Thyroid

Multinodular toxic goiter of the thyroid gland

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Nodular toxic goiter (Plummer’s disease) is a toxic thyroid adenoma.

Hyperthyroidism is associated with increased production of thyroid hormone tumors. In women, the incidence of the disease is higher and increases with age.

The disease often proceeds malosymptomatically, in the form of cardiovascular manifestations. In rare cases, hoarseness of the voice, mild dysphagia (a violation of swallowing), minor pain in the anterior surface of the neck.

Palpation is determined by the site of a soft-elastic consistency, mobile, with a smooth surface, as a rule, painless.

Diagnosis of nodular goiter

In identifying nodal education, you must consider the possibility of the presence of a malignant formation. A site biopsy helps determine the nature of the tumor.

In the diagnosis of the disease, data from anamnesis, the determination of the risk factors for the disease: age, sex, residence in areas deficient in iodine content, malignant thyroid tumors in relatives help.

On examination, palpable nodules.

Laboratory methods: determination of the level of thyroid-stimulating hormone (TSH)

- Ultrasound examination - assessment of the size and structure of the thyroid and nodules, the presence of microcalcifications.

- Thyroid scintigraphy - definition of "hot" and "cold nodes".

How the disease manifests itself and what troubles should be expected from this pathology

Multi-site goiter of the thyroid gland - this name means all nodal neoplasms of various origin, structures with parameters of 10 mm and more. This is a tumor, which is different in structure and composition from the tissues of the organ.

The nature of nodes is:

Follicular. Cystic. Colloid and others

Most often, the nodules do not interfere with the duties of the thyroid gland.

The presence of nodes in the thyroid gland may not interfere with its activity, but treatment is required. Because ignoring this problem can be a threat to life.

Classification

Classification by the degree of increase of the thyroid gland:

Zero degree - there is no increase, but the symptoms are already showing. The first degree - visual changes imperceptibly, but during palpation is felt. An ultrasound examination shows a volume of up to 30 cm³. Grade 2 nontoxic goiter is a clearly marked increase that is felt on palpation. Ultrasound detects an increase of more than 30 cm.

The size may increase due to diffuse hypertrophy of the thyroid or due to colloidal nodules.

The causes of the disease

The main reason for the manifestation and growth of pathology may be due to insufficient consumption of iodine-containing products. It is noticed that more than a third of the population is subject to pathology, when there is an insufficient iodine intake of 50% per day of the required amount over a long period - 10 years or more.

Iodine deficiency contributes to the gradual destruction of thyroid tissue. In this situation, foci of colloidal formations are actively formed, which have a capsular restriction. They, progressively increasing in parameters, often reach enormous sizes.

The following reasons may be a catalyst for the development of the problem:

Great body weight. With anemia. Chronic diseases of the gastrointestinal system. Sometimes a second pregnancy, and sometimes breastfeeding. Inflammation in the thyroid gland. Autoimmune diseases. Infectious diseases. Hormonal disorder. Toxic substances can cause thyroid dysfunction.

Some endocrinologists claim that the multinodular goiter begins to manifest itself when DNA cells are damaged. It is noticed that this disease often affects people with low incomes who feed poorly.

A large number of thyroid neoplasms almost always develop as benign and are not a threat to the life of the patient, but very rarely such formations can become malignant. And such a situation clearly carries a danger to man. In any case, when a small symptom appears, you should consult a doctor.

Symptoms of the disease

Most often, the pathology of a multinodular goiter develops as a colloidal form, in which at the initial stage the symptoms do not appear or are completely absent. With this form of development, its manifestation can be noticed only when the size of the thyroid begins to increase.

When multiple formations develop, the symptoms of the multinodular thyroid goiter are pronounced:

The mood changes often and dramatically. Twitching of hands, which suddenly begins. Weight fluctuations in both directions: both a decrease and an increase. Neck strain. Difficulties of memorization, frequent forgetfulness. Distracted attention, inhibited movement. Tachycardia. Uncomfortable condition of the neck. Hard breath. Increases sweating. Chill, then thirst. Disorders Chronic fatigue.

Colloid form

Colloid goiter of the thyroid gland is a benign growth. Nodular formations may be several or a single instance. Formation is formed when the outflow of a colloidal composition from the follicles is disturbed. The structure of the iron-like structure: thyreoglobulin, iodine and amino acid. In this disease there is a pathological increase in thyroid.

The thyroid consists of follicles: bubbles filled with liquid colloid.

In this liquid substance, thyroids are produced.

The colloidal form of the disease begins to develop during:

uncontrolled increase in follicles, the number of follicles is rapidly increasing.

