The thyroid gland is enlarged: how to understand in time that measures need to be taken

Thyroid diseases are a common problem: they rank second among all endocrine system disorders. The reason for this is the deterioration of the environmental situation, regular stress and iodine deficiency, which are typical for residents of large cities. One of these diseases is diffuse nodular goiter, which combines 2 different pathological processes: the formation of nodular formations and enlargement of thyroid tissue. The Alpha Health Center clinic is a modern medical center where you can make an appointment any day. You will receive professional advice from an endocrinologist with more than 7 years of experience and a personally developed treatment regimen.

What is a goiter

In medicine, this term refers to a pathological change in the thyroid gland, expressed in the formation of nodules. A node, in turn, is a neoplasm of any size with a capsule, determined by palpation or during a visual examination. The diffuse type of the disease involves uniform tissue proliferation. And mixed cases in which both of these pathological processes are combined are called diffuse nodular goiter.

With this disease there is no connection with tumor, or neoplastic, or inflammatory processes. Enlargement of the thyroid gland with diffuse nodular goiter is not an oncological pathology. This is a consequence of other, independent pathological conditions or changes.

Diffuse nodular goiter is more often diagnosed in women than in men. According to medical statistics, among patients with this disease there are 3 times more females. The vast majority of them are of middle age.

Pathologies of the thyroid gland in women

This is one of the most common pathologies in women. Since the body is subject to frequent hormonal changes, the thyroid gland may also be affected. It is known that due to hormones throughout the body, the normal functioning of all vital processes occurs. When the thyroid gland malfunctions, a woman’s body undergoes real chaos.

Problems with the menstrual cycle may arise, which negatively affects reproductive functions. In addition, the appearance may change significantly, trembling appears in the hands, skin color becomes dull, hair becomes weak.

Causes

The reasons why diffuse nodular goiter develops are not exactly clear. The most likely predisposing factors are considered to be age-related changes in the body associated with changes in the endocrine system and an unbalanced diet. The risk of developing diffuse nodular goiter increases with frequent and chronic stress, reduced immunity, and unfavorable environmental conditions.

The disease often develops against the background of:

• psychological injuries;
• infectious processes in the body;
• inflammatory diseases;
• autoimmune disorders;
• genetic predisposition;
• insufficient consumption of iodine-containing products;
• diseases of the central nervous system;
• bad habits;
• brain injuries;
• hormonal disorders.

Medical practice also shows that signs of a nodular process in the tissues of the thyroid gland are often found in elderly patients. This suggests that the development of diffuse nodular goiter may be associated with the natural mechanism of aging.

Treatment of subacute thyroiditis

After making a diagnosis, the endocrinologist will prescribe special procedures that will reduce pain, inflammation and other associated symptoms. These procedures include:

• Taking corticosteroids, such as prednisolone. Initially, a relatively large dose is prescribed, which is gradually reduced. Corticosteroids reduce inflammation and swelling of the thyroid gland and help reduce pain.
• Beta blockers. This group of drugs is used when there are symptoms characteristic of dehyperthyroidism - tachycardia and arterial hypertension. They help regulate heart rate and blood pressure. Some doctors recommend taking potassium along with beta blockers.
• Protective stomach medications. Corticosteroids may irritate the lining of the stomach. To avoid this, it is advisable to take stomach protective medications - omeprazole or Nexium.
• Thyroid hormones. As we have repeatedly mentioned, hypothyroidism develops at a later stage of subacute thyroiditis. Since the thyroid gland does not produce enough thyroxine at this time, it may be necessary to supplement it with a synthetic hormone analogue, levothyroxine. Levothyroxine is available on the market in two forms: euthyroxine and L-thyroxine.

Treatment of subacute thyroiditis does not last forever - once symptoms normalize, medical intervention stops.

With this type of thyroiditis, it is important to refrain from taking iodine supplements and iodine-containing products (seaweed, iodized salt) - they can worsen the condition.

Symptoms

Diagnosis of diffuse nodular goiter can be complicated by the fact that the disease manifests itself in different ways. In most cases, changes in the body are accompanied or are a consequence of increased synthesis of thyroid hormones. But this condition is not always met in diffuse nodular goiter. In some cases, thyroid hormones, on the contrary, decrease or are within normal limits.

