Thyroid enlargement
overview
The thyroid is an organ weighing 20-60 grams, which is located on the neck, below the Larynx to the esophagus laying around. Its job is to produce the thyroid hormones that are essential for survival Thyroxine and triiodothyronine. These two hormones are needed to regulate the metabolism in the body. The thyroid is very sensitive to external influences and can change its structure as a result. So can the thyroid gland when the thyroid enlarges up to a volume of 2 liters to grow.
Patients then develop a huge goiter of skin and tissue. The original name for a thyroid enlargement was goiter, nowadays it is mostly used Goiter used. An enlargement of the thyroid does not necessarily have to go hand in hand with a changed metabolic situation. The thyroid hormones are much more on one "Normal" level continues to produce, so that one speaks of a euthyroid metabolic condition. If an overactive thyroid is added to the thyroid enlargement, one speaks of one Hyperthyroidism, with a subfunction of one Hypothyroidism. A goiter is divided into different stages according to its external appearance. According to AWMF guidelines is divided into: Stage 0: no Goiter, followed by Stage 1a, a palpable goiter that cannot be seen with the naked eye. That closes Stage 1b , a goiter that becomes visible when the head is thrown back to the maximum. Stage 2 refers to a goiter that is visible when the head is in a normal position, and Stage 3As the last stage, a goiter that is very much enlarged and can be seen from a distance of several meters.
Read on under: Swelling of the thyroid gland
This classification was introduced to enforce a standardized definition of thyroid enlargement. However, since only the external appearance of the goiter is described here, no statement can be made about the actual function and metabolic status of the thyroid gland on the basis of the classification. Therefore the thyroid will be described further, for example on the basis of it location, of their function, and yours morphology. The location can eutop, or dystop be. Eutop describes - from the Greek "eu" = good, and "topos", the position - a correct, ie physiological position in front of the esophagus, under the Larynx, and not in Rib cage, or at another non-physiological point. This situation would then be described as dystop (from the Greek "dys-" = bad). Furthermore, the function of the thyroid gland can be euthyroid, i.e. normal, hypothyroid, so too weak, and hyperthyroid, so be too strong.
For the patient, however, what is sometimes most important is the description of the morphology. Here one divides into Diffuse goiter, Goiter nodosa. The former describes a diffuse, even enlargement of the thyroid gland with homogeneous growth. Struma nodosa is a nodular enlargement of the thyroid gland that already has lumps. Depending on the number of nodes, one further describes one Goiter uninodosa, and a Goiter multinodosa.
Symptoms
An enlargement of the thyroid gland can initially appear completely without physical symptoms, or it can also affect the metabolism. The size of the thyroid does not allow conclusions to be drawn about its function. Therefore, with an overactive thyroid, both hyperthyroidism (an overproduction of thyroid hormones) and hypothyroidism (underproduction) can be present. Of course, there can also be a completely normal, physiological production. Signs of hyperthyroidism are nervousness, restlessness, profuse sweating, weight loss with constant cravings, hair loss, rapid pulse, high blood pressure, diarrhea, to name just a few. Hypothyroidism is characterized by a depressed mood, listlessness, weight gain, dry skin, hair loss, possibly harsh voice, and constipation.
Usually not all symptoms are present at the same time, only a few. Hypothyroidism also often turns into hyperthyroidism, and vice versa. This is due to the impaired regulation of the thyroid hormones, which are then released sometimes too strongly, sometimes too little. If there is a euthyroid metabolic situation, i.e. neither an over- nor under-function of the thyroid gland, the thyroid enlargement is still noticeable physically: the excess tissue presses on the esophagus and, if necessary, the trachea. Patients report symptoms such as a strange feeling when swallowing, as if they had "a lump" in their throat. A tissue enlargement can be felt on the neck, depending on the stage. In advanced stages, there is also shortness of breath, especially during exercise. Wearing tight clothing, such as ties, is also perceived as uncomfortable because the neck is also constricted. A stridor, i.e. a wheezing sound when breathing in or out, can be an additional symptom.
