Nodular toxic goiterAug 20, 2019
Nodular toxic goiter is a disease accompanied by the appearance of one or more thyroid nodes, in which they begin to produce an increased and uncontrolled amount of thyroid hormones.
The causes of nodular toxic goiter are quite many. Among them, one can distinguish iodine deficiency or irrational intake of iodine-containing drugs, various autoimmune diseases, hereditary predisposition, psychotraumatic situations, past respiratory viral infections, pathology of the endocrine glands, malignant neoplasms, etc. While the toxic node of the thyroid gland is small, it is not yet able to cause changes in the level of hormones. When the node is enlarged (usually to a size of 2.5-3 cm), its function becomes so pronounced that it leads to the development of an overdose of thyroid hormones in the blood – thyrotoxicosis.
The main symptoms of nodular toxic goiter are caused by an increase in the level of thyroid hormones in the blood. Patients are concerned about weakness, rapid fatigue, irritability, tearfulness, a sharp weight loss, rapid pulse, a feeling of" interruptions " in the heart, sleep disorders. The skin becomes hot to the touch, moist. There may be an increase in the front surface of the neck, increased hair loss, there is an increased fragility of the nails. Patients also often complain of poor exercise tolerance.
It is characteristic that almost never in patients with nodular toxic goiter is not detected exophthalmos (bulbous eyes) – this symptom is characteristic of another form of toxic goiter-diffuse toxic goiter (Graves ' disease, or Basedova disease).
One of the mandatory methods of research is ultrasound of the thyroid gland. Ultrasound is safe and affordable, so in the vast majority of cases it is sufficient to assess the structure of the thyroid gland and identify nodes. High-frequency ultrasonic devices make it possible to detect liquid formations up to 1 mm in size and solid formations from 2 mm.
However, using ultrasound, it is impossible to make a differential diagnosis between nodular goiter, adenoma and thyroid cancer. This is only possible with morphological examination. Therefore, among the mandatory studies to establish a diagnosis is a cytological examination during puncture (fine needle aspiration biopsy under ultrasound control). Despite the fact that this method of research is simple and can be used in outpatient settings, it is very important when deciding on the need and scope of surgical intervention.
It is also important to evaluate the function of the thyroid gland. To do this, a blood test is used for TSH and thyroid hormones - T4 sv., T3 sv. With the development of thyrotoxicosis, the level of TSH in the blood decreases, and the level of T4 sv. and T3 sv. - increases. An increase in only T3 sv. is also a characteristic symptom of nodular toxic goiter.
Thyroid scintigraphy is the study of the accumulation of radiopharmaceuticals (isotopes) by the thyroid gland, i.e. drugs that are analogs of iodine, but have the ability to emit gamma rays. According to the results of scintigraphy, it becomes clear what is the cause of thyrotoxicosis: a toxic node of the thyroid gland (nodular toxic goiter) or the entire thyroid tissue (diffuse toxic goiter).
The answer to the question "who is to blame?" depends on the direction of treatment of the disease – with nodular toxic goiter, treatment should be aimed at eliminating the excessive function of the node (i.e., destroying its tissue or removing the entire node), and with diffuse toxic goiter, the goal of treatment is to suppress the function of the thyroid gland itself (with the help of medications, radioiodine therapy or surgical treatment).
All methods of treatment of toxic goiter should be divided into two groups: therapeutic treatment with medications and radioactive iodine, and surgical. The most radical method is surgery-removal of one lobe of the thyroid gland (if there is one node) or the entire thyroid gland (if there are many nodes, and they are located in different lobes of the thyroid gland). In some cases, therapeutic treatment is a method of preoperative preparation. There are deadlines for medical treatment, in case of ineffectiveness of which the patient should be operated on.
A more gentle method is radioactive iodine therapy (radioiodine therapy). Since in nodular toxic goiter, the accumulation of iodine occurs only in the tissue of the autonomously functioning node, and the rest of the thyroid tissue does not produce hormones, it is possible to introduce a small amount of radioactive isotope of iodine into the patient's body, which emits rays that penetrate into the accumulation zones of radioactive iodine. The toxic node of the thyroid gland that has accumulated radioactive iodine will be destroyed by the rays, while the rest of the thyroid tissue will be practically not affected, since it will not accumulate radioactive iodine. The advantages of therapy with radioactive iodine are complete painlessness, high efficiency, and the disadvantage is the higher cost of treatment and some others associated with the use of a radioactive drug.
In conclusion, it is worth noting that nodular toxic goiter is completely curable in all cases.