At an early stage, the course of the disease often has a latent form. Even with careful diagnosis, it is not always possible to recognize it. As diffuse nodular goiter increases, the symptoms of the disease become more vivid and noticeable.

Patients complain:

• to an unreasonably hoarse voice;
• labored breathing;
• causeless dry cough;
• hypertrophy of the thyroid gland, that is, its visual enlargement, noticeable externally.

Diffuse nodular goiter of the 1st degree can manifest itself as severe pain in the larynx, not associated with colds or infectious diseases. The patient feels constant discomfort when swallowing food or drinks, and when he tries to tilt his head, he experiences unpleasant compression. Dizziness is often observed with diffuse nodular goiter.

Subsequently, the symptoms worsen. Manifestations of diffuse nodular goiter of the 2nd degree are increasingly reminiscent of the symptoms of thyrotoxicosis, which occurs when the production of thyroid hormones increases. Characteristic signs of the disease at this stage are pain in the chest and behind the sternum, arterial hypotension, shortness of breath, which bothers you even after light physical exertion.

Diffuse nodular goiter of the 2nd degree can manifest itself:

• insomnia;
• decreased or lack of appetite;
• pain in the neck and larynx;
• irritability;
• nervousness.

Complaints about dermatological problems are possible - for example, patients with diffuse nodular goiter are often bothered by dryness and flaking of the skin. Elderly patients are characterized by impaired cognitive functions, in particular, forgetfulness and memory impairment. A decrease in body temperature may be observed with diffuse nodular goiter. In men, there are frequent cases of weakened erectile function and problems with potency, in women - menstrual irregularities, infertility, and during pregnancy - miscarriage.

Diffuse nodular goiter is a disease that can affect not only an adult, but also a child at an early age. The danger of pathological tissue proliferation in combination with nodular neoplasms of the thyroid gland is that it can negatively affect the mental and physical development of a young body. At the same time, the process of eliminating pathology, taking into account its anatomical location, is very complex. Often, with diffuse nodular goiter, Graves' syndrome develops due to excess thyroid hormone. It has a toxic effect on the body, which is manifested by nervousness, anxiety, and a constant feeling of hunger. This disease is also characterized by dry skin, tremor (uncontrollable shaking) of the lower and upper extremities, and protruding eyes.

With large diffuse nodular goiter, the symptoms also have their own specifics. A formation in the thyroid gland leads to compression of nearby tissues and structures, making swallowing and head movements difficult. The disease can lead to aphonia - loss of voice, paralysis of the recurrent laryngeal nerve. An enlarged thyroid gland is accompanied by dyssomnia, sweating, and sudden and causeless weight loss. If pain occurs, this indicates that the diffuse nodular goiter is pressing on the esophagus and trachea. Paralysis of the vocal cords and tissue fusion are observed with malignancy of the pathological process.

Autoimmune Hashimoto's thyroiditis

It develops if a person has a congenital predisposition to pathologies of the immune system at the gene level. Hashimoto's thyroiditis is characterized by mutations that affect antibody production. The immune system begins to perceive thyroid cells as foreign and dangerous to the body. It produces special proteins - antibodies, which act on the thyroid gland and disrupt its functioning. This form of pathology has a protracted, chronic course and can be a lifelong condition.

Causes of chronic autoimmune thyroiditis:

• Excess iodine in the body (mainly due to diet).
• Herpes.
• Deficiency of vitamins and minerals, primarily selenium.

If we are not talking about diffuse goiter, when the entire organ is enlarged, then classification by localization is applied:

• Unilateral – neoplasms on one side.
• Double-sided - on both sides.

In women, Hashimoto's thyroiditis is up to 10-20 times more common. The average age of patients is from 40 to 50 years, but younger people are increasingly becoming ill.

Symptoms of Hashimoto's chronic thyroiditis appear due to decreased activity of the organ (hypothyroidism). Among the main ones:

• Loss of energy, constant drowsiness.
• Unreasonable weight gain.
• Bad mood.
• Coldness of the body.
• Hair loss, even baldness.
• Stool disorders.
• Growth of the gland in size, but without pain.
• An increase in the interval between menstruation, up to their cessation, is a characteristic symptom of chronic thyroiditis of the thyroid gland in women.

