Endemic goiter : causes, symptoms, diagnosis, treatment, prevention

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2018-10-03 23:00:41

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Endemic goiter is an enlargement of the thyroid gland caused by iodine deficiency in the body. A healthy volume of the breast, usually in women did not exceed 20 cm3, and for men - 25 cm3. In the presence of a goiter, he is more given size. According to statistics, which was recently given by the world health organization, more than seven hundred million people who live in iodine-deficient territories, suffer from endemic goiter (ICD-10 code - E01.0).

They observed different degrees of functional insufficiency of the gland. Forty two million are diagnosed acquired form of mental retardation. The most unfavourable territories from the point of view of the content of iodine in the environment in our country is the Republic of Karelia, the Volga region, the Caucasus and the valleys of the Siberian rivers.

endemic goiter

Types

Endemic goiter can be of different types, for example:

  • Euthyroid type. The thyroid gland is increased in size, but the normal level of hormones is maintained.
  • Hypothyroid type. A goiter is combined with hypothyroidism, and in addition, with a reduced function of the thyroid gland.
  • Hyperthyroidic type. A goiter is characterized by the excessive work of glands.

In Addition to the above forms are distinguished also:

  • Development of diffuse goiter in which the thyroid gland enlarges uniformly.
  • Endemic Multinodular goiter. With the development of such a craw in the mass of cancer present in the nodes more dense fabric.
  • The Development of mixed goiter, when, in parallel with a diffuse increase in the thyroid gland may be palpable individual nodes.

Directly on its localization goiter is unilateral or bilateral. Next, find out what are the main causes of this pathology, and consider the extent of the disease.

Extent of endemic goitre

Often singled out:

  • 0 degree - no goiter.
  • Grade I – goiter is felt on palpation, but not detected visually.
  • Grade II - goiter is determined visually and by palpation.

To determine the exact size of the thyroid gland patient is prescribed ultrasound, which also brings out the form of a goiter.

Endemic goiter: pathogenesis of disease

As mentioned above, the cause of endemic goiter is the iodine deficiency in the human body. Iodine deficiency is, for example, acute. In such case, the body will collect all of its compensatory abilities and as soon as I resume the iodine, the person will be returned to the normal operation of his thyroid, due to which any damage to the other organs does not occur.

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Against the background of the development of chronic insufficiency such an important element like iodine, the situation is much more complicated. As a response to decreased intake of iodine, as a rule, there is an increase of the thyroid cells, which synthesize hormones. Thanks to the growth of these cells glands and the strengthening of their work for a short time to be stabilized relative to a normal quantity of hormones. But after some time will be inevitable in the process of fibrosis, and will begin to form knots. Pathogenesis of endemic goiter don't know everything.

thyroid goiter

On the background of prolonged iodine deficiency alone hypertrophy of the thyroid cells is not enough. Not only can they increase in size, but intensely divided. As a result, fibrosarcomas cells in the body is a lot, and this, in turn, means that there are prerequisites for further development of diffuse-nodular goiter.

The Causes of endemic goitre are that the thyroid gland against the background of an increasing shortage of iodine passes through several stages of changing its structure. First becomes euthyroid diffuse goiter, multinodular euthyroid then, but in the end - multinodular toxic.

Most common causes of pathology

Endemic goiter occurs due to lack of iodine.

The Most common causes of iodine deficiency are the following factors:

  • Certain medications that stimulate the excretion of iodine.
  • Emergence of diseases of the digestive system which are accompanied by malabsorption of necessary nutrients.
  • The Use of chelators.
  • Development of chronic renal failure, which is accompanied by increased excretion of iodine.
  • The Appearance of congenital anomalies of the gland in the form of aplasia or hypoplasia.
  • The Presence of transient States, which are accompanied by iodine deficiency. As an example of such conditions is the pregnancy along with childhood, puberty and intense physical activity. In addition, regular effect and psycho-emotional load.
  • Insignificant intake of iodine from food.
  • Small iodine with water.
  • The Presence of a disturbance of the energy balance.
  • The Development of chronic hypoxia.

Speaking about the causes that provoke the development of endemic goiter, should consider in more detail the lack of this element in everyday food. The majority of inhabitants of our country in the diet there are almost no fresh seafood with the fish. In additionanyone thinking about using iodized salt for cooking.

Of Course, accept only iodized salt will not fill the full extent of the iodine deficiency. This is due to the fact that iodine is a very volatile substance which quickly disappears from the structure of salt crystals as a result of the receipt by him of air. In this connection, you need to keep salt in salt shakers, and glass or metal tins that close tightly with a lid.

prevention of endemic goiter

Eating a significant amount of cauliflower, and in addition, beans and turnips threatens the development of iodine deficiency. This is because these products contain too much chromogenic substances that provoke an excessive growth of tissue of the thyroid gland.

Thus, iodine deficiency is primarily caused due to the following factors:

  • Lack of iodine in the environment and in drinking water. Such regions include Central Russia, the Urals, Altai and the Caucasus.
  • An Unbalanced diet, which is eaten enough fish, seaweed, dairy products, buckwheat and oat groats.
  • Systematic taking certain drugs that block the absorption of iodine.
  • The Presence of a genetic predisposition along with a genetic defect of thyroid hormone production.

Now consider how evident the presence in patients of endemic goiter of the thyroid gland.

Symptoms

Symptoms of goiter in the first place depend on the functions of the thyroid gland. Very often the patient may complain of the following feelings:

  • Weakness.
  • The Presence of low physical endurance.
  • Discomfort in the heart region.
  • Headaches.

