Thyroid Symptoms of Disease

The thyroid gland refers to the glands of internal secretion as well as the hypothalamus, pituitary gland, parathyroid( parathyroid) gland , the adrenal glands, the islet part of the pancreas, the sex glands are the ovaries in women and testicles in men.

The thyroid gland is a small organ located on the neck in front and along the sides of the trachea, just below the thyroid cartilage, and consists of two-lobes connected by an isthmus. Normally, the thyroid gland is almost not palpable.

The thyroid gland consists of a connective tissue, pierced with nerves, blood and lymphatic vessels;In the thickness of the connective tissue are the smallest vesicles - follicles. On the inner surface of their walls are follicular cells - thyreocytes, which synthesize thyroid hormones.

Thyroid hormones are essential for protein synthesis and growth hormone secretion;they promote the utilization of glucose by cells, stimulate the work of the heart, respiratory center, increase fat metabolism, etc. How to treat thyroid diseases folk remedies look here.

Thyroid activity is regulated as follows. When the body for one reason or another needs to increase metabolism, a signal about this comes into the hypothalamus. In the hypothalamus, the so-called thyrotropic releasing factor is synthesized, which, entering the pituitary gland, stimulates the production of a thyroid-stimulating hormone( TSH) in it. A thyroid-stimulating hormone activates the activity of the thyroid gland and increases the synthesis of its "personal"( thyroid) hormones, thyroxine, or tetraiodothyronine( T4) and triiodothyronine( T3).Most of the thyroid hormones - T4 and T3 - are in the blood in the bound inactive state, in a complex with certain proteins. Only with the "release" of these proteins, hormones become active.

All these complex mechanisms are necessary in order to keep in the blood as many active thyroid hormones as the body needs at the moment.

The calcitonin hormone is also produced in the thyroid gland. Its main effect is a decrease in elevated blood calcium levels.

It:

- congenital anomalies( absence of the thyroid gland or its underdevelopment, wrong location, non-healing of the tongue-thyroid duct);

- endemic goiter( associated with a deficiency in the surrounding nature of iodine);

- sporadic goiter( goiter that occurs in a small number of people living in areas where iodine is sufficient);

is a monoecious disease( differently, diffuse toxic goiter or thyrotoxicosis), associated with increased thyroid function;

-hypothyroidism( lowering of thyroid function);

- inflammatory diseases - thyroiditis;

- tumors and lesions of the thyroid gland. Damage can be open( when the integrity of the skin is broken) and closed( when it is not broken, apparently such damage can be invisible).

Normally, this body we do not see and do not feel.

With the first degree of enlargement, the thyroid gland is clearly palpable, but invisible to the eye.

At the second degree of magnification of iron it is well probed and appreciable on eyes at a swallowing.

With a third degree of enlargement, even a person far from medicine can see the thyroid gland;it looks like a "thick neck", but it can strongly not disturb the patient.

With the fourth degree of thyroid enlargement, the goiter sharply changes the outline of the neck.

With a fifth degree, the goiter reaches large, sometimes gigantic sizes. The appearance of such a patient attracts attention;a person may be tormented by shortness of breath, a feeling of heaviness, tightness in the chest, a feeling of a foreign body;Goiter can disrupt the functioning of blood vessels, nerves and internal organs.

In Russia, doctors used the above classification for a long time. However, the greatest importance is the exact size of the gland, determined by ultrasound. External inspection is much less important, because it may be errors. The doctor sometimes finds it difficult to determine the thyroid gland in young people with well-developed muscles. At the same time, in thin people it can be clearly visible. In addition, the possibility of determining the size of the thyroid gland in each particular patient depends on the structure of the neck, the thickness of the muscles and the fatty layer, the location of the thyroid gland on the neck also plays a role.

Stressing the estimated value of determining the size of the thyroid gland during examination, in 1992 the World Health Organization proposed a simpler classification of goiter:

0 degree - the thyroid gland is palpable( that is, determined by the fingers when viewed), the size of the lobes correspond to the last( nail) phalanxfingers of the patient.

I degree-sizes of lobes exceed the size of the last phalanges of the patient's fingers.

II degree-thyroid gland is palpable and visible. The

ultrasound is not the very first method of examination that the doctor assigns to each patient. But, if the patient has an increase in the organ, the doctor usually prescribes ultrasound of the thyroid gland. The volume of the thyroid gland in this case is calculated as follows: it is calculated by measuring the three main sizes of each lobe of the thyroid gland. First, the volume of each fraction is calculated by the formula:

fraction volume = length x width x thickness x 0.479.

Before this, the dimensions of each lobe of the thyroid gland( length, width and thickness) are measured, and the dimensions of the isthmus are not given a diagnostically important value. After this calculation, the volumes of lobes are added together and the volume of the entire thyroid gland is obtained.

It is believed that in women the volume of the thyroid gland should not exceed 18 ml, and in men - 25 ml. Anything greater than this is an increase in the thyroid gland, or goiter. In children, the size of the gland is determined by special tables.

With varying degrees of thyroid enlargement, its functions may not be altered( this condition is called euthyroid goitre or euthyroidism), lowered( this is called hypothyroidism) or increased( in which case the thyroid functional state is characterized as hyperthyroidism).The level of the gland functions depends on the level of its hormones: the more hormones released into the blood, the higher the function.

1. Medical examination. The doctor not only examines the patient, but also clarifies the nature of his complaints, finds out when they first appeared, increased or decreased over time. After the examination and conversation with the patient, the doctor makes a presumptive diagnosis and appoints the necessary tests or sends the patient to a hospital for examination.

2. General blood test.

3. General analysis of urine-both these studies refer to the so-called "mandatory diagnostic mimimum", which the doctor, as a rule, appoints to all patients.

4. Determination of basic metabolism. The main exchange is the level of energy that the body needs to maintain vital activity in complete rest after a 12-hour fasting. The method is based on determining the consumption of oxygen and the release of carbon dioxide for a certain period of time. Then the energy costs of the body are calculated in kilocalories per day. The study is carried out with the help of special instruments-the so-called "metabolism".This takes into account the indicators of special tables, which are compiled based on the gender, age, mass and length of the human body. The district therapist of all these calculations, of course, will not be conducted. As a rule, the main exchange is determined by a doctor-endocrinologist, often when the patient is hospitalized in a specialized department.

5. Determination of biochemical parameters of blood( liver enzymes, bilirubin, blood protein, urea, creatinine, etc.).It allows to reveal changes in organs and tissues that often occur in various thyroid diseases.

6. Determination of blood cholesterol. With increased thyroid function, the level of cholesterol is lowered, while it is lowered, it is increased. However, the method is not 100%, since many elderly patients have an increase in the cholesterol level in the blood, associated with atherosclerosis, and not with the disease of the thyroid gland. The method is more informative in children.

7. The determination of the duration of the Achilles reflex can serve as an additional method for evaluating the function of the thyroid gland. The method is simple enough, harmless, accessible.

8. Ultrasound examination of the thyroid gland allows you to determine its size, the degree of increase, the presence or absence of nodes in it, etc.

9. X-ray examination also allows to determine the size and extent of enlargement of the thyroid gland. In children, in addition to the chest X-ray, X-rays of the hands are often performed, which makes it possible to determine the so-called "bone age": in some thyroid diseases, it may lag behind the passport or outstrip it. Bone age reflects physical development, the rate of which in children can vary with various diseases.

10. Computer tomography and magnetic resonance imaging of the thyroid. With its help, you can determine the position of the thyroid gland, its contours, dimensions, structure, determine the density of nodes.

11. Determination of iodine associated with serum proteins. It characterizes the functional activity of the thyroid gland.

12. Radioimmunological methods for determining thyroid hormones. The content of thyroxine, triiodothyronine is determined, and more detailed analyzes are sometimes carried out. Highly informative is the definition of thyroid-stimulating hormone in the blood serum. Currently, a method is also used, such as the definition of antithyroid antibodies( more about them is written in the section "Diffuse toxic goiter").

13. The study of the absorption of radioactive iodine by the thyroid gland is not universally applied. In children this method is used only on strict indications( that is, if necessary)!

14. Puncture biopsy of the thyroid gland consists in the fact that the thyroid gland is punctured, then its structure is studied under a microscope.

15. X-ray diffraction of the thyroid gland is an X-ray study associated with the administration of contrast agents in the thyroid gland. Usually, an iodine-containing lipidol is formulated.

16. Additional research methods: electrocardiography, electroencephalography, etc. It should be remembered that not all methods must necessarily be used in each patient, but a single, universal method that with 100% accuracy would allow to determine a particular thyroid disease, notexist. The doctor chooses the research methods that are most suitable for this particular patient, taking into account the possibilities of the medical institution.

The main and most sensitive method of diagnosing thyroid diseases is to determine the level of thyroid-stimulating hormone( TSH), hormones T4 and T3 in the blood.

The TSH content standard( according to different sources, depending on the laboratory and method): 0.2-3.2 mIU / L;0.5-5.5 mIU / l.

The thyroid-stimulating hormone of the pituitary gland controls the activity of the thyroid gland. If its concentration is increased, this indicates a decrease in thyroid function. That is, the thyroid-stimulating hormone, as it were, "with all its might" tries to spur its activity. Conversely, with an increase in thyroid function, the thyroid-stimulating hormone "can rest", accordingly its concentration in the blood is reduced.

In case of thyroid dysfunction, the content of its own hormones in the blood is also measured.

Norm: 50-113 ng / ml;5-12 μg%( 4-11 μg%);65-156 nmol / l( 51 - 142 nmol / l) - depending on the method.

Thyroxine T4 is one of the forms of the thyroid hormone;it is formed in the thyroid gland, but does not have a particular effect on the metabolism. The more active form of the hormone is triiodothyronine( T3).T4 is converted to T3 in the liver.

Both T4 and T3 circulate in the blood mainly in the bound state, and in this form hormones are not active. Therefore the general or common level of a thyroxine a little that speaks about hormonal activity of a thyroid gland. The level of thyroxine varies with the change in the content of carrier proteins, and their concentration in turn changes in many states: pregnancy, medication, in many diseases.

The hormonal activity of the thyroid gland is determined by the concentration of free T3 and T4.

Increase in the total serum thyroxine concentration is observed nevertheless with increased thyroid function( hyperthyroidism), sometimes with acute thyroiditis or acromegaly.

Decrease in this index occurs in primary and secondary hypothyroidism( decrease in thyroid function), as well as in decreasing the concentration of thyroxine-binding protein( carrier protein).

Norm: 0.8-2.4 ng%( 0.01-0.03 nmol / l).

The activity of thyroid hormone T4 depends on the concentration of free T4.

An increase in free thyroxine is observed with hyperthyroidism( increased function of the thyroid gland), sometimes with active thyroiditis.

A decrease in this indicator occurs with hypothyroidism( reduced thyroid function).

Norm: 0,8-2,0 ng / ml.

T3, like T4, is associated with proteins in the blood, so the change in the content of serum proteins affects the level of total triiodothyronine as well as at the level of thyroxin.

Norm: 2-4.8 mg%.

TSG is the main carrier protein for thyroid hormones T3 and T4 in blood plasma. When the concentration of the carrier protein changes, the concentration of T4 also changes accordingly. Due to this, the regulation and maintenance of such a level of free hormones that is required for the normal functioning of the organism at a given moment occurs.

