Non-toxic (i.e. not accompanied by hyperthyroidism) goiter can be either diffuse or nodular. In some cases, it is formed due to stimulation thyroid gland TSH, which, in turn, is associated with a violation of the synthesis of thyroid hormones. Sometimes it is caused by mutations in genes encoding the growth and function of thyrocytes. However, many patients develop goiter for unknown reasons, since their serum TSH level remains normal. The most common of these worldwide is iodine deficiency (“endemic goiter”). The widespread use of iodized salt and the addition of iodides to fertilizers, animal feed and food products has sharply reduced the incidence of endemic goiter in developed countries. The US population does not currently appear to be iodine deficient. However, in a number of large regions of Central Africa, the mountainous regions of Central Asia and South America, as well as in part Central Europe and Indonesia (especially New Guinea), the population still does not consume enough iodine. The iodine requirement of an adult is 150-300 mcg/day. In regions where goiter is endemic daily consumption iodine (and its excretion in urine) does not reach 50 mcg, and where there is very little of it, less than 20 mcg. In some areas, goiter affects 90% of the population, and 5-15% of children are born with myxedema or neurological signs of cretinism. Differences in the prevalence of goiter in such areas may be due to the action of other goitrins, such as goitrin (an organic compound present in some root vegetables and cereals) and hydrocyanic acid glycosides (present in cassava and cabbage), which enhance the effects of iodine deficiency. Weak strumogens are also phenols, phthalates, pyridines and aromatic hydrocarbons contained in industrial waste.
The most common reason enlargement of the thyroid gland in developed countries - chronic thyroiditis (Hashimoto's thyroiditis). Mechanisms of goiter development in the absence of autoimmune processes in thyroid gland or iodine deficiency remain unknown. In some cases, this may result from mild disturbances in the synthesis of thyroid hormones (dyshormonogenesis) with relatively normal secretion. Finally, an enlarged thyroid gland may be associated with gene mutations that cause the development of benign (adenoma) or malignant (cancer) tumors.

Goiter is observed in different pathological conditions- chronic lymphocytic thyroiditis, subacute lymphocytic thyroiditis, multinodular nontoxic goiter, iodine deficiency. Most of these diseases are diagnosed by history, physical examination, and assessment of thyroid function (including determination of antibodies to iodide peroxidase). Non-toxic nodular goiter comes in three types: diffuse nodular, multinodular and single nodule. The revised American Thyroid Association (ATA) guidelines and national Russian guidelines recommend needle biopsy for any thyroid nodule larger than 1 cm in diameter, as well as smaller nodules that have features suggestive of cancer. With diffuse or asymmetrical enlargement of the thyroid gland, scintigraphy is indicated to identify “cold” (non-functioning) nodes, although only 10-20% of such nodes are malignant. Ultrasound of the thyroid gland complements scintigraphy data and allows you to determine original dimensions thyroid gland for further observation. If there are symptoms of compression of the trachea and esophagus, a CT or MRI of the neck is indicated. In elderly patients with multinodular goiter, autonomous secretion of thyroid hormones is often observed, which can be suspected by a decrease in plasma TSH levels.

Causes of benign nodules in the thyroid gland:

1. Focal thyroiditis
2. Dominant node in multinodular goiter
3. Benign adenomas
   a) Follicular
   b) From Hurthle cells
4. Thyroid cysts and parathyroid glands, as well as the glossothyroid duct
5. Agenesis of one lobe of the thyroid gland
6. Hyperplasia of the remnant thyroid tissue after thyroidectomy
7. Hyperplasia of the remnant thyroid tissue after radioiodine therapy
8. Rare: teratoma, lipoma, hemangioma

Pathogenesis of non-toxic goiter

The development of non-toxic goiter during dyshormonogenesis or severe iodine deficiency is accompanied by a violation of the synthesis of thyroid hormones and, as a result, increased secretion of TSH. TSH causes diffuse hyperplasia of the thyroid gland, followed by focal hyperplasia with necrosis and hemorrhage; New foci of hyperplasia gradually appear. Focal, or nodular, hyperplasia usually affects one of the clones of cells that either retain the ability to concentrate or lack this ability. Therefore, the nodes are “hot” (i.e., consisting of cells that accumulate iodine) and “cold” (from cells that do not accumulate iodine), as well as colloidal (from cells that synthesize thyroglobulin) and microfollicular (from cells that do not synthesize this protein). Initially, thyrocyte hyperplasia depends on TSH, but later the nodes become autonomous. Thus, a diffuse non-toxic TSH-dependent goiter over time can turn into a multinodular toxic and TSH-independent goiter.

