Acute pancreatitis in most cases develops from the transfer of inflammation from other organs to the pancreas, usually from the gallbladder and bile ducts. In mild cases of pancreatitis, only swelling of the pancreas occurs, in more severe cases there are foci of necrosis with progressive dynamics. This occurs because bile from the bile duct is refluxed into the pancreatic duct.
Acute swelling of the pancreas is called catarrhal pancreatitis. In this state, the gland is enlarged in volume, swelling can involve the retroperitoneal tissue, as well as the tissue of the transverse colon. Histological examination of catarrhal pancreatitis shows the presence of edema of the interstitial tissue, areas of minor hemorrhages and moderate degenerative changes in the glandular tissue.
The general condition of the patient with acute pancreatitis worsens, he is agitated, and often changes his position in bed. He is tormented by severe pain radiating to his back in the upper abdomen and left hypochondrium. Vomiting occurs, body temperature rises, and the pulse quickens. If after using special therapy the patient’s condition does not improve, surgical intervention is resorted to.
It should be noted that there is a certain similarity between the symptoms of pancreatic diseases. First of all, it is pain in the epigastric region and abdomen. Pain may also occur in areas such as the left hypochondrium, back and left shoulder blade.
Treatment of swelling of the pancreas when symptoms of pancreatitis appear is carried out with the help of special medications, as well as a balanced diet. It is very important not to drink alcoholic beverages or smoke. If the disease worsens or occurs in an acute form, then you need to take medications that help reduce the secretion of gastric juice, as well as enzyme-type drugs that do not contain components that make up bile.
During the treatment of edema, you can drink weak tea and non-carbonated alkaline mineral waters. It should be noted that after eating large quantities of fried, spicy or fatty foods, the pain intensifies. Under the influence of heat, pain intensifies; it can only be reduced by using cold.
Pancreatic cancer is a fairly serious disease characterized by the presence of a tumor in the tissue of this organ. There are four stages of this disease. In the first stage, the tumor is characterized by a relatively small size and does not protrude beyond the tissue of this organ. At the second stage, the tumor begins to approach neighboring organs. The third stage is characterized by the fact that the tumor moves to the stomach, large intestine and spleen. On the fourth, the tumor spreads to the lymph nodes.
With a disease such as pancreatic cancer, swelling quite often occurs in certain places of the body, but most often on the limbs and legs. In this case, there is an increase in local body temperature. In some cases, swelling due to pancreatic cancer is accompanied by pain. The skin becomes smooth, dry and flaky.
One of the main symptoms of hypothyroidism is swelling. Their development is based on a slowdown in all types of metabolism, so treatment must be comprehensive - diet, hormones, folk remedies.
Hypothyroidism is a pathological condition based on an insufficient amount of hormones produced by the thyroid gland. Edema in hypothyroidism is one of the main signs of the disease. They differ significantly from edema that occurs, for example, with pathology of the kidneys or heart. What is hypothyroidism? What is his treatment? Is it possible to get rid of swelling on your own? What are some reviews about drug and folk therapy for hypothyroidism? This will be discussed below.
As already mentioned, hypothyroidism is a consequence of a lack of thyroid hormones. Depending on the level at which the failure occurred, it can be primary, secondary and tertiary.
Primary hypothyroidism is the most common. Its cause is damage to the thyroid gland. The underlying causes of the disease may be:
Secondary hypothyroidism develops due to pathology of the pituitary gland. Normally, it produces thyroid-stimulating hormone, which stimulates the thyroid gland. Insufficient concentration of TSH in the blood leads to weakened thyroid function and the development of symptoms of the disease, including edema.
Tertiary hypothyroidism occurs when the hypothalamus is damaged, which has a regulatory effect on the pituitary gland. The causes of primary and secondary hypothyroidism have not yet been precisely established. Scientists suggest that they could be traumatic brain injuries, tumors, neurosurgical interventions, and inflammatory processes.
The following points play a major role in the pathogenesis of hypothyroidism:
Thyroid hormones influence the activity of all types of metabolism. Consequently, their deficiency is accompanied by a slowdown in metabolic processes in the body. Enzyme activity decreases and oxygen consumption by cells deteriorates. The activity of protein synthesis and breakdown decreases. The end products of metabolism are retained in the body, accumulating in the intercellular space.
In particular, creatine phosphate accumulates in muscle tissue. Glycosaminoglycans, a component of mucus, are deposited in the cavity organs that have a mucous membrane. They accumulate in all layers of the skin. Their excess increases the osmotic pressure in the interstitium and enhances the hydrophilicity of connective tissue fibers.
In parallel, there is an increase in the permeability of the vascular wall, the mechanism of which is precisely unknown, and a slowdown in the flow of blood and lymph. This promotes the release of free fluid from the bloodstream. Mucosal edema forms - myxedema. It is most pronounced in the leg area.
Edema in hypothyroidism has a number of distinctive properties. First of all, this is their localization and properties. If, with pathology of the cardiovascular system, the patient is primarily concerned about swelling of the legs, and with kidney diseases - the face, then with hypothyroidism, swelling of the entire body is observed - the face, arms, legs, and anterior abdominal wall.