According to the structural changes of the multinodular goiter, there are 3 types:

Nodal - increases unevenly. More often, women who have had uterine fibroids suffer from it. Diffuse - increase occurs evenly. This species is more common in the younger generation. Mixed - the name of the endemic nodular goiter. Some areas are uniform, others are unevenly growing.

Multiple colloidal goiter is not a dangerous thyroid problem. Modern methods of diagnosis can identify the disease and find an effective treatment.

The choice of treatment is made taking into account:

the form of the disease, the stage of development, the age of the patient is taken into account, the presence of other pathologies is determined.

When the disease is benign, it is advisable to use conservative treatment.

Often for the treatment of nodes used ethyl alcohol, which is injected using the puncture method.

Sometimes hormonal preparations containing thyroids are used.

The diffuse form is cured with the use of antithyroid drugs and iodine -131.

Surgical intervention is used in the following cases:

the tumor is rapidly increasing, and thyroid tissue is destroyed, a very large deformation of the neck.

Multinodular toxic goiter

In the normal state, the thyroid gland produces the required amount of hormones, that is, with an increase in TSH, vigorous production of hormones by the gland contributes to a decrease in TSH. Thyroid-stimulating hormone is produced in the pituitary gland, in quantities that maintain the balance of thyroid hormones in the blood.

On the body of the thyroid gland are sensitive receptors that respond to TSH. When the content of TSH increases, the thyroid cells begin to actively produce hormones.

If a nodular toxic goiter began to develop in a patient, his receptors do not perform their functions, but require constant hormone production from the thyroid gland, regardless of their content in the blood. This state is called “node autonomy”. Such focal neoplasms very rarely take on a malignant form. If a change occurs, then it is possible at the initial stage, when it is just being formed, and its dimensions are still small.

When the nodule is still small, it does not have the ability to influence the amount of hormones. Negative qualities appear when the size of the node 25 - 30 mm. Under such conditions, the activity of the thyroid gland, quite possibly, will lead to the appearance of an increased amount of hormones; this pathology causes a state of thyrotoxicosis.

At the same time, the pituitary gland lowers TSH, therefore the thyroid gland ceases its activity, however, hormones are still produced by focal neoplasms. Multi-node toxic goiter is a problem, during which only the affected nodule becomes active, and the organ is in a dormant state.

The catalyst for the development of nodules are:

Inadequate intake of iodine with foods. Genetic problems. High background radiation, poisoning by harmful substances. The diet does not satisfy the needs of the body in vitamins, minerals. Smoking. Stressful situations. Infectious and viral diseases of the nasopharynx.

Pathology is manifested by the symptoms:

The patient is often annoyed for any reason. Reduced performance. Hair falls out, nails break. Body skin becomes more moist and hot. There are problems in the cardiovascular system.

Toxic multinodular goiter is not accompanied by bulging eyes.

Diagnosis and treatment

For greater accuracy of the diagnosis of the disease after palpation produce:

Ultrasound, donate blood for TSH, T4, T3, biopsy, scintigraphy to identify the causes of thyrotoxicosis.

Only after studying all the results, it becomes possible to choose an effective treatment. Begin treatment with a proper diet. When the level of development of thyrotoxicosis is determined, measures are taken to suppress the activity of tumor foci that synthesize hormones in excess.

The most reliable method of treatment is considered surgery. Sometimes only one lobe of the gland or the entire organ is removed if the development of a multinodular process is observed. After surgery, the manifestations of thyrotoxicosis disappear.

Treatment with radioactive iodine

The thyroid gland is able to accumulate iodine entering the body. But when the organ itself is in an inert state, and the nodules are active, these structures accumulate iodine, but only in nodular tissues.

While using this method, iodine -131, which accumulates in the nodular tissues, is injected into the patient's blood. Such accumulation allows the action of I -131 destructively on the composition of the nodular tissue.

Uninfected thyroid tissue is not damaged.

This method is most effective. There are no traces left after the event and the disease itself disappears. But there is skepticism about this method. It is very difficult to accept that radiation in this case is curative.

A fundamental factor in the formation of nodular toxic goiter is the loss of sensitivity of the receptor mechanism of nodular cellular structures to the thyroid stimulating hormone. That is, a healthy thyroid gland produces hormones according to their concentration in the bloodstream: the higher the thyroid-stimulating hormone content, the more vigorously the gland functions. Thyroid-stimulating hormone is synthesized in the pituitary system, which, in turn, determines the concentration in the bloodstream of hormones secreted by the thyroid gland, and on the basis of the data obtained assesses the true need of the body. In this regard, it is possible to conclude that the pituitary gland always synthesizes thyroid-stimulating hormone deliberately and precisely in such quantities as to maintain the normal balance of thyroid hormones in the bloodstream.