The autonomous growth and functioning of thyroid nodules may be based on mutations of the gsp oncogene, leading to activation of the G s protein cell membranes. Such mutations are very often found in the tissue of nodes in patients with multinodular goiter. A chronic increase in G s protein activity causes proliferation and hyperfunction of thyrocytes, even with reduced TSH secretion.

Euthyroid goiter is often found in those regions where the population receives sufficient amounts of iodine (for example, in the USA). Among women, its frequency reaches 15%. As already noted, the causes of goiter in the absence of iodine deficiency, autoimmune diseases thyroid gland or obvious defects in thyroid hormone biosynthesis remain unknown. In some families with euthyroid multinodular goiter, mutations in the thyroglobulin gene were found, which indicates the possibility of such minor violations synthesis of thyroid hormones that does not lead to overt hyperthyroidism or even an increase in serum TSH levels.

Symptoms and signs of non-toxic goiter

Nontoxic goiter, as already noted, can be both diffuse and multinodular. The thyroid gland may feel firm to the touch, but often retains a soft or elastic consistency. Over time, it gradually increases, and the goiter can acquire enormous sizes, spreading beyond the sternum almost to the aortic arch. Cyanosis and swelling of the face and dilatation of the neck veins when raising the arms above the head ( positive test Pemberton) indicates an obstruction to the outflow of the jugular veins. There may be complaints of a feeling of pressure in the neck, especially when raising and lowering the head, and difficulty swallowing. IN in rare cases paresis occurs vocal cords due to compression of the return laryngeal nerve. The vast majority of patients remain euthyroid. An increase in the size of the thyroid gland appears to indicate compensated hypothyroidism.

Laboratory data and diagnosis of non-toxic goiter

At laboratory research find normal level SVT 4 and, as a rule, normal concentration Serum TSH. Insufficient production of hormones is apparently compensated by an increase in the mass of thyroid tissue. When the thyroid gland depends on the iodine content and TSH level and can be elevated, normal or reduced.

Scanning

When scanning the thyroid gland, a “spotty” pattern is usually observed with foci of increased (“hot” nodes) and decreased (“cold” nodes) isotope uptake. The administration of thyroid hormones (liothyronine) does not always reduce the incidence of “hot” nodes. Simple method monitoring the dynamics of goiter growth is ultrasound, which also allows you to detect cystic changes and calcification of individual nodes, which indicates previous hemorrhage into the tissue and its necrosis.

Differential diagnosis

The main thing when differential diagnosis- exclusion of thyroid cancer.

Treatment of non-toxic goiter

There are several approaches to treating non-toxic goiter. Levothyroxine is most often prescribed to lower TSH levels.

Since the thyroid gland usually decreases slowly and slightly, treatment must be prescribed long term. But if TSH levels are initially elevated, the effect of levothyroxine may be more noticeable. Radioactive iodine helps to reduce the size of the thyroid gland by 40-60%, however, due to reduced iodine uptake by the thyroid gland, the dose of the drug must be high. To stimulate iodine uptake and increase the effectiveness of treatment, a recombinant TSH drug is used. For large goiter accompanied by compression of the trachea and esophagus, it is indicated surgical treatment.

Except in cases of cancer, non-toxic goiter requires only observation. It grows very slowly and is almost never accompanied by symptoms of compression or dysfunction of the thyroid gland. The administration of thyroid hormones rarely leads to a significant reduction in its size. For a long time existing goiter foci of necrosis, hemorrhage and scarring, as well as functionally autonomous nodes that do not regress under the influence of T4, can form in it. In addition, the doses of T4 required to lower serum TSH levels may be dangerous, especially in elderly patients with increased risk atrial fibrillation and osteoporosis. Foci of autonomy, present in many non-toxic goiters, function and grow independently of TSH, and therefore the administration of T4 can provoke iatrogenic thyrotoxicosis.

