Thyroid enlargement

The thyroid gland is one of the organs involved in the hormonal regulation of human life. It is located in the front of the neck, anatomically represented by two lobes and an isthmus between them. The shape of the thyroid gland resembles a butterfly. Despite its small size, the gland takes on a significant amount of functional load on the production of hormones.

Location and structural features of the organ

The thyroid gland is located on the front of the neck, below the hyoid bone. Its lateral lobes are located at the height of the cricoid and thyroid cartilages. The lower pole of the organ is at the level of the fifth and fourth tracheal rings, and its weight reaches 30 grams in an adult.

In front, the gland is covered with skin, subcutaneous fatty tissue and four fascia: superficial, second fascia (surface plate), subtracheal plate of the fascia of the neck with hyoid muscles. The most superficial of all is the sternohyoid muscle, under it is the sternothyroid muscle.

In a fixed position, the thyroid gland is supported by a ligament – a thickening of the pretracheal plate of the fascia of the neck, which secures the organ to the adjacent cartilage and trachea. Under the muscles and the third fascia is the parietal plate of the fourth fascia, fused with it. In the direction of the midline of the neck, the second fascia fuses with the superior fascia, and together they form the white line of the neck.

Further, behind the parental sheet of the fourth fascia is the tissue of the interfascial suprasternal space, which is bounded behind by the visceral sheet of the fourth fascia, which forms the capsule of the thyroid gland – its protective outer shell surrounding the organ from all sides. Under the capsule, around the gland itself, there is loose fiber with vessels and nerves passing to the gland. The capsule is not connected closely and directly with the gland, due to which, for example, during surgery, cutting the capsule, you can move the thyroid lobes. In addition, the organ also has an internal fibrous capsule directly connected to the parenchyma by septa.

The upper pole of the lateral lobes of the thyroid gland reaches the level of the middle height of the cartilaginous thyroid plates, and the lower one descends under the isthmus and to the level of the fifth and sixth rings, 2-2,5 cm higher than the sternum notch zone.

Approximately one third of the world’s population has a pyramidal lobe of the gland, which rises along the top of the isthmus, or from the lateral lobes. Less common are additional shares. The isthmus is located in front of the trachea; in rare cases, the anatomical features of the structure of the gland do not imply the presence of an isthmus.

Connective tissue partitions that extend from the capsule into the parenchyma divide it into lobules, which in turn consist of follicles. The follicular walls are lined from the inside with a single layer of cuboidal epithelium. Inside the cavities of the follicles is a liquid colloid with ribonuclein, proteins, iodine, thyroglobulin and other enzymes in the composition.

Features of blood supply and functioning of the thyroid gland

The organ is supplied with blood through four arteries – the two upper ones, extending from the external carotid artery, and the two lower ones, extending from the thyroid cervical subclavian artery. The fifth unpaired artery is rare, and arises from the innominate artery or aortic arch. Accordingly, a person has a similar number of paired veins.

The innervation of the organ occurs due to the sympathetic and parasympathetic nerves.

One of the main functions of the thyroid gland is the secretion of iodinated hormones:

• thyroxine;
• triiodothyronine

The basis for the formation of hormones is iodine and the amino acid tyrosine. Iodine enters the body with food, air, water in the form of inorganic or organic compounds. Excess element is excreted in bile and urine. In the blood, its organic compounds form sodium and potassium iodides, and under the influence of oxidation by enzymes, they turn into iodine.

Thyroxine is a thyroid hormone that affects metabolic processes and regulates development and growth processes in the body. In the cells of the brain, oxidative reactions occur with its participation. An imbalance in its concentration causes the development of various pathologies – myxedema, cretinism. In addition, the processes of protein production directly depend on the amount of thyroxin.

Triiodothyronine is released during the deiodination of thyroxine in the liver and kidneys. The thyroid gland also produces it, but in smaller quantities.

Due to the production of iodinated hormones in the body, the thyroid gland affects:

• functioning of the central nervous system;
• higher nervous activity;
• growth, development of the body;
• metabolism;
• vegetative system (muscle contractions, respiratory movements, sweating processes);
• the ability of blood to clot.

