Endemic goiter is a disease that is accompanied by an increase in the size of the thyroid gland, as a result of which changes in the shape of the neck occur. This disease develops due to insufficient iodine content in the human environment. Endemic goiter in children is the most common manifestation of iodine deficiency disease. In many children, the disease is detected in adolescent return.

REASONS OF A GOITER

The human body develops normally if the endocrine system works properly, and with it the thyroid gland. Chronic iodine deficiency contributes to an increase in gland tissue with disruption of its work. If the right amount of iodine is not supplied to a person’s body, the thyroid gland increases, and the so-called goiter appears.

Iodine deficiency is of two types, depending on the cause of the endemic goiter. These include:

1. Relative iodine deficiency – the cause is the following factors:
   1. Taking certain medications;
   2. Congenital thyroid disorders;
   3. Impaired intestinal absorption of iodine;
   4. Diseases of the gastrointestinal tract.
2. Absolute iodine deficiency – the reason for this is an insufficient intake of iodine with water and food.

Experts note the factors that provoke the occurrence of goiter in children and adults:

• Lack of sanitary and hygienic conditions in places of residence and work;
• Infectious and inflammatory diseases of a chronic nature, especially helminthic invasions;
• The use of drugs that impede the transport of iodine to the thyroid cells;
• Insufficient intake of products containing: molybdenum, manganese, selenium, zinc into the human body. These elements contribute to the assimilation of iodine by the body;
• Genetic defects in the production of thyroid hormones;
• Contamination with chemical elements of drinking water, as a result of which the absorption of iodine (calcium, urochrome , nitrates) becomes more difficult ;
• Hereditary factor.

WHAT ARE THE VARIETIES OF ZOBE?

Endemic goiter is divided into:

• Mixed (diffuse-nodular) goiter;
• Nodular endemic goiter;
• Diffuse nodular goiter.

The size of the goiter is divided into degrees:

• At 0-degree – the goiter is not felt to the touch;
• At 1-degree – felt when palpated, but not noticeable;
• At grade 2, it is felt when touched and seen from a distance.

Symptoms of the Manifestation of a Goiter

With endemic goiter, hyperplasia occurs – an increase in the thyroid gland. This is due to the manifestation of the body’s reaction to a low concentration of iodine, as well as caused by a deficiency of thyroid hormones. Often, together with goiter, a disease develops – hypothyroidism. The body, increasing the mass of the thyroid gland, tries to compensate for the insufficient content of thyroid hormones, due to which the following symptoms of goiter occur:

• Headaches;
• Discomfort in the area of ​​the heart;
• Low endurance of physical activity;
• General weakness.

Such symptoms can occur even at the stage of development of the disease, when the size of the thyroid gland is normal, and the level of thyroid hormones is practically unchanged. Later, as the gland grows, new symptoms of this disease appear:

• Choking attacks;
• Dry cough;
• Difficulty swallowing and breathing
• Feeling of suffocation in the neck.

Symptoms of endemic goiter due to the course of a more severe stage of the disease are manifested by cardiac pathology. This pathology is characterized by hyperfunction and pronounced expansion of the right ventricle and atrium. Among the complications of endemic goiter that may occur, it is worth highlighting the following:

• Malignant degeneration;
• Thyroid hemorrhage;
• Subacute and acute thyroiditis.

In children, the symptoms of this disease are most intense. The disease is most often complicated in childhood by the development of endemic cretinism: a disorder of the central nervous system, delayed physical and intellectual development.

DISEASE DIAGNOSIS

The main diagnostic method for this disease is ultrasound, as a result of which the form of the disease is established: nodular or diffuse endemic goiter. Thanks to radioisotope scanning of the thyroid gland, its functional state is assessed.

Diagnostics also includes laboratory tests of blood and urine. Patients whose symptoms indicate an endemic goiter are checked for the presence of thyroglobulin , as well as hormones T3, T4, TSH.

With a nodular goiter, an additional biopsy is used to determine the nature of the disease, which can be both benign and malignant.

METHODS OF TREATMENT OF ENDEMIC GOITER

The choice of treatment for goiter should be differentiated in relation to the form of the disease. Treatment is conservative and surgical. The conservative method is used at an early stage of the disease. Iodine therapy is effective only when the thyroid gland has not increased in size by much.

