Thyroid hypertrophy

Thyroid hypertrophy (goiter) can be caused by a variety of reasons, and its symptoms, diagnosis, treatment, and prognosis can vary depending on the underlying cause. Here's some general information:

Causes of thyroid hypertrophy:

1. Iodine deficiency: Lack of iodine in the diet can lead to the development of endemic goiter, which is the most common cause of thyroid enlargement.
2. Autoimmune diseases: Autoimmune diseases such as chronic thyroiditis (Hashimoto's) or Graves' disease can cause thyroid hypertrophy. In the case of Graves' disease, this can lead to hyperthyroidism (increased thyroid activity).
3. Neoplasms: Rarely, tumors or cysts in the thyroid gland can cause enlargement of this gland.

Symptoms of thyroid hypertrophy:

• Enlargement of the neck (larynx).
• Difficulty swallowing or feeling a lump in the throat.
• Increased fatigue.
• Nervousness, irritability.
• Weight loss or gain.
• Menstrual cycle disorders in women.
• Heart palpitations and other symptoms related to thyroid activity (in the case of hyperthyroidism).

Diagnosis of thyroid hypertrophy:

• Physician consultation and physical examination.
• Ultrasound (ultrasound) of the thyroid gland.
• Blood tests for thyroid hormone (T3 and T4) and thyroid hormone (TSH) levels.
• Thyroid puncture and biopsy to determine the nature of the tumor or cyst (if necessary).

Treatment of thyroid hypertrophy:

• Treatment depends on the cause and severity of the hypertrophy. It may include taking medications (e.g., thyrostatics for hyperthyroidism), radioiodine therapy, surgical removal (thyroidectomy), or correction of dietary iodine deficiency.

Prediction:

• The prognosis depends on the cause and degree of hypertrophy. Most cases can be successfully controlled and treated, and patients can recover.
• In the case of autoimmune diseases, treatment may be required for a long period of time.
• In the case of neoplasms, the prognosis depends on the type and stage of the tumor.

It is important to see a doctor for accurate diagnosis and treatment planning if thyroid hypertrophy is suspected.

Causes of the thyroid hypertrophy

Some of the most common causes include:

1. Iodine deficiency: Lack of iodine in the diet can be one of the main causes of thyroid hypertrophy. The thyroid gland increases in size to try to compensate for iodine deficiency and produce enough thyroid hormones (thyroid hormones).
2. Autoimmunediseases: Some autoimmune diseases, such as Hashimoto's disease and Bazedov's disease (gravidarum), can cause thyroid hypertrophy. In these cases, the immune system targets the thyroid gland, which can lead to inflammation and enlargement of the gland.
3. Hormonal changes: Some changes in hormonal balance can cause thyroid hypertrophy. For example, pregnancy or the use of hormonal medications can affect thyroid function.
4. Hot spots and nodules: Hot spots and nodules in the thyroid tissue can also be a cause of thyroid enlargement. These areas secrete more hormones than the rest of the gland, which can cause hypertrophy.
5. Thyroid Disease: Some thyroid diseases, such as adenomas and benign tumors, can cause thyroid enlargement.
6. Age: With age, some people experience a natural enlargement of the thyroid gland without any particular pathologic cause.

Pathogenesis

The pathogenesis of thyroid hypertrophy (goiter) involves various processes and mechanisms that can lead to an increase in the size of this gland. The causes and mechanisms of thyroid hypertrophy can be varied, including:

1. Iodine deficiency: One of the main mechanisms of goiter development is related to iodine deficiency in the diet. The thyroid gland needs iodine to synthesize thyroid hormones (thyroxine - T4 and triiodothyronine - T3). When iodine deficiency occurs, the gland increases in size in an attempt to compensate for the deficiency and produce enough hormones.
2. Autoimmuneprocesses: Autoimmune diseases such as Hashimoto's disease and Bazedov's disease (gravidarum) can lead to thyroid hypertrophy. In these cases, the immune system is directed to attack the thyroid gland, which causes inflammation and tissue destruction, which in turn can lead to an increase in the size of the gland.
3. Nodules and tumors: The formation of nodules and benign tumors in thyroid tissue can lead to localized hypertrophy.
4. Hormonal changes: Hormonal changes such as pregnancy, puberty and menopause can affect thyroid function and cause thyroid enlargement.
5. Genetic factors: Heredity may play a role in the development of thyroid hypertrophy.

Under the influence of these factors, the thyroid gland increases in size to cope with changes within the body or to compensate for deficits in function. The process of hypertrophy can be reversible if the cause is removed (for example, by normalizing the level of iodine in the diet), or become chronic if the pathological process persists.

