Diffuse changes in the thyroid parenchyma. Diffuse focal changes in the thyroid gland: causes and treatment

Thyroid

diffuse changes thyroid gland- this is a violation of the normal development of tissues of a generalized nature, which is diagnosed on the basis of an ultrasound examination and can be a sign of several pathologies. This indicator needed for a comprehensive examination.

In medical practice, this is a fairly common violation. endocrine system. The very concept of extensive pathology in this case will speak of a uniform and general growth or decrease in the size of thyroid tissues.

General information

A normal organ has clear contours, without knots that are determined visually, the shape of the organ resembles a butterfly. The lymph nodes around it are not enlarged. All this normal performance, which can vary depending on the degree of deformation.

An ultrasound examination, which most accurately determines all violations in the normal functioning of the internal secretion, can establish the nature of the modification and the degree of deformation of the lobes.

An equally important step in the examination, in order to determine why diffuse changes in the thyroid gland have occurred, is a blood test. Only by analyzing the results of these two examinations can one trace the pathological process, and on the basis of this, make a diagnosis.

The tissue pathology itself is not a diagnosis; after the identified defect, further hormonal diagnosis follows. To do this, it is enough to determine the level and synthesis of several hormones. These are thyroid-stimulating and thyrotoxin, which will become the main indicators and determine the further course - the start of therapy or preventive measures.

When, on the basis of all examinations, diffuse changes in the thyroid parenchyma are confirmed and a causative disease is identified, a directed effect on the pathological factor begins. But there is a possibility that a slight deviation from the norm will not be dangerous in the hormonal plan of the human body as a whole. Then all kinds of preventive measures are taken in order to avoid the spread of pathology and the onset of the development of diseases of the endocrine system.

The reasons

Diffuse changes in the thyroid gland are manifested by changes in the proportions, most often accompanied by the following pathologies:

autoimmune disorders such as autoimmune thyroiditis- damage to the thyroid gland, which causes hypothyroidism, at the initial stage proceeds in a latent form and requires treatment;
endemic goiter causes diffuse changes due to insufficient synthesis of iodine;
goiter of a toxic nature - is the cause of the development of thyrotoxicosis and requires immediate treatment.

To determine which specific disease provokes diffuse changes in the thyroid gland, hormonal diagnostics are performed, and they are also used additional measures for a reliable diagnosis.

Ultrasound signs

Thyroid ultrasound

As mentioned above, the lesion is determined by ultrasound diagnostics. What information can be seen on an ultrasound?

First, the dimensions and possible deviations in them. This can also be seen visually, but already at a more severe stage of hyperthyroidism. Further, according to a certain formula, the volumetric dimensions of both shares are calculated. It is important to determine the structure of the organ and its consistency (echogenicity). The echogenic structure is compared with the structure of nearby tissues. In the normal state, it may be slightly increased or decreased. With damage, echogenicity will be impaired, that is, uneven.

Treatment

In the treatment of lesions of the parenchyma, as an independent disease, there is no need and sense, since it is always only a sign of other pathological defects of the endocrine system. Therefore, therapy is carried out on the basis of the diagnosis, which is most often hyperthyroidism, hypothyroidism, endemic, toxic goiter and others.

With endemic lesions, therapy is carried out with iodine preparations. In case of ineffectiveness, L-thyrotoxin hormone is added to the course of therapy. Autoimmune lesions are eliminated conservative treatment, which is aimed at reducing the synthesis and production of thyroid hormones.

Particular attention of endocrinologists is occupied by endemic zones, the percentage of the disease in which is several times higher than the permissible norm. Lack of iodine in these regions can provoke any, in addition to modifications in the parenchyma, abnormalities.

Any deformation without a causative (main) disease is not treated, but preventive measures and constant monitoring by a specialist are carried out. But what you should not do is to ignore any qualitative or quantitative indicators of the level of hormones and the size of the thyroid gland.