At the beginning of the disease, the severity of the symptom is weak. Sometimes it is regarded as excess weight gain. The face is somewhat rounded, the shape of the eyes narrows. Symptoms may increase so gradually that the patient himself does not attach much importance to them. But, if you look at the photos that were taken several months before going to the doctor, the changes are obvious.
The swollen tissue is cold, pale, and has a pasty consistency. When pressed, a hole is formed only in advanced cases. Doctors call this condition the term “pasty.” In addition to the skin and subcutaneous tissue, with hypothyroidism, fluid accumulates in the intercellular space of internal organs. Outwardly, this is manifested by specific symptoms of the disease. Delayed treatment contributes to the progression of symptoms.
Treatment of hypothyroidism is a long process. First of all, it requires patience from the patient, because its main task is not just to remove swelling of the legs, arms or around the eyes, but to normalize the functioning of all organs and systems. This goal can only be achieved through an integrated approach, which includes proper nutrition, hormone replacement therapy and treatment with folk remedies.
Thanks to proper nutrition and monitoring fluid intake, patients with hypothyroidism are able to keep their weight within normal limits and prevent the appearance of edema. This statement should be taken especially seriously by those patients who are obese, and those who have severe fluid retention, in particular, there is intense swelling of the legs. What should such patients do?
First of all, you need to reduce the total calorie intake of your diet. It is recommended to sharply limit, or better yet, completely exclude sweet and starchy foods, confectionery, and baked goods. To control the concentration of lipids in the blood, limit the amount of animal fat consumed:
The deficiency of fats is replenished with vegetable oils. If possible, consume seafood and fatty fish. Eating foods with plenty of fiber is encouraged - it removes toxins and helps fight constipation, one of the symptoms of hypothyroidism. For the same purpose, it is recommended to take low-fat fermented milk products and freshly squeezed vegetable juices.
If you study the reviews of patients, you will notice that proper nutrition quite successfully helps to cope with the main manifestations of hypothyroidism. Of course, treatment with diet alone will not lead to the desired result, but it can enhance the effectiveness of tablet drugs.
This is the main direction, which involves the treatment of hypothyroidism with exogenous hormonal drugs. Not so long ago, thyroxine and triiodothyronine were used for this purpose. But negative reviews about the effect of the second drug on the myocardium led to the fact that endocrinologists began to use it only in cases of hypothyroid coma.
When administered intravenously, it has a good therapeutic effect. In addition, there are reviews from patients that after starting to take hormones, pain in the muscles and bones appears. This is the result of calcium deficiency in bone tissue, which occurs due to disruption of the thyroid gland.
Of the thyroxine preparations, eutyrox and L-thyroxine are most often prescribed. Treatment of the disease with hormones is based on the following principles:
Treatment of hypothyroidism with folk remedies is more symptomatic. To relieve swelling of the legs, diuretic herbs are used - horsetail, parsley, bearberry. To increase the overall tone of the body - eleutherococcus, anise, nettle, lily of the valley, walnut. Cocklebur relieves symptoms well.
Soy products stimulate the production of TSH in the pituitary gland. Sea kale and kelp replenish iodine deficiency, which improves the general condition of the body, reduces swelling of the legs, and eliminates constipation and drowsiness. In most cases, reviews of the use of folk remedies are positive.
Before treating hypothyroidism, you need to take a photo. This photo will help make the assessment of the effectiveness of treatment more objective. It is easy to determine whether swelling on the face and around the eyes has decreased. To assess the degree of swelling of your arms and legs, you can measure their circumference with a measuring tape. Another way to check the effect of the products is regular weighing. With proper treatment, weight should decrease. Carefully adhere to all the doctor’s recommendations, and good results will not keep you waiting.
In a single “orchestra” of endocrine glands that control our body with the help of hormones, one of the leading “instruments” is the thyroid gland. This small organ behind the larynx, similar in shape to a butterfly, and in structure to a raspberry or blackberry, supports metabolism in every cell of the body, protects us from stress and other unfavorable conditions. However, the thyroid gland itself needs protection and careful treatment on our part. How can I help her? Endocrinologist Alexandra Semenovna ENINA answers these and other questions.
— Alexandra Semyonovna, in your practice, do patients often encounter any disturbances in the functioning of the thyroid gland and why do they occur?
— Endocrinologists have to deal with thyroid dysfunction very often. Probably only diseases of the pancreas are treated more often, primarily diabetes mellitus, the number of patients of which is multiplying today like an epidemic. Pathologies of other endocrine glands are much less common.
There are quite a few factors contributing to thyroid diseases: hereditary predisposition, radiation, and climate (our thyroid gland prefers summer and the south). And, of course, stress, which primarily affects the thyroid gland, since it seems to take all our troubles upon itself.
But still, the most common cause of thyroid diseases is insufficient intake of iodine into the body. Unfortunately, most regions of our country, including St. Petersburg, suffer from iodine deficiency. But residents of southern countries, where people eat a lot of fruits and seafood, rarely encounter thyroid diseases.
— Why does the thyroid gland need iodine?