Help to make a diagnosis:

• Laboratory tests - a symptom of Hashimoto's thyroiditis is an increase in the level of T3 and T4 when inflammation has just begun, and later their production decreases, but the amount of TSH in the blood increases.
• The appearance in the blood of specific antibodies to thyroid cells.
• Ultrasound.
• Scintigraphy (if necessary, as an additional examination).

Treatment of a chronic inflammatory process of the autoimmune type is aimed at normalizing the functioning of the gland and treating hypothyroidism. Hormonal therapy is used for this. The dosage is individual in each case. Proper selection of medications restores the normal quality of life of patients or significantly slows down the rate of progression of the disease.

Stages and types of disease

The World Health Organization divides the development of diffuse nodular goiter into several forms:

• zero;
• primary;
• secondary.

They are determined by the severity of symptoms. With the zero form of diffuse nodular goiter, there are no clinical manifestations. The primary form of the disease can be diagnosed after palpation. Secondary diffuse nodular goiter is when the tumor is visually noticeable.

Classification is also used according to the type of nodular formations. From this point of view, cystic formations and pseudonodules are distinguished. Their number also varies - from single or solitary formations to multinodular, conglomerate ones.

What hormones are produced by the thyroid gland?

Information from the outside can influence the nervous system. For example, this happens during hunger, danger, fear. The information received is analyzed by the hypothalamus. The pituitary gland and hypothalamus interact with each other. The pituitary gland promotes the production of thyroid-stimulating hormone (TSH), and directly controls the functioning of the thyroid gland. With hypofunction of the gland, TSH increases, with hyperfunction it decreases.

The thyroid gland is responsible for the production of thyroxine, triiodoteronine and calcitonin. In addition, it helps maintain a constant environment and self-regulation in the body.

Metabolic and energy processes are regulated by thyroxine and triiodoteronine. The role of calcitonin has not been fully studied, but in total it is responsible for ensuring that a normal concentration of calcium is present in the body. It, in turn, is an important condition for the normal functioning of the musculoskeletal system.

Diagnostics

To diagnose diffuse nodular goiter, an initial examination by an endocrinologist is necessary. It allows you to identify signs of the disease through visual assessment and palpation. If there is a suspicion of diffuse nodular goiter, the doctor will prescribe additional tests to clarify the diagnosis:

• blood test - to check the concentration of thyroid hormones;
• stool and urine analysis;
• Ultrasound examination allows you to find out the cause of the nodular formation.

To exclude the possibility of developing cancer, a fine-needle aspiration biopsy is used. It is performed if the diameter of the nodular formation reaches a centimeter or more. Scintigraphy is also performed - radioisotope scanning, which makes it possible to study the autonomy of the functional thyroid gland. Computed tomography provides the doctor with information about the size of the organ, its contours and structure, and the features of regional lymph nodes. X-rays are needed to ensure that foreign objects do not enter the esophagus or sternum area.

Only after laboratory tests are carried out, the endocrinologist selects drug therapy for the patient, which can gradually reduce the manifestations of the disease.

Treatment methods

Treatment is required only for goiter symptoms. Thus, thyrotoxicosis with a diffuse increase is treated with goitrogenic drugs that suppress the synthesis of hormones, or the producing adenoma is removed. Insufficient function, on the contrary, is compensated for by synthetic endocrine drugs.

Nodular goiter cannot be treated with any medications; removal of a benign neoplasm is necessary:

• if you suspect cancer;
• compression of surrounding structures by the mass of the gland;
• life-impairing cosmetic neck deformity;
• if it is impossible to use radioactive iodine in a patient with thyrotoxicosis.

In other cases, with a node less than a centimeter, the patient is monitored with annual blood tests and ultrasound. For “goitrogenic” risk factors, examinations are carried out every six months. The growth of a node between examinations is a reason for a biopsy.

The question of surgery is raised when cellular atypia is detected, since cancer can occur under its mask in 30% of cases. The cytological picture of “follicular neoplasia”, and even more so “suspicion of cancer”, is the basis for removal of the affected lobe - hemithyroidectomy.