Thyroid follicular hypertrophy (also called follicular goiter) is a subtype of goiter that is characterized by enlarged follicles in the thyroid tissue. Thyroid follicles contain colloid and play an important role in the synthesis of thyroid hormones such as thyroxine (T4) and triiodothyronine (T3).

Hypertrophy of thyroid follicles can be caused by various factors including iodine deficiency in the diet, autoimmune processes, heredity and others. This type of hypertrophy can manifest with the following characteristics:

1. Increased thyroid size: The follicles of the thyroid gland increase in size, which can lead to the formation of nodules or an increase in the volume of the gland as a whole.
2. Increased number of follicles: This type of hypertrophy is characterized by an increase in the number of follicles in the thyroid tissue, which can be seen on microscopic examination.
3. Nodule formation: In some cases, follicular hypertrophy can lead to the formation of nodules or benign tumors in the thyroid gland.
4. Increased thyroid hormone synthesis: Follicular hypertrophy can affect the process of thyroid hormone synthesis and lead to increased or decreased thyroid hormone production, which can affect thyroid function.

Symptoms of the thyroid hypertrophy

Here are some of the main symptoms of thyroid hypertrophy:

1. Thyroid enlargement: The main sign of thyroid hypertrophy is an increase in the size of the thyroid gland, which can be seen and/or felt in the anterior neck area.
2. Weight loss or gain: Thyroid hypertrophy can affect metabolism, which can lead to involuntary weight loss or gain.
3. Heart palpitations (tachycardia): Increased thyroid activity can increase heart rate.
4. Nervousness and irritability: Thyroid hypertrophy can cause nervousness, anxiety and irritability.
5. Changes in appetite: Increased or decreased need for food may be a symptom.
6. Hand shaking (tremor): Thyroid hypertrophy can cause hand tremors.
7. Increased eating symptoms: Enlargement or pain in the throat area when swallowing.
8. Increased urination: Polyuria may be a symptom.
9. Insomnia: Difficulty sleeping can occur due to thyroid activity.
10. Increased sensitivity to heat: Thyroid hypertrophy can increase sensitivity to heat and heat.

Thyroid hypertrophy in a child

Hypertrophy (enlargement) of the thyroid gland in a child can have different causes and manifestations. Here is general information on the subject:

Causes of thyroid hypertrophy in children:

1. Iodine deficiency: One of the most common causes of thyroid enlargement in children is iodine deficiency in food and water. This can lead to the development of endemic goiter.
2. Autoimmunediseases: Some children may develop autoimmune thyroid diseases such as Hashimoto's (hypothyroidism) or Graves' disease (hyperthyroidism), which can cause an enlarged thyroid gland.
3. Hormonal changes: Some hormonal changes, including puberty, can temporarily enlarge the thyroid gland.

Symptoms and signs of thyroid hypertrophy in children:

• An increase in the size of the thyroid gland (goiter).
• Noticeable bulges or knots in the neck.
• Changes in the voice (hoarseness).
• Difficulty swallowing or breathing.
• Nervousness.
• Learning and Behavioral Problems.

Diagnosis:

• Physical examination and palpation of the thyroid gland.
• Blood tests to measure thyroid hormone (T3 and T4) and thyroid hormone (TSH) levels.
• Ultrasound (ultrasound) of the thyroid gland.
• Hormonal studies to determine the cause of hypertrophy.

Treatment:

• Treatment depends on the cause of hypertrophy:
  • For iodine deficiency, iodine supplements or iodized salt may be prescribed for children.
  • For autoimmune diseases, medications are used to control thyroid hormone levels.
  • In some cases, especially if there are nodules or complications, surgery (thyroidectomy) may be necessary.

Prediction:

• The prognosis depends on the cause of hypertrophy and the effectiveness of treatment. Under regular medical supervision and proper treatment, most children with thyroid hypertrophy have a good prognosis. However, uncontrolled hypertrophy can lead to complications and affect the child's overall health.

Be sure to discuss any thyroid symptoms or changes with your pediatrician or pediatric endocrinologist

Stages

The stages of thyroid hypertrophy may vary depending on the classification system, but can generally be described as follows:

1. Primary (preclinical) hypertrophy:

   • In this stage, thyroid enlargement is usually unnoticeable visually and may only show an increase in the size of the gland on ultrasound.
   • Thyroid hormone levels in the blood may remain within normal limits and the patient may not experience symptoms of hyperthyroidism (overactive thyroid gland).

