UDK 616-053.2:616.441-008.6

T.G. Seliverstov

diffuse magnification thyroid gland in girls

Irkutsk State medical University(Irkutsk)

Potassium iodide (iodomarin) is one of the drugs of choice for. prevention and treatment, pathology not only of the thyroid gland, but also in combination with the latter with disorders, sexual development, in children of puberty.

Keywords: thyroid gland, iodomarin

DiFFusE ENLARGEMENT oF THYROID GLAND iN GIRLs

T.G. Seliverstova

Irkutsk State Medical University (Irkutsk)

Potassium, iodide is one of preparation of choice for prophylaxis and treatment of pathology not only of thyroid, gland, but also of its combination with disturbances of sexual development of children of puberty age.

Key words: thyroid gland, potassium iodide

They say about the delay in sexual development when a girl at the age of 13 has no signs of development of the mammary glands, and by the age of 15 there is no menarche. In addition, ascertain the lag of bone age from the passport for 2 - 7 years.

Puberty in a girl usually begins at the age of 8-10 years. In the prepubertal period, there is a maximum increase in growth, there is also a change in the shape of the chest, hands, feet, shoulders, face, growth of the skeleton, especially the limbs. The maximum increase occurs in the year preceding the menarche. A change in the shape and size of the pelvis occurs at a later age. The sequence of appearance of secondary sexual characteristics is important. The entire period of their development lasts from one and a half to seven years.

The processes of puberty and physical maturation proceed correctly only with a normally functioning thyroid gland. Therefore, even with minimal violations (endemic goiter), there are serious changes in the body of adolescents. In this regard, the purpose of our study was to evaluate the effectiveness of iodine preparations in the therapeutic correction of delayed sexual development in girls living in an endemic region.

materials and research methods

Under observation for 12 months, there were 70 girls, aged 11 to 17 years, who had endemic goiter of the first degree, delayed sexual development. All girls underwent traditional therapy for the underlying disease, including dietary, vitamin, vascular therapy and physiotherapy. Of these, 40 girls who made up group 1, in complex therapy received iodine preparations in age dosages (drug "Jodomarin 200"). The second group included 30 girls who did not receive iodine preparations. All children lived in an iodine-deficient

region from birth, individual prophylaxis of goiter was not carried out.

At the beginning of treatment and then, with an interval of 6 months, we assessed the dynamics of changes (the severity of secondary sexual characteristics, laboratory and instrumental data).

The diagnosis of endemic goiter of the 1st degree was made according to the classification adopted by WHO, 1999. The stages of puberty were assessed according to the generally accepted method of J.M. Tanner (1962).

Ultrasound scanning of the pelvic organs and the thyroid gland was performed using the Aloka-630 apparatus using a transabdominal probe and a probe for examining the thyroid gland, operating at a frequency of 7.5 MHz. The results obtained were compared with those proposed by F. Delange et al. (1997).

The basal levels of hormones in the blood serum were determined: luteinizing (LH), follicle-stimulating (FSH), thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4) and prolactin using clinical kits for radioimmunoassay (Immunotech, Czech Republic). Blood sampling for the study of prolactin was performed at night, at 2 o'clock, other hormones - in the morning, on an empty stomach.

Bone age was assessed according to X-ray examination of the bones of the hand. To exclude organic pathology of the pituitary gland, computed tomography of the hypothalamic-pituitary region was performed.

Results and discussion

In a comparative assessment of the initial anthropometric data and characteristic changes in reproductive systems No significant differences were obtained.

The study of the functional state of the thyroid gland did not reveal hormonal disorders. We placed particular emphasis on this

exclusion of primary hypothyroidism, which is characterized by an increase in the level of thyroid-stimulating hormone and pituitary prolactin.

The initial data on the health characteristics of the health status of girls indicate the presence of pronounced signs of delayed sexual development and endemic goiter of the 1st degree (Table 1).

Similar studies were carried out 6 months after therapy, which included, in addition to the traditional treatment of delayed sexual development, the introduction of iodine preparations (Jodomarin) for girls in the first group. As can be seen from Table 2, a more significant improvement in indicators was determined for girls in the first group, while in the second

Table 1

Data from the results of the examination of girls before treatment (M ± m)

1st group 2nd group

11-13 years 3.6 ± 0.72 (n = 12) 4.95 ± 1.05 (n = 1O)

14-15 years old 8.48 ± 1.92* (n = 15) 5.6 ± O.84* (n = 1O)

16-17 years old 11.69 ± 0.59 (n = 13) 11.6 ± 0.81 (n = 1O)

Ultrasound of the genitals

11-13 years corresponds to 10-11 years (n = 12) corresponds to 9-10 years (n = 10)

16-17 years corresponds to 16 years (n = 13) corresponds to 15-16 years (n = 10)

PRL (mU/ml) 402.42 ± 13.5* (n = 40) 244 ± 7.9* (n = 30)

LH (mU/ml) 4.62 ± 0.61* (n = 40) 2.55 ± 0.58* (n = 30)

FSH (mU/ml) 7.22 ± 0.85* (n = 40) 4.66 ± 0.81* (n = 30)

TSH (mU/ml) 2.2 ± 0.74* (n = 40) 5.32 ± 1.08* (n = 30)

Т3 (nmol/l) 2.02 ± 0.50 (n = 40) 2.6 ± 0.57 (n = 30)

Т4 (nmol/l) 127.9 ± 28.73 (n = 40) 117.8 ± 28.89 (n = 30)

R-graphy of the hand 1-2 years lag in 2.2 ± 0.63%* 1-2 years lag in 85.7 ± 13.23%*

Potassium iodide + -

note: * - p< 0,05.

table 2

Data from the results of the examination of girls 6 months after treatment (M ± m)

1st group 2nd group

Sexual development (Tanner, points)

11-13 years 3.8 ± O.6O (n = 12) 4.3 ± 1.1 (n = 1O)

14-15 years 8.9 ± O.96* (n = 15) 6.1 ± O.5* (n = 1O)

16-17 years old 11.6 ± O.6 (n = 13) 11.8 ± O.3 (n = 1O)

Ultrasound of the genitals

11-13 years corresponds to 11-12 years (n = 12) corresponds to 11 years (n = 10)

14-15 years corresponds to 13-14 years (n = 15) corresponds to 12-13 years (n = 10)

PRL (mU/ml) 360 ± 10.5 (n = 40) 320 ± 9.7 (n = 30)

LH (mU/ml) 3.5 ± 0.51 (n = 40) 3.1 ± 0.48 (n = 30)

FSH (mU/ml) 7.3 ± 0.68* (n = 40) 5.2 ± 0.6* (n = 30)

TSH (mU/ml) 1.5 ± 0.31* (n = 40) 5.32 ± 1.1* (n = 30)

Т3 (nmol/l) 2.4 ± 0.75 (n = 40) 2.71 ± 0.61 (n = 30)

Т4 (nmol/l) 132 ± 27.3 (n = 40) 125 ± 27.90 (n = 30)

R-graph of the hand corresponds to the age of 100% (n = 40) lag by 1-2 years in 79 ± 10.23% (n = 30)

Potassium iodide + -

Ultrasound of the thyroid gland corresponds to I st. corresponds to Art. I.

note: * - p< 0,05.