Concentration of TSH increases in pregnancy, viral hepatitis;sometimes an elevated concentration of TSH is due to heredity. In addition, the level of TSH is elevated if a woman is taking hormonal medications or, in general, any preparations of estrogens.

Narcotic drugs and certain drugs( eg clofibrate, methadone) also increase the level of TSH in the blood.

The decrease in the concentration of TSH is observed with the following diseases and conditions:

Drugs that lower the level of TSH in the blood are aspirin and furosemide, anabolic steroids, and other steroid preparations in high doses.

Antibodies are substances that the immune system produces to fight antigens. Against a certain antigen are strictly defined antibodies, so their presence in the blood allows you to conclude on which "enemy" the organism is fighting. Sometimes the antibodies formed in the body during the illness remain forever. In other cases - for example, in autoimmune diseases - antibodies are detected in the blood against certain own antigens of the body, on the basis of which an accurate diagnosis can be made.

If it is required to confirm the autoimmune nature of thyroid disease, then the determination of the level of antibodies in the blood to its cells - antithyroid antibodies, or antibodies to thyroglobulin - is applied.

Perhaps there is no such area of ​​modern medicine in which ultrasound is not used - ultrasound. The ultrasound method is harmless and has no contraindications. By results of US it is possible to define the sizes and the form of many organs, the changed sites and a liquid in a pleural or abdominal cavity, presence of stones in kidneys and a cholic bubble.

When suspected of most thyroid diseases, ultrasound can mainly determine that the thyroid nodule is( or is not) a cyst. As a rule, other, more complex diagnostic methods are required.

This study is based on the ability of the thyroid gland to capture i131 iodine. With normal thyroid function, iodine absorption is 6-18% after 2 hours, 8-24% after 4 hours and 14-40% after 24 hours. With reduced thyroid function, the absorption of radioactive iodine is reduced. It is necessary to know that the same results can also be obtained if the patient took medications containing iodine or bromine or simply iodized skin. The study is conducted one and a half to two months after the withdrawal of such drugs.

Scintigraphy - a scan of the thyroid gland with the use of radioactive iodine or technetium.

When performing a scintigraphy of the thyroid gland with technetium, a fluid containing a radioactive preparation of technetium - a substance that, like iodine, accumulates in the thyroid gland, is injected into the vein of the hand. Due to this, the sizes and functional activity of the thyroid gland are determined with the help of devices. Functionally inactive nodes - they are called "cold" nodes - are recorded on the scan as rare strokes. The accumulation of I 131 in them is reduced. In the field of functionally active - "hot" - nodes accumulation of I131 is strengthened, and on the scan they are recorded as densely shaded areas. The dose of radiation with this survey is small.

Thermography - the registration of infrared radiation, which allows more confident than scintigraphy, to suspect the malignancy of the node: cancer cells have a more active metabolism and, accordingly, a higher temperature than benign nodes.

Fine-needle aspiration biopsy of the thyroid gland - taking cells from the "suspicious" part of the gland for subsequent histological and cytological analysis - is used for suspected neoplasm and allows you to establish whether it is benign or malignant.

The doctor injects a very thin needle into the thyroid and, pulling the syringe piston, takes a sample of the gland tissue - either from a single node, or from the largest node( with a multi-node goiter), or from the densest part of the gland. Further this tissue sample is examined in the laboratory.

The only possible complication is a small hemorrhage in the thyroid gland, which quickly passes. Serious bleeding can only be in people with reduced blood coagulability, so if you belong to this category, then you need to warn the doctor about it.

Symptoms of any disease are caused by changes in the function of the affected organ and / or changes in the organ itself.

Dysfunctions of the thyroid gland can manifest itself in two forms: hypothyroidism - a decrease in its function and, accordingly, the level of thyroid hormones in the blood, and hyperthyroidism( thyrotoxicosis) - an increase in the level of thyroid hormones.

Sometimes thyroid disease occurs without a marked change in the level of its hormones.

The change in the thyroid gland is usually expressed in the formation of goiter - an increase in the gland. The goiter can be diffuse( with a uniform increase in the gland) or nodular - with the formation of individual seals in it.

The goiter may be associated with hypothyroidism or hyperthyroidism, but often the thyroid gland is enlarged in order to produce the necessary amount of hormones, in other words - that the gland function remains normal.

It must be emphasized that hypothyroidism and hyperthyroidism are not diseases, but functional states of the thyroid gland( more precisely, of the whole organism) at a given time.

This is the name of a specific condition, when the results of tests indicate that the function of the thyroid gland is broken, in fact it works perfectly normal. Most often it happens in people who are seriously ill, exhausted or have undergone a serious operation. In this state, an inactive( bound) form of T3 accumulates in excess in the body.

There is no need to treat the thyroid gland with pseudodysfunction. After curing the underlying disease, laboratory indicators return to normal.

Any thyroid disease occurs in women many times more often than men. The thyroid gland in women is exposed to very high loads during pregnancy. Iodine for the production of thyroid hormones the fetus can get, of course, only "through" the mother's body. And for this, a future mother should receive virtually twice as much iodine as before pregnancy.

However, among those who are not pregnant and have never given birth, there are also many people who suffer from thyroid diseases.

Women are several times more likely than men to suffer from so-called autoimmune diseases. At least two diseases of the thyroid gland are of an autoimmune nature: Hashimoto's thyroiditis( manifested by hypothyroidism) and diffuse toxic goiter, or Basedova's disease( manifested by hyperthyroidism).

The essence of the autoimmune reaction is that the immune system "attacks" the body's own tissues.

Hypothyroidism is a condition caused by a prolonged, persistent deficiency of thyroid hormones.

Hypothyroidism can be primary, secondary and tertiary. Primary hypothyroidism is associated with the pathology of the thyroid gland itself, secondary - with the pathology of the pituitary gland, tertiary - with the pathology of the hypothalamus.

The most common causes of primary hypothyroidism are Hashimoto's thyroiditis, partial or complete thyroidectomy, treatment with radioactive iodine, lack of iodine in nutrition. A rare cause is congenital defects in the development of the thyroid gland.

Secondary hypothyroidism is rare. The reason for this is the lack of production of TSH( thyroid-stimulating hormone), caused by insufficiency of the anterior lobe of the pituitary gland.

Tertiary hypothyroidism is even more rare.

In hypothyroidism, regardless of its cause and whether it is primary, secondary or tertiary, all metabolism slows down in the body, its overall energy is reduced. Symptoms develop gradually:

Thyroid disease, even if not cured completely, is at least well controlled. If you do not engage in the thyroid gland, it will have a bad effect on the condition of the heart.

This is one of the most dangerous complications of hypothyroidism, which can be triggered by cold, infection, trauma, some tranquilizers and sedatives. At the same time, breathing slows down, there are convulsions, insufficient blood supply to the brain. Hypothyroid coma is a life threatening condition requiring immediate hospitalization!

Even with a general examination of patients with hypothyroidism, anemia, increased cholesterol in the blood, and an increase in ESR are often detected.

There is a decrease in the level of total and free T4 in serum and an increase in the level of TSH.An increase in the level of TSH at a normal T4 level is characteristic of latent "subclinical" hypothyroidism.

With secondary hypothyroidism, the level of TSH can be reduced.

Absorption of I131 by the thyroid gland is reduced( less than 10%), but if the cause of hypothyroidism is autoimmune thyroiditis or iodine deficiency, then iodine uptake may be, on the contrary, increased.

Hypothyroidism affects 2-5% of the population of our country, and another 20-40% hypothyroidism manifests a few mild symptoms. In women, this condition is observed in 5-7( and according to some data - 10) times more often than in men;older people suffer from hypothyroidism more often than young people. But, despite the large prevalence, hypothyroidism often remains undetected. This is due to the fact that many of his symptoms( lethargy, drowsiness, sluggishness, brittle hair, puffiness of the face, chilliness, etc.) are not characteristic and can be mistaken for manifestations of other diseases. Sometimes the diagnosis can be made only on laboratory data.

Iodine deficiency is the most frequent and, perhaps, the most simple reason for reducing the thyroid function. Iodine is required for the synthesis of thyroid hormones, and its organism can be obtained only from the environment - with food and water. And this means that iodine should be enough in the water and soil of the area where the food that we consume grows and "runs".

Endemic goiter I-II degree( "endemic" means "common in a certain area") is sick with 20-40% of Russians, III-IV degree - 3-4%.In St. Petersburg, the intake of iodine with water and food averages 40 μg at a rate of 150-200 μg.

Uniform, without nodal formations, an increase in the thyroid gland( diffuse non-toxic goiter) is the most frequent manifestation of insufficient intake of iodine in the body.

With moderately expressed stages of the disease, the hormonal system copes with iodine deficiency due to compensatory mechanisms: the pituitary gland begins to synthesize TSH intensively, thereby stimulating the function of the thyroid gland. The concentration of thyroid hormones in the blood at the same time remains at a more or less normal level, because of what this form of goiter is sometimes called "euthyroid"( "correct hormone").

Euthyroid goiter often develops at the onset of puberty, during pregnancy and during the postmenopausal period.

Not only the lack of iodine in the diet can be the cause of such goiter, but also such factors as, for example, consumption of zobogenic products, in particular turnips.

In addition, quite a few drugs can inhibit the synthesis of thyroid hormones and, as a consequence, lead to the development of goiter: aminosalicylic acid, sulfonylurea preparations( antidiabetic drugs), lithium preparations, and iodine in large doses.

Another frequent manifestation of iodine deficiency in adults is nodular goiter. In conditions of shortage of iodine, some thyroid cells can acquire partial or complete independence from the regulating influence of the thyroid-stimulating hormone of the pituitary( TSH) and grow into one or more nodal formations. Autonomous nodes in the thyroid gland are most often found in people older than 50-55 years.

The effects of iodine deficiency on health are not limited to goiter. The lack of thyroid hormones in the tissues - the main stimulants of all metabolic processes - affects the entire body, especially those organs and tissues that require accelerated metabolism, and primarily the brain. This is especially important in childhood. Iodine deficiency during intrauterine development and in the first years of a child's life can lead to severe forms of dementia( cretinism).In adults, the consequence of a lack of iodine in the environment can be a moderate decrease in intellectual capacity.

Adults and adolescents - 100-200 micrograms( micrograms) per day;

Infants and children under 12 years of age - 50-100 mcg;

Pregnant women and mothers breastfeeding - 200 mcg;

To people who underwent surgery for goiter, 100-200 micrograms per day.

The average level of iodine intake in the US is 500 mcg, in Japan it is up to 1000 mcg.

The goiter is common among highlanders, in parts of Central Asia, in Egypt, Brazil, Congo, India. In these areas, there is not enough iodine in nature( water, air and soil).As a result, the body receives less iodine than it needs, and the thyroid gland increases. First, the enlargement of the gland is beneficial to the body, since it helps improve its function. However, with time thyroid function may be impaired. Dangerous are the nodular forms of goiter, when the gland tissue acquires the form of nodes: it can degenerate into a tumor.

There is almost no goiter in the coastal areas and in areas with black earth soil: in such places, natural iodine is sufficient for the body.

The content of iodine in the atmosphere is of great importance. Most likely, that is why in the coastal areas people do not suffer from this disease: when evaporation of sea water, iodine from it enters the air, then gets into the soil, into lakes, streams and rivers. The height of the terrain above sea level and its nature are also important. In the highlands, iodine content is reduced not only in soil but also in the air. You can correct the existing state of things with the help of food. The unfavorable social and living conditions play a role, as well as a hereditary predisposition to the formation of goiter.

