Diffuse thyroid changes

Diffuse changes in the thyroid gland are changes in the tissues of the entire thyroid gland, which are detected during an ultrasound examination (ultrasound).

With certain transformations in the gland, ultrasound diagnostics reveals a change in the ability of the thyroid tissue to reflect sound (called echogenicity). In this case, it can be said that the entire gland reflects ultrasound waves in a way that a healthy organ should not. In the future, a more accurate diagnosis is required that will reflect the true state of the thyroid gland. Therefore, "diffuse changes in the thyroid gland" is just a term used in the ultrasound diagnostics method and can mean various diseases of the gland.

[ 1 ], [ 2 ], [ 3 ]

Causes diffuse thyroid changes

The causes of diffuse changes in the thyroid gland are as follows:

• Insufficient iodine in the body.

If a person lives in an area where the soil and water are poor in iodine, this significantly affects the appearance of diffuse changes in the thyroid gland. These regions are called endemic in medical practice, that is, where a certain disease is widespread. Therefore, it can be said that thyroid diseases in such areas are common.

• Changes in the hormonal balance of the thyroid gland.

Disruption of thyroid hormone production (more or less of them than the body needs) affects the change in the appearance of the gland and the structure of its tissue. In this case, an increase in the organ may occur, which occurs uniformly and in all directions, which is called diffuse enlargement of the thyroid gland.

• Autoimmune disorders expressed in inflammation of the thyroid tissue.

Usually, inflammatory processes in this organ have an autoimmune nature. That is, inflammatory disorders in the thyroid gland occur because the human immune system, due to a number of pathological reasons, begins to become aggressive towards the thyroid gland. This disease is called chronic autoimmune thyroiditis. The course of this disease is characterized by the formation of antibodies and lymphocytes in the body, causing damage to the cells of the thyroid gland. It should be taken into account that in the normal state of the human immune system, antibodies are produced in response to the penetration of foreign elements into the body.

• Unbalanced diet.

With a lack of food rich in iodine, changes in the structure and functioning of the thyroid gland may be observed. The same anomalies occur if the patient's food contains large quantities of food products that contain substances that interfere with the production of thyroid hormones. Such products include cabbage (white cabbage, cauliflower, Brussels sprouts), corn, beans, turnips, peanuts, soybeans.

• A change in the environmental situation in a region that occurred suddenly due to various factors.

For example, the tragedy of the Chernobyl nuclear power plant, which resulted in a sharp deterioration of the environment in the territories adjacent to this plant, caused widespread changes in the thyroid gland of the population.

Diffuse changes in the thyroid gland are a manifestation of the following diseases:

• endemic goiter,
• chronic autoimmune thyroiditis,
• subacute thyroiditis,
• mixed goiter,
• diffuse toxic goiter.

[ 4 ]

Symptoms diffuse thyroid changes

Symptoms of diffuse changes in the thyroid gland are manifested by the following factors:

1. The appearance of heterogeneity in the structure of the tissue and different densities of the surface of the gland, which exclude the appearance of focal transformations in the thyroid gland.
2. A change in the volume of the thyroid gland, which is expressed in its enlargement. In some cases, the growth of thyroid tissue leads to the formation of a goiter - a strong pathological increase in the volume of the thyroid parenchyma.
3. The appearance of fuzziness and blurriness of the external contours of a given organ.
4. Changes in the functioning of the thyroid gland that are accompanied by hormonal imbalances. There are two types of such changes:
   • hyperthyroidism – manifested by an increase in the level of thyroid hormones;
   • hypothyroidism – manifested by a decrease in the level of thyroid hormones.

Among the accompanying symptoms of diffuse enlargement of the thyroid gland, the following can be distinguished:

• the appearance of dry hair;
• the occurrence of brittle nails;
• the presence of constant colds;
• presence of constant chills;
• the presence of constant lethargy, weakness and increased fatigue;
• decreased performance and labor productivity (physical and intellectual);
• the appearance of an anxious and neurotic state, as well as increased irritability or depression;
• decreased intellectual abilities;
• the emergence of problems with cognitive processes – memorization and reproduction of information, concentration, general perseverance;
• the appearance of changes in weight that are not related to the quantity and quality of the patient's nutrition;
• the appearance of disturbances in the functioning of the endocrine system, which cause hormonal imbalance in the body;
• the emergence of problems with the human sexual sphere, a decrease in the sexual functions of the body;
• the presence of persistent, chronic constipation that is not related to the patient's diet.