Surgery is indicated only in cases of rapidly growing goiter or causing symptoms obstruction. The retrosternal spread of goiter in itself is not an indication for surgery. note that left lobe The thyroid gland extends down from the middle of the thyroid cartilage almost to the collarbone, displacing the trachea to the right. The gland has a tuberous surface and contains many large and small nodes. Multinodular goiter is rarely malignant, but its size and pressure on neighboring organs may require subtotal thyroidectomy.

If surgery is contraindicated, symptoms of compression can be temporarily eliminated by destroying the functioning tissue with radioactive iodine, sufficient doses of which reduce the size of the goiter by approximately 30-50%.

Course and prognosis of non-toxic goiter

For non-toxic goiter, pharmacological doses of iodide are contraindicated, as they can cause hyperthyroidism or (in the case of an autoimmune process in the thyroid gland) hypothyroidism. Sometimes individual nodes begin to function intensively, and a non-toxic goiter turns into a nodular toxic one. Nontoxic goiter often runs in families. Therefore, examinations and observations should also extend to family members of the patient.

Nontoxic single-nodular goiter is one of the diseases that are common in regions with insufficient quantity iodine in food products. This disease can be characterized by the occurrence and subsequent increase in size. It is believed that a non-toxic single-nodular goiter is present when the tumor formation does not exceed 2 foci, and the functions of the gland itself do not change.

For what reasons can a single-nodular goiter form?

1. Many scientists have come to the following conclusion: this disease occurs due to a lack of iodine or disturbances in the metabolism of hormones, which most often lead to a decrease in their numbers. Due to the lack of some important hormones an inverse proportionality arises: some hormones are lacking, but others begin to be synthesized faster, and their concentration increases noticeably, which causes the appearance of a goiter.
2. One per appearance nodular goiter may be affected by any genetic pathologies that change the maximum sensitivity to iodine deficiency or systems with enzymes involved in the synthesis of thyroid hormones.
3. Irradiation radioactive substances V large quantities may cause the development of a single-nodular non-toxic goiter.
4. Stress, overwork, jar of Hearts- all this should not be excluded from possible reasons formation of pathology.

How can nodular nontoxic goiter of the thyroid gland be classified according to severity?

1. Zero degree. The thyroid gland cannot be determined by palpation.
2. 1st degree. During a visual examination, a nodular non-toxic goiter cannot be seen, but you can feel it with your fingers. This degree is characterized by the appearance of the first symptoms not normal operation thyroid gland.
3. 2nd degree. The presence of a goiter can be easily determined by swallowing; it can be palpated quite simply. Patients diagnosed with stage 2 of this disease often complain of difficulty swallowing and painful sensations in the cervical region when bending and turning the head.
4. 3rd degree. The outline of the neck is deformed due to. The patient notes weakness, low blood pressure, and lacks appetite.
5. 4th degree. The contour of the neck changes radically. There is an increase in the number of signs: breathing becomes difficult, discomfort in the throat, the skin becomes drier, and increased sweating is noted.
6. 5th degree. The multinodular goiter of the thyroid gland increases to enormous sizes, it compresses internal organs. The main signs: a lump is felt in the throat, breathing is extremely difficult, it is difficult to swallow, tachycardia appears, observed nervous condition, the patient is shaking with chills, may experience different types disorders, the contour of the neck changes significantly, memory decreases, the patient complains of constant fatigue.

What methods are used to diagnose this disease? The presence of a single-nodular non-toxic goiter can be determined using the following procedures:

1. Visual inspection and palpation method.
2. Ultrasound examination of the gland, which will help determine the number and nature of the nodes.
3. A puncture biopsy allows you to diagnose the presence of nodes in the thyroid gland that exceed 1 cm in size.
4. Definition hormonal levels, which helps to understand the degree of gland dysfunction.

Treatment

The correct treatment method can be chosen based on laboratory and instrumental data and the main cause of the disease.