Calcitonin (thyrocalcitonin) is a non-iodized hormone, that is, it does not contain iodine. Its amount directly affects the amount of phosphorus and calcium in the blood, under its influence the amount of these substances decreases. The hormone is produced by parafollicular cells of the thyroid gland located outside the follicles.

All hormones produced are involved in metabolic processes to maintain life, and also affect the functioning of the digestive organs, respiratory, reproductive and nervous systems.

Thyroid enlargement: what is it and why does it appear

In the normal state, the organ is not visible to the eye, and is not palpable with the fingers. However, there are some pathologies in which the thyroid gland enlarges, sometimes to such a size that a person has a large goiter on the neck.

Enlargement of the gland is a common symptom of diseases that affect people of various age categories. They are dangerous because they cannot always be detected in the initial stages, and the changes that occur in the body can be the beginning of irreversible processes.

By itself, an enlarged thyroid gland is not always a pathologically dangerous condition, and does not even require emergency treatment in all cases – it all depends on the etiology.

Doctors distinguish 3 stages of changes in the size of the body:

• Stage 1: normal, no changes;
• Stage 2: the thyroid gland has increased in size, but it is not visible during examination, it does not deform the neck, the organ can only be felt;
• Stage 3: the increase is noticeable to the naked eye, especially when turning the head, it deforms the contours of the neck.

In addition, the degree of thyroid enlargement is also known:

• 0 degree: no increase or slight increase, in which the organ is not visible to the eye, and is not palpable;
• 1 degree: the isthmus is determined by palpation, the organ is not visually visible;
• 2 degree: both lobes and the isthmus can be felt, the organ becomes noticeable when swallowing;
• Grade 3: a noticeable visual increase, the neck becomes more rounded in appearance because of this;
• 4 degree: entails a change in the shape of the neck, the lateral parts of the organ extend beyond the outer edge of the sternomastoideus muscle;
• Grade 5: large, clearly visible goiter, which visibly deforms the neck.

According to the International Classification of Diseases 2010 (ICD 10), pathologies indicated by codes in the interval E00-E07 are thyroid diseases.

Causes, degrees and stages of organ enlargement, manifestations of pathology

There are various reasons for changing the size of an organ in a big way, among which doctors often mention:

• lack of iodine, selenium and fluorine in the diet (especially in children);
• influence of negative environmental factors, for example, toxic or radioactive substances;
• the presence in the blood of substances that prevent the production of thyroid hormones (aminosalicylic acid, resorcinol, sulfonamides);
• lack of vitamin D;
• viral and bacterial lesions that inhibit the functioning of the thyroid gland;
• chronic state of stress;
• lack of physical activity;
• hereditary predisposition;
• diseases and malformations of the hypothalamus and pituitary gland, which work in direct conjunction with the thyroid gland.

Such causes and diseases become a catalyst for the development of various pathological syndromes associated with organ enlargement:

• hypothyroidism;
• hyperthyroidism;
• euthyroidism.

Hypothyroidism is a condition of insufficient production of thyroid hormones as a result of a lack of iodine. Against this background, the body begins to work more intensively, respectively, grows in volume. Pathology can be primary or secondary: in the first case, the condition develops as a result of malfunctions of the thyroid gland itself, in the second – due to diseases of the hypothalamus and pituitary gland, as well as due to a lack of thyroid-stimulating hormone from the pituitary gland.

Hyperthyroidism is characterized by increased secretion of hormones, due to which its concentration exceeds normal values. It usually develops against a background of toxic diffuse goiter (Graves’ disease), inflammation of the thyroid gland, tumor neoplasms in it, in the hypothalamus or pituitary gland. The condition is accompanied by an increase in metabolic processes.

With euthyroidism, the thyroid gland is enlarged with normal hormones, that is, the results of tests for thyroid hormones do not show any abnormalities. Such a pathology develops as a result of the compensatory function of the body – in this way it tries to cope with a lack of iodine. The pituitary gland intensively produces thyroid-stimulating hormone, thus supporting the functioning of the thyroid gland.

Euthyroidism is a condition that occurs in adolescents during puberty, as well as in pregnant women or in women with the development of menopause. It can also occur as a side effect of certain medications.

