Echographic characteristics of thyroid lesions in children of the Astrakhan region. Signs of diffuse changes in the thyroid gland Diffuse changes in the thyroid gland in a child

Definition of the concept

Diffuse changes become possible due to ongoing negative processes in endocrine cells. The pituitary gland or antibodies increase the volume of the gland to compensate for the lack of iodine obtained from food and water. The hormonal balance is disrupted, and neoplasms appear.

Changes in tissue density are a consequence of various diseases. The increase occurs due to the proliferation of connective tissue and increased calcium concentration. Reduction - due to edema, the occurrence of an oncological tumor, inflammation.

During ultrasound examination, the affected thyroid tissue appears as a coarse-grained formation, in which areas with low and high echogenicity alternate.

Depending on the pathology, there are several types of diffuse nodular changes in the thyroid gland:

• Thyroiditis is an inflammatory disease that has acute, subacute, and chronic forms.
• Goiter, which is formed as a result of organ enlargement and has such forms as endemic and sporadic (depending on the cause), euthyroid (with normal hormone levels), toxic (with excess hormones), hypothyroid (with a lack of hormones).

To make such a diagnosis, a comprehensive study is required, after which treatment can be prescribed.

Causes of the disease

The causes of diffuse changes in the thyroid gland can be divided into two groups: main and accompanying.

The main reasons include:

• Imbalance of iodine in the body, which is necessary for the synthesis of the hormones thyroxine and triiodothyronine in the thyroid gland.
• Autoimmune reactions. They affect the activity of the thyroid organ and cause diseases such as Hashimoto's goiter and toxic goiter.
• Infections. They occur when bacteria enter the thyroid gland along with blood and lymph.

In addition to these reasons, there are also accompanying ones that can also provoke the disease. These reasons include the following factors:

• Poor nutrition, when the diet contains an excess of foods that disrupt the functioning of the thyroid gland. These are cabbage, beans, corn, peanuts.
• Radiation.
• Persistent intoxication associated with the type of activity.
• Disruption of the endocrine system.

When treating this disease, the effect will depend on the correct identification of the cause that caused the changes.

Symptoms and signs

The symptoms of this disease directly depend on the pathology. The manifestations of various forms of diffuse changes are determined by the level of hormones.

The main symptoms will be:

• Heterogeneity of thyroid tissue, different densities in its different parts.
• Blurred boundaries of the gland body.
• The growth of an organ, its transformation into a goiter.
• The presence of dysfunctions performed by the gland.

In addition, concomitant symptoms are added to the main symptoms, which are the result of a malfunction of the thyroid gland. Changes affect the following aspects of the body:

• Hair and nails become dull and brittle.
• A person is often exposed to colds.
• The general condition changes sharply, there is increased fatigue, movements become sluggish, you constantly want to sleep, and your body temperature rises slightly.
• Efficiency drops sharply.
• There are bursts of nervousness, and the person may become depressed.
• Weight loss or gain may occur.
• Intimate problems are typical.

External symptoms and signs of diffuse changes in the thyroid gland are immediately visible to a specialist. By carrying out the necessary research, the diagnosis is clarified, the cause of the disease is clarified, and then the correct treatment can be prescribed.

Forms of the disease

Thyroid disease has several forms. Changes can be dictated by various reasons, the degree of complication or the mechanism of tumor formation.

Based on this, the following forms are distinguished:

• diffuse changes in the thyroid parenchyma or transformation of its structure;
• According to the degree of manifestation of changes, pronounced deviations from the norm are distinguished from moderate ones;
• According to the structure of the body, neoplasms are diffuse-nodular and diffuse.

The thyroid parenchyma refers to the working body, consisting of small follicles, between which vessels with blood and lymph pass. Normally, the hormones triiodothyronine and thyroxine are produced here. When damaged, follicular cells grow and the hormone balance is disrupted. At an early stage, such a change can be detected by a doctor by palpation, then the growth becomes visible from the outside.

If the structure is disrupted, the density of the gland changes, some follicles are replaced by connective tissue.

If the parenchyma increases evenly and slightly, then this does not lead to hormonal and structural disorders. With pronounced deviations, severe deformation of the structure and parenchyma of the gland is observed.

In addition, pronounced diffuse changes cause not only hormonal imbalance, that is, the endocrine system suffers. The process involves the heart, blood vessels, bones, changes in the reproductive system are observed, and nervous disorders are noted.

If during ultrasound diagnostics, along with magnification, atrophied areas are detected, this makes it possible to diagnose diffuse focal changes in the thyroid gland, which may indicate oncology. Diffuse focal changes include neoplasms such as adenoma, cyst, lipoma, teratoma, hemangioma. A malignant tumor will be the last stage of the disease.

Diagnostics

Diagnosis of thyroid diseases in women and men occurs in stages. To make a diagnosis, it would be correct to go through:

• examination by a doctor;
• hardware examination.

First, during medical examination, everyone must undergo an examination by an endocrinologist. During the procedure, he examines the external signs of the gland. If any pathology is detected in the gland tissue, the specialist sends the patient for additional studies. Only after this will it be possible to prescribe treatment.

Hardware research includes the following procedures:

• ultrasound examination;
• magnetic resonance imaging;
• computed tomography.

They allow you to obtain all the necessary information about the condition of the patient’s thyroid gland. The most common procedure is ultrasound, which clearly shows echo signs of diffuse changes in the tissues of the gland.

Based on the results of the ultrasound, laboratory tests are prescribed that will determine the nature of the changes.

Treatment of thyroid diseases

Depending on the different forms of the disease, treatment is prescribed. It should only be done under the supervision of a doctor; self-medication without knowing the reasons that caused the changes and the extent of the disease can cause great harm.

The indication for prescribing various drugs for a specialist will be the degree of enlargement of the organ and the inability for it to perform its functions. There are three types of treatment:

• Taking iodine-containing medications and eating foods rich in iodine. This is possible if the functions of the organ are not changed and there are moderate diffuse changes in the thyroid gland.
• The use in the treatment of thyroid hormones (drugs Levothyroxine, Euthyrox), which compensate for the hypofunction of the endocrine organ.
• Surgical treatment followed by hormone replacement therapy. It is used in cases where there is a diffuse nodular change in the thyroid organ. Therapy in this case will protect against stable remission and will prevent a relapse form.

In any case, therapy will improve the condition of a patient who has endocrinological problems.

Preventive actions

In order not to know what diffuse changes in the thyroid organ are, and never experience the consequences, it is necessary to organize the correct prevention of this disease.

Preventive measures include the following:

• Eat iodized salt and foods rich in iodine. This applies to people who permanently reside in an endemic area.
• Include daily anti-stress therapy. This could include yoga classes, breathing exercises, relaxation sessions, and the use of sedatives.
• Support your immune system with multivitamins throughout the year.
• Undergo routine medical examination. When living in unfavorable conditions, it is advisable to visit an endocrinologist annually.
• Lead a healthy lifestyle, eliminate bad habits.
• If any endocrine diseases occur, undergo full treatment.