— Iodine is part of the hormones thyroxine and triiodothyronine, which are synthesized by the thyroid gland. With a lack of iodine, not enough of these hormones are produced - but they control the basic metabolism in the body, work in all its cells and systems, without them the body is simply not viable. As a child grows, his thyroid gland grows and develops along with him. The load on it is especially great during adolescence, when the process of puberty occurs, as well as in women during pregnancy. The gland's need for iodine increases, and it can only obtain it from food. So it turns out that we most often do not have enough iodine.
— What happens in the body when there is a lack of iodine?
— There is a decrease in thyroid function, which is called hypothyroidism. This is a lack of thyroid hormones, which leads to a sharp decrease in metabolic processes. The cells of all systems and organs begin to work not at full capacity. On the part of the nervous system, hypothyroidism manifests itself as slowness of thinking and movement, and memory impairment. If it occurs in the prenatal period, the child will not perform well at school in the future. With age, drowsiness appears and intelligence decreases; the person is at risk of rapid vascular sclerosis and early senile dementia.
Outwardly, these are usually overweight people, with pale skin, dull and brittle hair and nails; they have swollen upper and lower eyelids and slow speech. In women, due to swelling of the mucous membrane, the voice becomes rough. There is swelling of the lower extremities, arthrosis of the joints develops, these people walk very slowly. With latent hypothyroidism, people usually complain only of fatigue, lethargy, memory loss, impaired reproductive function, and weight gain due to fluid retention. But when swelling appears on the face, especially on the eyelids, bags under the eyes are already obvious hypothyroidism.
— How can we help such patients?
— You can help with combination therapy, which is always individual, because the causes of hypothyroidism can be different. Due to a lack of iodine, primary hypothyroidism occurs, and then it is treated with iodine preparations. But there is also secondary hypothyroidism, which is associated with the fact that the pituitary gland, as a result of injury or brain bleeding, stops producing thyroid-stimulating hormone, which controls the thyroid gland. In this case, iodine alone will not help; therapy with thyroid drugs is necessary to restore the production of your own thyroid hormones. If restoration cannot be achieved, then the person is injected with synthetic analogues of these hormones. Hypothyroidism can usually be cured one way or another.
— How do endocrinologists feel about self-administration of pharmaceutical iodine preparations?
— Many iodine preparations are made on a casein basis. In addition to the fact that casein itself can cause allergies, it also interferes with the absorption of many foods in our intestines, and under-oxidized foods can aggravate allergies. As for iodine, although in Russia there is a shortage of it almost everywhere, I am against taking artificial iodine preparations. The fact is that inorganic iodine (for example, from potassium iodide) is absorbed almost completely in the intestines, so its excess is easily achieved. It is possible even when applying iodine tincture to the skin. And our thyroid gland needs a limited amount of iodine, otherwise the formation of its hormones, which include not only iodine, but also many other trace elements, will be disrupted.
— Natural iodine compounds. When there is enough of this element in the body, the absorption process is suspended, and all excess iodine is simply eliminated from the body. Therefore, there is never an overdose of organic iodine.
The best way to get organic iodine is in the form of fish and seafood. Or you can use extracts from seaweed - spirulina or kelp, seaweed. However, I do not recommend using seaweed in its pure form in large quantities: it has the ability to extract heavy metals from sea water and accumulate heavy metals. There are no heavy metals in extracts from it. The use of iodized salt in food instead of regular salt also has a certain preventive effect.
— Why do goiters sometimes grow with diseases of the thyroid gland?
— When not enough iodine enters the body, thyroid cells begin to increase in size in order to capture as much iodine as possible and produce the required amount of hormones.
In those areas of the world where there is especially little iodine in the soil and water, the so-called endemic goiter occurs. There, people often experience an enlarged thyroid gland, so noticeable that it changes the shape of the neck, and in severe cases can even compress the trachea, cervical vessels and nerves. When the gland enlarges evenly, it is a diffuse goiter, but it happens that compactions appear in it - nodes, and the goiter is called nodular. Goiter, which occurs in early childhood and is caused by a lack of iodine in food and water, is successfully treated by taking iodine preparations.
Sometimes the cause of goiter is a violation of the absorption of iodine in the intestines, the effect of toxic substances on the body, or a congenital disorder in the production of hormones by the thyroid gland. In this case, the patient is given thyroid hormones. But the main danger of nodular goiter and thyroid nodules is their ability to degenerate into a malignant tumor. Therefore, it is imperative to treat thyroid nodules, and treatment is individual, depending on their nature.
— Are there inflammations of the thyroid gland?
— Yes, such diseases exist and are called thyroiditis. Of these, the most common are autoimmune and subacute thyroiditis. Autoimmune thyroiditis is the result of a genetic defect in the immune system: it produces antibodies that mistake the cells of one's own thyroid gland for foreign ones and damage them. The gland becomes denser, its ability to produce hormones decreases, that is, hypothyroidism develops.
Subacute thyroiditis is caused by a viral infection. There is pain in the thyroid gland, a possible increase in temperature, and a deterioration in general health. Here, too, immediate treatment is required, as persistent hypothyroidism can occur, and in severe cases, surgery is necessary.
- Let's move on to conditions associated with excess production of thyroid hormones by the thyroid gland. How do they manifest themselves?