Table 3

Data from the results of the examination of girls 12 months after treatment (M ± m)

1st group 2nd group

Sexual development (Tanner, points)

11-13 years old 5.2 ± 0.5 (n = 12) 4.3 ± 0.45 (n = 10)

14-15 years old 9.3 ± 0.7* (n = 15) 6.5 ± 0.7* (n = 10)

16-17 years old 11.8 ± 0.32 (n = 13) 11.6 ± 0.25 (n = 10)

Ultrasound of the genitals

11-13 years corresponds to 12-13 years (n = 12) corresponds to 11-12 years (n = 10)

14-15 years corresponds to 14-15 years (n = 15) corresponds to 13-14 years (n = 10)

16-17 years corresponds to 16-17 years (n = 13) corresponds to 15-16 years (n = 10)

PRL (mU/ml) 350 ± 11.5 (n = 40) 400 ± 12.6 (n = 30)

LH (mU/ml) 3.35 ± 0.5 (n = 40) 3.1 ± 0.5 (n = 30)

FSH (mU/ml) 7.5 ± 0.69* (n = 40) 5.2 ± 0.9* (n = 30)

TSH (mU/ml) 1.57 ± 0.35* (n = 40) 5.1 ± 0.95* (n = 30)

Т3 (nmol/l) 2.3 ± 0.76 (n = 40) 2.71 ± 0.87 (n = 30)

Т4 (nmol/l) 136 ± 25.7 (n = 40) 124 ± 25.6 (n = 30)

R-graph of the hand corresponds to the age lag of 1-2 years in 75 ± 10.1% (n = 30)

Potassium iodide + -

Ultrasound of the thyroid gland corresponds to 0 tbsp. corresponds to Art. I.

note: * - p< 0,05.

group shifts were observed less significant; the exception is a slight increase in the level of follicle-stimulating hormone and an improvement in the score in the age group from 11 to 13 years.

In the first group of girls, normalization of laboratory parameters of hormone levels occurred, including an increase in the level of peripheral hormones (in the middle of the corridor of normal values) of the thyroid gland (T3 T4). Significant normalization of the rate of biological maturation (bone age) after 6 months of treatment indicates a more favorable course of the disease. This fact proves the influence of thyroid pathology on the development of the reproductive system of adolescents.

The diagnosis of diffuse thyroid is usually made by ultrasound. It means such a conclusion that the tissues of the entire gland have changed evenly. This often occurs as a result of various diseases.

What are diffuse changes

Diffuse anomalies are a violation of the structure of the tissue of the organ throughout its volume. In evenly enlarged tissues, brushes, nodules and other formations may also be located. Often there is a diffuse change in tissues without foci and formations. This state is expressed in:

• an increase in the volume of the organ as a whole;
• change in density other than healthy;
• tissue inhomogeneity.

Pathology reflects the negative processes occurring in endocrine cells. The organ enlarges under the influence of thyroid-stimulating hormone or antibodies, but hyperplasia can also be protective. 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 of thyrocytes (cells synthesizing T3 and T4) causes hormonal imbalance. In addition, against the background of hyperplasia, focal neoplasms develop in the future.

It is impossible to call such a state of tissues a disease - this is just the conclusion of an ultrasound scan. Violation of the density of thyroid tissue is associated with various diseases and conditions, but in itself is not a disease. An increase, expressed in hyperechogenicity, occurs with the growth of fibers connective tissue, deposition of calcium and a decrease in the amount of colloid. Hypoechogenicity or decrease in density, edema, malignancy.

Diffuse heterogeneity of the gland is expressed in its coarse-grained structure. Ultrasound shows alternating areas of increased and decreased echogenicity. This pattern is manifested in the 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, medical or surgical treatment is carried out.

Reasons for diffuse changes

The causes of pathology are the following factors:

• lack of iodine in the body, characteristic of people living in iodine-deficient areas;
• changes in the hormonal balance of the thyroid gland;
• autoimmune inflammatory processes occurring in a number of diseases: for example, in chronic autoimmune thyroiditis;
• unbalanced nutrition: a change in the volume of the gland is caused by a passion for goitrogenic foods, which contain special substances that prevent the production of hormones (cabbage, beans, corn, soy products, peanuts);
• radiation release in the region.

Also, diffuse changes in the thyroid gland are manifested in the following diseases:

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

When to be examined

In most cases, the pathology is asymptomatic and is detected by chance during palpation of the neck during an ordinary medical examination. But even in this case, usually the patient cannot list any symptoms. Symptoms of trouble appear for the first time only with additional loads: stress, physical overstrain, 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 NS is able to respond both with excitability and fatigue. Often, the condition of the skin apparently changes, 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, the psycho-emotional factor has a stronger effect on women. When pregnancy occurs, the woman should continue the prescribed treatment.

In children, diseases of the glandular organ may have more dangerous consequences. This is due to the fact that pathologies of the hormonal ratio at this age can lead to problems. mental development and growth: malfunctions of the thyroid gland can adversely 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 (an organ tissue consisting of follicles): the entire parenchyma of the gland is transformed over its entire area, which is expressed visually in an increase in the volume of the organ in all directions. On initial stage the patient is still not worried about anything, but any overload can provoke the development of a pathological process and a violation of hormone production.
2. Structural anomalies are transformations associated with a deviation from the norm of the tissue structure. In the early stages, there may be no symptoms, although a specialist with palpation may reveal some anomalies. Further examination may reveal a normal hormonal status. However, if autoimmune disorders are present, an increase in antibody levels is detected. Further progression of the disease causes failures in all body systems - in the nervous, cardiovascular, reproductive systems, even metabolic processes are disturbed.
3. Diffuse focal changes in the thyroid gland - in a uniformly enlarged tissue, the appearance of foci is observed in which the structure of the gland tissue is changed. The foci may be surrounded by glandular tissue with an unchanged structure. Under the guise of foci, cysts, adenomas, hemangiomas, lipomas, oncological formations, etc. can be hidden. Such anomalies are formed with goiter, adenoma and thyroid cancer.
4. Diffuse nodular pathologies are often detected by palpation. An ultrasound usually confirms the presence of nodes in an enlarged organ. If the formations are larger than 1 cm, then a biopsy is recommended. A large number of nodes can provoke the process of cancerous degeneration.
5. Cystic is the phenomenon of the formation of cysts in an enlarged gland. Patients with such a diagnosis are recommended constant monitoring by an endocrinologist.

With a moderate increase in 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 the endocrinologist at least once a year are indicated.

If the anomalies are pronounced, it is necessary to determine the causes of their causes and drug treatment. The most frequently pronounced changes are formed in Graves' disease and HAIT. They usually cause functional disorders organ, as well as, as a result, violations of the production of hormones and other systems.

Possible consequences

Of the most likely consequences of diffuse tissue changes, the following can be distinguished:

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

Often provokes the manifestation of anomalies of CAI, in which violations 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 by different methods:

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

The following parameters can be distinguished, which are examined by ultrasound:

• the echostructure 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), reduced 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 an overgrowth of the gland;
• contours in healthy people are clear, in sick people they are blurred.

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

Treatment

diffuse changes thyroid gland - this is only the conclusion of an ultrasound study, which in itself does not require treatment. Based on this conclusion, the specialist can send for additional examination - ask to be tested 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 Euthyrox and Levothyroxine or may prescribe combined medicines- for example, Tireot.

