, an analysis for the hormones T3, TSH and T4 can not always detect the disease. Such a pathological condition in which the hormonal level remains normal is euthyroidism.

Against the background of euthyroidism, a person may develop more severe pathologies, leading to irreversible changes in thyroid gland. What is euthyroidism of the thyroid gland, is it dangerous and how to treat it - every person who cares about their health should know this.

Euthyroidism of the thyroid gland is a reversible change in the structure of the organ while maintaining its functionality. The symptomatic picture of euthyroid pathology excludes signs of hypothyroidism or hyperthyroidism.

Despite the fact that the growth of its tissues in the form of a diffuse increase or nodes is found in the thyroid gland, the hormone levels remain normal. However, this does not mean that the person is completely healthy.

Euthyroidism is a borderline condition in which the level of hormones can change upward or downward at any time.

The euthyroid state lasts for a short time. Usually, against its background, more serious changes quickly occur, accompanied by hypo- or hyperfunction of the thyroid gland. That is why timely detection and treatment of euthyroidism is so important.

The thyroid gland is very sensitive to all sorts of changes (both external and internal). Euthyroidism can be triggered by the following factors:

• insufficiency of iodine supplied to the body with food;
• hereditary predisposition;
• adverse environmental factors;
• inflammatory pathology of the gland;
• nervous breakdowns, stress;
• autoimmune thyroiditis(euthyroidism, as the initial stage of autoimmune inflammation of the gland, can last for years).

A euthyroid state may be seen in pregnant women with previously diagnosed hyperthyroidism. normalization of hormonal levels during pregnancy occurs due to an increase in the body's need for thyroid hormones.

If a physiological decrease in hormonal levels does not occur, doctors resort to drug therapy. The preservation of pregnancy and the birth of a healthy child directly depend on the normalization of hormonal indicators.

That is why it is so important to achieve medical euthyroidism during pregnancy in women who suffer from increased thyroid function.

According to the severity of pathological changes, endocrinologists distinguish euthyroidism:

1. 1 degree - an increase in the gland is not determined visually, palpation also does not reveal abnormalities;
2. Grade 2 - an increase in the gland is visually noticeable, but palpation does not give a result;
3. Grade 3 - an increase in thyroid tissue is noticeable upon examination and is confirmed by palpation.

Euthyroidism provoked by a lack of iodine is accompanied by nodular goiter: a diffuse overgrowth of the thyroid gland and the formation of single or multiple nodes. Depending on the nature of structural changes, several forms of nodular goiter are considered in euthyroidism:

• diffuse increase without nodular inclusions;
• identified single node;
• multiple nodes detected;
• multiple nodes merging with each other.

The nervous system is the first to react to euthyroidism. It is possible to suspect abnormalities associated with the thyroid gland by the following signs:

1. Rest as usual or normal sleep do not give the desired result. A person feels overwhelmed, notes an unreasonably growing weakness. There may be insomnia at night and drowsiness during the day.
2. Acute reaction to stimuli. Even minimal dissatisfaction can develop into a major quarrel. At the same time, a person suffering from euthyroidism is not only emotionally unstable, but also recovers from violent experiences for a long time.

Increased excitability of the nervous system is accompanied by symptoms associated with the work of other organs and systems:

• Neck - there is a lump in the throat that makes it difficult to swallow, periodically or constantly the patient feels pressure on the neck (a feeling similar to suffocation from a rope around the neck);
• Heart - a variety of violations of the rhythm of heart contractions from tachycardia (rapid heartbeat) to extrasystoles (extraordinary heartbeats);
• Weight - euthyroidism is characterized by a decrease in body weight for no apparent reason (against the background of a normal diet, without dieting, in the absence of serious diseases of other organs).

The patient himself or the doctor, when contacting the clinic, can visually or palpate an increase in the size of the gland and nodular inclusions. However, confirmation of structural changes with ultrasound is mandatory. Also, to confirm the diagnosis, an analysis of thyroid hormones is also required.

Normal hormonal values, together with glandular enlargement or detection of nodules/cysts, confirm a euthyroid state. To differentiate euthyroidism from oncology, it is advisable to conduct scintigraphy and biopsy of suspicious nodes.

The euthyroid state does not always require medical treatment. So, with a slight diffuse change in the thyroid gland and 1-2 nodes with a diameter of up to 0.8 cm (for example, with autoimmune euthyroidism), endocrinologists recommend only active monitoring: 1 time in 6 months. an ultrasound examination of the thyroid gland should be performed.

If the patient, against the background of severe symptoms, has rather serious structural changes in the tissues of the thyroid gland, a course is prescribed. drug treatment.

• To normalize the patient's condition and, at a minimum, to stop tissue growth, iodine preparations (Microiodine, Camphodal, Antistrumine and others) or L-Thyroxine (Levothyroxine) are prescribed.

Dosages of drugs are determined individually. In the absence of the result of monotherapy, it is possible to prescribe a combination of Levotiroskin with iodine-containing drugs.

Control ultrasound is performed every 3-6 months, after which the treatment regimen can be adjusted. A good result of the treatment is the elimination of symptoms that disturb the patient with euthyroidism and the absence of further tissue enlargement.

At effective treatment over time, the thyroid gland returns to normal: nodes disappear or decrease (0.8 mm or less), regression of diffuse growth is noticeable.

In the absence of a minimum therapeutic effect(stabilization) from drug therapy, the endocrinologist may suggest surgery.

The operation involves minimal excision of pathological elements (growing nodes) and partial resection of diffusely overgrown tissue.

Now such operations are performed by endoscopic access through mini-incisions. These achieve minimal tissue trauma, which leads to a short period of hospitalization (2-3 days) and fast recovery. At the same time, an excellent cosmetic effect is achieved: only barely noticeable small scars remain on the neck.

The complexity of the operation in euthyroidism is that it is necessary to accurately determine the volume of excised tissue. Excessive excision can lead to postoperative hypothyroidism, and insufficient excision will not give the desired therapeutic effect. Therefore, for such a surgical intervention, you need to contact only an experienced endocrinologist-surgeon.

Timely treatment of euthyroidism gives a favorable prognosis. Minor changes in the structure of the thyroid gland can be eliminated on their own by correcting the lifestyle: good nutrition, healthy sleep and rest, maintaining emotional stability.

With a sufficient dose of medication (regular intake of drugs prescribed by a doctor is required!) Pathological changes gradually regress.

The greatest danger is untreated euthyroidism or actively progressing against the background of drug treatment. In such cases, there is a high risk of rapid development of irreversible changes in the thyroid gland and violations of hormonal parameters.

In such cases, more serious therapy with hormones (for hypothyroidism) or their antagonists (for hyperthyroidism) is required.

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Euthyroidism of the thyroid gland, symptoms, treatment, nodular goiter

Euthyroidism is one of the pathologies of the thyroid gland that does not directly lead to changes in hormone production. However, this condition can have severe symptoms and requires treatment to prevent complications.

The thyroid gland can have various pathologies, which manifests itself in the work of the whole organism. Some of these diseases are sometimes not detected by checking the levels of hormones that the gland produces. Euthyroidism is one of those conditions.

Euthyroidism often becomes a catalyst for more serious diseases, due to which the thyroid gland is subject to negative effects, often irreversible. However, euthyroidism itself is called a reversible pathological process to which the thyroid gland is susceptible. Symptoms in this case are not similar to either hypothyroidism or hyperthyroidism, also called thyretoxicosis. During the pathological action in the cavity of the organ, its tissue grows excessively, however, the secretion of hormones is normal.

The main risk of euthyroidism is being in an indeterminate state, when the level of thyroid hormones can both increase and decrease. This situation does not last long, as it leads to more significant diseases, due to which the secretion of hormonal substances either increases sharply or falls. This scenario makes it necessary surgical treatment as soon as euthyroidism and its symptoms appear.

The thyroid gland is a small organ, but very important and sensitive to changing conditions, both external and internal. Thus, the following reasons can cause euthyroidism:

• Lack of iodine that a person receives regularly
• Heredity and genetic features
• Bad ecology
• Inflammation of the thyroid gland
• Severe psycho-emotional states
• Thyroiditis of autoimmune origin, in this case, the manifestations of euthyroidism, as its initial stage, can continue for many years

Euthyroidism is not uncommon in pregnant women who have previously been diagnosed with hyperthyroidism. This leads to the normalization of hormonal levels, as pregnant women naturally increase the need for hormonal substances that the thyroid gland produces.

If there is no decrease in the level of hormones, drug treatment is prescribed. If this is not done, then the pathological condition can cause an abortion or deficiencies in the development of the fetus. In this regard, drug euthyroidism is very important for pregnant women with increased thyroid function.

The severity of pathology for the endocrine system is determined by several degrees:

• Grade 1 - the thyroid gland is not visually enlarged, there are also no deviations on palpation
• Grade 2 - enlargement is noticeable, nothing is detected on palpation
• Grade 3 - the tissue structure is so enlarged that it can be seen both visually and on palpation

The manifestations of euthyroidism, provoked by iodine deficiency, lead to a disease called nodular goiter. This is a pathological phenomenon when there is a diffuse proliferation of tissues in the thyroid gland, leading to single or multiple nodes. Based on the depth of the pathology of what structural changes it brought, the following forms of nodular goiter are distinguished:

• Diffuse growth, when nodular inclusions are absent
• The presence of a single node
• Detection of multiple nodal structures
• A set of nodes that are connected to each other

The first symptoms are various deviations in the functioning of the nervous system. Usually they are not paid attention to, but the following situation should alert:

• When normal mode rest and sleep does not bring the usual results. Because of this, there is a chronic weakness, manifestations of unreasonable weakness. Often there is insomnia at night, turning into daytime sleepiness.
• Overreacting to non-habitual stimuli. An example would be a major quarrel over a minimal cause. Another symptom is that the patient takes a long time to recover from emotional upheavals.

The increased load on nervous system leads to the fact that euthyroidism is accompanied the following symptoms:

• Problems with the neck, expressed as a lump in the throat. The patient has difficulty swallowing, the neck is as if squeezed by a rope.
• Disorders of the heart muscle. Wide spectrum heart rhythm disturbances, such as tachycardia.
• Weight loss that occurs without effort, when the usual diet and physical activity is maintained.

If any of the indicated symptoms are observed and there is a suspicion of euthyroidism, you can independently, or better by contacting a doctor, check the thyroid gland for an increase in size. This is done by visual inspection and palpation.

If the organ is enlarged in size, then you should definitely contact a specialist who will once again check all the symptoms and prescribe additional ultrasound diagnostics and a laboratory test for the level of thyroid hormones. If hormonal levels are normal, but there is an increase in the size of the gland, as well as cysts or nodes, then the patient is said to be euthyroid.

Sometimes this pathology should be separated from a possible oncological disease. In this case, scintigraphy and biopsy of suspicious neoplasms are additionally indicated.

Euthyroidism does not always need treatment, which is often done with medication. When minor diffuse changes, and in the thyroid gland there are one or two nodes of small diameter (up to 8 mm), it is recommended to be regularly observed by an endocrinologist. As a rule, such a nodular goiter is observed in the autoimmune nature of the pathology, while ultrasound is recommended to be done once every half a year. The ultrasound examination procedure is quite cheap and common, so such an observation does not cause much trouble, while ensuring that the aggravation of the disease will not be missed.

If the existing symptoms are supported by serious structural changes in the organ, then the treatment is carried out with the help of medicines. To bring the patient's condition back to normal and stop the growth of tissues and nodes, the endocrinologist prescribes various iodine preparations, such as Microiodine, Thyroxine and others.

The doctor selects the dosage regimen and dosage based on the patient's condition. Usually treatment begins with taking one of the drugs. If there is no effect, then a combination is assigned medications.

Control examinations with such treatment are carried out every 3-4 months, with adjustments to be patient according to the results. A positive result is said if the result of therapy was to stop the growth of pathological tissues and nodes and the symptoms disappear. If we talk about indicators, then the treatment is considered effective when the nodes disappear or decrease to 8 mm, as well as the regression of diffuse growths.

Euthyroidism is treated with surgery if the effect of drug treatment is absent or does not correspond to the efforts made. The goals of surgical intervention are removal by excision of nodal elements and partial resection of overgrown diffuse tissue structures.

The operation is performed in a low-traumatic way using endoscopic techniques. The surgeon operates through minimal incisions, which leads to minimal possible complications, rapid healing and minor cosmetic imperfections.

If the operation has its own difficulties. To effectively eliminate euthyroidism, it is important to excise a strictly defined amount of tissue. If you overdo it, then hypothyroidism and a lack of hormone production can subsequently develop. The insufficiency of the removed tissue turns into a weak effect of surgical treatment. In these circumstances, the choice of an experienced surgeon is a very important part of therapy.

With timely detection, euthyroidism of the thyroid gland is successfully treated. At the same time, on early stages when the symptoms are not expressed, it is enough just to adjust the lifestyle to achieve positive results. Usually this consists in the normalization of nutrition, normalization of the mode of work and rest, the fight against emotional overload. If drugs are prescribed, then the course of their administration should be completed in order to avoid relapses.

The situation is most dangerous if euthyroidism progresses rapidly during drug treatment. At such a moment, it is important to take additional measures so that irreversible changes do not occur in the thyroid gland, which entail changes in the levels of vital hormones.

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Source: endocrine disorders of the thyroid gland are the second most common after diabetes. And 40% of these pathologies fall on various types of goiter.

"Goiter" is a collective concept that includes a number of diseases of the thyroid gland, provoking an increase in its size and the growth of individual nodes or their groups.

Normally, the volume of the thyroid gland is 9-25 ml for men and 9-18 ml for women. When a single node or a cluster of nodes is formed with an increase in volume, a nodular goiter is diagnosed.

If there is a uniform increase in the volume of the gland tissue, this is a diffuse goiter. There is also a mixed (diffuse-nodular) goiter.

When, against the background of an increase in the thyroid gland or its individual nodes, the production of hormones remains normal, we are talking about a diffuse nodular goiter (euthyroidism).

Diffuse nodular toxic goiter has a number of other names: Graves' disease, Graves' disease, hyperthyroidism. Most often, this disease affects women of childbearing age, since their body is especially dependent on hormones produced by the thyroid gland. Often the disease is observed in areas where water and soil has a low content of iodine salts.

Diffuse-nodular toxic goiter is characterized by the fact that in addition to an increase in the thyroid gland and the growth of its individual nodes, the production of hormones is much higher than the norm. This condition is called hyperthyroidism.

The patient becomes irritable, has a rapid heartbeat, shortness of breath during physical exertion, sleep disorders and gastrointestinal tract, sweating and trembling fingers.

In addition, diffuse-nodular toxic goiter provokes the development of exophthalmos or, in popular terms, bulging eyes.

