Nodal Toxic Goiter

The painful state of the thyroid gland, which is accompanied by the formation of single or several nodular formations, is called nodal toxic goiter.

As a rule, the formed nodules are independent glandular formations, which have the ability to manifest hormonal activity, regardless of the body's needs in this or that quantity of hormones. Thus, the production of thyroid hormones increases significantly, which immediately affects the general condition of the body.

[1], [2], [3], [4]

Causes of nodal toxic goiter

The fundamental factor in the formation of nodular toxic goiter is loss of sensitivity of the receptor mechanism of nodular cellular structures to thyroid-stimulating hormone. That is, a healthy thyroid gland produces hormones correspondingly with their concentration in the bloodstream: the more the thyrotropic hormone content, the more energetically the iron functions. The thyroid-stimulating hormone is synthesized in the pituitary system, which in turn determines the concentration in the bloodstream of the hormones secreted by the thyroid gland, and on the basis of the data it estimates the true need of the organism. In this regard, it can be concluded that the pituitary always synthesizes thyroid stimulating hormone in a thoughtful and even manner in such quantities to maintain a normal balance of thyroid hormones in the bloodstream.

On the surface of the thyroid gland, there are sensitive receptors that react to thyroid-stimulating hormone. With an increase in the amount of this hormone, thyroid cells activate and begin to produce hormones intensely.

If the patient has a nodal toxic goiter, his receptor organs cease to perform their function and begin to "demand" from the thyroid gland tireless and constant production of hormones, regardless of their level in the bloodstream. Such a state is defined by the concept of "node autonomy". Autonomous focal formations are extremely rarely malignant: if malignancy occurs, it happens at the initial stage of the formation of the node, 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 are manifested when the node 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 determined as the pathological state of thyrotoxicosis. At this stage, the intelligent pituitary gland, suspecting the wrong, inhibits the synthesis of its own thyrotropic hormone in order to correct the situation: it helps, the thyroid gland stops producing hormones, but they continue to be produced by focal formations.

Nodal toxic goiter is a disease in which only a pathological nodule is working, and the thyroid gland itself is plunged 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 failures.
• The effect of radiation or intoxication with harmful substances.
• Deficiency of some minerals.
• Smoking.
• Frequent stressful situations.
• Infectious and viral diseases, especially inflammatory processes of the nasopharynx.

[5], [6]

Symptoms of nodal toxic goiter

Often, the patient does not notice the initial stages of the disease: pathology can be detected only when examining the blood for the quantitative presence of thyroid hormones. With the development of the process, patients notice apathy, increased fatigue, capriciousness, irritability. Many people notice loss of body weight, increased heart rate, arrhythmia. The surface of the skin when wet and warm. In far-reaching cases, the condition of the hair and nail plates may worsen.

The heart rate increases almost twice, to 120 tremors per minute. Pursue constant fatigue, physical labor becomes impossible.

It should be noted that with nodal toxic goiter there is never a pop-eyed. This feature is inherent in another form of a similar disease - diffuse toxic goiter, when not only education but all thyroid gland works autonomously.

Diffusive nodular toxic goiter is also called Based's disease, Graves' disease, or hyperthyroidism. This form of goiter can provoke the appearance of the following symptoms:

• increased sweating;
• sleep disorders;
• increased appetite;
• exophthalmos (eaves eyes);
• trembling fingers;
• aggressiveness, irritability.

If the disease lasts for a long time, there may be dyspeptic phenomena, a feeling of squeezing in the neck.

Classification of nodal toxic goiter

Given the etiology and course of the pathology, goiter is divided into the following varieties:

• eutireoid colloid proliferative form of goiter;
• diffusive-nodal (or combined) form;
• Nodules of benign and malignant nature.

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

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

• 0 degrees - the thyroid gland is not visible and can not be palpated.
• 1 degree - the thyroid gland is not visible, but it is felt during palpation and is noticeable when swallowing.
• 2 degrees - the thyroid gland is noticeable when swallowed and probed. The shape of the neck is unchanged.
• 3 degrees - the thyroid gland is visible, the outlines of the neck are changed.
• 4 degrees - shchitovidka of considerable sizes, the neck is thickened.
• 5 degrees - shchitovidka of huge size, puts pressure on the trachea and esophageal tube.

This classification has several drawbacks, for example:

• In addition to our country, no 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 the palpation of the gland, so the error of diagnosis can be 30%.

