Simple non-toxic goiter (euthyroid goiter). Autoimmune disease of the thyroid gland

International Statistical Classification of Sickness and Problems Affected by Health – this document, broken down under the WHO Certification, for ensuring a unified approach to methods and principles of treating sickness.

Once every 10 years, we look at each other, make changes and amendments. On this day, the ICH-10 is a classifier, which gives the opportunity to designate an international protocol for the treatment of those with other ailments.

Principles of classification of endocrine diseases

Class IV. E00 - E90. Ailments of the endocrine system, disorders of eating and impaired speech exchange, including also ailments and pathological conditions of the thyroid gland. Nosology code according to ICD-10 - type E00 to E07.9.

Syndrome of natal iodine deficiency (E00 - E00.9)
Illness of SC, associated with iodine deficiency and similar conditions (E01 - E01.8).
Subclinical hypothyroidism due to iodine deficiency (E02).
Other forms of hypothyroidism (E03 - E03.9).
Other forms of non-toxic goiter (E04 - E04.9).
Thyrotoxicosis (hyperthyroidism) (E05 - E05.9).
Thyroiditis (E06 - E06.9).
Other diseases of the thyroid gland (E07 - E07.9).

All the nosological ones are not the only disease, but the number of pathological states is low, which may have their own peculiarities - both in the causes of blame, and in the methods of diagnosis. Henceforth, the protocol of jubilation is due to the succession of all factors and the burden of insurance will become.

Ailment, її causes those classic symptoms

On the back of my mind, I guess that the thyroid gland can be especially budov. It is made up of follicular cells, like microscopic bags, filled with a specific motherland - keloid. As a result of pathological processes, the bags begin to grow at the rosemaries. The very same thing, which is the nature of the growth, which may have been poured into the growth of hormones by the vine, and the fallow disease that develops.

Regardless of those who suffer from thyroid diseases are different, most of the causes are similar. And in certain vipadkas, you definitely don’t go into it, the shards of the mechanisms do not climb up.

Recession is called the main cause of the development of pathological diseases of internal secretion.
Influx of the navkolishny middle - unfriendly ecological situation, radiological background, lack of iodine in water and food products, ingestion of food chemistry, additives and GMOs.
Illness of the immune system, damage to metabolic processes.
Stress, psychoemotional instability, chronic autonomic syndrome.
Forty changes caused by hormonal changes in the body.

The most common symptoms of thyroid disease also show a general trend:

almost discomfort in the area of the neck, tightness, difficulty in forging;
losing weight without changing the diet of eating;
damage to the work of sweat ridges - it can be a sign of zayva pliability and dryness of the furrows;
drastic changes in mood, skhilnist to depression or zaiva nervousness;
lowering the severity of the mind, worsening the memory;
scargs for the robot ShKT (lock, carry);
problems in the robotic cardiovascular system - tachycardia, arrhythmia.

All these symptoms are to blame for suggesting that it is necessary to turn to the doctor - as a minimum, a long-term therapist. And vin, having failed the first follow-up, for the need to send to the endocrinologist.

Deyakі zahvoryuvannya thyroid zoloza zustrichayutsya more often for other rіznyh ob'ektivnyh and subjective reasons. Let's take a look at what is the widest behind the statistics.

See thyroid pathology

Cyst of the thyroid gland

There is a small, good-natured puff behind the roses. It’s important that you can call lighting as a brush, as you move 15 mm. at the diameter. Everything below this cordon is an expanded follicle.

Tse zrіla dobroyakіsna puff, like a lot of endocrinologists classify like a cyst. The only difference is that the empty cystic light is filled with keloid, and the adenoma is the epithelial cells of the thyroid gland.

Autoimmune thyroiditis (AIT)

Ailment of the thyroid gland, which is characterized by inflamed tissue, caused by damage to the robotic immune system. As a result of such a breakdown, antibodies are vibrated by the body, which begin to “attack” the thyroid gland cells, saturate them with leukocytes, which cause ignition processes. In the hour, the water cells collapse, cease to vibrate, they will need a lot of hormones and wine pathological camp which is called hypothyroidism.

eutheriasis

This is a practically normal state of the thyroid gland, with which the function of the production of hormones (TSH, T3 and T4) is not broken, but also the morphological state of the organ will change. Even more often, such a camp can run asymptomatically and waste all life, and a person does not suspect about the presence of ailment. The pathology does not affect specific exaltation and most often manifests itself in a typical way.

Goiter nodular

Nodular goiter ICD code 10 - E04.1 (with a single knot) - a new thyroid pit, which can be empty or epithelial. A single vuzol is rarely established and it is known about the cob to the process of new creation in looking at multiple vuzlov.

Goiter

Bagatovuzlovy goiter ICD 10 - E04.2 - the price of a nerіvnomіrne zbіlshennya thyroid gland with the established number of nodes, which can be both cystic and epithelial. As a rule, this type of goiter is characterized by increased activity of the organ of internal secretion.

Diffuse goiter

Vіn is characteristic of equal growth of the thyroid gland, which indicates a decrease in the secretory function of the organ.

Diffuse toxic goiter is an autoimmune disease, which is characterized by a diffuse increase in the thyroid gland and a stable pathological manifestation of the supra-mundane amount of thyroid hormones (thyrotoxicosis).

Tse zbіlshennya rozmіrіv thyroid zoloza, as it is not indicated for the production of normal quantities of thyroid hormones and not є after the inflamation of neoplastic dentures.

Illness of the thyroid gland, caused by iodine deficiency in the body. Recognize euthyroid (increased organ growth without impact on hormonal function), hypothyroid (increased production of hormones), hyperthyroid (increased production of hormones) endemic goiter.

Better rozmіrіv organ, as you can watch, like a sick person, so healthy. The newlyweds are kind and do not care about plumpness. Doty does not care about specific exaltation, the docks begin to change at the organ of zbіlshennya rozmіrіv osvіti.

Okremo next to guess about such a rare disease, like hypoplasia of the thyroid gland. It is not congenital disease, which is characterized by an underdiagnosed organ. As if ailment is blamed for protracted life, it is called atrophy of the thyroid gland.

Cancer of the thyroid gland

One of the small-scale pathologies, which is manifested only by specific diagnostic methods, the symptoms are similar to those of other thyroid ailments.

Methods of diagnostics

May all pathological neoplasms rarely develop into an evil form (cancer of the thyroid gland), only for a long time and untimely rejoicing.

For the diagnosis of vicorist, there are the following methods:

medical examination, palpation;
analysis of antibody titer to thyroid tissue
ultrasonic follow-up of the SC;
hormone analysis;
if necessary, a thin-necked biopsy.

For some deeds, jubilation may not be needed by others, for example, reconciliation of the new creation is even smaller. The specialist simply watches over the camp of the sick. Sometimes new creations spontaneously grow up, if they start to grow fast at rosemaries.

The most effective ways of jubilation

Likuvannya can be conservative, tobto medication. The preparations are prescribed for suvoriy vidpovidnosti to laboratory results. Self-talk is unacceptable, fragments of the pathological process help control and correction of a specialist.

For obvious indications, an operative visit is carried out, if a part of the organ is seen, as if it is weak to the pathological process, or the whole organ.

Treatment of autoimmune diseases

medicamentous - straightened out by excess hormones;
treatment with radioactive iodine or an operation - to bring down the infection, which causes hypothyroidism;
reflexotherapy computer has been upgraded to the robot crawler.

Ailments of the thyroid gland, especially in the world - the manifestation is to be cut wider. As soon as you turn up to fahіvtsya and spend all the necessary therapeutic visits, you can significantly improve the quality of life, and in such situations, you will get sick more often.

In order to sort out, which may be a diffusely nodular goiter, the code of microbial 10 and what wine means, it is necessary to sort out, which is the designation of "microbial 10". It is deciphered as an “international classification of ailments” that is a normative document, the task of which is the implementation of methodological approaches and the establishment of materials among doctors of the world. That, speaking in simple terms, is the international classification of all known illnesses. And the number 10 indicates the version of the revision of the classification, at the moment there is 10-a. I diffusely nodular goiter as a pathology is classified as class IV, which includes disease of the endocrine system, disruption of metabolic processes and etching, as an alphanumeric code E00 to E90. Illness of the thyroid gland itself takes positions from E00 E07.

Let's talk about diffusely nodular goiter, following the memory that the classification according to ICD 10 is divided into the group of different pathologies of the thyroid gland, as the reasons for the appearance of morphology are different. Cerebral neoplasms in tissues of the thyroid gland (single-nodular and multi-nodular), and pathological growth of tissues due to dysfunction, as well as changes in the formation and clinical syndromes, caused by diseases of the endocrine organ.

The stench can be diagnosed in different ways, the pathological features visually “generate” the neck, some may be seen less in the process of palpation, in other cases, they are only indicated in the case of a different ultrasound examination.
The morphology of the disease allows us to see such types: diffuse, nodular and diffuse nodular goiter.

One of the changes made by the 10th revision in the ICD was the classification of pathological thyroid ulcers not only for morphological signs, but also for the reasons for their appearance.

In such a rank, one sees such a goiter:

endemic approach to iodine deficiency;

euthyroid or non-toxic;

thyrotoxicosis become.

For example, to look at viniclia due to iodine deficiency, endemic goiter microbial 10 is given to you code E01. The official formula should sound like this: "Sickness of the thyroid gland, tied up with iodine deficiency and become similar." So, as a given group of diffuse nodular goiter, as well as diffuse nodular goiter, can be attributed to this code of international classification, but only a species that has developed due to lack of iodine.

Microbial code 10 E04 maє for the prevention of sporadic non-toxic forms of goiter. You can see people like a diffuse yogo, so they are vuzlov - one vuzol or impersonal. So diffusely nodular goiter, which may not be the cause of iodine deficiency, but, for example, a genetic shift to dysfunction of the thyroid gland, can be "marked" with the alphanumeric code E04.

If you want to bring respect to the group of people who are ill under the E05 microbial code, the main concept of these pathologies will be thyrotoxicosis. Thyrotoxicosis is called a camp, when there is a toxic effect on the body due to excess thyroid hormones in the blood, for example, adenoma of the thyroid gland. The main reasons for such processes are toxic goiter: diffuse toxic goiter, nodular toxic goiter (one and the same multinodular) and mixed form. So the toxic type of diffuse-nodular goiter is included in itself up to the E05 group.

However, don't ever try to beware of one doctor. There are fluctuations, if you need to move to another place in the country. Otherwise, it is possible to continue exaltation in foreign clinics with certified fahivtsiv. That and doctors need to be exchanged with the data of the laboratory tests. Itself in such situations one can see the importance and corrosiveness of such a document, like ICD 10. different lands, scho, naturally, for an hour, and resources. And the hour, as it seems, is expensive.

