Endemic and sporadic goiter

Sporadic goiter is a common ailment that is associated with a violation of the thyroid gland structure, namely, with its increase. Despite the fact that the disease is considered relatively safe, it should not be ignored - the patient needs qualified help.

Of course, faced with a similar problem, patients are interested in additional information. What is the disease? What symptoms should I pay attention to in the first place? What can modern medicine offer in terms of treatment? Answers to these questions will be useful to many readers.

What is an ailment?

Quite often in medical practice, terms such as endemic and sporadic goiter are used. Both these diseases are accompanied by nodal or diffuse enlargement of the thyroid gland along with the preservation of its functional activity. Nevertheless, there is still a difference between them.

Endemic goiter is an ailment that is associated with a deficiency of iodine in the body, which is so important for the normal functioning of the thyroid gland. This form of ailment is registered among residents of areas with iodine deficiency in food and water. According to statistics, the disease is common in Brazil, India, some regions of the US and Russia, Egypt, Switzerland. The disease is much more common among residents of high mountain areas.

Sporadic goiter of the thyroid gland is accompanied by the same symptoms and structural changes. Nevertheless, the ailment has nothing to do with living in areas with a low iodine content.

The main causes of the development of the disease

Not always specialists can find out why sporadic goiter develops. Nevertheless, there are several risk factors:

• To begin with, it is worth mentioning genetics, since hereditary predisposition to such a disease has been proved. In most cases, it is a violation of the processes of iodine metabolism and the formation of hormones in the thyroid gland.
• Risk factors are also attributed to the negative impact of the environment.
• Of great importance is nutrition, since along with food, substances that interfere with the normal synthesis of thyroid hormones (for example, flavonoids, thiocyanide) can enter the human body.
• Often the cause of this disease is the intake of drugs that disrupt the absorption of thyroid hormones by the tissues of the body.
• Sporadic goiter can develop during periods when the body's need for thyroid hormones is increased, for example, during puberty or pregnancy.
• The cause of the development of the disease is sometimes an adenoma or a tumor that grows in the tissues of the thyroid gland.

Insufficient synthesis of hormones, a violation of iodine metabolism, a decrease in the sensitivity of the body to thyroid hormones - all this triggers compensatory mechanisms. The pituitary gland begins to secrete more thyroid-stimulating hormone, which provokes hyperplasia of the thyroid tissue.

Sporadic goiter: classification

There are many classification systems for this disease. For example, depending on the functional activity of the thyroid gland:

• Eutireoidnuyu form (hormonal background within the norm, the thyroid gland is not broken);
• Hyperthyroidism (characterized by increased activity of the gland and an increase in the level of thyroid hormones);
• Hypothyroid form (thyroid function decreases, the number of hormones decreases).

In consideration take and location of goiter - it can be cervical, partially retrosternal, retrosternal and pseudo-esophagus. Allocate and goiter root of the tongue.

Depending on the structure, the goiter may be diffuse (the thyroid gland is hypertrophied, the tissues are uniform), nodular (more dense nodules are formed in the thick of the gland) and mixed.

Stages of development of the disease and a brief description

The sporadic goiter is accompanied by a gradual increase in the thyroid gland. Depending on the size of the body, several degrees of development of the disease are distinguished:

• Zero degree - the gland is not palpable, its dimensions are still within normal limits.
• The first degree - at this stage, the gland is not visually visible, but its isthmus is seen during swallowing, it can be felt during palpation.
• The second degree - the thyroid gland is well palpated and visible during swallowing.
• The third degree - during this period the thyroid gland is already clearly visible not only during swallowing, but also at rest. You can also note the change in the contours of the neck (it looks thicker, the "second" chin appears).
• The fourth degree - a struma is well visible, the form of a neck varies.
• The fifth degree is a neglected form of the disease, in which the thyroid gland reaches enormous dimensions. Often the enlarged organ compresses the trachea and esophagus, preventing swallowing and breathing.

The doctor, drawing up the scheme of therapy, necessarily pays attention to the degree of enlargement of the gland.