If diffuse and focal changes in the thyroid gland are nevertheless detected, then the patient in this case should understand that increased attention to health is required and compliance with all doctor’s recommendations. Then such a diagnosis will not have a negative impact on life.

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If you have changes in the tests, you will be prescribed a further full examination. This is done in order to protect you, dear patients, from wasting money, because the prices for tests are quite high.

If your tests are within normal limits, then, most likely, you will be recommended observation and preventive use of certain medications. In general, in this case everything depends not only on diffuse changes, but also on the size of the gland as a whole. If the size increases, there is a high probability that you will be prescribed treatment even with normal tests.

Causes of diffuse changes in the thyroid gland?

When you find out that there are diffuse changes in the thyroid gland, is it time to find out why this happened? What caused such changes to occur? Since this can occur in various diseases, I will list them all so that you can have some reference.

• Endemic goiter. It occurs due to a deficiency of the most important microelement for the thyroid gland - iodine.
• Sporadic goiter. It occurs for the same reason as endemic, but the peculiarity is that it occurs in a person living in an area of ​​normal iodine content in the soil and air. The reason often lies in the pathology of enzyme systems that are involved in the synthesis of hormones, and in the individual deficiency of iodine in the body.
• Diffuse toxic goiter. A serious illness characterized by the development of thyrotoxicosis, which requires immediate medical attention.
• Autoimmune thyroiditis. Autoimmune damage to the gland, which results in hypothyroidism. It can occur hidden, without the development of hypothyroidism in the early stages. Requires medical intervention when obvious signs of hypothyroidism appear.
• Other types of thyroiditis. These include subacute thyroiditis, postpartum thyroiditis, silent thyroiditis and others.

To find out which of these diseases means changes in the thyroid gland, hormonal testing, and in some cases, auxiliary research methods will help.

It must be remembered that any change in the thyroid gland should not be ignored. Contact your doctor in time to start treatment on time if necessary.

Diffuse changes in the thyroid gland: signs, symptoms and types of disease

Causes of diffuse changes

Modification of thyroid tissue can occur for a number of reasons:

1. 1. Iodine deficiency. In regions where the soil and water contain insufficient amounts of iodine (endemic), diffuse changes in the thyroid gland are widespread.
2. 2. Hormonal imbalances. When the thyroid gland produces more or less hormones than required, its tissue structures and size change.
3. 3. Chronic autoimmune thyroiditis or lymphomatous thyroiditis. The inflammatory process of thyroid tissue most often appears due to autoimmune causes. The human immune system produces antibodies and lymphocytes that attack the gland’s own cells as foreign.
4. 4. Sudden change in the environmental situation in the region. Emissions of toxic substances into the atmosphere and water lead to disruption of the ecological balance in the areas adjacent to the release site and cause a surge in thyroid disorders and diseases among the population.
5. 5. Unbalanced diet. Changes in the structure and functions of the thyroid gland occur when there is a lack of food rich in iodine in the body - primarily various seafood.
6. 6. A diet high in goitrogens—foods containing substances that interfere with normal hormone production—also causes thyroid abnormalities. Goitrogens include: cabbage, corn, soy products, broccoli, flaxseed, strawberries, pine nuts, etc. Temperature treatment of these products causes changes in their molecular structure, reducing the goitrogenic effect.

Diffusion of the thyroid gland occurs due to the following diseases:

• endemic goiter;
• subacute thyroiditis;
• autoimmune thyroiditis (AIT);
• chronic autoimmune thyroiditis (CAIT);
• diffuse toxic goiter;
• mixed goiter.

Women are most susceptible to diffuse changes in the thyroid gland during the decline of reproductive functions; in men and children, this disease is much less common.

Thyroid diseases in children

Modifications of the thyroid gland in children have serious consequences, expressed by retardation in physical and mental development, and negatively affect the functioning of the hypothalamic-pituitary part of the brain. Determining the root cause of the disease helps to choose the optimal course of treatment, but cannot guarantee that the disease will not return after a while.

Provoking factors may be:

1. 1. Iodine and selenium deficiency, leading to the appearance of nodular goiter in children and a decrease in their intellectual capabilities.
2. 2. Infectious diseases that disrupt the functioning of the thyroid gland.
3. 3. Autoimmune diseases that change the structure of the thyroid gland and lead to hormonal imbalance.
4. 4. Bad ecology: high background radiation stimulates tumor processes in organ tissue.
5. 5. Poor quality food containing artificial additives that impair the absorption of beneficial macro- and microelements.
6. 6. Stress and psycho-emotional stress that disrupt the synthesis of hormones in the child’s body.

Symptoms of diffuse changes in the thyroid gland

Modifications in the structure of thyroid tissue affect the metabolic processes of the body and are manifested by symptoms:

• hypothyroidism – slowing down the synthesis of thyroid hormones;
• hyperthyroidism – acceleration of their production.

Types of thyroid diffusions

An ultrasound examination of the thyroid gland can detect various types of changes in the organ. The main parameters studied using ultrasound: echogenicity, contours of the organ and its structure.

Echogenicity is a parameter showing the properties and composition of tissues and fluids of the organ under study under the influence of ultrasonic waves. The higher the density of the fabric, the greater its ability to reflect sound. In this way, the condition of the diagnosed areas is determined.

Parenchyma diffusion

The parenchyma of the thyroid gland consists of follicles - the structural units of the organ. Their purpose is to store and replenish colloidal fluid, which serves to produce thyroid hormones: triiodothyronine and tetraiodothyronine (thyroxine), which regulate the body's metabolic processes. The normal size of a follicle is forty to fifty micromicrons. Each follicle is connected to blood vessels and capillaries of the lymphatic system.

Thyroid parenchyma diffusions are transformational modifications of the entire parenchyma tissue, distributed evenly over the entire area. There is an increase in the volume of the organ in all directions.

An endocrinologist can detect this condition by palpating (feeling the organ). An ultrasound examination will reveal echo signs of diffuse tissue changes, but the patient himself may not experience symptoms of the disease. In this case, the gland works under strain, so any malfunction caused by overexertion or stress can cause an imbalance in the production of hormones, which will negatively affect the condition of the entire body.

Such modifications of the gland parenchyma are most often associated with the chronic course of autoimmune thyroiditis (AIT), which disrupts the production of hormones and leads to the proliferation of the organ.

Diffusion structure

Following the growth of the gland volume, an increase in tissue density occurs.

Early stages of the disease have no symptoms. An abnormality in organ tissue can be detected by palpation. To confirm the diagnosis, it is necessary to determine the hormonal status and level of antibodies to the thyroid gland using a blood test. At the initial stage of the disease, hormones may be normal.

If diffuse disorders in the structure of the thyroid gland are of the type AIT (autoimmune thyroiditis), then even in the early stages an increase in antibodies in the blood serum is detected - the immune system is already working hard against its own organ.

An ultrasound will detect changes in the echostructure of the gland.

