Nodular toxic goiter

A painful condition of the thyroid gland, which is accompanied by the formation of single or multiple nodular formations, is called nodular toxic goiter.

As a rule, the resulting nodules are independent glandular formations that have the ability to exhibit hormonal activity, regardless of the body's need for a particular amount of hormones. Thus, the production of hormones by the thyroid gland increases significantly, which immediately affects the general condition of the body.

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Causes of toxic nodular goiter

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

On the cell surface of the thyroid gland there are sensitive receptors that react to the thyroid-stimulating hormone. When the amount of this hormone increases, the thyroid cells become active and begin to intensively produce hormones.

If a patient has a nodular toxic goiter, its receptor organs stop performing their function and begin to "demand" the thyroid gland to produce hormones tirelessly and constantly, regardless of their level in the bloodstream. This condition is defined by the term "node autonomy". Autonomous focal lesions are extremely rarely malignant: if malignancy does occur, it 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 nodule grows to 25-30 mm: in such cases, the activity of the gland can lead to the appearance of a large number of hormones in the bloodstream, which is defined as a pathological condition of thyrotoxicosis. At this stage, the smart pituitary gland, suspecting something is wrong, slows down the synthesis of its own thyroid-stimulating hormone to correct the situation: this helps, the thyroid gland stops producing hormones, but they continue to be produced by focal formations.

Nodular toxic goiter is a disease in which only the pathological nodule functions, while the thyroid gland itself goes into a dormant state.

What is the trigger for the development of nodules in the thyroid gland?

• Lack of iodine in the body.
• Genetic failures.
• Exposure to radiation or intoxication with harmful substances.
• Deficiency of certain minerals.
• Smoking.
• Frequent stressful situations.
• Infectious and viral diseases, especially inflammatory processes of the nasopharynx.

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Symptoms of toxic nodular goiter

Often, the patient does not notice the initial stages of the disease: the pathology can be detected only by examining the blood for the quantitative presence of thyroid hormones. As the process develops, patients notice apathy, increased fatigue, capriciousness, irritability. Many notice weight loss, increased heart rate, arrhythmia. The skin surface is moist and warm to the touch. In advanced cases, the condition of the hair and nail plates may worsen.

The heart rate increases almost twofold, to 120 beats per minute. Constant fatigue follows, physical work becomes impossible.

It should be noted that exophthalmos never occurs with nodular toxic goiter. This symptom is inherent in another form of a similar disease - diffuse toxic goiter, when not only the formation, but the entire thyroid gland works autonomously.

Diffuse nodular toxic goiter is also called Basedow's disease, Graves' disease, or hyperthyroidism. This form of goiter can cause the following symptoms:

• increased sweating;
• sleep disorders;
• increased appetite;
• exophthalmos (bulging eyes);
• finger tremors;
• aggressiveness, irritability.

If the disease lasts for a long time, dyspeptic symptoms and a feeling of pressure in the neck area may appear.

Classification of toxic nodular goiter

Taking into account the etiology and course of the pathology, goiter is divided into the following types:

• euthyroid colloid proliferative goiter;
• diffuse-nodular (or combined) form;
• nodules of benign and malignant nature.

Rare malignant forms are divided into follicular, papillary, medullary and undifferentiated types.

In modern domestic medicine, the generally accepted classification of the disease according to O. V. Nikolaev is used:

• 0 degree – the thyroid gland is not visible and cannot be palpated.
• 1st degree – the thyroid gland is not visible, but can be felt when palpated and is noticeable when swallowing.
• 2 degrees – the thyroid gland is visible when swallowing and can be felt. The outline of the neck is unchanged.
• 3rd degree – the thyroid gland is visible, the outline of the neck is changed.
• 4th degree – the thyroid gland is of significant size, the neck is thickened.
• 5th degree – the thyroid gland is of enormous size, putting pressure on the trachea and esophagus.

This classification has several disadvantages, for example:

• Apart from our country, no other country in the world uses this classification;
• according to this scheme, sometimes doctors have to combine the degrees of goiter (for example, goiter of 1-2 degrees, or 2-3 degrees, etc.);
• The scheme is based on palpation of the gland, so the diagnostic error can be 30%.

There is also a classification from the World Health Organization:

• Grade 1a – the gland is clearly palpable, but not visible.
• Grade 1b – the gland can be felt and is visible when the head is tilted back.
• Grade 2 – the gland is visible even in the natural position of the head.
• Grade 3 – the enlarged gland is visible from a distance.
• Grade 4 – severe enlargement of the gland.