ICD-10: see the goiter

ICD 10 - International classification of ailments of the 10th revision was created to systematize data on ailments that are similar to their appearance.

For the purpose of understanding the disease, a special coding was broken up, in which the great letters of the Latin alphabet and numbers are embedded.

Illness of the thyroid gland is assigned class IV.

Goiter, as a type of disease of the thyroid slough, also inclusions up to ICD 10 and may be sprat types.

See goiter from ICD 10

A goiter is a clear manifestation of an increase in the tissue of the thyroid gland, which is due to impaired function (toxic form) or through changes in the structure of the organ (euthyroid form).

Classification of the ICD 10 transfers the territorial middle of iodine deficiency (endemic), through some possible development of pathologies.

Inhabitants of the regions suffering from iodine-poor soils are the most affected by ailments - the whole geography of the territory, regions, far out to the sea.

An endemic type of goiter can seriously interfere with the function of the thyroid gland.

Classification of goiter according to MKL 10:

Diffuse endemic;

Bagatovuzlovy endemic;

Non-toxic diffusion;

Non-toxic single node;

Non-toxic rich knots;

Other clarified see;

endemic unspecified;

Non-toxic Unspecified.

A non-toxic form - one that is toxic in nature, does not affect the normal production of hormones, causes an increase in the thyroid gland in morphological changes in the organ.

Zbіlshennya obyagu most often svіdchit about the development of goiter.

In case of visual defects, it is not possible to immediately establish the cause of that type of illness without additional analyzes and follow-up.

For accurate diagnosis, all patients need to undergo an additional ultrasound scan, blood for hormones.

Diffusion endemic process

Diffuse endemic goiter, ICD code 10 - E01.0, is the most common form of infection.

In this case, the entire parenchyma of the organ was reduced through the gostra or chronic lack of iodine.

Patients are worried about:

weakness;

apathy;

head bіl, zamorochennya;

poison;

more difficult forging;

etching problems.

Later, pain may develop in the region of the heart due to a decrease in the concentration of thyroid hormones in the blood.

AT heavy upheavals it is shown surgical insertion and removal of the goiter.

Residents of iodine deficiency should be encouraged to regularly take iodine-containing products, vitamins, and regularly undergo obstezhennia.

Rich nodular endemic process

This species has code E01.1.

In case of pathology, on the tissues of the organ there are sprats of new creation, which are well established.

Goiter grows through iodine deficiency, which is characteristic of a specific mass. The symptoms are seen as follows:

hoarse, hoarse voice;

pain at the throat;

breathing is more difficult;

zamorochennya.

It is necessary to remember that only with the progression of the disease, the symptoms become pronounced.

At the bud stage, drowsiness is possible, such signs can be seen before relapse or other illnesses.

Non-toxic diffusion process

The code for ICD 10 is E04.0.

Improvement in the area of the thyroid gland with daily changes in functionality.

Vіdbuvaєtsya through autoimmune damage in the structure of the body. Signs of illness:

headaches;

poison;

characteristic deformity

Possibly aggravated as bloody.

A number of doctors are aware that euthyroid goiter can not be extorted by doti, the docks of wine do not sound like a stravochid and trachea and do not sound like a spasmodic cough.

Non-toxic single node process

May code E04.1.

This goiter is characterized by the appearance of one clear neoplasm on the thyroid gland.

Vuzol bring discomfort in case of wrong chi untimely glee.

In the world of the progress of ailments, swelling is clearly pronounced.

With the expansion of the university, there is pressure on nearby organs, which leads to serious problems:

broken voice, dihannya;

forging is more difficult, problems with etching;

zamorochennya, headache;

the work of the heart-vascular system is incorrect.

The area of the node can be very sick, it is affected by the ignition process and swelling.

Goiter unspecified endemic

May code from ICD 10 - E01.2.

Tsey type of confusion with territorial iodine deficiency.

If there are no clearly pronounced symptoms, the doctor cannot determine the type of illness after proper analyses.

Illness is expected for an endemic sign.

Non-toxic rich knotting process

Non-toxic rich knot type, code E04.2. at MKL 10.

Pathology of the structure of the thyroid gland. for yakoї clearly pronounced vozlovih new creations of sprat.

The pits sound asymmetrically ruffled.

Other types of non-toxic goiter (specified)

Until further clarification of the forms of non-toxic goiter, infection, which is given the code E04.8, is given:

Pathology, for which it was revealed as a diffuse growth of tissues, and illumination of the nodes - diffuse - nodular form.

The growth of that commissure of a few nodes is a conglomerate form.

Similar resolutions are observed in 25% of cases of illness.

Unspecified non-toxic goiter

For this type of goiter, the code is E04.9 in ICD 10.

Stay in quiet moods, if the drug as a result of obstezhennya indhilyaє toxic form of illness, but can not be the same as the pathology of the structure of the thyroid gland present.

Symptoms in different cases, analysis of a new picture cannot be presented.

How can MKL 10 help?

Tsya klassifikatsiya razroblen nasampered for the appearance of that porivnyannia clinic zahvoryuvan, for statistical analysis of mortality in other territories.

The classifier brings harm to the doctor and the patient, helping to make an accurate diagnosis and choose the most viable strategy of healing.

Nodular and diffuse goiter of the thyroid gland

Characteristics

Risi zahvoryuvannya read s yogo name:

Diffusive - means that there is no clear macroscopic (to be guarded by an unobstructed eye) between diseases and healthy vines. At the early stages, it is important to see the hour of the microscopic follow-up. Illnesses of patients and yogo groups may be evenly roztashovani among healthy people.

The goiter may be on the verge of the schilnist of the pathological children at the same time at the same rank of the university. The stinks become commemorated with ultrasonic follow-up without being in the middle before the cob of ailment.

Mechanism for the development of disease infestations due to the infusion of thyroid-stimulating hormone (TSH) on the tissue. Vin viroblyayetsya in the hypophysis. This hormone stimulates the growth and development of the colony. In pathology, there is an increase in clitin, and then the tissue itself (hypertrophy). Tse to bring to the fact that the number of hormones (tyronins), which are vibrated by the thyroid gland, increase. At the first stages of their vision, they are controlled by the work of the hypothalamic-pituitary system of the brain. Through a sprat of rocks (an hour to lie in external factors) immune cells through the zbіy defense system begin to attack hypertrophic cells of the colony. It is called an autoimmune process. The wall of cells is collapsing, hormones are massively found at the roof.

Causes of pathology

The development of a diffuse goiter is more associated with autoimmune processes, the silience decreases to some extent. It is not necessary to bring up the fact that in children, in some of them, there is an endocrine pathology, nodular goiter develops more often. Blame yourself on the sickness under the influx of outrageous officials. To that term yogo on the cob raznyatsya. In the middle of the century, an interval between 30 and 50 years is considered. Women suffer from this pathology 8 times more often.

Outrageous factors that provoke the development of an illness:

stress;

injuries;

chronic pathologies of the upper dichal pathways

Clinic of illness

Diffusive goiter procures for a long time. Often yogo is manifested already for the obviousness of the singing complication. All stinks are related to the increase in the production of thyroid hormones. As a result, not a positive, but a toxic effect on the body is manifested.

early signs

You can suspect the disease for early symptoms. The stench is considered obvious only for the obviousness of damage in equal hormones in the thyroid gland and TSH. At the early stages, all the signs may appear differently and so self-sign (unstable).

Before the first symptoms can be seen:

tachycardia (improved heartbeat);

lack of masi tila for good eating;

causeless headaches;

drinkability.

Piznі symptoms and aggravation

At the stage of disintegration of ailments, the ailing person has a sign of stamina. There are few new symptoms. All of them are grouped like this:

Endocrine. The high exchange rate of speeches causes a decrease in the weight of the body on aphids to increase appetite. In women up to 40-45 years of age, menstrual cycle failures are observed. They also have a characteristic early onset of menopause.

Neurological. Patients are drastically and with an unstable psyche. Often there is a tremor of kintsivok, sleeplessness and weakness with ruhi (especially when trying to get up from the bed).

Cardiology. Various disorders of the heart rhythm (tachycardia, extrasystole, militant arrhythmia), arterial hypertension and heart failure. The rest comes to the sickness stages. Vaughn is characterized by a backside, swollen legs, an enlarged abdomen due to ascites empty stomach).

dermatological. Promoted to dermatitis (inflammation of the skin curve) in the natural folds of the body. With a trivial diffuse goiter, the changes are stubborn. The stinks become brittle, deformed.

Ophthalmological. The eyes of the patients are visible from the orbits. To make them visually bigger. The upper and lower legs, through the constant tension, swell the crossed look.

Diagnosis and the stage of healing

For the establishment of the diagnosis, it is necessary to have a number of symptoms with an increase in the amount of hormones in the thyroid gland. Rіven TSH can be like advances, and decreases.

An important clinical significance is different at the steps of the scaling. To the extent of laboratory and instrumental methods of research, stench was considered the main criterion for the stage of illness and the effectiveness of the treatment. Before them one can see:

0 steps should be set, as there are no changes in the thyroid gland. With any clinical and / or laboratory data, there is an increase in the production of hormones.

The 1st world is set up with a slight increase in the fall. Calls won't show up. Tse it is possible to palpate less (make with fingers).

The 2nd world means that the increase in the ridge will mean the hour of forging. Low patient awareness with whom the breast is in the throat.

The third step is the post-visual improvement of the climb. The patient spends the whole hour watching the breast in the throat.

The 4th stage is set up with larger ridges, which lead to deformation of the shii. A number of authors see the 5th step, if they change not only the anterior, but also the lateral surfaces.

Celebration

Therapy for diffuse goiter can be three options:

conservative medical treatment;

radioiodine therapy;

surgical exuberance.

Choosing the method to lie down in the stage of illness, I will become the individual characteristics of the patient. In other words, this combination is victorious.

Medical treatment administering drugs that reduce the production of thyroid hormones and/or block thyroid disease. The main drug is Mercazolil. Vіn pereshkodzhaє synthesis of hormones. Yoga reception is carried out under the control of equal tironin. As additional therapy, beta-blockers (Concor, Egilok, Anaprilin, Bidop and In), potassium preparations (Asparkam, Panangin) and sedative herbs (valerian, dog nettle) are prescribed.

Radioiodine therapy zastosovuetsya in case of progression of illness (clinical and laboratory-instrumental deterioration) through fate, without regard for medical treatment. The procedure improves the administration of the isotope iodine-131. Vin vibirkovo accumulates in the thyroid gland. In case of disintegration of the 10th nucleus, the radioactivity of the viprominence is increased. There's a living clitiny creep. It is especially important to be quiet, so that a high level of metabolism can be achieved. The result of therapy is the removal of all hypertrophic tissue.