But diffuse-nodular non-toxic goiter does not depend on the place of residence of a person, but is provoked by heredity, chronic diseases, irrational nutrition, the action of certain chemicals, pregnancy and other factors.

The insidiousness of diffuse-nodular goiter lies in the fact that at the beginning of its development it may not show any signs. Symptoms of diffuse nodular goiter become more pronounced when the thyroid gland is already significantly enlarged, while squeezing the trachea, esophagus and other neighboring organs. At this stage, the following symptoms are observed:

• an increase in the volume of the thyroid gland;
• compression of the esophagus and trachea;
• chronic dry cough with asthma attacks;
• feeling that there is a "lump" in the throat;
• voice becomes hoarse.

Diffuse-nodular goiter of the thyroid gland can occur due to a number of reasons:

• genetic predisposition;
• infectious lesion;
• mental trauma;
• autoimmune processes;
• age (women are more often affected after years);
• geographic location (for example, a person lives in an area with a low iodine content);
• environmental situation (poor sanitary conditions, the influence of harmful substances, pollution of the territory, etc.);
• eating food with little or no iodine at all.

Grade 0 goiter shows absolutely no symptoms and can only be detected through tests or ultrasound. Diffuse-nodular goiter of the 1st degree is not visible externally, but the doctor can detect it when probing. Not only an endocrinologist can diagnose a diffuse nodular goiter of the 2nd degree by palpation, it can be seen on the neck when a person swallows.

In the third stage of goiter, the thyroid gland has contours that violate the shape of the neck. The fourth degree makes the shape of the neck thick and ugly, and with the fifth degree, the thyroid gland grows so much that it presses on neighboring organs.

Often diffuse-nodular goiter of the 2nd degree can develop against the background of Basedow's disease. Therefore, headaches and pains in the neck, heart, sweating and swelling of the skin, disorders of the gastrointestinal tract, trembling of the limbs, excessive appetite against the background of weight loss, shortness of breath, high blood pressure can join the above symptoms.

For a more accurate result, an ultrasound examination of the thyroid gland and a blood test for the hormones that the gland produces are prescribed. When the growths of the gland are quite large, a biopsy may also be performed to rule out cancer.

Diffuse-nodular goiter of the 2nd degree, like the 1st, is eliminated with the help of drugs that normalize the activity of the endocrine system. Doses of medications taken are constantly adjusted by the attending physician, depending on many factors: the patient's age, level of vitality, possible comorbidities, test results during the treatment period.

Sometimes thyreostatic drugs are ineffective, the disease is initial stage can pass into a diffuse-nodular goiter of the 2nd degree and beyond. In this case, doctors recommend surgery. This method is especially indicated in cases where the enlarged thyroid gland strongly compresses the trachea, and therefore there are difficulties in the breathing process.

Also, an indication for surgery in the diagnosis of diffuse nodular goiter of the 2nd degree is the detection of atypical cells during histological examination.

Diffuse-nodular goiter of the 2nd degree is characterized by a significant proliferation of thyroid nodules, which can reach more than 3 cm in size. Simple surgical removal of the nodules does not lead to the final recovery of the patient. Nodes can grow again. Treatment of this pathology is aimed at the destruction of the factors that provoke the transformation of the thyroid gland.

If grade 2 diffuse nodular goiter is treated with conventional surgery, a 6 to 10 cm collar incision is made in the neck, crossing the prethyroid muscles. As a result, there may be keloid scars making the postoperative scar very noticeable.

But sometimes such an operation is the only way to save a person's life. So, if you have a diffuse nodular goiter, treatment should not be postponed until later, because thyroid neoplasms in an advanced form can become malignant.

Modern technologies allow surgical treatment of such a disease as diffuse nodular goiter of the 2nd degree using an innovative video-assisted mini-access technique when the neck muscles do not intersect. Such an operation with an incision length of 2 cm will not only effectively relieve the problem, but will not leave a noticeable scar on the neck.

Due to the fact that diffuse-nodular goiter of the 2nd degree is treated by surgical intervention with a mini-access, the patient does not need to stay in the hospital for weeks, he will be discharged after 3-4 days, having prescribed the necessary further treatment. If you have suspicions of stage 2 diffuse nodular goiter, it is better not to postpone a visit to the endocrinologist.

Prevention of a disease such as goiter is primarily associated with the use of a sufficient amount of iodine. There is a mass prevention, which consists in the daily consumption of iodized salt.

There is also a group prevention of iodine deficiency. It is recommended for certain categories of the population that may be most at risk of developing thyroid diseases - these are children, adolescents, pregnant women and women during lactation. The recommended dose of iodine is:

• for children 1-2 years of age - 50 mcg;
• children 2-6 years of age - 100 mcg;
• for children from 12 years old - 150 mcg;
• for breastfeeding and pregnant women - 200 mcg.

At the same time, doctors advise eating more foods rich in iodine: sea fish and seafood, sea kale, walnuts, persimmons.

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Source: a person feels healthy - there is no cause for concern. The reality changes exactly the opposite when a doctor diagnoses a serious disease that goes unnoticed against the background of good health. This category of diseases includes euthyroidism of the thyroid gland, symptoms and treatment - this is the necessary minimum of knowledge about the organ that produces vital thyroid hormones. Lack of energy and problems of reproductive function also directly depend on the state of the thyroid gland.

The correct functioning of this gland is extremely important for the body, because otherwise it is subjected to intense destruction. Formed in the third week of fetal development, after birth, this organ, which resembles a horseshoe in its shape, serves as a kind of talisman of beauty, optimism and procreation for women and men. Any pathology is a reason to pay attention to the state of the thyroid gland, especially if nodes and goiter are formed.

It is not easy for a specialist to make an accurate diagnosis, because the primary signs are almost invisible. But to diagnose euthyroidism of the thyroid gland, as well as thyroiditis, it seems possible for a number of symptoms:

• fatigue, drowsiness, which causes constant sensation fatigue;
• enlarged thyroid:
• discomfort in the neck, resembling a lump in the throat;
• sudden weight loss;
• arrhythmia, palpitations.

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The causes of thyroid disease can be different, and the consequences of improper treatment or a neglected condition are always serious. According to statistics, diffuse nodular goiter of the thyroid gland is a diagnosis that is overwhelmingly made for women, and only one out of five patients is a man. The thickenings that appear on the anterior part of the wall may be uneven, and outwardly nodular goiter in reality or in the photo looks like a cosmetic defect. The symptoms of thickening are mechanical, and the manifestation of the disease looks like:

• a lump that feels like a foreign object stuck in the city;
• hoarse voice;
• frequent attacks of suffocation, as if it were difficult to breathe;
• dizziness;
• painful sensations when pressing on the nodular formations.

The degree of formation of nodular goiter depends on the composition, severity of the course of the disease. With euthyroidism of the thyroid gland, the diagnosis is made through a set of procedures. Probing and ultrasound are considered the most optimal methods for determining the degree of compaction. Single-nodular goiter is the initial stage of the disease and visually pathological formations are not noticeable, then palpation and a special study help to identify nodular non-toxic goiter of the first degree.

Two or more masses that are easily palpable and visible indicate that a multinodular euthyroid goiter is progressing. For a disease of the second degree, accompanied by an enlarged thyroid gland, pain in the neck when bending over and a feeling of discomfort when swallowing are characteristic. Among other characteristic symptoms that may occur in a sick person, there are irritability, loss of appetite, swelling, trembling of the limbs. At this stage, nodular goiter is still amenable to conservative treatment.

A hereditary factor that leads to a failure of immunity and provokes an increase in the thyroid gland can disrupt the functioning of the cardiovascular system of the body. Therefore, diffuse-nodular goiter of the thyroid gland (colloid) belongs to the category of dangerous diseases, sometimes requiring surgical intervention, if the formations reach large sizes. Sleep disorder, pronounced hand tremor, vitiligo, hair loss are the most characteristic symptoms diffuse goiter or Graves' disease.

Pathology of the thyroid gland, which turns into a lack or excess of hormones for the body, affects both women and men. The latter are less likely to suffer from euthyroid thyroid symptoms and treatment in the stronger sex have a number of features. But both in those and in others, the symptoms of the pathological process can be detected by an endocrinologist during a consultation, laboratory tests and studies, for example, scintigraphy, will also help.

It is more difficult to diagnose the presence of this disease, since the inflammation is asymptomatic until it passes to the stage of tumor formation. Although manifestations of euthyroidism of the thyroid gland in the stronger sex are less common, the disease is more difficult to tolerate. In order not to start the disease and not bring the treatment to the point of surgical intervention, one cannot ignore the general signs of thyroid disease (permanent weakness, headache difficulty breathing) and you need to seek help from a specialist.

The fair sex is also susceptible to euthyroidism, but the symptoms and treatment may vary slightly. The most dangerous thing is that the disease can turn into infertility. If the gland does not work properly, then this causes a violation of the hormonal balance, and this leads to the failure of the entire reproductive system. Problems arise with attempts to bear a child, in addition, one or another scale of thyroid euthyroidism in women can cause mood swings, memory problems, swelling, brittle nails, and joint pain.

Whatever the signs of thyroid disease, but after the examination comes the mandatory stage - treatment. The correct determination of the stage of the disease outlines a further scheme when conservative drug therapy, surgery or treatment is used for recovery. folk remedies.

Among the medications that are prescribed for children and adults, iodine preparations prescribed by courses are considered the most popular. With positive dynamics of the course of euthyroidism of the thyroid gland after taking them, prevention is recommended, otherwise combination therapy demonstrates its effectiveness. If the disease takes severe forms (large or multiple nodes, a malignant tumor), then there is only one treatment option - surgery.

The use of folk remedies is also widely used in the treatment of thyroid euthyroidism. Thyroid disease helps to defeat decoctions, fees, tinctures that are taken orally or make compresses, and the most useful and popular product for this is walnuts. The diet should be strengthened with foods containing iodine, and you should also eat more fruits, vegetables and dairy products.

To prevent the disease, during recovery or in cases where an autoimmune thyroid disease is observed, there are no contraindications for preventive measures. Maintaining the functioning of the thyroid gland is no less important than normalizing the functioning of a vital organ, especially for those who live in ecologically unfavorable areas. Be sure to monitor the quality of food consumed and that the diet contains foods with iodine. Hardening, taking vitamin complexes, quitting smoking - all this helps to resist a serious illness.

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

Source: - the state of the thyroid gland, in which this organ secretes a normal amount of thyroid hormones (triiodothyronine (T3) and thyroxine (T4)), but there are beginning changes in its anatomical structure. The thyroid-stimulating hormone of the pituitary gland TSH (thyrotropin) is also normal.

Note: we can talk about the onset of euthyroidism when the growth of the thyroid gland begins, and the level of hormones does not change.

Most often, this condition is provoked by:

• a decrease in the amount of iodine supplied to the body;
• hormonal imbalance during pregnancy;
• the beginning of the development of autoimmune thyroiditis (euthyroid phase, which can last for years, or a lifetime);
• hereditary factor (the presence of a condition and diseases of the thyroid gland in the family);
• unfavorable ecological background;
• frequent inflammatory pathological processes in the gland tissue;
• taking medication (as a side effect);
• neuropsychic overload, stress and neurotic reactions, emotional and volitional disorders,

In asymptomatic cases, euthyroidism is an incidental diagnostic finding on ultrasound of the thyroid gland, radiological research methods, and MRI.

Euthyroidism, depending on the cause that caused it, can manifest itself:

• emotional stress;
• rapid depletion of mental reactions;
• sleep disorders, accompanied by insomnia and drowsiness during the day;
• unpleasant, pressing pains in the neck and throat;
• sensation of a lump in the throat, accompanied by distension and problems with swallowing;
• a visible increase in the size of the thyroid gland;
• fast-onset and severe fatigue.

The most common form of manifestation of euthyroidism is nodular goiter, accompanied by diffuse tissue growth.

Clinically, 4 forms of this disease are determined:

• nodular goiter with a single enlarged node;
• nodular goiter with multiple enlarged nodes;
• goiter, in which multiple nodes are combined with each other;
• nodular goiter caused by a deficiency of iodine in the body.

The severity of the process (WHO classification):

• 1 - during palpation, the thyroid gland is not felt and is not visually determined;
• 2 - on examination, the goiter is not visible, but palpable on palpation;
• 3 - the goiter is clearly palpable with a finger examination and is determined by visual examination.

With manifestations of euthyroid nodular non-toxic goiter, the patient may experience the following clinical manifestations process:

• weight loss and visible weight loss;
• discomfort foreign body, bursting in the chest;
• violation of the rhythmic activity of the heart in the form of tachyarrhythmias, extraordinary contractions of the heart (extrasystoles) and other disorders.

The main diagnostic methods include:

• questioning the patient and examining the thyroid gland;
• assessment of the content of pituitary hormones (TSH) and thyroid gland (T3, T4);
• Ultrasound, which allows you to assess the condition of the thyroid gland, the size and presence of formations (cysts, nodes, etc.)

Additionally, radioisotope diagnostics (scintigraphy) is performed.

The tactics of treating the euthyroid state depends on the results of the diagnosis. In mild and stable cases, simple observation is carried out with control visits to the doctor, testing and ultrasound. On average, once every six months.

Note: with existing complaints, a choice is made between conservative and surgical methods of treatment.

The pronounced symptoms of euthyroidism and the patient's poor health allow him to prescribe iodine preparations (Antistrumin, Microiodine, Kamfiod, Camphodal, etc.), Levothyroxine.

With little efficiency conservative treatment, the presence of a large number of bulk nodes, cystic formations, progressive enlargement of the thyroid gland, surgical treatment is recommended. The operation is carried out with the obligatory cytological examination and biopsy of the material, to clarify the existing pathological process.

To be treated only folk methods in this case, it should not be, but as an additional therapeutic benefit, some recipes can be used home cooking. The endocrine function of the thyroid gland is supported and normalized by tincture of walnut partitions, infusion and decoction of chicory, sugar mixture chokeberry.

It is good to include seaweed in the diet - kelp, shrimp, crabs.

Euthyroidism itself is a condition that does not require medical measures, but only observations, but in the case when euthyroidism passes into the disease phase, medical intervention is required. Compliance with the appropriate regime, elimination harmful factors, diet, regular examinations make the course of euthyroidism favorable.

Doctors who diagnose diseases, especially during preventive examinations, should pay attention to patients who have a genetic predisposition to thyroid diseases.

People who have developed euthyroidism should avoid prolonged exposure to direct sunlight, reduce exposure to stressful situations, and conduct rehabilitation measures when frequent illnesses nasopharynx. You should also avoid living in environmentally unfavorable areas.

note: you should be especially careful when taking medications, in particular antibiotics and hormonal drugs.