Often incomprehensible diagnostic terms, for example, "diffusion changes in the thyroid gland" are mistaken for an independent disease. In fact, these are objective data that the ultrasound diagnostician sees on the screen.

Structural changes in the thyroid gland can be observed with total absence any symptoms, but may also result from serious illnesses. In any case, this is a pathological process that requires accurate diagnosis and adequate treatment.

Diffuse changes indicate that the structure is different from a healthy organ, abnormal ultrasound echoes are distributed evenly.

There are the following reasons leading to diffuse changes in the thyroid gland:

Iodine imbalance. It plays a role, both a deficiency and an excess of this element in the body. In order to maintain production active substances hypersecretion of the thyroid gland begins, as a result of which it increases in size and grows.
The presence of genetic defects leading to autoimmune reactions. Thyroid tissues become inflamed and their structure changes. Pathology develops under the influence of infections and inflammations, injuries, exhaustion, alcohol abuse and smoking.
Complications after a viral infection. Acute or subacute thyroiditis may develop.
Other causes: climate change; being in a zone of increased radiation activity; malnutrition; professional intoxication; diseases of the endocrine system.

Symptoms

Symptoms that accompany diffuse changes in the thyroid gland are different with its hypo- or hyperfunction.

Signs of hypothyroidism:

apathetic mood;
rapid fatigue and decreased performance;
deterioration of memory processes;
problems with hair (brittleness, loss) and nails (brittleness);
a decrease in body temperature may be accompanied by chills;
bowel dysfunction (constipation);
weight gain.

Signs of thyrotoxicosis (hyperthyroidism) are:

hyperexcitability nervous system manifested in aggressiveness;
tachycardia and arrhythmia;
hypertension;
tremor of the upper limbs;
feeling hot, sweating;
bowel disorders (diarrhea);
weight loss;
ophthalmopathy, edema of the eyelids, blurred vision.

Common symptoms in hyper- and hypothyroidism are a decrease in sexual activity, in women - violations menstrual cycle(amenorrhea, oligomenorrhea).

In cases of a significant increase in the size of the body, squeezing of closely spaced blood and lymphatic vessels occurs. Patients complain of pain in the neck and when swallowing, coughing and difficulty breathing may occur.

If these symptoms appear, contact your endocrinologist immediately!

Types of change

Diffuse changes in the structure of the thyroid gland can be of a different nature, depending on which they distinguish:

nodal;
parenchymal;
diffuse focal;
cystic;
expressed;
moderate.

Nodal changes. The epithelial tissue of the thyroid gland (parenchyma) has a follicular structure. The follicles are surrounded by blood lymphatic vessels and are responsible for the release of hormones. Nodal changes in the organ provoke an increase in the size of the follicles, and a parenchymal neoplasm appears inside. Changes can be both benign and transform into a malignant form. For this reason, it is extremely important to control the endocrinologist already at early stages manifestations of nodules. Diffuse changes in the parenchyma of the thyroid gland in the later stages are noticeable on palpation.

Diffuse-focal changes in the thyroid gland are the most insidious. If you "start" this problem, the pathology will develop into oncology. Against the background of healthy tissue of the organ, foci are formed - areas that have a heterogeneous structure. These can be cysts, tumor formations (lipomas, adenomas, etc.).

Cystic changes are accompanied by an increase in the thyroid gland in size. They are capsules. Cysts can quantitatively grow and transform into malignant tumors.

A pronounced form of changes has a greatly enlarged organ with a significant deformation of the parenchyma. This often occurs during Graves' disease. Diffuse changes in the thyroid gland according to the type of AIT (autoimmune thyroiditis) are also pronounced and are classified depending on the cause of the appearance.

At moderate changes, the parenchyma increases slightly, and hormonal disorders are not observed.

Diagnostics

Diagnose Data pathological changes the endocrinologist during survey and a palpation can. The size of the gland, the presence of seals, soreness, pulsation are estimated.