— This condition in which the production of thyroid hormones by the thyroid gland significantly exceeds the norm is called hyperthyroidism, or thyrotoxicosis. Externally, thyrotoxicosis usually looks like this. A woman comes and complains that she eats all the time, does not limit herself to anything, but is constantly losing weight. She is terribly nervous, impatient, aggressive, explodes for any reason, screams at her family and friends, at her employees. Can't concentrate at work. Her nervous system is constantly overexcited, which causes serious sleep disturbances and weakens her memory. The thyroid gland noticeably enlarges due to strong blood flow. Heart pounding, pulse. 150-160, without pauses. Many develop weakness, heart failure, edema, and atrial fibrillation.
Another characteristic symptom is very rapid intestinal motility. Immediately after eating, the patient runs to the toilet; the food does not have time to be absorbed - it is not surprising that the person loses weight. It breaks down proteins. He feels hot all the time, his skin is hot, sweaty, his blood pressure is high. In advanced cases, the eyeballs protrude. Osteoporosis often develops. All this is a manifestation of the destructive (catabolic) effect of hormones.
— For what reasons does thyrotoxicosis occur?
- The reasons are different. Very severe stress often leads to the release of excess thyroid hormones into the blood. Sometimes it is excess iodine in food. And a lack of iodine can stimulate the pituitary gland to produce thyroid-stimulating hormone, which signals the growth of the thyroid gland. The thyroid gland begins to grow. This growth may not occur evenly. The cells that produce thyroid hormones grow faster than the nourishing and other service cells of the gland. As a result, foci form in the thyroid gland, which take on “increased obligations” to produce hormones - so-called “burning thyroid nodes” arise. This type of disease is called nodular toxic goiter. In those cases when the thyroid gland begins to enlarge evenly and at the same time produce a lot of hormones (diffuse toxic goiter), their destructive effect on the cells and tissues of the body is even stronger. And all the energy that we receive from food turns into heat, because metabolic processes in cells are extremely intense.
— How is thyrotoxicosis treated?
— The endocrinologist begins by prescribing thyreostatic drugs to the patient, which reduce the production of thyroid hormones. Here it is important not to go to the other extreme - not to cause drug-induced hypothyroidism. During this period, it is very good to consume bee products, especially royal jelly - it strengthens the heart. And when the production of hormones has already decreased, be sure to include a diet and add iodine products to avoid hypothyroidism.
People with thyroid eye disease have suffered from thyroid dysfunction in the past or will in the future
Thyroid disease can affect the eyes, causing the muscles and soft tissues inside the eye socket to swell. This pushes the eyeball forward and causes various eye symptoms. Treatment includes measures to protect the eyes: the use of artificial tears, medications, and in some cases even surgery. The thyroid disease itself also needs to be treated.
When thyroid disease affects the eyes, there is swelling of the muscles and fatty tissue surrounding the eyeball within the orbit (eye socket). Edema is associated with inflammation of these tissues. There is limited space inside the orbit of the eye, so when the tissues swell, the eyeball moves forward. This causes the clear window at the front of the eye (cornea) to lose its protection. The eyeball cannot move as easily because the muscles now have less control over it. When the disease is very severe, the nerve connections from the eyeball to the brain can become compressed and damaged. This period of swelling is accompanied by healing.
Thyroid eye disease is also called thyroid ophthalmopathy, dysthyroid eye disease, ophthalmopathy, or ophthalmic Graves' disease.
The thyroid gland is a small, butterfly-shaped gland that is located at the top of the throat (trachea) at the front of the neck. It plays an important role in controlling the rate at which chemical reactions occur in the body's tissues (metabolic rate). The thyroid gland may become overactive or underactive. It is most often associated with an autoimmune disease.
The immune system usually creates small proteins (antibodies) that can attack foreign organisms (bacteria, viruses). In people with autoimmune diseases, the immune system produces antibodies against the body's own tissues. It is not yet clear why this happens. Some people develop autoimmune diseases: their immune system attacks the body's own tissues. Autoimmune thyroid disease (See article: Hashimoto's Thyroiditis ) occurs when the body's antibodies attack the gland. In some people, these same antibodies can also attack the tissue surrounding the eyeball. This is a thyroid eye disease. It is not known why this occurs in some people and not others. Therefore, thyroid eye disease is an autoimmune disease that is most often associated with an overactive thyroid gland. In some cases, thyroid eye disease occurs even when the thyroid gland is working normally. However, people with thyroid eye disease usually have a history of thyroid dysfunction or are beginning to experience thyroid dysfunction.
This rare condition affects approximately 16 women and 3 men out of 100,000 people each year. Most of these people have problems with an overactive thyroid gland, which is due to an autoimmune condition. This usually occurs in middle age. Some people have genes that increase their risk of thyroid eye disease. In addition, this risk is increased in smokers.
Symptoms cause swelling in the tissues of the eye socket and push the eyeballs forward: 1) The eyes may become red and irritated because the cornea is affected and poorly lubricated. 2) There may be dry eyes because the production of tears by the lacrimal glands is impaired. 3) Your eyes may hurt. 4) Eyes may appear more prominent. 5) Double vision (diplopia) may develop because the muscles become too swollen to function properly. 6) In the later stages of the disease, vision may become blurry and colors may appear less vibrant. The two eyeballs are not always affected to the same extent.