Sensory receptors that respond to thyroid stimulating hormone are located on the cell surface of the thyroid gland. With an increase in the amount of this hormone, thyroid cells are activated and begin to intensively produce hormones.

If a patient has a nodular toxic goiter, its receptor organs cease to perform their function and begin to “demand” the constant and constant production of hormones from the thyroid gland, regardless of their level in the bloodstream. This condition is defined by the concept of "autonomy of the node." Autonomous focal formations are extremely rarely malignant: if malignancy occurs, this happens at the initial stage of node formation, when its size is still minimal.

A small nodule on the gland does not have a pronounced ability to influence the concentration of hormones. Its negative properties appear when the node grows to 25-30 mm: in such cases, the activity of the gland can lead to the appearance of a large amount of hormones in the bloodstream, which is defined as the pathological state of thyrotoxicosis. At this stage, the intelligent pituitary gland, suspecting something was wrong, inhibits the synthesis of its own thyroid-stimulating hormone to correct the situation: it helps, the thyroid stops producing hormones, but they continue to be produced by focal formations.

Nodular toxic goiter is a disease in which only the pathological nodule works, and the thyroid gland itself plunges into a sleeping state.

What is the starting point in the development of nodules in the thyroid gland?

Lack of iodine in the body. Genetic disruption. The effect of radiation or intoxication with harmful substances. Deficiency of some minerals. Smoking. Frequent stressful situations. Infectious and viral diseases, especially inflammation of the nasopharynx.

Nodular toxic goiter - a few nodes in the thyroid gland, the size of which exceeds 10 mm.

Nodes are classified by the structure of the tissues of the gland:

colloidal, follicular, cystic, diffuse.

Multiple toxic goiter can have mixed tissue composition.

Symptoms of multinodular goiter

A multinodular toxic goiter may not manifest itself for a long time without causing serious thyroid gland disruption. Painful symptoms occur as the growth of neoplasms.

Symptoms of nodular goiter:

apathy, chronic fatigue, irritability, sudden weight loss, bad hair, heart problems, moist and hot skin.

Due to the constant fatigue and heart palpitations a person loses working capacity.

Nodular toxic goiter does not cause ophthalmopathy, this symptom is more characteristic of diffuse toxic goiter or Graves disease.

Symptoms of Graves Disease:

insomnia, excessive sweating, peep eyes, aggressiveness, mental problems.

Strong growth of the tumor causes a symptom of squeezing in the neck, problems with swallowing food and breathing.

The most serious complication of thyrotoxicosis leading to death is thyrotoxic crisis.

Symptoms of thyrotoxic crisis:

excessive sweating, rapid pulse, tremor of the limbs, clouding of consciousness, pathological sleep, coma, urinary retention. Causes of goiter formation

The main reason for the growth of goiter is the loss of sensitivity to thyroid receptor receptors of thyroid cells. Loss of sensitivity leads to increased synthesis of endocrine gland hormones and the appearance of nodes, mostly benign.

What starts the process:

heredity, genetic diseases, radioactive irradiation of the gland, alcohol and smoking, stress and excessive physical exertion, viral and infectious diseases, frequent inflammatory processes in the nasopharynx. The main types of nodular goiter

Classifications of thyroid nodular disorders by ultrasound:

Zero stage, no tumors, iron is normal. The first stage: colloid nodes of the first and second type, Hashimoto nodes of the first type, subacute thyroiditis, toxic diffuse goiter. The second stage: the third and fourth degree colloid node, the second type of Hashimoto node, cystic neoplasms. The third stage: the oncological process is questionable. Fourth stage: malignant tumors. Diagnosis of nodules

Diagnostic procedures begin with inspection and palpation of the thyroid gland, listening to complaints and analyzing symptoms. After that, the patient is sent for ultrasound and laboratory tests for hormones of the endocrine gland.

Ultrasound specialist provides information on the size of the thyroid gland, echogenicity, blood supply, tissue composition, lymph nodes.

A blood test for hormones T4, T3, TSH and calcitonin is necessary to obtain information about the functioning of the endocrine gland. To clarify hypofunction or hyperthyroidism, the patient is asked to take a test for cholesterol, glucose, albumin and gamma globulin.

If oncology of the endocrine gland is suspected, the patient is sent for scintigraphy. The definition of formations, both hot and cold, allows you to determine their malignancy.

Biopsy of the endocrine gland provides information on pathological changes in thyroid tissue, colloidal, diffuse or cystic. After processing the data of the survey and laboratory tests, the endocrinologist prescribes treatment.