There is also a classification of the World Health Organization:

• Degree 1a - iron is clearly palpable, but not visible.
• The degree of 1b - iron is palpated and visible when the head is tilted back.
• Degree 2 - gland is visible even in the natural position of the head.
• Degree 3 - enlarged iron is visible remotely.
• Degree 4 - a strong increase in the gland.

To determine the degree of disease in children, most often use the calculation of the ratio of the volume of the gland with the total body area of the child (after measuring growth and body weight).

[7]

Diagnosis of nodal toxic goiter

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

• Definition of nodal formations on the thyroid gland. As a rule, ultrasound is used, which determines the nodes already from 2 mm. This method is not dangerous for the patient, it is available and inexpensive. I
• Evaluation of the functionality of the gland. For this purpose, a blood test for thyroid-stimulating hormone and thyroid hormones (free T3 and T4) are performed. With thyrotoxic damage, the thyroid-stimulating hormone concentration decreases, and the thyroid hormone content increases. Sometimes only T3 rises, which also indicates the development of nodular goiter.
• If, on the basis of the passed stages, the doctor discovered signs of increased activity of the thyroid gland, then the studies of the cause of pathology are appointed.
• Radionuclide diagnostic methods. Scanning and scintigraphy with technetium-99 is used, which allows to detect areas with increased and reduced isotope absorption. Research 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: directly nodular formation, or all gland tissue.

[8], [9], [10], [11], [12]

Treatment of nodular toxic goiter

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

Radical operative method - resection of a part, or all thyroid (with multiple development of nodes). Plus operative treatment is 100% elimination of a problem. Less is a violation of the integrity of tissues, the likelihood of complications after surgery, a possible further need for life-long hormonal treatment.

Treatment with radioactive iodine

The method is based on the fact that iodine can accumulate only in the tissues of the nodular formation when the disease occurs, since the remaining glandular tissues are in a "dormant" state. The so-called radioactive iodine-iodine-131 is injected into the bloodstream of the patient, which penetrates into the tissues of the node while destroying it. Healthy tissue shchitovidki thus practically do not suffer. The advantage of the method is its effectiveness and the absence of tissue traumatization. Minus is people's distrust of radiation doses, although studies have shown that there are no side effects in the procedure. 3.

The interstitial destruction of the nodal formations is a minimally invasive method of affecting the tissues of the nodes, leading to their destruction. Among such procedures, the most common methods of ethanol sclerotherapy (the introduction of alcohol into the nodal formation, is used at sites up to 20 mm), laser destruction (long-term irradiation of the node with a laser, is used at nodes up to 40 mm) and radio frequency ablation. Radiofrequency ablation is the most effective of the latter methods, which allows to destroy a node up to 80 mm literally in half an hour. The procedure proceeds under local anesthesia and is rarely accompanied by negative consequences.

Prevention of nodal toxic goiter

To protect your body from the development of nodular toxic goiter, you must follow the following recommendations:

• if you live in a zone with a deficiency of iodine, then you and your family should make up for its deficiency by using iodized salt or special drugs prescribed by the doctor;
• an increased need for iodine occurs in pregnant and lactating women, as well as in childhood and adolescence;
• consume seafood (sea fish, kelp, shrimp, etc.), this will periodically replenish the amount of iodine in the body.

Most of all iodine can be obtained from sea products: sea kale contains 220 μg / 100 g of product, and shrimp - 150 μg / 100 g.

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

The highest content of iodine in the cod liver is about 370 μg / 100 g.

Prevention of nodal toxic goiter is not only products enriched with iodine. If possible, it is recommended at least once in 1-2 years to rest on the sea, because iodine penetrates into the body also from the air and from the water.

Forecast of nodal toxic goiter

At nodal toxic goiter the prognosis is relatively favorable: the risk of malignancy and squeezing of vital organs is small. However, the consequences directly depend on the qualified and adequate treatment of goiter. Even after effective therapy, periodic examinations should be performed and ultrasound should be performed. The observation is carried out annually during the first 2 to 3 years, and the blood test - 2 months after the treatment.

The worst prognosis belongs to the nodal formations, which turned into an aggressive malignant process.

With the right approach, the nodal toxic goiter is absolutely curable: it is important to begin treatment on time and be sure to bring it to a positive result.

[13], [14]