Endemic goiter

Endemic goiter is characterized by an enlarged thyroid gland, which can cause the neck to become deformed. The disease develops as a result of low iodine levels in the body. In childhood, this disease is quite common, in some cases the disease can only be detected in adolescence, after puberty.

People from regions where there is virtually no iodine in the environment are especially susceptible to developing the disease. Normal development and functioning of the body largely depends on the endocrine system, in particular on the functioning of the thyroid gland.

With chronic iodine deficiency, thyroid tissue begins to grow, and its functional capabilities change, which leads to disruptions in the functioning of many internal organs and systems.

ICD-10 code

In ICD 10, this disease belongs to the class of endocrine system diseases E00-E90, subclass of thyroid diseases E00-E07, code E01.0 - diffuse goiter (endemic), caused by a lack of iodine in the body.

Causes of endemic goiter

The endocrine system ensures the normal functioning of the entire body. If the body lacks iodine, the thyroid tissue begins to increase in size, the functioning of the endocrine system is disrupted, and with it the entire body.

Endemic goiter develops for two reasons: relative or absolute iodine deficiency in the body.

The cause of relative iodine deficiency may be certain medications, a violation of the intestinal absorption function, due to which the body does not receive the required amount of iodine, congenital pathologies of the thyroid gland, and diseases of the digestive system.

Absolute iodine deficiency develops due to low iodine intake from food or water.

Chronic infectious and inflammatory processes (especially worms), poor living or working conditions, taking medications that impede the supply of iodine to the thyroid gland, and eating foods low in selenium, molybdenum, manganese, and zinc, which help the body absorb iodine, contribute to the development of the disease.

Also, the cause of the development of goiter can be contaminated drinking water, which prevents the absorption of iodine (especially water with nitrates, calcified), abnormalities in the production of thyroid hormones, heredity.

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Symptoms of endemic goiter

Endemic goiter in the early stages can cause headaches, weakness, fatigue, and the patient may also feel discomfort in the heart area.

At the initial stages of the disease, the level of hormones is practically unchanged, but as the disease progresses, the amount of thyroid hormones in the body decreases, a suffocating dry cough, difficulty swallowing or breathing appear.

In the later stages of the disease, various heart pathologies develop, in particular, hyperfunction of the right ventricle and atrium.

In childhood, the symptoms of the disease may be more pronounced.

Endemic goiter of the 1st degree is detected by a specialist during palpation of the thyroid gland. In a normal state, the goiter is almost impossible to see at this stage of the disease, but with an extended neck and a pulled back head, it is clearly visible.

Endemic goiter of the 2nd degree is clearly visible; a specialist can easily detect an increase by palpation.

Diffuse endemic goiter

It most often affects women aged 20 to 50. The disease is characterized by an increase and increased activity of the thyroid gland due to attacks by the body's own immune system. The causes of diffuse goiter are considered to be a pathological state of immunity, in which the body produces an increased number of autoantibodies that enlarge the gland and stimulate its production of hormones. Treatment is mainly drug-based, surgical treatment is prescribed in the case of too large goiter. Remission occurs in about 70% of cases when taking medications.

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Nodular endemic goiter

It is not a separate disease, but a group of diseases characterized by the development of volumetric nodular formations. Often, the appearance of nodes in the thyroid gland is associated with a malignant process.

With nodular goiter, visible cosmetic defects on the neck and a feeling of suffocation are possible.

Treatment usually involves suppressive drugs (thyroid hormones, radioactive iodine) and surgery.

Nodular goiter is diagnosed in about half of the population, and the disease is found several times more often in women. As a rule, uterine myoma is often detected in women with nodular goiter.

Multinodular endemic goiter usually develops against the background of a normally functioning thyroid gland. The causes of the nodes are insufficient iodine intake with food or impaired absorption of this microelement due to liver disease, digestive system disease or poor nutrition (large amounts of soy, cabbage, rutabaga in the diet).

In nodular goiter, the thyroid gland produces low amounts of thyroid hormones, which in turn leads to an increase in the level of thyroid-stimulating hormones in the body and stimulation of the thyroid gland.

When the body's need for thyroid hormones decreases, colloid accumulates in the thyroid gland, resulting in follicles appearing in it. If the need for thyroid hormones reappears, the thyroid tissues grow, resulting in multiple nodular formations appearing in the thyroid gland after several years.

Endemic goiter in children

Endemic goiter most often develops in children who live in regions with insufficient iodine content in water or soil.

Iodine deficiency in the body leads, as in adults, to disruption of thyroid hormone production and enlargement of the thyroid gland. In infancy, an enlarged thyroid gland can compress the trachea, which will lead to the child's death. Also, with iodine deficiency in the body, the child lags behind in development, both mentally and physically, in addition, the development of endemic cretinism is possible (feeblemindedness, growth retardation, disproportionate physique).