There is no iodine deficiency in the USA, Canada, Australia, the countries of Scandinavia.

Iodine deficiency is a serious problem in Congo, Bangladesh, Bolivia, Afghanistan, Tajikistan.

Despite the fact that Russia does not yet have this list, the problem of iodine deficiency for our country is very urgent! The fact is that most of those who live in the iodine deficiency region do not make any expressed complaints about their health condition, so they are often left without attention. A lack of iodine may not necessarily be strong.

The territories with mild iodine deficiency include Moscow, St. Petersburg, Lipetsk, Krasnodar, Sakhalin;as well as the United States and Japan.

The regions with severe iodine deficiency include the Republic of Tuva( more than 30% of the population are sick here), the Arkhangelsk region( more than half of people are sick with goiter), the Republic of Sakha( Yakutia) - up to 39% of the population suffers from goitre. There is little iodine in Africa, in Madagascar, in most Asian countries.

The districts with an average iodine deficiency include the Moscow, Nizhny Novgorod, Yaroslavl regions, as well as many other cities and regions of Russia;Portugal, Spain, Italy, South America, the Iberian Peninsula.

In the worst case, a person awaits cretinism - a sharp lag in mental development, up to the total inability to serve themselves and navigate in the surrounding environment. But there are few nerfs among the sick - no more than 10%.Up to a third of patients complain of brain disorders. And the remaining 60-70% -all only to reduce mental and physical performance.

How is it manifested? In adults, fatigue, weakness, especially at the end of the week and the working day;drowsiness, lethargy;can be a decrease in mood, potency, sex drive. A person becomes passive, not much interested.

Adolescents may not only have mood and behavior disorders, but also poor performance. Children spend a lot of time on books, but still do not learn the material. Many of them often get sick. Girls are delayed and later on they are menstruating, boys lag behind their peers in growth and physical development.

Development in children is disrupted. And for them, this is especially important: the emerging organism loses iodine, and therefore can not assimilate the information necessary for the development. Such children later start talking, walking, running;less inclined to moving games and are more likely to get sick when entering a day nursery and kindergarten.

But this all happens if a woman has managed to endure and give birth to a child. After all, pregnant women with a deficiency of iodine often have miscarriages, stillbirths;children are more often born with vices and deformities. Many women for years are treated for infertility, not knowing that the cause of everything is iodine deficiency.

Severe forms of iodine deficiency associated with hypothyroidism( cretinism), it is not difficult to reveal even to people far from medicine. The most dangerous if a severe shortage of iodine accompanies the child from early childhood. These children are inactive, their skin is swollen, they have a dull facial expression, the tongue is big, it does not fit in the mouth, breathing is noisy, heavy. Hair is dry and brittle, teeth grow wrong. Appetite is reduced, body proportions are disturbed. There is a marked lag in mental development. With a sharp lack of iodine in the environment, signs of the disease can manifest themselves in initially healthy children: over time, the child becomes less active, begins to lag behind in growth, his mental development slows down.

The severe iodine deficiency in the region is indicated by the increase in the number of sick men in relation to the number of women( as a goiter is more "female", the ratio is 1: 3 is considered unfavorable), an increase in the incidence( up to 60% of the population in such regions may suffer from goiter), frequenting of the most dangerous - nodular forms of goiter.

According to ITAR-TASS in 2001, the number of children with intellectual disabilities in Russia has increased by 20% in the previous 5 years. Psychological disorders are detected in 15% of all children. It is impossible to say unambiguously that this sad statistics is associated with iodine deficiency in the environment. But you can not neglect this factor. It has been proved that with a lack of iodine, the level of intelligence of both adults and schoolchildren is reduced. And this means that it will be more difficult for young people to study at school, in a school, in a university, it will be more difficult to master new professions and skills.

Diffuse, nodular and mixed goiter are distinguished in form. The thyroid gland increases in all cases. But in the first case, it is evenly affected, in the second, knots are formed in its tissue, and in the third case, both are combined.

In ancient times, treated goiter with the help of seafood, seaweed and sea salt. Now such measures are taken mainly for prevention. Although, in any case, with endemic goiter, patients need a certain diet. A large amount of iodine contains sea products. Iodine is also found in: feijoa( especially in feijoa), barberry( roots, berries, leaves), cranberries, onions, leeks, asparagus, beets, cod liver, lettuce, melon, mushrooms, green peas, radish, radish, strawberries, tomatoes, turnip, walnut, garlic, egg yolk, bananas, spinach, rhubarb, potatoes, peas, apple seeds, dark berries( blackberry raspberry, black currant, blackberry, blueberry).Completely fill the deficit of iodine, these products can not, but in regions that are not rich in iodine, they must be eaten. However, most of these products also contain vitamins and minerals, so in any case are useful.

For the normal functioning of the thyroid gland in the body, in addition to iodine, the presence of other elements is desirable: zinc, molybdenum, vanadium, zirconium. A lot of molybdenum is found in cabbage, carrots, oats, radish, ashberry, garlic. Zinc is abundant in wheat bran, wheat germ, barberry, valerian, ginseng, nettle, raspberry, carrot, parsley, radish, black currant, sorrel, gooseberry, legumes, liver of animals. Vanadium and zirconium can be obtained from food products such as cucumbers, melons, watermelons. Widely known sedative herbs, mint and lemon balm also contain vanadium and zirconium. It is believed that these herbs are useful to put in tea - both for enriching with vitamins, and for improving taste.

In the treatment of goiter, iodine and thyroid medications are used. Preparations of thyroid hormones are usually prescribed for diffuse forms of goiter( for which there are no nodes in the thyroid gland), accompanied by a decrease in thyroid function. You can treat endemic goiter only with the help of a doctor. In no case is self-treatment unacceptable!

Immediately it is worth mentioning: these methods do not replace iodine-containing drugs and treatment by a doctor. They can only be used as an adjunct to treatment. It is believed that the traditional medicine improves the condition of the patient -if, of course, he applies them not instead of, but together with the means recommended by the endocrinologist.

With an increase in the thyroid gland, lemons and oranges can be useful. Citrus fruits are used as follows: one lemon and one orange( without pits) are scrolled in a meat grinder with a peel, then a spoon of honey is added to this mixture, it is infused for 24 hours and taken with boiling water 1 teaspoon 3 times a day.

In goiter, grasses are used, such as the swamp, swamp green, European zuznik, knotty cinnamon. Kasatik marsh is used in the form of tincture: the herb infused with 70% alcohol is taken 2 tablespoons 3 times a day. The bedstrawer is tenacious in the form of infusion: 2 tablespoons of raw material are poured into 2 cups of boiling water and insisted. Infusion is used in half a cup 3 times a day. Used and infusion zyuznika European: 30 g of grass poured a glass of boiling water and insisted;Apply 2 tablespoons 3 times a day. Cinnamon knotty can be used in goiter as follows: 1 teaspoon of roots is infused in 1 cup of boiling water until cooled. Then the infusion is drunk gradually during the day, for 1 day - 1 glass.

It is believed that the thyroid gland stabilizes a well-known plant such as hawthorn. Infusion of dried hawthorn fruit( 1 dessert spoonful per cup of boiling water) is taken half a cup twice a day.

The WHO Special Commission recommended for the prevention of iodine deficiency add 2 parts of potassium iodide per 100,000 parts of table salt to the salt. Mass iodine prophylaxis, organized centrally in disadvantaged regions in the goiter, allows to reduce the incidence of goiter in both adults and children. However, even after the prevention, the danger of goiter in these regions does not disappear: the natural and climatic data remains the same, which means that iodine will still be inadequate in the environment. Therefore, some time after the cessation of iodine prophylaxis, the number of goitre patients will increase again. The task of local and central authorities, health authorities-to carry out preventive measures again and again, do not leave the region without attention.

You can check with your local therapist about whether your area is iodine deficient. If your region is iodine deficient, then it is necessary to replenish artificially by what nature does not give us. There are three ways: to take iodine preparations, natural products rich in iodine, as well as what our industry produces-iodized bread and iodized salt. In nature, many iodine contain seafood: mussels, shrimps, crabs;the most inexpensive and affordable to the wide consumer is the sea kale( seafood is not customary for our cuisine, so at the end of our book we give recipes of dishes from these products).But there is a need to eat seafood regularly, from day to day, and not from case to case, otherwise you will not cover a deficit. Not everyone is able to afford it.

Where it is easier to buy special iodine preparations sold in the pharmacy, and drink them in courses. Only to buy it is necessary to MEDICINE, and not biologically active additive: it is difficult to trace the true content of all components, and an overdose of iodine is as dangerous as its deficiency. It is believed that children and pregnant women living in iodine deficient regions should receive such medications NECESSARILY: no matter how hard you try, you can not make up for their daily needs.

For whom iodine preparations are dangerous:

is for older people with signs of goiter.

-for patients with nodular goiter forms.

- for unopened people presenting complaints. Such people can not drink iodine preparations without consulting a doctor.

Iodized bread in our stores can be found rarely. But here are the iodized salts - please, as much as you like. Yes, only almost no one uses it: according to physicians, only 2.7 to 20.4% of families regularly eat iodized salt. Meanwhile, in dysfunctional regions, everyone should do this! Iodized salt is not dangerous, overdose is completely excluded. The fact is that there is a special blocker in the thyroid gland, which comes into play if too much iodine enters the body. In general, physicians consider a safe dose of up to 300 micrograms of iodine per day.

Most people, alas, reason otherwise. Salary is small, the pension is small, a pack of ordinary salt is cheaper than iodized for two rubles. At first glance it seems that it is cheaper - it means, it is more profitable. Meanwhile, each of us eats only one pack of salt for a year. A maximum of two. It turns out - four rubles a year for their own health. Is it cheap or expensive? To solve to us. ..

During pregnancy, a woman's need for iodine increases dramatically. To develop the nervous system of the child, thyroid hormones are needed, which the baby receives while in the womb of the mother. Therefore, the load on the thyroid gland in a woman during pregnancy increases. If there is enough iodine in the body, then the woman will not have any consequences. If iodine does not go to the body, then a pregnant woman can develop goiter. At the same time, the amount of iodine that came into the woman's body not only during pregnancy but also earlier is important. In other words, if a woman before pregnancy is constantly under-received iodine, the consequences of this may manifest later. In this case, goiter can be formed not only in the woman herself, but also in the child.

So, the Belgian researcher D. Glinoer, in the region with moderate iodine deficiency, the thyroid volume in women increased by 30% at the end of pregnancy, while in 20% of all pregnant women the volume of the thyroid gland was 23-35 ml( instead of 18 ml, whichshould be normal).Even after giving birth, the size of the thyroid gland in many women did not return to those that were before.

Similar data were presented by another foreign researcher - P. Smith. According to him, with iodine deficiency, the volume of the thyroid gland in pregnant women increased almost half, while in normal conditions - only by 20%.Researchers note that a small increase in the thyroid gland by the end of pregnancy occurs in almost all women. This is considered a variant of the norm.

In addition, the researchers found that in women who received iodine prophylaxis during pregnancy, children are born with a smaller volume of the thyroid gland than those women who did not receive iodine prophylaxis. On average, the volume of the thyroid gland in such babies was almost one-third. An increase in the thyroid gland is determined on average for every tenth newborn, if his mother did not receive iodine during pregnancy, the families living in iodine-deficient regions are referred to.