How to determine if euthyroidism is a disease or not? Doctors call this condition borderline between the norm and pathology – that is, functional changes in this case may develop, but not necessarily in every case. You can talk about the presence of pathology when there is an increase in the thyroid gland, but at the same time the level of hormones produced by it remains stable.

To diagnose the syndromes of euthyroidism, hypo- and hyperthyroidism, an examination and questioning of the patient are carried out; ordered ultrasound of the thyroid gland. After that, the patient is sent for testing for hormones to determine thyroid hormones. If the results of the ultrasound examination are insufficient, the patient may be prescribed an MRI and radioisotope diagnostics. Usually, when euthyroidism is detected during pregnancy or in a teenager, special therapeutic measures are not prescribed – doctors prefer to monitor the condition and work of the organ.

Characteristic varieties of the gland enlargement process

The increase can manifest itself in several types. So, the presence of diffuse goiter indicates a uniform change in the size of the organ, and nodular enlargement occurs with the formation of local nodes over the entire area of ​​the gland. With a nodular increase, against the background of a lack of iodine, thyrocytes partially go out of control of the thyroid-stimulating hormone produced by the pituitary gland, as a result of which nodes are formed (seals similar to tumor formations that increase the total volume of the organ). If fluid accumulates in the node, it is believed that the patient has a cyst. This type of goiter is more common in people over the age of 50.

Another classification of pathology – for the reasons that provoke it. Depending on the etiology, goiter can be:

• endemic;
• sporadic.

Endemic goiter is formed as a result of a lack of iodine in the surrounding body, while sporadic goiter develops in those people who have everything in order with the amount of iodine in the diet. Like endemic, it can be nodular, diffuse or mixed. Its development is provoked by poor ecology, exposure to radioactive substances, hereditary predisposition.

In addition to visual changes in the contours of the neck, deviations in the organ can be detected by palpation, paying attention to changes in its density and mobility. Normally, the body has an elastic and soft texture. When swallowed, it moves normally along with the cartilage.

Symptoms of pathology: how to detect the disease

In what cases can you suspect an enlarged thyroid gland? The development of pathology in humans, most often, is accompanied by the appearance of certain symptoms.

The first signs of deviations in the work of the body are:

• weight fluctuations: an increase or decrease in body weight for no apparent reason may indicate that the gland produces an insufficient or excessive amount of hormones;
• visual change in the contours of the neck: when a medium or large goiter is formed, it becomes more rounded, powerful;
• violation of the heart rhythm: hypothyroidism provokes a stable slowing of the heartbeat, hyperthyroidism – its acceleration;
• reflex cough: if the gland increases sharply or gradually, it begins to take up more volume than normal and interferes with normal breathing and swallowing, causing in some cases a sensation of a lump in the throat;
• decrease in body tone, a feeling of chronic fatigue: in this case, a person feels lethargic, irritable, he has problems with sleep, changes in behavior;
• hair loss: unreasonable thinning of the hair should alert, since the problem may not be a lack of vitamins, which is usually sinned in the first place;
• sensation of heat and chills: thyroid pathologies directly affect the processes of thermoregulation of the human body, therefore, due to hypothyroidism, the patient can often and unreasonably throw in chills without fever, and with hyperthyroidism, in heat with heavy sweating.

In addition, the feeling of pain when swallowing food or swallowing saliva should alert a person – this may be a sign of the formation of nodular formations in the parenchyma of the organ. To the touch, the enlarged gland is dense and hard. During swallowing, it does not move, although normally it should move freely along with the cartilage. When pressed, pain may not be felt, but palpation is usually accompanied by discomfort.

You should also pay attention to the following symptoms:

• dry skin and brittle nails;
• constipation or diarrhea;
• numbness or tingling in the fingers; menstrual irregularities in women;
• problems with vision;
• muscle weakness.

Are lymph nodes associated with the thyroid gland? Of course, those lymph nodes that are located in close proximity to the organ can respond to changes in its work. Inflammation of the lymph nodes is a symptom characteristic of an inflammatory disease of the thyroid gland. It is also observed when neoplasms appear in the organ.