To determine the degree of the disease in pediatric patients, the most common method is to calculate the ratio of the gland volume to the total body area of the child (after measuring height and body weight).

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Diagnosis of toxic nodular goiter

Diagnostic measures for nodular toxic goiter are carried out in stages:

• Determination of nodular formations on the thyroid gland. As a rule, an ultrasound examination is used, which determines nodes from 2 mm. This method does not pose a danger to the patient, it is accessible and inexpensive. I
• Evaluation of the functionality of the gland. For this purpose, a blood test is performed for thyroid-stimulating hormone and thyroid hormones (free T3 and T4). In case of thyrotoxic damage, the concentration of thyroid-stimulating hormone decreases, and the content of thyroid hormones increases. Sometimes only T3 increases, which also indicates the development of nodular goiter.
• If, based on the stages completed, the doctor has discovered signs of increased thyroid activity, then further studies are prescribed to determine the cause of the pathology.
• Radionuclide diagnostic methods. They use scanning and scintigraphy with technetium-99, which allows detecting areas with increased and decreased isotope absorption. The study is often used repeatedly, for example, before and after taking iodine preparations. The results of the study make it possible to understand what caused the increased production of thyroid hormones: the nodular formation itself, or all the tissues of the gland.

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Treatment of toxic nodular goiter

Therapeutic measures for nodular toxic goiter should pursue a single goal: to suppress the excessive functional capacity of the nodular formation. This can be achieved in various ways.

Radical surgical method – resection of part or the entire thyroid gland (in case of multiple node development). The advantage of surgical treatment is 100% elimination of the problem. The disadvantage is the violation of tissue integrity, the probability of complications after surgery, and the possible further need for lifelong hormonal treatment.

Treatment with radioactive iodine

The method is based on the fact that in case of a disease, iodine can accumulate only in the tissues of the nodular formation, since the rest of the glandular tissues are in a "dormant" state. The so-called radioactive iodine - iodine-131, which penetrates the tissues of the node, simultaneously destroying it, is introduced into the patient's bloodstream. Healthy thyroid tissues are practically not affected. The advantage of the method is its effectiveness and the absence of tissue trauma. The disadvantage is people's distrust of therapeutic doses of radiation, although studies have shown the absence of any side effects during the procedure. 3.

Intra-tissue destruction of nodular formations is a minimally invasive method of influencing the tissues of nodes, leading to their destruction. Among such procedures, the most common methods are ethanol sclerotherapy (injection of alcohol into the nodular formation, used for nodes up to 20 mm), laser destruction (long-term irradiation of the node with a laser, used for nodes up to 40 mm) and radiofrequency ablation. Radiofrequency ablation is the most effective of the latest methods, which allows you to destroy a node up to 80 mm in literally half an hour. The procedure takes place under local anesthesia and is rarely accompanied by negative consequences.

Prevention of toxic nodular goiter

To protect your body from developing nodular toxic goiter, you must follow these recommendations:

• If you live in an area with iodine deficiency, you and your family should replenish the deficiency by consuming iodized salt or taking special medications prescribed by a doctor;
• an increased need for iodine occurs in pregnant and lactating women, as well as in childhood and adolescence;
• eat seafood (sea fish, kelp, shrimp, etc.), this will allow you to periodically replenish the amount of iodine in the body.

The most iodine can be obtained from seafood: seaweed contains 220 mcg/100 g of product, and shrimp – 150 mcg/100 g.

Meat and dairy products contain from 7 to 16 mcg/100 g, and drinking water – from 0.2 to 2 mcg/l.

The highest iodine content is found in cod liver – about 370 mcg/100 g.

Prevention of nodular toxic goiter is not only iodine-enriched products. If possible, it is recommended to have a seaside vacation at least once every 1-2 years, because iodine also enters the body from the air and water.

Prognosis of toxic nodular goiter

In case of nodular toxic goiter, the prognosis is relatively favorable: the risk of malignancy and compression of vital organs is low. However, the consequences directly depend on qualified and adequate treatment of goiter. Even after effective therapy, periodic medical examinations and thyroid ultrasound should be done. Monitoring is carried out annually during the first 2-3 years, and blood tests are done 2 months after treatment.

The worst prognosis belongs to nodular formations that have developed into an aggressive malignant process.

With the right approach, nodular toxic goiter is completely curable: it is important to start treatment on time and be sure to complete it until a positive result is achieved.

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