During pregnancy, women with a tendency to pathology of the thyroid gland, with preventive purpose iodine preparations should be taken, since pregnancy leads to an overstrain of the enzyme and hormonal systems of the body and rapid development deficiency of essential minerals, elements and iodine.

People who have been diagnosed with euthyroidism should have regular check-ups with an endocrinologist, blood tests, and an ultrasound of the thyroid gland.

Lotin Alexander, medical columnist

Information is provided for informational purposes. Do not self-medicate. At the first sign of disease, consult a doctor. There are contraindications, you need to consult a doctor. The site may contain content prohibited for viewing by persons under 18 years of age.

Source: euthyroidism, methods of its treatment and prevention

Like other endocrine glands, the thyroid gland affects all the internal organs of the body through hormones. The state of the body in which the thyroid gland produces an insufficient amount of hormones is called hypothyroidism. If the activity of the thyroid gland is increased, and it secretes too many hormones into the blood, hyperthyroidism or thyrotoxicosis develops. Both diseases are dangerous in their consequences and can be diagnosed through laboratory tests.

But there is also a borderline state, when pathological processes begin to develop in the thyroid gland, in which the concentration of hormones remains within the normal range. This condition is called euthyroidism, and it is quite difficult to recognize it.

What are the symptoms of euthyroidism of the thyroid gland, what is it, and what methods will help prevent its development, and, if necessary, cure it?

Euthyroidism of the thyroid gland is a term that refers to the normal functioning of the organ, in which there are no symptoms indicating malfunctions in its work. The normal function of the thyroid gland is said when the blood concentrations of thyroid hormones produced by it, as well as thyroid-stimulating hormone produced by the pituitary gland, are within the normal range.

However, the concept of "normal" is not synonymous with "healthy". Most often, this concept is applied to patients with nodular goiter - an increase in the thyroid gland while maintaining its normal function. The euthyroid state is often associated with iodine deficiency.

If euthyroidism is not detected in the early stages, more serious changes in the structure of the thyroid gland occur against its background, leading to the development of thyrotoxicosis.

Having dealt with what euthyroidism is, you can begin to consider the causes of its development. The main reasons for the development of euthyroidism are the following factors.

• Lack of iodine, as a result of which clinical euthyroidism develops. In this case, thyroid cells begin to grow, thus seeking to replenish iodine from other sources. As a result, the thyroid gland increases, forming a diffuse goiter or colloid cysts.
• Pregnancy. In pregnant women, euthyroidism of the thyroid gland develops against the background of hyperthyroidism. During this period, the hormonal background is restored due to the fact that the body begins to experience an increased need for thyroid hormones.

• Autoimmune thyroiditis. In this case, euthyroidism is the initial stage of the disease, which can last for years.
• Medical euthyroidism develops as side effect while taking various medications. This condition is reversible, and after discontinuation of the drugs that caused this condition, the thyroid tissue is restored.
• Euthyroidism is often inherited. It is this factor that explains the development of pathology in children.
• Unfavorable environmental situation in the region of residence.
• Thyroid injury or surgery.
• Frequent stress.

Euthyroidism is accompanied by a nodular goiter, which is formed due to the growth of diffuse tissues of the thyroid gland.

According to the severity of the nodular goiter is divided into three degrees.

• Nodular goiter 1 degree. This pathology proceeds in a latent form. During visual examination and palpation of the thyroid gland, no abnormalities can be detected.
• If euthyroidism is accompanied by nodular goiter of the 2nd degree, it can be detected by visual inspection. However, no nodes are found on palpation.
• The third degree of the disease occurs with a significant proliferation of thyroid tissues, which is not only noticeable during visual inspection, but also easily palpable.

Diagnosis of euthyroidism is complicated by the fact that this condition practically does not manifest itself. Therefore, people go to the doctor only after the thyroid gland has significantly increased in size. However, there are still signs of pathology, you just need to pay attention to them in time. The main symptoms of thyroid euthyroidism include the following manifestations:

• increased irritability;
• sensation of a lump in the throat;
• feeling tired and weak;
• hoarse voice;
• violation of the heart rhythm;
• unexplained weight loss.

Turning to the endocrinologist for the first time, it is not always possible to identify the presence of pathology, since the symptoms of euthyroidism are inherent in many other diseases. Visual inspection only confirms the presence of goiter of the second degree. Therefore, to confirm or exclude the presence of structural changes in the thyroid gland, the following diagnostic methods are used:

• Ultrasound of the thyroid gland;
• blood tests for the content of thyroid hormones and thyrotropin.

A preliminary diagnosis is confirmed if the concentration of hormones in the blood is within the normal range, and an ultrasound examination in the tissues of the thyroid gland reveals structural changes in the form of nodes or cysts. To exclude the development of oncological processes, the patient may be offered a scintigraphy and biopsy.

If you do not pay attention to the symptoms of pathology in time, they can turn into serious consequences. An increase in euthyroid goiter leads to compression of the vessels and arteries located in the neck. In such people, breathing becomes difficult, pain occurs when swallowing, the voice becomes hoarse, and eventually disappears altogether.

Improper functioning of the thyroid gland affects the human nervous system, as a result of which irritability develops into permanent depressive states. In such people, there is a deterioration in memory and attention, as well as a decrease in reaction.

The lack of iodine-containing hormones leads to an increase in the level of cholesterol in the blood, which causes atherosclerotic heart disease and blood vessels. The reproductive system is also undergoing changes. In women, the menstrual cycle is disturbed, and in men, erection worsens. In the future, infertility may develop.

by the most dangerous consequence nodular goiter is the degeneration of a benign neoplasm into a malignant one.

Euthyroidism is characterized by different symptoms, and treatment is selected based on the manifestations of the pathology. If a patient is diagnosed with a slight change in the structure of the thyroid gland, drug treatment is usually not prescribed to him. In this case, it is enough to periodically visit a doctor and conduct an ultrasound scan.

Patients begin to be treated with medications already at more advanced stages of euthyroidism. Treatment is aimed at relieving the symptoms of the pathology and stopping the growth of tissues. For these purposes, hormonal and iodine-containing drugs are used. If drug treatment does not bring tangible positive results, the patient is operated on, during which the nodes or part of the thyroid gland are removed.

In euthyroidism, it is useful to use drugs traditional medicine, the purpose of which is to saturate the body with iodine, which can normalize thyroid function. For this, the following compositions are used:

• tincture of partitions of walnuts;
• decoction of chicory roots;
• chokeberry, grated with sugar;
• dried kelp.

During preventive examinations, doctors primarily pay attention to patients who have a hereditary predisposition to thyroid diseases. Such people should try to avoid prolonged exposure to ultraviolet radiation, including sunbathing and visiting a solarium. Stress is capable of provoking the disease, so you need to try to smooth out any conflict situations.

Pregnant women with a predisposition to thyroid diseases should adjust their diet in favor of products containing iodine. The same recommendation applies to children who have thyroid disorders. In the presence of euthyroidism, you need to regularly undergo medical examinations including an endocrinologist.

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Source: what is thyroid euthyroidism, what are the symptoms of the disease and its treatment?

All these questions concern patients faced with such a diagnosis.

Of particular concern is the question of how well the disease can be cured, and whether there is a possibility of relapse.

Thyroid euthyroidism refers to pathological changes in the structure of the gland, which are reversible.

The tissues of the organ grow rapidly, which leads to its diffuse growth or an increase in nodes.

At the same time, the level of thyroid-stimulating and thyroid hormones remains unchanged, although the likelihood of a hormonal surge is very high. The formation of several nodes means the development of a multinodular goiter.

Against the background of a short euthyroid state, pathological processes develop that accompany hyper- or hypofunctionality of the thyroid gland. Given this fact, when euthyroidism is detected, treatment should be started immediately.

The endocrine system is highly sensitive to exogenous and endogenous factors. The most vulnerable in this regard is the thyroid gland. The occurrence of thyroid euthyroidism is caused by the following reasons:

• stress;
• ecology;
• iodine deficiency;
• pathology of the thyroid gland of an inflammatory nature;
• aggravated heredity;
• hyperthyroidism of pregnant women;
• chronic autoimmune thyroiditis (AIT).

Euthyroidism during pregnancy occurs due to the fact that the hormonal level of a woman undergoes significant changes. As a rule, the disease disappears with the normalization of the hormonal background.

If necessary, medical therapy should be resorted to to ensure the preservation of the fetus.

In addition to the main reasons, the development of the disease can be provoked by the following factors:

• the use of drugs that depress the work of the thyroid gland (drug euthyroidism);
• excessive stress of a psychological or physical nature;
• poisoning active ingredients(arsenic, strontium).

Clinical euthyroidism of the thyroid gland can proceed for several years without deterioration, being a stage of autoimmune type thyroiditis.

Speaking about the classification of euthyroidism, depending on the severity of the disease, there are three degrees of development of the disease:

1. The first is due to a slight increase in the thyroid gland, which is not visualized and not determined by palpation.
2. The second - the gland is visually enlarged, but palpation does not reveal pathology.
3. The third is a clearly visualized and palpable increase in the thyroid gland during palpation examination.

Non-toxic goiter is the growth of the thyroid gland and the formation of single or multiple nodes. Taking into account the nature of pathological changes in the structure of the thyroid gland, five types of nodular goiter are distinguished:

• endemic, arising from iodine deficiency;
• nodular goiter - euthyroidism, in which the size increases, but there are no nodular formations;
• nodular goiter 1 degree with one node;
• nodular goiter 2 degrees with several nodes;
• nodular goiter, in which several nodes are interconnected.

Each degree of severity is characterized by certain symptoms of thyroid euthyroidism.

First of all, some manifestations from the nervous system are observed:

• loss of concentration;
• weakness;
• insomnia along with daytime sleepiness;
• nervousness;
• migraine;
• increased irritability;
• long recovery period after irritation.

In parallel with disorders of the nervous system, other signs of a violation of the usual functioning of organs may appear:

• violation of the heart rhythm (tachycardia, extrasystole);
• a sharp drop or fast growth body weight;
• difficulty swallowing reflex;
• feeling of fullness in the neck and chest;
• dry cough;
• change in voice timbre (hoarseness);
• an increase in the size of the thyroid.

A change in the size of the thyroid gland can be noticed by the patient himself, but ultrasound and an analysis for thyroid hormones are required to confirm the structural changes in the organ.

Due to mild symptoms in the initial stages of euthyroidism, patients turn to specialists when the disease becomes chronic. There are frequent cases of late detection of nodular goiter and even cancer.

Treatment of euthyroidism of the thyroid gland is selected depending on the results of the examination and the conclusion of the doctor.

Sometimes only constant monitoring by an endocrinologist and an ultrasound of the thyroid gland every six months is required. These cases include the following options:

• diffuse changes in the thyroid gland are insignificant;
• the presence of one or two nodes does not exceed 80 mm in diameter (AIT - autoimmune euthyroidism);
• hormones within acceptable limits.

In other cases, when a violation of the structure of the thyroid gland is accompanied by severe symptoms, surgical or conservative treatment is used.

To restore the functioning of the thyroid gland and return to acceptable sizes, courses of medications are prescribed. Treatment with a number of drugs is widely used:

• "L-thyroxine";
• "Yodbalance";
• "Microiod";
• "Camphodal";
• "Antistrumin".

Levothyroxine is a synthetic thyroid hormone. It is taken in the morning on an empty stomach to increase effectiveness, with the possibility of dividing into two doses on the recommendation of a doctor (in the morning).

The daily dose of the drug varies depending on the diagnosis as follows:

1. Hypothyroidism - from 50 to 100 mcg at the first stage of img at the maintenance stage;
2. Congenital hypothyroidism in children - up to 6 months, the dosage per day at the rate of 8-10 mcg per kilogram of the child's weight and from 6 months to 1 year kg per kilogram per day.
3. Euthyroid goiter - 100 to 200 mcg in 24 hours.
4. Endemic goiter - at the initial stage 50 mcg per day, at the maintenance stage from 100 to 200 mcg.

Maximum efficiency is achieved on the fourth day of admission. The thyroid gland with diffuse goiter of the 1st degree decreases from three months to six months.

• diabetes;
• intolerance or high sensitivity to the components;
• malabsorption syndrome;
• insufficiency of the adrenal cortex;
• cardiovascular diseases;
• hypofunction of the thyroid gland (severe);
• thyrotoxicosis.

Side effects include the following disorders:

• hypothyroidism;
• rash or itching;
• tachycardia and arrhythmia;
• dysmenorrhea;
• brain pseudotumor;
• migraine;
• leg cramps.

"Iodbalance" helps to compensate for the lack of iodine in the body. It is taken orally after meals once a day with water. The drug is prescribed in the following dosages:

• during pregnancy and lactation - 200 mcg 1r / day;
• in order to prevent endemic goiter in patients under 14 years old - 50 mcg-100 mcg per day;
• in order to prevent endemic goiter in patients aged 15 years and older - 100 mcg-200 mcg per day;
• after hormonal therapy and resection of the thyroid gland - 100 mcg - 200 mcg during the day.

Among the contraindications are the following factors:

• iodine intolerance;
• thyroid adenoma or nodular toxic goiter;
• dermatitis herpetiformis (senile);
• subclinical hyperthyroidism;
• the use of radioactive iodine;
• the likelihood of oncology;
• galactose intolerance or lactase deficiency.

Taking the drug may be accompanied by a number of side effects:

Taking medications is carried out under the supervision of the attending physician, the dosage and duration of the courses are selected individually.

Thanks to the advice of traditional medicine, it is possible to treat the disease at the initial stage of formation. The following components have proven themselves best:

• chokeberry;
• chicory;
• kelp (seaweed);
• sap;
• sea ​​water;
• partitions walnut.

With euthyroidism, recipes with natural ingredients are very popular:

1. Chokeberry is taken in pureed form with sugar (proportions - 1/1) three times a day, 1 teaspoon.
2. Laminaria rich in iodine can be consumed both fresh, 4 tablespoons, and in the form of dried crushed leaves, 1 dessert spoon per day.
3. It is useful to take 1 glass per day of sea water, diluted in a ratio of 1 * 1 with fresh water.
4. The intake of warm cabbage juice (not lower than 40 degrees) one glass a day has a beneficial effect on the entire body.
5. Bubbly Fucus is used in salads, allowing you to make up for iodine deficiency.
6. A mixture of 1 part resin (pine resin) and 4 parts honey, boiled for half an hour in a water bath, is used 1 dessert spoon three times a day.

Perfectly helps in the fight against euthyroidism European zyuznik, giving improvements in the third week of admission. Honey syrup is prepared as follows:

1. Grind dry zyuznik and mix with flower honey 1 * 1.
2. Consume daily before meals with water.

The extract of the zyuznik on alcohol has a more effective effect and is created according to the following recipe:

1. Mix 4 parts of dry zyuznik with 10 parts of alcohol (70%).
2. Insist in a glass container for three weeks.
3. Strain and consume 20 cap. on an empty stomach three times a day.