An increase in the proportions of an organ: why does it happen

It is known that the thyroid gland consists of the right and left lobes, sometimes additional lobes are also formed in it. Normally, the right lobe is always slightly enlarged in relation to the left. The normal weight of the thyroid gland on average is about 30 grams. An increase can occur not only in the entire volume of the organ, but also in a separate lobe, especially against the background of an inflammatory process or the formation of a benign cyst.

Multiple cysts are diagnosed quite rarely, basically, they have a single character.

With an increase in the left lobe, the patient is suspected of pathological processes and diseases. The most common cause is a benign cyst. The sizes of cysts reach up to 3 centimeters – such formations do not respond with soreness. If the cyst grows more than 3 centimeters, it already causes pain. This is due to the fact that the increasing formation compresses the adjacent organs with the left lobe. In addition to pain, the patient has hoarseness in his voice, cough, sore throat. An asymmetric change in the size and shape of the neck is observed – a growing increase appears on the left side.

Change in the size of the isthmus of the thyroid gland

An increase in the isthmus of an organ is a rather rare occurrence, but it always indicates that pathological changes are occurring in it.

The isthmus is the junction of the left and right lobes. It is located in the region of the second and third cartilage of the trachea. In some cases, the isthmus is at the level of the cricoid arch or the first cartilage of the trachea. The normal isthmus is an elastic, painless fold with a smooth and even surface.

The main reason for the increase is hormonal changes in the body. The problem may be the growth of metastases from closely located organs, or from the thyroid lobes.

The development of pathology in women, men, children

Why does the thyroid gland increase in women

The thyroid gland in women is somewhat more prone to size changes due to the frequent hormonal disruptions to which they are prone.

If the organ is unable to cope with the load, a hormonal failure begins in the human body, and the woman notices a violation of the menstrual cycle, delays, and difficulties in conceiving a child. The patient feels trembling in her hands, she feels worse, her hair falls out and grows dull, her nails break.

An increase in the thyroid gland for a woman negatively affects the course of the process of puberty, pregnancy, and menopause. During pregnancy and during childbirth, a woman’s organ is especially vulnerable, and in order to protect it from stress, and the body from infection, from reduced immunity and iodine deficiency, iodine-containing drugs are often prescribed.

Enlargement of the thyroid gland in men

Pathology appears less often in men, since their thyroid gland has a slightly different anatomical structure. So, even the initial stages of an increase in a man can be immediately visually noticed, and for this you do not need to do an ultrasound or go to an endocrinologist.

Hyperfunction in men is manifested in a sharp weight loss, a change in behavior – the patient becomes more excited, talkative and restless. His fingers tremble, there is increased sweating, weakness, sexual dysfunction, arrhythmia. All this happens against the backdrop of a goiter growing on the neck.

The hypofunction of the organ is accompanied by increased fatigue and pressure fluctuations, constant chills and an unreasonable increase in body weight. In addition, there is erectile dysfunction.

Another type of thyroid enlargement is associated with the development of thyroiditis with rapid progression. The patient develops increased sensitivity to low temperatures, difficulty swallowing, gray hair appears early. This disease tends to be hereditary, and negatively affects reproductive function.

Child development pathology

An increase in the thyroid gland in a child is a common deviation. The main reason for the appearance lies in the lack of iodine in food and fluid intake, which is superimposed on hereditary predisposition.

In addition, the disease can develop in children living in environmentally unfavorable areas, for example, with an increased level of radioactive particles in the air, soil, and water.

At the beginning of the appearance of pathology, it is difficult to detect it in a child, since it proceeds imperceptibly. Symptoms of the disease gradually increase – weakness, sleep disturbance, weight fluctuations up or down. Drowsiness alternates with insomnia, swelling of the body, shortness of breath, and increased excitability appear. Such manifestations are often attributed to a seasonal lack of vitamins, or age-related changes.

Prevention involves periodic visits to the doctor, starting from infancy.

Thyroid disease in adolescents

For this age group, an increase in the thyroid gland is an urgent problem that appears as a result of hormonal age-related changes and puberty. A significant role in this process is played by hereditary predisposition, the presence of congenital diseases, iodine deficiency. Symptoms are similar to pathology in children and adults.