The diagnosis can be made simply by examining the eye if thyroid disease is already known. Blood tests are sometimes performed to confirm the diagnosis. Hormone levels in the blood can indicate how well the thyroid gland is functioning. More specific blood tests may be done to measure the level of antibodies in the blood.
You need to do an ultrasound of the thyroid gland to see how actively it is working. If your doctor is particularly concerned about eye orbital swelling, he or she may order an MRI, which will determine which tissues are most affected. The doctor should also evaluate how well you see colors as well as your peripheral vision. An eye movement test may be done to show which muscles have been affected by the autoimmune process. These assessments should be carried out throughout the illness.
If thyroid eye disease is left untreated, the inflammation should resolve on its own within a few months or years. However, symptoms caused by swelling (such as bulging eyes) may remain permanent because some of the tissue that has been stretched may not always return to its original shape. The goal of treatment is to limit the damage caused during the period of inflammation. Treatment of thyroid eye disease requires joint efforts of an ophthalmologist and an endocrinologist.
At an early stage of the disease and when the disease is mild, artificial tears are used, but they may not be enough. As the disease progresses, you may need immunosuppressants, a family of drugs that suppress the immune system that produces abnormal antibodies. Commonly used immunosuppressants are steroids such as prednisolone. You may also need to take certain other medications (omeprazole protects the stomach lining) to counteract some of the more common side effects of steroids. If you have a very severe illness, your doctor may prescribe a course of steroids given through an IV.
About 5 in 100 people with thyroid eye disease have a severe form of the disease, which causes the optic nerve (the connection from the back of the eyeball to the brain) to shrink. This can damage your entire vision. In this case, the doctor may decide to organize decompression. This is a procedure that creates space in the orbit for inflamed tissue to spread. This relieves pressure on the nerve. In some cases, surgery may be performed to move the eyeballs back. Sometimes surgery to remove pulled muscles allows you to return everything to its place. If there are problems with elongated tissues that need surgical correction after the inflammation has passed, surgery is done in the orbit and then on the muscles.
If double vision (diplopia) develops, your doctor may prescribe modified glasses that block vision from one eye; or cover your eyes with a special prism to stop diplopia. Radiation therapy (treatment by exposure to a radioactive substance) may be used for some people. The goal is to reduce swelling in the eye. It is used along with other forms of treatment. There are a number of new treatments for thyroid eye disease that are being studied. In addition, the doctor will treat abnormal thyroid function. For this purpose, medications (radioactive iodine) or thyroid surgery will be prescribed.
Advice for patients with thyroid eye disease: 1) Smoking worsens the course of the disease, so give up this bad habit. 2) Bright light can irritate the eyes, in which case sunglasses will be useful. 3) If you drive a car and have double vision, be sure to control it with prism glasses.
Complications of thyroid eye disease. Most people do not develop permanent complications. However, they do occur in some people, especially those whose treatment is delayed or whose disease is severe. More often, complications occur in older people, as well as in smokers and patients with diabetes. Possible complications: 1) damage to the cornea; 2) constant squint or double vision; 3) damage to the optic nerve, which leads to decreased vision or color perception; 4) unsightly appearance.
Complications due to treatment: 1) side effects due to the use of immunosuppressive drugs. 2) side effects due to surgery: double vision (in 15 out of 100 people with thyroid eye disease); loss of vision (less than 1 in 1,000 people with thyroid eye disease).
Thyroid eye disease is a long-term illness. The period of inflammation lasts from several months to several years (usually about two years). However, for most people the condition is mild and requires only the use of artificial tears and regular eye exams. Then this disease goes away on its own. For patients with severe thyroid eye disease, the prognosis depends on how early the diagnosis is made and how intensively treated. About 1 in 4 people will eventually have reduced vision.
Surgical treatment of the thyroid gland is a highly complex operation. The gland is the size of half a small apple, and the nodules contained in it are comparable to the seeds of this fruit.
To operate on such a miniature organ, the surgeon must have extensive experience and perform operations at least 50 times a year. Viktor Alekseevich MAKARIN, a member of the European Association of Thyroidologists, told us about the intricacies of his profession at the North-Western Regional Endocrinological Center of St. Petersburg.
— For what diseases of the thyroid gland is surgery necessary?
— Surgical treatment is prescribed based on the cytological conclusion. If the TAB answer says “papillary carcinoma”, “medullary carcinoma”, “anaplastic carcinoma”, “follicular tumor”, it is necessary to operate the thyroid gland.
In all these cases, there is a malignant process, except for the follicular tumor, where it is suspected, but is more accurately diagnosed only after surgery (based on the results of histological examination).
In cases where the nodes in the thyroid gland are benign, surgery can be performed for compression of the neck organs, a cosmetic defect (too large goiter), or a toxic adenoma.
— Is the thyroid gland always removed completely?
— There are several types of operations on the thyroid gland: thyroidectomy (complete removal), hemithyroidectomy (removal of one part), subtotal resection (saving a few grams of the thyroid gland) and resection (removal) of the isthmus.