A small goiter, no signs of disease and no enlargement of the organ - all these factors indicate that active treatment not required. It is necessary to suppress the synthesis of thyroid hormones using a conservative method. Nodules that do not exceed 1 cm in size should be treated using special therapy, which is based on the use of drugs with high content Yoda. The course of treatment is about a year. After this method of therapy, it is necessary to perform an ultrasound of the thyroid gland.

Large nodes are treated with L-thyroxine, which is taken for one year. Conservative methods help to normalize the size of the node and try to reduce it.

If a non-toxic uninodular goiter cannot be conservative treatment, then surgery is necessary. Considering the degree of development pathological processes, either a node resection or a complete resection is performed.

Folk recipes

There are a great many folk remedies that can help cope with goiter. And these natural medicines can be easily obtained. Most best option to get rid of goiter - a mixture of lemon and garlic. How to cook it? Take a few cloves of garlic, chop them thoroughly, then mix the mixture with the juice of 5 lemons. At the end, add 1 tsp to the mixture. honey The product should be infused for a week in a cool place. Take 10 ml orally 2 times a day on an empty stomach.

Because many people can't stand it pungent odor garlic, there is an equally effective alternative. Most herbalists strongly recommend using cherry infusion for people with a similar disease. You need to take cherry branches with swollen buds, then chop them well. To cook remedy, you need to boil the branches in water for 10 minutes. The proportions are as follows: per 100 g of branches - 450 ml of water. Then the broth is filtered and drunk warm 3 times a day before meals.

Description:

Simple nontoxic goiter is a disease characterized by diffuse or nodular enlargement of the thyroid gland in people who do not live in areas where goiter is endemic.

Symptoms:

A simple non-toxic goiter can for a long time proceed unnoticed by the patient, especially during early stages. Upon examination and palpation, an increase in the size of the thyroid gland or uneven structure of the gland - nodules - may be detected. Palpation of the thyroid gland is painless.

Subsequently, unpleasant sensations appear in the thyroid gland, a feeling of a lump in the throat, difficulty swallowing, a feeling of pressure in the neck when tilting and turning the head. Sometimes, with a large thyroid gland, when lying on your back, there may be difficulty breathing. Thyroid function is usually preserved.

But sometimes they appear signs of lung hypothyroidism (decreased thyroid function), which increases under unfavorable conditions ( chronic diseases, increased physical and mental stress, pregnancy).

The patient develops chilliness and slowness. Weight may increase. The skin of patients is dry. Body temperature may be slightly reduced. The heart rate slows down. In women it may be impaired menstrual cycle. Hypothyroidism may also be the cause.

Causes:

Simple non-toxic or sporadic goiter is more common in women and in those working with goitrogenic substances. These are mercury, benzene, thiocyanates, nitrates.

There is a hereditary predisposition to the development of this type of goiter. It can be familial and occur over several generations, especially in women childbearing age. The frequency of non-toxic goiter increases with age, with malnutrition, especially with a lack of protein in the diet.

For the production of thyroid hormones, one of the following is necessary: essential amino acids– tyrosine. And with a lack of it in food, the synthesis of thyroxine and triiodothyronine slows down. When exposed to pesticides, nitrogen oxides, lead salts, mercury, hydrogen sulfide compounds, cyanides, the formation of thyroid hormones is suppressed, which can also lead to the development of goiter. The effect of all is especially enhanced unfavorable factors V adolescence, when the body grows and rebuilds and needs a large amount of thyroid hormones. The same thing happens during pregnancy during menopause. Increases the need for thyroid hormones over long periods of time stressful situations and chronic diseases.

A simple non-toxic goiter may occur when long-term use some medicines. These are drugs containing lithium, perchlorates, thiocyanates, thiouracil and thiourea derivatives. It also has an adverse effect on the functioning of the thyroid gland. large number fats in blood plasma.

Treatment:

For treatment the following is prescribed:

In the treatment of simple non-toxic goiter great value has a diet. Nutrition should be complete. You need to eat enough protein in your food. Goitrogenic (promoting the development of goiter) should be excluded from food products. These are radishes, radishes, beans, rutabaga, cauliflower, peanuts.