2. Clinical hypertrophy:

   • At this stage, the thyroid gland may become more prominent, visible or palpable on physical examination.
   • Thyroid hormone levels may begin to change and the patient may begin to experience symptoms of hyperthyroidism such as nervousness, anxiety, sweating, fast heartbeat, etc.

3. Subclinical hyperthyroidism:

   • In this stage, the thyroid gland enlarges further and thyroid hormone (TSH) levels become lower than normal, while thyroid hormone levels of T3 and T4 remain within normal limits.
   • The patient may experience symptoms of hyperthyroidism, but their intensity may be less than in higher stages.

4. Clinical hyperthyroidism:

   • At this stage, T3 and T4 levels become higher than normal and the symptoms of hyperthyroidism become more severe and characteristic of an overactive thyroid gland.
   • An enlarged thyroid gland may be visible even without palpation.

Forms

Thyroid hypertrophy, or goiter, can take many forms, which are determined based on the characteristics and prevalence of enlargement of the gland. There are the following forms of goiter:

1. Diffuse (widespread) goiter: In this form, the thyroid gland enlarges evenly throughout its entire volume. Diffuse goiter can lead to an overall enlargement of the thyroid gland.
2. Nodular (nodular) goiter: In this form, nodules or areas of enlarged tissue form inside the thyroid gland. The nodules may be single or multiple and of different sizes.
3. Multinodular (multiple nodular) goiter: In this form, the thyroid gland contains many nodules that may be located in different parts of the gland. Multinodular goiter can be a mixed type, where the nodules are combined with diffuse enlargement of the gland.
4. Retrosternal (posterior mediastinal) goiter: In this form, the enlarged thyroid gland is located behind the sternum and can put pressure on the trachea, which can cause breathing problems.
5. Natural goiter: This type of goiter is seen in some people and may be related to natural fluctuations in the size of the thyroid gland without the presence of pathology.

Thyroid lobe hypertrophy and diffuse thyroid hypertrophy are two different types of thyroid enlargement (hypertrophy) that may have different causes and characteristics:

1. Thyroid lobe hypertrophy: This is a condition in which one or both lobes (left and right) of the thyroid gland increase in size. Thyroid lobe hypertrophy can be caused by various factors such as iodine deficiency, autoimmune diseases (such as chronic thyroiditis or Bazed's disease), heredity, tumors, and others.
2. Diffuse thyroid hypertrophy: Diffuse hypertrophy, or diffuse goiter, is a uniform enlargement of the entire thyroid gland. It can be caused, for example, by iodine deficiency, autoimmune diseases, hyperthyroidism (increased thyroid activity), or other factors. Diffuse hypertrophy may be accompanied by an increase in thyroid volume without nodule formation.

To diagnose and treat both lobe hypertrophy and diffuse thyroid hypertrophy, a physical examination including ultrasound (ultrasound), measurement of thyroid hormone levels, biopsy if nodules are present, and other tests are required. Treatment depends on the cause and extent of hypertrophy and may include drug therapy, radioablation (removal of tissue using radioactive iodine), or surgery. The exact treatment will be prescribed by an endocrinologist based on diagnostic results.

Complications and consequences

The following are some of the possible complications and consequences of thyroid hypertrophy:

1. Hypothyroidism: In some cases, hypertrophy of the thyroid gland can lead to impaired thyroid function, which can cause hypothyroidism (decreased levels of thyroid hormones). Hypothyroidism is accompanied by symptoms such as weakness, fatigue, weight gain, decreased body temperature, and depression.
2. Compression of surrounding tissues: An enlarged thyroid gland can put pressure on the blood vessels, trachea, and larynx, which can cause difficulty breathing and swallowing.
3. Nodules and tumors: Nodules and benign tumors can form in a hypertrophied thyroid gland. Although these are usually not malignant, they may cause additional problems and require additional treatment.
4. Goiter attack (goiter crisis): Some people with thyroid hypertrophy may experience goiter attacks, which are accompanied by a sudden increase in symptoms of hyperthyroidism, such as rapid heartbeat, high body temperature, and anxiety. This condition requires medical attention.
5. Hyperthyroidism: Hypertrophy of the thyroid gland can lead to increased production of thyroid hormones, which can cause hyperthyroidism. Symptoms of hyperthyroidism include rapid heartbeat, weight loss, nervousness, and hand tremors.
6. Complications of pregnancy: Thyroid hypertrophy can affect pregnancy and the health of the baby. Inadequate control of thyroid function during pregnancy can cause complications for both mother and fetus.
7. Malignant thyroid tumors: In rare cases, an enlarged thyroid gland can be the site of thyroid cancer. Therefore, it is important to have regular medical examinations and thyroid checks.