As the disease progresses, gradual disruptions in the functioning of the entire body occur:

1. 1. Nervous system: anxiety, restlessness, irritability and imbalance appear.
2. 2. Cardiovascular system: changes in heart rate, atherosclerosis.
3. 3. Reproductive system: infertility, early menopause - in women, decreased sperm count and motility - in men.
4. 4. Metabolic disorders.

Diffuse-focal changes

Diffuse-focal changes - proliferation of the thyroid gland with foci characterized by an altered tissue structure. The surrounding glandular tissue is most often unchanged.

Ultrasound helps detect the type of tumor. It could be:

• adenoma;
• cyst;
• teratoma;
• lipoma;
• hemangioma;
• cancer tumor;
• paraganglioma.

Diffuse focal changes occur in the thyroid gland in the following diseases:

• adenoma;
• mixed goiter;
• nodular goiter

Such diffuse focal changes appear on ultrasound as areas of increased or decreased echogenicity. The echogenicity indicators of benign and malignant neoplasms have parameters corresponding to these diseases, so the diagnosis determined using ultrasound is accurate.

Diffuse nodular changes

If areas of increased density are detected by palpation, diffuse nodular changes in the thyroid gland are suspected and an ultrasound is prescribed.

If changes in the tissues of the gland are diagnosed with nodule formation, the size of which exceeds 1 cm, a biopsy is prescribed to examine the contents of the node.

Most often, the node is an enlarged follicle in a capsule that separates it from healthy organ tissue.

With a strong enlargement of the node, a change occurs in the functioning of nearby organs and tissues, causing symptoms:

• suffocation;
• lump in the throat;
• pain;
• voice change.

Over time, large nodes undergo malignancy - degeneration into malignant tumors, so it is necessary to monitor the size of the identified nodes and their structure.

Malignant tumors on ultrasound have the following parameters:

• reduced echogenicity of the tumor;
• heterogeneous loose structures of thyroid tissue;
• deposits of calcium salts in the tissue of the node.

Nodular changes appear in diseases of the thyroid gland such as:

• nodular colloid goiter;
• fibrocystic adenoma;
• carcinoma.

Diffuse cystic changes

Diffuse cystic changes are the appearance of cystic formations in the tissues of the thyroid gland with a general increase in the volume of the organ.

A cyst is a cavity filled with colloid and enclosed in a capsule. For a long time, cystic formations may not produce any symptoms.

When infection occurs and suppuration occurs, signs of acute inflammation appear: fever, intoxication, pain.

Cysts, like nodes, can degenerate into malignant neoplasms, and therefore require observation and timely treatment.

Moderate diffusion

Moderate diffuse changes with a normal structure of the thyroid parenchyma generally do not cause disruptions in the functioning of the organ. In this case, no treatment is needed. An annual examination is necessary to timely determine signs of changes in tissue structure.

Pronounced diffusion

Severe diffuse changes in the thyroid gland are a strong increase in tissue, diagnosed by ultrasound examination.

Diseases with pronounced diffuse changes in the thyroid gland:

• autoimmune thyroiditis;
• hyperthyroidism in Graves' disease (Graves' disease).

These diseases are accompanied by focal (nodular or cystic) enlargements of the thyroid gland. Failures in the production of thyroid hormones affect the nervous, cardiovascular, reproductive, and skeletal systems. Severe diffusions must be treated using medications after testing and examination.

Drug treatment and folk remedies

After diagnosing changes in the thyroid gland, determining the presence of nodules and their size, blood is taken to analyze the hormones produced. Medications for treatment and the duration of their use are prescribed based on the results of the examination.

For minor diffuse disorders, a course of iodine preparations is prescribed: Iodine balance, Iodomarin.

If there is a lack of thyroid hormones (CAIT, hypothyroidism), hormone replacement therapy with Eutirox or L-thyroxine with periodic monitoring of hormones in the blood.

For Graves' disease and hyperthyroidism, hormone suppression is used with thyreostatics: Mercazolil or Tyrosol.

Enlargement of the thyroid gland to a size that compresses nearby organs, proliferation of nodes of more than 1 cm leads to surgical intervention.

Treatment with folk remedies will help to significantly reduce the consumption of synthetic hormones:

1. 1. For hyperthyroidism, use an infusion of leaves, stems, and roots of cocklebur - 1 tbsp. l per glass of water, keep on low heat for 10 minutes. After standing for an hour, drink 2 tbsp. l. before eating. You need to take this infusion for six months.
2. 2. Another herbal infusion that treats the thyroid gland is prepared according to this recipe. Take herbs in proportion: mint, valerian, motherwort - 1 part, hawthorn - 2 parts. Pour one tablespoon of the mixture into 1 glass of boiling water and leave for half an hour. Take half a glass twice a day before meals.
3. 3. Potentilla herb is used to prepare an infusion: brew 1 tbsp. l. dry herbs to 1 cup boiling water. Drink a third of a glass three times a day for about a month, then take a break from taking it for 15 days.
4. 4. An alcohol tincture is prepared from the root of the cinquefoil: mixing 50 g of the root with half a liter of alcohol and infusing it for 21 days. Take a dose of 30 drops three times a day.

If a puncture is taken for a malignant type of neoplasm, it can cause significant complications. In this case, treatment is carried out by excision of the organ.

Prerequisites for development

Diffuse structural changes in the thyroid gland in most cases are formed in the presence of other diseases, for example, goiter.

The gland can become diffusely heterogeneous in the presence of certain endogenous processes in the body:

• significant, prolonged emotional and psychological stress;
• endocrine and autoimmune pathologies;
• incorrect approach to nutrition;
• bad habits;
• genetic predisposition.

The environment is also a strong factor affecting humans. Due to unfavorable environmental conditions, soil depletion, water pollution, industrial emissions, the functioning of the thyroid gland, which immediately responds to these manifestations, is deteriorating.

Diffuse changes in the thyroid gland. Diagnosis and symptoms

It is quite difficult to make a diagnosis and identify pathology in a timely manner, this is due to the fact that its symptoms are mild or completely absent.

You can identify signs of diffuse changes in thyroid tissue:

• severe and regular fatigue;
• decreased attention and concentration;
• frequent colds;

When the thyroid gland malfunctions, the immune response decreases, which, in turn, leads to:

• increased human susceptibility to infections (bacterial, viral);
• soreness and discomfort in the muscles;
• excessive dryness and peeling of the skin;
• sudden weight loss or weight gain;
• hair loss;
• delamination and brittleness of the nail plate;
• decreased libido;
• disorders of the nervous system (apathy, depressive disorders);
• disruptions in intestinal function.

Depending on the degree of diffuse changes in the thyroid gland, women may experience different symptoms. This may affect the regularity of the menstrual cycle, the possibility of conceiving and bearing a child.

The symptoms of diffuse pathology of the gland are more pronounced in adolescents (during puberty), after childbirth, and also during menopause.

Methods of detection

If you have primary clinical symptoms, you should immediately contact an endocrinologist.

During the examination of the patient, a thyroid examination (palpation) is performed. This makes it possible to identify the presence of nodes in the gland, its structure and size.