Treatment of multinodular toxic goiter

For the treatment of multinodular goiter of the endocrine gland, drug therapy, surgery, and radioactive iodine therapy are used.

The method of treatment is selected individually, taking into account the nature of the violation, the symptoms, the sex and age of the patient, history.

Thyrostatics are included in the drug therapy of a multinodular goiter. For the treatment of drugs used Tyrozol and Merkazolil. Большие концентрации тиреостатиков могут привести к гипотиреозу эндокринной железы, который компенсируется синтетическими гормональными препаратами.

Treatment of diffuse toxic goiter of the thyroid gland is aimed at eliminating the symptoms of thyrotoxicosis, while thyreostatics do not always give the desired effect and, if a relapse occurs, the patient is sent to remove the endocrine organ.

Complete removal of the gland eliminates the symptoms of hormone oversupply, but leads to hypothyroidism and lifelong treatment with synthetic hormones.

The most safe modern methods of treatment include radioactive iodine therapy, which has the following advantages:

The almost complete absence of contraindications, with the exception of pregnancy and the period of breastfeeding in women. Relatively low cost. No additional treatment with thyreostatics is required. Manipulation is carried out on an outpatient basis.

Treatment of toxic goiter is impossible without a diet that includes foods containing proteins, vitamins, carbohydrates and fats, and a large amount of fluid.

Protein nutrition is necessary for patients, since a rapid metabolism leads to a serious decrease in body weight and a general weakening of the body. Food is recommended to take at least five times a day, in small portions.

Foods that should be excluded from the diet:

white sugar, flour products from white flour, fatty, smoked and spicy, alcoholic beverages, fish and meat broths, black tea, cocoa, canned food.

Useful products to help the treatment process:

kelp, fresh berries, vegetables and herbs, pasta from durum wheat, cereal, bran, fish, lean meat, especially turkey, dairy and dairy products, eggs, vegetable oils.

A mobile lifestyle and proper nutrition can significantly reduce the severity of thyrotoxicosis symptoms and lead a healthy lifestyle.

Symptoms of the disease

Nodular toxic goiter can be single-node (if the node is one) or multi-node (several nodes). Regardless of the form of the disease and the number of pathological inclusions, its manifestations are the same in each case, and treatment should take place according to similar principles. The main symptoms of this disease are:

  1. Psycho-emotional instability. Patients complain of sudden tides of anger or rage, which may not be justified by anything, but at the same time such people may cry for no reason or suddenly succumb to melancholy.
  2. Tachycardia and feeling of irregular heartbeat at rest. Heart rate is much higher than normal, and can be 120-130 beats per minute.
  3. Redness of the skin, as well as high humidity. This symptom is associated with increased sweating, a person may feel a sense of heat at normal body temperature.
  4. Insomnia and twitching in arms and legs (tremor of limbs).
  5. Weight loss with a normal diet.
  6. Feeling of a foreign body in the throat, feeling of a lump in the area of ​​the thyroid gland. This symptom is present at the stages at which the goiter is already quite large and therefore brings physical discomfort to the person.
  7. Very fast fatigue. Even the smallest physical exertion becomes a test for a person; symptoms such as severe weakness and dizziness appear.

The most dangerous manifestation of the disease, which can be observed with nodular toxic goiter, is thyrotoxic crisis. This is a condition of the body in which there is an acute inhibition of vital functions due to a sharp increase in thyroid hormones in the blood. All symptoms characteristic of nodular toxic goiter are exacerbated. A person may develop significant tremor, hyperthermia, a persistent increase in pulse rate, blockage of urination, loss of consciousness, turning into a podor (pathological sleep). If you do not seek help in time, a coma may develop. Therefore, when the warning symptoms appear, one should immediately consult a doctor to avoid such complications.

It should be noted that in the clinical picture of nodular toxic goiter there is no such symptom as exophthalmos (eyes bulging of the orbits), unlike diffuse goiter, in which this symptom is usually one of the most pronounced. In general, the symptoms of nodular toxic goiter are not specific, because they are similar to many of the manifestations of other thyroid abnormalities. But their appearance should alert, and become a reason for referring to the endocrinologist for the purpose of consultation and subsequent diagnosis.

Treatment of the disease

The main task in choosing the tactics of treatment of nodular toxic goiter is to suppress the increased secretion of thyroid hormones. Since the culprit of such an incorrect selection of cells is the nodular consolidation of the thyroid gland, then the struggle must be waged exclusively with it, while the healthy parts of the gland must remain unaffected. In the treatment of this type of goiter can be identified the following areas:

  • surgical (removal of nodules by surgical intervention),
  • conservative (the use of drugs of radioactive iodine, which affects only the nodes and does not affect the rest of the structure of the thyroid gland).