Drug treatment of simple non-toxic goiter is carried out with synthetic thyroid hormones (thyroxine, thyroid). Thyroxine is prescribed on an empty stomach. The dose of the drug is selected individually under the control of the patient’s condition and the amount of thyroid hormones in the blood. If the patient maintains a constant weight, the pulse normalizes and blood pressure, the size of the thyroid gland decreases, in the blood normal amount hormones - the dose is considered sufficient.

Surgical treatment of simple non-toxic goiter is carried out if the thyroid gland rapidly increases in volume, despite treatment, if there are signs of compression of the neck organs and if a so-called cold node is found in the thyroid gland. Cold is a nodular formation that, when radioisotope research does not accumulate radioactive iodine and the results of his biopsy are doubtful, that is, cancerous degeneration of thyroid cells cannot be ruled out. The prognosis for this disease is favorable. With timely treatment, recovery occurs.

Diffuse nontoxic goiter is scattered, episodic and irregular in nature. The development of the disease is not associated with functional disorders or the course of inflammatory and tumor processes endocrine structure. It occurs in women several times more often than in men. Exacerbation occurs especially during puberty, pregnancy, lactation and the end of menopause.

The conditions and risk factors contributing to the pathogenesis of OND have not yet been fully elucidated. Believed to appear in areas with reduced level iodine content. This stressor is typical for the entire territory of Russia. The absence rate in the region is the incidence of euthyroid goiter in adolescents is up to 5%, and hereditary hypothyroidism is up to 3%.

A significant intake of calcium and thiocyanates into the body (which was previously associated with an increase in endocrine gland) is toxic in nature. A number of moments were noted when plant products reagents were found - thiocyanates, which caused the formation of non-toxic disseminated goiter. In animal experiments, feeding cabbage and field turnips led to an enlargement of the thyroid gland.

The next reason for the development of the disease may be a lack of microelements due to iodine deficiency. These primarily include: cobalt, molybdenum, zinc, copper. Dysfunctions of enzyme production systems affect the synthesis of thyroid hormones, which is also one of the signs of sporadic goiter. An autoimmune variant cannot be excluded, causing diffuse expansion of the organ in the initial phase of hypertrophy.

The process of insufficient iodine intake, leading to the development of non-toxic goiter in the early stages, includes 2 main directions: hyperplasia (iodine deficiency) and hypertrophy (changes in hormone levels). The hyperplastic effect occurs when the activity of tissue growth elements is inhibited, which causes division of thyrocytes and an increase in the number of thyroid cells (hyperplasia).

Hypertrophic syndrome is formed based on cell stimulation thyroid-stimulating hormone due to iodine deficiency. As a result, the thyroid cells increase in size (hypertrophy). In combination, both mechanisms lead to the appearance of signs of the disorder.

Signs of goiter

Symptoms of the pathology are noticeable by swelling in the neck area. An experienced endocrinologist during palpation identifies a small goiter (grade 1), and a serious proliferation of gland tissue (grade 2) is indicated by a change in the shape of the neck.

Grade 1 goiter has a soft structure and moderate density. The gland is mobile during swallowing, and its enlargement is diffuse. Sometimes nodes are identified. Signs of compression in sporadic nontoxic goiter are not observed due to their small size and acceptable density.

Symptoms of compression appear with the simultaneous formation of a node in the gland, the diagnosis of which becomes more difficult with a greatly enlarged disseminated goiter. It is characterized by the presence of a visible defect, compression of the trachea and upper section Gastrointestinal tract - esophagus.

Older people may develop nodular forms. But whether their appearance specifically relates to the case of disseminated goiter still needs to be established.

If ignored for a long time, the disease gradually turns into hypothyroidism. The first sign is expressed in a decrease in the level of intelligence, speech impairment and deafness. Then the vessels and nerve fibers are compressed, blood circulation is disrupted, which leads to hyperfunction and expansion of the right heart chambers - the formation of a “goitrous heart”. As a result, a malignant tumor develops.

Diagnostics and therapy

The definition of sporadic is based on diffuse increase thyroid organ and in the absence of signs of hyperthyroidism or hypothyroidism. Indicators of basal metabolism and the level of iodine associated with blood substance proteins are within normal limits.

A complete examination after interview and examination includes the following types tests:

• laboratory;
• instrumental;
• additional;
• differential.