Additional diagnostic methods are associated with determining the morphological structure of the thyroid gland and the level of its activity, that is, the production of hormones.

Most effective method– Ultrasound diagnostics. Abnormal areas of the organ give darkening (increased echogenicity), heterogeneous echostructure and blurry (fuzzy) contours. This study determines the exact size of the organ.

In cases of controversial data, ultrasound studies do magnetic resonance imaging, computed tomography, x-ray studies and scintigraphy. If diffuse-focal changes in the thyroid gland or nodular changes are diagnosed, the patient is given a biopsy for histological examination pathological process.

The concentration of hormones in the blood (T3, T4) is determined by taking tests. In autoimmune thyroiditis, blood elevated level antibodies.

Treatment

The treatment strategy is worked out by the endocrinologist after an accurate diagnosis has been made.

When diffuse changes in the thyroid gland are insignificant, iodine preparations are prescribed. Levothyroxine is prescribed for hypofunction. Hyperthyroidism is treated with drugs that suppress the production of the hormone - thyreostatics. Acute inflammatory processes are treated with antibiotics.

In the case of pronounced diffuse changes of a parenchymal nature, radioactive iodine is used. Its isotopes destroy overgrown follicles.

If, as a result of diffuse changes in the thyroid gland and a significant increase in the size of the organ, neighboring tissues and organs are squeezed, a partial resection of the gland is performed or it is completely removed. After such an operation is necessary.

Prevention

plays an important role in prevention healthy lifestyle life: a balanced diet (mandatory inclusion of foods rich in iodine), sports, avoiding alcohol and smoking, good rest.

If you have a family history of thyroid pathologies, you need to pay closer attention to your health. Try to avoid stressful situations.

It is especially important to take multivitamin iodine-containing complexes for people living far from the sea or ocean.

All people over 35 years of age should have a consultation with an endocrinologist once a year..

Thyroid parenchyma- epithelial functional tissue of an organ containing actively dividing cells. Composed of vesicles of different sizes called follicles, these are structural and functional units. The average size of each follicle is 40-50 microns, they are all braided with blood vessels and lymphatic capillaries. Follicle cells produce a hormone involved in the regulation of calcium and phosphorus metabolism.

State of cardio-vascular system directly envy of the health of the thyroid gland. Violation of the functions of this important organ, the phenomenon of stagnation and accumulation of colloid in its parenchyma leads to heart failure and atherosclerosis. The number of patients who have diffuse changes in the thyroid parenchyma has recently been growing, this is due to dietary habits and environmental conditions.

Modern ultrasound diagnostic equipment makes it possible to make a correct diagnosis when scanning the anterior part of the neck (location of the thyroid gland) of patients. Changes in the parenchyma of the thyroid gland can be detected by palpation of the larynx, often you can notice an increase in the volume of the organ.

This pathology causes an increase or decrease in hormone levels, which can lead to problems in other organs and systems. Because it is the three hormones secreted by the gland into the blood that affect the nutrition of tissues with oxygen and are involved in the metabolism of proteins, fats and carbohydrates. The growth and development of the organism depends on their activity. Diffuse-focal changes in the thyroid gland can become a prerequisite for the formation of benign and malignant tumors.

If you feel unreasonable irritation, drowsiness, lethargy, weakness, you must immediately undergo an examination by an endocrinologist. With an increase in the size of the gland, potassium iodide or the use of iodized foods help. Prevention of thyroid diseases is recommended to be carried out constantly, the course and dose of drugs will be prescribed by the attending physician.

Only the fine-mesh structure of the glandular tissue is considered normal or homogeneous, in which the dotted hypoechoic granularity does not exceed 1 mm in diameter. If, during imaging, the heterogeneous nature of the echographic structure is ascertained and there are areas differing in echogenicity corresponding to diffuse or focal pathology of the thyroid gland, then the doctor may prescribe subsequent more accurate studies.