Surgical treatment is carried out only for the duration of the effect of drug therapy and short-term (for 1-2 months) increased infections. The meta method is useful in viscous hypertrophic tissue. In some cases, they go in to a complete resection (removal) of the ulcer.

All methods of guilt are carried out for the completion of a special diet. Vaughn maє on the vase, including fatty, greased and smoked hedgehogs. Strength is limited to 6-8 g per doba (for the presence of arterial hypertension - up to 3). From meat it is allowed to live in less chicken and low-fat varieties of yalovichi. Riba (perevaga seems to be freshwater) can be eaten with a stewed looking vegetable. All porridges (Greek, barley, barley) are allowed.

RCHD (Republican Center for the Development of Health Protection of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2016

Nontoxic multinodular goiter (E04.2), Nontoxic single nodular goiter (E04.1)

Surgery, Endocrinology

General information

Short description

toppled
Joint commission for the quality of medical services
Ministry of Health and Social Development of the Republic of Kazakhstan
date "13" Lipnya 2016
Protocol #7

Goiter- Tse zbіlshena thyroid gland. If, at the same time, knots of illumination are formed in it, go about the nodular goiter.
Nodular goiter- a series of ailments, like washing one bed of rice - vuzluvaty utvory in the thyroid gland.
Note*: Zalіza is made up of clitins (folkulіv) filled with koloid speech. The vuzol of the thyroid gland can be single or multiple (rich nodular goiter) and cystic or plump, as it forms from the follicle.

ICD-10 and ICD-9 codes:

MKL-10		MKL-9
The code	name	The code	name
E04.1	Non-toxic single nodular goiter	06.00
E04.2	Nontoxic bagatonodular goiter	06.20	Unilateral thyroid lobectomy
		06.21	Subtotal resection of the thyroid gland
		06.31	Hanging a poshkodzhenoy plot of the thyroid pit
		06.32	Enucleation of the hand or the node of the thyroid gland
		06.60	Vision of the sublingually ruffled thyroid gland
		06.98	Other operations on the thyroid gland

Date of release / revision of the protocol: 2016 rec.

Koristuvachi protocol: surgeons, endocrinologists, therapists, general practitioners.

Evidence scale:
At this protocol, the following classes of recommendations and equal proofs for request are awarded:
Riven I- Evidence, otrimanі in the course of admission in the form of one long-term rank of a broken-down, controllable follow-up or meta-analysis
Riven II- Evidence, otrimani protyamnі accepted from one kind of disaggregated clinical trial without proper randomization, from an analytical cohort or according to the type of tests-control (importantly from one center) or from taking away dramatic results from uncontrolled trials.
Riven III- Prove, obtained from the opinions of authoritative reports on the basis of clinical evidence.
Class A- Recommendations, which were praised for accepting 75% of the multi-sectoral group of experts for the weather.
Class B- Recommendations, yakі buli deshcho spіrnі that did not zastrichali zgodi.
Class C- recommendations that called out the real differences among the members of the group.

Classification

Fallow in addition, as the same factors have plunged into the development of illness, what kind of warehouse that went to goiter, you see it like this:
a single (solitary) vuzol;
multiple nodular goiter (multiple nodular goiter);
· conglomerate nodular goiter (thyroid bulge is formed by a large number of conjunctivitis);
Diffuse-vuzlovy goiter (thyroid fold, in yakіy є nodules, zbіlshena);
· Right cyst of the thyroid gland;
follicular adenoma (good puff);
· Evil fluff.

The degree of development of this disease depends on the improvement of the thyroid gland. Until 2001, it was accepted to rock the classification of nodular goiter, proponated in 1955 by O. V. Nikolaev. Then the All-World Organization for the Protection of Health has launched a system for identifying the degree of infection of the vine. In this hour, physicians in their practice beat the system as persuasively.

Classification of the growth of goiter, proponated by Mykolaiev:
Step 1-a - the thyroid fold is not visible, the prote is noticeable on palpation;
· Stupin 2-a - the hallway is visualized, especially when forging;
· Third stage - thyroid gland zbіshuє contour shiї ("tovsta shiya");
Step 4-a - an obvious goiter is observed, the shape of the shi is changed;
· Stupin 5-a - thyroid ridge increases to great expansions. With whom you squeeze internal organs, roztashovani order.

Classification, proponated by the All-World Health Organization (WHO):
Step 0-a - goiter daily;
Stage 1-a - goiter is visible on palpation, the proteus is not visible;
Step 2-a - the goiter is palpable and can be clearly seen with the eye.

Diagnostics (ambulatory)

DIAGNOSTICS AT OUTPATIENT RIVNI

Diagnostic criteria

Skargi and history: unacceptable sight in the area of the neck, associated with increased thyroid ulcers: feeling the pressure on the neck, intolerance to tight compresses. As the expansion of the thyroid gland continues to increase, there may be signs of pressure on the otochuyuschie organs, especially in the supine position, it may cause difficulty with diarrhea, and it may be necessary to shift during covation. When the goiter is large, the judges are crushed, which can lead to the destruction of blood circulation and the development of heart failure.
NB! In some cases, skargi with given nosology can be daily.

Physically obstezhennya: palpation of the thyroid gland, which allows you to reveal the presence of the goiter itself, evaluate the level of its virulence, and determine the size of the nodular dentures.

Laboratory studies:
Significance of the level of TSH and thyroid hormones in the blood - an increase in the level of TSH is indicated for those who are ill with ultrasound, who have symptoms of reduced or increased thyroid function, as well as during conservative exuberance nodular goiter with thyroid hormone preparations to monitor the adequacy of therapy;
· Appointment of calicitonin in the blood - in patients who may experience medullary thyroid cancer in the family (including those within the syndrome of multiple endocrine neoplasia type 2), to a large extent, either basal or pentagastrin-stimulated calcitonin in the blood. In other cases, calcitonin is not indicated. Tim not less, low authors recommend total screening for calcitonin in patients with nodular goiter. Serious arguments against such an approach are the rarity of medullary thyroid cancer (when screening, almost 11,000 patients with nodular goiter, medullary carcinoma was detected in 45 cases) and a good track record.
· Appointment equal to thyroglobulin - increase in thyroglobulin in the blood of the authorities in rich disease of the thyroid gland, which in front of us proceeds with thyrotoxicosis. It is carried out for 2-3 days after the puncture biopsy, and also for 1-2 months after the operation on the thyroid gland. Concentration of thyroglobulin is not a differential marker of benign or evil puffiness. This indicator is very important diagnostic value after surgery for the drive of differentiated thyroid cancer: with progression of disease, after non-radical surgery, recurrence and metastasis, instead of thyroglobulin in the blood rises.

Instrumental tracks:
X-ray of the organs of the chest - to exclude the pathology of the organs of the thoracic emptying;
· Esophagogastroskopiya (EFGS) - to exclude the pathology of the upper thyroid gland;
· Ultrasound of the organs of the empty stomach (liver, zhovchny mіkhur, pidshlunkova slough, spleen, nirki), Ultrasound of the empty stomach, radiography of the organs of the chest, FBS, ECG, sporography, CT of the organs of the chest and organs of the cervical emptying - for indications
TAB - thyroid biopsy
scintigraphy of the thyroid gland
fibroscanning of the thyroid gland
Note*: the methods of laboratory and instrumental diagnostics were appointed as visceral tests for hospitalization.

Diagnostic algorithm:

Diagnostics (hospital)

DIAGNOSIS ON STATIONARY RIVNI

Diagnostic criteria on the stationary level:
In most cases, goiter vuzli may have a small rozmіr and may be revealed only for an hour with fahіvtsy. The severity of the symptoms of the disease characterizes this type of disease, like a nodular goiter of the proliferative type.

Skargi and history:
In this situation, the main symptoms of nodular goiter are the self-exposure of the nodules. With increased nodules in rosemaries, the following signs of nodular goiter are indicated:
· Visible swelling at the throat;
bіl in the throat;
· Difficulty forging;
· Growing difficulty breathing;
hoarseness of voice and constant dry cough;
· Detection of poisons when changing the position of the body;
· parts of zamorochennya;
· A little bit of tension in the head with cheeks.
These are the mechanical symptoms of nodular goiter, like an increase in the thyroid slough and a swell on the affected organs (larynx, stravochid).
Symptoms of diffuse nodular goiter:
· sickness to partial bronchitis, pneumonia and acute respiratory infections;
· Low arterial pressure;
· Zbіy heart rhythm, bіl at the heart;
· Back at physical advantages;
· Nudota, vіdsutnіst appetite;
daytime drowsiness with nocturnal sleeplessness;
· Loss of respect and memory;
Depression and nervousness;
· Dryness of skin folds;
· Decreased body temperature;
· bloating (zvіdsi - zbіlshennya vazі with reduced appetite);
· In children - the development of physical and rosal development;
· In cholovіkіv - decrease in sexual craving and potency;
· In women - disruption of the menstrual cycle, spontaneous abortions, without pregnancy.
If a goiter develops on the aphids of Graves' ailment, then, in addition to more symptoms, there may be warning signs of:
· Postiyne more like hunger with regular vraty vrat;
· Trival increased temperature;
· dry and hot cloths;
· drativity;
Hand tremor
· Vipinannya eyes.

Anamnesis:
Most of the nodular infections are asymptomatic, with their presence of symptoms including their malaria (Riven Z).
It is necessary to record the onset data of the anamnesis (river C):
· Contagion of SC in relatives;
· sickness shiї and їх likuvannya in anamnesis;
· Zbіlshennya rozmіrіv shiї;
· hoarseness, dysphonia, dysphagia or back;
· roztashuvannya, schіlnіst and rozmіr vuzlovoї osviti;
· Pain or pain at the dilyantsі shiї;
Shiina lymphadenopathy.
Symptoms of hyperthyroidism or hypothyroidism, factors that increase the likelihood of cancer (Riven C):
· Prominennya heads that shiї in anamnesis;
Medullary cancer or MEN-2 in relatives;
Вік young 20 or older than 70 years;
become a human being;
· Increased university lighting;
schіlna chi solid consistency;
cervical lymphadenopathy;
· Not zmіschuvane vuzlove osvіtu;
· Permanent hoarseness, dysphonia, dysphagia or back.