Laboratory tests are taken for quantification levels of hormones, antibodies and iodine deficiency. Instrumental diagnostics includes ultrasound to determine the density, size, and structure of the goiter. Additional testing - Doppler sonography, radiography, biopsy of material. Differential study carried out with toxic goiter, autoimmune thyroiditis, neck cyst and thyroid tumor.

Treatment of pathology with the use of iodine medications is ineffective. From this it follows that the pathogenesis of goiter does not occur due to iodine deficiency. The basis for therapy with this element is its low content in urine. To eliminate the deficiency of the substance, it is necessary to consume iodized salt, seafood products nutrition. Treatment can last up to 6 months.

At hormonal deficiency- hypothyroidism - it is recommended to take medications containing levothyroxine. Throughout the course, clinical and instrumental studies. Surgical intervention is possible in the event of a nodular form, when diffuse non-toxic goiter interferes with the normal functioning of nearby organs.

Patients suffering from sporadic goiter undergo medical examination with a full endocrinological examination, especially if the pathology is detected in a child. Competent prevention of iodine deficiency and timely treatment exclude a negative prognosis - the goiter practically does not grow.

Diffuse nontoxic goiter is the general name for an enlarged thyroid gland, in which its function remains unchanged.

On initial stages patients are not in any danger.

However, since the thyroid gland is located next to the trachea and esophagus, its enlargement leads to the patient having difficulty breathing and eating.

Therefore, it is still necessary to treat goiter.

Diffuse nodular nontoxic goiter occurs most often due to a lack of iodine and.
Autocrine factors also affect the growth of the thyroid gland:

• epidermal;
• fibroblastic;
• transformative.

In autocrine disorders, cell malfunctions are caused by substances that the cell itself produces.

Except , diffuse goiter may also arise for other reasons. The growth of the thyroid gland is influenced by the patient’s gender, age, and predisposition to the disease.
Here are the main causes of diffuse non-toxic goiter:

• smoking;
• taking certain medications;
• poor nutrition;
• gene mutation;
• micronutrient deficiency;
• chronic stress.

In addition to iodine itself, the body needs selenium. This element is needed for the iodine molecule to integrate into certain reactions in the body.

Consequently, it will not be able to work normally, which means that there is a possibility of diffuse non-toxic goiter.

This condition can occur in both adults and children. Goiter occurs much less frequently in children than in adults.

The functioning of the thyroid gland is very important for a child. From her normal functioning depends on height, metabolism, body weight and much more.

Non-toxic most often occurs due to iodine deficiency. The child grows, and he constantly needs a large amount of this element. Therefore, it is necessary to monitor the nutrition of children.

Symptoms of pathology

With diffuse non-toxic goiter, the work of the gland does not change at first, so there are usually no clear complaints.

Over time, as the thyroid gland begins to increase in size, symptoms appear.
The main symptoms include:

• headaches;
• weakness;
• decreased performance;
• fatigue;
• difficulty swallowing;
• feeling of a lump in the throat;
• breathing problems;
• drowsiness.

When the gland enlarges significantly, the contour of the neck changes. That is, you can see with the naked eye that the neck in the area of ​​the goiter has become larger.

If measures are not taken, the gland will grow, vascular compression will develop and this will lead to superior vena cava syndrome.

And constant shortness of breath due to an enlarged gland can lead to the patient beginning to choke.

Classification of the disease

In general, diffuse goiter is divided into several types:

1. Diffuse nontoxic goiter – occurs due to disruption of the thyroid gland, not associated with inflammation or tumor. arises due to unfavorable environmental conditions and genetic disorders. Typically, with such a goiter, the thyroid gland protrudes outward at the front of the trachea.
2. Colloid nodular goiter – also called endemic, it occurs due to iodine deficiency. It occurs more often in women after forty years of age, when living in an area with insufficient iodine.
3. Simple non-toxic goiter – may be spherical or diffuse, this is thyroid hypertrophy without inflammatory process, hypo- or hyperthyroidism. This is a non-cancerous form of thyroid changes. Usually occurs during the period of hormonal changes in the body (pregnancy, puberty).
4. Nodular nontoxic goiter – Nodules appear on the surface of the thyroid gland, which can only be seen with a scan. The causes of nodular goiter are unknown. It could be a genetic disorder or an unhealthy diet.