Detection of nodular formations in the thyroid gland is a serious reason for performing a puncture biopsy and the treatment, accordingly, will be completely different. If the nodes of the goiter grow rapidly and become large, in order to avoid squeezing other nearby organs, it is necessary surgical intervention. After the operation, the use of thyroid hormones is prescribed. To prevent the recurrence of goiter.

In the case of diffuse changes in the thyroid parenchyma and the presence of a heterogeneous structure, signs of inflammatory processes can be suspected. Inflammation of the perenchyma may be normal for people living in large cities where the condition environment does not always correspond to the norm. In addition, this change is often triggered by stress, viral infections during which suffers the immune system. The norm of the volume of the thyroid gland in women should be 18 cm 3, in men up to 25 cm 3.

A very important period - bearing a child requires careful, constant monitoring by an endocrinologist. It is necessary to monitor the hormone-producing function of the thyroid gland, to donate blood for TSH, T4 free and AT-TPO in order to know how it works thyroid and whether she has enough strength to provide mother and child with hormones. Diffuse changes in the mother's thyroid parenchyma do not affect the fetus, the main thing is that its main function is not disturbed. During pregnancy and lactation, it is mandatory to take potassium iodide preparations for prophylactic purposes, the number and timing of administration should be indicated by the doctor under whose supervision the patient is.

Most diseases of the thyroid gland in children are associated with its increase, which is the result of various pathological processes occurring in the parenchyma of the organ. Hyperplasia or hypertrophy of thyrocytes, infiltration of gland tissue with lymphocytes, accumulation of cystic fluid, and much more are caused by a lack of iodine in food, a defect in hormone genesis, genetic predisposition, radiation damage, viral and infectious diseases, nervous disorders etc. Examination of children includes: history taking, hormonal, immunological and cytological examination.

The diagnosis of diffuse thyroid is usually made by ultrasound. It means such a conclusion that the tissues of the entire gland have changed evenly. This often occurs as a result of various diseases.

What are diffuse changes

Diffuse anomalies are a violation of the structure of the tissue of the organ throughout its volume. In evenly enlarged tissues, brushes, nodules and other formations may also be located. Often there is a diffuse change in tissues without foci and formations. This state is expressed in:

an increase in the volume of the organ as a whole;
change in density other than healthy;
tissue inhomogeneity.

Pathology reflects the negative processes occurring in endocrine cells. The organ enlarges under the influence of thyroid-stimulating hormone or antibodies, but hyperplasia can also be protective. For example, in most cases, an increase in the volume of the glandular organ compensates for the lack of iodine in the body. But a constant excess of thyrocytes (cells synthesizing T3 and T4) causes hormonal imbalance. In addition, against the background of hyperplasia, focal neoplasms develop in the future.

It is impossible to call such a state of tissues a disease - this is just the conclusion of an ultrasound scan. Violation of the density of thyroid tissue is associated with various diseases and conditions, but in itself is not a disease. An increase, expressed in hyperechogenicity, occurs with the growth of connective tissue fibers, calcium deposition and a decrease in the amount of colloid. Hypoechogenicity or decrease in density, edema, malignancy.

Diffuse heterogeneity of the gland is expressed in its coarse-grained structure. Ultrasound shows alternating areas of increased and decreased echogenicity. This pattern is manifested in the current autoimmune inflammation.

If diffuse changes are detected on ultrasound, then further examination of the organ is required. When diagnosing the disease that caused them, observation, medical or surgical treatment is carried out.

Reasons for diffuse changes

The causes of pathology are the following factors:

lack of iodine in the body, characteristic of people living in iodine-deficient areas;
changes in the hormonal balance of the thyroid gland;
autoimmune inflammatory processes occurring in a number of diseases: for example, in chronic autoimmune thyroiditis;
unbalanced nutrition: a change in the volume of the gland is caused by a passion for goitrogenic foods, which contain special substances that prevent the production of hormones (cabbage, beans, corn, soy products, peanuts);
radiation release in the region.

