Symptom complex: enlargement of the thyroid gland.
The pathogenesis of endemic goiter is primarily associated with iodine deficiency in the environment. Thyroid diseases are less likely to affect males. Goiter is familial in 40% of cases, while in 16%, more than two members of the pedigree are affected. Clinically symptomatic sporadic goiter develops in the absence of iodine deficiency. For sporadic goiter, family accumulation has also been noted. One of the factors that leads to the growth of the thyroid gland is heterozygosity for genetic defects in the synthesis of thyroid hormones. An analysis of studies of this pathology testifies in favor of the multifactorial genesis of both endemic and sporadic goiter. A shift in the sex ratio with obstruction of goiter endemic due to an increase in the frequency of lesions in men indicates that for the manifestation of the disease at the floor, it is less affected, more significant environmental components are needed. Inherited by AD type. Clinic. The thyroid gland is enlarged (often to the III degree). Treatment of goiter is long. Iodine preparations or thyroid hormones are used. Inefficiency of therapy – indications for surgery.
Benign tumors of the thyroid gland, differing in size and histological picture. Papillary and follicular adenomas are distinguished. Thyroid adenomas function independently of thyroid stimulating hormone.
In the presence of adenoma, a node forms in the thyroid gland, which slowly grows over many years, while the thyroid function remains normal for a long time. When the node reaches a sufficiently large value, the function of the gland usually increases, the secretion of thyroid-stimulating hormone is inhibited and atrophy of the rest of the thyroid gland develops. Clinically, during this period, patients exhibit signs of thyrotoxicosis (toxic adenoma). Sometimes hemorrhagic necrosis develops in the tissue of adenoma, which leads to a decrease in its previously increased function. Adenomas often actively accumulate radioactive iodine, which allows them to be detected during radioisotope scanning in the form of a “hot” node. Confirm the diagnosis allows morphological examination. It is sometimes difficult to decide whether a follicular tumor is benign or malignant. In this case, a larger amount of thyroid tissue has to be excised surgically.
In toxic adenoma, radioactive iodine is treated. The absence of signs of thyrotoxicosis requires regular monitoring, as 30% of patients develop hyperthyroidism.
B Cell Thyroid Cancer
Papillary adenocarcinoma is observed in about 2% of cases. The medical history of the disease is short, due to the high biological activity of B cells. Patients complain of the presence of a rapidly increasing nodular mass in the thyroid gland. Macro- and microscopically, this form is difficult to differentiate from papillary adenocarcinoma from A-cells. The correct diagnosis can be made if there is a high activity of succinate dehydrogenase (LDH). The tumor metastasizes mainly to the regional lymph nodes. Follicular adenocarcinoma is also a rare disease, occurs in 2-2.5% of cases, usually in young streets. It has a favorable clinical course, regional metastases are detected extremely rarely. Tumor marker – LDH. Undifferentiated cancer – 0.5%. It has an aggressive clinical course and all the features characteristic of A-cell undifferentiated cancer. Tumor marker – LDH.