Diagnostics of the thyroid hypertrophy

Diagnosing thyroid hypertrophy (enlargement) usually involves several steps:

1. Medical History and Physical Examination:

   • The physician interviews the patient to determine symptoms, medical history, and risk for thyroid hypertrophy (e.g., family history).
   • A physical examination is performed, including palpation of the thyroid gland to assess its size, texture, and sensitivity.

2. Examination of thyroid hormone levels:

   • Blood is analyzed for thyroid hormones such as thyroid hormone (TSH), thyroxine (T4), and triiodothyronine (T3). These tests can determine the functional status of the thyroid gland and detect hyperthyroidism (increased activity) or hypothyroidism (decreased activity).

3. Ultrasound (ultrasound):

   • Thyroid ultrasound is performed to determine the size and structure of the gland, as well as to detect nodules, cysts and other changes.

4. Thyroid scintigraphy:

   • This study can be performed to assess thyroid function and identify hot (hyperfunctioning) or cold (hypofunctioning) areas.

5. Thyroid biopsy:

   • If ultrasound or other tests show suspicious nodules, a biopsy may be performed to take tissue samples for further testing for cancer or other abnormalities.

6. Additional examinations:

   • In some cases, additional tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans may be ordered to get a more detailed view of the structure of the thyroid gland.

Ultrasound (ultrasound examination) of the thyroid gland provides important information about the size, structure, and condition of this gland. The specifics of ultrasound for thyroid hypertrophy can vary depending on the degree of enlargement and other characteristics. Here are some features of ultrasound in thyroid hypertrophy:

1. Enlargement: The main characteristic of thyroid hypertrophy is an increase in the size of the thyroid gland compared to normal. Ultrasound can measure the size of the gland and determine how enlarged it is.
2. Structural evaluation: Ultrasound helps determine the structure of the thyroid gland. The doctor can assess whether both lobes of the thyroid are evenly enlarged or if there is an uneven enlargement or deformity.
3. Nodules: An ultrasound scan can show the presence of nodules in the thyroid gland. Nodules can be glandular (with fluid), solid, or mixed. Ultrasound can also evaluate the characteristics of nodules, such as their size, shape, and blood supply.
4. Doppler ultrasound: This method assesses the blood supply to the thyroid gland. Changes in blood supply may be important in the evaluation of thyroid status.
5. Echogenicity: Ultrasound can also determine the echogenicity of thyroid tissue, which can help in determining the nature of the tissue (e.g., cysts, calcinates, etc.).
6. General condition: The physician can evaluate the general condition and morphology of the surrounding tissues and lymph nodes in the thyroid region.

It is important to note that ultrasound results should always be interpreted by a doctor, as they can be different depending on the individual characteristics of the patient and the cause of thyroid hypertrophy. If you suspect thyroid hypertrophy or other thyroid problems, see your doctor for an ultrasound and further diagnosis.

Differential diagnosis

The differential diagnosis of thyroid hypertrophy involves identifying the underlying cause of thyroid enlargement and ruling out other conditions that may mimic its symptoms. Below are some conditions that may be part of the differential diagnosis:

1. Hypertrophy of the thyroid gland due to iodine deficiency (endemic goiter):

   • This type of hypertrophy is associated with dietary iodine deficiency and can be diagnosed by ultrasound and blood tests for thyroid hormone levels. It is also important to find out if the area where the patient lives is endemic for iodine deficiency.

2. Autoimmune thyroid diseases (Hashimoto's, Graves' disease):

   • Blood tests for thyroid antibodies and thyroid hormone levels are used for differential diagnosis of autoimmune diseases. Ultrasound can also help to identify structural changes in the gland.

3. Malignant thyroid tumors (thyroid cancer):

   • Thyroid cancer requires a biopsy and cytologic examination to confirm the diagnosis. Additional tests such as scintigraphy or PET-computed tomography may also be required.

4. Cysts or tumors of the larynx:

   • Enlargement in the larynx area may be associated with cysts, tumors, or other problems that are unrelated to the thyroid gland. Examining the larynx and performing a computed tomography (CT) or magnetic resonance imaging (MRI) scan can help in the differential diagnosis.

5. Infections or inflammatory processes:

   • Uncontrolled infection or inflammation in the neck area can also cause swelling and enlargement. A physical examination and examination of the patient can help rule out infectious or inflammatory causes.