Excessive function is suppressed by thyreostatics - iamazol, propylthiouracil are prescribed. In some diseases, treatment with radioactive iodine is prescribed, which destroys part of the gland tissue from the inside, which reduces hormone-producing functions. During the course of therapy, it is periodically necessary to check the level of the hormone, which is done using laboratory tests.

A high titer of antibodies indicates autoimmune inflammation. Usually this is a chronic process. HAIT requires observation by an endocrinologist. This disease is subject to therapy only in the presence of hypothyroidism. Usually in this case, the patient is prescribed levothyroxine. Special treatment may be prescribed for women planning a pregnancy.

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

With nodular goiter, when they begin to grow rapidly to large sizes, it is carried out surgical intervention, since formations can lead to squeezing of neighboring organs and disruption of their proper functioning. After surgical treatment hormone therapy is carried out to ensure stable remission and prevent relapses.

In no case is self-medication unacceptable. 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, inherent only 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 an important role in the development of pathologies. Anti-stress therapy, which includes relaxation, auto-training, yoga, and breathing practices, will also be effective.
3. Constant strengthening of immunity, including the use of vitamin complexes.
4. Normalization of body mass index.
5. Regular examinations at the endocrinologist and ultrasound of the thyroid gland after 35 years once a year.

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

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Zinaida asks:

Good afternoon They did an ultrasound of the thyroid gland to the child and this is what we saw: the left lobe is 39x11x12 mm, the right lobe is 34x12x12, the volume is 7.2 cm3, in the structure of both lobes there are anechoic formations with a clear, even contour from 2 to 4 mm, avascular. In conclusion, they wrote: cysts in both lobes of the thyroid gland, signed up for an endocrinologist. but until that day of the doctor’s appointment comes, you can go crazy, tell me how dangerous it is, or rather, these cysts can dissolve or ....

Responsible Berezhnaya Irina Yurievna:

Hello Zinaida According to the ultrasound examination, the child really has cysts, most likely follicular cysts, which is not threatening to health; may not be visualized (disappear) in dynamics. You have no reason to worry. Calmly plan to consult a doctor, tune in to a mandatory examination by ultrasound once every six months.

Elena asks:

Hello boy 7 years old on ultrasound right lobe education 4 mm, regular shape with clear boundaries. Fabric arr. isoechoic. Echostr-ra is heterogeneous due to the alternation of small hydrophilic patches and fibrous foci. The rest is the norm. Submandibular lymph nodes 3-4 mm in number. resp. x-ra (sore throat). TTG-4.36, T4 St..-16.6; T3 St.-5.7; ATPO-7.6. Appointed until the endorm for 1k. 1 time per day for 3 months, then control. Your opinion is very important. Thank you.

Responsible Volobaeva Ludmila Yurievna:

Good afternoon Endorm is a dietary supplement and its therapeutic effect has not been proven. I recommend not touching the child and after 3 months retake TSH and T4 free, and after 6 months an ultrasound of the thyroid gland.

Nellie asks:

Before school, my daughter had an ultrasound of the thyroid gland, they said that the indicators were increased such as the right lobe width 14 length 38, thickness 14 volume 3.6 left width 14 length 37 thickness 13 volume 3.2 isthmus 3.5 total 6.8. Child height 130 cm weight 29 kg. I’m very worried, I don’t know what to do, is it worth worrying, please tell me. Thank you I will wait for an answer

Responsible Berezhnaya Irina Yurievna:

Hello Nell An increase in the volume of the thyroid gland is not a pathology. According to your data, it is impossible to make a conclusion about the state of the organ, because there is no description of the structure. Just do a re-examination in a specialized center.

Elena asks:

My daughter is 6.5 years old. They were tested before school. Ultrasound of the thyroid gland showed - the right lobe is -33, the volume is 2.7, the left lobe is 33, the volume is 2.9, the total volume is 5.6, the contour is even and clear, the capsule is not compacted, the mobility during swallowing is preserved, the echostructure is heterogeneous, moderately diffusely, blood supply - volume 16., regional lymph nodes - no.
Conclusion - moderate diffuse changes in the thyroid gland, an increase in the volume of the thyroid gland compared with the age norm.
What does this mean? Is it necessary to donate blood for hormones (afraid of injections to the point of fainting)? There are no complaints, the knots are normal to the touch. Thank you!

Responsible Volobaeva Ludmila Yurievna:

Good afternoon
Your baby has minor changes in the thyroid gland. In such a situation, it is indeed necessary to check the following:
1) thyroid-stimulating hormone.
2) free thyroxine.
3) antibodies to thyroperoxidase. If these indicators are normal, then everything is fine.

Natasha asks:

We found a node in the left lobe up to 8 mm with liquid content, nodes in the right lobe up to 5 mm - is this serious?

Responsible Berezhnaya Irina Yurievna:

Hello Natasha Yes, it can be serious. A description of the found formations would make it possible to be more specific. The size of education does not play a role in the projections. Please do an examination at a specialized center.

Olga asks:

Hello, my daughter is 7 years old, they did an ultrasound and here is the result: the thyroid gland: the contours are clear, even, symmetrical, mobile. Dimensions: right lobe 42*11*13mm, volume 2.9 cm3 left lobe 42*10*13mm, volume 2.6 cm3 PPT 0.9 m2 (weight 23kg, height 122cm) - norm up to 4.2 cm3 Total volume 5 .5 cm3 - 131% - 1st Isthmus 3.2mm - normal up to 3mm echostructure of areas: heterogeneous due to the alternation of hypo- and isogenic areas echogenicity: general-medium elasticity: preserved Nodules: no Conclusions: diffuse enlargement of the thyroid gland of 1 degree, violation of the structure thyroid gland. Please help me figure it out, is this really scary?

Responsible Berezhnaya Irina Yurievna:

Hello Olga In your case, additional examination of thyroid function is necessary. After consulting a doctor and receiving the results of the necessary hormonal examinations, it will be possible to answer your questions specifically. It is very important not to waste time, many issues of impaired function are being resolved.

Valentina asks:

Hello! My son is 7 years old. 2 nodes (0.5 and 0.2 cm) were found in the left lobe of the thyroid gland. The volume of the left lobe is 1.3 right.-1.6. iodomarin 6 months. And the doctor from diagn. The center said Iodomarin should not give any cases. Tell me, please, how to be?

Responsible Berezhnaya Irina Yurievna:

Hello Valentina There is no connection between the location of the nodes and the opening of the iodomarin. The appointment in this case is due, probably, with a preventive purpose. Nodes are examined primarily by ultrasound and in dynamics. Treatment without diagnosis is unacceptable.

Ruslan asks:

Please tell us what to do. A 15-year-old daughter was diagnosed with subclinical hypothyroidism. Analyzes 12.06.2014:
TSH 5.7 μIU / ml, T4 - 18 pmol / l, AT to TPO 61.8 U / ml. A month before the test, Zobofit was taken 1k 2 r per day. Analyzes previous 04/09/2014: TSH - 4.8 μIU / ml, T4 - 17.7 pmol / l, AT to TPO 5.2 U / ml. The doctor 2 months ago recommended taking thyroxine. We are very afraid that we will have to take it all the time. Why increased AT to TPO? Whether the goiter could influence. What does the increase in AT to TPO mean? Could this be a mistake? Previously it was normal. Only TSH was within 4.05, 4.8 - 6.22. How to treat?