Quite informative diagnostic methods are: , blood tests for , .

When neoplasms are detected, a histological examination of the resulting sample is performed.

How to treat diffuse changes in the thyroid gland

Pediatricians and endocrinologists state that among children, especially girls, there is an increase in the incidence of thyroid disease.

For local pediatricians, the following questions become relevant: “What do we attribute this situation to? What examination needs to be carried out on an outpatient basis? How to interpret the survey results? In what case is in-depth inpatient examination and treatment required?

When examining patients with suspected thyroid pathology, specialists widely use ultrasound diagnostics, which allows not only to assess the size of the thyroid gland, but also to identify changes in its structure. It is equally important that this diagnostic method is non-invasive, non-aggressive, and does not bear a psychological burden on the growing organism.

We would like to present our own observations, first of all, to primary care specialists. The further course and outcome of the disease depends on the timeliness of management tactics and correct interpretation of the results of the echographic picture of the thyroid gland. The work was carried out on the basis of the State Healthcare Institution “Regional Children's Clinical Hospital named after. N. N. Silishcheva" Astrakhan from 1994 to 2010

In most cases, despite the enlargement of the thyroid gland, endemic goiter occurs, detected in regions with iodine deficiency, which does not require hospitalization of the child in a hospital. To describe this disease, the following terms are used: juvenile, pubertal, diffuse nontoxic, simple, euthyroid (that is, without dysfunction) goiter.

In 2003, the Ministry of Health of the Astrakhan Region, employees of the Astrakhan State Medical Academy, with the participation of endocrinologists of the city and region, as part of the activities of the regional target program “Prevention of Iodine Deficiency Diseases”, conducted a survey for “endemicity” using the Tiromobil project. The incidence of enlarged thyroid glands among schoolchildren in the city and region aged 8-11 years ranged from 17.5% to 30%. The median iodine concentration in urine corresponded to the average degree of iodine deficiency - 26 µg/l. Indicators of iodine content in urine varied from 18.8 to 30.4 μg/l.

For comparison: according to screening studies conducted in 1995-1998. by employees of the Endocrinology Research Center, the frequency of enlarged thyroid glands among Moscow school students varied from 7.3% to 12.5%, reaching 15% in certain age categories, and the median concentration of iodine in the urine corresponded to a mild degree of iodine deficiency - 72 mcg/ l.

In the vast majority of cases, in conditions of mild to moderate iodine deficiency, a slight enlargement of the thyroid gland is detected only with a targeted examination. In itself, the fact of a moderate enlargement of the thyroid gland with normal function of the latter practically does not affect the work of other organs and systems. Therefore, the child most often does not present any specific complaints and does not give the impression of being seriously ill. Therefore, iodine deficiency goiter is spoken of in the literature as a sign of “hidden hunger.” There is no talk yet of any clearly expressed and clinically manifest dysfunction of the thyroid gland. In principle, a goiter is formed to prevent the development of hypothyroidism.

For the treatment of euthyroid endemic goiter, as a rule, it is sufficient to prescribe iodine preparations (potassium iodide) in a physiological dose, that is, 100-200 mcg per day. The effectiveness of treatment is assessed 6 months after its start. If there is a tendency to reduce the size of the thyroid gland, therapy is continued for 1.5-2 years. After discontinuation of potassium iodide, the use of iodized salt is recommended. If, while taking iodine preparations for 6 months, the size of the thyroid gland has not normalized, then the use of levothyroxine (L-thyroxine) orally in the morning 30 minutes before breakfast at a dose of 2.6-3 mcg/kg body weight per day in combination with 100-200 mcg of iodine (potassium iodide) per day, long-term. An adequate dose of L-thyroxine is selected in accordance with the level of thyroid-stimulating hormone in the patient’s blood serum. After normalization of the size of the thyroid gland according to ultrasound examinations performed every 6 months, it is recommended to switch to long-term intake of prophylactic doses of iodine (Fig. 1).

When considering the structure of thyroid pathology in children of the Astrakhan region in dynamics, it can be seen that the share of homogeneous forms of goiter in 1994 accounted for 86.4%, and by 1998 the percentage of homogeneous forms of goiter decreased and was already 34.2%, that is decreased by 2.5 times. Heterogeneous forms of goiter have increased since 1994 by 1998, according to dynamic examination data, by more than 5 times (Fig. 1). Most likely, this situation was caused by iodine deficiency.

The main role in the pathogenesis of iodine deficiency goiter is assigned to autocrine growth factors (AGF), in particular insulin-like growth factor type 1 (IGF-1), epidermal growth factor (EGF) and fibroblast growth factor, which, under conditions of iodine deficiency in the thyroid gland, have a powerful stimulating effect on thyrocytes, causing an increase in the volume of the thyroid gland and disruption of its structure.

We have found that in children with euthyroid goiter, echographic changes such as diffuse structural heterogeneity (83.3%), hypoechoic inclusions in the gland tissue (50%), increased vascularization (33.3%) are more often detected in the thyroid gland. degree, hyperechoic and anechoic inclusions are visualized (16.7% each); the structure of the gland is homogeneous in only 16.7% of cases, and only 1/6 of the examined did not reveal any inclusions.

When a diffusely heterogeneous structure is detected, the circle of “suspected” diseases includes chronic autoimmune thyroiditis and diffuse toxic goiter. The etiology and pathogenesis of chronic autoimmune thyroiditis is as follows: an inherited defect in the function of T-suppressors leads to stimulation by T-helper cells of the production of cytostimulating or cytotoxic antibodies to thyroglobulin, the colloid component or the microsomal fraction. Depending on the predominance of the cytostimulating or cytotoxic effect of antibodies, hypertrophic and atrophic forms of autoimmune thyroiditis are distinguished. When associated with HLA-B8 and DR5, the predominant production of cytostimulating antibodies and the formation of a hypertrophic form of chronic autoimmune thyroiditis occurs, and with the association of HLA-DR3, with the predominant production of cytotoxic antibodies, an atrophic form of autoimmune thyroiditis is formed.

In children of the Astrakhan region, the hypertrophic form of autoimmune thyroiditis (Hashimoto's goiter) is more common - 81.3%, the atrophic form was detected in only 6.2% of patients.

The diagnostic criteria for Hashimoto's goiter are: goiter, the presence of antibodies to thyroid pyroxidase or microsomal fraction, the presence of characteristic ultrasound changes in the structure of the thyroid gland.

In children with chronic autoimmune thyroiditis, other autoimmune diseases of endocrine and somatic origin may be registered, which may indicate an innate predisposition to autoimmune reactions. Our department treated children with autoimmune thyroiditis combined with type 1 diabetes mellitus, diffuse toxic goiter, and autoimmune alopecia. Moreover, in comparison with 1994, the proportion of patients with chronic autoimmune thyroiditis increased 5 times.