Physically obstezhennya;
When looking at the patient, it may not be changed, the proteus junction may be visible when the head is thrown back. On palpation, it is possible to distinguish between a nodular, diffuse, and richly nodular goiter. Palpation assess the soreness of the nodule, its consistency, swelling to ossified tissues, widening of the goiter behind the sternum (reaching the lower pole during suturing). In case of a node of great size (more than 5 cm in diameter), deformity of the neck, swelling of the cervical veins (rarely, only for more significant expansion of the nodes) can be caused. Signs of pressure in the case of a great retrosternal goiter are heard when the hands are raised above the head (Pemberton's symptom), with which hyperemia of appearance develops, confusion or untiredness. Obov'yazkovo dosl_dzhuyut lymphatic nodes shi.

Laboratory studies: div. outpatient rіven.

Instrumental follow-up:
· Ultrasound of the thyroid gland: Optimal for follow-up SC are sensors with a frequency of 7.5 MHz and 10 MHz. Ninі vykoristovuєtsya kolorovoe Dopplerіvske kartuvannya, scho allows vіzualіzuvat dіbnі sudini u shchz. The indications for ultrasound examination are the appearance of a “nodule” in the thyroid gland during palpation.
Note*: The ultrasound protocol is responsible for reflecting the following requirements:
· Do you feel the "vuzlu" organic change in the tissue of the thyroid gland?
· Does the patient have a solitary (solitary) "vuzol" or a sprat "vuzlіv"?
· How to understand the structure of the "node"?
· What is the nature of the blood flow in the "vuzli"/capsules?
· Visnovok ultrasound may be of a descriptive nature and not revenge the "clinical diagnosis".
Ultrasound method can be used for calcification and with additional help it is impossible to determine the morphological characteristics of the pre-sliding thyroid gland. Prote, it is possible to show indirect signs of your illness, which will help the clinician to conduct a diagnostic test.

Ultrasound signs of thyroid glands
Right cyst	Anechoic establishment of the correct form with equal and thin walls and homogeneous in place, which contains the capsule
"Vuzol" with moderate cystic changes	"Vuzol" in part of the thyroid gland with the presence of hypoechoic zones. Take a capsule
Coloid "woozles"	Nodules in the thyroid cavity with a different echogenic structure, which make the capsule clear
Adenomi	Nodules round shape with clear contours, encapsulation, reduced echogenicity (mostly)
adenocarcinoma	Established in the thyroid gland with fuzzy contours, a solid structure, reduced echogenicity, and sometimes there is evidence of microcalcifications in the closed and / or the presence / illegibility of the capsule

·
Thin-headed puncture biopsy: Thin-headed puncture biopsy of the thyroid gland allows a direct assessment of structural changes in the thyroid tissue. Guidelines for the method є: confirming the diagnosis of swelling of the thyroid gland, including malignancy; the manifestation of morphological changes in the fabric of the "vuzla"; differential diagnosis between autoimmune thyroiditis and nodular goiter.
Note*: Use of a newly formed thyroid gland, if it is possible to puncture, due to the following procedures. In singing depressions, with viconan puncture biopsy under ultrasound control, they can be blamed for singing folding, associated with a small size of "vuzlіv". Todі vypravdano actively-vikіkuvalnu tactics vednya ailing.

Cytological diagnosis of the pathological process in the thyroid gland is based on the presence of sinus signs. On the effectiveness of the method of puncture biopsy, the following factors are added: the qualification of the doctor, who viroblya puncture, the qualification of the doctor-cytologist; dotrimanya correct technique for preparing smears, a quantity of taken material.

The main feature of a true nodular goiter is the presence of a capsule. For a nodular goiter, it is also characteristic of different changes of a regressive character, and itself: bloody, cystic degeneration of the "nodule", calcification of the stroma or the capsule of the "nodule". When performing a puncture biopsy in case of nodular goiter, as a rule, the column and thyrocytes are removed. The spiking of these components characterizes the type of goiter: in different cases, it is more important to have a colony, or a colony goiter, and for the presence of a large number of thyrocytes - a proliferating colony goiter.
Але іноді навіть при виконанні всіх перерахованих умов, у разі підозри на наявність злоякісної пухлини на підставі анамнестичних та клінічних даних, слід незалежно від результатів цитологічного дослідження та розмірів "вузла", домагатися гістологічного уточнення діагнозу шляхом його профілактичної резекції. For the presence of two and more clinical symptoms with lower listings, prompt treatment is indicated independently, depending on the results of further laboratory and instrumental obstezheniye, shards of risk for thyroid cancer in such ailments voice calls, increase in regional lymph nodes, presence in this patient with medullary thyroid cancer

Cytological investigation of the punctate of the nodular thyroid slough does not allow superficial differentiation of benign puffer - follicular adenoma of highly differentiated thyroid slough cancer. Tsya the situation dictates the likuvalnu tactics in case of follicular adenoma - we have ailments shown promptly likuvannya.
·
Radioisotope scanning: The Danish method allows to exclude thyroid cancer only in 10% of all "nodules", which are functionally active ("hot"). If there are 90% of other "bunches" ("warm" and "cold"), then for the help of the method of isotope scanning it is impossible to work out any kind of song about their morphological dominance. The frequency of the growth of evil swell in these "nodules" reaches 5-8%. The method of isotopic scanning can be corny in patients with ultrasound, while ignoring the level of thyroid-stimulating hormone (TSH) in the blood under suspicion of thyrotoxicosis. In this case, an autonomously functioning "vuzol" is often diagnosed, which most often appears as "hot" on scans.
The risen of the rijik formulant of the functions autonomous thyroids is pricked, the number of NIMIKH (COUNTIONS, SCHOTHIKHEN OF TLAI EUTIROOZA), with trivalum in the regions of the iodine defixita, universities of the union at the uglye of the uglynes of the uglynes of the uglynes of the uglyniy of the uglyniy of the uglyniy of the umbers of the uglyniy of the umbers of the uglymes of the uglyniye Most of the functional autonomy develops with a multi-nodular goiter.
·
X-ray examination of the chest with barium contrast: Dane doslіdzhennya allows to reveal the ringing or the displacement of the trachea and the stravokhod in an ill person for a nodular goiter, and also to diagnose a retrosternal goiter.
Indications before the X-ray examination of the chest with barium contrast in case of nodular goiter:
- nodular goiter of significant growth;
- retrosternal nodular goiter;

Diagnostic algorithm: ambulatory rіven

A list of the main diagnostic approaches:
Basic (obov'yazkovі) diagnostic obstezhennia, which is carried out on a stationary level in case of emergency hospitalization, diagnostic obstetrics are carried out, which have not been carried out on an outpatient basis:
UAC;
· OAM;
· Biochemical blood analysis: glucose, albumin, electrolytes;
· Coagulology (PTI, fibrinogen, hour of throat, INR);
· Designation of blood group for the AB0 system;
· Determination of the Rh factor of the blood;
· Blood test for VIL;
· Blood test for syphilis;
· Determination of HBsAg in blood serum by ELISA;
· Identification of total antibodies to hepatitis C virus (HCV) in blood syrometry by ELISA;

· Ultrasound of the organs of the empty cervix;
X-ray of the chest organs.

Revision of additional diagnostic visits: Additional diagnostic examinations to be carried out on a stationary level - for indications :
Ultrasound of the organs of the empty stomach (liver, zhovchny mіkhur, pіdshlunková zaloza, spleen, nirki);
· ECG for exclusion of cardiac pathology;
Inspection radiography of the organs of the chest;
· Computerized tomography of the chest organs;
· Spirography.

Differential diagnosis

The main task of an endocrinologist is to carry out a differential diagnosis of nodular thyroid glands. For whom, practically all the most important methods of research can be used. The main significance in the differential diagnosis of nodular thyroid glands is the puncture biopsy under ultrasound control. A puncture biopsy is indicated for all nodal findings that are larger than 1 cm in diameter. A smaller clinical significance is not possible; a puncture biopsy is not indicated for them.
·
The most characteristic signs, both clinical and instrumental-laboratory, are indicated below, for which one can judge the morphological nature of node illumination in a patient.

Differential diagnosis of cancer of the thyroid gland and benign tumors of the thyroid gland
Methods of scalding	thyroid cancer	Adenoma/nodular goiter
Anamnesis	Presence of thyroid cancer in relatives; Prominence of SC, head, shi in anamnesis.	History of no tightness
clinical picture	Solitary "vuzol"; "vuzol" in a person's mind; "vuzol" in a person older than 55 years old or younger than 25 years old; "vuzol" painful on palpation; shvidkozrostayuchiy "vuzol"; dysphagia	Bagatovozlovy goiter; "vuzol" in a woman in a woman aged 25-55 "woozli", painless on palpation; vіdsutnіst shvidkogo rostannya "vuzla"
Instrumental methods	Cancer suspicion on ultrasound (hypoechogenicity, indistinct interstitial nodes, changes in lymphatic nodes) Cytological picture of thyroid cancer	Cytological picture of adenoma, nodular colloid goiter

Differential diagnosis of nodular euthyroid goiter, toxic adenoma, toxic nodular goiter
		Bagatonodular euthyroid goiter		Toxic adenoma	Bagatovozlovy toxic goiter
Type of goiter				Solitary "vuzol"	Great goiter with an impersonal "vuzlіv"
TSH, St. T4, T3		Norm		Subclinical (TSH suppression, T4 and T3 normal) or manifest thyrotoxicosis (TSH suppression, high levels of thyroid hormones). Often - isolation of T3-thyrotoxicosis (TTH suppression, T4 - normal, T3 movement)
Triviality of presence of goiter/"nodule" before the development of thyrotoxicosis		Thyrotoxicosis is not		Rocky	Rich Rocks
Vik		Vіd 45 roіv		30-70 years	50-70 years
The severity of thyrotoxicosis		daily		Ring out the middle	Middle chi vashka
Differential diagnosis of nodular goiter with hypertrophic form of chronic autoimmune thyroiditis and intermediate form of acute thyroiditis
Characteristics	Nodular colonic (euthyroid) goiter		Vognishcheva form of acute thyroiditis			Chronic autoimmune thyroiditis (hypertrophic form with pseudonodules)
Trivality of foundation	Rocky		Swedish clinical development (days). Variability of the clinical picture			Rocky
Clinical manifestation	Practically asymptomatic, in moderate depressions there is slight pain on palpation		Severe pain on palpation, on turning the head. Shvidka (days) normalization will become during therapy with glucocorticoids			In the phase of euthyroidism, the symptomatology is daily (goiter, palpation at the node of the pregnancy). Possible phases of thyrotoxicosis (hashitoxicosis), euthyroidism, hypothyroidism.
Laboratory data	euthyroidism		Increased SHOE, in the phase of aggravation - thyrotoxicosis			The level of thyroid hormones, characteristic at the stage of AIT. High titers of antithyroid antibodies.
ultrasound	Adjustment of different echogenicity with a clear capsule		Hypoechoic lesion in the tissue of the thyroid gland without a clear capsule			Inhomogeneous in terms of echogenicity, the plant without a capsule on aphids is characteristically altered in case of AIT on the superfluous tissue of the thyroid gland
Cytological picture	Expanding follicles, large number of colonies, narrowed thyrocytes, nuclear cells without mitosis figures		Giant cells of third-party bodies, degeneration of the follicular epithelium, histocytes			Ryasna lymphocytic infiltration, B-clitin transformation (Gurthle-Ashkenazi cells)

Likuvannya (outpatient clinic)

FUN IN OUTPATIENT RIVNI

Tactics of jubilation:
Investigation to lie down depending on the results of a thin-necked aspiration biopsy.
For TAB:
· as manifestations of a colonic goiter - watchfulness for the function of the thyroid gland and the size of the node by a profile doctor;
· as manifestations of cancer - the patient is guilty of transfers to the profile fahivtsu.