Also, diffuse changes in the thyroid gland are manifested in the following diseases:

endemic, mixed, ;
subacute thyroiditis;
HAIT.

When to be examined

In most cases, the pathology is asymptomatic and is detected by chance during palpation of the neck during an ordinary medical examination. But even in this case, usually the patient cannot list any symptoms. Symptoms of trouble appear for the first time only with additional loads: stress, physical overstrain, inflammatory disease, hypothermia. With further examination of the hormonal status, the amount of hormones T3 and T4 may be normal, or may be changed.

When the concentration of thyroid hormones changes, pathologies occur in any system of the body. The NS is able to respond both with excitability and fatigue. Often, the condition of the skin apparently changes, symptoms characteristic of heart disease appear. However, any symptomatic therapy will not bring a pronounced effect.

More often, this pathology manifests itself in women, since they are more susceptible to hormonal fluctuations during pregnancy, menopause and other conditions. Also, the psycho-emotional factor has a stronger effect on women. When pregnancy occurs, the woman should continue the prescribed treatment.

In children, diseases of the glandular organ may have more dangerous consequences. This is due to the fact that pathologies of the hormonal ratio at this age can lead to problems in mental development and growth: malfunctions in the thyroid gland can negatively affect the processes of the brain, in particular its hypothalamic-pituitary division.

Forms of diffuse changes

There are several forms of diffuse changes in the gland:

Parenchyma (an organ tissue consisting of follicles): the entire parenchyma of the gland is transformed over its entire area, which is expressed visually in an increase in the volume of the organ in all directions. At the initial stage, the patient is still not bothered by anything, but any overload can provoke the development of a pathological process and a violation of hormone production.
Structural anomalies are transformations associated with a deviation from the norm of the tissue structure. In the early stages, there may be no symptoms, although a specialist with palpation may reveal some anomalies. Further examination may reveal a normal hormonal status. However, if autoimmune disorders are present, an increase in antibody levels is detected. Further progression of the disease causes failures in all body systems - in the nervous, cardiovascular, reproductive systems, even metabolic processes are disturbed.
Diffuse focal changes in the thyroid gland - in a uniformly enlarged tissue, the appearance of foci is observed in which the structure of the gland tissue is changed. The foci may be surrounded by glandular tissue with an unchanged structure. Under the guise of foci, cysts, adenomas, hemangiomas, lipomas, oncological formations, etc. can be hidden. Such anomalies are formed with goiter, adenoma and thyroid cancer.
Diffuse nodular pathologies are often detected by palpation. An ultrasound usually confirms the presence of nodes in an enlarged organ. If the formations are larger than 1 cm, then a biopsy is recommended. A large number of nodes can provoke the process of cancerous degeneration.
Cystic is the phenomenon of the formation of cysts in an enlarged gland. Patients with such a diagnosis are recommended constant monitoring by an endocrinologist.

With a moderate increase in the thyroid gland without nodes and foci of compaction, as well as without structural disorders and dysfunctions of the organ, special treatment is not required. However, observation and regular visits to the endocrinologist at least once a year are indicated.

If the anomalies are pronounced, it is required to determine the causes of their causes and drug treatment. The most frequently pronounced changes are formed in Graves' disease and HAIT. As a rule, they cause functional disorders of the organ, as well as, as a result, disturbances in the production of hormones and other systems.

Possible consequences

Of the most likely consequences of diffuse tissue changes, the following can be distinguished:

malfunctions of the digestive tract due to a lack of enzymes;
weight gain;
insomnia;
sensitivity to cold.

Often provokes the manifestation of anomalies of CAI, in which violations of the cardiovascular system are noted:

increased heart rate;
hypertension;
fever;
change of consciousness.