Decoctions of various herbs are very effective:

The recipe for a decoction of alder cones is as follows:

1. Grind alder cones and mix 100g of the mixture with 50g of black cumin seeds.
2. Add 50 g of swollen cherry buds and 50 g of chamomile flowers.
3. Add 50 flowers of marigolds and herbs of iron in the amount of 25 g.
4. Pour one and a half tablespoons of the resulting mixture into three glasses cold water and leave overnight.
5. In the morning heat the mixture without boiling.
6. Take after meals 3 times a day for 7 weeks.

In combination with drug therapy, treatment with folk remedies significantly speeds up the recovery process even in the later stages of the disease.

Patients with euthyroidism should be especially careful about their diet. The menu should definitely include iodine-containing products:

It is necessary to adjust the diet in such a way as to consume about 3100 kcal daily. You should eat foods rich in beneficial properties:

The amount of consumption of carbohydrates and fats must be reduced in order to avoid hypercholesterolemia, which can be caused by a decrease in thyroid function.

A large role in the diet for patients suffering from euthyroidism is given to the use of iodized salt. Also, be sure to use the following items:

• mushrooms;
• vegetable crops;
• fruits;
• cereals and rye black bread;
• lean meat;
• berry crops;
• dairy products.

In case of thyroid pathologies, the daily meal should be divided into 5 times. The method of preparation can be any, except for frying.

Taking into account the peculiarities of the state of the nervous system of patients with euthyroidism, it is necessary to exclude a number of elements from the diet:

It is advisable to eat soups that are not very rich, and to minimize the use of vegetables that have a goiter effect:

The treating endocrinologist is responsible for developing a special diet for euthyroid patients.

In cases where none of the selected methods of treatment gives a visible effect, surgery is recommended.

The surgical method consists in partial resection of the pathologically overgrown tissue in combination with the removal of the formed nodes.

The procedure is performed by endoscopic access, in which the tissue is incised in a minimal amount.

Thanks to this sparing method, hospitalization takes no more than three days. After the operation, only a slight scar remains on the neck.

Thyroid goiter or struma is an enlargement of the thyroid gland. Goiter is not an independent pathology, but rather a group of diseases that are manifested by an increase in the thyroid gland. Sometimes the organ grows so much that it deforms the neck and compresses the surrounding organs.

The main causes of goiter are considered to be a lack of iodine in food and water, hereditary predisposition or poor environmental conditions.

Manifestations thyroid goiter depend on its hormone-forming function.

• Hypothyroidism. Decreased production of hormones. This condition causes a decrease in the slowdown of all metabolic processes in the body: obesity, swelling, lethargy.
• Thyrotoxicosis. Increased production of hormones. Metabolic processes proceed very quickly, which causes weight loss and increased stress on the nervous system.
• Euthyroidism. The production of hormones is normal. In this case, the manifestations of goiter depend on the size of the thyroid gland.

Degrees of enlargement of the thyroid gland:

1 degree. Signs of increase are not detected.
2 degree. The increase is not noticeable in the normal position of the neck, but the goiter is palpable on palpation.
3 degree. Goiter can be detected during examination and palpation.

To date, goiter has been found in more than a million people in Russia. This pathology is diagnosed in women 6 times more often than in men. This statistic is related to female body, which is more susceptible to hormonal fluctuations: during menstruation, pregnancy and menopause.

Goiter often occurs during the period of hormonal adjustment in adolescents. Another dangerous period for the thyroid gland begins after 50 years, when, due to age-related changes, the functioning of the endocrine glands worsens.

Thyroid goiter - a pathology described in treatises ancient egypt, India and Ancient Greece. As early as 2000 BC, the Chinese treated goiter with iodine-rich seaweed. They associated its appearance with poor water quality and living in mountainous areas. Modern medicine agrees with these statements.

In the Middle Ages, angels and demons were often depicted with thyroid goiters. And in the Renaissance, Italian painters depicted the Madonna with a thickening on the neck characteristic of a goiter. This phenomenon was so widespread that it was considered the norm.

In the 18th century, scientists associated goiter with dementia and cretinism, which is true. It was believed that only the king could cure a person with an enlarged thyroid gland. “The king touches, and God heals,” said the French monarch, putting his hand to the sick. According to records, Henry IV cured more than one and a half thousand people in this way.

Why does a goiter occur?

Goiter of the thyroid gland- a collective concept for different diseases, each of which has its own mechanism of occurrence. Therefore, it is necessary to consider them separately.

Endemic thyroid goiter

The appearance of endemic goiter of the thyroid gland is associated with insufficient intake of iodine with food and water in certain areas. The disease is characterized by an increase in the volume of the gland and a decrease in the amount of its hormones - thyroxine and triiodothyronine.

The mechanism of the occurrence of pathology is associated with iodine deficiency. This element is necessary for the thyroid gland to produce hormones that regulate the main processes in the body. In order to get it, the thyroid gland filters large amounts of blood, up to 4 liters in 20 minutes. If there is little iodine, it increases its size and mass, thus trying to increase the number of cells responsible for the production of hormones. But since the concentration of iodine in the pancreatic tissue is below the norm, it is still not possible to achieve the desired concentration of thyroxine and triiodothyronine. To stimulate the thyroid gland to work more efficiently, the pituitary gland secretes the hormone thyrotropin (thyroid-stimulating hormone). This substance causes an active division of thyroid cells, and a further increase in its volume and mass.

Such a goiter is called endemic because there are certain areas - endemic, where most people suffer from iodine deficiency. These are not only highlands, but also large cities. Recently, Moscow and the Moscow region began to be considered an endemic area.

Basedow's disease

Other names for Graves' disease - Graves' disease or diffuse toxic goiter. This is an autoimmune disease that is accompanied by an increase in the size of the thyroid gland and increased production of its hormones. An excess of iodine-containing hormones leads to poisoning of the body.

Mutations in certain genes, infections, traumatic brain injuries, mental shocks, hormonal changes during pregnancy can provoke Graves' disease. Under the influence of these factors, the functioning of the immune system is disrupted. Immunity cells take the thyroid gland for a foreign object and attack it. It causes defensive reaction thyroid gland - its cells begin to actively divide, while the amount of hormones that they produce also increases.

Goiter Hashimoto

Hashimoto's goiter or Hashimoto's thyroiditis- chronic inflammation of the thyroid gland, caused by a defect in the immune system, occurs in 3% of people. Antibodies attack thyroid tissue, mistaking its cells for foreign microorganisms. But unlike Graves' disease, hormone production is reduced. This is due to the fact that the cells that produce hormones die. Fibrous tissue forms in their place. connective tissue, also a lot of leukocytes accumulate in the thyroid gland, which attack the gland.

The tendency to goiter Hashimoto's is inherited. Injuries and operations on the thyroid gland can provoke the development of the disease, infectious diseases, inflammation in the neck, chronic pharyngitis, poor ecology, deficiency or excess of iodine.

Thyroid adenoma

Thyroid adenoma or nodular non-toxic goiter is a benign formation that looks like a node. The growth of hormone-producing cells leads to an excess of these substances in the body and the appearance of signs of thyrotoxicosis (poisoning by thyroid hormones).

The causes of thyroid adenoma are not fully understood. The formation of a node is associated with an excess of the pituitary hormone thyrotropin, which leads to the active division of thyroid cells. In a certain area, the cells are more sensitive to its action and begin to actively grow. Another possible reason is the disruption of the nerve endings in this place. As a result, the signals of the nervous system that regulate the vital activity of cells are distorted. Violation of innervation causes their active growth and division in a limited area.

Congenital goiter

Congenital sporadic goiter occurs in children born to mothers who experienced iodine deficiency during pregnancy. Also, the disease is associated with genetic defects in the formation of hormones. In this case, the child's hormone production may be reduced or not disturbed. Another option for the abnormal development of the gland is its atrophy or reduction. If extremely little hormones are produced during embryonic development and in early childhood, then cretinism develops.

During the formation of the thyroid gland in the prenatal period, the number of hormone-producing follicles increases. At this stage, the mass of the gland increases 5 times, up to 100 g. Later, a colloid, a precursor of hormones, accumulates in the follicles, and the mass of the gland increases to 500 g.

Fibroplastic goiter Riedel

Riedel's fibroplastic goiter or fibrous thyroiditis is an enlargement of the thyroid gland as a result of an autoimmune inflammatory process. As a result of the attack of lymphocytes, connective tissue, represented by fibrin fibers, grows in the gland. Therefore, the gland increases in size and becomes very hard to the touch "iron goiter".

Nodular goiter of the thyroid gland

Nodular goiter of the thyroid gland is the growth of a limited area of ​​thyroid tissue. A node is called all the formations of the thyroid gland, which differ in structure from the rest of the tissue of the organ.

Depending on the number of nodes, a single-nodular goiter is divided (1 node has formed) and a multi-nodular goiter (2 or more nodes).

Due to environmental degradation, this pathology is widespread. It is estimated that 50% of the population has nodes of various sizes.

Causes of nodular goiter

What pathologies cause the appearance of nodes in the thyroid gland

• Nodular colloid goiter- the most common cause of the appearance of nodes in the thyroid gland, its share is 90%. Follicles are structural elements of the thyroid gland lined with thyrocyte cells. An increase in the size of the follicles in a limited area occurs as a result of the accumulation of a viscous liquid in it - a colloid.
• Thyroid adenoma- benign neoplasm. A thyroid tumor that occurs when one of the cells has a malfunction in the genetic program. In this case, the cells do not die, giving way to young ones, but continue to divide. In this place, an overgrowth surrounded by a capsule is formed.
• thyroid cancer. The mechanism of tumor formation is similar to adenoma. But in cancer, malignant cells are the basis of the neoplasm. They not only push apart the surrounding tissue, but also cause disturbances in it and can form metastases in other organs.
• pituitary adenoma. A neoplasm in the pituitary gland leads to increased production of its thyrotropin hormone. This substance activates the growth and functioning of the thyroid gland, and also increases the concentration of its hormones. This leads to the occurrence of nodular toxic goiter.
• Autoimmune diseases(autoimmune Hashimoto's thyroiditis). Failure of the immune system leads to the appearance of proteins containing iodine in the blood. The immune system produces specific antibodies to fight them. As a result of the immune attack, thyrocytes (thyroid cells) also suffer in which high concentration iodine. In place of dead cells, scar tissue grows, which forms knots.
• Cyst. Nodules in thyroid tissue may be associated with a dermoid cyst containing hair and sebaceous glands. This neoplasm appears during fetal development and causes congenital nodular goiter.
• Tuberculosis of the thyroid gland. Mycobacterium tuberculosis enters the thyroid gland and creates a focus of inflammation there. Gradually, a dense shell of calcium forms around it.

Disposing factors

• Insufficient intake of iodine and other minerals. The thyroid gland needs iodine to supply the body with hormones. If it is not enough in the blood, then iron increases the number of cells that trap it. Sometimes this does not happen evenly throughout the organ, but in separate areas - nodes.
• Stagnation of blood and lymph. Violation of the outflow from the gland may be associated with vascular damage by atherosclerosis. Stagnation in a separate area and an increase in the concentration of metabolic products of the gland cause swelling and accelerated cell division.
• hereditary factors. Certain features of the body are inherited, in which the thyroid gland is forced to work very actively in order to produce more hormones: increased metabolism, reduced sensitivity to thyroid hormones.
• Dysfunction of the autonomic nervous system. Violation of the nerve endings in a separate area of ​​​​the thyroid gland can provoke the formation of a node.
• Atmospheric pollution, bad ecology. It is especially dangerous if the radiation background is increased in the territory, the water is polluted with nitrates, contains a lot of calcium, there is little selenium, manganese, copper, cobalt in the soil, and therefore in food products. Such changes are reflected primarily in the state of the thyroid gland, causing mutations in its cells.

trigger factors

• Stress, mental trauma and traumatic brain injury undermine the work of the central and peripheral nervous system, reduce immunity. Violation of innervation causes a spasm of individual muscle groups, which impairs blood circulation.
• Hormonal disorders. Adolescence, pregnancy, menopause are periods of strong hormonal surges. During them, all components of the endocrine system suffer, including the thyroid gland, which is forced to work at the limit of its capabilities.
• Decreased immunity after infectious and inflammatory diseases. Immunity factors that regulate cell growth and division are disrupted. Inflammatory processes in the throat and neck can activate defense mechanisms when cells begin to actively grow.

Symptoms of nodular goiter

External manifestations of nodular goiter become noticeable immediately. Until the node reaches 1-2 cm, it is not visible. Such small formations are discovered by chance at a doctor's appointment or during an ultrasound examination of the thyroid gland.

A node on the thyroid gland can be detected independently, due to the superficial location of the gland. It is located on the front surface of the neck, below the Adam's apple (Adam's apple). Normally, the thyroid gland is elastic and homogeneous. If compacted areas are found during probing, these are the nodes. Usually they are not soldered to the skin and move when swallowed.

If the nodes are large enough (grade 3), then they can be seen under the skin. The neck becomes asymmetrical, swelling appears on one side. Multiple nodes in both lobes cause a uniform thickening of the neck on both sides.

Common manifestations of nodular goiter depend on the level of hormones produced by the thyroid gland.

Signs of nodular goiter with a decrease in hormone production

• decrease in body temperature, even inflammatory diseases do not cause fever;
• lowering blood pressure and heart rhythm disturbances;
• increased swelling: face, lips, tongue, extremities;
• insomnia at night and drowsiness during the day;
• weight gain;
• decreased physical and mental performance, memory and attention;
• dry skin, especially noticeable on the heels and hands;
• fragility of nails, hair loss;
• decrease in sexual desire;

Signs of nodular goiter with increased production of iodine-containing hormones

• fever, prolonged fever for no apparent reason;
• palpitations, over 100 beats per minute at rest.
• irritability and nervousness, overexcitation;
• good appetite and at the same time weight loss;
• hot skin;
• excessive sweating, especially on the palms;
• trembling in the hands;
• protrusion eyeball(exophthalmos);
• indigestion, loose stools.

Signs of nodular goiter with normal hormone production

• if the size of the node exceeds 2-3 cm, then there is a feeling of pressure and discomfort in the neck;
• difficulty in swallowing;
• sore throat;
• shortness of breath when turning the head.

Diagnosis of nodular goiter

Diagnosis of nodular goiter begins with a survey. The doctor asks about the manifestations of the disease and finds out the factors that can cause the degeneration of nodular goiter into a cancerous tumor of the thyroid gland:

1. whether someone from close relatives had thyroid cancer;
2. whether radiation therapy especially on the head and neck area;
3. Have you visited the Chernobyl zone?

Particularly carefully examine the nodes on the thyroid gland in children under 14 years of age.