Responsible Volobaeva Ludmila Yurievna:

Good afternoon Taking thyroxine won't harm your daughter or her thyroid. Iron will not forget how to "work". Enhanced level TSH is a growth stimulator of the thyroid gland, so it is important to bring it back to normal. For this there is only one effective treatment- thyroxin. It must be taken once a day on an empty stomach and after 2 months repeat TSH.

Natalia asks:

Hello! Help! They made an ultrasound of shields. glands. The boy is 8.8 years old. Weight 39 kg, height 146 cm. The right lobe is 43 mm long, 8 mm wide, 15 mm thick. Volume 3.3 cm cube. The left share is 43 mm long, 11 mm wide, 17 mm thick. Volume - 4.5 cm cube. Surface area of ​​the body 1.2 sq.m. The total volume is 7.8 ml, the echostructure of the parenchyma is medium-grained, heterogeneous with foci of reduced echogenicity. In conclusion, hyperplasia, diffuse changes in the thyroid gland. I read on the Internet that this is the norm or not? Help me please.

Responsible Berezhnaya Irina Yurievna:

Hello Natalia Changes in the structure of the thyroid gland give grounds for further examination. The described changes correspond to autoimmune thyroiditis. You need to consult an endocrinologist.

Elena asks:

Hello! The result of the child's TSH is 4.6 μIU / ml., Tell me, is this the norm or its excess? Could the drug iodomarin affect the level of TSH.

Responsible Renchkovskaya Natalya Vasilievna:

Hello, Elena.
Each laboratory indicates in brackets the norm for a certain age. You also need to see the child directly and know if there are any complaints, do an ultrasound of the thyroid gland.
Iodomarin promotes the formation of active thyroid hormones and thus TSH may decrease. Address directly to the doctor to the endocrinologist the pediatrician.
With uv. Natalya Vasilievna.

Svetlana asks:

Hello, my son is 6 years old, I passed the analysis for T4 free. - result 11.1, analysis for TSH - result - 2.09. Handed over the analysis against the background of reception of an iodomarin (as the doctor has told or said). We will not get an appointment soon, is it possible to find out if the tests are normal or not? Thank you.

Julia asks:

Hello, please tell me what the child has, we were diagnosed with bronchial asthma at the age of 1.5, we used the hormonal drug flexocid for a year, then we survived without it for a year, now we use it again, we were on an examination for asthma, we passed a bunch of tests, they showed that there was no allergy , but the thyroid gland services, they wrote an endemic goiter in question, after 3 months we passed a blood test for hormones, the endocrinologist said that they were in normal, and ultrasound right lobe 11 width 10 length 32 volume 1.9; left 11 width 11 length 29 volume 1.7 total volume 3.6, contours are clear, even; on the right; the shape is correct; the contours are clear; the structure is homogeneous; there are no regional lymph nodes; the conclusion is echo-signs of nodular formation of the shield. .

Responsible Berezhnaya Irina Yurievna:

Hello Julia Regarding the degree of increase and the need to take prophylactic drugs, you need to consult a pediatrician who is familiar with the endemic situation in your area. The task of the visualist is to describe the presence of the node and its characteristics (what has been done) and to control possible changes in dynamics (periodicity is about six months). Flexocide cannot provoke the formation of focal formations. Some medications(amiodarone, lithium preparations, interferon) can cause the appearance of antibodies to peroxidase, but the presence, the appearance of nodes with the use of drugs cannot be associated.

Elena asks:

Tell me, please, is it necessary to do a puncture biopsy of the thyroid nodule in a child of 6 years old, or can it be dispensed with? The size of the thyroid gland and hormones are normal, the formation is not palpable, clinically eutheriosis. The nodule in the middle segment is 1.5x0.6x0.5 cm, isoechoic, mixed structure, blood flow is not increased. The size of the node has not changed in 3 months. Diagnosis: focal changes in the thyroid gland. If done, how informative is the biopsy?

Responsible Berezhnaya Irina Yurievna:

Hello Elena Puncture biopsy is the only highly informative method for making a cytological diagnosis of the node, therefore it is necessary. The absence of a change in its size, unfortunately, this manipulation is not canceled. The informativeness of the puncture depends on the doctor, its conductor and the cytologist, therefore it is advisable to do it in specialized centers, where the effectiveness of this analysis is about 98%. Sunbathing, of course, is possible, it is necessary to avoid the active sun (panama hat with wide brim).

Olga asks:

Good afternoon Please help with advice! In December 2013, my daughter underwent an ultrasound of the thyroid gland, at that time she was 6 years 2 months old.
Ultrasound results:
Right lobe - 33.9 x 11.5 x 12.9 (volume 2.40)
Left share - 33.6 x 11.3 x 12.4 (volume 2.25)
Isthmus - 3.0
Volume - 4.65
The contours are even and clear. The echostructure is heterogeneous due to areas of unevenly reduced echogenicity.
On the right, along the posterior fold, in the middle third, an anechoic round formation 2.5 mm in diameter with hyperechoic inclusions, without reliable blood flow, is located. Nodes are not located. Vascularization is normal. Peripheral lymph nodes are not enlarged.
Conclusion: Diffuse-heterogeneous changes in the structure of the thyroid gland. An increase in the size of the thyroid gland. Small cyst of the right lobe of the thyroid gland.
With results of US we have addressed to the endocrinologist. The doctor prescribed iodomarin at a dosage of 125 once a day and gave a referral for TSH (6.4) and T4fr (13.4).
The problem is that from the time we started taking Iodomarin, my daughter began to recover very much, her appetite increased. Is this normal when taking such a dose of iodomarin?
I decided to do an ultrasound and turn to an endocrinologist myself, because. she has a problem with the thyroid gland - oncology of the thyroid gland, she was operated on in 2003.
Thank you in advance!

Responsible Berezhnaya Irina Yurievna:

According to the results of your examination of the child autoimmune thyroiditis. The norm in children and adolescents of the TSH indicator from 5 to 14 years is 0.4-5.0 mU / l. An increase in the content of TSH reflects the sensitivity of the hypothalamic-pituitary axis to a persistent decrease in the level of thyrohormones circulating in the blood. In case of malfunction of the gland, TSH rises above normal values, even if the level of T4 St. within the normal range. The presence or absence of symptoms depends on the attention of the doctor conducting the questioning. One of the most famous studies on subclinical hypothyroidism in childhood and adolescence is the work of D.C. Moore. In short, he considered AIT in childhood as a minimal damaging effect (mild insult) on the thyroid gland, and a moderate increase in TSH without the presence of a large goiter and clinical manifestations hypothyroidism - as a result of the restructuring of homeostasis. Thus, a new level of stable compensation of thyroid status (reset thyrostat) is achieved at the cost of chronic increase TSH in serum. The author also agrees with the opinion of other researchers who believe that with long-term observation, the risk of developing clinical manifestations of hypothyroidism remains in 1/3 of children and adolescents with subclinical hypothyroidism. Therefore, regular monitoring of such patients is necessary. The question of prescribing treatment with thyroxin should be decided by the doctor individually. Your consulting physician has obviously been guided by these data and further specialized therapy is not ruled out. There is no need to take iodine-containing drugs.