Infants, teenagers during puberty, pregnant women, nursing mothers are most sensitive to iodine deficiency. In general, women are more prone to iodine deficiency disorders than men.

In addition, a sufficient supply of iodine, like any other nutrients, into the body is only one side of the coin;the other side is the degree of absorption from the intestine. In addition, the individual characteristics of the organism are also important.

Assimilation of iodine by the body depends on the presence or absence of other substances in food. Some plant products contain substances that prevent the entry of iodine into the thyroid gland or inhibit the activity of the enzyme necessary for the synthesis of thyroid hormones. Such plant products include cabbage, radish, rutabaga, sunflower, dill, beans.

All of the above should be taken into account, but if iodine enters the body a little, it will have to be artificially added.

ATTENTION!Just do not take in the alcohol tincture of iodine or Lugol's solution! These medicines are for external use, iodine in them is contained in huge quantities, and its overdose is as dangerous as the deficit.

The main way to treat and prevent disorders caused by lack of iodine is the inclusion of iodine-rich foods in the diet. And the cheapest way of prevention and treatment of iodine deficiency states is the use of iodized salt. Iodine is also a part of many modern multivitamin preparations with trace elements.

Most of all iodine is found in seafood, including fish. However, different types of fish are very different in this respect. In most species of fish, the iodine content ranges from 5 μg to 50 μg in 100 g.

In prawns, 110 μg, in pinniped meat - 130 μg. Iodine rich squid, mussels and other mollusks. And, of course, the highest content of iodine in sea kale is laminaria.

Sea kale comes on sale in the form of canned food, frozen, and also in dried form. Dried must first be cleaned of mechanical impurities, then soak for 10-12 hours in cold water( for 1 kg of cabbage 7 - 8 liters of water), then rinse thoroughly. Frozen cabbage is thawed in cold water, then washed.

Boiled sea kale: pour cold water, quickly bring to a boil and keep on low heat for 15-20 minutes. After that, the broth is drained, cabbage is poured with warm water( 45-50 ° C) and after boiling, another 15-20 minutes are cooked. The broth is drained, poured with warm water and boiled for the third time, after which the broth is drained again. After such three-fold cooking of sea cabbage, its taste, smell and color improve significantly.

It must be said that the products listed above( except, of course, mineral waters) can contain very different amounts of iodine depending on the area.

In the grain, iodine is contained in the germinal part, so the most rich in iodine are grades of bread from low-grade flour, with bran.

When cooking, the iodine content in food decreases very significantly.

Special iodinated products

In hypothyroidism, a diet with a moderate reduced energy value is recommended - by 10-20% compared to the physiological norm. The content of carbohydrates and, especially, fats should be reduced in the diet. The protein content is within the physiological norm.

On the average it is recommended: 70 g protein, 70 g fat( 25 g - vegetable), 300 g carbohydrates.

Caloric content of the diet - no more than 2100 kcal.

It is necessary to limit primarily saturated fats and foods rich in cholesterol.

Iodine content in other( non-marine) products( in μg, in 100 g):

Exclude: fatty meat and dairy products, hydrogenated fats, solid margarine.

It is necessary to use in sufficient quantity products that have laxative properties, in particular vegetables and fruits, berries, juices, dairy products.

Cope with constipation helps and motor activity.

Belip

With hypothyroidism, calcium metabolism is also almost always disturbed, so people with thyroid function deficiency will be very helpful with belip( a protein-lipid product).It is a combination of low-fat fresh cottage cheese, cod and vegetable oil. Thus, belip contains deficient amino acids, polyunsaturated fatty acids, easily digestible calcium and many trace elements, including iodine.

For the preparation of fresh cottage cheese, calcium lactate or calcium chloride is used. To the skim milk, calcium lactate is added at the rate of 5-7 g per 1 liter of milk or to skim milk, heated to 25-30 ° C, add 2.5 ml( about 1/2 teaspoon) of a 40% solution of calcium chloride. Cottage cheese is pressed to a humidity of 65%.

Next, prepare a mixture of this cheese and raw crushed cod( 1: 1), from this mixture you can make pates, knels, meatballs, cutlets, etc.

Belip

Cod fillets, peel, rinse with cold water, get water andslightly wring out. Bread soaked in water;chop onion and fry in oil. Fish to pass 2 times through a meat grinder and mix with cottage cheese, bread, onions, then again pass through a meat grinder, salt, pepper and stir well. From the received forcemeat prepare cutlets, little bits, etc.; you can use it as a pie filling.

Preparations of thyroid hormones - thyroid hormones - are used primarily as a substitution therapy for hypothyroidism. In addition, they are prescribed for suppressive( suppressive) therapy in diffuse non-toxic goiter and thyroid neoplasms, to prevent recurrence of goiter after partial removal of the thyroid gland.

In clinical practice, drugs levothyroxine, triiodothyronine, as well as combined preparations are used. The main drug( the so-called drug of choice) for maintenance therapy is levothyroxine.

When primary hypothyroidism and endemic goiter during treatment with thyroid hormones, it is necessary to control the level of TSH( thyroid-stimulating hormone);with secondary hypothyroidism - the level of free T4.The TSH level should be determined 2 months after the selection of the maintenance dose, and then every 6 months.

Elderly people are first prescribed small doses( 25 μg), which then for 6-12 weeks increase to a full maintenance dose.

With extreme caution, thyroidin hormones are prescribed to people with coronary heart disease, arterial hypertension, impaired liver and kidney function. If the patient has cardiovascular diseases, it is necessary to monitor the condition of the cardiovascular system( ECG, Echo-KG).

WARNING!A maintenance dose can be chosen only by an endocrinologist under close clinical control, since a sick person may have angina attacks.

During pregnancy, the need for thyroid hormones increases by 30-45%, so the dose is increased. In the puerperium, the dose is reduced.

Produced in tablets at 0.05 and 0.1 mg( 50 and 100 μg).

Indications. Hypothyroidism( as a substitute therapy), diffuse nontoxic( euthyroid) goiter( for treatment and prevention), endemic goiter, autoimmune thyroiditis, thyroid cancer( after surgical treatment).

It is also used for diagnostic purposes - for evaluating the function of the thyroid gland.

Methods of administration and dose of .Take inside once a day, in the morning, at least 30 minutes before breakfast;washed down with water. A dose of more than 150 mcg is recommended to be divided into 2 doses.

When hypothyroidism begins with a dose of 50 μg( 0.05 mg) per day, in some cases( elderly people, patients with IHD) appoint 25 μg( 0.025 mg) per day. The usual maintenance dose is 75-150 μg( 0.75-0.15 mg) per day.

Every 2-3 weeks monitor the condition, determine the level of TSH in the blood and if necessary increase the dose. The drug acts slowly, the effect is observed after 4-5 weeks from the start of treatment.

At the nodes appoint 150-200 mcg( 0.15-0.2 mg) per day for 3 months, with incomplete effect - up to 6 months.

Maximum doses. In most cases, the effective dose for treatment of hypothyroidism does not exceed 200 μg( 0.2 mg) per day.

Side effects. Adverse reactions are rare, mainly due to an overdose and are symptoms typical of hyperthyroidism:

When these symptoms appear, the dose should be reduced.

For acute, severe signs of overdose, symptomatic therapy is performed: gastric lavage is done, beta-blockers, glucocorticoids are prescribed, etc.

Contraindications

Interaction with other drugs

With the simultaneous use of levothyroxine and antidiabetics, it may be necessary to increase the doses of the latter.

With simultaneous use of levothyroxine and anticoagulants, it is sometimes necessary to reduce the dose of the latter.

When used simultaneously with estrogens( including estrogen-containing oral contraceptives), an increase in the dose of levothyroxine may be required.

Phenytoin, salicylates, clofibrate, furosemide( in high doses) can enhance the action of levothyroxine.

Produced in tablets of 0.05 mg( 50 μg).

Indications. Primary hypothyroidism and myxedema, cretinism;cerebral-pituitary diseases that occur with hypothyroidism;obesity with hypothyroidism, endemic and sporadic goiter, thyroid cancer.

Methods of administration and dose of .Doses are set individually, taking into account the nature and course of the disease, the age of the patient and other factors.

Since triiodothyronine( T3) rapidly decomposes in the body, it is prescribed fractional - 3-4 times a day.

The initial dose for adults is 20 μg( 0.02 mg) per day. The dose is increased for 7-10 days to a full replacement dose of 60 μg( 0.06 mg) per day, in 2-3 doses.

Side effects. Overdose may cause thyrotoxicosis symptoms:

Contraindications

Thyreocomments

1 tablet contains 0.01 mg of triiodothyronine, 0.07 mg of L-thyroxine and 0.15 mg of potassium iodide. Indications for use the same as for triiodothyronine. Assign an average of 1/22 tablets per day.

Thyrotom

1 tablet contains 0.04 mg of triiodothyronine and 0.01 mg of L-thyroxine. Due to the presence of T3( triiodothyronine), the effect occurs quickly;due to the presence of T,( L-thyroxine) effect is more prolonged than when treated only with triiodothyronine. The initial dose is 1 tablet a day, gradually increasing the dose to 2-3 tablets per day. The daily dose for the elderly is 1 - 11/2 tablets.

Iodothyrox

1 tablet contains 0.1 mg( 100 μg) of levothyroxine sodium and 0.1308 mg( 130.8 μg) of potassium iodide( 100 μg iodine).

Polyglandular insufficiency syndrome is characterized by a decrease in the function of several endocrine glands and the body is deficient in several hormones.

The cause of polyglandular insufficiency syndrome may be a genetic predisposition to this condition;it is often a consequence of an autoimmune reaction;sometimes the activity of the endocrine gland is suppressed as a result of infection;in other cases, the cause is a disturbed blood supply or a tumor.

Usually at first some endocrine gland is affected, and behind it and others. Symptoms, of course, depend on which glands are affected. In accordance with this, and also taking into account the age of patients, polyglandular insufficiency syndromes are divided into three types.

Usually begins as a child. This type of polyglandular insufficiency is characterized by a decrease in the function of parathyroid zhelez( hypoparathyroidism) and adrenal glands( Addison's disease), and in addition - fungal infections, in particular chronic candidiasis. Obviously, it arises from a violation of immunity.

Quite frequent manifestations in this type of polyglandular insufficiency syndrome are cholelithiasis, hepatitis, malabsorption( poor intestinal absorption), and early baldness.

It is rare that insulin secretion in the pancreas decreases, which leads to the development of diabetes mellitus.

Most often develops in people at the age of about 30 years. In this type of polyglandular insufficiency, the function of the adrenal gland is always reduced, and very often the thyroid gland function is impaired, it is more often decreased, but occasionally, on the contrary, it is increased. More often than with polyglandular insufficiency of type I, the function of islet cells of the pancreas decreases and, as a consequence, diabetes develops.

This type of polyglandular insufficiency is sometimes considered as a previous type II stage. It also develops in adults. It can be suspected if the patient has at least two of the following symptoms:

If, in addition to two of these symptoms, there is adrenal insufficiency, then the diagnosis of type II polyglandular insufficiency syndrome.

Treatment of polyglandular insufficiency syndromes is only symptomatic - replacement therapy with appropriate hormones: thyroid - with hypothyroidism, corticosteroids - with adrenal insufficiency, insulin - with diabetes.