[ 5 ], [ 6 ], [ 7 ]

Forms

[ 8 ]

Diffuse changes in the parenchyma

Parenchyma is a specific set of organ cells that carries a specific functional load. Parenchyma differs from stroma in that it originates from different types of tissue. If stroma is formed only by connective tissue cells, then parenchyma can also include hematopoietic tissue (for example, in the spleen ), epithelial tissue (for example, various epithelial glands), nerve cells (or nerve nodes), and so on.

Parenchyma and stroma are in close "collaboration" and cannot be separated, since it is precisely this integrity that allows the organ to function normally. The stroma is a kind of frame, a "skeleton" for the organ, and the parenchyma fills each organ with a specific functional purpose.

The thyroid gland parenchyma is an epithelial functional tissue that consists of actively dividing cells. The thyroid parenchyma consists of follicles, namely vesicles of various sizes, which are the units of structure and functioning of this tissue. On average, each follicle is forty to fifty microns in size. Each vesicle is surrounded by blood vessels and capillaries of the lymphatic system. The thyroid gland follicles produce two hormones: triiodothyronine and tetraiodothyronine (or thyroxine ). The triiodothyronine unit contains three iodine molecules, and the thyroxine unit contains four iodine molecules. In an abbreviated version, thyroid hormones are respectively designated as T3 and T4. The T4 hormone secreted by the gland is transformed in the cells and tissues of the body into the T3 hormone, which is the main substance that affects human metabolic processes.

Diffuse changes in the thyroid parenchyma are changes in the entire parenchyma tissue that are associated with an increase in the thyroid gland. It should be taken into account that the entire parenchyma of the gland has undergone transformation, and these changes are distributed evenly over the entire area of the organ. Visually, this phenomenon can be observed as an increase in the volume of the thyroid gland in all directions.

Diffuse changes in the thyroid parenchyma are detected by palpation during examination by an endocrinologist. After undergoing an ultrasound scan, which is prescribed by a specialist, in some cases a diagnosis of "diffuse changes in the thyroid parenchyma" is established. Such a diagnosis can be made even in the absence of any other signs of thyroid disease. In these cases, the patient is not yet bothered by anything, but the gland itself is already functioning in tension mode. Therefore, any additional negative stimuli - stress, emotional and physical overload, infectious diseases - can provoke the progression of the disease. In this case, the functioning of the thyroid gland is disrupted, which is manifested in the appearance of an imbalance in the production of hormones. The production of thyroid hormones can increase or decrease, which affects their amount in the human blood, which negatively affects the functioning of the whole body, and also leads to the appearance of many symptoms of health disorders.

In some cases, such diffuse changes in the thyroid parenchyma are associated from the very beginning with a violation of the hormonal balance of the gland and lead to an external enlargement of the organ.

[ 9 ], [ 10 ]

Diffuse changes in structure

Diffuse changes in the structure of the thyroid gland are transformations occurring in the gland that are associated with changes in the structure of the organ tissue.

With diffuse enlargement of the thyroid gland, the structure of the gland changes: it becomes denser and increases in volume. In the early stages of diffuse enlargement of the thyroid gland, symptoms of such changes are usually absent. In this case, changes in the structure of the organ are noted during a visit to an endocrinologist, who examines and palpates the gland. After detecting abnormalities in the structure of the thyroid gland, the specialist prescribes a laboratory blood test to determine the hormonal status and the level of antibodies to the thyroid gland.

At different stages of diffuse enlargement of the thyroid gland, as well as with different diseases that caused it, the test results may be different. The initial stage of the disease may be accompanied by a normal hormonal status, that is, the absence of any disturbances in the reproduction of hormones by the thyroid gland. At the same time, the laboratory test results indicate an adequate amount of thyroxine and triiodothyronine, which the gland produces.