Surgical treatment is justified with massive size of nodes, if there is a tendency to their growth, and in the absence of the effect of the use of radioactive drugs. Surgical treatment allows you to quickly and effectively stop the process of thyrotoxicosis, since the cause of its occurrence, the node, is directly removed.

Complications after the removal of nodes are very rare, but since any surgery is always a risk, there are such conditions as:

  • paresis of the larynx (the cause may be accidentally hurt recurrent laryngeal nerve during surgery),
  • knots recurrence (disease recurrence),
  • violation of the parathyroid glands (reduced production of parathyroid hormone).

In the treatment of nodular toxic goiter with radioactive isotopes, the effect does not occur as quickly as during surgery, despite the high doses of the active substance contained in such preparations. Such treatment makes sense in the initial stages of the disease, when the goiter is not yet pronounced, and the size of the nodal formation does not cause physical discomfort to the patient. Hypothyroidism can be a complication of conservative treatment, although it occurs infrequently, since healthy thyroid tissue is not amenable to exposure to radioactive iodine.

With timely detection and observation in the dynamics of nodal toxic goiter successfully treatable, because the disease has a benign course. The main thing is to consult a doctor in time to make a correct diagnosis and draw up a further action plan.

About pathology

Diffuse nodular toxic goiter is characterized by its autoimmune nature and develops due to defects in the immune system, in which antibodies to the TSH receptors are produced, which have a constant stimulating effect on the thyroid gland. This leads to a uniform growth of thyroid tissues, hyperfunctions and an increase in the level of thyroid hormones: T3 and T4. An enlarged gland is called a goiter.

An overabundance of thyroid hormones can enhance the reactions of the main metabolism, significantly depleting the body's energy required for normal cellular activity. The most susceptible to the state of thyrotoxicosis are the heart, vascular and nervous systems.

About the causes of pathology

Nodular toxic goiter can develop mainly in women aged 20-50. In the elderly, as in childhood, such a disease occurs quite rarely. Endocrinology cannot yet answer exactly the question about the cause and the mechanism for initiating an autoimmune reaction underlying toxic diffuse goiter. This disease is sometimes detected in patients who have a hereditary predisposition, which is realized under the influence of many factors of the internal and external environment.

Infectious and inflammatory diseases contribute to the emergence of nodular toxic goiter (ICD 10 E05.2), along with mental injuries, organic brain damage (be it cranial injuries or encephalitis), autoimmune and endocrine disorders (these are functions of the pancreas, pituitary, gonads and adrenal glands ) and many others. The risks of goiter development when patients smoke are almost doubled.

Pathology Degrees and Classification

Diffuse nodular toxic goiter can manifest itself with the following variations of thyrotoxicosis, regardless of the size of the thyroid gland:

  • With a mild patient, neurotic complaints with no cardiac arrhythmias predominate. There may be complaints of tachycardia with a frequency of strokes of no more than one hundred per minute. There is no pathological dysfunction of other endocrine glands.
  • In the second degree of diffuse nodular toxic goiter, there is a loss of body weight within eight to ten kilograms per month. Also observed severe tachycardia. Nodular toxic goiter 2 degrees occurs quite often.
  • A severe degree is accompanied by weight loss to the point of exhaustion, there are signs of functional impairment of the kidneys, heart and liver. Usually this is observed when toxic goiter is not treated for a long time.

Next, find out in detail what symptoms accompany this endocrine pathology.

Symptomatology

What are the symptoms of nodular toxic goiter? Consider further.

Since thyroid hormones are responsible for performing various physiological functions, the occurrence of thyrotoxicosis is accompanied by a variety of clinical manifestations. Typically, patient complaints are directly related to cardiac and vascular changes, symptoms of endocrine ophthalmopathy and catabolic syndrome. Cardiac and vascular disorders may manifest as a rapid heartbeat, that is, tachycardia. Patients may experience palpitations in the chest, abdomen, or arms. Heart beats at rest in the presence of thyrotoxicosis can increase to 130 per minute. In the presence of moderate thyrotoxicosis, an increase in systolic and a decrease in diastolic pressure are observed, along with an increase in pulsation.

Myocardial dystrophy

In the case of a prolonged course of thyrotoxicosis, especially in elderly patients, bright and severe myocardial dystrophy develops. It can be manifested by abnormalities in the heart rhythm, which will be expressed by atrial fibrillation and extrasystole. Subsequently, all this will lead to changes in the myocardium and stagnation. For example, peripheral edema, ascites and cardiosclerosis may appear. Arrhythmia of breathing may occur, as well as a tendency to frequent pneumonia.