Hyperthyroidism, or thyrotoxicosis, is a condition in which the activity of the thyroid gland is increased and too many thyroid hormones are produced. In women, hyperthyroidism is noted 5-10 times more often than in men. At the age of 20 to 40 years, the cause is usually diffuse toxic goiter( Basedova disease, Graves' disease), and after 40 years - toxic multinodular goiter.

A less common cause of hyperthyroidism is toxic thyroid adenoma. In addition, subacute thyroiditis in the initial stage, usually accompanied by hyperthyroidism( the so-called "thyrotoxicosis leakage").Such thyroid disease as asymptomatic( or painless) thyroiditis also leads to hyperthyroidism. Finally, there may be an artificial thyrotoxicosis - for example, with an overdose of thyroid hormones, and sometimes even deliberate use of them.

Quite rare causes of hyperthyroidism are diseases of the non-thyroid gland, and other organs, usually a tumor:

A rare cause of hyperthyroidism is also metastasizing follicular thyroid cancer.

In hyperthyroidism, the excess of hormones leads to the acceleration of all metabolic processes: the oxygen consumption of tissues increases, which causes an increase in the basic metabolism of substances, the release of nitrogen( hypera-isuria), calcium, phosphorus, magnesium, water increases, blood sugar rises( hyperglycemia)which can pass into urine( glucosuria).Since everything is interrelated in the endocrine system, there are violations of the function of other endocrine glands.

Regardless of the cause, the condition of hyperthyroidism is characterized by the same very specific symptoms:

Usually only some of these symptoms are more or less pronounced. In older people, severe symptoms may not be present at all, and this condition is called latent hyperthyroidism. The only manifestation of it can be atrial fibrillation.

Hyperthyroidism, if it continues for a long time and is poorly compensated, increases the risk of osteoporosis.

This is the most common cause of thyrotoxicosis, although diffuse toxic goiter can not be called a common disease. Nevertheless, it occurs quite often, and women are sick almost 10 times more often than men. The disease can develop at any age, but most often in 30-50 years.

This is a multi-systemic disease, characterized by an increase in the thyroid gland( diffuse goiter), an increased thyroid function, which leads to thyrotoxicosis( hence the "toxic"), as well as a number of other typical symptoms( in particular, exophthalmos).

The cause of the disease is not known. There is a clear family predisposition. Very often the illness is preceded by a trauma. The trigger mechanism can serve as pregnancy, childbirth, breast-feeding, menopause. Of great importance are long-lasting neuroses of the type of vegetative-vascular dystonia, emotional explosions, infections( especially angina, influenza), craniocerebral trauma, excessive prolonged overheating of the body.

"Nodular goiter" is a collective concept. This disease requires special attention from doctors. The fact is that nodular goiter can develop not only due to lack of iodine in the environment. In addition, for nodular goitre can be taken tumors of the thyroid gland-both benign and malignant. Therefore, the nodal goiter in an unexamined patient is a preliminary, not a definitive diagnosis. But even in the examined patients, it requires close attention: it is believed that the nodes can degenerate into various tumors. Therefore, in nodular goiter, surgical treatment is more often used than with other forms of goiter. Operative treatment is used in the following cases: a suspicion of cancer;thyroid cancer;follicular adenoma of the thyroid gland;node more than 2.5-3 cm;presence of multinodal toxic goiter;presence of a cyst more than 3 cm;the presence of thyroid adenoma;retrosternal nodular goiter.

Manifestations of this disease can be different. First of all, the patient's complaints depend on what the thyroid hormones contain in the body. With a decrease in function( hypothyroidism), weakness, fatigue, memory loss, efficiency and interest in the environment, dry skin, brittle and hair loss, the appearance of edema on the face, chilliness, lethargy, constipation. With an increase in thyroid function, on the contrary: weight loss, sweating, palpitations, tremors, fatigue, quick temper, inadequate reactions. With normal thyroid function( euthyroidism), patients complain primarily of goitre-education in the neck. There may be complaints of headache, irritability, pain in the heart, a sense of heaviness and discomfort in the neck. If the struma is located vaginally, the disease can be manifested by coughing, shortness of breath, swallowing and breathing disorders. Sometimes the site becomes inflamed or there is a hemorrhage in the thyroid nodule. In such cases, complaints about pain in the neck are added to the patient's usual complaints. The goiter thus quickly increases. In case of inflammation, there may be an increase in body temperature.

To make an accurate diagnosis, you need to undergo certain examinations.

1. Medical examination.

2. Study of the level of thyroid hormones.

3. Ultrasound examination of the thyroid gland.

4. Fine needle puncture biopsy of the thyroid gland. A biopsy is the only method of confirming or refuting the diagnosis of a thyroid tumor, so it must be done by patients with nodular goiter.

5. Radioisotope study( scanning) of the thyroid gland. This method allows you to assess the size, shape of the thyroid gland, the activity of its nodal formations. It is believed that using this method, one can assume the presence of cancer in the thyroid gland. However, it is impossible to accurately determine the presence of a tumor and its nature, using this method.

6. Radiographic examination of the chest. It allows to assess the condition of internal organs( trachea and esophagus) in patients with goiter. The fact is that the goiter can put pressure on the internal organs, in which case the internal organs will be displaced. It is carried out only at high degrees of augmentation of a thyroid gland, and also at zagrudinnogo arrangement of a struma.

7. Computer and magnetic resonance imaging of the thyroid gland.

It is believed, however, that only those patients who have nodes in the thyroid gland determined by medical examination and not only ultrasound should be subjected to a detailed examination. According to ultrasound, nodes in the thyroid gland of an adult should exceed 1 cm in diameter. Anything less than this is not considered dangerous.

If you believe the statistics, thyroid lesions have almost 10% of the population, and only a part of them is associated with a deficiency in the body of iodine.

Iodine deficiency in the environment leads to the fact that the entire thyroid gland is forced to work in a strengthened mode. Most often, either a diffuse goiter( without nodes) or a multinodular goiter is formed: due to the fact that the entire thyroid gland is working with "overload", the nodulation process is not limited to any one part of the gland, but, as a rule, captures itcompletely.

Nodular goiter( multinodular goiter) and pregnancy. Nodal colloid struma, whose diagnosis is confirmed by cytological examination, is not a contraindication for pregnancy planning, except in cases of burdensome compression of the trachea( at large nodes and in the zoster).

Nodal and multinodal euthyroid colloid proliferating goiter, first diagnosed during pregnancy, is not an indication for abortion.

To exclude tumors, a fine needle aspiration biopsy of the node is performed. If the nodal formation is revealed in the second half of pregnancy, the biopsy, in the most emotional patients, can be postponed and carried out immediately after birth.

The only indication for the surgical treatment of the thyroid gland, when detecting a pregnant nodal formation, is the detection of cancer. The optimal period for surgery is the second half of pregnancy.

Treatment of nodular forms of goiter in pregnant women is carried out with preparations of thyroxine and physiological doses of iodine, under the control of the level of thyroid hormones.

This increase in the thyroid gland, which occurs in residents of "safe" regions - where the content of iodine in nature is sufficient. In another way, this ailment is sometimes called a simple, non-toxic goiter. Like endemic goiter, sporadic can be nodal in form( when knots form in the gland tissue), diffuse( when the gland tissue is completely affected) and mixed( when both patients identify in both glands).

It is believed that sporadic goiter occurs in 4-7% of the adult population, more often in women. In children, sporadic goiter is recorded in less than 5% of cases. The causes of the ailment can be very different. A significant role is played by adverse heredity: for example, there are families in which people from generation to generation suffer from goiter. Important and harmful external influences: magnetic field, radiation, pesticides, phenols - all this is not the best way affects our health. It happens that goiter develops as a result of exposure to the body of certain medicines.

What are these medicines?

- iodine-containing compounds: amiodarone( used for arrhythmia), phthalazole( a remedy used to treat intestinal infections), valocordin( cardiac and sedative), radiocontrast agents;

- some hormonal drugs;

- some antibiotics, antipyretic and analgesic, including aspirin;

-thyostatics: thiamazole, metizol, mercazolil, lithium preparations, etc.;

- certain drugs used to treat tuberculosis patients.

Under the influence of these drugs decreases the ability of the thyroid gland to bind iodine, inhibits the formation of hormones. To stimulate the work of the gland and make up for the lack of its hormones, the pituitary gland begins to intensively produce thyroid-stimulating hormone. As a result, the size of the thyroid gland increases. However, this does not happen to all people. We all live in an equally unfavorable situation, and we drink a lot of drugs, and there are few patients with sporadic goiter. Scientists believe that for the emergence of the disease requires a certain predisposition, associated with congenital disorders of iodine metabolism and the peculiarities of the formation of hormones in the body.

Sporadic goiter for a long time may not be manifested. Thyroid function is usually not disturbed. Over time, patients pay attention to the appearance of goiter and changes in the shape of the neck. If the enlargement of the thyroid gland is very large, then there may be coughing, hoarseness, impaired breathing and swallowing. But this is only in extreme cases. However, it is not worthwhile to sit and look indifferently at how the neck changes. The fact is that goitre, especially the nodular, can always be reborn in a tumor, including cancer. Therefore, any goiter necessarily requires a referral to the endocrinologist and examination. Methods of research are used the same as with other forms of goiter. To treat diffuse goiter, synthetic preparations of thyroid hormones are usually used, for example, L-thyroxine. Nodular goiter requires particularly careful examination and treatment.

In another way this disease is called Graves' disease, or thyrotoxicosis. The function of the thyroid gland is thus increased, so the ailment is sometimes also called hyperthyrosis.

An exact and unambiguous cause of this ailment has not yet been found. In both adults and children, the disease is associated with various causes.

Many researchers note the role of infectious diseases in the onset of diffuse toxic goiter. In children, it often develops after childhood infections, in adults - after the flu and ARVI.In some patients, the onset of the disease is preceded by exacerbation of chronic tonsillitis-a prolonged current inflammation of the tonsils. There are indications of physical and mental trauma, overheating in the sun, in children the alcoholism of parents is important. A great role is played by mental stress, stress. Some researchers note that patients with diffuse toxic goiter and before the disease have certain characteristics of character: often they are quick-tempered, excitable, touchy, irritable, any external irritation is ready to perceive as a personal insult and translate it into a conflict situation. It is not surprising that the psyche of such people is more susceptible to all kinds of injuries, and therefore the disease sometimes arises easier. Another famous doctor SP.Botkin wrote: "The influence of mental moments not only on the current but also on the development of the Graves' disease is not subject to the slightest doubt: grief, various kinds of loss, fright, anger, fear have repeatedly been the cause of development, and sometimes extremely rapid, within a few hours, the most severe and characteristic symptoms of Graves' disease. "

However, it is impossible to completely write off the causes of hyperthyroidism only on the nerves. Apparently, a whole complex of causes is important, which leads to the disruption of the glands of internal secretion, in the first place - the thyroid gland.

Hereditary predisposition also matters. If one of the twins suffers an illness, the risk of getting sick also increases in another. Women suffer from diffuse toxic goiter more often than men.

According to MA Zhukovsky( 1995), among the children with diffuse toxic goiter, the predominant part are girls, and the disease most often develops at the age of 11-15 years.

It used to be believed that the cause of Graves' disease are disorders in the hypothalamic-pituitary-thyroid gland system. It was believed that the pituitary gland produces too much thyroid-stimulating hormone, which ultimately leads to an increase in thyroid function. However, recent studies have shown that the level of thyroid-stimulating hormone in the blood of patients with diffuse toxic goiter can be not only elevated, but also normal, and sometimes even reduced. Therefore, views on the development of the disease were subsequently revised.