Algorithm for emergency situations: no.

Others see the glee: nі.

· consultation of an endocrinologist - to confirm the diagnosis of goiter and euthyroid state;
· consultation of a general practitioner, cardiologist and other higher education specialists – for indications.
consultation of an oncologist - with nodules larger than 1 cm.

Preventive visit:
Pervinna: healthy image life, rational eating, proper treatment of disease of the thyroid gland and safe introduction of the optimal amount of iodine into the body, 5-6 gr. iodized salt:
· force is guilty of escaping in good closing capacity (including falling on the force of direct sleepy changes);
· Dodavannya salt in їzhu only after re-preparation or in the very end of the process.
Secondary: Endocrinologist's Dispensary.

Prevention of recurrence of nodular/large nodular goiter after surgery:
In patients with unilateral resection of the part, recognized by levothyroxine sodium, it is necessary to prevent the recurrence of nodular goiter in the tissue of the ulcer, which is lost.
Iodine deficiency can be an additional factor that increases the risk of postoperative recurrence of nodular goiter. In conjunction with cym, prophylactic administration of levothyroxine sodium is recommended for all patients with bilateral resection of the thyroid gland.
If we often take levothyroxine sodium recommendations, we will be sick, if we can get a TSH level after 2 months after the operation, we will change the upper limit of the norm. We are ill with a euthyroid state of the thyroid gland function. Follow-up is carried out regularly (1 time for 6 months for the first time after the operation, then later) clinically and / or ultrasound determination of the volume of thyroid gland and TSH in the blood. If there is a tendency to an increase in TSH, then levothyroxine sodium should be prescribed in adequate doses.

Treatment of bagatovnodular toxic goiter
Bagatovuzlovy toxic goiter is most commonly seen in summer ailments, as they live in the minds of natural iodine deficiency, and often the cause of cardiovascular disease in them. Tactics of obstezhennja ailing є similar to that, as vikoristovuєtsya with euthyroid nodular goiter and include: looking around, palpation of the thyroid slough, ultrasound of the thyroid slough, puncture biopsy, TSH and for indications - radioisotope scan.
in case of functional autonomy of the node, the treatment with radioactive iodine is blocked I 131

Monitoring will become a patient:
· Control of ultrasound of the thyroid gland 1 time for 3 months;
· Laboratory control of thyroid hormones.

Indicators of the effectiveness of the treatment:
· Stable normal signs of hormones in the thyroid gland;
· Vidsutnіst zbіlshennya rozmіrіv vozlіv SC during dynamic ultrasound control.

Likuvannya (stationary)

FUN IN THE STATIONARY RIVNI

Tactics of jubilation: polygaє in the surgical removal of the parts of the thyroid gland and subtraction of the euthyroid state.

Non-drug treatment:
· Mode 2 - at the middle stage of severity of the state.
· Mode 1 - at an important station.
· Diet: the goal is sparing diet.

Medical treatment: nі.

surgical intervention,іz zaznachennyam indication for operative vtruchannya, zgіdno z addendum 1 to the second CP.

Others see the glee: Treatment with radioactive iodine - with the functional autonomy of the node.

Indications for consultation of specialists:
· consultation of the anesthesiologist - for the necessary preparation before the operation;
· consultation of a thoracic surgeon – in case of development of periesophageal conditions;
· consultation of a resuscitator - in cases of important complications, the nature of that general detoxification therapy;
· consultation of a cardiologist and other higher education specialists – for indications.
· Consultation of an oncologist - for the decision about the general operation.

Indications for transfer to intensive care and resuscitation:
У палати реанімації та інтенсивної терапії підлягають госпіталізації хворі з гострими розладами гемодинаміки різної етіології (гостра серцево-судинна недостатність, травматичний шок, гіповолемічний шок, кардіогенний шок та ін.), гострими розладами дихання, іншими розладами функцій життєво важливих системи, паренхіматозних органів та ін .);

Indicators of the effectiveness of litigation. Vidsutnіst vuzlovih utvoreny SHSHh and normalnі pokazynіv hormonіv SHCHZ.

Away Vedennya
· Determination of the level of TSH and thyroid hormones in the blood;
· Appointment equal to calcitonin in the blood;
· Appointment equal to thyroglobulin;
· Ultrasound of the thyroid gland.

Hospitalization

Indications for planned hospitalization: the presence of nodular goiter, as well as the growth of the disease

Indications for emergency hospitalization: nі.

Information

Dzherela and Literature

Minutes of the meeting of the Joint Commission on the quality of medical services of the MHSD RK, 2016
1. 1) Braverman L. Diseases of the thyroid. - Humana Press, 2003 2) Balabolkin M.I., Klebanova O.M., Kremenska V.M. Differential diagnosis and treatment of endocrine diseases. Posibnik, M., 2002 side. 278-281 3) Valdina E.A. Illness of the thyroid gland. Posibnik, St. Petersburg: Peter, 2006 4) Didov I.I, Melnichenko G.A. Endocrinology. National Kerіvnitstvo, 2012.Stor. 535-541 5) Didov I.I., Melnichenko G.A., Andreeva V.M. Rational pharmacotherapy for ailing the endocrine system and disrupting the exchange of speech. Help for practicing doctors, M., 2006, page 370-378 6) Didov I.I., Melnichenko G.A., Pronin V.S. Clinic and diagnosis of endocrine disorders. Navchalno-methodical help, M., 2005 7) Evidence-based endocrinology / Ed. Poline M. Camacho. Posibnik for doctors, Moscow: GOETAR-Media, 2008 8) Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer THYROID Volume 19, Number 11, 2009 Є Mary Ann Li. DOI: 10.1089 = thy.2009.0110 9) McDermott Michael T. Secrets of endocrinology, M.: Binom, 2003 10) Petunina N.A., Trukhina L.V. Diseases of the thyroid ulcer, M.: Geotar-Media, 2011 11) Shulutko A.M., Semikov V.I. Dobryakіsnі zahvoryuvannya thyroid and parathyroid slough. Forever-Methodical Posabel, 2008 12) "Klinichniy recommended American-Dologenic Associas of the University Zoba" Fadєv V.V., Podzolko A.V., magazine "Klinnoye Toy Tyreo-Duzniye", No. 1, 2006, 2006, 2006, 2006, 2006 goiter "Mahmud Kharib, Hossein Kharib, ThyroidInternational, No. 1, 2011 14) "Euthyroid goiter: pathogenesis, diagnosis, treatment" Fadeev V.V., journal "Clinical Thyroidology", No. 0

Information

The fast, which are vikoristovuyutsya at the protocol


AT	Arterial vice
ALT	Alanine aminotransferase
AST	Aspartate aminotransferase
APTB	activations partial thromboplastin hour
VIL	human immunodeficiency virus
VC	life is legen
SHKT	intestinal tract
ShVL	piece ventilation of legeniv
IFA	enzyme immunoassay
CT	Computed tomography
KShchS	acid puddle mill
INR	international normalization
IIM	maximum ventilation
MAUD	hvilinniy volume of dihannya
UAC	hot analysis blood
OAM	hot analysis of the section
WGC	chest organs
SHOE	rapidity of erythrocytes
GFR	glomerular filtration rate
ultrasound	ultrasonic follow-up
FBS	fiberoptic bronchoscopy
FEGDS	fibroesophagogastroduodenoscopy
LF	puddle phosphatase
thyroid	thyroid fold
ECG TAB	electrocardiogram thin-headed aspiration biopsy

List of retailers in the protocol from the assigned qualification data:
1) Izhanov Yergen Bakhitzhanovich - Doctor of Medical Sciences, Professor, AT NSCH im. O.M. Sizganova, m. Almaty.
2) Medeubekov Ulugbek Shalkarovich - Doctor of Medical Sciences, Professor, Head of head of the board, AT NNCG im. O.M. Sizganova, m. Almaty.
3) Tashev Ibragim Akzholovich - MD, professor, chemist at the department of surgery, AT "MUA".
4) Kalieva Miru Marativna - Ph.D., head. department clinical pharmacology and pharmacotherapy, KazNMU im. S.D. Asfendiyarov.

Statement on the day of the conflict of interest: no

List of reviewers:
Nurbekova Akmaral Asilivna – Doctor of Medical Sciences, Professor, Department of Endocrinology, KazNMU named after S.D. Asfendiyarova, chief out-of-state endocrinologist, Almaty city.

Reviewing the protocol after 3 years after its publication and date of the date of the beginning of decency, or for the evidence of new methods with equal evidence.

Addendum 1

Methods of operative and diagnostic insertion

The name of the operational and diagnostic intervention
- total strumectomy;
- subtal strumectomy.

METHODS, APPROACHES AND PROCEDURES OF DIAGNOSTICS AND RECEPTION - to deposit in the form of surgical treatment

Meta procedure performed / handed in: removal of the pathological fossa of the thyroid gland

Indications and contraindications for the procedure / insertion
Indicated before operative treatment in an emergency order:
cancer of the thyroid gland, suspicion of cancer in nodular goiter;
follicular adenoma of the thyroid gland (the reason is the inability to differentiate follicular adenoma in the form of highly differentiated follicular adenocarcinoma with cytological follow-up).

Indicated prior to operational treatment in a planned manner:
ailment with a knot at the thyroid gland with a yogo outer diameter over 3.0 cm:
· ailments with nodular goiter, yakі may have negative dynamics for the period of conservative likuvannya / watchfulness (growth of the nodule);
ailments with bagatovuzlovy toxic goiter (After carrying out medical preparation, for the presence of concomitant pathology, which does not allow for an operative intervention on the thyroid slough, such patients are treated with radioactive iodine treatment);
ailments with large cysts (more than 3 cm), which can form a fibrous capsule and stably accumulate homeland after oral aspiration
· ailments with adenomas of the thyroid gland, whether of a morphological type of ailment with retrosternal nodular goiter.