The onset of the catabolic syndrome is characterized by a sharp weight loss of about 15 kilograms against a background of good appetite. General weakness and hyperhidrosis are not excluded. Violation of thermoregulation, as a rule, is manifested in the fact that the patient experiences a feeling of heat and does not freeze at sufficiently low ambient temperatures. Elderly patients may experience evening subfebrile.

Symptoms of a deviation in the activity of the nervous system

With the functioning of the nervous system in the presence of thyrotoxicosis, mental instability is observed in the form of mild excitability, increased irritability and aggressiveness, anxiety and fussiness, tearfulness, mood variability and difficulties, if necessary, to concentrate attention. Sleep may be disturbed, depression may develop, and in severe cases persistent changes in the patient's mind and personality are observed.

Often, in the presence of diffuse nodular toxic goiter, there is a small tremor of the fingers. With the severe nature of the flow, the tremor can occur throughout the body, making it difficult to speak, perform movements, and write. The proximal myopathy, along with a decrease in the muscle volume of the limbs, is characteristic of such a patient; it is difficult for the patient to get up from the squatting position or from the chair. Sometimes an increased tendon reflex is noted.

Under the influence of an excess of thyroxin, the leaching of calcium from the bone tissue is carried out, bone resorption and the development of osteopenia syndrome (bone mass reduction) are observed. There is an additional pain in the fingers, which can take the form of drum sticks.

Skin changes

In the presence of this pathology, the skin is usually soft, warm to the touch, and in some patients vitiligo occurs, the skin folds darken, especially on the elbows. In 5% of patients with this pathology, prethibial myxedema develops, which is expressed in swelling, compaction and erythema of the skin in the region of the leg and foot.

In the presence of diffuse toxic goiter, a uniform enlargement of the thyroid gland is noted. Sometimes iron is greatly increased, and sometimes goiter may even be absent (this happens in 25% of cases). The severity of the pathology is not determined by the size of the goiter, since with a small volume a severe form of thyrotoxicosis can also occur.

We now turn to the consideration of methods of treatment of this disease and find out how it is eliminated in the conditions of modern medicine.

Treatment of diffuse nodular toxic goiter

Conservative therapy of thyrotoxicosis consists in taking antithyroid drugs. These are Mercazolil, Metizol, Tyrosol and Propitsil. They are able to accumulate in the thyroid gland and inhibit the production of thyroid hormones. Lowering the dose of drugs is carried out strictly individually, depending on the disappearance of the symptoms of thyrotoxicosis. It is necessary that the pulse normalized to eighty beats per minute, increased body weight and disappeared tremor with sweating.

Surgical intervention

Surgical treatment of thyroid nodal toxic goiter is used when total organ removal is required, which will lead to postoperative hypothyroidism, compensated by medication. The indications for performing the operation are allergic reactions to drugs in combination with a persistent decrease in the level of white blood cells during conservative treatment. In addition, the operation is needed when the goiter is large, there are cardiovascular disorders in combination with a pronounced goiter effect from mercazole. The operation in this pathology is possible only after medical compensation of the patient’s condition in order to prevent the onset of a thyrotoxic crisis at the stage of the early postoperative period.

Radioactive iodine treatment

This is perhaps one of the main methods of treatment of thyroid nodal toxic goiter. This technique is non-invasive, considered effective and relatively inexpensive and does not cause complications that can develop on the background of an operation on the thyroid gland. Contraindication to such treatment is pregnancy. An isotope with radioactive iodine accumulates in the cells of the endocrine organ, where it begins to decay and thereby provides local irradiation along with the destruction of thyrocytes. Treatment with radioactive iodine is carried out with compulsory hospitalization of the patient in specialized departments. The state of hypothyroidism in patients usually develops within six months after using iodine.

Therapy during pregnancy

In the presence of toxic diffuse goiter in a pregnant patient, she should be under the regular supervision of not only the gynecologist, but also necessarily the endocrinologist. Treatment of this disease during pregnancy is carried out with “Propylthiouracil” (this drug does not pass well through the placenta) in the minimum dosage necessary to maintain the amount of thyroxine. With an increase in the duration of pregnancy, the patient's need for thyrostatics is reduced, and most women after the thirtieth week of pregnancy do not take this medicine. After birth, they usually develop relapses of thyrotoxicosis.

Treatment for nodular toxic goiter of a thyrotoxic crisis implies an intensive use of large doses of thyreostatics. Preference is given to "Propylthiouracil". If it is impossible for the patient to use the drug himself, it is administered through a nasogastric tube. Additionally, glucocorticoids are prescribed in combination with adrenergic blockers, therapy, plasmapheresis, and so on.