Treatment with radioactive iodine is highly effective; in case of thyrotoxicosis, hormone production returns to normal within a month. Contraindicated only for pregnant and lactating women, unacceptable in case of decreased function.

Indications for radioiodine therapy:

• obligatory when the thyroid gland is “uncontrolled” by pituitary hormones - an autonomous function with hyperproduction;
• possible for nodes with contraindications to surgery.

If the patient is unable or unwilling to undergo surgery, and the benign nature of the process is absolutely proven, innovative alternative methods are possible:

• introduction of sclerosing substances into the node - alcohol, tetracycline and others;
• destruction of the node by laser, liquid nitrogen, electric current.

Hirudotherapy does not stand up to criticism; the folk method does not cure goiter. The thyroid gland is abundantly supplied with blood, leeches are promised abundant nutrition, but they are not able to change the pathological structure. Nodular goiter cannot be cured with any medications; the node can only be removed.

Treatment

If diffuse nodular nontoxic goiter syndrome occurs without complications, the patient is prescribed hormonal therapy and radioactive iodine preparations. In some cases, surgical treatment is advisable. It is indicated for the development of neoplasia, pronounced external manifestations of goiter, difficulty swallowing and breathing associated with compression syndrome.

Therapy is aimed primarily at restoring the hormone-producing function of the thyroid gland. Treatment with radioactive iodine preparations for diffuse nodular goiter usually demonstrates good results. Radical removal of the organ through surgery and subsequent hormone replacement therapy are indicated only in the absence of results from the prescribed drug treatment.

The likelihood of malignancy of the process with diffuse nodular goiter is low. The prognosis is generally favorable. If changes in the structure of the thyroid gland were noticed at the early stage of diffuse nodular goiter and are not severe, the main role is given to conservative treatment. The doctor selects medications with iodine compounds that are actively absorbed by the human body. In most cases, this measure is sufficient to eliminate the negative symptoms of diffuse nodular goiter and gradually reduce the thyroid gland down to its normal size.

What solution

Treatment for subacute thyroiditis usually takes 12 to 18 months. In 90-95% of cases, the result is very good - the disease ends in complete recovery, but it also happens that at a late stage hypothyroidism becomes chronic and remains a constant problem.

Permanent hypothyroidism develops in 5-10% of people with lower thyroiditis, according to the American Thyroid Association. Persistent goiter and thyroid dysfunction are most likely after postpartum thyroiditis.

If you suspect thyroiditis, immediately make an appointment with an endocrinologist. Early diagnosis and timely treatment play an important role in preventing the disease from becoming chronic.

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Complications

Without timely and adequate treatment, diffuse nodular goiter can lead to serious consequences. Therefore, doctors recommend seeking professional help immediately if you discover 3 or more signs of the disease. An advanced stage of diffuse nodular goiter increases the risk of malignancy of the process and the development of thyroid cancer. It often leads to death.

Other complications are possible with diffuse nodular goiter. Choking, problems with swallowing, compression of nerve endings and metabolic disorders can negatively affect the condition of many internal organs and systems.

Classification of thyroiditis

The classification of thyroiditis according to the International Classification of Diseases, 10th revision, distinguishes the following types of pathology:

• acute thyroiditis - an infectious lesion of the thyroid tissue: can lead to the formation of abscesses (purulent thyroiditis);
• subacute thyroiditis - De Quervain's thyroiditis (giant cell or granulomatous thyroiditis);
• chronic autoimmune thyroiditis - Hashimoto's disease or goiter (chronic lymphocytic thyroiditis or lymphoid goiter);
• Riedel's chronic thyroiditis or Riedel's goiter.

Thyroiditis induced by drugs or radiation does not have significant clinical significance, since this pathology is self-limiting and usually does not require serious measures.

Gestational or postpartum thyroiditis occurs during or after pregnancy due to changes in the immune system. It does not require serious treatment and usually goes away on its own.

Prevention

Since the exact reasons why diffuse nodular goiter of the thyroid gland develops are not yet clear, preventive measures are precautionary in nature.

Endocrinologists strongly recommend enriching your diet with foods rich in iodine:

• sea ​​fish;
• crustaceans;
• seaweed;
• whole milk;
• beef.