Today, the so-called "autoimmune theory" has become most widespread."Autoimmune" means "developing immunity against oneself."In other words, the body produces antibodies to the cells of the thyroid gland, as a result of which the thyroid gland function rises. These antibodies are called "thyroid-stimulating immunoglobulins."The most studied of them is the so-called LATS-factor, a long-acting thyroid stimulant: it occurs in almost half of patients with diffuse toxic goiter. The increased function of the thyroid gland is accompanied by an increase in the level of its hormones - thyroxine and triiodothyronine, which determines the manifestations of the disease.

Diseases against which thyrotoxicosis develops most often: diffuse-toxic goiter, nodal( multinodular) goiter, thyrotoxic phase of autoimmune thyroiditis.

It is usually impossible to predict in advance what kind of course the disease will have in a particular patient. It is believed that in children, diffuse toxic goiter occurs more easily than in adults. Light and medium-heavy forms can often last for years, without causing the patient special inconveniences. However, sometimes they can sharply turn into heavy ones. When diffuse toxic goiter affects many organs and systems, so the manifestations of the disease are very diverse. Determining the boundary between mild, moderate and severe forms of the disease is not always easy. Sometimes they can go into each other.

One of the main symptoms of diffuse toxic goiter is an increase in the thyroid gland. It can be of different degrees. At the same time, there is no direct connection between the degree of thyroid gland enlargement and the severity of thyrotoxicosis, but severe forms of the disease, as a rule, are accompanied by a large goiter.

Almost all patients have changes in the nervous system. It's irritability, nervousness, heightened impressionability, capriciousness, tearfulness. All this together is not necessarily found in every patient. But almost all authors note that patients with diffuse toxic goiter are more excitable, irritable, quick-tempered;many have increased activity, children - the desire to constantly move, the inability to sit still. Some children have problems with diligence in school: pupils can not normally attend classes. As in adults and children, there are frequent mood swings with a tendency to aggression and tearfulness( for medical professionals this is called a "convulsive roar").Many complain about sleep disorders, memory disorders, headaches.

A frequent sign of deviation from the nervous system in case of diffuse toxic goiter is a small tremor( tremor) of the fingers. Trembling becomes noticeable if the patient stretches out his arms. The severity of this symptom is not directly related to the severity of the disease. However, with severe forms of the disease, trembling of the fingers occurs almost always. Children may have tick marks - violent movements of the hands, head, muscles of the face. In adults, similar tics with diffuse toxic goiter are rare.

One of the signs of the disease is increased sweating. Sweat not only the whole body, but also the armpits, palms, feet. Even with a mild form of hyperthyroidism, over half of the patients complain of excessive sweating, and almost all with severe form. Skin in patients with thyrotoxicosis, as a rule, thin, moist, pink, often red spots appear on it;if you hold a blunt object over the skin, then a red trace remains on it for a long time.

Body temperature in patients is often increased, although not much. Many complain of itching, weakness and fatigue. All these manifestations are more pronounced in the severe form of the disease than with the medium-heavy and mild. In severe cases, the muscles of the entire body are affected, down to the muscles of the legs, the hand, the neck, and, more rarely, the chewing muscles. In the light and moderate forms of the disease, the muscles of the shoulder and arms suffer mainly: the patients complain of their weakness, the impossibility of performing prolonged and severe muscular work.

Another characteristic symptom of the disease is changes in the cardiovascular system. In varying degrees, as well as changes from the nervous system, they occur almost always.

The earliest symptom of diffuse toxic goiter is the rapid heart rate( tachycardia).Rapid palpitation often appears earlier than all other signs of goiter, sometimes even earlier than an increase in the thyroid gland. At a small part of patients complaints about a palpitation can be absent. In some cases, patients do not make complaints, but the doctor determines the increased pulse rate in patients. The pulse rate is usually more than 90 beats per minute( the heart rate of a healthy person is from 60 to 90, on average - 70-75 beats per minute).With diffuse toxic goiter, the pulse in some patients can reach 180-200 beats per minute. It should be noted that the pulse can be accelerated for no apparent reason. Increased heart rate in patients, as a rule, persists in sleep. Doctors listen to heart murmurs in many patients.

Some patients, especially those with severe thyrotoxicosis, have an increase in the left heart. The more severe the disease, the more frequent cardiac arrhythmias. Many patients complain of shortness of breath, but usually it is not associated with the activity of the heart, but with the fact that patients constantly experience a feeling of heat. So, in a warm room they are almost always covered with only a sheet and even in winter they often sleep with an open window. Even with an open window, patients often complain of stuffiness. Doctors find changes in the electrocardiogram, indicating a violation of metabolic processes and heart rhythm.

Most patients have increased blood pressure. In the most typical cases, the upper pressure is increased, while the lower one remains normal, sometimes it can even be lowered.

One of the true signs of diffuse toxic goiter is changes in the eyes, scientifically "endocrine ophthalmopathy".In total about 40 eye symptoms, or signs, which are almost always recorded in severe and, more rarely, in moderately severe forms of the disease, are known. Not necessarily one person will have all the known signs of medicine. The most famous of these symptoms are eyelashes and a wide opening of the eye cracks. Even people who are far from medicine know that for the patients with Graves' disease there are "widely opened eyes" that attract attention. Some people think that patients with thyrotoxicosis have a special, "angry" look. Others pay attention to the pronounced, in comparison with healthy people, the brilliance of the eyes. The appearance of most eye symptoms of the physician is not associated with the direct effect of an elevated level of thyroid hormones, but with the action of a special antibody - the LATS factor, or thyostimulating immunoglobulin. It is believed that as a result of this, cellulose, which is behind the eyes, swells, and the eyes seem to "buckle."All the eye symptoms doctors divide into groups: there are characteristic signs that arise from the pupils, cornea and conjunctiva, eye fundus, eyelids, muscles responsible for eye movements, and also from the structures that are located behind the eyeballs and patients are not visible. The latter are usually determined by the doctor when examined.

The most important "eye symptoms" that occur with diffuse toxic goiter

Changes that occur in patients on the part of the eye often give the patient's face an expression of fear, surprise or anger. On average, eyelashes are detected in more than half of patients with diffuse toxic goiter. It is believed that the more severe the disease, the more pronounced changes from the eyes take place, however, according to a number of authors, this is not entirely true. Even with severe forms of diffuse toxic goiter, changes from the eyes may sometimes be absent. Along with this, cases were described when patients with a mild form of diffuse toxic goiter presented many complaints about changes from the eyes. However, it often happens that the changes from the eyes are noticed first of all by the surrounding people, and not by the patients themselves. In children, eyelashes are usually less pronounced than in adults, but there are also exceptions. Usually, eyelashes are uniform, less often one eye( usually right) seems larger than the other. On average, one of the ten patients, or even less often, has uneven eyelashes, when one eye seems to be much larger than the other. In most cases, scientists explain this by pressure of an increased proportion of the thyroid gland on the nerve of the sympathetic nervous system, passing on the "sick" side. As a rule, such problems give patients a lot of cosmetic inconveniences. In children, fortunately, they are less common than in adults.

In addition to all these problems, eye contact with patients with diffuse toxic goiter is often disturbed by the feeling of "sand" in the eyes, lacrimation, sometimes pain in the eyes and the dilation of objects. Some authors consider endocrine ophthalmopathy( a complex of changes on the part of the eyes) as an independent disease, which is based on a violation of immunity, which results in antibodies to the eye muscles, fiber, etc. This causes swelling of the cellulose located behind the eyeball. In the absence of treatment, the edema of the cellulose becomes fibrosis, that is, it is replaced by a connective tissue. The connective tissue does not resolve. After that, eye changes become irreversible. It is believed that the predisposition to this disease is inherited. Usually it goes hand in hand with a diffuse toxic goiter.

In addition to the nervous system, heart, vessels and eyes, diffuse toxic goiter also exhibits changes in other organs and systems. This is due to the fact that the action of thyroid hormones on the body is very diverse and multifaceted.

.Adults often complain of disorders of the gastrointestinal tract. Most often this is diarrhea and vomiting. Patients, as a rule, eat a lot, but remain hungry, because they poorly digest food, that is, they suffer from increased appetite. In children diarrhea and vomiting are rare, but increased appetite occurs quite often.

All types of metabolism in diffuse toxic goiter are sharply increased. Strengthening of water metabolism leads to dehydration of the patient's body. Patients eat a lot, but do not get fat. On the contrary, most of them are losing weight, despite the increased or normal appetite. The body temperature rises.

In some cases, the liver function is impaired. The appearance of jaundice is a dangerous sign that occurs when a severe course of the disease occurs. With easier options, the liver can be enlarged, painful.

The activity of the adrenal cortex changes. There is a lack of hormones produced by the adrenal cortex, which is manifested by general weakness, fatigue, and decreased efficiency. Some patients may have an increased deposition of pigment in the skin( especially in the knee and elbow area), which also indicates an insufficient function of the adrenal cortex, an increase in lymph nodes, a lower "lower" blood pressure, along with a normal or elevated "upper".

The carbohydrate metabolism also changes. Some patients may have increased blood sugar. Conducting special tests( glucose tolerance test) allows you to establish that the body improperly absorbs and processes sugar. It is believed, however, that these changes are largely related to the impaired hepatic function that often occurs in the present ailment. The combination of diffuse toxic goiter and diabetes mellitus is observed in approximately 3% of patients, usually adults, in children such a combination occurs only in a few cases.

As all types of metabolism change, the structure of the bone system also changes. Many patients complain of increased brittleness and fragility of bone-osteoporosis. Children have increased growth and earlier appearance of ossification points. However, in the future, the process of growth ends faster than in healthy children, so later, on the contrary, growth may be delayed.

In children, premature physical development is often combined with a delay in sexual development. The process of puberty preserves the same sequence as in healthy children, but somewhat slows down. Monthly in teenage girls come a little later, and if a girl is sick after the establishment of the monthly cycle, then it is broken or even stopped. Adult women may also experience cycle disorders. Further, in the treatment of diffuse toxic goiter, the hormonal sphere is normalized, and the female cycle, as a rule, comes back to normal.

Along with metabolic disturbances, changes in the blood system can be observed: increased level of lymphocytes, erythrocyte sedimentation rate, decreased level of leukocytes.

Doctors distinguish three degrees of severity of thyrotoxicosis: mild, moderate and severe. This allows us to more specifically assess the health of the patient and determine his treatment.

The mild course is established on the basis of a laboratory hormone test with a small clinical picture( the signs of the disease can be erased or absent).

The course of moderate severity is set if there are severe manifestations of the disease.

Complicated( severe) is established in the presence of complications( atrial fibrillation, heart failure, changes and disruption of many internal organs, mental disorders, sharp weight loss).

This classification is convenient for doctors day, but not for patients. It is possible to estimate the severity of your illness tentatively on the basis of the following signs.

Light: heart rate 80-120 per minute, no atrial fibrillation, abrupt weight loss, working capacity is reduced slightly, little hand trembling.

Average: heart rate 100-120 per minute, increase in pulse pressure( the difference between the "upper" and "lower" arterial pressure), there is no atrial fibrillation, losing weight up to 10 kg, working capacity is reduced.

Heavy: heart rate more than 120 per min, atrial fibrillation, mental disturbances, pronounced changes in the parenchymal organs, body weight sharply reduced, disability reduced.