Symptoms of multinodular goiter

A multinodular toxic goiter may not manifest itself for a long time without causing serious thyroid gland disruption. Painful symptoms occur as the growth of neoplasms.

Symptoms of nodular goiter:

  • apathy,
  • chronic fatigue,
  • irritability,
  • drastic weight loss
  • bad hair
  • problems with heart,
  • wet and hot skin.

Due to the constant fatigue and heart palpitations a person loses working capacity.

Nodular toxic goiter does not cause ophthalmopathy, this symptom is more characteristic of diffuse toxic goiter or Graves disease.

Symptoms of Graves Disease:

  • insomnia,
  • heavy sweating
  • bug-eyed
  • aggressiveness,
  • mental problems.

Strong growth of the tumor causes a symptom of squeezing in the neck, problems with swallowing food and breathing.

The most serious complication of thyrotoxicosis leading to death is thyrotoxic crisis.

Symptoms of thyrotoxic crisis:

  • increased sweating
  • частый пульс,
  • tremor of limbs
  • помутнение сознания,
  • патологический сон,
  • кома,
  • задержка мочи.

Причины формирования зоба

The main reason for the growth of goiter is the loss of sensitivity to thyroid receptor receptors of thyroid cells. Loss of sensitivity leads to increased synthesis of endocrine gland hormones and the appearance of nodes, mostly benign.

What starts the process:

  • heredity,
  • genetic diseases
  • radioactive irradiation of the gland
  • alcohol and smoking
  • stress and excessive physical exertion,
  • viral and infectious diseases,
  • frequent inflammatory processes in the nasopharynx.

The main types of nodular goiter

Classifications of thyroid nodular disorders by ultrasound:

  • Zero stage, no tumors, iron is normal.
  • The first stage: colloid nodes of the first and second type, Hashimoto nodes of the first type, subacute thyroiditis, toxic diffuse goiter.
  • The second stage: the third and fourth degree colloid node, the second type of Hashimoto node, cystic neoplasms.
  • The third stage: the oncological process is questionable.
  • Fourth stage: malignant tumors.

Diagnosis of nodules

Diagnostic procedures begin with inspection and palpation of the thyroid gland, listening to complaints and analyzing symptoms. After that, the patient is sent for ultrasound and laboratory tests for hormones of the endocrine gland.

Ultrasound specialist provides information on the size of the thyroid gland, echogenicity, blood supply, tissue composition, lymph nodes.

A blood test for hormones T4, T3, TSH and calcitonin is necessary to obtain information about the functioning of the endocrine gland. To clarify hypofunction or hyperthyroidism, the patient is asked to take a test for cholesterol, glucose, albumin and gamma globulin.

If oncology of the endocrine gland is suspected, the patient is sent for scintigraphy. The definition of formations, both hot and cold, allows you to determine their malignancy.

Biopsy of the endocrine gland provides information on pathological changes in thyroid tissue, colloidal, diffuse or cystic. After processing the data of the survey and laboratory tests, the endocrinologist prescribes treatment.

Treatment of multinodular toxic goiter

For the treatment of multinodular goiter of the endocrine gland, drug therapy, surgery, and radioactive iodine therapy are used.

The method of treatment is selected individually, taking into account the nature of the violation, the symptoms, the sex and age of the patient, history.

Thyrostatics are included in the drug therapy of a multinodular goiter. For the treatment of drugs used Tyrozol and Merkazolil. High concentrations of thyreostatics can lead to hypothyroidism of the endocrine gland, which is compensated by synthetic hormonal drugs.

Treatment of diffuse toxic goiter of the thyroid gland is aimed at eliminating the symptoms of thyrotoxicosis, while thyreostatics do not always give the desired effect and, if a relapse occurs, the patient is sent to remove the endocrine organ.

Complete removal of the gland eliminates the symptoms of hormone oversupply, but leads to hypothyroidism and lifelong treatment with synthetic hormones.

The most safe modern methods of treatment include radioactive iodine therapy, which has the following advantages:

  • The almost complete absence of contraindications, with the exception of pregnancy and the period of breastfeeding in women.
  • Relatively low cost.
  • No additional treatment with thyreostatics is required.
  • Manipulation is carried out on an outpatient basis.

Treatment of toxic goiter is impossible without a diet that includes foods containing proteins, vitamins, carbohydrates and fats, and a large amount of fluid.

Protein nutrition is necessary for patients, since a rapid metabolism leads to a serious decrease in body weight and a general weakening of the body. Food is recommended to take at least five times a day, in small portions.

Foods that should be excluded from the diet:

  • white sugar,
  • flour products from white flour,
  • fat, smoked and spicy,
  • alcoholic beverages
  • fish and meat broths,
  • Black tea,
  • cocoa,
  • canned food.