All of the above does not apply to autoimmune disorders, since even in the early stages of such diseases, an increased amount of antibodies in the blood serum is noted. This happens because the patient's immunity has already begun to stimulate the human body to function more intensively against its own organ - the thyroid gland.

After laboratory tests (or in conjunction with them), an ultrasound examination is prescribed to establish a diagnosis and prescribe appropriate therapy.

The progression of thyroid disease leads not only to changes in the structure of the gland tissue, but also to disruptions in the functioning of the entire body. The nervous system takes the very first "blow": a person becomes anxious and restless, as well as irritable and unbalanced. Then problems with the functioning of the heart and blood vessels are observed, the activity of the reproductive system is disrupted. Metabolic processes in the body also suffer, since thyroid hormones regulate calcium metabolism in the body. As a result, the patient may develop multiple caries and osteoporosis.

[ 11 ]

Diffuse focal changes

Diffuse focal changes in the thyroid gland are an increase in thyroid tissue, in which foci with an altered structure of the gland tissue appear. In most cases, these foci are surrounded by glandular tissue of the thyroid gland with an unchanged structure.

Neoplasms that are detected by ultrasound may vary in structure and nature of formation. These include:

• cysts,
• adenomas,
• teratomas,
• hemangiomas,
• paragangliomas,
• lipomas,
• cancerous tumors.

Diffuse focal changes in the thyroid gland are not an independent disease, but appear as a consequence of a systemic imbalance in the body. Such anomalies are observed with the following diagnoses:

• nodular goiter,
• mixed goiter,
• thyroid adenoma,
• thyroid cancer.

Detection of diffuse focal changes in the thyroid gland should alert the doctor and the patient, since this phenomenon may indicate the onset of benign or malignant tumor processes in the organ. Such changes in the thyroid gland appear on ultrasound as foci with increased or decreased echogenicity. It is important to know that benign and malignant tumors have only their own echogenicity index. Such a difference in the examination parameters allows making the ultrasound diagnosis more accurate and competent.

[ 12 ], [ 13 ], [ 14 ], [ 15 ]

Diffuse-nodular changes

Diffuse-nodular changes in the thyroid gland can be detected by palpation of the thyroid gland during an appointment with an endocrinologist. This is possible due to the fact that the gland is located superficially and is easily palpated.

Palpation of the organ is performed as follows. The patient is positioned facing the specialist; the patient can sit on a chair, stand or lie on a couch. By pressing on the gland in a certain way, the endocrinologist evaluates the size of the thyroid gland, the density of its tissue, as well as the homogeneity of the organ structure. At this point, the doctor may detect areas with increased density and an increase in glandular tissue, which are called nodes. The specialist can also note diffuse changes in the thyroid gland, that is, a general increase in its volume. After such a preliminary examination, the endocrinologist prescribes an ultrasound diagnostic for the patient.

An ultrasound specialist can confirm or refute a previously made preliminary diagnosis. Usually, the endocrinologists' concerns are confirmed during the examination. If during the ultrasound the specialist detects nodes in the glandular tissue that exceed one centimeter in size, this serves as a basis for conducting a biopsy of the tissue of the suspicious node. The endocrinologist prescribes such a procedure after reviewing the results of the ultrasound diagnosis. And only after conducting a histological examination and laboratory blood tests for hormones does the attending physician establish an accurate diagnosis and prescribe a course of drug treatment.

Usually, the nature of the nodes is parenchymatous, that is, it is associated with the enlargement of one or more follicles of the glandular tissue of the thyroid gland. Specialists call a thyroid gland node a neoplasm in the structure of the parenchyma, which has its own capsule, which limits the node from healthy tissue of the organ.

For a long period of time, diffuse-nodular changes in the thyroid gland may be asymptomatic and only detected during an appointment with an endocrinologist. If the thyroid nodes increase greatly in size, they begin to affect the functioning of organs and tissues that are located nearby. For example, patients may complain of a feeling of suffocation, a change in the timbre of the voice, or the appearance of a feeling of a foreign lump in the throat. Also, large nodes are characterized by causing various changes in the structure and functioning of the larynx, which can cause pain symptoms.