The most effective is hormonal treatment with “Thyroidin” or “Triiodothyronine”. Positive results in the treatment of thyroidin are shown not only in the treatment of diffuse forms of goiter, but also in mixed forms, without serious destructive changes. With nodular forms of goiter, surgical treatment is indicated, because its transformation into a malignant tumor is possible.

Conservative treatment is indicated in cases where:

• Mixed goiter;
• All forms of endemic goiter, with the exception of huge goiters with compressive manifestations.

Conservative treatment of nodular goiter, as a rule, does not give an effect.

MEDICATION TREATMENT

Medical treatment includes the use of iodine preparations, as well as thyroid preparations.

With diffuse endemic goiter, as iodine preparations, 0.25% potassium iodide solution, antistrumin can be used . Treatment with iodine in the required rates is justified. This type of therapy is recommended at an early stage of goiter development, when its size is still moderate.

The use of iodine tincture or Lugol’s solution is contraindicated, because a large dose of iodine can provoke the occurrence of the so-called iodine- based , many allergic reactions and iodine thyroidins.

Treatment with iodine preparations, with a positive effect, is carried out until clinical recovery. If, after 3-5 months, the thyroid gland does not become smaller, it is necessary to switch to thyroidin treatment, the doses of which are individual.

Such treatment is useful for mixed, as well as mild conglomerate nodular goiter, especially preoperative preparation. According to the same principles as the treatment of hypothyroidism, the treatment of hyperthyroid endemic diffuse goiter is carried out .

Treatment of hyperthyroid endemic diffuse goiter is performed with diiodotyrosine and a micro dose of iodine. The use of antithyroid synthetic drugs (potassium perchlorate, mercazolil , methylthiouracil ) is contraindicated, since they can cause a hyperplastic reaction, because they have a goitrogenic effect.

During the treatment of goiter, proper nutrition and daily routine are of great importance. The diet should contain foods rich in proteins and vitamins. In some cases, marine climatotherapy has good results.

SURGERY

Such treatment is indicated in cases where conservative treatment is unsuccessful. Surgical intervention is performed with a large goiter, as a result of which the adjacent organs of the neck are compressed. The nodular forms of goiter must be removed, as they can degenerate into a malignant formation. The indications for surgery are:

• Suspected malignant degeneration of the goiter;
• Rapid progressive growth of goiter;
• Compression of argon in the neck.

The operation is performed under local anesthesia, or incubation endotracheal anesthesia.

PREVENTION

Prevention of the development of endemic goiter is to eliminate iodine deficiency. There are individual, group and mass prevention of iodine.

1. Mass prevention consists in selling iodized salt to the population, as well as iodized products;
2. Individual and group prophylaxis is carried out with antistramine . Individual prophylaxis is carried out for people who have undergone surgery associated with endemic goiter, who are in a state of euthyroidism and who live in places of endemic goiter.

Group prophylaxis is carried out in children’s groups (boarding schools, schools, kindergartens). For women during pregnancy and breastfeeding, prophylaxis is carried out under the supervision of a doctor, 1-2 tablets of antistramine per week.

One tablet of antistramine contains 1 mg of potassium iodide. Take the drug during prophylaxis, in the following doses:

• Pregnant and lactating women, high school students – 2 tablets per week;
• Children up to grade 7 – 1 tablet per week;
• Preschool children – ½ tablet per week.

It is recommended to take potassium iodide – 200 for prevention, in the following doses:

• Pregnant and lactating women – 150-200 mcg of iodine (per day ½-2 tablets per day);
• Adults and adolescents – 100-200 mcg of iodine (½-2 tablets per day);
• Preschool children – 50-100 mcg of iodine ((-1/2 tablets per day).

Prevention of endemic goiter with potassium iodide should continue for several years, and sometimes throughout life.

Prevention can also be carried out using iodized oil in capsules ( iodolipol ), one capsule of which provides the human body with the required amount of iodine for a whole year.

Endemic goiter, or rather the cause of its occurrence – iodine deficiency, threatens with many pathologies. In children, it contributes to a lag in intellectual and physical development, up to mental retardation in development. In pregnant women, it can cause spontaneous abortion, congenital anomalies. An enlarged thyroid gland contributes to dysfunction of the reproductive system, both in women and in men.