Useful products to help the treatment process:

  • kelp,
  • fresh berries, vegetables and greens,
  • durum wheat pasta,
  • porridge,
  • bran,
  • a fish,
  • lean meat, especially turkey,
  • dairy and dairy products,
  • eggs,
  • vegetable oils.

A mobile lifestyle and proper nutrition can significantly reduce the severity of thyrotoxicosis symptoms and lead a healthy lifestyle.

Short description

Thyrotoxicosis in patients with multinodal euthyroid goiter is triggered by the administration of large quantities of drugs containing iodine, including amiodarone, which contains 37% iodine.

Multinodular toxic goiter is often detected in iodine-deficient regions (endemic goiter areas), and the hyperfunction of such nodes is associated with an increase in iodine intake. This applies to cases where iodine is ingested with medicinal substances or with food (with increased consumption of iodized salt).

Clinically, hyperthyroidism was formerly called “iodine-based”, and now it is called “hyperthyroidism caused by iodine.”

Etiology and pathogenesis

Multinodular toxic goiter develops with prolonged chronic iodine deficiency in food and is one of the successive pathological conditions of the thyroid gland (TG), which are formed under conditions of iodine deficiency of mild and moderate severity.

Diffuse nontoxic (euthyroid) goiter enters the nodular (multinodular) nontoxic goiter, then the functional autonomy of the thyroid gland develops, which is the pathophysiological basis of multinodular toxic goiter. Under conditions of iodine deficiency, the thyroid gland is exposed to the stimulating effect of TSH and local growth factors causing hypertrophy and hyperplasia of the follicular thyroid cells, which leads to the formation of the struma Strum - 1) Goiter - a pathologically enlarged thyroid gland, 2) (outdated). Adenomatous growths that develop in some organs atrophy and sclerosis, for example, kidneys, ovaries, pituitary, adrenal glands
. The basis for the development of nodes in the thyroid gland is the microheterogeneity of thyrocytes - various functional and proliferative activity of the thyroid cells.

If iodine deficiency persists for many years, then stimulation of the thyroid gland, becoming chronic, causes hyperplasia and hypertrophy in thyrocytes, which have the most pronounced proliferative activity. Over time, this leads to the emergence of focal accumulations of thyrocytes with high sensitivity to stimulating effects.
In conditions of ongoing chronic hyperstimulation, active division of thyrocytes and delay on this background of reparative processes lead to the development of activating mutations in the genetic apparatus of thyrocytes (mutation of the TSH receptor), leading to their autonomous functioning.
Over time, the activity of autonomous thyrocytes leads to a decrease in the level of TSH and an increase in the content of T3 and t4 (phase of clinically overt thyrotoxicosis). Since the process of the formation of the functional autonomy of the thyroid gland is extended over time, iodine-induced thyrotoxicosis manifests itself in older age groups (after 50 years).

Symptoms, current

The clinic of multinodular toxic goiter is preceded by a long period of the presence of nodular goiter, in which the content of thyroid hormones in the blood serum is within the normal range, and the concentration of TSH TSH - thyroid stimulating hormone (produced by the pituitary and stimulates the formation of thyroid hormones)
in serum slightly reduced.

Frequent manifestations:
- heart failure resistant to conventional drug therapy,
- atrial atrial arrhythmia of permanent or periodic form with episodes of atrial arrhythmia,
- sharp muscle weakness (it is difficult for the patient to get up, climb stairs, walk),
- depression, periodic convulsions, irritability or instability of the emotional state (some doctors regard this condition as a "menopausal syndrome", since most of the cases of these conditions occur at an appropriate age).

In the case of hemorrhage in the "hot" node comes self-healing, and in the future such a node is transformed into a cyst. In some cases, the symptoms of thyrotoxicosis occur according to the type of subclinical, with a possible transition to a clear thyrotoxicosis.

Laboratory diagnosis

Laboratory methods (determination of thyroid hormones) allow us to diagnose two variants of thyrotoxicosis, which are very often the stages of one process:

1. Subclinical thyrotoxicosis: decrease in the level of TSH in combination with normal levels of free T4 and free t3.

2. Manifest (explicit) thyrotoxicosis: lowering TSH and increasing free T4 and free t3.

Differential diagnosis

Most often there is a need for the differential diagnosis of multinodular toxic goiter and diffuse toxic goiter (DTZ), since diseases occurring with destructive thyrotoxicosis are quite easy to distinguish according to thyroid scintigraphy.
The principles of differential diagnosis of multinodular toxic goiter and DTZ are presented in the table below.

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