Diffuse euthyroid goiter is a disease characterized by a general growth of the thyroid gland, which is visible to the naked eye and easily palpable. The functions of the organ are preserved. The most common cause of pathology is insufficient intake of iodine in the body.

Characteristics of the disease

A characteristic feature of euthyroid goiter is that the process of hormone production is not disturbed, respectively, their level remains normal. Such a disease is otherwise referred to as “diffuse non-toxic goiter” or euthyroidism .

The volume of the thyroid gland in men on ultrasound is normally no more than 25 ml, in women – 18 ml. Deviations from the established indicators upwards indicate an increase in the organ.

The development of the disease is associated with a low content of iodine in the environment in a number of regions, which is why the inhabitants of these territories consume the trace element with food in insufficient quantities.

Depending on the prevalence, endemic and sporadic goiter are distinguished. If the incidence rate among children 6–14 years old is 5%, they speak of endemic pathology. The second variety occurs with congenital and acquired disorders of the production of hormones T3 and T4. The formation of sporadic goiter has nothing to do with the amount of iodine consumed.

Euthyroid goiter is most often diagnosed in people under 20 years of age. Women are more susceptible to the disease due to the fact that during pregnancy, breastfeeding and puberty, they need large amounts of the trace element.

Disease classification

By the nature of the changes, pathology is divided into three varieties:

• diffuse form;
• nodal;
• mixed goiter (diffuse-nodular).

The first type is characterized by a gradual uniform growth of thyroid tissues. Nodular formations are not noted.

Nodular goiter is characterized by uneven growth of tissues. There are two options for the development of the disease:

• the presence of one node (single-nodular goiter);
• multiple formations that grow on their own ( multinodular or polynodular goiter).

The enlargement of the thyroid gland in both cases is insignificant. The diffuse-nodular form is expressed as a simultaneous flow of two processes: a diffuse enlargement of the organ and the formation of separately growing nodules (cystic, colloidal, etc.).

Stages of the disease according to the ICD:

• zero degree: the goiter is not palpable and not visualized, each lobe of the thyroid gland does not exceed the distal phalanx of the patient’s thumb;
• euthyroid goiter of the 1st degree: visible when swallowing, felt with superficial probing;
• second degree: visualized in a relaxed position of the neck, palpation is not difficult ( multinodular euthyroid goiter grade 2).

The mechanism of the development of the disease

In the first place among the causes of the disease is the lack of iodine that enters the body with food and water. Growth of gland tissue is a kind of compensatory reaction aimed at maintaining the production and level of thyroid hormones in conditions of insufficient intake of the microelement from the outside.

The body thereby adapts to the conditions of iodine deficiency. This is due to increased uptake of the element by thyrocytes , as a result of which the T3 hormone is produced in a larger volume. But the processing of the endogenous microelement also increases, as a result of which the synthesis of thyroid hormones is activated.

Despite the fact that the adaptive mechanism in the thyroid gland is regulated by the hormone TSH, synthesized by the pituitary gland, with diffuse goiter, its level remains within the normal range. Autocrine factors ( fibroblast , epidermal and transformational) play an active role in the adaptation of the organ to iodine deficiency .

At the initial stage of the pathology, a compensatory increase in the level of thyrocytes is noted , due to which a parenchymal form of goiter develops. This disorder is common in children and adolescents.

In elderly and operated people, colloidal growth of the gland is observed, in which the tissue consists of large follicles filled with a jelly-like substance. This leads to a disruption in the production and breakdown of TG, as well as to a decrease in the degree of protein iodination.

Among the factors contributing to the development of the disease, there are:

• smoking;
• stressful situations;
• taking certain medicines;
• chronic infections.

The role of the hereditary factor in the mechanism of pathology development is not excluded.

Symptoms

The clinical picture is not pronounced, since the functions of the thyroid gland are not disturbed. Complaints of patients are reduced to weakness, fatigue and drowsiness. With a significant increase, the nearest organs are compressed – the esophagus and trachea. This leads to shortness of breath and a sensation of a lump in the throat. If left untreated, compression of the trachea can lead to asphyxia. Due to compression of nearby vessels, vena cava syndrome is observed.

As the tissues of the gland grow, the contour of the neck changes.

In order to assess the degree of the pathological process, a palpation method is used – probing. A slight increase in the thyroid gland does not affect the functioning of other organs in any way and is detected only during a targeted examination (during medical examinations, etc.).

In the absence of treatment based on correcting the amount of iodine consumed, the gland can grow to a very large size. A complication can be thyroiditis, inflammation of the goiter, the transition to a toxic form.

Diagnostics

Diagnostic measures are reduced to taking an anamnesis, taking tests and conducting instrumental methods of examination. When studying the anamnesis, first of all, pay attention to the place of residence of the patient, the presence of bad habits. In women, the number of pregnancies and the method of feeding the child are ascertained.

Laboratory tests include blood tests for the hormones TSH, TG, T3 and T4.

An instrumental study involves an ultrasound, which allows you to assess the shape, volume and structure of the organ.

If there are complaints of shortness of breath and a feeling of a lump in the throat, an x-ray of the sternum with contrast is performed.

Treatment

The scheme is selected depending on the duration and degree of the disease.

Three approaches to conservative therapy are used:

• the use of only iodine-containing medicines;
• the appointment of levothyroxine sodium ( euthyrox , L-thyroxine);
• combined scheme, consisting in the joint use of iodine-containing drugs and euthyrox .

At the initial degree, the patient is prescribed up to 200 micrograms of iodine per day. Due to this, the growth of thyrocytes is suppressed . Adverse reactions do not occur.

Levothyroxine inhibits the growth of thyrocytes , affects TSH and maintains its concentration at the level of 0.2-0.4 mmu / l. The disadvantage of the method is that after the drug is discontinued, iron continues to increase.

Combined administration consists in the joint intake of 200 micrograms of iodine and 150 micrograms of euthyrox . This is the most preferred scheme, since the gland is rapidly losing in size. At the same time, there is no risk of secondary growth, so the body receives the microelement from the outside.

Euthyroid goiter 0 degree is not treated in any way. However, the patient should regularly visit a specialist to monitor the dynamics of the disease.

Surgical intervention is resorted to in cases where the gland reaches a huge size, and compression of nearby organs is observed. The patient undergoes resection of the thyroid lobes.

Any therapeutic regimen, regardless of the degree and form of pathology, involves the preventive consumption of iodized salt in food.