ADENOMA THYROID SAME LEZY (nodular goiter) is camping benign tumors of the thyroid.
The etiology is not entirely clear. Previous believed that the beginnings of an adenoma of the thyroid gland for imposes in the embryonic zhiz no or early childhood and increase vayutsya under conditions blagopriyatst vuyuschih their development. Factors for development can serve iodine deficiency, autoimmune thyroiditis , insufficient formation of thyroid hormones, t. E. Causes at approximately the same as in the endemic skom goiter.
Thyroid adenoma in women is 4-5 times more common than in men. The wasps novnom they develop in 35-55 years of age, but are also observed in the young. In the epidemiological aspect of thyroid adenoma Global Developing often are in the thymus-stressed regions. It is believed that from 1 to 4% of women suffer thyroid adenoma, wherein no functional nating “cold” nodes meeting are approximately 10 times more frequently than “hot” nodes functioning. In the presence of thyroid adenoma, regardless of the size and functional consisting Nia they are known and recorded as goiter (diffuse enlargement of thyroid I and II extent not considered goiter).
Nodes are odi night ( solitary ), and many nye. They are covered with a connective tissue capsule, which is isolated from neighboring thyroid tissue. To the touch, adenomas of the thyroid gland are smooth, mobile.
- Trabecular adenoma , with standing strands of continuous cells without clearance, which corresponds wounds it fetal thyroid structure type.
- Tubular adenoma, comprising conductive strands of parallel cells between which there is clearance. Cytologically this corresponds bo Lee later period embryonic Foot of the thyroid gland. A colloid may be in the gaps.
- Mikrofollikulyarnuyu adenoma , on histological structure of soot sponds structurally quite time twisted thyroid. The walls of the small Folly Kulov lined with cubic and Jilin -cylindrical epithelium. The cavity is filled with follicular fluid kolloi house.
- Makrofollikulyarnuyu adeno mu , consisting of large folliku fishing, lined with squamous epithelium. The follicles are filled with a thick count Lois.
The closer thyroid adenoma in histologic skom structure of an embryonic ti ny, so they are more passive in gormonal Mr. respect and have respect Tel’nov great tendency to malignancy. The trabecular and tubular adenoma thyroid not possess method NOSTA capture iodine, consequently quently also synthesize thyroid hormones. In the hormonal sense, microfollicular adenomas of the thyroid gland are the most active .
- In practice, mixed-type thyroid adenomas are often found . In such cases, the type of thyroid adenoma is determined by the predominant content of a particular type of follicle, i.e., the histological structure.
Adenoma of the thyroid gland in the development of thyroid hormones are autonomous, their functions are not regulated by thyrotropin gipofi for. If adenomas thyroid hormone by wearing passive ( “cold” node), then the rest thyroid tissue does not change and remains functioning -normal. In cases where the adenoma of the thyroid gland is functionally active ( “hot” or “warm” sites), and produce a lot of thyroid hormones under their influence by feedback blo kiruetsya thyroid stimulating function gi pofiza. As a result, healthy thyroid tissue is deprived of stimulation and atrophy, which is clearly before stavlyaetsya on skenogrammah thyroid.
Adenoma thyroid anyway tumors are: though they dobrokachest governmental, but they sometimes revealing are cancer-degenerated cells. Moreover, the adenoma of his gi stologicheskomu structure closer to the embryonic type and gormonal Mr regarding passive, the more often it found pockets of Rako O rebirth. Statistics until shows that in the “cold” nodes Ocha thrust carcinoembryonic degenerative cells of also been observed in 10-30% of cases, functioning “warm” uzlah- approximately 1-3% of cases, and bo Lee active “hot” sites of rarely found.
Symptoms of thyroid adenoma occur imperceptibly for the patient and the usual but not cause concern. The nodes of up to 1 cm in diameter, do not always show up, especially if they are located in the interior of the lezy. To the touch, adenomas are smooth, mobile, painless. They grow slowly, sometimes for ten lety. Adenomas are bolez nennymi inflammations and krovoiz Liyang in them. After hemorrhage, cysts often form in them. The set Gia thyroid adenomas reach a value forest Nogo, walnuts. In Drew GIH cases thyroid adenoma, increasing, reaches a value so chicken and the goose eggs. Moreover, there are often multiple adenomas of various sizes. Large adeno we, especially retrosternal, may compress the trachea and not only to squeeze, and and cause it to Atro graphy and even the destruction of its walls.
With hormonal active thyroid adenomas, if they are moderately active, the patient remains in an euthyroid state due to atrophy of the remaining thyroid tissue. If the adenoma is very ac tive, there is a classic car ooze toxic goiter from mild to severe with all the character of the singularities of hyperthyroidism, with the exception of exophthalmos. From known that exophthalmos occurs not under the influence of thyroid hormones, and under the influence of the hypothalamic-pituitary hormones, in particular they munoglobulina LATS, which ties sexually-goiter is not produced.
Diagnosis and differential diagnosis. Diagnosis of thyroid adenoma We establish INDICATES based thyroid palpation and according skenogrammy . With diffuse toxic goiter differential ferentsiruetsya based on the presence or absence of data units and sk diffraction patterns . Often found mixed toxic goiter in the presence of “hot” or “ho lodnyh” nodes that must take into account when examination of the patient.
Treatment of nodular goiter.
Conservative leche of ineffective both in the “hot” and “cold” nodes.
- At the “cold” adenomas recom mended assignment thyroid hot Mon: tireoidin 0.1 g and triiodothyronine of 0.00002 g per day, tensile thief Lugol -10 drops daily Techa of several months. Usually the village les of components are reduced. The pro Otherwise recommended operator their proliferative removal.
- With “hot” thyrotoxic nodes, treatment is carried out as with thyrotoxicosis : mercazolil — 30–40 mg per day, predinsolone — 20–25 mg; the last within 10-12 days. After the subsidence of the phenomenon of thyrotoxicosis, surgical treatment can be recommended.
In the treatment of thyroid adenoma optionally go to solve very important in the question of the presence of malignancy adeno us. On the other hand, operate, coh and disease does not cause special Stra danii and even clinically manifested no undesirable. It should be borne in mind that after the opera tion thyroid hypothyroidism often develop an incurable or recurrent you adenoma of the thyroid gland. The fact is that even the needle biopsy is not always mo Jette give a final figure that depends on finding the end of the puncture needle in a particular part of the adenoma.
Tentatively, one should take into account:
1) the younger the patient’s age, the more nodes are more capable of malignancy;
2) hot nodes are usually not malignant ;
3) the presence of knots and hypothyroidism probability maligniza tion increases.
Women after 50-60 years, if the nodes do not grow, are taken under observation.