OVERVIEW
OVERVIEW
Goiter is a non-inflammatory, non-neoplastic hyperplastic enlargement of the thyroid epithelium. A hyperiodinemic goiter is a compensatory enlargement of the thyroid gland, mostly diffuse and mild to moderate in size, caused by a long-term intake of iodine far in excess of the body’s needs, which occupies the functional groups of peroxidase and reduces the synthesis and release of thyroid hormones due to the Wolff-Chaikoff effect, resulting in a decrease in the level of thyroid hormones in the blood.
Whether medical insurance
Yes, it is
Department
Endocrinology
Clinical symptoms
The main manifestation is diffuse enlargement of the thyroid gland. There may also be fear of heat and sweating, easy to lose temper, expression of indifference, dry and thickened skin and other manifestations.
Harmful effects
It can cause over secretion of thyroid hormone and hyperthyroidism. Hyperiodized goiter in newborns may compress the trachea, and in severe cases, it may lead to asphyxia and death.
Examination
Ultrasonography, urine iodine test, thyroid iodine uptake test, perchlorate release test, plasma inorganic iodine measurement, thyroid function test, nuclear scan, X-ray film, etc.
Diagnosis
Diagnosis is made on the basis of medical history and clinical manifestations such as diffuse enlargement of the thyroid gland, fear of heat and sweating, combined with iodine-absorption test of the thyroid gland and nuclear scanning.
Treatment principle
Generally, drug treatment is the mainstay of treatment. Surgery may be performed if there are symptoms of compression or calcification of the goiter.
Curability
Mild cases can be recovered with medication; moderate cases can be improved with medication, and some of them can be cured.
Dietary advice
Reduce the consumption of iodine-containing foods, such as seaweed and seaweed.
Causes
Epidemiology
The disease can be divided into endemic and sporadic according to the epidemiologic characteristics, and endemic high iodine goiter is more common than sporadic goiter. According to the route of high iodine intake, it can be categorized into water source and food source. According to geographical distribution, it can be divided into coastal type and inland type.
Etiology
Caused by long-term intake of iodine far in excess of the body’s needs.
Symptoms and Diagnosis
Typical symptoms
Thyroid gland is enlarged, most of them are diffusely enlarged, often in I～II degree. The size of both sides is not equal, the surface is smooth, the texture is tough, there is no vascular murmur, there is no tremor, and it rarely causes tracheal compression. However, neonatal hyperiodinemic goiter can compress the trachea, and in severe cases, it can lead to asphyxia and death. High iodine goiter may be secondary to hyperthyroidism, and some patients may develop hypothyroidism, but mucous edema is rare.
Diagnostic basis
1. history of residence in disease-endemic areas or history of high iodine intake. 2. clinical manifestations such as diffuse enlargement of the thyroid gland, fear of heat and sweating, easy to lose temper, expression of indifference, dry and thickening of the skin, etc. 3. urine iodine>800μg/L, decreased iodine uptake rate of the thyroid gland, a positive perchlorate release test, and a significant increase in the iodine content of the plasma inorganic iodine and the thyroid gland. 4. serum T3 is slightly high or normal, and T4 is slightly low or normal. The T3/T4 ratio is elevated. Most of the serum thyroid stimulating hormone (TSH) measurements are in the normal range, and only some are elevated.
Treatment
Treatment guidelines
General drug treatment is the mainstay, with compression symptoms, goiter calcification, etc. can be treated surgically.
Medication
For early mild cases, taking potassium iodide or compound iodine solution, most of them can be cured. In moderate to severe cases, taking thyroid tablets can shrink the thyroid gland, and some of them can be cured. Thyroxine treatment can correct thyroid insufficiency and inhibit thyroid-stimulating hormone, which can shrink the thyroid gland and reduce multiple nodules, but it is difficult to disappear.
Radiotherapy
Radioactive iodine therapy may be used for those who are not suitable for surgical treatment.
Surgery
Surgery is not usually used, but should be considered when compression symptoms occur. ultrasound confirms calcification of goiter or goiter combined with hyperthyroidism can be treated surgically.
Prognosis
Mild cases can mostly recover with medication, and moderate cases can be partially cured by taking oral thyroid tablets to shrink the thyroid gland.
Nursing care
Daily care
1. Patients should have sufficient rest, live a regular life, take appropriate activities and avoid exertion. 2. Keep the environment quiet and avoid noisy. 3. Take medication as prescribed by the doctor and observe the efficacy of the medication and the adverse reactions. 4. Follow up the doctor regularly to recheck the function of the thyroid gland.
Diet
Minimize the consumption of iodine-containing foods, such as kelp and seaweed. Diet should be light and nutritious, avoid alcohol and stimulating food.