Treatment of eye symptoms mainly patho genetic. Prevention of exophthalmos consists in timely treatment of hyperthyroidism.

•                In the presence Prizna Cove exophthalmos is impossible from the start to use large drug doses imidazole, which can lead to TTG hypersecretion, exophthalmic factor.
•                In what Nation when the euthyroid state must assign longer time thyroid hormyl us (T 4 , Ts ) so that the pulse frequency is not passed phi ziologicheskih boundaries 100 beats per min.
•                In the period of development of exophthalmos when roofing to that in the retrobulbar space stve accumulated mucopolysaccharides , a good therapeutic effect of the eye is called steroids and gammaterapiya (6000 rad) of the hypothalamic-pituitary region of the three fields, as well as retro-orbital with one reception time in large to Zach steroid 40 – 80 mg per day, or the introduction of hydro cortisone into the orbital space at 10-12 days of 30 to 40 mg daily in each orbit.

Regression exophthalmus not often occur in cases where there is a great prescription, during which, in the retro-orbital space nakap Lebanon a lot of fat, and a connector tissue was. In these cases, conservative tive treatment is not effective. Previous lozhena operation – decompression Op bits by its expansion in three spatial directions.

GOITER.

GOITER is a tumor-like enlargement of the thyroid gland (hyperplasia). It is observed in a significant part of the population living in certain areas with endemic goiter, and also happens with bazedovoy disease, malignant tumors of the thyroid gland and its inflammatory changes.

Endemic goiter .

Goiter is endemic – have withdrawn chenie thyroid III -V degree.

The degree of enlargement of the thyroid gland.

•                1 degree – the thyroid gland is not visible during examination, but is felt during swallowing;
•                Grade 2 – the thyroid gland is visible during examination during swallowing, is well defined when palpating, but does not change the shape of the neck;
•                3 degree – an enlarged thyroid gland changes the shape of the neck;
•                Grade 4 – the thyroid gland is visible upon examination and changes the shape of the neck in the form of a protruding goiter;
•                5 degree – an increase in the thyroid gland leads to compression of the trachea, nerves, blood vessels, esophagus, etc.

More than 1.5% of the surveyed population in areas with iodine deficiency in the soil has endemic goiter.
Endemic goiter is extremely common slaughtering Levan on all continents of the globe, especially in mountainous, remote from the sea areas. Eg -conjugated foci are Switzerland, Germany, Poland, the USA, Egypt, Britain, China, Cohn of western Ukraine, Central Asian republics, the Urals, Armenia, Georgia -. Svaneti, etc. The reason endemicity highlands is leaching of iodine compounds rainwater and transfer them to the seas, why on the seashores no endemic goiter is observed.

Goiter is endemic in the highlands relatively often combined with ghee potireozom and cretinism in the BPE on me as a plain goiter often Protek is without thyroid dysfunction.

In endemic goiter hyperthyroidism does not happen, as the disease develops in deficiency minute reoidnyh hormones .

Hearth endemic goiter is considered an area where more than 1.5% of the surveyed for settlement detects thyroid enlargement VI-V degree. If more than 10% of the population, an increase of thyroid 1-2 degrees, it speaks of hyper endemic Plaza thyroid. It is known that in zobnonapryazhennyh endemic Ocha gah men suffer from goiter almost as much as women and vice versa, slabonapryazhennyh thymus foci mostly common in women (at approximately 8-10 times more often), so cha tin endemic goiter most accurately reflects the ratio of male patients zo bomb III — V degree to the number of sick women (Lenz- Bauer index ). Most zobnonapryazhennymi Rayo us are those in which the index is 1: 1-1: 3; Moderate conjugation – areas with an index of 1: 4-1: 5 and finally slabonaprya -conjugated – areas with an index of 1: 6-1: 8 and more.

For the correct assessment of the ratio, it is necessary to compare the same age groups. Follows should be noted that only one race prostranennost disease among the population does not fully reflect the degree of severity of the endemic. An important indicator is the clinical course of goiter. The more discovered INDICATES patients with nodular goiter and cretinism, the area is considered more zobnonapryazhennoy .

Etiology.

In 1849, Prevost and Brown theorized iodine deficiency, which is in the far fully confirmed shem. Under normal circumstances, the body per day ki receives 120 micrograms of iodine, of which 70 g with vegetable food, with 40 ug animal food, with 5 micrograms of Doi and 5 mcg of the atmosphere, through the lungs. Although water enters only a small portion of iodine, in fact has no practical importance, however, the amount of iodine in de reflects its contents in the soil of the area. Therefore, the definition showers iodine content in water, it is possible to draw conclusions about its containing SRI in the soil, in plants and in the Atmos Feret.

Besides iodine insufficient STI important role played by other factors, namely: lack of trace elements (bromo, zinc, to Balta, copper), sanitary and hygienic skie conditions avitaminosis, incomplete valuable nutrition, chronic infectious tion and other certain role in. Must calcium . In areas with hard water for the same with the holding of iodine in the soil thyroid enlargement occurs more frequently.

It was found that some Fruko you and vegetables have strumogennym property (provoke the development of goiter), for example, cabbage, turnips, rutabaga, radish, carrots, beans, spinach, peanuts, peaches. Strumogennost these products due to the presence in their structure of thiocyanates ( thiourea , thiouracil , and its pro derivatives), perchlorates, which spo sobny block capture of iodine by the thyroid gland and its further binding of tyrosine.