Depending on the disease, the surgeon will determine the scope of surgical intervention. For example, if a patient is diagnosed with carcinoma, a full operation is required - thyroidectomy.
In case of follicular tumor, thyrotoxic adenoma, diffuse toxic goiter, it is possible to remove part of the thyroid gland or subtotal resection.
If the lymph nodes of the neck are affected, it is necessary to perform lymph node dissection (excision of the lymph nodes).
— How is preoperative preparation going?
— When the patient has received a conclusion from an endocrinologist surgeon for surgical treatment, it is necessary to determine the date of the procedure. There is an opinion that it is bad to have surgery in the summer months, but in fact, the operation can be performed at any time of the year.
There is no special preparation for surgical treatment; the main requirement is the absence of acute chronic diseases or their exacerbations.
— Is the choice of general or local anesthesia of fundamental importance?
— Most operations on the thyroid gland are performed under general anesthesia (the patient is in a medicated sleep and does not feel pain).
Patients often ask about the possibility of local anesthesia, but from a safety point of view, general anesthesia is the most optimal choice.
— It all depends on the extent of the surgical intervention. On average, a thyroidectomy is performed in 60-100 minutes. Although sometimes the surgeon needs more time, for example, when the lymph nodes of the neck are affected, the operation lasts up to 4-6 hours.
— What complications occur with thyroidectomy?
— All complications can be divided into two groups: nonspecific (characteristic of any field of surgery) and specific (related, for example, only to operations on the thyroid gland).
Common consequences can be bleeding, suppuration, swelling, but they are rare and even if they occur, they respond well to treatment.
It happens that during thyroidectomy of the thyroid gland, damage to the laryngeal recurrent nerves occurs or hypoparathyroidism develops (a painful condition associated with a decrease in the level of parathyroid hormones).
The recurrent laryngeal nerves (there are two of them - right and left) are located behind the thyroid gland and pass through the vocal cords. If the nerves are damaged, the patient may temporarily lose their voice. The risk of voice loss ranges from 1 to 13% (it all depends on the skill of the surgeon).
Hypoparathyroidism is manifested by a lack of calcium in the body, due to which the patient may feel goosebumps in various parts of the body and cramps. This complication is much less common than temporary loss of voice.
Letters from readers are commented on by a surgeon-endocrinologist at the North-Western Regional Endocrinological Center (St. Petersburg), a member of the European Association of Thyroidologists, Viktor Alekseevich MAKARIN.
I was diagnosed with non-toxic nodular goiter. Surgical treatment was recommended. Ultrasound results: left lobe 19x23x53 mm, volume 13 cubic meters. cm; right lobe 20x16x55 mm, volume 9.2 cubic meters. cm, total volume 22.2 cu. see. The contours are smooth, the structure is of normal echogenicity, heterogeneous. There are nodes in the left lobe - 30x20 mm, in the right lobe - 8x6 and 30x16 mm. Cytological conclusion: colloid, erythrocytes, a small number of macrophages. Do I really need to have surgery? O. YANUSOVA, Arkhangelsk region.
— To the people you presented in the letter, you really have nodes in the thyroid gland, but I did not see a clear cytological conclusion. The answer “colloid, red blood cells, a small number of macrophages” is not a standard conclusion of a fine-needle aspiration biopsy (FNA). I recommend that you have a repeat puncture of the thyroid nodules at a specialized endocrinology center.
Based on the results of a repeat biopsy, it will be possible to determine further treatment tactics. If there is a benign process and no complaints, it will be enough for you to do an ultrasound once a year and monitor the TSH level. If, over time, compression of the neck organs or autonomously functioning nodes (toxic adenoma) appears, surgical treatment can be considered.
I am 20 years old, 17 of them I lived in the iodine-deficient Irkutsk region. The endocrinologist sent me for an ultrasound of the thyroid gland. A nodule measuring 18 mm was discovered in the right lobe. Hormones are normal, and the answer to FNA is a follicular tumor, possibly an adenoma. The endocrinologist and surgeon strongly recommend surgery. I’m basically ready, but the thought of laser treatment still haunts me. What will the specialist advise? M. TANIROV, Moscow.
- Indeed, if the biopsy results in a follicular tumor, it is necessary to undergo surgery. There is no alternative.
Laser treatment is not recommended, since cytological examination does not exclude a malignant process.
The head of the endocrinology department of the Nizhny Novgorod Regional Clinical Hospital named after N. A. Semashko, Honored Doctor of Russia Georgy Petrovich RUNOV, answers readers’ questions.
I had surgery and had my thyroid gland removed. Tell me what I should do now: do I need to follow a diet, are there any restrictions? How to live after removal of the thyroid gland? E. VOSTROVA, Nizhny Novgorod region.
— There is no need to follow a special diet, but age and concomitant diseases should be taken into account. If you are overweight, you need to limit yourself in fats and carbohydrates.
You do not indicate in your letter how much of the thyroid gland was removed. It is possible that the rest of the organ continues to function. Thyroid function should be examined at least once a year. You need to be examined for hormones: determine free thyroxine (T4), thyroid-stimulating hormone (TSH).
