Endemic goiter - symptoms, treatment and prevention. Endemic goiter - symptoms, treatment and prevention Factors contributing to the disease endemic goiter

Endemic goiter is an enlargement of the thyroid gland, which is caused by iodine deficiency in the body. The healthy volume of the gland, as a rule, does not exceed 20 cm 3 in women, and 25 cm 3 in men. If a goiter is present, it is larger than the given dimensions. According to statistics recently cited by the World Health Organization, over seven hundred million people who live in iodine-deficient areas suffer from endemic goiter (ICD-10 code - E01.0).

They have varying degrees of functional insufficiency of the gland. Forty-two million are diagnosed with an acquired form of mental retardation. The most unfavorable territories in terms of iodine content in the environment in our country are the Republic of Karelia, the Volga region, the Caucasus and the valleys of Siberian rivers.

Kinds

Endemic goiter comes in different types, for example:

• Euthyroid type. In this case, the thyroid gland is increased in size, but the normal level of hormones is maintained.
• Hypothyroid type. This goiter is combined with hypothyroidism, and in addition, with reduced thyroid function.
• Hyperthyroid type. This goiter is characterized by excessive work of the gland.

In addition to the above forms, there are also:

• The development of diffuse goiter, in which the thyroid gland enlarges evenly.
• Multinodular endemic goiter. With the development of such a goiter, nodes of denser tissue are present in the mass of the gland.
• Development of mixed goiter, when, in parallel with diffuse enlargement, individual nodes can be palpated in the thyroid gland.

Directly according to its localization, a goiter can be unilateral or bilateral. Next, we will find out what the main reasons for the appearance of this pathology are, and also consider the degrees of the disease.

Degrees of endemic goiter

Most often distinguished:

• Grade 0 - absence of goiter.
• I degree - the goiter is felt upon palpation, but is not detected visually.
• II degree - goiter is determined visually and by palpation.

To determine the exact size of the thyroid gland, the patient is prescribed an ultrasound, which also reveals the shape of the goiter.

Endemic goiter: pathogenesis of the disease

As mentioned above, the cause of endemic goiter is primarily iodine deficiency in the human body. it can be, for example, sharp. In such a case, the body will collect all its compensatory capabilities and, as soon as the supply of iodine is resumed, the person will return to normal functioning of his thyroid gland, due to which no damage to other organs will occur.

Against the backdrop of the development of chronic deficiency of such an important element as iodine, the situation is much more complicated. As a response to a reduced intake of iodine, as a rule, there is an increase in thyrocytes, which synthesize hormones. By increasing the volume of these gland cells and enhancing their work, the relatively normal amount of required hormones will be stabilized for a short time. But after some time, the process of their fibrosis will become inevitable and nodes will begin to form. Not everyone knows the pathogenesis of endemic goiter.

Against the background of long-term iodine deficiency, thyrocyte hypertrophy alone is not enough. Not only can they increase in size, but they also divide rapidly. As a result, there are a lot of fibrosing cells in the body, and this, in turn, means that prerequisites appear for the further formation of diffuse nodular goiter.

The causes of endemic goiter are that the thyroid gland, against the background of the development of increasing iodine deficiency, goes through several stages of changes in its structure. First, the goiter becomes diffuse euthyroid, then multinodular euthyroid, and eventually multinodular toxic.

The most common causes of pathology

Endemic thyroid goiter occurs due to iodine deficiency.

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

• Taking certain medications that stimulate the excretion of iodine from the body.
• The appearance of diseases of the digestive system, which are accompanied by impaired absorption of substances necessary for the body.
• Use of enterosorbents.
• The development of chronic renal failure, which is accompanied by increased excretion of iodine.
• The appearance of congenital anomalies of the gland in the form of aplasia or hypoplasia.
• The presence of transient conditions that are accompanied by iodine deficiency. Pregnancy is an example of such conditions, along with childhood, puberty and intense physical activity. In addition, regular psycho-emotional stress also affects.
• Insignificant intake of iodine from food.
• Low intake of iodine from water.
• Presence of energy imbalance.
• Development of chronic hypoxia.

When discussing the reasons that provoke the development of endemic goiter, we should consider in more detail the lack of this element in everyday food. Most residents of our country almost never have fresh seafood and fish in their diet. In addition, few people think about using iodized salt for cooking.

Of course, taking it will not fully compensate for the iodine deficiency. This is due to the fact that iodine is a very volatile substance that quickly disappears from the structure of salt crystals due to the entry of air into them. In this regard, it is necessary to store salt not in salt shakers, but in glass or metal jars that are tightly closed with a lid.