Read more about this under Thyroid pain
causes
The most common cause of an enlarged thyroid is Iodine deficiency. Since the thyroid gland needs iodine to produce its hormones, it reacts very sensitively to a lack of intake of this element. In the case of permanent iodine deficiency, the body performs a very simple calculation: If 100 cells can only work halfway due to a lack of iodine supply, you need 200 cells to be able to produce the same amount of thyroid hormones. This is, of course, a simplified example, in reality there are many more gland cells, and the thyroid gland no longer functions exactly “halfway”. However, this example shows why the thyroid gland suddenly grows with iodine deficiency.
Iodine deficiency was mostly in in earlier times a big problem in "Iodine deficiency areas". This is the name given to areas in which the population cannot naturally take in enough iodine with food. Austria For example, thereupon a legal iodination of food has been introduced, so that the iodine is inevitably absorbed with the food, and iodine deficiency areas are also supplied. You can also use iodized in Germany salt to buy. Since the introduction of these measures, the number of goiter operations has increased gone back sharply.
Here you can find more information on the topic: Iodine deficiency
In addition to the iodine deficiency, which makes up 90% of the goiter, there are a number of other causes that can be responsible for an enlargement of the thyroid: Tumors of the pituitary gland can lead to the constant release of too much of the thyroid stimulating hormone (TSH). The TSH stimulates the thyroid gland to produce thyroid hormones. If a high production rate is required of the thyroid for a long time, it has to expand its capacities, so to speak, and enlarge. This is exactly what happens when too much TSH affects the thyroid. In addition, inflammation of the thyroid gland can also occur, which is called "thyroiditis". Inflammation is always accompanied by swelling, so that in this case too, goiter develops.
Also Cysts and benign and malignant tumors can cause thyroid tissue to swell. But not only the body's own processes can lead to an enlargement of the thyroid gland, externally supplied drugs that are "strumigen" - that is, goiter-producing - can play a role. These include, among other things Lithium, anti-thyroid drugs, nitrates, and thiocyanate. The list of possible causes is long, with iodine deficiency at 90% making up the vast majority.
therapy
Thyroid enlargement should definitely be clarified by a doctor. A mere enlargement does not cause any discomfort at first. Reached the thyroid but areas around 2 liters Volume (normal value 20-60 milliliters), are postural damage and impairment of head movement and the Neck muscles expected. This can lead to permanent posture damage, solely due to the high, non-physiological weight. Furthermore, extreme thyroid enlargement naturally affects the respiratory and food tract, so that it too Breathing problems, and difficulties swallowing comes. This still represents the most favorable course in the event that the enlargement was actually only caused by iodine deficiency and not by a tumor metastasis, an adenoma, or another malignant disease.
Have so Thyroid cancer generally one with early treatment good 5 year survival rate from 60-90%. In the case of anaplastic thyroid carcinomas, however, the 5-year survival rate is only 10%, which shows that an enlarged thyroid can also be fatal. Therefore, a prompt clarification by the family doctor is necessary. Due to the slow growth, however, patients usually wait until the last moment, otherwise they too no complaints feel.
In principle, there are 3 treatment approaches to treat an enlarged thyroid. They all have different indications, as well as advantages and disadvantages. First, drug treatment by substituting the missing thyroid hormones and giving them iodide. To take up the previous example, if 100 cells are enough iodine have available to produce sufficient thyroid hormones for the body, one can do without the remaining 100 gland cells, they become superfluous and can be broken down. This is how the thyroid gland shrinks. The substitution of thyroid hormones also has the consequence that the thyroid gland via the thyrotropic regulation cycle is not fired even further with TSH – TSH eventually stimulates the thyroid tissue to grow and produce. However, drug treatment can only be used if not one at the same time Hyperthyroidism present. After all, if you were given iodine, you would add oil to the fire and provide the thyroid with additional "fuel", even more Hormones to produce.