Good afternoon According to the test results, the child has severe hypothyroidism. If the boy did not take thyroxine, then it is necessary to start taking it as soon as possible. If taken, then it is necessary to increase the dose of the drug, it is possible to replace it with another brand. The issue of replacement and dose is decided exclusively internally. But that a thyroxine is necessary is unambiguously.

Diffuse changes in the thyroid gland are changes in the tissues of the entire thyroid gland, which is detected during an ultrasound examination (ultrasound).

With certain transformations in the gland with the help of ultrasound diagnostics a change in the ability of the thyroid tissue to reflect sound (called echogenicity) is stated. In this case, we can say that the entire gland reflects ultrasonic waves in a different way than a healthy organ should do. In the future, a more accurate diagnosis is required, which will reflect the true state of the thyroid gland. Therefore, "diffuse changes in the thyroid gland" is just a term that is used in the method of ultrasound diagnostics and can mean diseases of the gland that are different in nature.

ICD-10 code

E00-E07 Diseases of the thyroid gland

Causes of diffuse changes in the thyroid gland

The causes of diffuse changes in the thyroid gland are as follows:

• Insufficient amount of iodine in the body.

If a person lives in an area where the soil and water are poor in iodine, then this greatly affects the appearance of diffuse changes in the thyroid gland. These regions in medical practice are called endemic, that is, those where a certain disease has a mass distribution. Therefore, we can say that thyroid diseases in such areas are common.

• Changes in the hormonal balance of the thyroid gland.

Violation of the reproduction of thyroid hormones (more or less of them than the body needs) affects the change appearance gland and its tissue structures. In this case, an increase in the organ may occur, which occurs evenly and in all directions, which is called a diffuse enlargement of the thyroid gland.

• Autoimmune disorders, expressed in inflammation of the tissues of the thyroid gland.

Usually, inflammatory processes in this organ are of an autoimmune nature. That is, inflammatory disorders in the thyroid gland occur due to the fact that human immunity, due to a number of pathological causes begins to become aggressive to the thyroid gland. This disease is called chronic autoimmune thyroiditis (or lymphomatous thyroiditis). The course of this disease is characterized by the formation of antibodies and lymphocytes in the body that damage the cells of one's own thyroid gland. It should be noted that under normal immune system human production of antibodies occurs on the penetration of foreign elements into the body.

• Unbalanced nutrition.

With a lack of food rich in iodine, changes in the structure and functioning of the thyroid gland can be observed. The same anomalies occur if the patient's food contains large quantities of food products, which contain substances that prevent the production of thyroid hormones. These products include cabbage (white, cauliflower, Brussels sprouts), corn, beans, turnips, peanuts, soybeans.

• A change in the ecological situation in the region, which occurred suddenly due to various factors.

For example, the tragedy of the Chernobyl nuclear power plant, which affected the sharp deterioration of the environment in the territories adjacent to this plant, caused general changes in the thyroid gland among the population.

Diffuse changes in the thyroid gland are a manifestation of the following diseases:

• endemic goiter,
• chronic autoimmune thyroiditis,
• subacute thyroiditis,
• mixed goiter,
• diffuse toxic goiter.

Symptoms of diffuse changes in the thyroid gland

Symptoms of diffuse changes in the thyroid gland are manifested in the following factors:

1. The appearance of heterogeneity in the structure of the tissue and different density of the surface of the gland, which exclude the appearance of focal transformations in the thyroid gland.
2. Change in the volume of the thyroid gland, which is expressed in its increase. In some cases, the growth of thyroid tissue leads to the formation of a goiter - a strong pathological increase in the volume of the thyroid parenchyma.
3. The appearance of fuzziness, blurring of the external contours of this organ.
4. The resulting changes in the functioning of the thyroid gland, which are accompanied by a violation of the hormonal background. These changes are of two types:
   • hyperthyroidism - manifested in an increase in the level of thyroid hormones;
   • hypothyroidism - manifested in a decrease in the level of thyroid hormones.

Among the accompanying symptoms of diffuse enlargement of the thyroid gland, the following can be distinguished:

• the appearance of dry hair;
• brittle nails;
• permanent colds;
• the presence of constant chills;
• the presence of constant lethargy, weakness and increased fatigue;
• decrease in working capacity and labor productivity (physical and intellectual);
• the appearance of an anxious and neurotic state, as well as increased irritability or depression;
• decrease in intellectual abilities;
• the emergence of problems with cognitive processes - memorization and reproduction of information, concentration of attention, general perseverance;
• the appearance of changes in weight that are not related to the quantity and quality of nutrition of the patient;
• appearance of malfunctions endocrine system that cause hormonal imbalance in the body;
• the occurrence of problems with the sexual sphere of a person, a decrease in the sexual functions of the body;
• the presence of permanent, chronic constipation, not related to the diet of the patient.

Forms

Diffuse changes in the parenchyma

Parenchyma is a certain set of organ cells that carries a certain functional load. The parenchyma differs from the stroma in that it originates from various kinds fabrics. If the stroma is formed only by connective tissue cells, then the parenchyma may also include hematopoietic tissue (for example, in the spleen), epithelial tissue(for example, various glands of the epithelium)), nerve cells (or nerve nodes) and so on.

The parenchyma and stroma are in close "collaboration" and they cannot be separated, since it is this integrity that allows the organ to work normally. The stroma is a kind of skeleton for the organ, the "skeleton", and the parenchyma fills each organ with a specific functional purpose.

The thyroid parenchyma is a functional epithelial tissue, which consists of actively dividing cells. The thyroid parenchyma consists of follicles, namely vesicles of various sizes, which are the units of the structure and functioning of this tissue. On average, each follicle is equal to forty to fifty micromicrons. Each of the vesicles is braided with blood vessels and capillaries. lymphatic system. Thyroid follicles produce two hormones: triiodothyronine and tetraiodothyronine (or thyroxine). The triiodothyronine unit contains three iodine molecules, and the thyroxine unit contains four iodine molecules. Thyroid hormones are abbreviated as T3 and T4 respectively. The hormone T4, secreted by the gland, in the cells and tissues of the body is transformed into the hormone T3, which is the main substance that affects the metabolic processes of a person.

Diffuse changes in the parenchyma of the thyroid gland are changes in the entire tissue of the parenchyma that are associated with an increase in the thyroid gland. At the same time, it should be taken into account that the entire parenchyma of the gland underwent transformation, and these changes are distributed evenly over the entire area of ​​the organ. Visually, this phenomenon can be observed as an increase in the volume of the thyroid gland in all directions.

Diffuse changes in the parenchyma of the thyroid gland are detected by palpation during examination by an endocrinologist. After undergoing an ultrasound scan, which is prescribed by a specialist, in some cases a diagnosis of "diffuse changes in the thyroid parenchyma" is established. Such a diagnosis can be made even in the absence of any other signs of thyroid disease. In these cases, the patient is still not bothered by anything, but the gland itself is already functioning in tension mode. Therefore, any additional negative stimuli - stress, emotional and physical overload, infectious diseases - can provoke the progression of the disease. In this case, the functioning of the thyroid gland is disturbed, which is manifested in the appearance of an imbalance in the production of hormones. The production of thyroid hormones can increase or decrease, which affects their amount in the blood of a person, which negatively affects the functioning of the whole body, and also leads to the appearance of many symptoms of a health disorder.