Eating a significant amount of cauliflower, as well as beans and turnips, threatens the development of iodine deficiency. This is due to the fact that these products contain too many goitrogenic substances, which provoke excessive growth of thyroid tissue.

Thus, iodine deficiency primarily occurs due to the following factors:

• Insufficient iodine content in the environment, as well as in drinking water. Similar regions include central Russia, the Urals, Altai and the Caucasus.
• An unbalanced diet, against the background of which not enough fish, seaweed, dairy products, buckwheat and oatmeal are consumed.
• Systematic use of certain medications that block the absorption of iodine.
• The presence of a hereditary predisposition along with a genetic defect in the production of thyroid hormone.

Now let’s look at how the presence of endemic thyroid goiter manifests itself in patients.

Symptoms

The symptoms of goiter primarily depend on the functions of the thyroid gland. Especially often, patients may complain of the following sensations:

• Appearance of weakness.
• The presence of low physical endurance.
• Feeling of discomfort in the heart area.
• The appearance of headaches.

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

• A feeling of squeezing in the neck area.
• Presence of difficulty swallowing and breathing.
• The appearance of a dry cough.
• The occurrence of asthma attacks.

It is interesting to note that the diffuse type of goiter is the most common form. Women get it four times more often than men. This is primarily due to the increased need of women for the hormones of this gland during puberty, and also during pregnancy.

It should be borne in mind that the doses of drugs with iodine, according to the recommendations, should be as follows:

• 50 mcg is the norm for infants.
• 90 mcg should be taken by children under seven years of age.
• 120 mcg is the norm for children from seven to twelve years old.
• Adults should take 150 mcg.
• 200 mcg should be consumed by pregnant and breastfeeding women.

Figures and facts

About two hundred million people on the planet suffer from this pathology. It is called one of the most common human scourges. Ninety percent of all goiters are caused by iodine deficiency. The incidence of goiter among children has increased by six percent over the past ten years. Today, this incidence is approximately twenty-five percent of all childhood endocrinological diseases.

Everyone should know the pathogenesis of endemic goiter.

Complications

The disease can cause various complications. These usually include:

• Presence of goitrous heart. This is a condition in which the blood vessels leading from the heart are compressed. This may cause the heart to enlarge on the right side.
• Presence of compression of the esophagus and trachea.
• The appearance of hemorrhages in the thickness of the thyroid gland.
• The occurrence of inflammation of the gland.
• Development of malignant degeneration of the thyroid gland.

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

Diagnosis of pathology

An instrumental method for diagnosing goiter is ultrasound. Thanks to this study, the form of the disease is established, which may be diffuse or nodular.

If nodules are present, sonoelastography may be prescribed - a study that allows you to determine the density and elasticity of nodular formations. This makes it possible to find out what the nature of the pathology is: benign or malignant. For the same purpose, a thyroid biopsy is additionally performed. Among other things, to clarify the diagnosis, the level of hormones such as TSH and T4 is checked. Patients with this type of disease tend to have significantly imbalanced thyroid hormone levels. In turn, the rate of iodine excretion in the urine is reduced. But the initial stage of the examination is primarily palpation. This method allows you to do the following:

• The size of the lobes of the diseased organ is determined.
• The clarity of the border with surrounding tissues is assessed.
• The consistency of the gland is assessed. In this case, the doctor pays attention to such signs as compactions, softening, nodular formations and their approximate size.
• The condition of the lymph nodes is assessed along with the presence of lymphangitis.

In addition to palpation, ultrasound, as already noted, is a very informative and at the same time accessible method, which provides the following information:

• Exact width, thickness and height of lobes.
• Isthmus size.
• Complete information about the structure of the organ, and in addition, about its homogeneity.
• The presence of a nodular formation and its exact dimensions.
• The degree of volume of individual shares. The total volume of the thyroid gland is also determined.
• Condition of the surrounding tissue.

What is the treatment for endemic goiter?

Treatment of the disease

In the case of a slight enlargement of the gland, just a few courses of potassium iodide are often sufficient, as well as diet therapy with foods rich in iodine. Treatment of goiter complicated by hypothyroidism primarily involves hormone replacement therapy.

Treatment of goiter, which is in a nodular form at a late stage, usually requires surgical intervention.

At the postoperative stage, patients undergo hormonal replacement treatment. Among folk remedies, sea kale powder is recommended. It is taken a teaspoon at night and washed down with water. The course of therapy is from twenty to thirty days.

