Among the urban population, especially among the female part in the age group up to fifty years old, diffuse goiter of the thyroid gland The disease of the thyroid gland - craw: the disruption of the pituitary gland   considered one of the most common diseases. For this disease characteristically uniform increase in organ size and increased production of thyroid hormones. Pathological manifestations and severity of the disease are not directly dependent on the size of the crop, so it is important to pay attention to the appearance of any deviations in health status.

As a consequence, can develop the disease

The problem of studying the causes of goitre, or Graves' disease, scientists are engaged in a long time. It puts forward many scientific theories, but in recent years there is a consensus of a genetic autoimmune nature of the disease. In favor of the hereditary nature of the facts say the presence of familial cases of goiter, as well as identification of specific antibodies in the blood tireiodnyh relatives of patients with goiter. The development of autoimmune processes in the body of a patient with diffuse goiter has some features:

• revealing a high frequency of various autoimmune processes among close relatives of patients with goiter. This may be the presence of Addison's disease, pernicious anemia, myasthenia gravis, and other disorders
• circulating in the blood of a patient with goiter antibodies exert a stimulating effect on the cells, which is an important feature. This stimulating effect leads to hypertrophy and hyperfunction of the cancer. In the case of other diseases of the autoimmune nature of autoantibodies exhibit blocking or antigen-binding properties

Previously, it was believed that the basis for the development of a diffuse increase in cancer is the increased production of thyroid hormones the central (or thyroid-stimulating hormone, TSH). It was proved that the opposite reaction occurs when the level of the central thyrotropin reduced or changed. There is suppression of pituitary function due to increased blood levels of hormones produced by the thyroid gland.

After conducting numerous studies have provided data on the increase in the number of clinical cases of primary cancer lesions of the thyroid gland in those patients in whom the diagnosis of diffuse goiter. Most often it is highly differentiated mikroraki among them can be papillary, follicular and mixed forms. Combined treatment of any type of this cancer leads to recovery of the patient, but it is important to quickly identify the disease process and to conduct therapy. Given such a high risk of cancer incidence, it can be argued that the problem of diffuse goiter and its diagnosis is important.

Clinical manifestations of change in the hormonal profile

A variety of clinical manifestations in diffuse goiter can be explained by the influence of elevated blood level of thyroid hormones on the state of organs and body systems. The disease is characterized by complex mechanisms of development, accordingly, it defines a variety of pathological symptoms developing in the craw. The principal or cardinal symptoms can be called three symptoms:

• exophthalmia or exophthalmos
• tremor
• tachycardia Tachycardia - the body to the limit?

These clinical manifestations are the main but not the only ones. Expressions influenced by thyroid hormones is subject to the nervous system. Patients with diffuse goiter distinguished irritability and irritability Irritability - you try to control my temper , Nervousness, restlessness, frequent changes of mood, tearfulness, sleep disturbances Dreams: how to understand our dreams   as insomnia .  These changes lead to the fact that patients are conflicting, quarrelsome in the team and at home, which is often caused quarrels .  The opposite situation may occur when patients become apathetic, they are no longer interested in the surrounding reality, there are bouts of muscle weakness .  One of the major manifestations of the disease is goiter .  The size of the thyroid gland is uniformly increased, the consistency of soft iron, without pathological tissue sections sealing .  The value of the crop varies depending on the clinical situation - under emotional stress or excitement value increases, decreases during treatment .  Due to the increased secretion of hormones takes effect on overall metabolism, which manifests increased decay energy in the body .  Patients with diffuse goiter progressively lose weight, despite the persistence or even increased appetite .  But not in all cases the weight is reduced .  There is an increase in body weight in the form of the disease, which was called "fat Basedow" .  This condition is explained by the peculiarities of the pathogenesis and requires a special selection of therapy .