The literature describes that autoimmune thyroiditis is characterized by ultrasound signs in the form of heterogeneity of structure, decreased echogenicity (lack of diffuse echogenicity), thickening of the capsule, and sometimes the presence of calcifications in the thyroid tissue. However, the own data of echographic changes have their own characteristics. We have found that in children with autoimmune thyroiditis, changes such as diffuse heterogeneity of the structure (87.5%), enlarged gland (81.3%), and the presence of hypo-, hyper- and an-echoic inclusions (56.3) are most often visualized. %), absence of inclusions (43.7%) (presented in descending order). Reduced echogenicity of the thyroid gland was found in 50% of children, increased echogenicity and vascularization in 31.3%, respectively, and the presence of fibrous cords in 18.7%. Moreover, fibrous cords were found only in chronic autoimmune thyroiditis.

Thus, the most characteristic ultrasound signs for chronic autoimmune thyroiditis, according to our data, are an enlargement of the thyroid gland, diffuse heterogeneity of the structure, reduced echogenicity, the presence of fibrous cords in 1/5 of cases and in more than half of the cases the presence of inclusions (hypo-, hyperechoic) in gland tissue.

In all patients with chronic autoimmune thyroiditis (100%), examination revealed very high titers of antibodies to thyroid pyroxidase. The minimum value was 109.7 U/ml, the maximum was 962.8 U/ml. Therefore, an antibody level to thyroid peroxidase (TPO) of less than 100 U/ml was regarded as doubtful. In 40% of children with chronic autoimmune thyroiditis, hypothyroidism was detected, when the level of thyroid-stimulating hormone (TSH) increased and ranged from 4.9 to 14.7 μIU/ml (with the norm being up to 3.6). However, the presence of acquired hypothyroidism in children was regarded as a result of autoimmune thyroiditis.

Indications for treatment with levothyroxine for chronic autoimmune thyroiditis are clinical and subclinical hypothyroidism and goiter with a TSH value at the upper limit of normal 2-3.5 µIU/ml. Levothyroxine should be prescribed at an adequate dose. The criterion of adequacy should be considered the achievement of a normal TSH level; the optimal TSH range during treatment with levothyroxine is the range of 0.5-2.0 μIU/ml.

Currently, one of the most common diseases of the thyroid gland in children is diffuse toxic goiter. If in 1994 not a single hospitalization with diffuse toxic goiter was registered in the endocrinology department of the CSCH in Astrakhan (Fig. 1), then in 1998 the percentage of hospitalizations with this diagnosis was 8.8%, and in 2008 this pathology increased 2.5 times and amounted to 22.3%.

Thyrotoxicosis is a pathological condition of diffuse toxic goiter that develops as a result of the effect of excess amounts of thyroid hormones on the organs and systems of the body. The disease manifests itself with the following symptoms: the child becomes irritable, whiny, restless, and gets tired quickly. Despite a good appetite, losing weight, heart palpitations, irregular heartbeat, increased sweating, trembling in the hands and throughout the body, the skin becomes moist and hot, in some cases ophthalmological symptoms appear - shiny eyes, exophthalmos, rare blinking, lacrimation. The pathogenesis of this disease is an inherited defect in T-suppressors, leading to the formation of forbidden clones of T-helpers that stimulate the formation of autoantibodies that bind to thyroid-stimulating hormone receptors on the follicular cells of the thyroid gland, which leads to diffuse enlargement of the gland and stimulation of the production of thyroid hormones. Patients with diffuse toxic goiter require examination and treatment in a hospital setting, since prescribed thyreostatic therapy can cause complications in the form of an allergic reaction and agranulocytosis. Sonographic changes in the structure and size of the gland in diffuse toxic goiter look like this: most often the gland is enlarged in size (79%), diffusely heterogeneous (93%), echogenicity is reduced (58%), hypoechoic inclusions are visualized in 43%, increased vascularization and echogenicity is only 28.5%. Moreover, in half of the cases no inclusions were found in the gland (Fig. 2).

As can be seen in Fig. 2, reduced echogenicity was more common in diffuse toxic goiter.

The most characteristic ultrasound signs identified in children with diffuse toxic goiter are an enlarged thyroid gland with a diffusely heterogeneous structure, reduced echogenicity; in half of the cases the gland contains inclusions, often hypoechoic, and has increased vascularization.

The ultrasound picture resembles autoimmune thyroiditis, since both diseases are of an autoimmune nature.

The level of free thyroxine in the blood serum of patients with diffuse toxic goiter was elevated or high and ranged from 25.6 to 142.5 pmol/l (with the norm up to 21), and the TSH level was very low: in the range from 0.009 to 0 .11 µIU/ml (with the norm being 0.32-3.6). Thyroid-stimulating hormone in diffuse toxic goiter was reduced in 100% of cases.

According to our data, congenital primary hypothyroidism occupies an important place in the structure of thyroid diseases. Screening for congenital hypothyroidism, which began to be carried out in the Astrakhan region since 2007, makes it possible to diagnose the disease at birth.

The study found that in primary congenital hypothyroidism, hypoplasia of the thyroid gland is most often detected (72.7%), the total volume of the thyroid gland was in the range from 0.17 to 1.0 cm 3. As is known, favorable mental development can be expected only when treatment with levothyroxine is started in the first month of a child’s life. A low level of thyroid hormones, especially in the first months of life, leads to a delay in the process of myelination of nerve fibers, reduces the accumulation of lipids and glycoproteins in the nervous tissue, which ultimately causes morphofunctional disorders in neuron membranes and brain pathways. The consequence of these pathological processes is the development of mental retardation and delayed psychophysical development. At birth, in 85-90% of cases, there are no clinical manifestations of hypothyroidism. The concentration of TSH in the child’s blood serum, taken from the heel on days 4-5 of life, should not exceed 20 µU/ml. If the TSH concentration is 50-100 or higher μU/ml, immediately after taking blood from a vein to retest thyroid hormones, replacement therapy with levothyroxine is prescribed. The initial dosage is 12.5-25-50 mcg/day or 8-10-12 mcg/kg/day. We have determined that primary congenital hypothyroidism is characterized by ultrasound changes in the form of a significant reduction in size (72.7%), diffuse heterogeneity of the structure (63.6%), and increased echogenicity (63.6%). Inclusions in the form of cysts and nodes, increased vascularization are not typical for primary congenital hypothyroidism. Increased echogenicity of the thyroid gland was more common in congenital hypothyroidism.

For euthyroid goiter, sizes are in the range of 10-35 cm 3, for diffuse toxic goiter - 19.8-103.2 cm 3, for chronic autoimmune thyroiditis - 9.8-46.1 cm 3.

Analyzing the possible causes that negatively affect the morphological and functional state of the thyroid gland in children of the Astrakhan region, a direct connection between structural changes in the thyroid gland and natural geochemical and man-made risks (the presence of the gas industry, developed agricultural activities in the region) cannot be ruled out. For example, among the chemical substances that contaminate drinking water, in the structure of the total carcinogenic risk, the greatest share falls on the risk from arsenic content in drinking water, which exceeds the permissible value. In some districts of the Astrakhan region, such as Enotaevsky, Narimanovsky, there is a decrease in the content of such microelements as aluminum in the environment; in the Enotaevsky, Limansky, Krasnoyarsk regions, the content of cobalt is reduced; these microelements are involved in the regulation of thyroid function and cell division. In the Chernoyarsk, Enotaevsky, Narimanovsky, Limansky, Kamyazyaksky districts, the content of selenium, which has a powerful antioxidant and protective effect on thyroid cells, is reduced, which increases the risk of developing nodules and tumors by 4 times. Most of the territory of the Astrakhan region has low levels of vitamins A and E, which are natural antioxidants.