Prevention of endemic goiter is no less important.

Diet as a preventative measure

• Consumption of seafood in the form of shrimp, squid and mussels.
• Use of seaweed and other seaweed in the diet.
• Eating boiled sea fish up to three times a week.
• Use of fermented milk drinks in the diet, especially those containing bifidobacteria. Thus, you should drink two glasses of these drinks a day.
• Consumption of medium-fat cottage cheese up to three times every seven days.
• Consumption of nuts of all types up to 50 grams per day.
• Adding all types of seeds to food.
• Use in the diet of dried fruits in the form of raisins, dried apricots, apricots, figs, prunes, apples and pears.
• Eating cranberries, lingonberries, strawberries, gooseberries, black currants, viburnum, red rowan and so on.
• Use vegetables in the diet in the form of carrots, cabbage, beets and raw pumpkin.
• Eating greens, for example, onions, horseradish, celery and so on.
• Taking freshly squeezed juices from vegetables, berries or fruits.
• Taking drinks made from rosehip, dandelion or hawthorn root.
• Drinking mineral or spring water.
• Use 50 grams of honey in the diet.

Other ways to prevent goiter

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

• Mass preventive methods consist of the production of iodized salt, bread and confectionery products, which should contain this element. In addition, television promotes control over the iodine content in foods.
• Group prevention is carried out mainly in risk groups, namely in child care institutions, schools, secondary and higher educational institutions. In addition, attention is paid to pregnant women. This primarily includes conducting explanatory conversations along with the controlled distribution of iodine preparations, for example, “Antistrumin”, “Iodomarin” and “Iodocomba”.
• As for individual prevention, it consists of consuming foods that are rich in iodine. It is very important to take iodine supplements for people who are at risk, as well as for those who live in endemic regions.

How to prevent endemic goiter in children? Mixed-fed babies need 90 micrograms of iodine daily. Pregnant women, children and adolescents require up to 200 micrograms per day. In addition to taking appropriate medications, it is important to follow a diet, which should be based on sufficient iodine content in food.

Endemic goiter is a disease of the entire body, the main symptom of which is an enlargement of the thyroid gland. It is located on the front of the neck, below the larynx. The thyroid gland is part of the body's endocrine system that produces hormones. Once in the blood, hormones affect metabolism, growth, nervous system, general human constitution, etc. To produce hormones, the thyroid gland needs iodine; if it is not enough, it enlarges. An endemic goiter is formed. Over time, nodules (nodular goiter) may appear. Treatment is medication; in severe cases, surgery.

Symptoms of endemic goiter

• Enlarged thyroid gland.
• Hoarseness and difficulty breathing.
• Swelling of the eyelids and palms.
• Voice change.
• Pale, cold and dry skin.
• Fatigue.
• Anemia.

Causes of endemic goiter

It has been proven that the higher the location above sea level, the less iodine in the air, drinking water and food. This is the main factor. Iodine deficiency in the body is aggravated by unfavorable living conditions, helminthic infestation, etc.

Treatment of endemic goiter

There are three main clinical forms of the disease, the method of their treatment is different. But in most cases, they resort to medications, additionally prescribe thyroid hormones, as well as a diet with sufficient amounts of vitamins. If treatment is started in a timely manner, there is a possibility that the gland will shrink. Sometimes they resort to surgery. The indication is mechanical compression of neighboring organs by the goiter and malignant degeneration of the thyroid gland.

With endemic goiter, it is impossible to help yourself. But it is within your power to prevent its development.

As soon as a kind of pouch (goiter) begins to form just below the larynx, you should immediately consult a doctor. Small changes can be noticed when looking in the mirror (for example, when swallowing saliva).

First of all, blood is taken from a vein for analysis. Metabolism studies are carried out and the functional activity of the thyroid gland is determined. If necessary, ultrasound examination and tissue biopsy are performed.

Course of the disease

The main symptom of the disease is an enlarged thyroid gland. It can be expressed to varying degrees and have different goiter consistencies. Depending on the clinical form, other symptoms may appear: sweating, irritability, weight loss, anemia, pallor, increased sensitivity to cold, menstrual irregularities, swelling of the eyelids, difficulty swallowing.

Is endemic goiter dangerous?

If not treated in a timely manner, the goiter can greatly increase in size. If you live in an area where there is a lack of iodine, then take more vitamins and watch your diet.

In many areas there is a lack of iodine. There is little of it in the air, drinking water, and food. In this case, you need to include seafood in your diet.