The main treatment for diffuse goiter should be directed to the blockade increased synthesis of thyroid hormones .  For this purpose for many years successfully used drugs and Mercazolilum methylthiouracil .  Therapy Mercazolilum shown in all forms of the disease and the severity of any .  Admission thyreostatics may be accompanied by the development of adverse reactions (allergic reactions as hives and itching, agranulocytosis, fever, arthralgia) .  The most negative development is a complication of treatment of pharyngitis .  The first sign of this complication is the complaint of discomfort or pain in the throat, so the need for careful monitoring of the patient during the entire course of therapy .  So far, no single point of view on how long should the therapy .  Everything is decided individually depending on the specific clinical situation .  There is information about the possibility of developing cancer after prolonged and uncontrolled appointment thyreostatics .  In addition to the reception of drugs and surgical treatment of radioiodine therapy .

Marina Solovyov

In recent years, it has been found that the node changes in the thyroid are more common than diffuse and in most cases are not dangerous. But at the same time the nodes can increase in size to compress the surrounding organs and tissues as well as malignant - regenerate into malignant tumors. True to the last complication is more common for single (solitary) nodes.

What multinodular goiter of the thyroid gland and the reasons for its development

Multinodular goiter is characterized by multiple nodes in the thyroid gland. Usually such formations are euthyroid (normal thyroid function) character are called multisite euthyroid goiter (IES), and are more common in women than in men.

The disease is based environmental iodine deficiency in the diet, and water or its inadequate absorption in the patient. The latter may be due to the nature of the power (many soybean, turnip, swede, cabbage) or gastro-intestinal tract and liver.

This deficiency of iodine the thyroid gland produces enough thyroid hormone, it causes the pituitary to produce large amounts of their thyroid stimulating hormone (TSH), thyroid stimulating. Influenced TTG begins proliferation (growth) of cells of the thyroid gland and increase in final volume.

If the body's need for thyroid hormone decreases, the iron accumulates and forms large colloid goiter with large follicles filled with colloid (bubbles). Then the need for thyroid hormone increases again and the breast tissue grows. The alternation of these processes for a number of years and causes the formation of multinodular goiter.

Symptoms

If there are no violations of the thyroid gland and increase its expression, the disease is asymptomatic. But while such complications can develop as a significant increase in thyroid Increase in thyroid - that underlies the disease   by compression of the surrounding organs, tissues, blood vessels and nerves, as well as the development of hyperthyroidism (increased content of the toxic effects of thyroid hormones in the blood) many years after the occurrence of multinodular euthyroid goiter. The last complication was named the functional autonomy of the thyroid gland (thyroid FA), as related to the independent of pituitary TSH capture of iodine and formation of thyroxine Thyroxine - the main thyroid hormone   (T4) cells thyroid nodule thyrocytes.

These nodes are called "hot", they are identified in the study, radioisotope thyroid with radioactive iodine. "Hot" nodes produce much thyroid hormone Thyroid hormones: mechanism of action and physiological effects That leads to suppression of pituitary TSH secretion and reduce the remaining functioning thyroid tissue. Most are independently operating units appear in elderly people with multinodular goiter. Very often this pathology occurs in areas of iodine deficiency in food and water.

Diagnostics

Multinodular goiter (if it is large enough to deform the neck) can be detected by the patient, and can be a random finding at baseline medical examination or during ultrasonography (USG).

After identifying goiter patient carefully examined. To do this, take a blood on hormones (revealed the relationship between thyroid hormone and pituitary TSH, which speaks volumes specialist) conducted thyroid ultrasound Thyroid ultrasound - to examine the evidence   (nodes are identified, their location and structure). Spend fence as content nodes using fine-needle aspiration biopsy (FNA) under the control of the ultrasonic beam, followed by laboratory cytology (studied cells found in punctate) exploration and definition of the nature of the node (cyst, benign or malignant tumors, and so on).

Of great importance is also scintigraphy - a study of the thyroid gland using radioactive iodine. This study identifies the "hot" (ie, releasing more hormones than the remaining thyroid tissue) and "cold" (non-functioning) components, which, according to many researchers, the most prone to degenerate into a malignant tumor. In what could be done as magnetic resonance imaging, which allows you to examine in detail the structure of the nodes.

The studies carried out assessment of multinodular goiter and its progression with the development of compression of the surrounding tissues or thyrotoxicosis. If the doctor sees that the disease progresses, goiter removed surgically. When non-operation and does not increase in the size of the crop for the sick just watching.

Galina Romanenko