Goiter (Struma) - a persistent increase thyroid without signs of inflammation and malignant growth.
While in some places the disease is rarely appears and sick individuals, in other places affected a considerable part of the population. Therefore, there are sporadic goiter, not connected with a certain place, and the endemic goiter, widespread in some areas. Sporadic goiter occurs in connection with neurohumoral disorders in the body that affects the function of the thyroid gland, as well as due to mental injury. Goiter endemic mostly widespread among the population of Alpine areas.
The root cause of endemic goiter identify lack of iodine in food, mainly in drinking water.
Common contributing factor for all foci of endemic goiter are unsatisfactory sanitary and hygiene conditions, whose role in the development of goiter in iodine deficiency is unmistakable.
Postmortem goiter divided on spilled (diffuse), anchor (Nowotny) and mixed (diffuse-Nowotny). In diffuse goiter all the tissues of the thyroid gland is affected equally. Reproduction of the epithelium of the thyroid gland without higher education colloidal substance is called parenchymatous goiter, increasing colloidal substances spilled colloid goiter. In some cases there is a growth of connective tissue and such goiter is called fibrosis.

Fig. Different degree of enlargement of the thyroid gland

Over and symptoms. Diffuse goiter maintains the shape of the normal thyroid gland. The enlargement of the thyroid gland may be minor to sharply expressed. The degree of increase of the thyroid gland is classified according to the international scale in the following way. I degree: iron is not visible, but are able to probe her neck, and sometimes share. II degree: iron visible when swallowing movements and becomes palpable. III degree: iron visible when viewed even without swallowing. IV degree: the size of cancer increased so that the configuration neck changed. V degree: goiter large size, deforming the neck.
Right share increases are usually higher. For endemic goiter characteristic uzlovatom. Nodes are found in the lateral lobes and neck cancer. If multiple nodes in the thyroid gland is possible to feel rough, irregular goiter. Consistency can be soft, tough, elastic, dense depending on changes in its tissues. In the absence of inflammatory changes of goiter, especially hub, usually moving in relation to surrounding tissues.
The clinical picture of goiter diverse. It depends on the size of goiter and the degree of compression of the adjacent organs and thyroid function. In diffuse goiter there are complaints of discomfort in the neck when fastened the collar, while stooping head. During the inspection, in addition to increasing of the thyroid gland, sometimes marked expansion of subcutaneous veins of the neck. When a large goiter can be offset and the compression of the trachea, accompanied by difficulty breathing, hoarseness due to compression return nerve. With symptoms of hyperthyroidism are fatigue, irritability, sweating, palpitations and other symptoms, diffuse toxic goiter (see diffuse toxic Goiter). Endemic goitre not uncommon manifestations decreased function of the thyroid gland (see Hypothyroidism), due to degenerative and atrophic changes in the parenchyma of the thyroid gland. The transformation of goiter in thyroid cancer occurs mainly in nodular forms.
A special place is occupied by nonspecific the thyroiditis. These include goiter Riedel and goiter Hashimoto.
Goiter Riedel characterized by lesions of one lobe of the thyroid gland with significant growth of dense connective tissue and gradual transition process of the surrounding muscles and neurovascular bundle, sdavlennoy trachea and nerves. Clinic chronic thyroiditis Riedel in the early stages are very similar with nodular goiter. Patients indicate a tight knot, sometimes noted a feeling of tightness in the neck, complaining of shortness of breath and severe in the supine position, difficulty swallowing, hoarseness. During feeling discover dense site or share the thyroid gland, which is a characteristic symptom of the disease. Ill usually middle-aged people.
Chronic thyroiditis Hashimoto (lymphomatosis goiter) usually affects both lobes of the thyroid gland with the enlargement of lymphoid tissue and less severe fibrosis. In the tissue of the gland find changes typical of chronic inflammation. Was diagnosed with autoimmune nature of this disease.
Goiter Hashimoto more common in women during menopause (55-60 years); the disease faster than the goiter Riedel. Iron dense, but never "iron" consistency characteristic thyroiditis Riedel. In the initial stage can be lung symptoms of hyperthyroidism, but then come hypothyroidism, in advanced cases develops myxedema.
Preventive measures are of great importance in the fight against endemic goiter. They are to improve the General health conditions of life of the population, full of benign power, the addition of a small quantity of iodine to the food table salt; prevention with iodized salt (2.5 g of potassium iodide per 100 kg of salt) is widely distributed in endemic goiter areas of the USSR. In some pockets because of this endemic goiter eliminated. In the centers of endemic goiter preventive and curative work carried out protivosemnye clinics and offices.
Treatment. The purpose of iodine is not only preventive, but in diffuse goiter and therapeutic measure. In those cases where it does not have a therapeutic effect, see the operation (see Strumectomy). In nodular goiter, and the goiter Hashimoto (with suspected malignancy) and the goiter Riedel should appoint surgical treatment, which is especially shown at large Zobov, compressing the trachea and deprives patients of disability.