In some cases, such diffuse changes in the thyroid parenchyma are associated from the very beginning with a violation of the hormonal balance of the gland and lead to an external increase in the organ.

Diffuse structural changes

Diffuse changes in the structure of the thyroid gland are transformations that occur in the gland, which are associated with a change in the structure of the organ tissue.

With a diffuse increase in the thyroid gland, the structure of the gland changes: it becomes denser and increases in volume. In the early stages of diffuse enlargement of the thyroid gland, there are usually no symptoms of such changes. In this case, changes in the structure of the organ are ascertained when visiting an endocrinologist who examines and palpates the gland. After detecting abnormalities in the structure of the thyroid gland, the specialist prescribes a laboratory blood test in order to determine the hormonal status and the level of antibodies to the thyroid gland.

At different stages of diffuse enlargement of the thyroid gland, as well as with different diseases that caused it, the test results may be different. The initial stage of the disease may be accompanied by a normal hormonal status, that is, the absence of any disturbances in the reproduction of thyroid hormones. At the same time, in terms of laboratory research there is an adequate amount of thyroxine and triiodothyronine, which are produced by iron.

All of the above does not apply to autoimmune disorders, since even in the early stages of such diseases, an increased amount of antibodies in the blood serum is noted. This is because the patient's immunity has already begun to stimulate the human body to enhanced functioning against its own organ - the thyroid gland.

After laboratory tests (or together with them), an ultrasound examination (ultrasound) is prescribed to make a diagnosis and prescribe appropriate therapy.

The progression of thyroid disease leads not only to a change in the structure of gland tissues, but also to malfunctions of the whole organism. The very first “hit” is taken by the nervous system: a person becomes anxious and restless, as well as irritable and unbalanced. Then there are problems with the functioning of the heart and blood vessels, the activity of the reproductive system is disrupted. Metabolic processes in the body also suffer, since thyroid hormones regulate calcium metabolism in the body. As a result, the patient may develop multiple caries and osteoporosis.

Diffuse-focal changes

Diffuse-focal changes in the thyroid gland is an increase in thyroid tissue, in which the appearance of foci with an altered structure of the gland tissue is observed. Moreover, in most cases, these foci are surrounded by glandular tissue of the thyroid gland with an unchanged structure.

Neoplasms that are found on ultrasound can be different in structure and nature of the formation. These include:

• cysts,
• adenomas,
• teratoma,
• hemangiomas,
• paragangliomas,
• lipomas
• cancerous tumors.

Diffuse-focal changes in the thyroid gland are not an independent disease, but appear as a result of a systemic imbalance in the body. Such anomalies are observed with the following diagnoses:

• nodular goiter,
• mixed goiter,
• thyroid adenoma,
• thyroid cancer.

The detection of diffuse-focal changes in the thyroid gland should alert the doctor and the patient, since this phenomenon may indicate the beginning of the development of benign or malignant tumor processes in the organ. Similar changes in the thyroid gland appear on ultrasound as foci with increased or decreased echogenicity. It is important to know that benign and malignant tumors have only their inherent indicator of echogenicity. Such a difference in the parameters of the examination allows us to make the diagnosis of ultrasound more accurate and competent.

Diffuse-nodular changes

Diffuse-nodular changes in the thyroid gland can be detected by palpation of the thyroid gland at an appointment with an endocrinologist. This can be done due to the fact that the location of the gland is superficial, and it is perfectly palpable.

Palpation of the organ is performed as follows. The patient is facing the specialist; while the patient can sit on a chair, stand or lie on the couch. By pressing on the gland in a certain way, the endocrinologist evaluates the size of the thyroid gland, the density of its tissue, as well as the uniformity of the structure of the organ. At this point, the doctor may detect areas with increased density and an increase in glandular tissue, which are called nodes. Also, a specialist can state diffuse changes in the thyroid gland, that is, a general increase in its volume. After such a preliminary examination, the endocrinologist prescribes an ultrasound scan for the patient.

An ultrasound specialist can confirm or refute a previously made preliminary diagnosis. Usually, the fears of endocrinologists during the examination are confirmed. If, during an ultrasound scan, a specialist detects nodes in the glandular tissue that are larger than one centimeter, this serves as the basis for a tissue biopsy of the suspicious node. The passage of such a procedure is prescribed by an endocrinologist after reviewing the results of ultrasound diagnostics. And only after the histological examination and laboratory blood tests for hormones, the attending physician establishes an accurate diagnosis and prescribes a course drug treatment.

Usually, the nature of the occurrence of nodes is parenchymal, that is, it is associated with an increase in one or more follicles of the glandular tissue of the thyroid gland. Specialists call a thyroid nodule a neoplasm in the structure of the parenchyma, which has its own capsule, which limits the node from the healthy tissue of the organ.

For a long time, diffuse-nodular changes in the thyroid gland can be asymptomatic, and can be detected only at an appointment with an endocrinologist. If the thyroid nodes greatly increase in size, they begin to affect the functioning of the organs and tissues that are located nearby. For example, patients may complain of a feeling of suffocation, a change in the timbre of the voice, or the appearance of a feeling of a foreign lump in the throat. It is also common for large nodes to cause various changes in the structure and functioning of the larynx, which can cause pain symptoms.

For a large number of nodes, the process of degeneration of benign tissue into malignant is characteristic, which is called the process of malignancy. What is the nature of such a phenomenon, sometimes not known to the experts themselves. Therefore, patients who have diffuse-nodular changes in the thyroid gland should be under the constant supervision of endocrinologists.

Malignant neoplasms on ultrasound are characterized by reduced echogenicity, heterogeneity of the thyroid tissue structure and the presence of deposits of calcium salts in the neoplasm tissue.

Nodular changes in the thyroid gland are symptoms of the following diseases:

• nodular colloid goiter,
• fibrocystic adenoma,
• carcinomas.

Diffuse cystic changes

Diffuse cystic changes in the thyroid gland is the presence of cystic formations in the glandular tissue of the thyroid gland against the background of a general increase in the volume of the organ.

Cystic neoplasms are cavitary in nature. Cysts have a capsule that limits them from normal thyroid tissue, and a cavity is always found inside the neoplasm. This cavity is filled with a colloid, that is, a liquid that contains a large amount of hormones produced by the gland.

Over a long period of time, diffuse cystic changes in the thyroid gland may not show any symptoms. And only at a preventive examination by an endocrinologist will there be a suspicion of the presence of cysts in the organ. The course of diseases such as a simple thyroid cyst and fibrocystic adenoma are accompanied by the formation of cysts in the organ.

Cysts are manifested not only in an increase in a certain area of ​​\u200b\u200bthyroid tissue, which can give a feeling of the presence of a foreign element in the front of the neck. For such neoplasms, the appearance of suppuration from the ingress of a certain infection into the cyst is characteristic. In this case, the process of suppuration is accompanied by symptoms of an acute inflammatory process - an increase in body temperature, general intoxication of the body, the appearance of a sharp pain in the area of ​​​​the cyst and nearby tissues.

For cysts, as for nodes, the process of degeneration of benign tissue into malignant is characteristic. Therefore, endocrinologists advise patients with a similar disease not to neglect the constant visits to specialists, and also strictly follow all prescribed methods of therapy.