Inspection carried out in the normal position of the neck. Then the doctor probes the neck in the projection of the thyroid gland. If the size of the node exceeds 1 cm and it is located on the anterior surface of the gland, then it can be detected by palpation.

This cheap, accessible and painless method allows you to obtain information about the size of the thyroid gland, its condition, homogeneity, blood supply, as well as identify changes in the cervical lymph nodes.
Ultrasound can detect such signs of nodular goiter:

• size and number of nodes;
• the degree of reflection of ultrasound from them;
• the shape and uniformity of the node;
• the presence of a capsule;
• blood circulation in the node.

If during the ultrasound a node larger than 1 cm is detected or the person has been exposed to carcinogenic factors, then a fine-needle puncture biopsy and a blood test are prescribed.

Laboratory diagnosis of nodular goiter

Hormonal studies.

In the blood, the level of TSH, T4, T3, calcitonin is determined. A test for thyroglobulin, as well as for the presence of antibodies to the thyroid gland, is considered optional for the diagnosis of nodular goiter.

Pituitary thyroid-stimulating hormone or thyrotropin (TSH)

This test is done for all patients with thyroid nodules. Normally, the level of TSH in adults is 0.3-4.0 honey/l, in children 5-14 years old 0.4-5.0 honey/l.

Decreased TSH levels below 0.3 honey / l indicates that the thyroid gland produces a lot of iodine-containing hormones and does not need stimulation with thyrotropin. A decrease in TSH concentration can occur with toxic multinodular goiter, toxic adenoma, autonomously functioning thyroid nodes, as well as during pregnancy, after suffering stress and following a strict diet.

Enhanced level above 6 honey / l says that the functional activity of the gland is reduced and the body stimulates its work with the help of TSH. This may be due to nodes that appeared as a result of an attack of immunity on thyroid cells, oncological neoplasms.

Triiodothyronine (T3)

Normal concentration

• Total T3 1.2-2.8 nmol / l (hormone T3 is associated with transport proteins)
• Free T3 2.5-5.8 pmol / l (protein-free part of the hormone that has an active effect on the body)

With nodular goiter of the thyroid gland T3 concentration is increased. This means that the node consists of overgrown follicles that produce the hormone.

Decrease in T3 concentration can talk about a cyst, adenoma, or a malignant neoplasm that reduces the number of cells responsible for the formation of the hormone.

Indications. Research is carried out if low level thyroid-stimulating hormone.

Thyroxine (T4)

Normal values

• Total T4 64-142 nmol / l (not the active part of the hormone associated with blood plasma transport proteins)
• Free T4 11-25 nmol/l (protein-free part of the hormone)

Increasing the concentration of T4 observed in autoimmune failures, when proteins appear in the blood that act like thyroid-stimulating hormone. They cause the thyroid gland to produce more thyroxine.

T4 drops below normal in the later stages of Hashimoto's thyroiditis, when connective tissue forms in place of hormone-producing follicular cells.

Indications. The study is carried out with a low level of thyroid-stimulating hormone (TSH). At a high concentration of TSH, free T4 is determined.

Calcitonin

Normal values ​​for women are 0-28 pg/ml, and for men 0-20 pg/ml. Significant excess, more than 200 pg / ml, may indicate that the identified node is medullary thyroid cancer. Such a tumor increases the production of the hormone by C-cells of the thyroid gland.

Indications. If you suspect the presence of malignant cells in the node, if one of the close relatives was diagnosed with medullary thyroid cancer.

The results of a thyroid hormone test can be significantly affected by various medicines: dexamethasone, propranolol, estrogens ( oral contraceptives), aspirin and furosemide. Therefore, do not forget to indicate at the time of blood sampling what medications you are taking.

total protein and albumin(one of the types of protein) are reduced. Total protein is below 60 g/l, and albumin is below 35-40 g/l. Low protein concentration is associated with active protein metabolism. Proteins are quickly consumed if the thyroid gland secretes an excess amount of hormones.

Increased levels of gamma globulins above 15 g/l. These antibodies appear during the activation of the immune system to fight infections. They may indicate an autoimmune nature of the goiter.

Lowering blood cholesterol seen in people with increased level thyroid hormones. In them, cholesterol is consumed with an increase in metabolism and is spent on the construction of cells and the formation of hormones.

Increasing sugar levels in the blood in 10-15% of people with overactive thyroid gland. Associated with a violation of the production of insulin in the pancreas. Since hyperthyroidism disrupts the work of all endocrine glands.

Scintigraphy or radioisotope scan of the thyroid gland

The patient is injected intravenously with Rezoscan containing radioactive isotopes 99mTc, or a radioisotope of iodine-123. After that, their level in the thyroid gland is measured several times using a gamma camera. After 2 and 4 hours, it is determined how actively the thyroid gland captures the isotope from the blood. The concentration with increased production of hormones (hyperthyroidism) is 11-69 μCi, and with reduced (hypothyroidism) 1-5.6 μCi.

When re-examined after 24 hours, determine the maximum concentration. In hyperthyroidism, it is 25-80 μCi, and in hypothyroidism, 0.6-9 μCi.

The study helps determine the shape and size of the nodes, as well as to find out whether they accumulate iodine (hot nodes) and whether they produce hormones. If no isotope is found in the node, then the node is called "cold", such formation is not involved in the production of hormones.

primary goal scintigraphy reveal the functional autonomy of the thyroid gland when it works independently of thyroid-stimulating hormone. This happens with multinodular toxic goiter and thyrotoxic adenoma.

Indications. Increased production of thyroxine (T4) in middle-aged and elderly patients, reduced levels of thyroid-stimulating hormone.

X-ray examination chest

Before the study, you need to drink barium to contrast the esophagus. The method allows you to identify the displacement of the trachea and narrowing of the esophagus with large nodes that compress the surrounding organs.

Indications. Retrosternal nodular goiter, nodular goiter grade 3-4.

Fine needle biopsy of the thyroid gland

A sample of the material from the node is taken with a thin needle under ultrasound control. The material is then sent to morphological and cytological examination to the laboratory. With nodular goiter of the thyroid gland, they find:

Indications. Nodes larger than 1 cm, smaller nodules if suspected malignant tumor, active node growth.

In the evening before the operation, sedatives are prescribed, which ensure normal sleep and help avoid unnecessary stress.

The operation is performed under general anesthesia. Due to the superficial location of the thyroid gland, it is not among the complex and rarely leads to complications.

Rehabilitation after surgery

The recovery period after surgery to remove colloid goiter is relatively short. In most cases, after 3-4 days a person can return home. Restriction of physical activity is necessary only for the first 2-3 weeks. In the future, all patients lead a full life.

To replenish the deficiency of hormones after removal of the thyroid gland, it is necessary to take synthetic hormones L-thyroxine, Euthyrox, Bagothyrox. They completely replace natural hormones and restore balance in the body. In some cases, they are appointed for life. The exact implementation of the doctor's recommendations allows you to feel completely healthy.

Treatment of colloid goiter with folk remedies

Unfortunately, folk remedies cannot completely overcome colloid goiter. But with the help of traditional medicine, you can stop the further growth of the thyroid gland.

Decoction of cocklebur
To prepare a decoction, you need to take 1 tsp. dry crushed cocklebur leaves and pour 1 cup boiling water. Then bring to a boil and let it brew for 2 hours. Decoction drink warm 3 times a day before meals. For each reception, it is necessary to brew a fresh portion of the herb.
A decoction of cocklebur helps to stop the growth of colloid goiter, regardless of the cause of its appearance. This remedy relieves swelling and has analgesic and tonic properties. The first results will appear in 3 weeks. The course of treatment is 2 months, then 1 month break, after which it is necessary to repeat the course.

Potentilla white tincture
It is necessary to take 250 g of dried cinquefoil roots and grind them roughly. Pour into a glass container and pour 1 liter of vodka. Let the medicine brew for 15 days in a cool dark place. Take a tincture of 1 tsp. twice a day after meals with a glass of water. The course of treatment lasts 6-8 weeks.
Potentilla roots normalize the secretion of thyrotropin hormone, which regulates the functioning of the thyroid gland. Potentilla tincture is recommended for people who are contraindicated hormonal preparations. This plant is effective in both hyperthyroidism and hypothyroidism.

A decoction of chokeberry
Take 10 tbsp. dried chokeberry and pour 1 liter of boiling water. Boil for 5 min. Let it brew for 1 hour. Add 2 tbsp. honey and drink 4 times a day, 250 ml for 30 minutes. before meals.
The course of treatment is 1 month, then 1 month break and repeat the course. During a break, it will be useful to make a compress in the thyroid gland from fresh dandelion leaves or white cabbage.

Prevention of colloid goiter of the thyroid gland

What do we have to do?

1. Enrich the diet with foods high in iodine and other trace elements. Also eat more greens and drink enough water.
2. Replace regular salt with iodized salt.
3. drink away vitamin complexes during periods of reduced immunity.
4. Lead an active lifestyle, more often walk in the fresh air and play sports.
5. Once a year, undergo a medical examination of the thyroid gland by an endocrinologist.
6. Yoga and breathing exercises will be helpful.
7. Follow the daily routine. Go to bed at the same time, allocate at least 8 hours for rest.

What not to do?

• Be located in areas of industrial and radiation pollution.
• Take uncontrolled drugs that interfere with the absorption of iodine (periodate, potassium perchlorate), as well as calcium preparations.
• Limit the intake of iodine and B vitamins necessary for the normal functioning of the body.
• Eat large quantities of cabbage (white, cauliflower, broccoli, Brussels sprouts), corn, sweet potatoes. These products contain strumagenic substances that cause the growth of the thyroid gland.
• To allow hypothermia of the body, especially in the neck and throat.
• Smoking and alcohol abuse are strongly discouraged.

Diffuse thyroid goiter

diffuse goiter thyroid gland- Uniform enlargement of the thyroid gland, in which no nodes and seals are formed.

This phenomenon is very common. So, in endemic areas that occupy a third of the territory of our country, diffuse goiter of varying degrees is found in 50% of the population. Outside these zones, the incidence rate exceeds 20%.

Like other thyroid diseases, diffuse goiter can occur with a decrease in hormone levels - diffuse non-toxic goiter, normal hormonal levels, or increased hormone production - diffuse toxic goiter.

Causes and symptoms of diffuse goiter

The appearance of diffuse goiter is associated with various diseases:

1. Diffuse toxic goiter or Graves' disease, also known as Graves' disease, is an autoimmune disease characterized by increased production of hormones (hyperthyroidism). Pathology has 3 main signs: goiter, increased heart rate and "bulging eyes" as a result of inflammation of the tissues around the eyes.
2. Diffuse colloid goiter- an increase in the number and volume of follicle vesicles and the accumulation of colloid (a jelly-like substance, a precursor of hormones) in them.
3. endemic goiter- an increase in the gland associated with iodine deficiency in certain areas. An increase in the number of cells does not always help normalize hormone production. Therefore, endemic goiter causes symptoms of hypothyroidism - a deficiency of thyroid hormones.

Disposing factors leading to the formation of diffuse goiter

• iodine deficiency in water and food. The thyroid gland needs this element, which is an integral part of hormones. Lack of iodine causes an increase in the number of cells - thyrocytes, which are designed to catch it from the blood.
• hereditary predisposition. Diffuse goiter often occurs in members of the same family. This is due to the peculiarities of the work of immunity, which are inherited. Antibodies appear in the blood, which bind to sensitive areas on the thyrocyte membrane, and stimulate the growth of the thyroid gland. New cells and new follicles are formed, which produce an excess of hormones that cause intoxication of the body. This mechanism is typical for diffuse toxic goiter.
• Uncontrolled taking iodine-containing drugs, work in enterprises where iodine is mined or used. The enlarged thyroid gland, which is used to actively trapping iodine in conditions of deficiency, continues to do so when it is supplied in excess. In this case, the production of hormones increases sharply, intoxication of the body develops - thyrotoxicosis. This condition is called "iodine-based phenomenon". In some cases, only surgery to remove most of the thyroid gland can correct the situation.
• Female. Women are more disposed to the appearance of diffuse goiter. For example, they suffer from Graves' disease 10 times more often than men. Such statistics are associated with the peculiarity of the functioning of the female endocrine system. A woman experiences serious hormonal changes during pregnancy, lactation, menopause. Abortions and taking hormonal contraceptives without a doctor's prescription also adversely affect. Since all the endocrine glands are interconnected, the function of the thyroid gland is disturbed during hormonal disruptions.
• Autoimmune disorders: diabetes, rheumatoid arthritis, scleroderma. Disturbances in the functioning of the immune system, when antibodies attack the cells of one's own body, mistaking them for foreign ones, can also affect the thyroid gland. In this case, damage to the thyroid gland is part of the overall immune response.
• Age diffuse toxic goiter, as a rule, develops in people under 40 years of age, when the immune system is most active. Endemic and diffuse colloid goiter can appear at any age.
  Not all people who are exposed to disposing facts develop diffuse goiter.

The disease is provoked trigger factors:

• nervous exhaustion. Prolonged stress, strong psychological shocks disrupt the nervous regulation of the thyroid gland, which ensures the normal functioning of the organ.
• Decreased immunity associated with past illnesses, hypothermia, smoking, severe physical activity. A disruption in the functioning of the immune system can cause antibodies to enter the blood, which provoke an attack of lymphocytes on the thyroid gland.
• Thyroid surgery. The operation to remove the node can provoke a diffuse overgrowth of thyroid tissue. Thus, the body tries to restore its functions.

External manifestations of diffuse goiter

At the initial stages diffuse goiter does not show itself. With a significant increase in the thyroid gland, when the mass of the organ reaches 40-50 g instead of 20 g, a cosmetic defect appears - a bulge on the front surface of the neck. With such a pathology, both lobes increase evenly. Often, a thickening in the form of a roller forms on the neck.

Subjective sensations depend on the degree of development of diffuse goiter. If the thyroid gland increases in volume over 50-60 ml, then it begins to compress the surrounding organs and nerves, and the following symptoms occur:

• feeling of pressure in the neck;
• difficulty in swallowing;
• breathing becomes noisy due to squeezing of the larynx;
• shortness of breath that appears in the supine position;
• dizziness.

You can independently determine the enlargement of the thyroid gland. Palpation carried out in two stages.

Superficial palpation: swipe with fingers right hand along the front surface of the neck from the middle of the thyroid cartilage (in men from the Adam's apple) to the fossa between the collarbones. The head must be kept straight and not tilted back. Thus, it is necessary to feel the neck during swallowing and in a calm state. At the same time, a uniform thickening is found in the middle part of the neck. Its consistency is usually soft, elastic, rarely dense, without knots. The thyroid gland is painless, not soldered to the skin and moves when swallowing simultaneously with the larynx.

deep palpation performed by a doctor. The hands cover the neck in a semicircle. With the thumbs of both hands, he feels each lobe and isthmus separately. The specialist examines the gland, determines its size and the presence of seals.