These symptoms can occur even at an early stage of the disease. With subsequent growth of the thyroid gland, patients may experience the following symptoms:

  • The Appearance of a squeezing sensation in the neck.
  • The Presence of difficulty swallowing and breathing.
  • The Appearance of dry cough.
  • The Occurrence of asthma attacks.
the pathogenesis of endemic goiter

Interestingly, the diffuse type of goitre is the most common form. Women they are sick four times more often compared to men. This is primarily due to increased demand of women in the hormones of this gland during puberty and pregnancy.

It Should be borne in mind that doses of iodine, as recommended, shall be as follows:

  • 50 µg are the norm for infants.
  • 90 mcg should take children up to the age of seven years.
  • 120 mcg – this is the norm for children from seven to twelve years.
  • 150 mcg adults should take.
  • 200 ág should be consumed by pregnant or nursing women.

Facts and Figures

About two hundred million people on the planet suffer from this pathology. It is called one of the most common disasters people. Ninety percent of all cases of the appearance of goiter caused by iodine deficiency. Six percent increased the incidence of goiter among children over the past ten years. Today, this frequency is approximately twenty-five percent of all children's endocrine diseases.

The Pathogenesis of endemic goitre everyone should know.

Complications

The Disease can result in different complications. To them, as a rule, include:

  • The Presence of the thymus of the heart. We are talking about a state in which the compressed blood vessels, which depart from the heart. This can lead to enlargement of the heart on the right side.
  • The Presence of compression of esophagus and trachea.
  • The Appearance of hemorrhages in the body of the thyroid gland.
  • The Appearance of inflammation of the gland.
  • Development of malignant transformation of the thyroid gland.

To prevent complications of endemic goitre, it is necessary to undergo diagnosis.

Diagnostic pathology

Instrumental methods of diagnosis of goiter is ultrasound. Thanks to this study establish the form of the disease which may be diffuse or nodular.

multinodular goiter

In the case of nodes can assign sonoelastography - study, which allows to determine the density with elasticity nodules. This gives you the opportunity to find out what the nature of the pathology: benign or malignant. With the same purpose to further carry out a biopsy of the thyroid gland. In addition to confirm the diagnosis, check the level of hormones such as TSH and T4. Patients with this type of the disease usually greatly upset the balance of thyroid hormone. In turn, the rate of discharge of iodine in urine was low. But the initial step in the survey is primarily palpation. This method allows you to do the following:

  • Determines the size of the lobes of the patient's body.
  • Evaluated the sharpness of the borders with the surrounding tissues.
  • Evaluated the consistency of the gland. The doctor pays attention to such features as seals, softening, nodules, and their approximate size.
  • Assesses the state of the lymph nodes along with the presence of lymphangitis.

In Addition topalpation is very informative, however, and available method is, as already mentioned, ultrasound examination, which gives the following information:

  • Accurate width, thickness and height of shares.
  • The size of the isthmus.
  • Full information about the structure of the body, and in addition, its uniformity.
  • The Presence of nodules and its exact dimensions.
  • The extent of the volume of individual shares. As it turns out, the total volume of the thyroid gland.
  • The condition of the surrounding tissue.

What is the treatment of endemic goiter?

Treatment

In the case of minor breast augmentation is often just a few courses of treatment of potassium iodide, and in addition, the diet with foods that are rich in iodine. The treatment of goiter complicated by hypothyroidism in the first place involves conducting hormone replacement therapy.

The Treatment of goiter, which is the anchor form at a late stage, usually requires surgical intervention.

endemic goiter causes

At the postoperative stage patients undergo hormone replacement treatment. Folk remedies recommended the powder of the seaweed. He takes a teaspoon at night and washed down with water. Therapy is from twenty to thirty days.

Prevention of endemic goitre is no less important.

Diet as a measure of prevention

It is recommended that People following the diet for the prevention of endemic goitre:

  • Consumption of seafood in the form of shrimp, squid and mussels.
  • Use in the diet of kelp and other seaweeds.
  • The Use of sea boiled fish up to three times a week.
  • Use in the diet of fermented drinks, especially those containing bifidobacteria. Thus, it should be drinking two glasses of such beverages a day.
  • The Use of curd average fat content up to three times in seven days.
  • Nuts of all kinds to 50 grams per day.
  • Add in eating seeds of all kinds.
  • Use in the diet of dried fruits in the form of raisins, dried apricots, dried apricots, figs, prunes, apples and pears.
  • Use cranberries, cranberries, strawberries, gooseberries, black currant, viburnum, mountain ash red and so on.
  • Use in the diet of vegetables as carrots, cabbage, beets and raw pumpkin.
  • Use green, for example, onion, radish, celery and so on.
  • Reception of fresh juice from vegetables, berries or fruit.
  • Welcome drink of rose hips, dandelion root, or hawthorn.
  • Drink mineral or spring water.
  • Use in the diet of honey 50 grams.

Other ways to prevent goiter

Prevention of endemic goiter divided into mass, group and individual type:

  • Mass of the preventive method consists in the production of iodized salt, bread and confectionery, which must contain this element. In addition, on TV is propaganda control over the content of iodine in the products.
  • Group prevention carried out mainly in high-risk groups, namely children's institutions, schools, secondary and higher educational institutions. In addition, attention is paid to pregnant women. These primarily include the holding of discussions, along with controlled distribution of iodine preparations, for example, “Antistrumin”, “Codomain” and “Itokama”.
  • As regards individual prevention, it is to eat foods that are rich in iodine. Very important intake of iodine by people who are at risk, as well as those who live in endemic regions.
complications of endemic goitre

How to prevent endemic goiter in children? Babies who are on mixed feeding, daily need 90 micrograms of iodine. Pregnant women, children and teenagers need up to 200 micrograms per day. In addition to medication important diet, which should be based on a sufficient iodine content in food products.

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