Moderate diffuse changes

When undergoing an ultrasound examination of the thyroid gland, moderate diffuse changes in the thyroid gland can be detected. This means that the gland has some uniform enlargements over the entire surface, but they are not so large as to cause great concern. In this case, most often, the body functions in correct mode, without disturbing the reproduction of hormones.

With moderate diffuse changes in the thyroid gland, there are no foci of tissue compaction or nodes. The entire parenchyma of the thyroid gland is enlarged to a small extent, but without changing the structure of the tissue.

In this case, the endocrinologist may consider that special treatment of the problem is not required. Such a decision can only be made when there are no other symptoms and disturbing manifestations of thyroid dysfunction for the doctor and patient.

At the same time, it must be remembered that the situation with an enlarged thyroid gland cannot be let out of control. Therefore, once or twice a year it is necessary to visit an endocrinologist, who will conduct an examination of the anterior zone of the neck, and also refer the patient to an ultrasound scan.

Pronounced diffuse changes

Pronounced diffuse changes in the thyroid gland are manifested in a strong increase in thyroid tissue, which is diagnosed as a result of an ultrasound examination.

Pronounced diffuse changes in the thyroid gland are characteristic of the following diseases of the organ:

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

In some cases, pronounced diffuse changes in the thyroid gland are accompanied by a focal (nodular or cystic) increase in thyroid tissue.

As a rule, pronounced diffuse changes in the thyroid gland are associated with a violation of its functioning, which affects the hormonal balance in the patient's body. The gland begins to insufficiently or intensively produce certain thyroid hormones, which, in general, affects general state the health and well-being of the patient. In addition to disturbing transformations in the gland, patients may complain of problems with cardiovascular system, nervous system, reproductive organs, skeletal system and so on. All such ailments are the result of improper functioning of the thyroid gland, the hormones of which affect the functioning of the whole organism.

Pronounced diffuse changes in the thyroid gland require mandatory drug treatment, which is prescribed by an endocrinologist after all the tests and examinations necessary in this case.

Diagnosis of diffuse changes in the thyroid gland

Diagnosis of diffuse changes in the thyroid gland can be carried out in several ways. The study of anomalies in the structure and functioning of the thyroid gland is carried out in the following order:

• Examination by an endocrinologist.

When visiting this specialist Feeling (palpation) of the anterior cervical region of the patient is performed. If during this procedure some thickening of the thyroid gland is detected, alarming the doctor, the endocrinologist sends the patient for additional examination. Clarifying procedures will allow concretizing the diagnosis and choosing the most best option problem solving in the form of appropriate treatment.

• The use of imaging research methods, namely:
  • ultrasound examination (ultrasound);
  • computed tomography;
  • magnetic resonance imaging (MRI).

Ultrasound diagnostics or ultrasonography(ultrasound) is the most popular method for examining the thyroid gland. This method of obtaining information about the state of the thyroid gland compares favorably in that it is the safest diagnostic tool. Computed and magnetic resonance imaging are considered more potentially dangerous methods that affect the patient's health and, for these reasons, are used less frequently.

In the vast majority of cases, the diagnosis of "diffuse changes in the thyroid gland" is determined by the patient after the ultrasound procedure. Indications for such a study can be of several types:

• complaints of the patient about his own state of health and well-being and / or sensations and external changes in the anterior cervical region;
• suspicions that arose during the examination of the patient on the existing pathologies in the structure of the thyroid gland;
• existing violations of the functioning of the thyroid gland, namely, a statement of hormonal imbalance in the patient's body, obtained as a result of laboratory studies (blood tests, and so on).

If there is no preliminary evidence in favor of pathological changes in the thyroid gland, ultrasound is not prescribed, since it is not a screening diagnostic method.

The diagnosis of "diffuse changes in the thyroid gland" is established if the results of ultrasound indicate a change in the echogenicity of the thyroid tissues. At the same time, heterogeneity of the echostructure of the organ can be detected - a decrease or increase in echogenicity in different parts of the gland, as well as a general decrease or increase in the echogenic qualities of the thyroid gland.

Computed or magnetic resonance imaging is good for detecting diffuse or focal lesions of thyroid tissue. The results of these studies are of great validity, since they can be used to qualitatively assess the structure and density of thyroid tissues.

Diagnosis of diffuse changes in the thyroid gland is, first of all, a statement of the fact of changes in the thyroid tissue. Clarifying diagnoses that allow you to determine the disease require additional methods studies (for example, laboratory tests for hormones and so on).

Diffuse changes in the thyroid gland are changes in all tissues of the thyroid gland. They can be identified using ultrasound (ultrasound examination). They are not a disease and occur due to some biochemical processes.

Causes

Doctors identify several reasons why diffuse changes in the thyroid gland occur.

These include:

• lack of iodine;
• imbalance of hormones;
• autoimmune disorders;
• inflammatory processes;
• improper and unbalanced food intake;
• a sharp change in the ecological environment that occurred due to various factors.

If a person lives in an endemic environment where there is a lack of iodine, then he may experience some diseases associated with its deficiency.

If there is a violation in the work of the gland, then this changes its structure and tissue. It may increase (organ hyperplasia).

Inflammation occurs due to autoimmune disorders. This causes autoimmune thyroiditis in chronic form(HAIT). With this disease, the production of lymphocytes and antibodies increases. They damage the tissue of the body.

If the body does not receive enough iodine from the food consumed, then the functioning of the hormone-producing organ fails. Also, failures occur with an excess of iodine. Therefore, it is very important to monitor its amount when eating food.

Diffuse changes in the thyroid gland occur in some ailments.

These include:

• goiter endemic and mixed;
• goiter toxic diffuse;
• subacute thyroiditis;
• chronic autoimmune thyroiditis.

Symptoms

With certain factors, signs of diffuse changes in the thyroid gland appear:

• goiter, which increases its size;
• hyperplasia;
• on ultrasound, the contour of the organ is blurred;
• heterogeneity and foci appear;
• organ malfunctions.

Failures are of 2 types - hypothyroidism and hyperthyroidism.

Changes can be recognized by the following symptoms.

• dry hair;
• fragility of nail plates;
• frequent illnesses;
• weakness and fatigue;
• anxiety;
• neurotic state;
• depressive state;
• memory impairment;
• jumps in body weight that are not associated with eating;
• disruptions in the endocrine system;
• problems with sexual functions;
• Difficulties with stools independent of eating.

Echo signs are manifested by seals and nodes in the tissues of the thyroid gland, as well as the presence of uneven density. There is a persistent dynamics of the growth of the size of the node.

Most often, diffuse changes in the thyroid gland are diagnosed by chance during an examination by a doctor. He may notice a slight hyperplasia of the thyroid gland and send the patient for examination.

Forms

Parenchymal changes

The parenchyma performs important functions and consists of different tissues (hematopoietic and epithelial, as well as nerve cells and others). The parenchyma can work correctly only together with the stroma. They form a duet that allows the body to function properly.

Parenchyma tissue is made up of follicles different sizes. They are shrouded in vessels and lymphatic capillaries. main function follicles is the production of hormones, which include iodine molecules.

Diffuse changes in the thyroid parenchyma occur in the follicles. They are considered structural and functional parts. In this case, the entire parenchymal tissue changes. This causes hyperplasia of the gland and affects both lobes of the organ.