A large number of nodes are characterized by the process of degeneration of benign tissue into malignant tissue, which is called the process of malignization. The nature of such a phenomenon is sometimes unknown even to specialists themselves. Therefore, patients who have been diagnosed with diffuse-nodular changes in the thyroid gland should be under constant supervision of endocrinologists.

Malignant neoplasms on ultrasound are characterized by reduced echogenicity, heterogeneity of the thyroid tissue structure and the presence of calcium salt deposits in the neoplasm tissue.

Nodular changes in the thyroid gland are symptoms of the following diseases:

• nodular colloid goiter,
• cystic fibrous adenoma,
• carcinomas.

[ 16 ], [ 17 ]

Diffuse cystic changes

Diffuse cystic changes in the thyroid gland are the presence of cystic formations in the glandular tissue of the thyroid gland against the background of a general increase in the volume of the organ.

Cystic neoplasms are cavitary in nature. Cysts have a capsule that separates them from normal thyroid tissue, and a cavity is always found inside the neoplasm. This cavity is filled with colloid, i.e. a liquid that contains a large amount of hormones produced by the gland.

For a long period of time, diffuse cystic changes in the thyroid gland may not show any symptoms. And only during a preventive examination by an endocrinologist will a suspicion of the presence of cysts in the organ arise. The course of such diseases as a simple thyroid cyst and cystic fibrous adenoma are accompanied by the formation of cysts in the organ.

Cysts manifest themselves not only in the enlargement of a certain area of thyroid tissue, which can give the feeling of a foreign element in the front of the neck. Such neoplasms are characterized by the appearance of suppuration from the penetration of a certain infection into the cyst. In this case, the suppuration process is accompanied by symptoms of an acute inflammatory process - an increase in body temperature, general intoxication of the body, the appearance of sharp pain in the area of the cyst and nearby tissues.

Cysts, like nodes, are characterized by the process of degeneration of benign tissue into malignant tissue. Therefore, endocrinologists advise patients with such a disease not to neglect regular visits to specialists, and also strictly follow all prescribed methods of therapy.

[ 18 ], [ 19 ], [ 20 ]

Moderate diffuse changes

During an ultrasound examination of the thyroid gland, moderate diffuse changes in the thyroid gland may be detected. This means that the gland has some uniform enlargements over the entire surface, but they are not so large as to cause great concern. In this case, most often, the organ functions in the correct mode, without disruption of hormone production.

With moderate diffuse changes in the thyroid gland, no foci of tissue compaction or nodes are observed. The entire thyroid parenchyma is slightly enlarged, but without changes in tissue structure.

In this case, the endocrinologist may consider that no special treatment of the problem is required. Such a decision can only be made if there are no other symptoms or manifestations of thyroid dysfunction that worry the doctor and the patient.

It is important to remember that the situation with an enlarged thyroid gland cannot be left out of control. Therefore, once or twice a year it is necessary to visit an endocrinologist who will conduct an examination of the anterior zone of the neck, and also refer the patient for ultrasound diagnostics.

Pronounced diffuse changes

Pronounced diffuse changes in the thyroid gland are manifested by a strong increase in thyroid tissue, which is diagnosed as a result of an ultrasound examination.

Pronounced diffuse changes in the thyroid gland are characteristic of the following diseases of the organ:

• autoimmune thyroiditis,
• hyperthyroidism in Graves' disease (Basedow's disease).

In some cases, pronounced diffuse changes in the thyroid gland are accompanied by focal (nodular or cystic) enlargement of the thyroid tissue.

As a rule, pronounced diffuse changes in the thyroid gland are associated with a disruption in its functioning, which affects the hormonal balance in the patient's body. The gland begins to insufficiently or intensively produce certain thyroid hormones, which, in general, affects the general health and well-being of the patient. In addition to disturbing transformations in the gland, patients may complain of problems with the cardiovascular system, nervous system, reproductive organs, skeletal system, and so on. All such ailments are a consequence of improper functioning of the thyroid gland, the hormones of which affect the functioning of the entire body.