Contraindication before the procedure / insertion: contraindications for elective surgery - the presence of urgent pathology of organs and systems, as well as decompensation. chronic illness organism.

Translation of the main and additional diagnostic approaches: div. outpatient rіven.

Methodology of the procedure / insertion:
Zagalnі position, yakі nebhіdno vykonuvaty for any kind vtruchannya z drive benign disease of the thyroid slough:
· correct choice a place for opening the skins and roses for stretching fabrics with a method of ensuring sufficient exposure to the installation of cosmetic materials;
· subfascial vision of the thyroid gland as a necessary mind, which gives the opportunity to overcome the conflict with the laryngeal nerves, the colothyroid glands and other important organs of the thyroid gland;
· Retelny hemostasis, boots "dry" operating field allows you to carry out the operation anatomically and without complications.
The operation is carried out under general anesthesia, in case of contraindications before anesthesia, it is possible to perform under general anesthesia. Access to the world-similar rozrіz on shiї. The operation is either partial (subtotal strumectomy) in case of damage to only one part of the thyroid slough, or total strumectomy in case of multiple nodular bilateral lesions of the thyroid slough.

Performance indicators: more attention to patients with a minimal risk of relapses.

Attached files

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Principles of classification of endocrine diseases

Syndrome of natal iodine deficiency (E00 - E00.9)
Illness of SC, associated with iodine deficiency and similar conditions (E01 - E01.8).
Subclinical hypothyroidism due to iodine deficiency (E02).
Other forms of hypothyroidism (E03 - E03.9).
Other forms of non-toxic goiter (E04 - E04.9).
Thyrotoxicosis (hyperthyroidism) (E05 - E05.9).
Thyroiditis (E06 - E06.9).
Other diseases of the thyroid gland (E07 - E07.9).

Ailment, її causes those classic symptoms

Recession is called the main cause of the development of pathological diseases of internal secretion.
Influx of the navkolishny middle - unfriendly ecological situation, radiological background, lack of iodine in water and food products, ingestion of food chemistry, additives and GMOs.
Illness of the immune system, damage to metabolic processes.
Stress, psychoemotional instability, chronic autonomic syndrome.
Forty changes caused by hormonal changes in the body.

The most common symptoms of thyroid disease also show a general trend:

almost discomfort in the area of the neck, tightness, difficulty in forging;
losing weight without changing the diet of eating;
damage to the work of sweat ridges - it can be a sign of zayva pliability and dryness of the furrows;
drastic changes in mood, skhilnist to depression or zaiva nervousness;
lowering the severity of the mind, worsening the memory;
scargs for the robot ShKT (lock, carry);
problems in the robotic cardiovascular system - tachycardia, arrhythmia.

Deyakі zahvoryuvannya thyroid zoloza zustrichayutsya more often for other rіznyh ob'ektivnyh and subjective reasons. Let's take a look at what is the widest behind the statistics.

See thyroid pathology

Cyst of the thyroid gland

There is a small, good-natured puff behind the roses. It’s important that you can call lighting as a brush, as you move 15 mm. at the diameter. Everything below this cordon is an expanded follicle.

Autoimmune thyroiditis (AIT)

Ailment of the thyroid gland, which is characterized by inflamed tissue, caused by damage to the robotic immune system. As a result of such a breakdown, antibodies are vibrated by the body, which begin to “attack” the thyroid gland cells, saturate them with leukocytes, which cause ignition processes. In the hour, the water cells collapse, the necessary number of hormones cease to vibrate, and a pathological state appears, which is called hypothyroidism.

eutheriasis

Goiter nodular

Goiter

Diffuse goiter

Vіn is characteristic of equal growth of the thyroid gland, which indicates a decrease in the secretory function of the organ.

Tse zbіlshennya rozmіrіv thyroid zoloza, as it is not indicated for the production of normal quantities of thyroid hormones and not є after the inflamation of neoplastic dentures.

Cancer of the thyroid gland

One of the small-scale pathologies, which is manifested only by specific diagnostic methods, the symptoms are similar to those of other thyroid ailments.

Methods of diagnostics

May all pathological neoplasms rarely develop into an evil form (cancer of the thyroid gland), only for a long time and untimely rejoicing.

For the diagnosis of vicorist, there are the following methods:

medical examination, palpation;
analysis of antibody titer to thyroid tissue
ultrasonic follow-up of the SC;
hormone analysis;
if necessary, a thin-necked biopsy.

The most effective ways of jubilation

Likuvannya can be conservative, tobto medication. The preparations are prescribed for suvoriy vidpovidnosti to laboratory results. Self-talk is unacceptable, fragments of the pathological process help control and correction of a specialist.

For obvious indications, an operative visit is carried out, if a part of the organ is seen, as if it is weak to the pathological process, or the whole organ.

Treatment of autoimmune diseases

medicamentous - straightened out by excess hormones;
treatment with radioactive iodine or an operation - to bring down the infection, which causes hypothyroidism;
reflexotherapy computer has been upgraded to the robot crawler.

The concept of nodular goiter in microbial cb 10 revisions

This nosological unit belongs to the class of diseases of the endocrine system, the disorder of eating and impaired speech exchange (E00-E90), the block of diseases of the thyroid gland (E00-E07).

Talking about the nodular goiter, it is important to remember that according to the ICD 10 different forms of disease of the thyroid ulcer are understood, which are explained through the vinification of that morphological characteristics. Otherwise, it seems that they have taken the chi of the newly-created, that at the vine and wash the capsule. The process can be one, or it can be richly knotted in a fallow manner. In case of this disease, there is no visible cosmetic defect, which is indicated by palpation, otherwise it is less likely to be confirmed for the help of ultrasound diagnostics. In this order, they see such morphological goiter:

Vuzlovy
diffuse
Diffuse-nodular

Classification

However, ICB 10 review still put the classification as the basis not only morphology, but the reason for the blame, seeing:

Endemic goiter as a result of iodine deficiency
non-toxic goiter
thyretoxicosis

Endemic goiter with iodine deficiency

Mkb 10th nosological unit to be assigned code E01. For this pathology, hyperthyroidism is characteristic. Tobto the activity of the thyroid gland without clinical manifestations toxic infusion of thyroid hormones It is possible to speak about the syndrome of thyrotoxicosis, if the symptoms of thyroid hormone intoxication are clearly manifested.

Etiology

As a matter of fact, name the cause of this disease - iodine deficiency in the body, with the difference at any stage of the body when the deficiency of this element is observed. As a result of the lack of information to the disruption of the absorption of iodine in the intestines, or to congenital pathologies of the thyroid gland, when the hormone production is disrupted, this is a variant of malnutrition. Absolute nedolіk vinikaє in endemic areas, de water, soil and kharchovі products with critically low iodine content.

Pathogenesis

With iodine deficiency, the synthesis of hormones T3, T4 is reduced, and the production of thyroid-stimulating hormone is promoted in the hypophysis, which stimulates a hyperplastic reaction in the tissues of the thyroid gland. Nadal process can become water-reinforced, so with the resolution of nodular goiter or diffuse. However, the mixed type is not included.

sporadic forms

In microbial 10 under code E04, non-toxic forms of goiter are seen. Vcheni dosі to talk about the wisdom of the sub-term in terms of endemic and sporadic, because the pathogenesis of the cause of the rest has not been clarified until the end. In microbial 10 review, the non-toxic form is subdivided into single node, bagatov node and diffuse.

Etiology

Genetic officials play an important role in the development of sporadic forms. It is a fact that not all residents of endemic areas develop hyperthyroidism, but it is more important to have a new birth genetic diseases associated with a defect in the X chromosome. As a result, the body can change the sensitivity threshold to iodine deficiency, as well as thyrotropic stimulation. For classical reasons, it is possible to mention the absence of the amino acid tyrosine, which is necessary for the synthesis of thyroxin. reception medicinal preparations storehouses store perchlorate, lithium salt, thiourea.

Under the code E05 microbial 10 okremo indications for the syndrome of thyrotoxicosis. This clinical syndrome is deluded by the negative influx of excess TSH. Thyrotoxicosis is a late disease of the thyroid gland, and itself:

diffuse toxic goiter
autoimmune thyroiditis
supraworld intake in the body of iodine preparations, or thyroid hormones
toxic adenomi
pituitary adenoma
increase in sensitivity to hormones in the thyroid gland

Diffuse goiter of the thyroid gland: symptoms and manifestations of illness

The article describes the symptoms of diffuse toxic goiter, all the variability of its manifestations, it is given an understanding of the form of severe pathology. Here, too, the degree of development of the disease has been rehabilitated and characterized with original photos and video materials.

Severely chronic endocrine disease, - diffuse goiter of the thyroid gland, the symptoms of which appear practically in all systems of the human body, may have an autoimmune nature. This is the development of manifestations of manifestations of a defect in the immune system, which is manifested in the production of antibodies directed against TSH receptors, which stimulate the thyroid gland.

Last of all є:

Equal growth of thyroid tissue.
Hyperfunction of the creep.
An increase in the concentration of hormones that are vibrated by the thyroid gland - thyroxin (T4) and triiodothyronine (T3).

The hypertrophic thyroid gland has a good name - goiter.

Etiology and pathogenesis of illness

This pathology most often affects women of the age category 20 - 50 years. In children and people of a frail age, diffuse goiter is caused very rarely. If there are reasons for the disease and the mechanisms that trigger the autoimmune process, then the stinks for the moment are left for endocrinology tasks, as if there is still a need for virishiti.

For the time being, we can only talk about recessionary shyness, which is realized under the influence of a complex of factors, both internal and external:

Mental trauma.
Pain of infectious-toxic character.
Organic damage to the structures of the brain (trauma, encephalitis).
Autoimmune pathologies.
Kurinnya (div. Thyroid fold that chicken: not safe pіdsterіgayut).
Endocrine disruption and so on.

Further, thyroid hormones, which vibrate with significant changes in the norms, speed up exchange reactions, which lead to a quick depletion of energy resources, like tissues of other organs, and the entire human body. We are suffering structural elements of the central nervous and cardiovascular systems. Report description all stages of the development of pathology are described in the video in this article.

Classification

In such a disease, as if a goiter is diffuse, the symptoms are rich in why lie in the form of this stage. Pathology can be classified.

The following stages of illness are distinguished in the fallow in the form of an increase in the thyroid gland:

Nulyova - there is no goiter.
Persha - goiter is palpable, the proteus is not visually marked. Rosemary is often picked up at the dozhina distal phalanx of the first finger.
Friend - Goiter is felt both by palpation and visually.

Goiter, fallow in the form of buvae:

Diffuse.
Vuzlov.
Diffuse-nodular (zmіshanim).