In the event that diffuse goiter has led to increased production of hormones (diffuse toxic goiter), then symptoms of hyperthyroidism occur.

• pronounced goiter;
• enlargement of the eyeballs due to autoimmune inflammation and swelling of the tissues surrounding the eye. The eyes are wide open, there is a characteristic luster, it gives the impression of an angry look;
• heart palpitations over 120 beats per minute, stabbing pains in the region of the heart and increased arterial pressure- the result of stimulation of the cardiovascular system by autonomic nerves;
• Excessive sweating is associated with the active work of the sweat glands. The skin swells and becomes like an orange peel;
• weight loss with increased appetite caused by an accelerated metabolism, when all reserves "burn out", being converted into energy. This explains the subfebrile temperature of 37-37.5 degrees for no apparent reason, which lasts for a long time.
• trembling of the hands and head, fussiness, irritability, anxiety, sleep disturbances are the consequences of poisoning the central nervous system with thyroid hormones.
• menstrual irregularities, absence of menstruation for six months or more, in men a decrease in sexual desire, impotence is a consequence of disturbances in the functioning of the internal genital organs, which are caused by a malfunction in endocrine system. An increase in the concentration of thyroid hormones leads to inhibition of the work of other endocrine glands.

Decreased thyroid function glands(hypothyroidism) with diffuse goiter is rare. This state manifests itself:

• puffiness. This is especially noticeable on the face. It becomes puffy, the cheeks appear thick, and the eyes narrower. Lips and tongue increase in volume. Because of this, teeth marks can be seen on the lateral surfaces of the tongue. Puffiness is clearly visible on the hands and feet, taking diuretics does not relieve swelling, which is hallmark poor thyroid function.
• Loss of appetite due to weight gain speaks of a slow metabolism. One of the main functions of iodine-containing hormones is the stimulation of these processes in cells. With a deficiency of triiodothyronine, cells slowly consume nutrients that are deposited in the form of fat and glycogen.
• Dry skin and violation of pigmentation (the appearance of light spots on the skin) is caused by a violation of the sweat and sebaceous glands, as well as insufficient production of melanin pigment.

Diagnosis of diffuse goiter

Diagnosis of diffuse goiter begins with a survey and examination by an endocrinologist. It determines the stage of the goiter.

• First stage- changes are not determined without additional research;
• Second stage- changes are not visible to the eye. If during probing it is determined that the proportion of the thyroid gland exceeds the size of the phalanx of the thumb, then the second stage is diagnosed.
• Third stage- the goiter is palpable and determined by eye.
  The next stage: the endocrinologist gives the patient a referral for an ultrasound examination and a blood test for hormones.

Thyroid ultrasound

Harmless and painless examination reveals signs of diffuse goiter:

• increase in volume by at least 20 ml. Length (cm) x width (cm) x depth (cm) exceeds 40 ml;
• the echo structure of the gland is homogeneous, without nodes, normally reflects ultrasonic waves;
• with compaction of the gland caused by Graves' disease, ultrasound is reflected better - increased echogenicity;
• the gland may be enlarged symmetrically or asymmetrically;
• the edges are rounded;
• secondary foci of degeneration (destruction) caused by hemorrhages or necrosis in individual follicles may be detected;
• with Doppler ultrasound, dilated vessels are clearly visible;
• in Hashimoto's thyroiditis, the thyroid gland looks darker than normal. It is heterogeneous and hypoechoic, ultrasound passes through it at a low speed and is poorly reflected.

Hormonal blood test

Determining the level of TSH

The norm in children is 0.4-5.0, in adults 0.4-4.0 mIU / l. The pituitary thyroid-stimulating hormone is responsible for stimulating the thyroid gland. With diffuse goiter, its level may be lowered or normal.
With Hashimoto's thyroiditis and endemic goiter, TSH is elevated - the pituitary gland "spurs" the thyroid gland to produce hormones.

An increase in the level of TSH in diffuse toxic goiter, when T3 and T4 are high and without additional stimulation, may be associated with a pituitary adenoma that produces this hormone.

Level detection thyroxine T4

Total T4: 60-140 nmol / l - the sum of inactive and free thyroxine
Free T4: 10-23 pmol / l - an active hormone not associated with plasma transport proteins.
With Graves' disease, the thyroid gland secretes a lot of the hormone and the level of total T4 significantly exceeds the norm of 190-206 nmol / l; 245-260 nmol/l. With Hashimoto's thyroiditis, T4 levels may be normal or low. This is due to the fact that the cells that are responsible for the production of the hormone die and are replaced by connective tissue. With endemic goiter, the level of T4 is reduced, since there is not enough iodine for their production.

Level detection triiodothyronine T3

Total T3: 1.50-2.80 nmol / l - the sum of bound and free T3.
Free T3: 3.1-12.3 pmol / l - a biologically active hormone that is not associated with plasma transport proteins.
With Graves' disease, the hormone is secreted in excess and its level is above normal. With Hashimoto's thyroiditis and endemic goiter, the concentrations of free and total T3 are reduced.

Determination of the level of antibodies to TSH receptors

TSH receptors are found on thyroid cells. These plots cell membrane capture the hormone, due to which the regulation of thyroid function occurs. If the immune system perceives the receptors as foreign microorganisms, then autoantibodies are produced to destroy the TSH receptors. These antibodies are also called thyroid-stimulating immunoglobulins (TSIs).

An immune attack occurs with Graves' disease (diffuse toxic goiter) in 80-95% of cases, as well as with Hashimoto's goiter. Normally, the level of antibodies to TSH receptors should not exceed 1.5 IU / l. In sick people, it is higher than 1.75 IU / l.

This analysis does not directly indicate the changes that take place in the thyroid gland, but gives an idea of ​​how much the disease affects the body as a whole and individual internal organs.

With Graves' disease, an elevated level of hormones is marked by a decrease in the level of protein in the blood, as it is spent on the needs of actively working cells. With endemic goiter (hypothyroidism), an increase in the level of protein fractions, especially gamma globulins, is characteristic.

The level of glucose in the blood moderately increases (hyperglycemia) 6.7-10.0 mmol / l, which is caused by increased absorption of glucose in the intestine. Hypocholesterolemia is also noted - a decrease in cholesterol levels below 150 mg%. Thyroxine causes the breakdown of cholesterol and its excretion with bile. These changes occur in Graves' disease.

X-ray examination

An x-ray of the neck and chest is necessary for a large goiter, when there are signs of compression of the larynx and esophagus. The picture is taken in the front and side projections. This makes it possible to notice the narrowing and shifting of the organs of the neck, changes in the lymph nodes, the abnormal location of the thyroid gland - behind the sternum or around the trachea.

Radiodiagnostics of diffuse thyroid goiter

Radiodiagnosis - determination of the absorption of radioactive iodine-131 or technetium-99 by the thyroid gland. Isotopes in liquid form are injected into a vein. After 24 hours, their concentration in the thyroid tissue is measured using a special gamma camera. With Graves' disease, an image of an enlarged thyroid gland appears on the screen, the tissue of which has absorbed 31-80% of the injected dose of the isotope. The body actively captures iodine from the blood to produce hormones and the concentration of radioactive substances in it increases. Iodine or technetium is evenly distributed throughout the tissue, no nodes are detected.

Hashimoto's goiter does not accumulate iodine. A low concentration of isotopes indicates that the thyroid gland is not active and secretes hormones weakly.

This method began to be used much less frequently, after it became possible to accurately determine the levels of TSH and thyroid x hormones in the blood.

Biopsy and morphological examination

Fine needle aspiration biopsy is necessary if secondary nodes or seals are found against the background of diffuse goiter. The indication for a biopsy is a suspicion of thyroid cancer and an increase in cervical lymph nodes with goiter.

The procedure is not significantly different from taking blood from a vein, with the only difference being that it is carried out under ultrasound guidance. The resulting tissue sample is sent to the laboratory for morphological study of the cells of their structures.

Diffuse endemic goiter - this is an increase in the number of thyrocytes, cells characteristic of the thyroid gland. Therefore, colloid and follicular epithelial cells without atypia (normal thyroid cells) are found in the tissue sample. They have regular, not enlarged, single nuclei.

At Hashimoto's thyroiditis signs of atrophy and destruction of follicles are found: blood and damaged thyrocytes.

At Graves' disease lymphocytes are found in the sample - these are signs of an attack by the immune system on the thyroid gland.

This study allows you to get a three-dimensional picture of the thyroid gland. Diffuse goiter is evidenced by such changes:

• enlarged thyroid gland;
• dilated vessels;
• smooth edges;
• absence of cysts and nodes;
• areas of dystrophy and sclerosis appear with a long-term diffuse goiter.

Treatment of diffuse goiter

Treatment of diffuse thyroid goiter is aimed at normalizing the level of thyroid hormones. To do this, use drug treatment with hormonal and iodine-containing drugs, surgery or radioactive iodine. The choice of method depends on the hormonal status, the size of the goiter, the age of the patient, his state of health and concomitant diseases.

Medical treatment

Iodine preparations
These drugs are designed to compensate for iodine deficiency, which provokes the growth of the thyroid gland in endemic goiter. However, recent studies have shown that with diffuse toxic goiter, they must be prescribed with caution. Since the additional intake of iodine in this case causes an increase and compaction of the thyroid gland.
With goiter caused by iodine deficiency, these funds are an indispensable part of the treatment. In some cases, they are enough for recovery.

Diiodotyrosine.
The drug contains iodine and an amino acid, from which the hormone thyroxine is subsequently formed. It blocks the release of thyroid-stimulating hormone from the anterior pituitary gland, which neutralizes excess free thyroxine. Taken with hypothyroidism, 0.05 g 2-3 times a day in courses of 20 days. A break between them is 10-20 days.

Potassium iodide
A drug that contains inorganic iodine. In the thyroid gland, a molecule of iodine is released from it, which is included in the composition of the hormone tyrosine. It is used for endemic goiter to replenish iodine deficiency and normalize the production of thyroid hormones. The tool also helps to reduce the sensitivity of the thyroid gland to the action of thyroid-stimulating hormone.

Take 180-200 mg per day in courses lasting 20 days, with breaks of 10 days. With endemic goiter, it is taken for a long time at 0.04 g once a week. So that the remedy does not irritate the gastric mucosa, it is advisable to use it after meals, drinking jelly or sweet tea.

Thyrostatic drugs or antithyroid drugs
These drugs reduce the production of thyroid hormones, disrupt the release of iodine from the compounds, slowing down the synthesis of thyroxine (T4). They are used for hyperthyroidism for the treatment of hyperthyroidism and during preparation for surgery.

Mercazolil
The drug blocks the enzyme peroxidase, disrupting the iodination of thyroxine and triiodothyronine. Start taking with a dosage of 5 mg 3 times a day after meals. The tablet is not chewed and washed down with a sufficient amount of water. With severe thyrotoxicosis, a single dose is gradually increased to 10 mg 3 times a day. After the level of hormones has returned to normal, the dosage is reduced by 5 mg every 5 days. The maintenance dose is 5 mg every three days.

Propylthiouracil
Eliminates or weakens thyrotoxicosis by disrupting the conversion of ionized iodine into a biologically available form, which is necessary for the formation of hormones. However, it can cause thyroid growth. This is due to an increase in the production of thyroid-stimulating hormone by the pituitary gland in response to a decrease in the concentration of thyroid hormones.
single dose 0.1 - 0.2 g, taken every 6 hours. After reaching the effect in 2-3 weeks daily dose reduced by a third. The doctor individually prescribes the drug depending on the level of thyroid hormones. The course of preparation for surgery or treatment with radioactive iodine lasts 2-3 weeks. In the future, every 2-2.5 weeks, the dose is reduced, bringing it to 50-100 mg per day. It takes 1-1.5 years to treat Graves' disease.

Thyroid hormones
For the treatment of Graves' disease, synthetic thyroid hormones are prescribed together with thyreostatic drugs. This therapy helps to prevent an increase in goiter associated with an increase in the level of the pituitary hormone. To do this, appoint 0.05-0.1 μg L - thyroxine in a day. In addition, such a scheme can reduce by a third the likelihood of recurrence of diffuse toxic goiter. During treatment, hormone levels are monitored to maintain balance and prevent hypo- or hyperthyroidism.

In endemic goiter with low or normal thyroid function, L- thyroxine is prescribed 25-100 mcg per day for 1 time. The drug is taken before breakfast 30 minutes before meals with plenty of water.

b-blockers
In the event that diffuse goiter caused interruptions in the work of the heart, then beta-blockers are prescribed. These drugs decrease the strength and frequency of the heart's contractions, allowing it to rest. By reducing the minute volume of pumped blood, lower blood pressure.

propranolol 20-40 mg orally every 4-8 hours. Preferably consumed with sufficient liquid and semi-liquid food. This drug is prescribed for high levels of thyroid hormones.
Anaprilin, 20 mg 3 times a day, half an hour before meals. This remedy normalizes the work of the heart without affecting the concentration of hormones.

Sedative drugs
Helps improve sleep and reduce anxiety. Often used in patients with increased thyroid function Phenobarbital (Primidone) 0.01-0.03 g 2-3 times a day. The drug not only calms, but also reduces the level thyroid hormones in the blood, accelerating the consumption of thyroxine.

Steroid hormones
For the treatment of eye symptoms (pain behind the eyeball, its increase in size, changes in the eyelids) are used corticosteroids. Most often prescribed Prednisolone 60-100 mg per day. After 2-3 weeks, the dose is gradually reduced by 5 mg every next week. To avoid withdrawal in the last week Prednisolone take 5 mg every other day. Treatment continues for 2-3 months. Remember that the treatment of eye symptoms of Graves' disease should be started as early as possible. After 6 months, connective tissue forms around the eyes, and only surgery can get rid of bulging eyes.

Remember that during the treatment of diffuse goiter, every 3-4 months it is necessary to undergo an examination: weighing, monitoring blood pressure and pulse, determining free T4, T3, thyroid-stimulating antibodies. The results of the survey make it possible to judge the effectiveness of treatment, help to adjust the dose in a timely manner and prevent the development of side effects from the use of drugs. After the restoration of thyroid function, you will be observed by an endocrinologist for another 2-3 years to prevent recurrence of the disease.

Surgery diffuse goiter

Indications for surgical treatment of diffuse goiter:

• severe thyrotoxicosis;
• large goiter (grade 3), which is a cosmetic defect and compresses the larynx;
• allergic reactions on antithyroid drugs;
• lack of effect from drug treatment for 6 months;
• diffuse toxic goiter complicated by atrial fibrillation.
In patients older than 40 years, radioactive iodine treatment may be prescribed as an alternative to surgery.

