Endemic goiter

Endemic goiter is characterized by an increase in the thyroid gland, which causes the neck to deform. The disease develops as a result of low levels of iodine in the body. In childhood, this disease occurs quite often, in some cases it is possible to detect the disease only in adolescence, after puberty.

Particularly susceptible to the development of the disease people from regions where the amount of iodine in the environment is practically nonexistent. Normal development and functioning of the body largely depends on the endocrine system, in particular, from the functioning of the thyroid gland.

With chronic iodine deficiency, thyroid tissue begins to expand, and its functionality changes, which leads to malfunctions in many internal organs and systems.

ICD-10 code

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

Causes of endemic goiter

The normal work of the whole organism is provided by the endocrine system. If the body lacks iodine, the tissues of the thyroid gland begin to increase, the work of the endocrine system, and with it of the whole organism, is disrupted.

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

The reason for the relative deficiency of iodine may be some drugs, a violation of the absorption function of the intestine, because of which the body receives less of the required amount of iodine, congenital abnormalities of the thyroid gland, diseases of the digestive system.

Absolute deficiency of iodine develops because of low intake of iodine with products or water.

Contribute to the development of chronic infection-inflammatory processes (especially worms), poor living conditions or work, taking medications that make it difficult to supply iodine to the thyroid gland, eating foods that are low in selenium, molybdenum, manganese, and zinc, which help the body absorb iodine.

Also, the cause of the development of the stream may be contaminated drinking water, which prevents the absorption of iodine (especially water with nitrates, calcined), anomalies 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, in addition, the patient can feel discomfort in the heart.

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

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

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

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

Endemic goiter of the 2nd degree is well seen, the specialist without difficulty reveals an increase in feeling.

Diffuse endemic goiter

More often affects women from 20 to 50 years. The disease is characterized by an increase and increased work of the thyroid gland due to attacks of the body's own immune system. The reasons for the development of diffuse goiter are the pathological state of immunity, in which the body produces an increased number of autoantibodies that increase the iron and stimulate the production of hormones. Treatment is mainly medicated, surgical treatment is prescribed in the case of too large a size of the string. Against the background of taking drugs in about 70% of cases, a remission occurs.

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Nodal endemic goiter

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

With nodular goiter visible visible cosmetic defects on the neck, a sense of suffocation.

For treatment, usually prescribed suppressive drugs (thyroid hormones, radioactive iodine), surgical intervention.

Nodular goiter is diagnosed in about half of the population, while in women the disease is several times more common. As a rule, the uterine fibroids are often detected with a nodal stream in a woman.

Multinodular endemic goiter usually develops on the background of a normally functioning thyroid gland. The reasons for the appearance of nodes is the inadequate intake of iodine in the body with food, or a violation of the assimilation of this trace element due to liver disease, digestive system or malnutrition (large amounts in the diet of soybeans, cabbage, and rutabaga).

In nodular goiter, the thyroid gland produces a low amount 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, a colloid accumulates in it, as a result follicles appear in it. If the need for thyroid hormones reappears, the tissues of the thyroid gland expands, as a result of which, in a few years, multiple nodular formations appear in the thyroid gland.

Endemic goiter in children

Endemic goiter often develops in those children who live in regions inadequate iodine in water or soil.

Deficiency of iodine in the body leads, as well as adults, to disruption of the production of thyroid hormones and an increase in the thyroid gland. In infancy, an enlarged thyroid gland can transmit trachea, which will lead to the death of the child. Also, with iodine deficiency in the body, the child lags behind in development, both mentally and physically, except for this, development of endemic cretinism (dementia, growth retardation, disproportionate physique) is possible.

To determine the size and structure of the thyroid gland in children, ultrasonography, a blood test for the level of hormones, etc.,

As treatment, medications are prescribed (antistum, hormone therapy).

For the prevention of the disease is prescribed the use of sea or iodine-enriched salt, nutritional 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 nodal formations, and contours, tissue structure, etc. On ultrasound it is possible to detect congestion of colloid or hemorrhage in the node, calcifications, adenomas, carcinomas.

Also in the diagnostic activities include laboratory tests (blood, urine).

With a shortage of iodine, the excretion of this trace element with urine is reduced and is usually less than 50 mg per day. The blood test allows you to determine the level of thyrotropin, T ₃, T ₄, thyroglobulin.

When a nodular form of the struma is identified, a biopsy is assigned to help establish the nature of the pathological process (malignant or benign).

Fine needle aspiration biopsy allows to reveal the homogeneous masses of the colloid, the number of cells of thyroid epithelium,

An increase in the thyroid gland is diagnosed if the volume of the thyroid gland exceeds the upper limits of the norm (at each age and for each gender, their normal values are established).

For men, the upper limit of the thyroid gland volume is set at 25ml (cm ³ ), in women - 18ml (cm ³ ). In children, the indices range from 4.9 to 15.6 ml.

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

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Treatment of endemic goiter

Endemic goiter is a serious enough violation, the treatment of which should be handled by a specialist.

Treatment can be conservative (usually with a small size of the stria or at the initial stages of the disease) or surgical.

Good results with not severe destructive changes in the thyroid tissue show hormonal therapy with thyroidin or triiodothyronine.

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

With drug treatment specialist in each case selects preparations with iodine content, thyroid drugs, determines the regimen of intake and dosage.

With iodine deficiency, antirustine or potassium iodide solution helps. Such drugs are prescribed at the initial stage of the disease, with a moderate amount of thyroid.

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

With properly selected treatment, the size of the thyroid gland decreases (it is important to undergo a complete course of treatment). In the event that after a few months the thyroid gland does not decrease in size, iodine-containing drugs are replaced with thyroidin (the dosage and the course of admission are selected by the specialist in each case).

Thyroidin can have a positive effect and with some mixed forms of the struma, the drug is also used in the nodular form during the preparation for the operation.

Children are given thyroid surgery after conservative methods have been unsuccessful. An emergency operation is indicated in cases of compression of the organs adjacent to the neck (with too large a size of the string).

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

If the goiter increases too quickly, the adjacent organs are squeezed, or there is a suspicion of a malignant process - the operation on the thyroid gland is appointed 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, improvement of water supply sources is of no small importance.

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

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

Iodized salt is obtained by adding to ordinary potassium iodide, for storage it is necessary to use dishes that are tightly closed (otherwise iodine can weaken, and with it all the good). It is especially important to prevent goiter in childhood, so up to 12 years there is a physiological hyperplasia of the thyroid gland, which can become the onset of the disease.

Prognosis of endemic goiter

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

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

After treatment, the patient can continue his usual lifestyle.

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

In addition, with an increase in the thyroid gland in both men and women, the reproductive function is impaired.