Pronounced diffuse changes in the thyroid gland require mandatory drug treatment, which is prescribed by an endocrinologist after conducting all the necessary tests and examinations in this case.

[ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ]

Diagnostics diffuse thyroid changes

Diagnosis of diffuse changes in the thyroid gland can be carried out in several ways. The study of anomalies in the structure and functioning of the thyroid gland is carried out in the following order:

• Examination by an endocrinologist.

When visiting this specialist, the patient's anterior cervical region is palpated. If during this procedure some alarming thickening of the thyroid gland is detected, the endocrinologist sends the patient for additional examination. Clarifying procedures will allow to specify the diagnosis and choose the most optimal solution to the problem in the form of appropriate treatment.

• Application of visualization research methods, namely:
  • ultrasound examination (ultrasound);
  • computed tomography;
  • magnetic resonance imaging (MRI).

Ultrasound diagnostics or ultrasound examination (US) is the most popular method of examining the thyroid gland. This method of obtaining information about the state of the thyroid gland has the advantage of being the safest diagnostic tool. Computer and magnetic resonance imaging are considered more potentially dangerous methods that affect the patient's health and for these reasons are used less often.

In the overwhelming majority of cases, the diagnosis of "diffuse changes in the thyroid gland" is determined for the patient after an ultrasound procedure. Indications for such a study can be of several types:

• patient complaints about their own health and well-being and/or sensations and external changes in the anterior cervical region;
• suspicions of existing pathologies in the structure of the thyroid gland that arose during examination of the patient;
• existing dysfunctions of the thyroid gland, namely the identification of hormonal imbalance in the patient's body, obtained as a result of laboratory tests (blood tests, etc.).

If there is no preliminary evidence of pathological changes in the thyroid gland, an ultrasound examination is not prescribed, since it is not a screening diagnostic method.

The diagnosis of "diffuse changes in the thyroid gland" is established if the ultrasound results indicate a change in the echogenicity of the thyroid tissue. In this case, heterogeneity of the echostructure of the organ can be detected - a decrease or increase in echogenicity in different parts of the gland, as well as a general decrease or increase in the echogenic qualities of the thyroid gland.

Computer or magnetic resonance imaging is good for detecting diffuse or focal lesions of thyroid tissue. The results of these studies have greater validity, since they can be used to qualitatively assess the structure and density of thyroid tissue.

Diagnosis of diffuse changes in the thyroid gland is, first of all, a statement of the fact of changes in the thyroid tissue. Clarifying diagnoses that allow us to determine the disease require additional research methods (for example, laboratory tests for hormones, etc.).

[ 28 ], [ 29 ], [ 30 ]

Treatment diffuse thyroid changes

First of all, it is necessary to remind that treatment of diffuse changes of the thyroid gland cannot be carried out independently. Only an endocrinologist and only after a thorough examination has the right to prescribe the appropriate therapy. There are cases when independent choice of drugs led to serious health problems and various complications of the underlying disease.

The choice of treatment strategy for diffuse changes in the thyroid gland is influenced by the degree of its enlargement, as well as the type of functional disorders of the organ:

With some enlargement of the thyroid gland without disruption of its function, specialists usually prescribe potassium iodide. It is also possible to recommend taking iodine-containing products that help regulate the thyroid gland without any medical intervention. Such products include:

• seaweed,
• buckwheat groats,
• red caviar,
• cod liver,
• persimmon,
• fish oil,
• sea fish (herring, salmon, halibut, flounder, tuna, cod),
• various seafood (crabs, squid and shrimp),
• sunflower oil, preferably unrefined,
• feijoa,
• apple seeds (four seeds contain a daily dose of iodine) – they must be gnawed and chewed thoroughly.

It is important to remember that such treatment (use of potassium iodide ) should be carried out in courses with breaks. The duration of the course of therapy, as well as the break, is indicated by an endocrinologist.

