Goiter is a persistent enlargement of the thyroid gland, which is not associated with malignant growth, inflammation. The thyroid gland can grow evenly (diffuse goiter) or in it can form limited seals – nodal goiter. If the function of the gland is reduced, the hypothyroid goiter develops, if it is increased – a toxic goiter. The goiter is usually located on the front surface of the neck, less often – behind the sternum, near the root of the tongue. The development of goiter in atypical places can squeeze nearby tissues and vessels (aorta), interfere with swallowing food, change the timbre of the voice, and in patients with bronchial asthma may provoke attacks of suffocation. Let’s have a look at the causes of this dangerous disease and the best ways of its treatment.
The main cause of goiter in the thyroid gland is iodine deficiency in soil, water, and food. Studies on the amount of iodine required by the body showed that a person needs 100-200 micrograms of iodine per day. With a decrease in the intake of iodine in the body to 50 mcg there is an increase in the thyroid gland.
However, not all inhabitants of the endemic area are ill. This indicates that there are other reasons for the formation of goiter:
In the diagnosis of goiter, blood and urine tests of laboratory type are used. The blood of a person with any clinical signs of neoplasm is checked for the ratio of such hormones as TSH, T3, T4 and thyroglobulin. The diagnosis is determined on the basis that those who encountered the type of ailment presented usually have a disturbance in the balance of thyroid hormones and an increased ratio of thyroglobulin. At the same time, data on the release of iodine in the urine remain reduced.
The instrumental way to diagnose the formed goiter is ultrasound. Thanks to it, it is possible to accurately determine the form of the development of the disease, for example, diffuse it or nodal goiter. With the help of radioisotope scanning, an assessment is made of the functional state of the endocrine gland. At the nodal type of endemic goiter as an additional measure of examination, specialists resort to biopsy of the gland. This makes it possible to determine the nature of the disease. So, it can be benign or malignant.
If as a result of palpation there are suspicions of goiter in the thyroid, in order to establish a certain diagnosis, identify the etiology and stage of the development of the disease, it is necessary to consistently conduct such mandatory examinations as:
One can distinguish three most accurate and easily feasible tests for determining the ratio of iodine in the body:
Diagnosis of goiter of the thyroid gland is made in the presence of an increase in the thyroid gland in people living in endemic terrain, the diagnosis is facilitated by palpation of the neck, in which there is no increase in regional lymph nodes and a painless thyroid gland is determined. As a rule, there are no clear clinical signs of thyroid dysfunction. With ultrasound diagnosis there are cystic changes, areas of calcification and fibrosis, uneven echogenicity.
Timely recognition of symptoms will be the key to successful treatment, which will help to cope as quickly as possible with the disease. So, if there are signs of an increase in goiter, it is necessary to consult a specialist-endocrinologist. Consulting a doctor is very important because any other specialists can simply refer to overwork.
The main method of treating goiter should be considered hormone replacement therapy. For this, a variety of active derivatives of tyrosine are used. This is because they are characterized by the physiological parameters of those hormones that are produced by the endocrine gland. It is extremely important to choose not just a sufficient dosage of a drug, but one that does not lead to negative results. Treatment, periodic use of drugs, very often should continue until the end of life. It is recommended that you do not forget about controlling the ratio of hormones.
Thyroid hypothyroidism is also amenable to adjustment due to hormone therapy. It is much more complicated with hyperfunction. So, if there is a real danger of formation of a tumor of any genesis or complications of the cardiovascular type, then it makes sense to resort to surgery (about which it will be discussed later). This will change the situation on hypothyroidism. In turn, this will allow for easier and more accessible adjustment due to hormone therapy.
In a more severe form of endocrine gland hypofunction, a person can fall into a coma. Hyperfunctions are inherent in the fact that a toxic crisis can lead to a fatal outcome. In this regard, it is necessary to comply with a strict diet and the receipt of the necessary ratio of iodine in the body. At the same time, it is absolutely necessary to consult a specialist and submit tests for the amount of iodine in the body. In fact, as is known, a large amount of iodine also affects the thyroid gland negatively.
Surgical intervention on this organ is extremely difficult because the endocrine gland contains a significant number of blood vessels. This makes the operation much more problematic. However, in some cases, it is indispensable, so surgical intervention in goiter is one of the most frequently used treatment methods.
Thus, local anesthesia is administered and large nodal or potentially dangerous areas are removed. In the most complicated and neglected cases, it is permissible to remove one of the thyroid glands. It can also, in turn, provoke hypo- or hyperthyroidism. However, even with the resection of one or more sites, there is a need for drug rehabilitation.
An alternative way to treat the thyroid gland is to use radioactive iodine. This solution is used to destroy the tissues of the endocrine gland. It is extremely difficult to find the optimal dosage. Additional groups of analyzes are also carried out for this purpose. In this case, in the first year in 25% of people hypothyroidism begins to form.
With many years of insufficient compensation for iodine deficiency, an increase in the thyroid gland develops – an endemic goiter.
For the treatment of endemic goiter of the 2nd degree, not only monotherapy with iodine preparations is used, but monotherapy with Synthroid (Levothyroxine) drugs, as well as combined treatment with iodine and levothyroxine, which is the most pathogenetically grounded and effective. The dose of levothyroxine for the treatment of diffuse endemic goiter is selected empirically, starting with a minimum of 25 g / day. up to the level of free T4 (cT4) and TSH (the target TSH level is 0.1-0.4 mIU / L) under control. Most often, the dose of L-T4 is 75-150 g / day, less often up to 200 g / day.
For the combined treatment of endemic goiter, iodine and Synthroid (Levothyroxine) drugs are administered under the supervision of the clinic, sT4, and TTG.
Doses of Synthroid (Levothyroxine) for the prevention of node growth in nodal euthyroid goiter can be different and depend on the age of the patient and the presence of concomitant cardiovascular pathology. Before the appointment of treatment with levothyroxine in nodular goiter, it is necessary to conduct a differential diagnosis of thyrotoxic adenoma and thyroid cancer.
In diagnosed nodular goiter, as a rule, take at least 1 year to take levothyroxine sodium in a dose calculated in accordance with the body weight. The drug is taken 1 time per day, every morning, preferably 1 hour before meals. Synthroid (Levothyroxine) normalizes metabolic and immune processes in the thyroid gland, has a weak anti-inflammatory effect, suppresses the growth of nodes and helps reduce the size of the thyroid gland.
Thus, for the treatment of diffuse or nodular goiter it is required:
The drug Synthroid (Levothyroxine) normalizes the thyroid gland, restores the hormonal balance, in greater and lesser dosage shows different kinds of effects on the problem organ. An effective drug Levothyroxine sodium is indicated in the complex treatment of many endocrine pathologies. Levothyroxine eliminates the deficiency of hormones that do not fully produce the thyroid gland. The degree of drug exposure depends on the dosage. In high concentration, the active component suppresses the production of TSH, while at the middle it normalizes the functioning of the central nervous system, the heart, affects development, and controls the growth process. Small doses of the drug are recommended for anabolic effects.
After taking Levothyroxine tablets, the patient feels the first effects after several days. With a course application, a stable therapeutic effect is manifested after 3 to 6 months. When examining patients, doctors reveal positive dynamics: the growth of the tissues of the affected gland stops. Even in severe clinical cases, a large number of nodal formations, a third of patients have a pronounced reduction of the endocrine organ.
Levothyroxine actively penetrates the digestive tract, binding to plasma proteins – more than 98%. To strengthen the therapeutic effect in the instructions, it is indicated that it is necessary to take the hormonal drug on an empty stomach.