However, before an enlarged thyroid gland, this deficiency is compensated by a more rational synthesis of hormones. The composition of thyroid hormone is increased to 20 times the proportion phi ziologicheski enhanced hot Mona T 3 , the synthesis of which 25% is consumed less iodine than the synthesis of T 4 . Because of this fur -organisms the body for a long time is smiling in the payment status of thyroid hormones that obst exists goitre.

In the development of both endemic and sporadic goiter, heredity is of importance. When pro galactic examinations very often all members of one family Detect alive enlargement of the thyroid gland. Heritage governmental predisposition obuslov Leno genetic defect Fermi Comrade thyroid for the synthesis of thyroid hormones.

Types of endemic goiter.

By functionally consists NIJ craw is:

•                Euthyroid
•                Hypothyroid

Pathologically distinguish two main forms:

•                Diffuse
•                Uzlo -hand ( adenomatous )
•                Mixed

Each histological structure is:

•                parenchymal
•                colloidal

Parenchymal , less mature divided into trabecular , tubular and ma krofollikulyarnuyu . Colloidal in size, and maturity of the follicles in the oche its red is divided into mikrofollikulyar hydrochloric and makrofollikulyarnuyu .

Increasing the thyroid often occurs cyclically, with a period of stimulation and rest (yn involution and atrophy). Uneven stimulation of individual sites mo Jette cause atrophy adjacent to the lek because of their compression: after approx servation of such sites fibrous capsule formation units. Other adenomas contain follicles that mo gut hormone to be active ( “hot” nodes) and passive ( “ho lodnye” nodes). At constant STI emulation originated in adenomas can pull the blastomatous change, Cha hundred observed in zobnonapryazhennyh endemic areas dominated by the immature (undifferentiated) forms. Secondary regressive destructive change Niya in adenomas cause hemorrhage, fibrosis, calcification and the formation vanie cysts. Clinical symptoms.

The clinic is clear enough. Upon examination, the doctor can already determine the degree of enlargement of the thyroid gland, and with the help of ultrasound it is possible to determine the type, shape and size of the goiter.
Withdrawn thyroid chenie often begins in pu bertatnom period and is an invertible process. In most cases, endemic goiter develops diffusely. With prolonged its existence in the gland can be felt the unit nye or multiple nodes. Ras position goiter can be Aber rantnym, retropharyngeal, fundamentally Yazi ka and elsewhere. Zagrudny goitre with such localization easier revealed etsya radiographically.

Of the common symptoms, general weakness, fatigue during physical exertion, headaches, discomfort in the heart area are characteristic. Most patients complain of a feeling of compression in the neck.
With an enlargement of the thyroid gland of the 5th degree, compression of neighboring organs (esophagus, trachea, blood vessels) occurs, which can lead to difficulty in swallowing, breathing, hoarseness, suffocation, dry cough. Compression of the veins of the neck leads to circulatory disorders: expansion of the veins of the neck and blood vessels of the chest, a feeling of heaviness in the head, puffiness of the face.

The disease can lead to metabolic disorders, growth, psyche. Especially often mental disorders, delayed physical and mental development begin if goiter develops at an early age.

Diagnostics.

•                Ultrasound scan
•                Roentgen
•                Functional nal state thyroid determine etsya the general state of the patient, level of basal metabolism, the level of T 3 and T 4 , TSH in the blood at ste absorption fine radioactive yo and thyroid gland etc.

Prevention

Prevention is central to the fight against endemic goiter.
The most important of these events are: Seizing shenie sanitary conditions, mass screening and early treatment of patients with GI perplaziey thyroid gland III degree goiter and endemic III degree. Iodine prophylaxis is very effective ; it is widely used here and abroad. For this purpose, iodized produced for domestic use salt (25 g potassium iodide per ton with li).

In addition to mass “silent” pro galaxies, endemic goiter existing group and individual prevention. Group – is distributing tablets antistrumin op ganizovannym collectives, schools nicks (1 tablet per week ADULT lym tablets and 1/2 to 14 years of age). Individual pro galaxies, conducted among pregnant women, women with Uwe lichenie thyroid I-II degree, and those undergoing subtotal thyroidectomy to prevent re tsidiva goiter.

In connection with the improvement of material living conditions of the population, upot Use by not only local pro ucts power, but also from others about domains, the incidence of endemic goiter considerable tion decreased and continues to decrease progressively.

TREATMENT OF GOITER.

•                The fight against the spread of Endemic Goiter includes general health measures (protection of drinking water supply sources, nutrition, improvement of all sanitary conditions, etc. ..)
•                Carry out iodine prophylaxis .
•                Iodine treatment gives good re results of in the early stages of diffuse Foot goiter.
•                Antistramin is prescribed for 1-2 tablets 1-3 times a week, containing 0.001 g of potassium iodide.
•                Also used are thyroid hot Mona in small doses, for suppressing Nia TSH secretion ( tireoidin – 0.05 – 0.1 g, triiodothyronine – 0.00002 g daily or every other day).

We do not recommend the use of antithyroid drugs – merkazolila ., Etc. In endemic goiter large presence of large nodes and long Stu over 5 years shown opera tive treatment.