The use of the radiological method at a younger age is controversial among specialists.

Contraindications for surgery

• severe cardiovascular insufficiency;
• concomitant diseases of the liver, kidneys and lungs in which it is dangerous to do general anesthesia;
• unable to normalize thyroid function with medication, which can lead to severe intoxication thyroid hormones after surgery thyrotoxic crisis.

The operation is postponed for 2-3 weeks in case of exacerbation of chronic diseases, infectious diseases.

Preparing for the operation
During preparation for surgery, patients with Graves' disease are prescribed drugs that reduce the level of thyroid hormones. Iodine preparations help reduce blood circulation in the thyroid gland and reduce its bleeding during surgery.

In the preparatory period, it is necessary to normalize the pressure and prepare the heart for surgery. For these purposes, b-blockers are used. If there are chronic foci of inflammation in the body, then it is necessary to undergo a course of antibiotic treatment. Such medical preparation lasts from 3 weeks to 3 months.

A thorough examination is carried out immediately before the operation. It is aimed at studying the state of the thyroid gland and other vital organs. Required research:

• determination of the level of thyrotropin and thyroid hormones, and antibodies to TSH receptors;
• general and biochemical analysis blood, determination of blood clotting;
• general analysis urine;
• Ultrasound of the thyroid gland and abdominal organs;
• chest x-ray.

The operation is prescribed only after all tests are normal.
The operation takes place under general anesthesia. The endocrinologist surgeon removes most of the thyroid gland, leaving approximately 5 g to maintain hormonal balance in the body. This site takes on a hormone-forming function, which allows you to refuse lifelong use of synthetic thyroid hormones.

Rehabilitation after surgery
After 3-4 days after the operation, the doctor will remove the staples and you can return home. Full recovery takes several weeks.

In the first days after surgery, it is necessary to take liquid food, as chewing causes pain, and swelling of the tissues can interfere with swallowing. In the next few weeks, special dietary restrictions are not required. But then you have to control the amount of calories consumed. After the removal of the thyroid gland, the metabolism decreases and there is a risk of developing obesity.

Make sure that the food is complete, rich in vitamins and proteins. Sea fish and seafood are especially important. But do not be zealous with supplements containing iodine. Their uncontrolled use can cause deterioration of the condition.

Daily routine is very important for restoring health. Get at least 8 hours of sleep a day. Be sure to walk 1-2 hours a day. Try to avoid direct sunlight, which is contraindicated after surgery.

After the operation, it is necessary to take the drugs prescribed by the doctor to improve metabolism. A significant improvement occurs 4-6 weeks after the operation, but this is not a reason to miss a scheduled visit to the doctor. Constant adjustment of the dose of drugs is necessary. The first year after the operation, it is necessary to visit the endocrinologist once a month.

The neck scar may enlarge and become red for the first few months. But after 1.5-2 years it will become lighter and thinner. To eliminate a cosmetic defect, the doctor may advise you with Contractubex or Solaris creams.

Treatment of folk remedies for diffuse goiter of the thyroid gland

Buckwheat-nut mix
Take 20 walnut kernels, 2 tbsp. buckwheat and grind in a coffee grinder. Then pour into a glass container and pour 250 g of honey. Mix until a homogeneous mass is obtained. Take 4 times a day after meals. You can drink warm tea or a decoction of mint.
Take the medicine for 5 weeks. At the same time, every 9 days, take a three-day break. The result should be noticeable after 20 days.

Dandelion compress
To prepare a compress, you need to take young dandelion leaves and dip them in melted butter. Add 1 tbsp. milk and heat. Then put a gauze napkin on the neck and put the heated leaves on it. The compress must be kept for 10-15 minutes. Repeat the procedure 3 times. The compress is done 2 times a day. The course of treatment lasts 2-3 months.
Dandelion compress has a soothing effect and helps relieve swelling. The first results are usually noticeable after 3-4 weeks. This method of treatment is recommended for pregnant women and children. The effectiveness of compresses increases significantly if they are combined with other alternative methods of treating diffuse goiter.

Infusion from the root collection
It is necessary to take 100 g of dry licorice root, 50 g of soapwort root and madder dye. Rinse and chop the rhizomes, then place in an enamel bowl, pour 2 liters. boiling water and boil for 20 minutes. Then let it brew for 2 hours in a cool place. Take 1 glass every morning before meals. The course of treatment is 10 weeks. The first results should appear in 3-4 weeks.

Herbal decoction
To prepare a daily dose of decoction, you need to take: 1 tsp. crushed stalks of St. John's wort and licorice root, 2 tsp each. angelica and radiola rosea, 5 pcs. rose hips. Collection pour 1 liter of boiling water and hold on medium heat for 10 minutes. Let it brew for 2 hours. Then strain and pour into a thermos. Drink a decoction 3 times a day in a warm form before meals.
The decoction must be prepared every day. The course of treatment lasts 12 weeks. The decoction will be effective if the patient has a non-toxic form of diffuse goiter. It is worth remembering that a decoction of a collection of herbs has a strong tonic effect. Therefore, it is recommended to take it before 18:00.

Prevention of diffuse thyroid goiter

In order to prevent diffuse goiter, it is necessary to carry out comprehensive prophylaxis.

What do we have to do?

1. Strengthen immunity, harden. Start by rubbing your body wet towel once a day, after a month, replace rubbing with a contrast shower.
2. Eat a diet rich in foods high in iodine. It can be seafood and green salads.
3. Add iodized salt to dishes after heat treatment of foods, as iodine evaporates at high temperatures.
4. Get enough zinc, manganese, selenium, molybdenum, cobalt, copper. For this, 2 times a year it is necessary to use vitamin-mineral complexes.
5. Perform a set of breathing exercises according to the Buteyko method. Although these breathing exercises are designed to treat asthma, they can reduce the level carbon dioxide in the body, stimulate the absorption of trace elements and strengthen the thyroid gland.
6. Do daily exercises with exercises to strengthen the muscles of the neck.
7. Spend holidays by the sea, where the air is rich in iodine vapor.
8. Drink up to 2 liters of water, sedative tea and dried fruit compote.

What not to do?

1. Expose the body to stress and physical overload.
2. Stay in areas with high levels of radiation and environmentally polluted areas for a long time.
3. Ignore regular visits to the doctor, especially if there is a hereditary tendency to diffuse goiter.
4. Resort to self-healing methods. Any changes in the thyroid gland are a reason to contact an endocrinologist.
5. Take hormonal and iodine-containing drugs without a doctor's recommendation.

Toxic thyroid goiter

Toxic thyroid goiter is an enlargement of the thyroid gland, in which the body is poisoned by thyroid hormones. Intoxication causes dysfunction of internal organs and acceleration of all metabolic processes in the body. This condition is called thyrotoxicosis.

Causes of toxic goiter

The disease occurs more often in women 20-50 years old. In 80% of cases, toxic goiter is associated with diffuse toxic goiter, it is also called Graves' disease or Graves' disease. This pathology is associated with a malfunction of the immune system. The remaining 20% ​​are due to Plummer's disease - an adenoma that produces hormones and multinodular toxic goiter.

Disposing factors leading to the appearance of toxic goiter

1. hereditary predisposition- this is the main cause of diffuse toxic goiter, which is an autoimmune disease. Scientists believe that 20 genes are responsible for the development of diffuse toxic goiter. They code for a congenital deficiency of T-regulatory cells, which are designed to destroy defective T-lymphocytes. These lymphocytes "attack" the thyroid protein. As a result of a series of immune reactions, B-lymphocytes are connected, which are responsible for the formation of autoantibodies. They produce specific protein substances ( autoantibodies to the TSH receptor), which attach to thyroid cell receptors. The gland perceives them as TSH (thyroid stimulating hormone of the pituitary gland) and in response activates the growth and production of hormones.
2. Diseases of the pituitary gland. In some cases, the pituitary gland (a gland located in the brain) develops a tumor that produces large amounts of thyroid-stimulating hormone. This substance stimulates the growth of the thyroid gland and the production of thyroid hormones in its follicles.
3. Overdose of thyroid hormones And iodine preparations in the treatment of the thyroid gland. Improper intake of drugs disrupts the synthesis of hormones and leads to the active growth of the tissue that makes up the thyroid gland.
4. Restructuring in the work of the nervous and endocrine systems. Such stages a woman's body goes through during puberty, pregnancy, after childbirth, during breastfeeding and the onset of menopause. It is with this that the fact that toxic goiter occurs 10 times more often in women than in men is associated.

However, not all people who have changes in their genes or who have experienced hormonal changes develop toxic goiter. His appearance is provoked trigger factors

1. Infectious diseases
   • flu
   • angina
   • rheumatism
   • tuberculosis
   During infections, the amount of antibodies in the blood increases dramatically. During this period, it becomes more difficult for the immune system to get rid of defective autoantibodies, which cause the malfunction of the thyroid gland.
2. Traumatic brain injury. The regulation of the thyroid gland passes through the pituitary gland and hypothalamus. Violations in these brain structures (contusion, swelling) distort the signals coming from the central nervous system and provoke an increased synthesis of hormones.
3. Encephalitis. Inflammation of the brain causes a malfunction of the pituitary gland and disrupts the signal transmission from the brain to the thyroid gland, activating its work.
4. Stress and mental trauma are often triggering factors for the development of toxic goiter, since the thyroid gland is very sensitive to disorders in the nervous system.
5. Taking large doses of iodine. Some people have an increased susceptibility to iodine. And the more iodine they consume, the more iodine-containing hormones are released and the stronger the intoxication.
6. Prolonged exposure to the sun. Prolonged insolation and sunburn cause intoxication, which disrupts the innervation of the thyroid gland. Ultraviolet rays cause an increased division of thyrocytes that produce hormones.

Symptoms of toxic goiter

The thyroid gland at toxic goiter evenly enlarged on both sides of the neck. It is painless, elastic, rather soft, moves when swallowing. In some cases, by placing a hand on it, you can feel the characteristic "buzz" caused by the movement of blood through the dilated vessels. This picture corresponds to diffuse toxic goiter.

At thyrotoxic adenoma gland is enlarged unevenly. In it, you can feel one node with a size of 1 cm or more. Large formations cause deformation of the neck and thickening on one side.

At multinodular toxic goiter many painless seals are felt in the thyroid gland. There are 2 or more of them, the nodes can be located in one lobe of the thyroid gland or affect both its halves and the isthmus.

In the event that the thyroid gland is enlarged by 2 times and its volume reaches 40 ml, there are signs of compression of the larynx and trachea:

• difficulty in swallowing;
• feeling of a lump in the throat;
• shortness of breath when lying down;
• coughing and hoarseness of voice when squeezing the vocal cords.

Subjective manifestations toxic goiter are associated with intoxication of the body with thyroid hormones, which affect all organs and systems. But the most characteristic 3 symptoms: goiter, enlargement of the eyeballs and tachycardia. Let us consider in more detail the manifestations of toxic goiter.

1. Heart disorders and circulatory systems are associated with its stimulation by the autonomic nervous system, which is influenced by thyroid hormones, epinephrine and norepinephrine. In addition, an accelerated metabolism requires intensive work of the heart. This is manifested by an increase in blood pressure, rapid heart rate (more than 140 beats per minute), a tendency to atrial fibrillation. Such overloads lead first to an increase in the volume of the heart, and then to a weakening of the heart muscle.
2. Forward displacement of the eyeball(exophthalmos or bulging eyes). The symptom of "angry look" is associated with inflammation and swelling of the tissues around the eyes. The state is called exophthalmic factor - a protein secreted pituitary gland.
3. Defeats central and peripheral nervous system. Thyroid hormones increase the excitability of the cerebral cortex, causing tearfulness, mood swings, decreased attention and memory, fatigue and sleep disturbance, trembling of the whole body and especially the fingers.
4. Stimulation of the sympathetic nervous system leads to an increase in body temperature. The skin becomes hot and moist, the face reddens.
5. Thyroid hormones accelerate fat, protein and carbohydrate exchange. At the same time, energy does not accumulate in ATP, but is dissipated - energy metabolism is enhanced. This leads to the expenditure of fats from the subcutaneous adipose tissue and weight loss. Weight loss occurs against the background of a good appetite.
6. Damage to the digestive organs manifested by abdominal pain, vomiting, a tendency to diarrhea. Violation of liver function leads to poor digestion.
7. Damage to the endocrine glands may have different manifestations. Dysfunction of the ovaries leads to disruption of the menstrual cycle and the complete absence of menstruation, mastopathy. In men, sexual desire decreases, impotence develops. And damage to the pancreas can lead to the development of diabetes.

Diagnosis of toxic goiter

At the appointment with the endocrinologist, you will find a detailed survey necessary to determine the causes of the disease and the nature of its course. The doctor pays special attention to the factors that can lead to thyroid cancer:

• whether someone from close relatives had thyroid cancer;
• whether irradiation was carried out on the head and neck area;
• whether they stayed on the territory affected by the Chernobyl accident.

After that, the doctor performs palpation of the thyroid gland. At the first stage, he determines the size of the gland and its elasticity with sliding movements of the fingers. Second phase: thumbs both hands, the doctor deeply probes the lobes and determines the presence of nodes, their number and size. A seal can be detected if it is located on the surface and its size exceeds 1 cm.

Thyroid ultrasound

This is a mandatory test that all patients with thyroid disorders undergo. At
diffuse toxic goiter the following signs of the disease are found:

• uniform increase in both lobes of the thyroid gland;
• the edges of the gland are smoothed and rounded;
• echogenicity (the degree of reflection of ultrasonic waves) of the thyroid tissue is reduced as a result of an increase in moisture content;
• the structure of the gland is homogeneous;
• dilated vessels are visible;
• in Doppler mode, an increase in blood circulation is noticeable.