Due to the increased need of the body and the lack of iodine, vitamins and trace elements, a teenager may develop sporadic and endemic goiter. Diffuse toxic goiter appears in people during puberty, and develops against the background of infectious diseases, chronic infectious processes in the nasopharynx, hereditary predisposition.

Consequences and complications of the disease

Like many other pathologies and diseases, an enlarged thyroid gland rarely goes away without negative consequences. They can be reversible, or provoke irreversible changes.

As a result of an increase in the thyroid gland, the patient develops disorders and digestive disorders, increased sensitivity to temperature fluctuations, weight loss or gain, insomnia, which is replaced by drowsiness.

Increased production of hormones provokes the acceleration of all processes in the body, and increased intestinal motility, resulting in diarrhea. Accordingly, with a reduced synthesis of hormones, peristalsis slows down, and the patient develops constipation, bloating.

The excess concentration of hormones in the blood also speeds up the metabolism, and a person quickly loses weight. Against this background, sleep disturbance appears, and in a few days the patient can sleep for only a few hours. In this case, there is an increase in body temperature, severe sweating. The lack of thyroid hormones, on the contrary, causes weight gain, drowsiness, a decrease in temperature and a constant feeling of chills.

In addition, the consequences of an enlarged thyroid gland are:

• feverish conditions;
• violation of clarity of consciousness;
• tachycardia;
• rave;
• disorders of the functioning of the central nervous system;
• dysfunction of hearing, vision;
• respiratory disorders.

If the disease is not adequately treated, it can turn into severe complications and conditions. Patients in some cases develop hypothyroid coma or thyrotoxic crisis. In a coma, the body temperature drops below 35 degrees, and the brain begins to suffer from oxygen starvation. The crisis, on the contrary, is accompanied by a high temperature (up to 41 degrees), delirium and hallucinations, and a decrease in blood pressure. Both conditions can end in the death of the patient.

Treatment for an enlarged thyroid gland

The treatment process begins with diagnostic measures to find out what caused the onset of thyroid disease. In addition, the attending physician must determine the degree of increase, its stage, the level of disorder in its functioning, and determine the final diagnosis.

First of all, therapeutic therapy involves the appointment of hormonal drugs with a substitution purpose. If the hormonal indicators according to the results of the tests are normal, the patient is assigned to control and monitor his health. Be sure to conduct a control ultrasound of the thyroid gland every 2-3 months.

In the most dangerous cases, surgical intervention is necessary, sometimes removal of part or all of the thyroid gland. After surgery, a person is prescribed hormone therapy for the rest of his life.

In addition, topical treatments include taking iodine-containing drugs such as Iodomarin, radioactive iodine therapy, and prescribing drugs to reduce the production of thyroid hormones.

Replacement therapy mainly involves the use of the drug L-thyroxine. The dosage of the substance must be developed individually for each case. At the beginning of therapy, the drug is taken in small doses, but the dosage is gradually increased towards the middle of the course. The total duration of hormone treatment ranges from several months to an indefinite number of years. In the process, there is a noticeable decrease in the size of the organ, and in the absence of nodes, the return to normal size occurs very quickly.

If hyperthyroidism is diagnosed, then drugs are prescribed to reduce hormone production – metizol, thiamazole, tyrosol.

Is it possible to treat an enlarged thyroid gland with folk remedies? According to doctors, traditional medicine recipes can be an addition to general medical therapy, but cannot fully replace qualified medical care. To normalize the functioning of the body, decoctions of chamomile, berries and leaves of red and chokeberry, decoctions of walnut partitions are used.

A prerequisite for recovery is adherence to the principles of a balanced diet. For the normal functioning of the gland, the presence of iodine-containing products in the diet is important – seaweed, currants, dates, persimmons, apples. In some cases, the patient is prescribed a special therapeutic diet.

The process of enlargement of the thyroid gland can not always be seen visually, or felt in the course of normal life. For example, it is possible to detect a moderate increase in size at first only according to the results of ultrasound, since more obvious external symptoms increase gradually. The appearance of a large formation on the front surface of the neck, which is painful on palpation, and also interferes with swallowing and feels like a lump in the throat, indicates a large increase in the size of the organ, and this symptom is easier to notice.

In any case, if you find manifestations of an enlarged thyroid gland, you must definitely contact an endocrinologist.