After removal of the thyroid gland, I was diagnosed with postoperative hypoparathyroidism. I am worried about cramps in my legs, arms, neck, stomach, and numbness in my toes. As prescribed by an endocrinologist, for the first 10 months I took Pilatahistin, 1 drop once a day, gradually increasing to 9 drops 3 times a day. Now I’m taking osteomol, it’s a little better. But at night my legs still burn with fire, I can’t feel my fingers, it’s as if goosebumps are crawling under my skin. A year has passed since the operation. Please tell me how dangerous this disease is and how to fight it? E. F. NOVIKOVA, Tomsk region.
— In case of postoperative hypoparathyroidism, systemic (without interruptions) calcium-retaining therapy should be carried out.
In treatment, calcium preparations (calcium carbonate, calcium citrate) should often be combined with calcium-preserving agents (vitamins of group D, vigantol, alpha-calcidol, calcitriol, dihydrotachysterol).
There are also ready-made combination medications that simultaneously contain both calcium and vitamin D3 (calcium D3, calcium D3-forte). These drugs should be prescribed by the attending physician.
Normal calcium levels will help prevent seizures. It is desirable that the calcium level in the blood is in the range of 2.1-2.5 mmol/l.
I am 31 years old. Diagnosis: thyroid cyst. Tell us about the methods of treating this disease. Y. G. VORONOVA, Nizhny Novgorod.
Candidate of Medical Sciences Olga Vladimirovna RUINA answers the question
— A thyroid cyst is a nodular formation with a cavity filled with liquid contents.
Cysts can appear as a result of hemorrhages, dystrophy (malnutrition) of the gland, or an increase in its follicles.
In most cases, cysts are benign. However, their “behavior”, alas, is unpredictable. In some cases, cysts do not show negative dynamics for years, in others they quickly increase in size, and thirdly, they disappear on their own. The reason to consult a doctor is usually the moment when the cyst becomes noticeable to the eye and deforms the neck. By this time, the size of the formation usually exceeds 3 cm.
As the cyst grows, the patient begins to complain of a feeling of a “lump” in the throat, difficulty swallowing and breathing, hoarseness or loss of voice, and neck pain.
Cysts less than 1 cm in diameter are usually only observed. For large formations, a puncture is performed, during which the cyst is emptied and material is taken for cytological examination.
If contents accumulate in the cyst again, the question of surgical removal is raised.
Lotions and warming compresses cannot be placed on cysts, as they can provoke inflammation.
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Probably only the laziest representative of the gentle sex did not look for signs of thyroid disease Not very good condition of the skin, nails and hair, excess weight and changes in mood make you consider these to be signs of thyroid disease.
Yes, indeed, these are some of the common signs of thyroid disease, but they are far from the only ones. But we should not forget that the same signs can cause not only ill health of the thyroid gland, but also other organs. These signs only allow one to suspect the disease, and a conclusion is made only on the basis of a set of patient complaints, examination data and examination of the thyroid gland. Without this, the diagnosis can only be considered probabilistic.
Recently, a woman came to me with the problem of excess weight. She kept insisting that she definitely had some kind of thyroid disease. She motivated this by the fact that she had been carrying extra pounds for a long time and could not lose them.
I tried, as best as possible, to explain to my reader that the signs of thyroid disease do not necessarily include weight gain and the inability to lose extra pounds. In addition to this, there are other signs.
Then she asked me to voice the symptoms of thyroid disease. What followed was a rather long and not very interesting correspondence, since the lady did not want to let go of her excuse for being overweight.
By the way, she was never found to have a single disease, so we came to the conclusion that we need to reconsider our diet and increase physical activity.
As a result of this, the idea to write this article was born. In it I want to talk about the most common signs that may indicate a thyroid disease.
All diseases of the thyroid gland can be divided into groups that characterize the functioning of the gland.
Naturally, diseases with normal functioning of the gland will occur without any manifestations, since it is the disrupted functioning that causes changes in health. Although... but more on that a little later.
So, you can suspect a thyroid disease associated with thyrotoxicosis (increased work of the gland) and begin an examination in the following cases when there are:
To find out whether there is actually a rapid heartbeat or increased blood pressure, you need to measure your pulse and resting pressure. It is considered ideal when you measure immediately after waking up, without getting out of bed. Normally, the heart rate is 60-80 beats per minute, and blood pressure is not higher than 120/80 mmHg. Art. If in the morning the pressure is normal and the heartbeat is not rapid, but in the afternoon there is a deviation from the norm, then most often the cause is not related to thyroid disease, but is a sign of another disease.
Interruptions in the functioning of the heart are felt in different ways. Most often, this is a feeling of temporary cardiac arrest or interruptions in heart rhythm (alternating frequent and rare heartbeats). Interruptions in the functioning of the heart can be detected independently. To do this, you need to feel the place on the wrist where the pulse is felt and monitor the pulse waves for 1 minute. If the pulse is uneven and irregular, then there may be a rhythm disorder, which requires an ECG and consultation with a cardiologist.
A person with thyrotoxicosis has a very good appetite; it can only be disrupted in very severe forms. But at the same time, a person progressively loses weight, no matter how much he eats. This is due to accelerated metabolism with increased levels of thyroid hormones. But in very rare cases, on the contrary, there is an increase in body weight. This sign of thyroid disease was called “fat based”, when, with all other obvious signs of thyrotoxicosis, there is excess weight.
