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What is diffuse toxic goiter?
Diffuse toxic goiter is a pathological condition caused by increased production of thyroid hormones by diffuse tissue of the thyroid gland, and leading to poisoning of the body with these hormones – thyrotoxicosis.
Etiology and pathogenesis
This pathology belongs to autoimmune diseases. The development of the disease occurs in a polygenic, that is, multifactorial way. Among the causes of DTG, there are psychological injuries, craniocerebral injuries, nasopharyngeal diseases, infectious and inflammatory diseases, and heredity. Patients with diffuse toxic goiter produce antibodies that damage thyroid cells. Due to violations, it begins to produce a large number of thyroid hormones.
In most cases, women suffer from diffuse toxic goiter. The disease affects them 8 times more often than males. The average age at which the peak of the disease occurs is from 30 to 50 years. However, there are cases when goiter develops in other age groups: in adolescents, expectant mothers and those women who have entered the menopause period. DTG is a common pathology, one person out of 100 suffers from it.
[Video] Dr. A.V. Thyroid Clinic Ushakova – Diffuse toxic goiter:
Indications for operation
There are clear indications for surgical intervention:
Severe course of the disease;
The third stage of goiter with clamping of the larynx and a pronounced cosmetic defect;
Inability to take antithyroid drugs due to an allergic reaction;
Ineffectiveness of drug treatment for six months;
Atrial fibrillation;
Frequent relapses of the disease.
It is impossible to perform an operation in case of kidney and liver disease, as well as in other conditions that are contraindications to general anesthesia. As a rule, almost the entire organ is subject to removal. The operation is called a thyroidectomy. It is carried out when all indicators return to normal. Postoperative hypothyroidism is treated with hormone replacement therapy. 5 days after surgery, the patient is allowed to go home.
Radioactive iodine treatment
The method of treatment with radioactive iodine gives positive results. For this, the patient needs to take the capsules or liquid that contain it inside. The introduction of the drug through a vein is practiced, but extremely rarely.
When the agent enters the body, it begins to accumulate in the cells of the gland, which causes their death. Connective tissue is formed in place of dead cells. Studies show that iodine also tends to accumulate in the mammary and salivary glands, in the mucous membranes of the gastrointestinal tract.
It is noteworthy that the agent is distributed unevenly in the body. One, predominantly the central part of the gland, is destroyed, while its peripheral sections continue to function. Moreover, the tissues surrounding the organ do not suffer from the action of the isotope.
There are features of the therapy:
Before starting treatment, it is important to stop taking antithyroid drugs. This should be done a few days before the start of intense exposure to radioactive iodine. If this is not done, the effectiveness of isotope therapy will be reduced;
You can not start treatment during pregnancy;
It is worth giving up certain foods a few days before the start of therapy. In particular, we are talking about seafood (shrimp, mussels, crab sticks, seaweed, fish, crabs, etc.), as well as from iodized salt. It is worth avoiding foods containing such salt (sausage, cheese, canned food);
Do not eat soy-based products. Sometimes their iodine content is extremely high;
It is not recommended to eat two hours before the procedure and less than the same time after taking the capsule;
In order to avoid aggravation of endocrine ophthalmopathy, which can be provoked by radioactive iodine treatment, it is advisable to preliminarily take glucocorticoids;
Beforehand, it is necessary to conduct an ultrasound of the thyroid gland, which allows to determine its size. This must be done in order to calculate the dose of the administered drug as accurately as possible;
It is worth giving up breastfeeding if a woman is being treated with radioactive iodine.
The isotope is excreted mainly in the urine. Therefore, if it gets on things or bedding, they must be replaced and washed, preferably separately. If there are children under the age of 2 in the immediate environment, contact with them should be avoided for at least 9 days. If the work is related to communication with children, then you should take a sick leave for one month after the therapy.
Some scientists put forward theories that those parts of the thyroid gland that have been replaced by connective tissue are prone to the formation of cancerous tumors. Therefore, a clear contraindication to radioactive iodine therapy is the period of childbearing, breastfeeding, childhood and adolescence, and an increase in goiter in volumes of more than 40 ml.
As probable complications after passing the therapeutic course, the development of iodine-induced thyrotoxicosis is distinguished. Moreover, if its symptoms appear immediately after the first dose of the drug, then most often they pass quickly and without a trace. When signs of pathology occur later, after 5 days from the start of treatment, then the disease will be protracted.
Also, against the background of radioactive iodine therapy, a thyrotoxic crisis may develop, a retrosternal goiter may form, and it may become impossible to use preparations containing iodine. Sometimes patients complain of a feeling of sore throat, weakness, nausea and loss of appetite. There may be slight swelling in the corresponding area of the neck.
Another rule is the use of contraceptives after the end of the isotope treatment. This must be done for 4 months to avoid the risk of fertilization and harm to the health of the unborn child. It is best to plan pregnancy no earlier than two years after the therapy, since radioactive iodine tends to cross the placenta.
Prevention
Comprehensive disease prevention is the best way to avoid it.
To do this, you must adhere to the following recommendations:
Monitor the state of immunity, temper the body. Do not immediately start diving into the hole. You should start with wiping with a damp towel, gradually moving to more intense temperature changes by dousing;
Diet is important to keep the gland in good condition. To do this, you need to include marine products and greens in the diet, as they are rich in iodine and other trace elements;
When adding salt to dishes, you need to use its iodized counterpart. It is important to salt already cooked food, since iodine tends to evaporate during the heat treatment process;
After consulting with the doctor, you can, on his recommendation, take vitamin-mineral complexes in courses several times a year;
Perform physical exercises aimed at strengthening the muscles of the neck;
Drink at least 2 liters of water per day;
Avoid increased physical activity and stress;
Try not to be in places with radiation levels above the established norm;
Visit an endocrinologist for preventive purposes. This is especially true for those who have had cases of diffuse toxic goiter in the family;
Do not use iodine-containing preparations without consulting a doctor;
Sanitation of all foci of chronic infection is necessary.
If there is no adequate therapy for the disease, the prognosis for the patient is unfavorable. DTG over time will necessarily lead to the development of serious complications, such as heart failure, exhaustion of the body, thyrotoxic crisis.
Most patients respond well to drug treatment, their condition returns to normal, and the heart rhythm is restored. The operation often causes subsequent hypothyroidism, so it is important to take the appropriate funds.