More often it is found on examination by a doctor and during an ultrasound scan. Diffuse thyroid parenchymal changes will be diagnosed even when the signs are not obvious. At this time, nothing bothers a person yet, but the gland is already hard to work. The patient can accelerate the development of the disease by stress, overstrain, both physical and mental, as well as various infections.

When the functioning of the thyroid gland is disturbed, a hormonal imbalance occurs. This negatively affects the health and functioning of the body as a whole. Basically, changes in the parenchyma (diffuse) appear due to hormonal failure and provoke an increase in the organ (may occur in adults, children and adolescents).

Diffuse-focal changes

Diffuse-focal changes in the thyroid gland are expressed in the form of hyperplasia of the organ with the manifestation of foci, with altered structures and tissues. Formations can be detected on ultrasound, but they can be of different types.

These include:

• cystic;
• adenoma;
• teratoma;
• hemangioma;
• paraganglioma;
• lipoma;
• oncological tumors (cancerous).

They are not separate diseases and appear with an imbalance of some functions, and can also occur with the following ailments:

• nodular and mixed goiter;
• thyroid adenoma;
• autoimmune thyroiditis in a chronic form (chaitis);
• oncological diseases of the organ.

The manifestation of diffuse-focal changes may indicate that tumors of a malignant or benign form are developing in the body.

They can be seen on ultrasound, which is allowed to do to children and adolescents. HAIT during examination is important to differentiate from diseases.

Treatment for HAIT is carried out and prescribed individually.

Diffuse-nodular changes

Nodular diffuse changes in the thyroid gland can be detected during palpation. This is possible due to the fact that the gland is located almost on the surface, and it can be easily felt, especially with hyperplasia.

Most often, nodes occur due to parenchymal changes with an increase in follicles. Doctors characterize the node as a separate, capsular formation, limited from healthy tissues.

Usually such changes do not make themselves felt for a long time. When they begin to change size, usually increasing, this affects the performance of organs and tissues. Most often, patients complain of a change in voice, a feeling of suffocation and a feeling of the presence of a foreign object in the neck. It is also possible the appearance of pain due to structural changes in the larynx.

It is important to note that often benign education turns into a malignant form.

Doctors call this process - malignancy. The reasons for the occurrence of nodal changes have not yet been fully studied, and are currently ongoing. Therefore, patients with such a diagnosis must be constantly under the supervision of a doctor.

It can also be a symptom of diseases such as:

• fibrocystic adenoma;
• carcinoma.

Formations of a malignant form are easily seen on ultrasound. Their structure differs in heterogeneity and echogenicity of tissues.

Diffuse-cystic changes

This kind is cystic formation in the tissues of the thyroid gland with its hyperplasia. They are cavitary and have a limiting capsule separating them from healthy tissues. Their cavities are filled with colloidal fluid. It contains hormones produced by the gland.

They may not appear for a long time or the symptoms may be blurred. Most often they are found at the appointment with the endocrinologist.

Basically, they manifest themselves in the form of an increase in the thyroid gland with suppuration or infection. This is accompanied by signs that are characteristic of inflammatory processes in acute form. Appears heat body and pain in the area of ​​the cyst.

People with these changes need to visit a doctor regularly and undergo examinations.

Diffuse moderate changes

Moderate diffuse changes in the thyroid gland can be determined by ultrasound. At the same time, the gland is slightly enlarged. They do not cause severe discomfort because their size is small. At the same time, the organ itself works in the normal mode without failures.

With such a change, there are no foci, the parenchyma has an increased size, but without changes in its tissues.

Usually, doctors do not prescribe treatment when changing the moderate form. This only happens when the patient has symptoms or pain.

It is necessary to visit the doctor regularly and monitor the development of changes.

Diffuse pronounced changes

This form of change is manifested by a significant increase in the thyroid gland. Can be determined by ultrasound.

Pronounced changes are manifested in some diseases of the organ.

These include:

• thyroiditis of an autoimmune nature or aitis;
• hyperthyroidism, which appears during Graves' disease (Graves' disease).

Sometimes with such a change, cystic and nodular types of formations are observed.

This is mainly due to disruption of the work and functioning of the gland, which negatively affects hormonal background organism. The body begins to intensively produce hormones, or vice versa. A pronounced diffuse change can disrupt the functioning of the cardiac, nervous, reproductive systems, as well as the blood vessels of the body. These failures occur in case of improper functioning of the thyroid gland.

They can occur in children, adolescents and women. It is rare in men.

Changes by type of AIT

Autoimmune thyroiditis (AIT) appears, as a rule, in people who have reached the age of 39-43 years. Most often, women suffer from it, recently children and adolescents are affected by it. AIT is mainly due to hereditary factors, but it can also be provoked by some pathological changes- excessive body weight, bad habits and malnutrition.

With autoimmune thyroiditis, the immunity and working capacity of a person decreases, problems with stools arise, hair and nails become brittle, and sexual activity is disturbed.

AIT can be detected by ultrasound, CT and MRI. When confirming the presence of changes and different echogenicity in the tissues, a diagnosis of "autoimmune thyroiditis" is made.

Diagnostics

In the thyroid gland, diffuse changes can be diagnosed in the following ways:

• examination by an endocrinologist;

Most often, ultrasound is used, this is the safest method of examination. It gives the most accurate results.

Indications for an ultrasound examination may be as follows:

• a person's complaints about their health;
• external changes in the gland;
• clearly defined violations of the work of the body;
• unsatisfactory results of blood and urine tests.

Diffuse changes are detected in the presence of echogenic tissues. There may also be a different echostructure of the organ. This is indicated by reduced or increased echogenicity in different parts of the organ.

Computed tomography or magnetic resonance imaging well detects foci and diffuse lesions. Also, with their help, the doctor sees the picture completely, which allows him to accurately determine the diagnosis.

Treatment

The choice of treatment method depends on the strength of the increase and the types of changes in the thyroid gland.

If they are caused by iodine deficiency, then doctors recommend eating foods rich in this substance.

These include:

• seaweed;
• buckwheat;
• sea ​​fish;
• Red caviar;
• feijoa;
• apple seeds.

Sometimes iodine-containing drugs are prescribed.

During treatment, it is necessary to control the level of iodine in the body and when it reaches the norm, you need to stop taking iodine-containing drugs.

With an increased content of iodine, it is necessary to reduce the consumption of foods rich in this substance. The doctor may prescribe special means to reduce its content.

Treatment is carried out in courses with constant supervision by a doctor, it is also necessary to periodically check the content of hormones in the blood. This is done using special analyzes in laboratory conditions.

Some forms of goiter require surgical treatment. IN postoperative period an appointment is scheduled hormonal drugs, which provide stable remission and prevent recurrence.

Such treatment is prescribed on an individual basis based on the symptoms and concomitant diseases, as well as their strength.

Self-treatment can lead to deterioration and serious consequences.

Prevention

You can avoid the occurrence of diffuse changes, autoimmune and chronic autoimmune thyroiditis by following simple rules.

These include:

• control of iodine intake;
• maximum reduction of stressful situations;
• taking vitamins;
• regular visits to the doctor;
• timely treatment of all diseases.

Such simple rules will help to avoid unpleasant consequences associated with structural changes in the thyroid gland.

Forecast

With diffuse changes in the thyroid gland, the prognosis is favorable, in the case of timely treatment. This means that you need to closely monitor your health and the health of your child.