A patient with thyrotoxicosis is always hot and stuffy, and tends to go to colder rooms. The room temperature that is comfortable for a person with thyrotoxicosis will be low for a healthy person. This is also associated with rapid metabolism, as a result of which a lot of thermal energy is released, which must be removed from the body, creating appropriate environmental conditions.
Trembling in the body is also one of the common signs of thyrotoxicosis. At first it is not noticeable, although there is already a violation of writing and curvature of handwriting. Further, as the disease progresses, trembling can spread to the entire body. The patient becomes like an aspen leaf trembling in the wind.
Eye damage does not always accompany thyrotoxicosis; it all depends on the cause of thyrotoxicosis. I wrote about this in my previous articles. This symptom is often found in diffuse toxic goiter and is called “endocrine ophthalmopathy.” This is an independent autoimmune disease of the fatty tissue of the orbit of the eye, which requires separate additional treatment. The main signs can be considered wide open palpebral slits, which even creates the impression of bulging eyes, there is also tearing, “a feeling of sand in the eyes.”
A person with thyrotoxicosis changes not only externally, but also psychologically. He is more irritable, moody, whiny, angry, anxious, and fussy. There is a sleep disorder.
Diseases of the thyroid gland, characterized by hypothyroidism (reduced gland function), are often manifested by the following symptoms:
Skin with hypothyroidism has a characteristic appearance. Unlike thyrotoxicosis, with hypothyroidism the skin is dry, flaky, has a pale gray tint, elasticity is reduced, and the skin seems to hang. Dryness is especially pronounced on the elbows, knees, and face. This is due to a decrease in collagen synthesis during hypothyroidism, which serves as the skin framework. It has been noted that hypothyroidism is characterized by loss of eyebrow hair at the outer edge of the eye. Nails are peeling, and hair is dull and brittle.
Due to a decrease in the metabolic rate, little thermal energy is produced in the body, and this causes a constant feeling of cold and chilliness.
Swelling associated with hypothyroidism can range from mild swelling under the eyes to widespread swelling of the entire body, including fluid accumulation in the cavities (pleurisy, for example). Mainly due to excess fluid, excess weight increases. Edema is associated with impaired protein metabolism in hypothyroidism. A swollen and large tongue can cause difficulty speaking. Speech becomes slow and slurred.
Increased body weight is associated, as I already said, with excess fluid volume and slow metabolism, due to which all energy consumed accumulates in fat depots. You can cope with obesity only by normalizing the level of thyroid hormones. But in rare cases, with hypothyroidism, obesity may not exist, the weight remains at the same levels or even becomes lower.
People with hypothyroidism often have a low pulse (below 60 beats per minute) and low blood pressure (below 110/70 mm Hg), but as it turned out, in 30%, the pulse and blood pressure are, on the contrary, elevated.
Since hypothyroidism slows down the overall metabolism, nerve impulses travel more slowly. Therefore, there is slowness of speech, thinking, reactions and precision in movements. Such patients move very slowly. As a result, intellectual abilities and memory decrease. It is noted that with hypothyroidism there is pathological drowsiness, especially during the day. But, fortunately, after correction of this condition, these signs of thyroid disease disappear without damage.
Hoarseness and hoarseness are also common symptoms of hypothyroidism. This is due to swelling and swelling of the vocal cords.
A very common sign of hypothyroidism is constipation. Since all processes in the body are slowed down, the motor activity of the intestines is also no exception. For years, patients may suffer from constipation, be treated for dysbiosis, and the real cause may be hypothyroidism. When the underlying cause is identified and eliminated, intestinal motility is restored.
Diseases that are characterized by normal hormonal levels include:
But despite normal hormone levels, these diseases may have other symptoms that are not related to the activity of hormones.
For example, with autoimmune thyroiditis, the thyroid gland can be significantly enlarged, so that it is visible to the eye, but at the initial stage there is no hypothyroidism, and therefore this can only be the only symptom.
With nodular or multinodular colloid goiter, tumor protrusions in the neck in the projection of the thyroid gland, a feeling of squeezing, impaired swallowing and breathing in very large sizes, which is associated with compression of the trachea and esophagus, may be visible.
With endemic goiter, a uniform enlargement of the thyroid gland can also be observed, and if the deficiency is not expressed, then hypothyroidism may never occur, but the size of the gland will progressively increase.
Oncological diseases are accompanied by pain in the thyroid gland, the appearance of hoarseness, which indicates germination beyond the gland.
Cysts, like colloid goiter, can only cause visual discomfort and sometimes impair the passage of food and breathing.
A retrosternal goiter is usually not visible from the outside, because it is located behind the sternum, but if it is large in size, it can compress nearby organs and cause a lot of symptoms that are in no way related to the thyroid gland.
And that's all for me. I hope that you have not found any of the signs of thyroid disease mentioned in this article. And if you find it, then remember that the diagnosis is never made based on one sign and if you still have doubts, then contact a specialist to dispel your fears. Subscribe to blog updates to receive new articles directly to your email.
With warmth and care, endocrinologist Dilyara Lebedeva