Simple goiter

Cause pathogenesis of simple goiter causes can be divided into three categories : ① synthetic thyroid hormone materials (iodine) deficiency; This is the cause of simple goiter in the cause of China's far from the sea in the mountains, and the Yunnan-Guizhou Plateau in Shaanxi, Shanxi, Ningxia, and other places, mountain soil was washed salt loss, as well as food and drinking water iodine shortage, the more people have the disease, also known as the "endemic goiter." The lack of raw materials "Iodine", and thyroid function still needs to maintain normal circumstances, anterior pituitary TSH secretion increased, which has prompted the occurrence of thyroid compensatory enlargement. ② thyroid hormone requirements increase : In adolescence, pregnancy, lactation and menopause, the body's metabolism is brisk, thyroid hormone requirements increase, caused a long period of TSH secretion of excessive, also prompted goiter. This enlargement is a biological phenomenon, often in adults or lactation after pregnancy to narrow. ③ thyroid hormone biosynthesis and secretion of obstacles, Some simple goiter due to the occurrence of the gland hormone biosynthesis and secretion process of a link obstacles, goiter as to the substance of peracetic acid, sulfur oxygen acid, nitrate, etc. can impair thyroid iodide uptake of inorganic : Sulfa drugs, and thiourea drugs containing thiourea kind of vegetables (carrot, cabbage) can prevent thyroid hormone synthesis. This caused blood thyroid hormone decline. Therefore, it strengthened the anterior pituitary TSH secretion prompted goiter. Similarly, the recessive genetic birth defects such as peroxidase or proteolytic enzymes, lack of can also result in thyroid hormone biosynthesis or secretion, which leads to goitre. Simple goiter most significant pathological changes is the height of follicular expansion, with a large number of colloid, and follicular cell wall into a flat, it is an indication of thyroid function shortage. Although the microscope to see the proliferation of local state grounds performance columnar cells formed to penetrate the follicular cavity papillary body But such was the proliferation of compensatory. Patterns, simple goiter can be divided into Artemis chronic and nodular two. The former was particularly prevalent in adolescence, expansion of follicular average scattered throughout the gland ministries. As for the latter, was particularly prevalent in the endemic area, the expansion of an integrated follicular or several nodules ranging from the size, nodules have not been around the integrity of the fibrous capsule. Nodular goiter by considerable period of time, due to poor blood circulation, often within the nodules occurred degeneration, Cyst formation caused (often with intracystic hemorrhage) and local fibrosis and calcification. Tuberous tremendous long-term oppression nodules intergovernmental organizations, will enable the functional organization of shrinking degradation, the clinical manifestations of hypothyroidism. Another development of the nodules result of a certain degree of autonomy, that the secretion of thyroid nodular thyroid hormone function, no longer dependent on the thyroid stimulating hormone, or be exempt from taking thyroid hormone suppression, at this time, such as with a large dose of iodine dose treatment, very prone to secondary hyperthyroidism. In addition, the nodular goiter have occurred malignant potential. Clinical manifestations of simple goiter is not normally the function of changes in general no systemic symptoms, basal metabolic rate normal. Early, bilateral diffuse thyroid enlargement, soft, smooth surface without nodules, which can swallow up and down. Gradually enlarged gland in the side, but also on both sides, and a number of lay hands (or individual) nodule; Variable cyst-like lesions, Concurrency can intracystic hemorrhage, nodules in a short period of time is rapidly increasing. Larger nodular goiter, oppression adjacent organs, which leads to various symptoms. ① trachea oppression : the more common, since the side of the oppressed, to his trachea or lateral shift change bending; Since both sides of oppression, trachea into the flat. Because tracheal narrowing cavity, respiratory difficulty, especially substernal goiter more serious. Tracheal prolonged pressure can be softened and caused suffocation. ② oppression of the esophagus rare. Only substernal goiter may oppression esophagus and cause discomfort when swallowing, but no obstruction symptoms. ③ oppression neck deep vein, the head and neck can cause blood return, This situation was particularly prevalent in the thoracic outlet at large goiter, particularly substernal goiter. Clinical appeared facial bruising and swelling, neck and chest superficial veins dilate. ④ oppression of the recurrent laryngeal nerve, which can cause vocal cord paralysis occurred voice hoarse. Oppression neck sympathetic ganglion chain, may cause Horner's (Horner) SARS. Nodular goiter, secondary hyperparathyroidism, can also occur malignant. Treatment 1. Puberty or pregnancy physiological goiter, can not give medication, should eat kelp rich in iodine, laver, and so on. 2.20 young people before the age of diffuse simple goiter, will be given a small amount of thyroid hormone, to contain anterior pituitary TSH secretion. Usual dose of 15-30mg, twice daily oral, 3 ~ 6 months for a course of treatment. 3. For the following circumstances, timely surgical treatment purposes subtotal thyroidectomy. ① developed into nodular goiter who ② oppression trachea, esophagus, or the recurrent laryngeal nerve ganglion arising from the clinical symptoms. ③ substernal goiter. ④ huge goiter and work life were affected. ⑤ nodular goiter with secondary hyperparathyroidism were. ⑥ nodular goiter were suspected malignant.