For the heavy interruption of the process:

Light foot.
Middle.
Vazka.

Fallow in the functional state of the thyroid gland, goiter can be:

Euthyroid.
Hypothyroid.

By localization, you can:

Zvichaynim.
Often chesty.
Kiltsev.
Ті, which was displaced from embryo anlages.

The symptomatology of the disease lies in the parameters determined by the classification.

Show illness, fallow due to the severity of the pathological process

Diffuse-toxic goiter, symptoms of which are more varied, fallow depending on the severity of the process, may still manifest:

For light forms, neurotic scargs are preferred. There is tachycardia, and the heart rate is picked up at 100 beats / min, without disturbing the rhythm. Other insufficiencies of internal secretion are not included before the pathological process.
At the middle stage of severity, diffuse thyroid symptoms may be worse, - up to tachycardia, which exceeds 110 beats / min, the vaga is added, which reaches 10 kg for a month.
The severe form is characterized by a progression of the vara, right up to cachexia. In addition, there are first signs of impaired functioning of the heart, as well as liver and liver.

A severe form of the development of an illness, as a rule, is guarded for the presence of a diffuse toxic goiter for a long time, and also if people without proper knowledge try to get involved in this infection with their own hands.

Peculiarities of showing a euthyroid state

Shards of the thyroid gland function normally with euthyroid goiter, but the clinical picture is entirely to lie down in the form of an increase in the disease. The zero step on the aphids of saving the normal practice of the body is absolutely not visible. In the world zbіlshennya rozmіrіv thyroid glands appear and step-by-step succumb to її injections on other systems of the body.

For example, euthyroid goiter diffuse 1st stage symptoms are less obvious:

Severe weakness.
Increased stubbornness.
Headaches.
Behind the sternum, at the projection of the heart, there are incomprehensible sights.

Difficult breathing.
Looks like Shi's pressure.
Problems with forgings.
Trachea pressure, which leads to attacks of poison and dry cough.

In order to prevent the sbіlshennya I will, I should at the same time seek medical help and not engage in self-admiration. In addition, the next memory is that the price of jubilation is greater, the more the disease is launched.

Features of manifestations of diffuse-nodular goiter

The cream of diffuse goiter is also known as zmishana (diffuse-nodular) and nodular form. Diffuse goiter - ce rіvnomіrne zbіlshennya thyroid gland for the mind and the presence in the tissues of local udchіlnen. In case of nodular form, normal structures show pathological nodular growths.

Zmishany goiter is a complex of edema and diffuse growth. Vіn occupies one of the first places in the structure of thyroid gland pathologies after the frequency of the population.

The first stages of illness can give a poor symptomatology, or not give it a fever. Ale away from the progression of the pathological process to rob the manifestation of illness.

The development of diffuse-nodular goiter is ranked at three levels for the international classification of the WHO, or at five for the Russian:

Zero step (I for WHO). There are no symptoms;
First step (I according to WHO). It manifests itself as an insignificant increase in the ailment of the patient, an unreasonable decrease in body temperature, chronic fatigue, hypotension.
Another step (II for WHO). There are problems with forgings, pain sensations in the head and on the head, while vikonannі nahilіv of the tunic of that head. Shards of diffusely nodular goiter, the symptoms of which progressively worsen, continue to grow and increase the production of hormones, then begin to show hyperthyroidism, - increased arterial pressure, contractions, exophthalmos, pathological disorders of the motor. So, through the compression of the trachea by the tissues of the thyroid gland, the butt develops.
Third stage (II s WHO). At this stage of its development, diffusely nodular goiter of the thyroid slough shows more symptoms. Suffer heart-sudinna, endocrine that nervous system. Strongly changed the shape of the shi. The skin is either dry, or re-decomposed, in the wake of the overworld vibrating to avenge the iodine of hormones, it has a reddish tinge. From the side of the shlunkovo-intestinal tract - carry it through constipation. Tremor, hypotension, bradycardia up to 40 beats/min or tachycardia over 100 beats/min. Irrespective of your appetite, you will lose weight if you are sick. Changing the position of the head, a sharp attack of the poison is observed. Їх torment postіyna ass.
Fourth step (III for WHO). Vіdіznyаєtsya vіd poperednії ії іn thії form thаr size thіѕ goiter, whісh changes thе configuration оf thії.
Fifth step (III for WHO). It is characterized by extreme severity of illness, when many systems of the human body suffer: endocrine, nervous, herbal, cardiovascular. Sometimes a possible lethal kinets. Expand the majestic goiter that decorously change old look sick. Yogo's voice becomes hoarse or disappears again. Decrease intellect, memory, reproductive functions.

Physicians vikoristovuyutsya insults of different clasifications, ale tsіnіshoy є rosіyskа, oskіlki z її її dopomogoyu overbіg goiter is described in a rich report.

One of the strongest manifestations of the use of resources in the thyroid gland is hypothyroidism, which develops in childhood, is cretinism. Wines are characterized by manifestations of physical, rosum, mental and intellectual development, short stature, low growth, more mature cysts, deaf-muteness in some cases.

Okremi syndromes, power in diffuse goiter

Damage to the skin system of the body can be caused before the appearance of specific scars, moreover, there are very few syndromes that are characteristic of this disease in hyperthyroidism.

Cardiovascular system

The disruption of the normal work of the heart and the vessel manifests itself:

Tachycardia at rest (up to 130 beats/min), with some kind of pulsation in different parts of the body, such as hands, life, head, chest.
Growing systolic arterial pressure and falling diastolic.
Severe myocardial dystrophy (especially in people of a frail age).
Cardiosclerosis.

Destruction of the work of the cardiovascular system is a direct threat to the life of the sick. The fight against them is to be carried out by the joint efforts of endocrinologists and cardiologists, and it is the fault of the sick to follow the instructions for treatment, divided by these fahivtsy.

catabolic syndrome

For a new characteristic, show it like this:

Rizke weight loss (up to 15 kg) with increased appetite.
Severe weakness.
Hyperhidrosis.
Subfebrile condition in the evenings (striking in the frail population of patients of a frail age).
Disorder of thermoregulation.

The rest of the manifestation is characterized by a constant feeling of heat;

organize zoru

Thyrotoxicosis can lead to endocrine ophthalmopathy, which is characterized by the following symptoms:

Expansion of spectacle widths.
Incomprehensible signs of stupor that lead to "squeaking in the eyes", dryness of the mucous membrane of the eyes, chronic conjunctivitis.
Vitrishkuvatistyu.
A glint of eyes.
Periorbital swelling in the posterior growth of periorbital tissues.

The remaining symptom, perhaps, is the most threatening, causing scaling to squeezing the ophthalmic nerve and the ophthalmic apple, moving the internal pressure, pain in the eyes, or even total blindness.

Nervous system

Thyrotoxicosis in the first turn lead to mental instability in the form of easy awakeness and tearfulness to aggressiveness and difficulty concentrating respect.

It is also to cause illness to other destruction:

Depression.
Relax sleep.
Tremor of different severity.
M'yazova weakness zі zanizhenny obsyagu m'yazіv kіntsivok.
Advancement of tendon reflexes.

In severe forms of thyrotoxicosis, ailments can develop persistent damage to the psyche of the patient and the individual.

Skeleton brushes

Trivaliy overcame thyrotoxicosis, with excess thyroxine to produce to mimic ions in phosphorus and calcium from the bones, which causes:

Ruinuvannya of the bone tissue.
Lowering the mass of the brushes, and navit їh schіlnostі.
Bil at the brushes.

The fingers on the hands step by step become similar to "drumsticks".

Shlunkovo-intestinal tract

Derangement of etching manifests itself in pain syndrome, incontinence of degeneration right up to diarrhea, sometimes nudo and vomit. A severe form of illness can lead to thyrotoxic hapatosis, fatty degeneration of the liver and cirrhosis.

Hall of internal secretion

If all the warehouses of the endocrine system are mutually connected, then the damage to the thyroid gland leads to the failure of the functioning of other parts of the body.

Nadirkovі zlozi may suffer from thyroid deficiencies, symptoms of which are:

Shkirna hyperpigmentation (especially on open cuts).
Hypotension.

Damage to the work of the ovaries through thyrotoxicosis may cause a rare manifestation, when such changes occur:

The frequency and intensity of menstruation decreases.
Developing fibrocystic mastopathy.

Pomirny thyrotoxicosis may not be included in reproductive function women. The threat here in another case is antibodies, which stimulate the thyroid gland, pass through the placental barrier, leading to the manifestation of transient neonotal thyrotoxicosis in neonates.

The state sphere of people who suffer from milking is often observed in gynecomastia and erectile dysfunction.

Dihanna system

In patients with thyrotoxicosis, there is more frequent diarrhea, as well as sickness to the development of pneumonia.

Curve the skins

Thyrotoxicosis pours into the camp. There it becomes soft, warm and warm. Sometimes it develops brightly, the skin folds are dark, which is especially noticeable in the area of the elbows, shii, across. The hair falls out, nails are affected by onychomycosis and thyroid acropah.

A small number of ailments suffer from pretibial myxedema, which manifests itself in sagging, narrowing, as well as erythema of the skin curves on the feet and gomilks, like when it comes to drilling.

In order for a diffuse goiter not to reach its stages and not only to be healthy, but also to live ill, when the first sign of illness appears, one should not go straight to the therapist or endocrinologist.

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Diffusive toxic goiter (DTG)- Graves' ailment, Parry's ailment, Graves' ailment - genetically determined autoimmune disease, which is manifested by a persistent hyperproduction of thyroid hormones in a diffusely increased thyroid stalk under the influence of specific thyroid stimulating thyroid hormones

KID according to ICD-10
E05.0. Thyrotoxicosis with diffuse goiter.

Epidemiology

Illness becomes approximately 5-6 drops per 100 yew. Population. The disease most often manifests itself in women from 16 to 40 years of age, more importantly in women's status.

Etiology and pathogenesis

The main role of the development of the disease is to lie in the recessive sillness with the inclusion of autoimmune mechanisms. 15% of ailments in road accidents may have relatives from such illnesses themselves. Approximately 50% of relatives of patients know circulating thyroid autoantibodies. Psychiatric trauma, infectious disease, vaginess, the use of large doses of iodine and a trip to sleep can be provocative factors. B-lymphocytes and plasma cells recognize TSH receptors of thyrocytes as antigens and produce thyroid-stimulating autoantibodies. By binding to TSH receptors in thyrocytes, similarly to TSH, stench triggers the adenylyl cyclase reaction and stimulates the function of the thyroid gland. As a result, the mass and vascularization increase, the production of thyroid hormones increases.

clinical picture

Thyrotoxicosis with DTG is usually severe. An excess of thyroid hormones causes a toxic influx on all organs of the system, activates catabolic processes, after which you lose weight, you may experience mild weakness, subfebrile temperature, tachycardia, and arrhythmias. Later, myocardial dystrophy, supra-nirnikov and insulin deficiency and cachexia develop.