Adequate nutrition is especially important when the immune system is weakened, in childhood and old age. If one of your close relatives has been diagnosed with diffuse nodular goiter, it is recommended to regularly visit an endocrinologist and monitor hormone levels through testing - at least once a year. Good sleep, a properly organized rest regimen, and an active lifestyle will also help reduce the risk of developing the disease.

Prevention of thyroiditis

A healthy lifestyle with:

• Sufficient intake of vitamins and minerals.
• Treatment of acute respiratory viral infections and infections, especially in the nasopharynx, other ENT organs and the oral cavity.

The prevention, diagnosis and treatment of these diseases is carried out by an endocrinologist, in some cases with the help of an immunologist.

You can undergo high-quality examinations in an express format at a medical clinic. Pre-registration is possible online or by calling the clinic.

At the Kutuzov Treatment and Diagnostic Center, you can undergo a full examination using high-precision equipment and determine the cause of the pathology. Modern treatment methods and unique proprietary developments allow our specialists to achieve excellent results. We value your time and offer doctor visits by appointment. Come to our center to undergo a thorough examination and receive an individual treatment plan for the identified pathology in comfortable conditions and at a convenient time. In addition, the doctor will give comprehensive recommendations on preventive measures that will help avoid the development of pathology in the future.

Diagnosis and treatment of diffuse nodular goiter of the thyroid gland in Moscow

The danger of diffuse nodular goiter is that in the early stages it practically does not manifest itself externally. Symptoms become apparent only after changes in thyroid hormone levels and significant enlargement of the thyroid gland. The later diffuse nodular goiter is diagnosed, the more radical methods of therapy may be needed.

"Alpha Health Center" recommends checking the condition of the thyroid gland, and if necessary, undergoing treatment in a modern medical center.
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Causes of goiter

Due to the disease, goiter can be sporadic and endemic, and in this classification they focus not on the individual development of the pathology, but on the state of goiter morbidity in the region as a whole. The pathology is endemic in areas where goiter of any size and shape is found in every twentieth child and every third adult.

The most common causative factor in the development of pathology is iodine deficiency, which leads to a decrease in the production of iodolipols by thyroid cells, for which the production of glandular tissue growth stimulants increases compensatoryly. The enlarged glandular tissue is actually a goiter, which over time undergoes involution with the formation of nodules.

The formation of goiter is helped by a defect in the synthesis of thyroid hormones or perverted sensitivity of cells to them, taking certain medications that promote goiter growth and are called “goitrogens”. Goitrogens or thyreostatics are used to treat thyrotoxicosis. Pathology can be caused by some components of food; all of them have the ability to block the production of thyroid hormones; it is believed that soy flavonoids and thiocyanates contained in a variety of cabbages, corn and tobacco leaves have a particularly active effect on glandular tissue.

Hereditary predisposition is also important for the development of the pathological process, but specific genes have not yet been identified.

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Signs of the disease

Signs of an enlarged thyroid gland in Tibetan medicine are manifestations of the “heat” or “cold” scenario.

The “heat” option is associated with disturbance of the Bile dosha: the nervous system and cardiovascular system are activated, and metabolism accelerates. Hyperfunction of the thyroid gland is accompanied by dysfunction of the liver and reproductive function.

Signs of hyperplasia according to the “cold” scenario are caused by the disturbed Mucus dosha. “Cold” inhibits all processes in the body, and symptoms of hypothyroidism develop. Metabolism slows down, manifested by drowsiness, swelling, deterioration of memory and mental abilities.

The decisive factor for the development of goiter is the disturbance of the Wind constitution, which is responsible for the emotional sphere. With frequent grievances, anxieties, and irritability, an emotional “lump” forms in the throat - a spasm from unexpressed emotions. The normal flow of blood in the thyroid gland is disrupted, which provokes the development of the disease.