Summarizing the literature data and materials from our own observations over a 16-year period, we recommend to primary healthcare providers, as well as pediatric endocrinologists:

1. Under conditions of iodine deficiency, the number of heterogeneous forms of goiter has increased, which requires differential diagnosis between endemic (euthyroid, juvenile) goiter and chronic autoimmune thyroiditis. To do this, antibodies to thyroid pyroxidase (anti-TPO antibodies) are tested. The diagnostic titer of antibodies to TPO, taking into account the practice of our department, should be above 100 U/ml.
2. Children with autoimmune diseases (autoimmune thyroiditis and diffuse toxic goiter) are at risk for other autoimmune diseases, such as diabetes mellitus, B12-deficiency anemia, vitiligo, rheumatoid arthritis, etc.
3. Patients with chronic autoimmune thyroiditis, as well as patients with euthyroid goiter, in a region with iodine deficiency can receive physiological doses of iodine (100-200 mcg per day).
4. When a child is first treated with thyroid pathology, it is necessary to perform an ultrasound of the thyroid gland and test the blood for hormones: free thyroxine (free T4), TSH.
5. Indications for levothyroxine replacement therapy are chronic autoimmune thyroiditis with the presence of goiter with TSH levels above 1.0 µIU/ml or the presence of clinical or subclinical hypothyroidism, as well as endemic goiter (diffuse non-toxic, euthyroid) in the absence of effect from treatment with potassium iodide (Iodomarin) in 6 months.
6. The dynamics of ultrasound and thyroid hormones are assessed once every 6 months.
7. When a patient receives levothyroxine, the adequacy of treatment is assessed by the level of thyroid-stimulating hormone once every 6 months for children over one year old, and for children up to one year old by the level of free T4 or total T4 (for congenital hypothyroidism) every 3 months.
8. Children with diffuse toxic goiter should initially receive thyreostatic treatment in a hospital setting until euthyroidism occurs; maintenance treatment is carried out on an outpatient basis.
9. When differential diagnosis of thyroid diseases, it is necessary to take into account ultrasound data:

• Reduced echogenicity of the thyroid gland according to ultrasound data is more common in autoimmune diseases of the thyroid gland (autoimmune thyroiditis and diffuse toxic goiter).
• Increased echogenicity is 2 times more common with congenital hypothyroidism, but can also occur with autoimmune diseases of the thyroid gland.
• In simple (endemic, non-toxic) goiter, the echogenicity of the thyroid gland is normal.
• Hypoechoic and hyperechoic inclusions occur in diffuse nontoxic goiter, chronic autoimmune thyroiditis, and diffuse toxic goiter.
• Primary congenital hypothyroidism is characterized by hypoplasia of the thyroid gland and the absence of any inclusions in its structure.
• Fibrous cords occur only in chronic autoimmune thyroiditis.
• Increased vascularization of the thyroid gland is more characteristic of autoimmune diseases of the gland.
• Increased vascularization of the thyroid gland does not occur in congenital hypothyroidism.
• The largest size of the thyroid gland is characteristic, first of all, of diffuse toxic goiter, but can also occur in chronic autoimmune thyroiditis.

Literature

1. Ochirova E. A. What does a kidney “look like” in diabetes. Research methods for diabetes (ultrasound diagnostics) // Planet Accu-Chek. 2010. No. 2. 28 p.
2. Endemic goiter: information letter No. 8. Compiled by E. P. Kasatkina, V. A. Peterkova, M. Yu. Martynova and others. M.: RAMS ENTs, 2000. 10 p.
3. Iodine deficiency diseases in children and adolescents: diagnosis, treatment, prevention: Scientific and practical program. M.: International Fund for Mother and Child Protection, 2005. 48 p.
4. Fadeev V.V. Pathogenetic therapy of euthyroid goiter // Consilium Medicum. 2002, vol. 4. No. 10. pp. 516-520.
5. Denisov I. N., Shevchenko Yu. L. 2000 diseases: a reference guide for a practicing physician. 2nd ed. M.: GEOTAR-MED, 2003. 1343 p.
6. Peterkova V. A., Semicheva T. V., Kasatkina L. N.. etc. Consensus. Autoimmune thyroiditis in children: clinical guidelines for diagnosis and treatment. M.: Berlin-Chemie, 2002. 8 p.
7. Gerasimov G. A. Recommendations for treatment with thyroid hormones and iodine: a manual. M.: Berlin-Chemie, 1999. 15 p.
8. Treatment regimens. Endocrinology / Ed. I. I. Dedova, G. A. Melnichenko. M.: Litterra, 2007. 304 p.
9. Dedov I. I., Peterkova V. A, Bezlepkina O. B. Congenital hypothyroidism in children (early diagnosis in children). M.: Berlin-Chemie, 1999. 23 p.
10. Screening program for early diagnosis and treatment of congenital hypothyroidism: guidelines. Ministry of Health and Medical Industry; edited by acad. RAMS I. I. Dedova. M.: MSZN RF, 1996. 24 p.
11. Atlas of health of the population of the Astrakhan region. Astrakhan: State Enterprise of the Astrakhan Region “Publishing and Printing Complex “Volga”, 2010. 160 p.

N. Yu. Otto*
G. R. Sagitova**, Doctor of Medical Sciences, Associate Professor

*State Healthcare Institution "Regional Children's Clinical Hospital named after N. N. Silishcheva", **AGMA, Astrakhan

1 The image of an organ on the screen of an ultrasound machine is presented in black and white, where all acoustic effects are distributed over the range from absolutely black to absolutely white on a “gray” scale. Depending on the saturation (brightness) of gray color the tissue under study has, it is said to be echogenic. The echogenicity of parenchymal organs - the liver, spleen, pancreas - is traditionally considered normal; the reflection of ultrasound rays from them is normally approximately the same. If there are pathological formations, then their echogenicity is compared with normal. Formations that have approximately equal echogenicity with the surrounding tissues are called isoechoic. Structures that have greater brightness are described as formations of increased echogenicity, or echogenic (these include bone tissue, stones, hemangiomas). Structures of lower brightness than normal are described as hypoechoic. All structures that are acoustically transparent, that is, completely transmitting ultrasound rays, are anechoic. They look completely black (blood, urine, bile).

Thyroid diseases in adolescents often go unnoticed, and the problem becomes noticeable when the disease reaches a more dangerous stage.

An annual clinical examination by an endocrinologist helps to detect pathology at the very beginning of its development and begin treatment on time.

The thyroid gland is a miniature organ located in the neck, weighing barely 30 g in a healthy state.