Thyroid ulcer, as a rule, is evenly increased, soft-elastic consistency, painless, shifts when pressed.

The clinical picture is framed by the influx of excess thyroid hormones on the organs and systems of the body. Folding and number of factors, which take part in pathogenesis, reflect the variability of clinical manifestations of illness.

In the analysis of scarg and the results of the ob'ektivnoy obstezhennia reveal different symptoms, which can be seen in sprat syndromes.

Damage to the central and peripheral nervous systems. Under the influx of excess hormones in the thyroid gland, patients develop increased alertness, psycho-emotional lability, decreased concentration of respect, tearfulness, shortness of breath, sleep disturbance, tremor of the fingers of the hands of the thyroid gland, and a "telegraph syndrome") reflexive.

Ocular Syndrome hypertonicity of the eye apple and upper groin due to impaired vegetative innervation under the influx of excess thyroid hormones.

Symptom of Dalrimple(exophthalmos, thyrogenetic exophthalmos) - expansion of the ophthalmic fissure with the appearance of a white conjunctiva of the sclera between the iris upper loft.
Graefe's symptom- the appearance of the upper bandage in the iris shell when fixing the look at the object, which is correctly moving down. In case of this, the upper lining of that iris shell is overfilled with the sclera's husk.
Kocher's symptom- when fixing a look at the object moving uphill, the object between the lower fold and the iris shell becomes streaked with the male of the sclera.
Symptom of Stellwag- rydkisne migotinnya povik.
Mobius sign- Vtrata zdatnosti fixes a look at the nearby countryside. Due to the weakness of ophthalmic m'yazіv, which lead, fixation on a closely stashed object, ochnі apples disperse and occupy the outer position.
Symptom Repnov-Melekhov- "Angry look".

Ochnі symptoms (thyroid exophthalmos) with DTG followed in the form of endocrine ophthalmopathy, autoimmune disease, as not a manifestation of an accident, but often (40-50%) go with it. In endocrine ophthalmopathy, the autoimmune process damages the periorbital tissue. As a result of tissue infiltration of the orbit by lymphocytes, the deposit of acidic glycosaminoglycans, which are produced by fibroblasts, develops in combination with an increase in retrobulbar cell attachment, myositis and an increase in successful tissue in bark tissues. Postupovo іnfіltratsіya і nabryak pass fіbrosis i zmіni ochnyh m'yazyv become irreversible.

Endocrine ophthalmopathy clinically manifested by damage to the bark pulp, trophic disorders and exophthalmos. The sickness is turbulent, the twins see "squeaky" in their eyes, tearing. Often develops conjunctivitis, keratitis with a horny fold of the stratum corneum in the aftermath and hanging with an incompetent closure. In some cases, the disease develops evil leaks, asymmetry and protrusions develop. full-time apples until the resurrection of one of them from orbit.
There are 3 stages of endocrine ophthalmopathy:
I - swelling of the povik, visible "squeak" in the eyes, lacrimation;
II - diplopia, obezhennya vіdvedennya ochnyh apples, paresis look burnt out;
III - incomplete occlusion of the ophthalmic slit, horn fold, diplopia, atrophy of the optic nerve.

Damage to the cardiovascular system is manifested by tachycardia, fleeting arrhythmia, a development of dyshormonal myocardial dystrophy (“thyrotoxic heart”), and a high pulse pressure. Cardiac damage caused by a direct toxic influx of hormones on the myocardium, as well as by a strengthened work of the heart in connection with an increased demand for peripheral tissues in the mind of an increased exchange. As a result of the increase in shock and weak volume of the heart and the acceleration of blood flow, a systolic arterial pressure (AT) is moving up. At the top of the heart, there is a systolic murmur over the carotid arteries. Decreased diastolic AT in thyrotoxicosis is associated with the development of a deficiency of measles of supraventricular deposits and reduced production of glucocorticoids - the main regulators of the tone of the vessel wall.

Damage to the organs of the herbal system it manifests itself as a non-stable deformity from schilnistyu to diarrhea, attacks of pain in the abdomen, sometimes with a zhovtyanitsa, as it is associated with impaired liver function.

Damage to other burrows:
Impaired function of the measles of the epidermis, a decrease in diastolic AT, also resulting in hyperpigmentation of the skin curves. Often there is pigmentation around the eyes - a symptom of Jellinek.
The increase in the breakdown of glycogen and the intake of a large amount of glucose in the blood zmushuy pratsyuvaty pіdshlunkovu zloza in the mode of maximum stress, which, perhaps, lead to її insufficiency - developing thyroid-induced tsukroviy diabetes. Overbig cerebrodiabetes in ailments in an accident, they are signifi- cantly lost.
Among other hormonal disorders in women, there is a sign of dysfunction of the ovaries with disruption of the menstrual cycle and fibrocystic mastopathy (thyrotoxic mastopathy, Velyaminov's disease), and in men - gynecomastia.

Syndrome of catabolic disorders manifests itself in weight loss with increased appetite, subfebrile condition, and malignant weakness.

Pretibial myxedema- another manifestation of DTZ - develops in 1-4% of cases. With this, the skin of the front surface of the homil becomes swollen and sweaty. Often blamed for that erythema.

Diagnostics

Diagnosis of an accident, as a rule, does not reveal difficulties. The clinical picture is characteristic, the increase in the level of T3, T4 and specific antibodies, as well as a significant decrease in the level of TSH in the blood, make it possible to make a diagnosis. Ultrasound and scintigraphy allow to treat DTG in other diseases, which are manifested by thyrotoxicosis. Ultrasound reveals a diffuse increase in the thyroid gland, tissues are hypoechoic, "hydrophilic", with Doppler mapping they show a stronger vascularization - a picture of "thyroid burn". With radionuclide scanning, the thyroid gland is likely to ingest radioactive iodine.

Celebration

Tsіlі jubilation

Liquidation of thyrotoxicosis and related disorders. At this time, there are three methods of treatment of DTG - medical, surgical and treatment with radioactive iodine.

Medical treatment

Medical treatment is indicated for a previously diagnosed accident. To block the synthesis of thyroid hormones, thyreostatics are used: thiamazol, propylthiouracil. Thiamazole is prescribed at a dose of up to 30-60 mg per doba, propylthiouracil - up to 100-400 mg per doba. When a euthyroid drug is reached, the dose of the drug is reduced to a moderate dose (5-10 mg per doba), and for the prevention of the goiterogenic effect of the thyreostatic, levothyroxine sodium (25-50 mcg per doba) is additionally prescribed. The use of thyroid statics with levothyroxine sodium is based on the “block and replace” principle. Symptomatic treatment includes the use of sedative drugs and β-blockers (propranolol, atenolol). In case of supra-environmental insufficiency, endocrine ophthalmopathy, glucocorticoids (prednisolone 5-30 mg per doba) are prescribed. The course of treatment is carried out for 1-15 months under the control of the equal TSH. St_yka remіsіya protyag kіlkoh rokіv pіdmіni thyreostaticіv svіdchit pro oduzhannya. For a small commitment to thyroid disease, the positive effect on conservative therapy becomes 50-70%.

Surgical treatment

Surgical treatment is indicated for the presence of a stable effect in conservative therapy; great obligation to the thyroid gland (more than 35-40 ml), if it is important to assess the effect of conservative therapy; complicated thyrotoxicosis and compression syndrome.

At the basis of preparation before the operation lie the principles themselves, like every hour of the treatment of ailments in an accident. In case of intolerance to thyreostatics of vicorist, large doses of iodine can be used, which may have a thyreostatic effect. To this end, conduct a short course of training by Lugol's design. For 5 days, the dose of the drug is increased from 1.5 to 3.5 teaspoons per day with a general intake of 100 mcg / dose of levothyroxine sodium. In severe thyrotoxicosis, the course of preoperative preparation includes glucocorticoid and plasmapheresis.

To perform a subtotal subfascial resection of the thyroid fold behind O.V. Nikolaev from the excesses in total 4-7 g of thyroid parenchyma from both sides of the trachea. It is important that the preservation of such a quantity of tissue adequately supplies the body with thyroid hormones. In the rest of the years, there has been a trend towards the elimination of thyroidectomy in case of DTG, which leads to a risk of recurrence of thyrotoxicosis, or to an important hypothyroidism, as in the case of treatment with radioactive iodine.

The prognosis after surgery, as a rule, is good. Postoperative hypothyroidism is unlikely to be seen as a complication. Shvidshe, tse zakonimny result of operation, po'yazaniya іz zayvim radikalіzm, vpravdaniy profilaktiku recurrence of thyrotoxicosis. In these cases, replacement hormone therapy is needed. Recurrence of thyrotoxicosis occurs in 0.5-3% of cases. For the effect of thyreostatic therapy, treatment with radioactive iodine is prescribed, or a repeated operation.

Post-operational complication

The worst complication after surgery, which is usually associated with toxic goiter, is a thyrotoxic crisis. Mortality during a crisis at the temple, reaches 50% and more. Ninі tse ukladnennya poserіgayut even rarely.

The main role in the mechanism of the development of a crisis is to lead to acute supra-adrenal insufficiency and a rapid increase in the level of the free fractions of T 3 and T 4 in the blood. With this ailment, restless, the body temperature reaches 40 ° C, the skin curves become voluminous, hot and hyperemic, tachycardia and transient arrhythmia are pronounced. In the future, the heart-vessel that multiple organ failure develops rapidly, which becomes the cause of the lethal result.

Jubilation is carried out for the minds of a specialized resuscitation department. It includes the use of high doses of glucocorticoids, thyreostatics, Lugol's disease, β-adrenoblockers, detoxification and sedative therapy, correction of water-electrolytic disorders and cardiovascular insufficiency.

For the prevention of thyrotoxic crisis, surgery should be performed only after compensation for thyrotoxicosis.

Treatment with radioactive iodine

Treatment with radioactive iodine (131 I) is based on the adequacy of β-changes and the death of the follicular epithelium of the thyroid gland with subsequent replacement of yogo with successful tissue. This process is accompanied by strangulated functional activity of the organ and the resulting thyrotoxicosis. In this hour, therapy with radioactive iodine is recognized as the most rational way to treat diffuse toxic goiter without direct indications for surgical intervention (the presence of a compression syndrome). It is especially indicated for high surgical risk (severe concomitant illness, senile age), with a categorical illness of the type of surgery, and with recurrence of illness after surgical treatment.

A.M. Shulutko, V.I. Semikiv