Case from practice

A 50-year-old woman with diffuse enlargement of the thyroid gland came to the Naran clinic in Moscow. Olga Sergeevna complained of rapid heartbeat, sweating, difficulty swallowing, and poor sleep. According to an ultrasound examination, the volume of the thyroid gland was 36 cm³ (the norm is 18 cm³), according to the analysis, hormones were normal. From a conversation with the patient, it became clear that the development of the disease was influenced by severe stress. Olga Sergeevna is an emotional and excitable person. A doctor of Tibetan medicine diagnosed the woman with a constitutional disorder “Wind” and prescribed an appropriate set of treatment. The complex treatment included taking herbal remedies, acupressure, acupuncture, and moxotherapy. During the treatment, the woman’s well-being improved significantly - sleep was restored, sweating and rapid heartbeat disappeared, and the feeling of a lump in the throat went away. Three months after complex treatment, she was prescribed a second course of Tibetan herbal remedies. After two courses of treatment, control ultrasound showed that the volume of the thyroid gland decreased to 19 cm³. Olga Sergeevna was recommended a course of treatment after 6 months to consolidate the effect.

Questions

• Can the thyroid gland shrink after enlargement?
  An increase in the size of the thyroid gland indicates the development of pathological processes in it. With adequate therapy, the size of the thyroid gland decreases. If any abnormalities are detected in the thyroid gland, consultation with a specialist is necessary.
• Is an enlarged thyroid gland dangerous?
  The thyroid gland plays a key role in the functioning of the entire body, as it produces vital hormones. An enlarged thyroid gland leads to the development of serious diseases, in severe cases it can be fatal.
• How to recognize an enlarged thyroid gland?
  An enlarged thyroid gland can be recognized by its characteristic symptoms, appearance, and diagnostic data (ultrasound of the thyroid gland, CT scan, MRI of the thyroid gland, tests for thyroid hormones). Doctors of Tibetan medicine can recognize signs of thyroid pathology at the stage of pulse diagnosis.

Bibliography

1. Tibetan medicine: Big encyclopedia / Svetlana Choizhinimaeva. - Moscow: Eksmo, 2015. - 384 p. - (Russian Medical Library). ISBN 978-5-699-79532-1.
2. “Choosing vitamins.” — Iozefovich O.V., Ruleva A.A., Kharit S.M. — Issues of modern pediatrics — 2010.
3. Haglund MM, Moore AJ, Marsh H, Uttley D. Outcome after repeat lumbar microdiscectomy. // Br J Neurosurg. – 1995 – V. 9 – P.487–95.
4. Delicious food. Tibetan medical science about the art of food / Svetlana Choizhinimaeva. — Moscow: Arguments of the Week, 2021. — 320 p. ISBN 978-5-9908777-0-2.
5. Notes of a doctor of Tibetan medicine / Svetlana Choizhinimaeva. — Moscow: Arguments of the Week, 2021. — 160 p. — ISBN 978-5-6040607-2-8.
6. McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM et al. Recurrent disc herniation and long–term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. // Neurosurgery. – 2009 – V.64 – P.338–45.
7. "Physiological basis of nutrition." Zinchuk V.V. — Journal of Grodno State Medical University — 2014.

Consequences

The most dangerous complication of hypothyroidism is hypothyroid coma. The survival rate when it occurs ranges from 10 to 40%. A comatose state (drowsiness, disorientation, decreased blood pressure) develops due to lack of proper treatment, injuries, and operations. Other negative consequences of thyroid hypofunction are problems with the cardiovascular system. The patient's heart rate slows down (bradycardia), hypertension and metabolic cardiomyopathy develop.

In a child with hypothyroidism, both physical and mental development are impaired: children with congenital pathology are lethargic, amicable, and suffer from edema. Neglected forms progress to dwarfism and cretinism.

Complications of hyperthyroidism are similar to hypothyroidism:

• heart rhythm disturbance - atrial fibrillation, which completely disappears with treatment;
• due to a lack of calcium, osteoporosis develops, bones become fragile;
• decreased visual acuity due to swelling of the tissues around the eyeballs;
• Graves' dermopathy - swelling and redness of the skin of the feet and legs;
• thyrotoxic crisis. Symptoms of hyperthyroidism intensify against the background of severe tachycardia, sweating and confusion. The condition requires urgent care;
• oncology. Enlarged lymph nodes in the presence of nodular hyperplasia of the thyroid gland may indicate a malignant process.