• If there are problems with the functioning of the thyroid gland, for example, with a decrease in hormone production, the doctor may prescribe the patient to take synthetic analogues of the thyroid hormone. These include the drugs Euthyrox and Levothyroxine. It is also possible to prescribe combined drugs, for example, Tireotoma.

During the course of treatment, it is necessary to periodically check the level of hormone content in the blood. This is done using laboratory blood tests.

• In the case of a nodular goiter, if the nodes quickly increase in size and become large, surgical intervention is necessary. Since such a condition of the thyroid gland can lead to compression of surrounding organs and tissues and disruption of their proper functioning.

After the operation, specialists prescribe thyroid hormones. This measure is necessary to ensure stable remission and prevent relapse of the disease.

• It is important to remember that in the case of treating thyroid problems, the endocrinologist resorts to strictly individual therapy, which may be inappropriate in a number of other similar cases. The specialist takes into account the individual characteristics of the patient, which are inherent only to his body, as well as the specific course of the disease.

Prevention

In the conditions of general increased environmental unfavorability of human living conditions, it would not be superfluous to take preventive measures that can prevent disruptions in the activity (or structure) of such an important organ as the thyroid gland.

Prevention of diffuse changes in the thyroid gland should include methods that are aimed at individual and mass improvement of the disease situation.

• Individual measures for people living in regions that are unfavorable for the thyroid gland include:
  • eating iodized salt (it is important to remember that iodized salt should be added to food only after the food has been cooked, as iodine evaporates when heated);
  • the presence of food products in food that contain iodine in large quantities.
• Individual preventive measures are necessary for patients after thyroid surgery to prevent relapses of the disease. These include taking hormonal drugs prescribed by an endocrinologist.
• Preventive measures to prevent diffuse changes in the thyroid gland include complex anti-stress therapy. These methods include taking sedatives, learning relaxation and autogenic training, breathing anti-stress practices and yoga.
• Taking care of human immunity is an important factor in maintaining a healthy thyroid gland. Therefore, it is necessary to take vitamin and mineral complexes for preventive purposes, which should be selected by a doctor.
• Even in such a seemingly simple matter as taking vitamins, you should not self-medicate, but seek advice from specialists who are knowledgeable in this matter.
• If you have a hereditary predisposition to thyroid disease (or endocrine system disease), you should undergo regular examinations with an endocrinologist. If the specialist notices symptoms that alert him, he will be able to refer the patient for additional diagnostic testing.
• If there are certain signs of changes in the thyroid gland, for example, even a slight increase, you must definitely consult an endocrinologist. The basis for contacting a doctor may also be the appearance of such emotional states as anxiety, increased anxiety, increased fatigue, constant tiredness, sleep problems, etc. It is better to take certain steps at the onset of a suspected disease and stabilize your condition than to engage in treatment at later stages of an advanced process.
• Regular ultrasound examination of the thyroid gland is necessary for patients who already have a diagnosis related to thyroid disease in their medical history. This also applies to those people living in ecologically unfavorable regions.

Most endocrinologists agree that such an examination should be performed once a year by all persons over the age of thirty-five.

[ 31 ], [ 32 ], [ 33 ]

Forecast

The prognosis for diffuse changes in the thyroid gland in the early stages of the disease is favorable. This is possible if the treatment is carried out in a timely and correct manner.

After surgical treatment, with nodular goiter, postoperative hypothyroidism may occur - a deficiency of hormones produced by the thyroid gland. In this case, hormonal drugs are prescribed to avoid the occurrence of such a condition.

Also, such patients need to avoid direct sunlight in large quantities on the thyroid gland area and the entire surface of the body to avoid relapse of the disease.

The prognosis for the development of the disease will be favorable if you do not self-medicate and do not take iodine preparations without consulting a doctor. The same precaution is not superfluous in relation to food products containing iodine in large quantities.

Diffuse changes in the thyroid gland is a diagnosis that requires careful care of your own health and adherence to the recommendations of specialists. And only in this case can a person with such a diagnosis hope for a normal and fulfilling life in which his thyroid gland will not cause him any trouble.

[ 34 ], [ 35 ], [ 36 ]