This data does not in any way mean that it is possible to determine the severity of your illness regardless of the doctor. They will simply help you better orient in your condition or in the condition of your relatives( if you or they have thyrotoxicosis).Do not forget that independent treatment of endocrine diseases is unacceptable: it can lead to the most dangerous consequences - a more severe course of the disease, violations from the internal organs and even to a dangerous condition, such as thyrotoxic crisis.

Thyrotoxic crisis is an emergency that threatens life. It is caused by a sharp increase in the production of thyroid hormones: an increase in body temperature, extreme weakness, agitation and anxiety, abdominal pain, confusion and impaired consciousness( up to coma), mild jaundice. Intensification of cardiac activity in this condition can lead to heart rhythm disturbances and shock.

Thyrotoxic crisis occurs when inadequate treatment of thyrotoxicosis( diffuse toxic goiter) and can be provoked by the following conditions and situations:

Another complication of thyrotoxicosis is dystrophic changes in the myocardium, which is accompanied by the development of atrial fibrillation and heart failure.

A rare complication is periodic paralysis.

Toxic multinodular goiter is the second most frequent cause of thyrotoxicosis. In this disease, the thyroid gland increases not evenly, as in diffuse goiter, but in parts, which leads to the formation of one or more nodes. Multinodular toxic goiter usually develops in elderly women with a long-term multinodal non-toxic( without increasing the level of hormones) goiter.

The cause of nodular goiter may be a restriction or, on the contrary, excessive intake of iodine in the body, for example, with certain medications. Most often, with iodine-induced thyrotoxicosis( caused by excess iodine), symptoms of cardiac arrhythmias( arrhythmia, heart failure), depression, muscle weakness manifest themselves.

If suspicion of diffuse toxic goiter is primarily determined by the level of thyroid hormones in the blood. The concentration of thyroxine( T4) and triiodothyronine( T3) is increased;the concentration of thyroid-stimulating hormone( TSH), as a rule, is reduced.

When analyzing blood, antibodies to the thyroid tissue can be detected.

Assign other studies: scanning( with radioactive iodine or technetium), ultrasound, thyroid biopsy. Capture I131 elevated in the first hours of the sample, then decreases.

It is interesting that the seizure of I131 by the thyroid gland may increase with neurosis, and in this case, increased accumulation of iodine is noted throughout the study.

To bring the endocrine system into a normal state with increased function of the thyroid gland, it takes several years. There are three main methods for treating hyperthyroidism: medical treatment, surgical removal of part or all of the thyroid gland and "bloodless operation" - treatment with radioactive iodine, which destroys the gland tissue.

Medical treatment begins with the fact that the patient is prescribed thyreostatic drugs that suppress the activity of the thyroid gland.

The synthesis of thyroid hormones also inhibits lithium preparations, although weaker than mercazolil.

Lithium salts cause such adverse reactions as increased urination, loss of appetite, nausea, severe tremor, uncertainty of gait.

Contraindications to the use of lithium salts are parkinsonism, atrioventricular blockade of various degrees.

iodine preparations inhibit the release of T3 and T4 from the thyroid gland, their synthesis, iodine uptake by the thyroid gland, the transformation of the inactive form of the hormone T4v into a more active T3( which occurs in the liver and other organs).

With exophthalmos, diuretics are prescribed, and in severe cases - prednisolone. Radiation therapy is also used for this area. Surgical treatment is also possible.

Produced in tablets of 0.05 g( 50 mg).

Indications. Thyrotoxicosis.

Therapeutic action. Has a pronounced thyreostatic effect, reduces the formation of an active form of iodine in the thyroid gland, inhibits the conversion of T4 to T3.

Methods of administration and dose of .Take inside 50-100 mg 3 times a day.

During treatment, it is necessary to monitor the level of thyroid hormones, the blood picture, the level of activity of liver enzymes( transaminase), the concentration of bilirubin, alkaline phosphatase.

Duration of treatment - 1-1,5 years.

Side effects of

Possible:

Occasionally noted:

Contraindications

Interaction with other medicines. It is not recommended to apply simultaneously with drugs that inhibit the formation of leukocytes.

Produced in tablets of 0.005 g( 5 mg).

Indications .Diffuse toxic goiter( light, medium and heavy forms).

Therapeutic action. Causes a decrease in the synthesis of thyroxine in the thyroid gland, due to which it has a specific therapeutic effect with its hyperfunction. Like other antithyroid substances, it lowers the basic metabolism.

Methods of administration and dose. Is taken orally, after a meal: for light and medium forms of thyrotoxicosis - 5 mg, with severe form - 10 mg 3-4 times a day. After the onset of remission( after 3 to 6 weeks), the daily dose is reduced every 5-10 days by 5-10 mg and gradually the minimum maintenance doses( 5 mg once a day, every other day or once every 3 days) are selected until a persistenttherapeutic effect.

If the treatment is too early, a relapse of the disease is possible.

Maximum doses for adults: single dose - 10 mg, daily - 40 mg.

Side effects of

The drug in therapeutic doses is usually well tolerated. However, in some cases, may develop leukopenia( a decrease in the number of leukocytes in the blood), so once a week you need to do a clinical blood test.

Also possible:

If side effects occur, reduce the dose or stop taking the drug.

Patients receiving Mercazolil in preparation for surgery increase the risk of bleeding during surgery, therefore, once remission or significant improvement in the patient's condition is achieved, Mercazolil is canceled, iodine preparations are prescribed;the operation is performed after 2-3 weeks.

Contraindications

Interaction with other medicines. You should not combine the use of Mercazolilum with drugs that can cause a decrease in the number of leukocytes in the blood( sulfonamides, etc.).

Treatment with radioactive iodine in diffuse toxic goiter is indicated for patients older than 40 years( released from childbearing age).The dose of radioactive iodine is difficult to pick up, it is impossible to predict the reaction of the thyroid gland. Nevertheless, it is known that if an amount of I131 is administered sufficient to normalize thyroid function, then in about 25% of cases, hypothyroidism develops after a few months. Then, for 20 years or more, this frequency increases every year. However, if a lower dose is administered, the likelihood of recurrence of hyperthyroidism is high.

The main exchange with thyrotoxicosis is significantly increased, which means that there is an increased expenditure of energy, which can lead to weight loss. Therefore, thyrotoxicosis requires a high-calorie diet. The content of proteins, fats and carbohydrates should be balanced.

The men's diet should contain on average 100 g of protein, with 55% of the animal;fat - 100-110 g( 25% vegetable), carbohydrates - 400-450 grams( of which 100 grams of sugar).Caloric content is 3000-3200 kcal.

The woman's diet should contain: proteins - 85-90 g, fats - 90-100 g, carbohydrates - 360-400 g. Caloric content - 2700-3000 kcal.

Proteins should be easily assimilated, mainly from dairy products. Dairy products are also a supplier of well-assimilated fats and calcium, the need for which is increased in patients with thyrotoxicosis.

It is very important with thyrotoxicosis the content of vitamins in the diet. In addition to foods rich in vitamins( liver, vegetables, fruits), it is necessary to take and vitamin preparations. The same can be said about mineral salts. The diet includes products rich in iodine: fish, sea, sea kale and other seafood.

Do not eat large amounts of foods and foods that excite the cardiovascular and central nervous system - strong tea, coffee, spices, chocolate, as well as strong meat and fish broth. It is desirable to boil meat and fish first, and then put it out or fry.

Power should be 4-5 times. Water regime is not limited.

From drinks, tea, decoctions of rose hips and wheat bran are preferred. Juices are allowed in a diluted form, all except grape, plum, apricot.

Butter is limited to 10-15 g per day, vegetable oils - no more than 5 g in dishes. The remaining fats are not recommended.

In severe exacerbation of chronic enteritis with severe diarrhea, the dishes are liquid, semi-liquid, wiped, cooked on water or steamed. Limit the maintenance in a diet of fats and carbohydrates. The protein content should be within the physiological norm.

Approximate one-day menu for thyrotoxicosis 2,955 kcal

Thyroid gland nodes are present in about half of the adult population, and approximately 30% of cases have a knot diameter of 2 cm or more. In some cases, there is a single node, in others there are several nodes.

The unit node is usually benign. Sometimes it is a cyst. A good-quality knot does not pose a danger to life, but sometimes serious problems can arise. One of them is the development of hyperthyroidism, which requires appropriate treatment;the other is pressure on the throat and difficulty breathing if the knot is large. Occasionally the knot begins to bleed and a hematoma is formed - the accumulation of blood under the skin.

Thyroid enlargement due to a number of small nodes is called a multinodular goiter. The function of the thyroid gland is usually normal;If it rises, then a toxic multinodal goiter develops.

One of the most common inflammatory thyroid diseases - autoimmune thyroiditis, or Hashimoto's thyroiditis - is caused by an autoimmune reaction, that is, an "attack" of the immune system on the body's own cells, in this case, on the cells of the thyroid gland. As a result, its inflammation develops.

Usually the first symptom of thyroiditis is Hashimoto - a painless enlargement of the thyroid gland or a feeling of raspiraniya in the neck, "a lump in the throat."Most of the increase in the thyroid gland with this disease is very slight, but in some cases the goiter develops quite large and can squeeze the vocal cords and larynx, pharynx, etc. Then there are symptoms such as difficulty swallowing, coughing, hoarseness of the voice. There may be pain in the neck.

Most patients are forced to receive life-long hormone replacement therapy to compensate for progressive hypothyroidism. Most often a synthetic analogue of thyroxine is used - levothyroxine, or L-thyroxine.

This disease is a viral infection in which the thyroid gland is affected. People are mostly sick 30-50 years old, women are about 5 times more likely than men. Often the disease develops a few weeks after the flu or ARVI.

Symptoms of subacute thyroiditis are very vague: weakness and fatigue, pain in the neck, giving in the ear, lower jaw, nape. They develop gradually, although sometimes the disease can begin to acutely.

In the first stages of thyroid de Kerven is accompanied by mild hyperthyroidism, which is later replaced by hypothyroidism, as little expressed.

Treatment of subacute thyroiditis is reduced to taking aspirin, sometimes prednisolone is used. In most patients, the disease quickly heals, and the function of the thyroid gland is restored.

Postpartum, or asymptomatic lymphocytic thyroiditis, is a condition that occurs in about one in ten women in labor. The thyroid gland is enlarged;at palpation it is painless. Several weeks or months, its function is increased, then hypothyroidism usually occurs.

Symptoms often go unnoticed.

In most cases, thyroiditis occurs after several months without treatment, but in 5-7% of women 1-3 years after the birth chronic hypothyroidism develops. In such cases, as a rule, hormonal preparations are prescribed.

In recent decades, medicine and, especially, pharmacology have achieved such success that often, especially with the early detection of a tumor, you can completely cure a person.

What are the tools offered by scientific medicine for cancer treatment?

First of all, this is a surgical operation - the oldest and most proven means. Its success largely depends on the species and the stage of the malignant tumor.

The second method of treatment of malignant tumors is radiotherapy. Its action is based on the fact that radioactive radiation primarily destroys those cells that quickly divide. And in this respect, cancer cells do not know their peers.

The third method of treatment is chemotherapy. Currently, the following groups of drugs are used: alkylating agents, antimetabolites, plant alkaloids, antitumor antibiotics, enzymes, hormones, biological response modifiers.

Combination therapy is often used in the treatment of malignant tumors.