Endemic goiter is a disease of the thyroid gland caused by a lack of iodine in the area of ​​residence. The normal functioning of the thyroid gland, which is an organ of internal secretion, that is, an organ that produces hormones, depends, among other things, on a sufficient supply of iodine from the outside, since this element is not produced by the body itself. The daily iodine requirement for an adult is 150-200 mg. When 50 milligrams or less of iodine is consumed, a compensatory mechanism of hypertrophy (proliferation) is triggered in the thyroid gland.

Sources of iodine are air (4-5%), water (4-5%) and food (90%), however, in those areas where the soil is poor in iodine, there is not enough of it in the air, water, or food. grown in this area. This disease is called endemic because it affects a large number of people living in one area (from the Greek word “locality, region”). In order for hypertrophy of the thyroid gland to be recognized as an endemic goiter, it is necessary that at least 5% of children and 30% of adults living in the same territory are affected by this disease.

Factors contributing to the disease of endemic goiter

Why, despite the fact that everyone in such areas experiences iodine deficiency, does not 100% of the population develop endemic goiter? The fact is that for its development, in addition to iodine deficiency, additional exposure to predisposing factors is necessary.

Risk factors include the following:

• Hereditary predisposition;
• Consumption of water and food containing chemical compounds that interfere with the absorption of iodine (nitrates, calcium, urochrome, humic substances in water, gormogenic compounds in food);
• Insufficient intake of zinc, copper, cobalt, manganese, molybdenum and selenium into the body;
• The use of medications containing substances that interfere with the absorption of iodine;
• Weakening of the immune system as a result of infectious processes in the body, malnutrition and unsatisfactory sanitary and hygienic conditions. Some researchers consider the factor of impaired immunity to be the second most important factor in the formation of endemic goiter after iodine deficiency.

Endemic goiter in children

The most dangerous may be iodine deficiency in childhood, during the period when the formation and growth of the body occurs. Endemic goiter in children, in addition to an enlarged thyroid gland, is manifested by very serious general developmental disorders, both physical and mental. The most severe form of endemic goiter in children manifests itself in the form of so-called endemic cretinism.

Also, manifestations of endemic goiter in children include:

• In newborns and young children there is a high level of perinatal mortality and congenital developmental anomalies;
• In children and adolescents - delayed mental, psycho-emotional, physical and sexual development, low academic performance, susceptibility to colds and chronic diseases.

To prevent endemic goiter in children, the following iodine consumption standards have been determined:

• Infancy – 50 mcg;
• Children from 2 to 6 years old – 90 mcg;
• Children from 7 to 12 years old – 120 mcg;
• Adolescents 13 years and older – 150 mcg.

Symptoms of endemic goiter

The symptoms of endemic goiter at an early stage are similar to those of thyroiditis and other diseases of the thyroid gland. The leading symptom is an increase in the size of the thyroid gland. Then there is a feeling of squeezing of the throat, a feeling of a lump in the throat and difficulty swallowing. These signs intensify with the patient lying down. Subsequently, the goiter increases and becomes visible, while the cervical vessels are compressed and breathing becomes difficult, which leads to hypoxia, poor circulation, and ultimately to heart failure. In some cases, strumitis occurs at significant stages - inflammation of the hypertrophied thyroid gland, similar to thyroiditis. It should be borne in mind that endemic goiter can degenerate into a malignant tumor of the thyroid gland, although this happens quite rarely.

Diagnostics

Symptoms of endemic goiter, detected in one area where the disease is endemic, are the basis for making a preliminary diagnosis. As a rule, diagnosis in this case is necessary to differentiate endemic goiter from other diseases of the thyroid gland, in particular tumors.

Diagnosis of endemic goiter consists of the following:

• Palpation examination of the thyroid gland to determine the degree of its enlargement (0 - the gland is unchanged, I degree of hypertrophy - the goiter is palpated but not visible, II degree - the goiter is visible to the naked eye);
• Laboratory tests: clinical analysis of blood and urine, determination of iodine excretion in urine, determination of the level of thyroid hormones and thyrotropin in the blood, determination of thyroglobulin (tumor marker of the thyroid gland) in the blood;
• Instrumental studies: radioisotope examination of the thyroid gland, ultrasound, radioisotope scanning of the thyroid gland, fine-needle aspiration biopsy.

Treatment of endemic goiter

Treatment of endemic goiter can be either conservative or surgical.