The manifestation of structural changes in the thyroid gland can be dangerous and lead to various consequences that are almost impossible to predict with accuracy.

Diagnostics

Diagnostics is carried out by different methods:

Examination of the endocrinologist - the doctor conducts a survey to clarify the patient's complaints and palpation of the organ, on the basis of which he gives a direction for further examination.
Ultrasound examination is the most common method for detecting organ anomalies due to its availability and safety. The conclusion about the presence of diffuse changes is made on the basis of this examination.
Laboratory blood tests for hormones can determine the cause of the pathology.

The following parameters can be distinguished, which are examined by ultrasound:

the echostructure in the normal state should be homogeneous. If there are pathologies, it becomes coarse-grained. Some areas may reflect ultrasound differently;
increased echogenicity: characteristic of areas with a compacted structure (nodules and calcifications), reduced echogenicity occurs in autoimmune and inflammatory processes;
normal sizes for women are 18 ml, and for men - 25 ml: if the size of the glandular organ is exceeded, this indicates an overgrowth of the gland;
contours in healthy people are clear, in sick people they are blurry.

CT scans or are used to detect focal or nodular lesions. With their help, you can evaluate the density and structure of tissues.

Treatment

Diffuse changes in the thyroid gland are only the conclusion of an ultrasound study, which in itself does not require treatment. Based on this conclusion, the specialist can send for additional examination - ask to be tested for:

thyroid hormones;
TSH - pituitary thyrotropin;
antibody titer.

If hypothyroidism or thyrotoxicosis is detected based on the results of the examination, drug treatment is prescribed. The lack of hormones is compensated by their synthetic substitutes. Usually, the doctor prescribes a course of Euthyrox and Levothyroxine or may prescribe combined medicines- for example, Tireot.

Excessive function is suppressed by thyreostatics - iamazol, propylthiouracil are prescribed. In some diseases, treatment with radioactive iodine is prescribed, which destroys part of the gland tissue from the inside, which reduces hormone-producing functions. During the course of therapy, it is periodically necessary to check the level of the hormone, which is done using laboratory tests.

A high titer of antibodies indicates autoimmune inflammation. Usually this is a chronic process. HAIT requires observation by an endocrinologist. This disease is subject to therapy only in the presence of hypothyroidism. Usually in this case, the patient is prescribed levothyroxine. Special treatment may be prescribed for women planning a pregnancy.

In the absence of antibodies, abnormalities are associated with iodine deficiency. In the early stages, the endocrinologist may prescribe medications with potassium iodide, in the later stages - hormone therapy.

With nodular goiter, when they begin to grow rapidly to large sizes, surgical intervention is performed, since the formations can lead to squeezing of neighboring organs and disrupting their proper functioning. After surgical treatment hormone therapy is carried out to ensure stable remission and prevent relapses.

In no case is self-medication unacceptable. The endocrinologist selects an individual course of therapy for each patient, which is not applicable to other patients. doctor takes into account individual characteristics specific patient, inherent only to his body and features of the course of the disease.

How to prevent development

Most thyroid pathologies are of an insufficiently studied nature. Therefore, measures for their 100% prevention have not been developed. General algorithm preventive measures should be the following:

Replacing salt with iodized salt and introducing more iodine-containing foods into the diet.
Prevention of stress, since the psycho-emotional factor plays an important role in the development of pathologies. Anti-stress therapy, which includes relaxation, auto-training, yoga, and breathing practices, will also be effective.
Constant strengthening of immunity, including the use of vitamin complexes.
Normalization of body mass index.
Regular examinations at the endocrinologist and ultrasound of the thyroid gland after 35 years once a year.

If the patient is on time, then the prognosis of the cure is favorable. The reason for a visit to the doctor may be the appearance of anxiety, feelings of constant anxiety, fatigue, constant fatigue etc. It is better to play it safe and take some action at the very beginning of the alleged illness than to wait until the process develops to such an extent that it worsens the patient's quality of life.