At thyrotoxic adenoma or multinodular toxic goiter Ultrasound shows the following changes:

• one or more rounded formations different sizes;
• the node is clearly defined with smooth edges - this confirms that the adenoma has a capsule;
• a dark rim around the node indicates that it is entwined with blood vessels and produces hormones;
• ultrasound passes slowly in the nodes - a hypoechoic node with an inhomogeneous structure;

Laboratory methods for the study of toxic goiter

An analysis of thyroid hormones provides information about how efficiently the thyroid gland works and how much the level of hormones exceeds the norm. With toxic goiter, various studies are carried out:

1. Thyroid hormone analysis- determine the levels of T3 (triiodothyronine) and T4 (thyroxine). They are also called thyroid or iodine-containing hormones. They regulate growth and all metabolic processes in organism. In the blood, hormones circulate mostly in a bound, inactive form. They are attached to transport proteins in the blood. As needed, hormones are released from "carriers" and become active. The number of bound proteins changes under the influence of various factors: drugs, pregnancy, physical activity.
   The level of free hormones is relatively stable and is approximately 1% of the bound hormones. In laboratories, free T3 and T4 and total T3 and T4 (the sum of bound and free hormones) are determined.
   Normal performance:
   • T4 general 60-140 nmol/l
   • T4 free 10-23 pmol/l
   • T3 general 1.50-2.80 nmol/l
   • T3 free 3.1-12.3 pmol/l
   With toxic goiter, hormone levels are significantly higher than normal.
2. Pituitary hormone test- determination of the level of thyroid-stimulating hormone (TSH or thyrotropin). The pituitary gland is a gland in the brain that regulates the activity of other endocrine glands, those that secrete hormones into the blood. One of them is TSH, which is responsible for stimulating the thyroid gland: the higher its level, the more active the gland will work. But with toxic goiter, it already produces too many thyroid hormones and does not need stimulation. Therefore, the level of thyrotropin is low, less than 0.4 μIU / ml.
3. Blood test for antibodies. Antibodies are protein structures that are produced by cells of the immune system - lymphocytes. The presence of antibodies in the blood indicates that the immune system has taken up arms against the thyroid gland (substances that it produces and sections of the cell membrane). The attack of antibodies disrupts the normal functioning of the organ and causes the production of triiodothyronine and thyroxine.
4. Antibodies to TPO(thyroid peroxidase - an enzyme involved in the synthesis of hormones). An increase in antibody titer indicates that a defect in immunity has become the cause of the disease. In combination with symptoms of thyrotoxicosis high level antibodies to TPO more than 35 IU / ml confirms the diagnosis of "diffuse toxic goiter" and speaks of autoimmune disease thyroid gland.
5. Antibodies to TG(thyroglobulin, a precursor protein of thyroid hormones) if the level of antibodies is more than 40 IU / ml, then this may indicate autoimmune thyroiditis (the titer is increased in 90% of patients) and diffuse toxic goiter (in 50%), or tumors of the thyroid gland. But the antibody titer is increased in 25% healthy people. Therefore, this analysis has recently been prescribed infrequently.
6. Antibodies to TSH receptors. TSH receptors are areas of the thyroid cell membrane that are designed to capture thyroid-stimulating hormone from the pituitary gland. These antibodies bind to receptors and activate thyroid cells. An antibody titer greater than 1.75 IU/l is considered a positive result. This analysis clearly indicates diffuse toxic goiter and therefore is becoming increasingly popular.

Biochemical blood test

With toxic goiter, a number of changes occur in the blood:

• Decreased total protein(below 65.0 g/l) and albumin (below 35 g/l). Thyroid hormones cause protein breakdown in the cell. Proteins are quickly consumed due to increased metabolism and heat consumption;
• Elevated glucose(above 5.83 mmol / l) due to its active absorption from the intestine, as well as a decrease in insulin production in case of damage to the pancreas;
• Increase in gamma globulins(above 19% of the total blood protein) indicates toxic damage to the liver, which is responsible for the synthesis of these proteins.
• Increase in protein-bound iodine above 8 mcg, indicates that there is a high concentration of iodine-containing hormones in the blood.

Thyroid biopsy

A biopsy is the removal of thyroid tissue using a syringe. The resulting material (biopsy) is sent for morphological examination to the laboratory to detect cancer cells. More often carried out with multinodular toxic goiter, thyrotoxic adenoma and nodes against the background of Graves' disease. If no nodes are found on the ultrasound, then there is no point in performing a biopsy.

Indications for a biopsy:

• Knots more than 1 cm;
• Knots less than 1 cm if
  • Irradiation was carried out on the head area;
  • There are signs of cancer on ultrasound;
  • If close relatives have been diagnosed with cancer.

Morphological examination in toxic goiter does not reveal atypical cells with enlarged or numerous nuclei.

Computed tomography of the thyroid gland

This highly accurate and expensive examination is necessary if there is a suspicion that toxic goiter is associated with thyroid cancer or to clarify its location in retrosternal goiter. As a result, the doctor receives a very accurate layer-by-layer image of the organ. The presence of toxic goiter is confirmed by the following data:

• the volume of the thyroid gland is more than 19 ml in women and 25 ml in men;
• with diffuse toxic goiter, the structure of the gland is homogeneous, but it may contain secondary foci of destruction (degeneration);
• with multinodular toxic goiter or adenoma, rounded formations with the correct contour are found;
• compression of the esophagus and trachea with a large goiter with goiter of the 3rd degree;
• toxic goiter does not cause changes in the lymph nodes.

Treatment of toxic goiter

There are 3 main methods of treating toxic goiter:

• the use of thyreostatic drugs;
• surgery;
• treatment with radioactive iodine-131.

Each of the methods has its advantages and disadvantages, so the doctor individually determines the treatment regimen for each patient, taking into account the characteristics of the disease and the state of health.

Regardless of the method of treatment, people with toxic goiter need enhanced nutrition. Its calorie content should be 30% higher than normal to cover the costs of the body.

Drug treatment of toxic goiter

Drug treatment of toxic goiter takes place in 2 stages. For the first 2-3 weeks, high doses of drugs are prescribed to relieve the symptoms of thyrotoxicosis. In the future, the dosage is reduced and switched to maintenance therapy, which lasts 1-1.5 years.

Thyrostatic (antithyroid) drugs

Medicines based on methylmercaptoimidazole and thiourea accumulate in the thyroid gland.
They block the synthesis of thyroid hormones, inhibiting the action thyroid peroxidase. This enzyme ensures the oxidation of iodine and its attachment to hormones.

As a result of taking thyreostatics, lymphocytes penetrate less into the thyroid gland - the attack of immunity decreases. The drugs are used in the period of preparation for surgery and for the medical treatment of toxic goiter. Their main goal is to normalize the production of hormones, in medical terms, "introduce the body into a euthyroid state."

Mercazolil
Take 5-10 mg 3-4 times a day after meals. After normalization of hormone levels after 4-6 weeks, the dose is gradually reduced by 5 mg every week. Depending on the condition, the doctor prescribes a maintenance dose of 5 mg daily or every 3 days. The total duration of treatment is up to two years.

tyrosol
Take 20-40 mg per day for 3-6 weeks. The daily dose is usually divided into 2-3 doses. Tablets should be taken after meals with plenty of fluids. Take the medicine at the same time. After achieving the desired effect, after 4-5 weeks, the dose is reduced to 5-20 mg per day. The fact that there has been an improvement is evidenced by a decrease in the level of free T4 in the blood and weight gain. At this stage, treatment is supplemented levothyroxine. This is necessary in order to prevent an increase in the concentration of thyroid-stimulating hormone, which causes the growth of goiter.

Thyroid hormone preparations

Artificial hormones in small doses are prescribed after thyrotoxicosis has been eliminated. They are taken together with thyreostatics to reduce the activity of the pituitary gland, which, in response to a decrease in the level of thyroid hormones, begins to stimulate the thyroid gland, causing it to grow.

Levothyroxine (Eutyrox)
Assign 50-75 mcg per day. Take half an hour before breakfast 1 time per day. Used for drug treatment after it was possible to achieve normalization of hormones and after surgery to remove the thyroid gland.
Preparations containing iodine

Potassium iodide
Assign a dose of 250 mg 2 times a day. It is necessary to take it after a meal, drinking plenty of milk or sweet tea. With iodine deficiency, it is taken for a long time, in courses of 20 days with breaks of 10 days. In preparation for surgery, the duration of treatment is 2-3 weeks.

Beta blockers
They block the work of beta-adrenergic receptors, which are stimulated by adrenaline. Their intake reduces the reaction of the heart, kidneys, respiratory system to stress. In addition, beta-blockers reduce T3 levels. They eliminate tachycardia, sweating, anxiety, trembling in the hands and throughout the body, and normalize blood pressure. These drugs are prescribed during the period of thyrotoxicosis, after the normalization of hormones after 4-6 weeks they are canceled.

propranolol
Apply 20-40 mg orally every 4-8 hours, regardless of food intake. The dose is selected so that the pulse rate at rest does not exceed 90 beats per minute. Cancel the drug gradually, so as not to cause bronchospasm and myocardial infarction.
Other beta-blockers in the treatment of toxic goiter are less effective.

Glucocorticoid drugs
Steroid hormones in toxic goiter help fight adrenal insufficiency and eye symptoms of thyrotoxicosis, as well as reduce intoxication caused by thyroid hormones. Glucocorticoids normalize the activity of the immune system, reducing the aggression of lymphocytes against the thyroid gland and tissues surrounding the eyeball.

Hydrocortisone
Administered intravenously, 50-100 mg 3-4 times a day. It is most effective when combined with large doses of ascorbic acid.

Prednisolone
Assign short courses of 2 weeks, 15-30 mg daily, the daily dose is divided into 2 times. If the need arises, then take 100 mg every other day for several weeks, and then gradually reduce the dose.

Dopaminergic drugs
Active substance dopamine inhibits the production of anterior pituitary hormones. Slows down the transmission of impulses between nerve cells, weakening the simulating effect of the nervous system on internal organs. It acts on the peripheral nervous system, has a calming effect, relieves spasms, lowers blood pressure and body temperature, and slows down metabolism.

Reserpine
Assign 0.1-0.25 mg 3-4 times a day. It is desirable to use reserpine after meals, so as not to irritate the digestive system. The duration of treatment is selected individually.
During the treatment of toxic goiter, it is necessary to control the level of thyroid hormones, thyrotropin, thyroid-stimulating antibodies. Tests should be taken every 3-4 months.
If you develop tachycardia during treatment, be sure to tell your doctor about it. An accelerated heartbeat may be a sign of a recurrence of thyrotoxicosis, in which case the doctor will increase the dose of drugs.

Surgery

Indications for surgery for toxic goiter

• diffuse toxic goiter grade 3;
• multinodular toxic goiter;
• compression of the trachea and esophagus;
• with allergies to drug treatment of toxic goiter;
• reception Mercazolil causes goiter growth;
• frequent relapses against the background of properly selected thyreostatic treatment.

Contraindications for surgery

• severe form of toxic goiter, which caused persistent changes in internal organs or complicated by psychosis;
• severe damage to the kidneys, cardiovascular or respiratory system;
• it is impossible to normalize the production of thyroid hormones, which significantly increases the risk of postoperative complications;
• infectious diseases and the presence of foci of inflammation in the body. Surgery can be performed 3 weeks after recovery.

Preparing for surgery for toxic goiter
Preparation for surgery for toxic goiter takes 1-3 months. During this time, with the help of thyreostatics and iodine preparations, the function of the thyroid gland and the production of hormones are normalized.

Immediately before the operation, a number of studies are carried out to find out the state of the body:

• blood test for thyroid hormones;
• blood tests: general and biochemical analysis, determination of blood group and coagulability;
• Ultrasound of the thyroid gland and abdominal organs to detect hidden pathologies that can cause postoperative complications;
• analysis of feces for helminth eggs;
• Analysis of urine;
• ECG examination.

Completes the preparation of the examination by the therapist and anesthetist.

Rehabilitation after surgery
Thyroid surgery is performed under general anesthesia. After the procedure, when the effect of anesthesia wears off, moderate pain is felt at the suture site. For 3-4 days, you need to stay in the hospital so that the doctors monitor your condition and make sure that the danger of complications has passed.

Before discharge, you will be advised on how to handle the postoperative suture. To do this, you need peroxide, brilliant green and a sterile bandage. Apply peroxide to the seam. After it stops hissing, dry the area with a sterile bandage and grease with brilliant green. A fresh suture is covered with a bandage made of a sterile bandage, which is fixed with an adhesive plaster. If suddenly in some area the seam becomes inflamed, reddened, liquid begins to stand out from it, then you need to consult a doctor.

There are no special restrictions in daily activities. The recovery process takes 2-3 weeks, after which you can return to work. However, avoid hard physical labor, assembly line work, mental stress, prolonged exposure to the sun. You also have to forget about smoking.

After removal of the thyroid gland, it is required to take synthetic thyroid hormones (Levothyroxine, Euthyrox), which will help normalize the metabolism. But still there is a risk of obesity and problems associated with increased blood cholesterol levels. Therefore, it is necessary to monitor the calorie content of the diet and not exceed age norm consumption of fats and carbohydrates.

Treatment of folk methods of toxic goiter of the thyroid gland

Celandine tincture
Finely chop the celandine stems and fill a glass jar with them by ½. Then fill the container to the top with vodka and let it brew for 10 days. Start taking the medicine 2 drops a day in the morning on an empty stomach with boiled water. Add 2 drops every day. Having reached 16 drops, you need to take a week break. Then again continue with 16 drops.
The course of treatment lasts 2 months. The first results should be expected during the 10-day break. Remember that the medicine is toxic. Do not exceed the indicated dose!

feijoa medicine
Ripe feijoa fruits, walnut kernels and honey in equal proportions are mixed and ground in a blender. The medicine is taken 2 times a day for 2-3 tablespoons. in 30 min. before meals.
The course lasts 2 months. Feijoa is rich in iodine and other trace elements, it helps to restore the full functioning of the thyroid gland in the early stages of the disease. Recommended for children and pregnant women.

Infusion of nettle and sweet clover
Grind freshly picked nettles and sweet clover. Mix them in a ratio of 3:1. Then pour boiling water at the rate of a glass of vegetable raw materials per liter of water. Let it brew in an enamel bowl for 8-10 hours. Strain and take 100 g 3 times a day. The course of treatment is 2 months.
The infusion relieves swelling, has calming properties, restores the full functioning of the thyroid gland. The first effects should be expected in 10-14 days.

Prevention of toxic goiter of the thyroid gland

Prevention of toxic thyroid goiter comes down to strengthening the immune system and following balanced nutrition.

What do we have to do?

1. Do daily breathing exercises. In this case, it is recommended to use the Buteyko method. Breathing exercises can be replaced with yoga or jogging at an easy pace. Start with 15 minutes, gradually increasing to 40-50 minutes.
2. Visit the pool 2 times a week and take daily cold and hot shower.
3. Spend more time outdoors, in a pine forest or near the sea.
4. Stick to a daily routine. Go to bed and eat at the same time.
5. Stick to a properly balanced diet. Include more vegetables, walnuts, persimmons, herbs and seafood in your diet.
6. Seasonally take vitamin complexes.

What not to do?

1. Lack of sleep, overwork, exposing the body to stress and nervous overload.
2. Take drugs such as: ephedrine, novocaine and antihistamines without a doctor's prescription.
3. Ignore a visit to the endocrinologist and self-medicate when signs of goiter appear.
4. Long stay in areas with high levels of radiation.
5. Avoid hypothermia, head and neck injuries.
6. Long stay in the open sun.

Pathologies of the thyroid gland are diverse and are a very common problem. But timely diagnosis and the right treatment will help you regain your health.