Conservative treatment of endemic goiter depends on its stage, i.e. on how severe the thyroid dysfunction is. At minor stages of the disease, a diet rich in iodine-containing products is prescribed (sea kale, feijoa, seafood, sea fish, ordinary salt is replaced with iodized salt), and potassium iodide in tablets is prescribed as a drug treatment in intermittent courses.

If there is a significant deterioration in the function of the thyroid gland, hormone replacement therapy is carried out, prescribing synthetic analogues of the hormones it produces. Treatment of endemic goiter at this stage is carried out under regular monitoring of hormone levels in the blood.

If several courses of therapy have not been effective, and increasing hypertrophy leads to increased compression of the neck organs and cervical blood vessels, surgical treatment of endemic goiter is resorted to, performing subtotal resection of the thyroid gland. After such an operation, lifelong hormone replacement therapy is necessary.

Prevention

The most effective method of preventing endemic goiter is salt iodization. Potassium iodide (chemical formula KIO 3) or potassium iodide (KI) is added to regular table salt. This salt cannot be heated, so it should be used only when preparing cold dishes; this applies to a greater extent to potassium iodide. It should also be taken into account that during long-term storage, under the influence of direct sunlight and moisture, iodine salts are destroyed. Therefore, iodized salt must be stored in a dry, dark place and used within the expiration date indicated on the package.

Endemic goiter- a disease manifested by an enlarged thyroid gland in people living in areas where there are few iodine salts in the soil and water, and therefore too little of this element enters the body with food. Endemic goiter is called when 5% of children and 30% of adults in a given area have an enlarged thyroid gland.

In the territory of the former USSR, risk areas for this disease are Belarus, some regions of Ukraine, Central Asia, Transcaucasia, Siberia, the Urals and the Middle Volga region.

An adult should receive from 100 to 200 mcg of iodine per day from food and water. If he doesn't get enough of it, the thyroid gland tries to compensate for the iodine deficiency in the body and increase the production of hormones. As a result, it increases in size - a goiter appears.

In addition, the occurrence of this disease is facilitated by insufficient amounts of protein, vitamins, copper, zinc, selenium, molybdenum and cobalt in food. In addition, the absorption of iodine is disrupted by excess calcium, fluorine and manganese.

There are also some products (they are called goitrogenic) that interfere with the absorption of iodine by the thyroid gland. These are cabbage, turnips, radishes, carrots, soybeans, mangoes, peaches, radishes and peanuts. The fact is that they contain special chemicals - thiocyanate, thiouracil, thiourea, aniline derivatives, polyphenols and perchlorate - which interfere with the normal absorption of iodine.

In medicine, there have been cases where people who consumed large quantities of these products developed a goiter, sometimes reaching quite large sizes. But it completely disappeared as soon as the patients changed their diet.

Classification

Depending on the uniformity of enlargement, the glands are divided into diffuse goiter(thyroid gland is evenly enlarged) or nodular goiter(only part of the gland increases).

In addition, depending on the degree of preservation of thyroid function, there are euthyroid goiter (thyroid gland functions normally), hypothyroid goiter (with reduced thyroid function), hyperthyroid(with increased function). In about half of sick people, thyroid function is not impaired.

Symptoms

When the disease first begins, the main complaints of patients are related to unpleasant sensations in the neck area, in particular a feeling of pressure on the neck and intolerance to tight collars and ties. When the size of the thyroid gland increases, there are signs of compression of the surrounding organs and there may be difficulty breathing and a feeling of a lump in the throat when swallowing.

The symptoms of endemic goiter also depend on its form. At euthyroid form, a person is worried about weakness, morning fatigue and fatigue in the evening. Headaches occur that are not helped by regular painkillers - this is due to compression of the blood vessels in the neck.

At hyperthyroid In the form of a goiter, irritability, nervousness, decreased appetite, sleep disturbance and increased heart rate appear. A person loses weight, and the cheekbones on his face become sharper.

Hypothyroid goiter is characterized by slightly pale skin, muscle weakness and fatigue. In later stages, the patient's face becomes noticeably pale and swelling or swelling appears. The heart rate decreases and blood pressure drops. Women's menstrual cycles are disrupted: sometimes the pause between them reaches several months.

Now, for the purpose of prevention, in areas at risk of endemic goiter, the population is recommended to consume only iodized salt. Iodine is also added to other foods, such as bread and eggs. Nevertheless, the problem of endemic goiter still exists, so if you live in an area where there is iodine deficiency, check regularly with an endocrinologist and pay attention to any suspicious symptoms.