Throughout a person’s life, it controls metabolic processes in the body, the activity of tissues and organs.

The quality of the thyroid gland depends on a sufficient amount of iodine, which the body receives from food and water. For its work, the iron uses approximately a third of the total amount of iodine contained in the body.

If the thyroid gland is enlarged in a teenager, this primarily indicates iodine deficiency.

Features of the thyroid gland during adolescence

Adolescence, accompanied by the process of puberty, begins at approximately 11–12 years of age.

The thyroid gland in adolescents begins to work with increased activity in order to provide hormones to the growing body. At this time, the thyroid gland may also undergo external changes.

Important: Enlarged thyroid gland in adolescents is quite common. This occurs due to iodine starvation, when the body cannot meet the increased functional needs of the gland.

Common symptoms of thyroid disease

Enlargement of the thyroid gland in adolescents does not occur from the first day of the disease. This process may be preceded by a long period.

Thyroid gland in adolescents

If the thyroid gland does not cope well with its duties, the symptoms in a teenager are of the following nature:

• early sexual development or delay;
• growth retardation;
• dry skin;
• swelling;
• hair loss;
• discomfort and pain in the front of the neck;
• cardiopalmus;
• frequent constipation or diarrhea;
• decreased concentration;
• nervous conditions;
• sleep disorders;
• weight fluctuations.

Laboratory tests for thyroid diseases

It happens that the thyroid gland in a teenager is slightly enlarged, and it can be difficult to detect the pathology.

Important! Symptoms cannot serve as the only confirmation of the disease.

To make an accurate diagnosis of thyroid disease in adolescents, an extensive examination is carried out.

« After the first consultation, the doctor said that if I had waited another month, something irreparable could have happened... “

Laboratory methods

• total triiodothyronine (T3);
• free triiodothyronine (T4);
• general thyroxine;
• free thyroxine;
• blood for thyroid-stimulating hormone (TSH);
• antibodies to thyroglobulin (TG);
• X-ray;
• laryngoscopy.

Instrumental methods

To diagnose thyroid disease in adolescents, only certain types of examinations are required, which are prescribed

are determined after external examination and palpation of the gland.

Why is the thyroid gland enlarged in a teenager if the hormonal balance is not disturbed? It turns out that the whole problem is a lack of iodine.

Thus, the organ’s protective reaction to a deficiency of an important microelement is manifested.

Thyroid diseases in adolescence

During adolescence, the thyroid gland must produce a certain amount of hormones. Their shortage or excess leads to the following diseases (ICD-10/E00–E07 code):

Low functionality of the thyroid gland, which is accompanied by.

The cause may be congenital pathology, iodine deficiency conditions, traumatic damage to the gland, autoimmune diseases.

Symptoms:

• blood pressure disorders,
• weight gain,
• weakness,
• dry skin,
• brittle nails,
• hair loss,
• frequent nasal congestion.

This disease () is diagnosed if thyroid hormones are produced in excess in adolescents. The disease has three stages of severity, depending on which symptoms appear.

The following signs indicate that the thyroid gland in adolescents produces an excessive amount of hormones:

• increased irritability, excitability;
• rapid pulse, heart failure;
• loss of appetite;
• fast fatiguability;
• muscle weakness;
• deterioration of the condition of nails, hair, skin.

Prevention and treatment of thyroid diseases

The thyroid gland in adolescence most often experiences iodine deficiency, so prevention is aimed at replenishing it.

A specialist can prescribe special dietary supplements and, but the easiest way out is to replace regular salt with iodized salt, and: seaweed, fish, shrimp, boiled eggs, baked potatoes, cranberries, prunes.

In order for the thyroid gland to be provided with the necessary amount of iodine during adolescence, its daily dose should be 100 mcg per day.

If it is visually clearly visible that the thyroid gland is enlarged in a teenager, what should be done in this case?

Since the symptoms of insufficiency and excess production of hormones look approximately the same, it is not recommended to try to solve the problem with iodine-containing drugs and products before taking the test and consulting with a specialist.

Treatment of the thyroid gland in adolescents depends on the severity of the disease and the results of the examination.

It is aimed at restoring the functionality of the gland by taking drugs with iodine and hormonal therapy. Teenagers respond very well to treatment.

Typically, the diagnosis of diffuse thyroid gland is made by ultrasound. This means that the tissue of the entire gland has changed evenly. This often occurs as a result of various diseases.

What are diffuse changes

Diffuse anomalies represent a violation of the structure of organ tissue throughout its entire volume. Evenly enlarged tissues may also contain brushes, nodules and other formations. Diffuse tissue changes without foci or formations are often observed. This condition is expressed in:

• increasing the volume of the organ as a whole;
• change in density other than healthy;
• tissue heterogeneity.

Pathology reflects negative processes occurring in endocrine cells. The organ enlarges under the influence of thyroid-stimulating hormone or antibodies, but hyperplasia can also be of a protective nature. For example, in most cases, an increase in the volume of the glandular organ compensates for the lack of iodine in the body. But a constant excess number of thyrocytes (cells that synthesize T3 and T4) causes a hormonal imbalance. In addition, against the background of hyperplasia, focal neoplasms subsequently develop.

This tissue condition cannot be called a disease - it is just an ultrasound conclusion. Violation of the density of thyroid tissue is associated with various diseases and conditions, but is not a disease in itself. The increase, expressed in hyperechogenicity, occurs with the proliferation of connective tissue fibers, calcium deposition and a decrease in the amount of colloid. Hypoechogenicity or decreased density, edema, malignancy.

The diffuse heterogeneity of the gland is expressed in its coarse-grained structure. Ultrasound shows alternating areas of increased and decreased echogenicity. This picture appears with current autoimmune inflammation.

If diffuse changes are detected on ultrasound, then further examination of the organ is required. When diagnosing the disease that caused them, observation, drug or surgical treatment is carried out.

Causes of diffuse changes

The causes of the pathology are the following factors:

• lack of iodine in the body, typical for people living in iodine-deficient areas;
• changes in thyroid hormonal balance;
• autoimmune inflammatory processes that occur in a number of diseases: for example, in chronic autoimmune thyroiditis;
• unbalanced diet: changes in the volume of the gland are caused by an infatuation with goitrogenic foods, which contain special substances that interfere with the production of hormones (cabbage, beans, corn, soy products, peanuts);
• release of radiation in the region.

Diffuse changes in the thyroid gland also appear in the following diseases:

• endemic, mixed, ;
• subacute thyroiditis;
• HAIT.

When to get examined

In most cases, the pathology is asymptomatic and is discovered by chance during palpation of the neck during a routine medical examination. But even in this case, the patient usually cannot list any symptoms. Symptoms of trouble appear for the first time only under additional stress: stress, physical overexertion, inflammatory disease, hypothermia. With further examination of the hormonal status, the amount of hormones T3 and T4 may be normal or may be changed.

When the concentration of thyroid hormones changes, pathologies occur in any system of the body. The nervous system is capable of reacting with both excitability and fatigue. Often the condition of the skin changes, and symptoms characteristic of heart disease appear. However, any symptomatic therapy will not bring a pronounced effect.

