Diffuse and nodular goiter
Goiter is any abnormal enlargement of the thyroid gland.
Classification:
By epidemiology:
- Endemic goiter - Thyroid enlargement observed in a significant number of population
in a particular locality.
- Sporadic goiter - Goiter occurring sporadically.
By morphology:
- Diffuse goiter - diffusely enlarged thyroid
- Nodular goiter - irregular enlarged thyroid due to nodule formation
- Mixed goiter
By localization:
- Usually located.
- Partially sternal.
- Annular.
- Distilled goiter from embryonic bookmarks (goiter of the tongue root, additional lobe
of the thyroid gland).
Diffuse toxic goiter:
Triad of symptoms:
- goiter (an increase in the volume of the thyroid gland more than 18 ml in women and
23 ml in men),
- tachycardia (rapid heartbeat) and endocrine
- ophthalmopathy (exophthalmos, "bulging eyes").
Examples:
- Graves disease
- Inflammation (e.g., Hashimoto thyroiditis)
- TSH-secreting pituitary adenoma
- Iodine deficiency
Epidemiology:
- affects about 1% of the population, and its prevalence is higher in iodine-deficient
areas.
- Women get sick 10 times more often, the highest risk of developing DTZ is in young
and middle age, at 20-40 years, which is generally characteristic of autoimmune
pathology
Pathophysiology:
- is caused by a violation of the functioning of the immune system under the influence
of provoking factors against the background of a hereditary predisposition
Classification of thyrotoxicosis:
- Subclinical thyrotoxicosis - a decrease in TSH levels with normal thyroxine and
triiodothyronine values.
- Clinical (manifest) thyrotoxicosis - a decrease in TSH in combination with elevated
levels of thyroxine and triiodothyronine
- Diagnosis:
- Ultrasound
- Thyroid scintigraphy
Nodular goiter:
- presence of one or more nodular neoplasms
Examples:
- Uninodular goiter (e.g., cysts, adenoma, cancer)
- Toxic and nontoxic multinodular goiter
Epidemiology:
- at least 2–5% of the general population;
- With age, the prevalence of nodular goiter increases.
- In women, nodular goiter occurs in 5-10 times more often
Pathophysiology:
- There is an active proliferation of a pool of tumor cells that gradually form a nodule.
- Follicular adenoma is a benign tumor from the follicular epithelium, more often
originating from A-cells.
macrofollicular (simple)
microfollicular (fetal)
trabecular (embryonic)
- Less commonly, adenoma originates from B cells (oncocytoma).
Classification:
Depending on the number of foci, the following are distinguished:
- solitary nodule (single thyroid nodule);
- multinodular goiter (two or more thyroid nodules);
- conglomerate nodular goiter (a conglomerate of soldered nodes).
Depending on the thyroid function, the following are distinguished:
- nodular toxic goiter (hyperthyroidism);
- nodular nontoxic goiter (euthyroidism or hypothyroidism)
Degrees of nodular goiter:
- Grade 1 nodular goiter– the goiter is not visible, but is well palpable;
- Grade 2 nodular goiter – the goiter is palpable and visible on examination.
Structure of diseases:
- nodular colloidal goiter with varying degrees of proliferation (90%)
- follicular adenoma of the thyroid gland (7–8%);
- thyroid cancer (1–2%)
- other diseases (less than 1%).
Diagnosis:
- palpation
- fine needle aspiration biopsy
- thyroid scintigraphy
- ultrasound