Treatment of the thyroid hypertrophy

Treatment for thyroid hypertrophy (enlargement) can vary depending on the cause of the enlargement and its severity. Here are the general steps for treating thyroid hypertrophy:

1. Diagnosis and assessment of the cause:

   • In this step, the doctor performs a complete clinical examination and additional tests to determine the cause of thyroid enlargement. This may include blood tests for thyroid hormone levels and thyroid antibodies, ultrasound (ultrasound), biopsy and other procedures.

2. Treatment of the underlying disease:

   • If thyroid hypertrophy is caused by autoimmune diseases such as Hashimoto's or Graves' disease, treatment is aimed at controlling these diseases. This usually involves taking medications such as thyreostatics (to reduce thyroid activity) or radioiodine treatment (radioiodine therapy) to destroy part of the gland.

3. Correction of iodine deficiency:

   • If the hypertrophy is associated with iodine deficiency (endemic goiter), your doctor may prescribe iodine supplements in food or iodine preparations.

4. Surgical intervention (thyroidectomy):

   • In complex or long-term cases where conservative treatment is unsuccessful or not applicable, surgical removal of part or all of the thyroid gland may be necessary. This procedure is called a thyroidectomy.

5. Postoperative period and rehabilitation:

   • After surgery, patients need careful monitoring and rehabilitation. This includes taking medication to normalize thyroid hormone levels and monitoring the suture and thyroid gland.

6. Long-term follow-up:

   • After treatment, it is important to monitor the thyroid gland regularly with ultrasounds and blood tests to monitor thyroid hormone levels. This will help detect recurrences or other problems.

Treatment of thyroid hypertrophy should be individualized for each patient, taking into account the cause of the enlargement and the general state of health. It is important to get a consultation with a specialist and follow his recommendations to achieve optimal treatment results.

Prevention

Prevention of thyroid hypertrophy (enlargement) can vary depending on the cause, but at the heart of prevention is ensuring an optimal environment for a healthy thyroid gland. Here are a few measures you can take:

1. Proper nutrition:

   • Ensure adequate intake of iodine, which is a key component for normal thyroid function. Iodine can be obtained from foods such as seafood, milk, iodized salt and other products. In regions where soil iodine is low, iodized food supplements can also be used.

2. Avoiding excess iodine intake:

   • Avoid excessive intake of iodine as it can also cause thyroid problems. Follow the iodine intake recommendations on the food package.

3. Avoiding environmental impact:

   • Reduce environmental exposures and reduce the risk of thyroid exposure from toxic substances and radiation. This may include using protective equipment in hazardous work environments and being safe when exposed to radiation.

4. Control of autoimmune diseases:

   • If you already have an autoimmune thyroid disease such as Hashimoto's or Graves' disease, it is important to monitor the condition and follow your doctor's recommendations for treatment and control.

5. Regular medical examinations:

   • Regular medical checkups can detect any changes in thyroid health early. If you have a family history of thyroid disease or other risk factors, talk to your doctor about the need for more frequent checkups.

6. Healthy Lifestyle:

   • Support a healthy lifestyle with a balanced diet, physical activity and stress management. These factors can have a positive impact on your overall health and thyroid function.

7. Take medications as prescribed:

   • If you have already been diagnosed with hypertrophy or other thyroid problems, follow your doctor's recommendations and take your medications as directed.

Prevention of thyroid hypertrophy includes maintaining a healthy lifestyle and regular medical monitoring. If you have concerns or risk factors, discuss them with your doctor to develop an individualized prevention plan.

A list of some books and studies related to the study of thyroid hypertrophy

1. "Werner & Ingbar's The Thyroid: A Fundamental and Clinical Text" (Authors: Lewis E. Braverman and David S. Cooper) - This is a comprehensive textbook on the thyroid, including fundamental and clinical aspects. (Latest edition: 2020)
2. "The Thyroid: A Fundamental and Clinical Text" (Author: Sidney H. Ingbar) - The classic textbook on the thyroid gland and its diseases. (Latest edition: 2005)
3. "Thyroid Disease Manager" - This is an online resource that provides information on the diagnosis and treatment of various thyroid diseases. (Available online).
4. "Endotext" - This is an online resource that contains information about the thyroid and other endocrine glands. (Available online).
5. "UpToDate" - This is an online resource for medical professionals that includes reviews and recommendations for the diagnosis and treatment of thyroid hypertrophy. (Available online).

Literature

Dedov, I. I. Endocrinology : national guide / ed. By I. I. Dedov, G. A. Melnichenko. I. Dedov, G. A. Melnichenko. - 2nd ed. Moscow : GEOTAR-Media, 2021.