More often, this pathology manifests itself in women, since they are more susceptible to hormonal fluctuations during pregnancy, menopause and other conditions. Also, women are more strongly affected by the psycho-emotional factor. If pregnancy occurs, the woman should continue the prescribed treatment.

In children, diseases of the glandular organ can have more dangerous consequences. This is due to the fact that pathologies of hormonal balance at this age can lead to problems in mental development and growth: malfunctions in the thyroid gland can negatively affect the processes of the brain, in particular its hypothalamic-pituitary department.

Forms of diffuse changes

There are several forms of diffuse changes in the gland:

1. Parenchyma (organ tissue consisting of follicles): the entire parenchyma of the gland is transformed over its entire area, which is visually expressed in an increase in the volume of the organ in all directions. At the initial stage, nothing bothers the patient, but any overload can provoke the development of a pathological process and disruption of hormone production.
2. Structural anomalies are transformations associated with deviations from the normal tissue structure. In the early stages, there may be no symptoms, although a specialist may detect some abnormalities during palpation. Further examination may reveal normal hormonal status. However, if autoimmune disorders are present, an increase in antibody levels is detected. Further progression of the disease causes disruptions in all body systems - the nervous, cardiovascular, reproductive systems, even metabolic processes are disrupted.
3. Diffuse focal changes in the thyroid gland - in uniformly enlarged tissue, the appearance of foci is observed in which the structure of the gland tissue is changed. The lesions may be surrounded by glandular tissue with an unchanged structure. Cysts, adenomas, hemangiomas, lipomas, cancer formations, etc. can be hidden under the guise of foci. Such anomalies are formed in goiter, adenoma and thyroid cancer.
4. Diffuse nodular pathologies are often detected by palpation. Ultrasound usually confirms the presence of nodes in the enlarged organ. If the formation is larger than 1cm, then a biopsy is recommended. A large number of nodes can trigger the process of cancerous degeneration.
5. Cystic is the phenomenon of formation of cysts in an enlarged gland. Patients with this diagnosis are recommended to undergo constant monitoring by an endocrinologist.

With a moderate enlargement of the thyroid gland without nodes and foci of compaction, as well as without structural disorders and dysfunctions of the organ, special treatment is not required. However, observation and regular visits to an endocrinologist are indicated at least once a year.

If the anomalies are pronounced, it is necessary to determine the causes that caused them and medicinal treatment. The most often pronounced changes occur in Graves' disease and CAIT. As a rule, they cause functional disorders of the organ, as well as, as a consequence, disturbances in the production of hormones and other systems.

Possible consequences

The most likely consequences of diffuse tissue changes include the following:

• malfunctions of the gastrointestinal tract due to a lack of enzymes;
• weight gain;
• insomnia;
• sensitivity to cold.

Often provokes the manifestation of abnormalities of HAIT, in which disorders of the cardiovascular system are noted:

• increased heart rate;
• hypertension;
• fever;
• change of consciousness.

The manifestation of structural changes in the thyroid gland can be dangerous and lead to various consequences that are almost impossible to predict with accuracy.

Diagnostics

Diagnostics is carried out using different methods:

1. Examination by an endocrinologist - the doctor conducts a survey to clarify the patient’s complaints and palpates the organ, on the basis of which he gives a referral for further examination.
2. Ultrasound examination is the most common method for detecting organ abnormalities due to its accessibility and safety. The conclusion about the presence of diffuse changes is made precisely on the basis of this examination.
3. Laboratory blood tests for hormones can determine the cause of the pathology.

The following parameters can be identified that are examined by ultrasound:

• The echo structure in the normal state should be homogeneous. If there are pathologies, it becomes coarse-grained. Some areas may reflect ultrasound differently;
• increased echogenicity: characteristic of areas with a compacted structure (nodules and calcifications), decreased echogenicity occurs in autoimmune and inflammatory processes;
• normal sizes for women are 18 ml, and for men - 25 ml: if the size of the glandular organ is exceeded, this indicates the growth of the gland;
• the contours in healthy people are clear, in patients they are blurry.

CT or CT studies are used to detect focal or nodular lesions. With their help, you can evaluate the density and structure of tissues.

Treatment

Diffuse changes in the thyroid gland are only the conclusion of an ultrasound examination, which in itself does not require treatment. Based on such a conclusion, a specialist may send for further examination - ask for tests for:

• thyroid hormones;
• TSH—pituitary thyrotropin;
• antibody titer.

If hypothyroidism or thyrotoxicosis is detected based on the results of the examination, drug treatment is prescribed. The lack of hormones is compensated by their synthetic substitutes. Usually, the doctor prescribes a course of Eutirox and Levothyroxine or may prescribe combination medications - for example, Thyrotom.

Excessive function is suppressed with thyreostatics - iamazole and propylthiouracil are prescribed. For some diseases, treatment with radioactive iodine is prescribed, which destroys part of the gland tissue from the inside, causing a decrease in hormone-producing functions. During the course of therapy, it is necessary to periodically check the level of the hormone, which is done using laboratory tests.

Autoimmune inflammation is indicated by a high titer of antibodies. This is usually a chronic process. HAIT requires observation by an endocrinologist. This disease can only be treated in the presence of hypothyroidism. Usually in this case the patient is prescribed levothyroxine. Special treatment may be prescribed for women planning pregnancy.

In the absence of antibodies, the abnormalities are associated with iodine deficiency. In the early stages, the endocrinologist may prescribe medications with potassium iodide, and in the later stages, hormone therapy.

In case of nodular goiter, when they begin to quickly grow to a large size, surgical intervention is performed, since the formations can lead to compression of neighboring organs and disruption of their proper functioning. After surgical treatment, hormone therapy is performed to ensure stable remission and prevent relapses.

Self-medication is under no circumstances allowed. The endocrinologist selects an individual course of therapy for each patient, which is not applicable to other patients. The doctor takes into account the individual characteristics of a particular patient, unique to his body and the characteristics of the course of the disease.

How to prevent development

Most thyroid pathologies are of an insufficiently studied nature. Therefore, measures for their 100% prevention have not been developed. The general algorithm of preventive measures should be as follows:

1. Replacing salt with iodized salt and introducing more iodine-containing foods into the diet.
2. Prevention of stress, since the psycho-emotional factor plays a large role in the development of pathologies. Anti-stress therapy, which includes relaxation, auto-training, yoga, and breathing practices, will also be effective.
3. Constantly strengthening the immune system, including the use of vitamin complexes.
4. Normalization of body mass index.
5. Regular examinations by an endocrinologist and ultrasound of the thyroid gland after 35 years once a year.

If the patient is on time, then the prognosis for recovery is favorable. The reason for a visit to the doctor may be the appearance of anxiety, a feeling of constant restlessness, fatigue, constant tiredness, etc. It is better to play it safe and take some action at the very beginning of the suspected illness than to wait until the process develops to such an extent that it worsens the patient’s quality of life .