Sporadic goiter: the clinic and the main symptoms

At the initial stages, the ailment is often not manifested - the person feels quite normal. But as the disease develops, the thyroid gland begins to increase in size. At first it can be seen only during swallowing, but the organ is constantly growing, which is accompanied by a change in the contours of the neck.

An increase in the thyroid gland affects the work of nearby organs. There is a compression of the trachea, which is accompanied by the appearance of dry cough, difficulties with breathing. Patients complain of swallowing problems. In some cases there is hoarseness of the voice, which is associated with squeezing the nerve endings.

At the initial stages, the level of thyroid hormones is normal. But as the disease progresses, the amount of biologically active substances released can decrease or, conversely, increase. Disorders of the hormonal background are fraught with the appearance of other disorders. For example, some patients develop tachycardia, hypertension, arrhythmia. Many patients complain of constant fatigue and drowsiness, irritability, pain in the muscles, swelling around the eyes. Symptoms include night sweats, poor tolerance of heat or cold, increased sensitivity of the skin, constipation, which do not disappear even after a change in diet.

Diagnostic procedures

In most cases, patients turn to the doctor already at later stages of the development of the disease. At palpation the expert can feel an increase in the thyroid gland. It is extremely important to collect a full history (whether the patient lives in a region with iodine deficiency, if there are any other cases of goitre in the family) and to determine the cause of the development of the disease, because in many ways the success of therapy depends on this.

The ultrasound of the thyroid gland is necessarily performed. This simple study makes it possible to determine the presence of nodes and cysts, to ascertain the exact size of the organ, and so on. Also X-rays of the neck and chest, and sometimes a computerized tomography (gives the opportunity to see the degree of squeezing organs). The patient donates blood to determine the level of thyroid hormones. A biopsy is performed if there is a suspicion of a malignant neoplasm (most often with a nodular goiter).

What does the treatment look like?

What to do to the patient who was diagnosed with sporadic goiter? Treatment depends on many factors. As a rule, suppressive thyroid therapy is performed. Patients are assigned to take "Levothyroxine" or another drug containing L-thyroxine. The dose and duration of therapy are determined individually.

In case of iodine deficiency or disruption of his metabolism, the doctor additionally appoints iodide ("Antistrum"). An important part of therapy is the right diet. It is necessary to include in the diet foods rich in iodine and proteins, while limiting the amount of foods that contribute to the development of goiter (in particular radish, rutabaga, peanuts, radish, beans, cauliflower).

When is surgery indicated?

Taking medicines helps to normalize the thyroid gland, prevent its further growth and eliminate other disorders that accompany sporadic goiter. Surgery, however, is the only way to eliminate the already existing deformities. The decision to conduct the operation is made by the attending physician in case the overgrown organ squeezes the trachea, vessels and nearby tissues. During the procedure, the surgeon removes excess tissue, restores the normal form of the gland and neck.

Complications and possible consequences

In most cases, the ailment is well treatable. Nevertheless, there is a danger. For example, sporadic goiter in children is fraught with violations of physical development and cretinism. If it is a nodular form of hypertrophy, then there is always a chance of malignant cell degeneration.

An enlarged thyroid gland squeezes blood vessels, nerve endings, respiratory tracts, significantly worsening the patient's quality of life. For example, people with hypertrophy of grade VI and V are considered to be partially inoperative - they are contraindicated in occupations that require physical exertion.

Preventive actions

Sporadic goiter is a fairly common problem. And in this case it is much easier to prevent the development of the disease than to worry about treatment. Since the ailment is sometimes associated with iodine deficiency, it is necessary to monitor the diet, include iodized salt, sea kale and other products rich in this useful trace element in the diet.

It is also necessary to avoid other risk factors, in particular, the intake of potentially dangerous drugs. Periodically, doctors recommend taking iodine-containing medications for prevention (if the ailment can be caused by a deficiency of this substance in water and food). 1-2 times a year it is necessary to undergo examinations at the endocrinologist. If you have any symptoms, you should immediately contact a specialist.