Also any (uncontrollable) autonomies or Carcinomas in the thyroid gland must not be supplied with iodine because they cannot be controlled and can continue to grow. Drug treatment takes place over a period of one to one and a half years, one lifelong follow-up care and control however, is necessary. The second treatment approach is surgery. It is indicated if thyroid carcinoma is suspected or if the Air- and esophagus.
Also cold knots and suspected malignancy can speak in favor of surgery. The danger with an operation is that the thyroid tissue has already grown into adjacent structures and has infiltrated them. Specifically, the recurrent laryngeal nerve and the vessels supplying the brain can be affected. A so-called Recurrent palsyas it occurs after damage to the vocal cord nerve causes one or both of them Vocal folds can no longer be moved.
The complication rate in thyroid surgery is only 1%, but voice training is necessary after vocal cord paralysis so that the voice does not sound constantly hoarse.
The vessels supplying the brain can also be injured, with the risk arising less from an undersupply of blood to the brain than from a too profuse bleeding from the neck.
The brain is supplied with blood via a total of 3 large vessels, an injury to one of the three vessels can therefore be easily compensated for. However, bleeding in the neck area is not without it, as a lot of blood can be lost here, and the pressure in the vessels due to the proximity to the heart is relatively strong. However, belong Goiter-OPs are standard operations and usually proceed without complications. In small operations, only a small, line-thin scar remains under the Larynx. This will initially appear slightly reddish, but will hardly be visible in the course of the process. After the operation you usually need lifelong treatment L-thyroxine and iodine because the body initially wants to produce the missing thyroid tissue again. In order to prevent this, the above mentioned Medication used. Weaning would result in renewed growth.
The third and final treatment option is this Radioiodine therapy to call. To put it simply, radioactive iodine is introduced into the thyroid gland, which then destroys it from the inside out. The special trick with this method is that the radioactive iodine is only absorbed by the thyroid gland and not by any other body cell. This means that treatment is absolutely targeted.Since only thyroid cells absorb iodine, the radioactive ones settle Iodine isotopes in the cells of the thyroid gland. There they radiate highly energetically onto the surrounding tissue. Since after the (oral) application the patient emits radioactively himself and thus could harm other people, there is at least one 48 hour accommodation in one Radiation-proof building required by law. Radioiodine therapy may also be necessary as a pretreatment prior to surgery.
pregnancy
During pregnancy there may be a slight enlargement of the thyroid gland as it increases during this time Thyroid hormones must be produced. The increased production rate is reflected in a proliferation of the thyroid tissue. During this time, the pregnant woman also needs more iodine than usual, instead of 200 micrograms per day, around 230 micrograms. After all, the child has to be provided for. During pregnancy, an enlargement is absolutely normal, only if the enlargement is noticeably large and disturbs swallowing and breathing, a more detailed investigation is indicated. In children one can Iodine deficiency, and the associated enlargement of the thyroid gland have serious consequences: Even an insufficient intake of iodine during pregnancy can trigger an underactive thyroid in children.
An undersupply during and shortly after birth - with a high probability leads to mental retardation, since the thyroid hormones T3 and T4 are necessary for the development of the brain. Delaying iodine substitution after and during pregnancy has been shown to reduce the in children Intelligence quotient in the double-digit range. Iodine deficiency during pregnancy and in children is considered to be the most common preventable cause of retardation worldwide. Precise control of thyroid levels is therefore particularly important during pregnancy.
Conclusion
A Thyroid enlargement does not necessarily have to be a life-threatening complication as long as it is cleared up quickly enough and treated if necessary. The therapy is nowadays very simple and has few complications. It is all the more important to see a doctor at an early stage if an enlargement is detected. Serious long-term effects like that Retardation show in children why in this case alternative concepts such as homeopathy should not be used, but scientifically sound treatment should be used. Foods rich in iodine such as fish, dairy products and iodized are recommended for the prophylaxis of thyroid enlargement salt.