Depending on how strongly non-toxic diffuse goiter is expressed, the following types are distinguished:

• 0 degree – the gland cannot be palpated;
• 1st degree – only the isthmus is palpable;
• 2nd degree – an increase is visible when swallowing;
• 3rd degree – completely palpable;
• 4th degree – the appearance of the neck changes;
• 5th degree – very large sizes.

Of course, with grades 0 and 1, the problem is almost impossible to determine, since such a change is not visually visible and other symptoms may not appear.

A the following degrees are already more pronounced, so they are easier to diagnose. Therefore, grade 1 goiter is most often detected only during routine checks.

Diagnosis of goiter

Since the symptoms in the initial stages are very vague and it is quite difficult to determine DNS (diffuse non-toxic ash), a specialist usually prescribes certain tests and studies.

First of all, the endocrinologist palpates the gland and listens to the patient’s complaints, if any. After this, the doctor prescribes other additional tests.

The main research methods are as follows:

1. Ultrasound examination of the thyroid gland – allows you to find out the volume of the organ, its structure, and the presence of nodes.
2. Blood tests for thyroid hormones – must be taken TSH hormones, T4 and T3, as well as thyroglobulin.
3. Needle biopsy – allows you to find out the composition of the node, if it is identified.
4. Scintigraphy – necessary to assess isotope uniformity in the thyroid gland and is performed infrequently.
5. Contrast radiography – if it is necessary to confirm compression of the esophagus.

After accurate diagnosis, the specialist selects necessary treatment. The patient must adhere to the recommendations of the attending physician, as serious deterioration of the condition is possible, especially in grades 3-5.

Without proper treatment, the thyroid gland will continue to enlarge and cause not only discomfort, but also a health hazard.

Treatment of diffuse non-toxic goiter

How is this disease treated? Treatment can be medication or surgery.

The attending physician chooses the most best option, depending on the size of the gland, the form of the disease, the amount. The severity of disturbances in the functioning of organs located next to the thyroid gland is also important.

In the initial form of the disease, the doctor prescribes vitamins that are necessary for the thyroid gland. These are vitamins A, E, D, B12.

Drug therapy is chosen for goiter of 1-3 degrees. Appointed. It must be taken in doses prescribed by the doctor.

In addition, a specialist may prescribe the T4 hormone. Its use allows you to reduce the size of the thyroid gland, remove unpleasant symptoms. However, the hormone is not always used, as side effects are possible.

The specialist must prescribe a diet. It is necessary to consume iodine-containing foods (seafood and fish), as well as butter, liver, carrots.
In order for iodine to be well absorbed by the body, the following foods should be completely removed from the diet:

• horseradish;
• radish;
• any types of cabbage;
• turnip;
• turnip.

During the diet, it is imperative to exclude any baked goods and fast carbohydrates, since they interfere with the absorption of selenium, which is necessary for the normal functioning of the thyroid gland.
It is important to include foods rich in selenium in your diet:

• eggs and mushrooms;
• seafood;
• rice and beans;
• nuts and garlic;
• seeds and oatmeal.

At drug treatment and diet should be constantly monitored by an endocrinologist. It is imperative to undergo an ultrasound, palpation of the gland, and a blood test for thyroid hormones.

If the thyroid gland functions normally, the symptoms go away, which means it will not grow, and surgical treatment will not be required.

Regarding surgical intervention, use it if the thyroid gland reaches large sizes and interferes with neighboring organs.

If one node is enlarged, then only it is removed, and if the entire thyroid gland reaches a very large size, then the entire gland is removed.

After the operation, the doctor prescribes replacement hormonal therapy. Hormones must be used throughout life.

Forecast

Recovery from the initial stages of the disease occurs quite quickly. But it all depends on the age of the patient; in children, recovery occurs faster than in adults.

This disease must be treated in a timely manner, so it is advisable to undergo regular examinations with a specialist, because in the initial stages it is impossible to determine an enlarged thyroid gland.

This will avoid various complications and removal of the entire gland.