The only manifestation of thyroid cancer may be a slight swelling in the neck. In this case, you need to do a scan of the thyroid. This is especially true for those who have risk factors for thyroid cancer.

Thyroid cancer can be of four types:

Mixed - papillary-follicular - cancer is common;The rarest form is anaplastic cancer.

This type includes 60-70% of all malignant tumors of the thyroid gland. In women, it is diagnosed 2-3 times more often than in men, and more often in young people than in the elderly( but in elderly people it is more malignant).Often he is associated with radiation in a history on some other occasion.

If the tumor is small( less than 1.5 cm), then the treatment consists in surgical removal of the affected lobe of the gland and isthmus. In almost all cases, surgical treatment gives a good effect;relapses are extremely rare.

If the tumor is large( more than 1.5 cm) and spreads to large areas of the gland( in both lobes), then remove the entire gland. Further life-long hormone therapy with L-thyroxine is necessary. The daily dose on the average is 100-150 mcg.

This form accounts for about 15% of all cases of thyroid cancer. More often it is found in the elderly, in women more often than in men. Follicular cancer proceeds more malignantly than papillary cancer, and can give metastases.

Regardless of the size of the tumor, radical surgical intervention is required: removal of almost the entire thyroid gland. After this, radioactive iodine is administered. Such patients also receive life-long hormone therapy.

This form is no more than 10% of all cases of thyroid cancer and is found mainly in the elderly, women are somewhat more likely than men. The tumor grows very quickly, usually it is well noticeable. Anaplastic cancer progresses rapidly, and the prognosis is unfavorable. Although chemotherapy and radiotherapy before and after surgery are sometimes successful.

With this form of cancer, the thyroid gland produces too much calcitonin, since the cells of the medullary tumor are hormonally active. They can produce other hormones, so medullary cancer often manifests itself with very unusual symptoms. In addition, he may be accompanied by other types of malignant tumors of the endocrine system. This is called the syndrome of multiple endocrine neoplasms.

Medullary cancer metastasizes through the lymphatic system into the lymph nodes, and through the blood into the liver, lungs, bones. The only way to treat this form of cancer is total removal of the thyroid gland.

This is a rare hereditary disease characterized by the formation of benign or malignant tumors in several endocrine glands. And tumors can appear in the first year of life, and can - after 70 years. All manifestations of this disease are caused by an excess of certain hormones produced by tumors.

Multiple endocrine neoplasia is conditionally divided into three types - I, IIA and II B. Sometimes mixed or cross types are observed.

In this type of multiple endocrine neoplasia, tumors of parathyroid glands, pancreas and pituitary gland develop. This can occur simultaneously or in isolation.

In almost all cases, there are tumors of parathyroid glands producing excess parathyroid hormone. This condition is called hyperparathyroidism and usually leads to an increase in the level of calcium in the blood, which in turn can contribute to the formation of kidney stones.

Typically, type I neoplasia also develops pancreatic islet cell tumors - insulomas, and almost half of these tumors produce insulin. This leads to an increase in insulin in the blood - hyperinsulinemia - and, as a consequence, to hypoglycemia - a decrease in blood sugar.

Hypoglycemia is a frequent complication of insulin therapy for Type 1 diabetes mellitus( insulin-dependent) - a condition in which the blood glucose level drops sharply( less than 2.5mM / L).Thus there are such symptoms as hunger, sweating, trembling, palpitations;the skin is wet to the touch, cold, pale. Very characteristic behavioral disorders and visual impairment. To cope with this condition, it is enough to eat 5-6 pieces of sugar or drink a few sips of sweet juice, tea with sugar, lemonade.

More than half of insulomas produce gastrin - a substance that increases the acidity of gastric juice and is normally synthesized in the stomach. Therefore, these patients develop ulcers, respectively, with a clinic of stomach ulcers and pancreatic lesions.

In about two thirds of cases, insulomas are benign. Malignant insulomas progress more slowly than other types of pancreatic cancer, but just like any malignant tumor, they can metastasize to other organs.

Pituitary tumors in type I neoplasia develop in about two-thirds of cases, and in every fourth case, this tumor produces a prolactin hormone. This leads to violations of the menstrual cycle in women and to impotence in men. Very rarely, pituitary tumors produce adrenocorticotropic hormone, resulting in Cushing's syndrome. And about a quarter of tumors do not produce any hormones.

Sometimes, with type I neoplasia, adrenal and thyroid tumors also develop, but in the overwhelming majority of cases they are non-cancerous.

In this type of multiple endocrine neoplasia, medullary thyroid cancer and pheochromocytoma develop( adrenal tumor, often benign).Thyroid cancer occurs in almost all cases of type IIA neoplasia, pheochromocytoma - in about half of the patients. Pheochromocytoma, as a rule, manifests itself in increased blood pressure. Pressure can increase quite significantly, but not constantly, but periodically.

In approximately 25% of cases of type IIa neoplasia, parathyroid gland function is increased. Excess of parathyroid hormone leads to an increase in the level of calcium in the blood, which in turn leads to the formation of kidney stones and sometimes to kidney failure.

This type of multiple endocrine neoplasia is characterized by medullary thyroid cancer, pheochromocytoma and neuromas - tumor tissue around the nerves.

Medullary thyroid cancer can develop in early childhood. It progresses and metastasizes faster than with type IIa neoplasia.

Neuromas develop in almost all cases, are usually located on the mucous membranes and look like shiny nodules. Neuromas in the intestinal mucosa are presumably the cause of enlargement and lengthening of the colon, as well as a violation of the function of the gastrointestinal tract.

Patients with neoplasia of the PB type often have spine diseases( in particular scoliosis), deformities of the bones of the feet and thighs, weakness of the joints. Many patients have a characteristic appearance: long arms and legs.

Treatment of multiple endocrine neoplasias reduces to the treatment of specific tumors and correction of the hormonal balance.

So, surgical removal of the thyroid gland may be required for the following reasons:

In hyperthyroidism, the operation is mainly indicated for young people, as well as for very large goiter or for allergic reactions to medications.

The amount of surgical intervention can be different, it depends on the indications for the operation:

Total thyroidectomy is most often done for cancer, sometimes for a very large multinodal goiter.

In diffuse toxic goiter, as a rule, they are limited to subtotal resection of the thyroid gland.

Lifelong hormone therapy with thyroxine is required in all cases when more than two thirds of the thyroid gland was removed.

Any surgical intervention involves some risks. On the one hand, these are complications common to all operations, on the other hand, specific complications specific to this type of surgical intervention.

Common complications include local bleeding, development of infection in the wound, as well as the formation of thrombi in the veins of the legs and postoperative pneumonia. In addition, there is a risk associated with general anesthesia, but it is very small.

To the specific complications of thyroid surgery, the following can be attributed:

A person suffering from any thyroid disease must be sure to warn the doctor about it when applying for any other disease! This is especially true in those cases when a surgical operation is due( for whatever reason).Before the operation, it is absolutely necessary to normalize the function of the thyroid gland.

Thyroid dysfunction is widespread during pregnancy. The high content of thyroid hormones during pregnancy is usually caused by Graves' disease( thyrotoxicosis, or thyroiditis).At the base of the disease antibodies are formed, which stimulate the thyroid gland, and it begins to produce too many hormones. These antibodies can penetrate the placenta and enhance the activity of the thyroid of the fetus, causing it to increase heart rate and slow growth. Sometimes, in the case of a disease, antibodies are synthesized that block the production of the thyroid hormone. These antibodies can penetrate the placenta and suppress the synthesis of thyroid hormones in the fetus( hypothyroidism), which causes mental retardation( cretinism).

Several methods of treatment of thyrotoxicosis are used. Usually, the pregnant woman is prescribed the lowest possible dose of propylthiouracil. Often in the last 3 months of pregnancy, thyrotoxicosis manifests itself weaker, so the intake of propylthiouracil may be reduced or even abolished. The surgeon can remove the thyroid gland in the second trimester( at the 4-6th month of pregnancy) with intolerance to antithyroid drugs and a significant increase in the gland, accompanied by compression of the trachea. A woman should start taking thyroid hormone medications 24 hours after the operation and continue it throughout her life. These drugs do not cause any disturbances in the fetus.

The decrease in thyroid hormone levels during pregnancy occurs for two main reasons - due to Hashimoto's thyroiditis, which is caused by the production of antibodies that block the production of thyroid hormones and the previous treatment of thyrotoxicosis.

The decrease or increase in thyroid hormone levels after pregnancy is usually a temporary phenomenon, but may require treatment.

WARNING!Radioactive iodine, taken by a pregnant woman for the treatment of increased activity of the thyroid gland( hyperthyroidism), can penetrate the placenta and affect the thyroid gland of the fetus or cause a severe decrease in its function( hypothyroidism of the thyroid gland).Propylthiouracil and methylmazole - drugs also used to treat hyperthyroidism - can lead to an increase in the thyroid gland of the fetus;when necessary, propylthiouracil is usually used, because it is better tolerated by both the woman and the fetus.

Almost all cases of thyrotoxicosis in pregnant women are associated with diffuse-toxic goiter.

Detection of diffuse-toxic goiter in a pregnant woman is not an indication for abortion. Safe methods of conservative treatment of this disease have been developed.

All thyrostatics penetrate the placenta and can exert a suppressive effect on the thyroid gland of the fetus. Propitsil worse penetrates through the placental barrier, as well as from the blood into the mother's milk. In this regard, propitsil is the drug of choice for the treatment of thyrotoxicosis in pregnant women.

In case of intolerance to thyreostatic therapy - development of severe leukopenia, allergic reactions - operative treatment of diffuse-toxic goiter during pregnancy is possible. The optimal time is the second half of pregnancy. After removal of the thyroid gland, thyroxin is prescribed in a dose of 2.3 μg per 1 kg of body weight.

Hypothyroidism, caused by a prolonged, persistent deficiency of thyroid hormones - occurs in 19 out of 1,000 women, and 1 in 1,000 men. This disease is associated with a decrease in thyroid function. As a result, inadequate amounts of hormones( thyroxine and triiodothyronine) enter the blood, many organs and tissues suffer.

In 99% of cases, the cause of hypothyroidism is the destruction of the thyroid itself( primary hypothyroidism), in 1% - the pituitary or hypothalamus( secondary hypothyroidism).

Diseases of the thyroid gland against which hypothyroidism can be detected: endemic goiter, thyroiditis( inflammation of the thyroid gland), nodular goiter, multinodular goiter. Also, hypothyroidism can lead to: removal of the thyroid gland, irradiation of the thyroid gland, treatment with thyreostatics. In this case, the manifestations of the disease can not substantially differ.

This is one of the most common ailments associated with the metabolism: according to statistics, every tenth woman over 65 years old has symptoms of the initial stage of this disease.

The disease can be caused by malformations of the thyroid gland, can develop due to insufficient intake of iodine in the body( see "Endemic goiter"), as well as as a result of hereditary disorders( the thyroid gland can not produce a normal amount of hormones or produces hormones whose structureis broken and which do not have the necessary effect on the body).Sometimes children with a congenital form of hypothyroidism are born from mothers who have had diffuse toxic goiter and who received iodine medications or other drugs that cause a decrease in thyroid function during pregnancy.

In children hypothyroidism is more often congenital, in adults, acquired. An important role for the child's organism is played by the way the mother's pregnancy took place: occupational hazards, women's diseases, infections, inadequate nutrition, air polluted by industrial enterprises - all this can affect the state of the thyroid gland of the baby.