To determine the size and structure of the thyroid gland in children, ultrasound, blood tests for hormone levels, etc. are prescribed.

As a treatment, medications are prescribed (antistumin, hormonal therapy).

To prevent the disease, it is recommended to consume sea salt or iodine-enriched salt, and food supplements with iodine.

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Diagnosis of endemic goiter

Endemic goiter is mainly diagnosed by ultrasound examination, which establishes the form, stage, reveals the number of nodular formations, and contours, tissue structure, etc. Ultrasound can reveal colloid accumulation or hemorrhages in the node, calcifications, adenomas, carcinomas.

Diagnostic measures also include laboratory tests (blood, urine).

With a lack of iodine, the excretion of this microelement in the urine is reduced and is usually less than 50 mcg per day. A blood test allows you to determine the level of thyrotropin, T3 _, T4 _, thyroglobulin.

If a nodular form of goiter is detected, a biopsy is prescribed, which will help to establish the nature of the pathological process (malignant or benign).

Fine needle aspiration biopsy reveals homogeneous colloid masses, the number of thyroid epithelial cells,

An enlarged thyroid gland is diagnosed if the volume of the thyroid gland exceeds the upper limits of the norm (there are specific norms for each age and each gender).

For men, the upper limits of the thyroid volume are set at 25 ml (cm ³ ), for women – 18 ml (cm ³ ). For children, the indicators range from 4.9 to 15.6 ml.

Another diagnostic method is radioisotope scanning, which determines the diffuse enlargement of the gland, the degree, the presence of nodes, the level of isotope accumulation in the thyroid gland, impurities and lymphoid elements.

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Treatment of endemic goiter

Endemic goiter is a fairly serious disorder, the treatment of which should be carried out by a specialist.

Treatment can be conservative (usually for small goiter sizes or in the early stages of the disease) or surgical.

Hormonal therapy with thyroidin or triodothyronine shows good results in cases of mild destructive changes in thyroid tissue.

Nodular forms of the disease are subject to surgical treatment only, since in this case there is a high probability of developing a malignant process.

In drug treatment, a specialist in each individual case selects drugs containing iodine, thyroid agents, and determines the regimen and dosage.

Antistrumin or potassium iodide solution helps well in iodine deficiency conditions. Such drugs are prescribed at the initial stage of the disease, with a moderate thyroid size.

It is prohibited to use Lugol's solution or iodine tincture to replenish iodine in the body, since iodine in high doses causes a number of negative reactions (allergies, chronic inflammation of the thyroid gland, etc.).

With the right treatment, the size of the thyroid gland decreases (it is important to complete the full course of treatment). If after several months the thyroid gland does not decrease in size, then iodine-containing drugs are replaced with thyroidin (the dosage and course of treatment in each case is selected by a specialist).

Thyroidin can have a positive effect on some mixed forms of goiter, and the drug is also used for the nodular form during the period of preparation for surgery.

Thyroid surgery is prescribed to children after conservative methods have failed. Emergency surgery is indicated in cases of compression of organs adjacent to the neck (if the goiter is too large).

In children, only excess thyroid tissue is removed, without affecting adjacent tissues. In case of nodular goiter, surgery is also necessary, since the risk of developing a malignant process is quite high even in childhood.

If the goiter grows too quickly, adjacent organs are compressed, or there is a suspicion of a malignant process, thyroid surgery is prescribed immediately.

Prevention of endemic goiter

Prevention should include general health measures, improvement of living and working conditions of the population. The quality of drinking water and improvement of water supply sources are of no small importance.

As already mentioned, the disease develops as a result of iodine deficiency in the body, so it is necessary to carry out iodine prophylaxis, especially in regions where there is little natural iodine in the environment.

According to the research conducted, it is the use of sea or iodized salt, iodine-containing drugs that is the main means of preventing thyroid diseases.

Iodized salt is obtained by adding potassium iodide to regular salt; for storage, you need to use a container that closes tightly (otherwise, the iodine may evaporate, and with it all the benefits). It is especially important to prevent goiter in childhood, since physiological hyperplasia of the thyroid gland is observed up to 12 years old, which can be the beginning of the disease.

Prognosis of endemic goiter

The prognosis for endemic goiter depends on the stage at which the disease was diagnosed, its form, and compliance with all recommendations prescribed by the doctor.

In most cases, thanks to modern technology, the disease does not pose a threat to the life and health of the patient.

After treatment, the patient can continue his normal lifestyle.

Endemic goiter can lead to the development of many pathologies. In childhood, iodine deficiency can cause mental or physical retardation, during pregnancy – a cause of miscarriage or congenital anomalies of the fetus.

In addition, when the thyroid gland enlarges in both men and women, reproductive function is impaired.