What Is Thyroid Swelling?

Endemic goiter is one of the main manifestations of iodine deficiency disorders (IDD). The main cause of endemic goiter is iodine deficiency, so it is also called iodine deficiency goiter.

Endemic goiter is one of the main manifestations of iodine deficiency disorders (IDD). The main cause of endemic goiter is iodine deficiency, so it is also called iodine deficiency goiter.

Chinese name

Endemic goiter

Foreign name

iodine deficiency disorders, IDD

Endemic goiter I. Causes and common classification:

Is an endemic disease, mainly due to iodine deficiency, causing thyroid hyperplasia and degeneration. Children in severe areas show endemic cretinism. There are also hyperiodine endemic goiters. The thyroid gland is mostly diffuse and swollen, and it may be nodular in the later stages. Symptoms of compression can be seen clinically, with more tracheal compression, patients with a tight throat, chronic cough, shortness of breath after work, and even wheezing. Compression of the esophagus can cause difficulty swallowing; compression of the recurrent laryngeal nerve can cause hoarseness; osteoblasts behind the sternum can compress the superior vena cava and cause superior vena cava syndrome.

The disease causes compensatory hypertrophy of the thyroid due to iodine deficiency or relatively insufficient secretion of thyroid hormones. Except for goiter, there are generally no other systemic symptoms. It is more common in women aged 20-40. The onset of the disease is slow, the thyroid is soft and smooth in the early stage, and hard in the late stage, often accompanied by nodules of various sizes, which can compress the trachea and esophagus. Chinese medicine calls this disease "rickets."

Endemic goiter II . Diagnosis:

There are three diagnostic criteria established in China: patients live in iodine deficiency disease areas; goiter is larger than the subject's terminal thumb or smaller than the terminal thumb but has nodules; hyperthyroidism, thyroiditis, thyroid cancer and other thyroid diseases are excluded. In addition, the onset rate of children aged 8 to 10 years in the ward is greater than 5%, and the urine iodine is less than 100 g / L. It can be determined that the prevalence of onysis in the region has constituted a public health problem;

Endemic goiter III . Treatment principles:

(1) Iodized salt: The effectiveness of iodized salt in the prevention and treatment of goiter is related to the amount of iodine in table salt. China and other countries and regions with endemic goiter in the world supply iodized salt in the ward, but the concentration of iodine in the salt used is different. The iodine concentration in our country is 1/20000 ~ 1/50000. The iodide used is potassium iodide or potassium iodate.

(2) Iodine oil injection: Iodized oil is an organic iodide prepared by the addition reaction of vegetable oil and hydrogen iodide. After intramuscular injection of lipiodol, it can be stored in the body for at least 2 to 3 years. It is a relatively simple, economical, and reliable method of prevention and treatment. It is often used as an adjuvant treatment of iodized salt and is used in remote, inaccessible areas or endemic areas of Cretin disease. Commonly used iodine oils are: iodized poppy seed oil, iodized walnut oil, and iodized soybean oil. The iodine content per milliliter is 475mg, 507.3mg, and 485.2mg. If the dose of lipiodol injection is appropriate, it will not cause adverse effects on the body. A small number of people may have allergic reactions, such as urticaria, angioedema, bronchospasm, and shock; some patients may have iodine poisoning, nausea, vomiting, local pain, and syncope. There are also some patients with thyroid dysfunction, such as hyperiodine goiter, iodized thyroiditis, iodine hyperthyroidism, and hypothyroidism, but these are rare.

(3) Iodine and thyroid hormone: For early mild goiter, apply potassium iodide 10 30mg / d or compound iodine solution 3 5 drops / d, usually make goiter disappear within 3 6 months. For patients with moderate thyroid enlargement, dry thyroid tablets 60 to 120 mg / d can be used for 6 to 12 months. More than half of the patients can be cured. Those with more or more nodules cannot completely disappear. If the patient is pregnant or lactating, the dose of thyroid hormone can be appropriately increased, but the dose of dry thyroid tablets generally does not exceed 160 mg.

(4) Surgery: Surgery is a rarely used method, but if the indications are selected appropriately, good results can also be achieved. Surgery is suitable for hyperthyroidism; long-term use of iodine treatment is ineffective; goiter causes obvious compression symptoms; combined with bleeding, necrosis, cystic changes, calcification; suspected malignant changes; ectopic thyroid or complicated with hyperthyroidism, etc. . For patients with diffuse goiter or severe heart, liver, and kidney disorders and pregnancy, surgery should not be considered. Surgical complications and management are similar to those of other thyroid diseases.