Dr. Ushakov
Medical Thermography (thermovision)
Thyroid treatment (including nodes, increase)
ultrasonic scanning                 

Thyroid nodular or diffuse goiter( )

Content:

 

Patients with nodular thyroid goiter at the low TSH level shouldnt be subject to serum insertion of thyroid hormones. Moreover, advisability of such therapy is doubtful at any multimode goiter, as it leads just to very moderate reduction of its sizes, which are usually increased once again after treatment cancellation.
Peter A. Singer, MD in the monograph "Thyroid diseases" edited by Lewis E. Braverman, MD, University of Massachusetts medical Center Humana Press, Totowa, New Jersey

About thyroid disease

Presence of nodes in the thyroid gland or its volume increase it is accepted to call as nodular or diffuse goiter. These nodes in 2-4 times more often are revealed among women, with prevalence of about 20-65 per cents. From the morphological point of view, this disease is revealed in local or diffuse (general) structural TG nodes volume increase follicles, peculiar bricks, which form this building of this endocrine organ. Follicles are globular elements, consisted on the periphery of cells and internal colloid lake. It is comparatively often condition modification of these structural thyroid elements is connected with its function effort in response to organism need in hormones, generated by the thyroid gland.

Thyroid disease development

Thyroid tissue increase and nodular constitution may be appeared not only at the deficiency of iodine supply, but also at the sufficient iodine level (physiological level, 50-100-150 mcg/a day).

Thyroid gland may increase its volume in return:

  1. at the extremely low (considerable) iodine supply (this is an endemic goiter; its prevention and treatment is connected to iodine medications prescription);
  2. at the slight reduction of physiological iodine norm supply and additional negative factors (deficiency of compensatory organisms opportunities),
  3. at the normal (sufficient) iodine supply but extremely high functional TG intension in return to changes in the organism.

It is true, that iodine has an influence on the thyroid gland condition. But low iodine level doesnt play absolutely a determinative role in development of nodular and diffuse changes of the thyroid tissue. Twenty five per cent of population, suffering from goiter, live in the region, where preventive iodine measures are conducted, and individual iodine additives far from always fully eliminate goiter development.

Against a background of sufficient (!) iodine saturation, Th-d changes appear at the increased functional load. As the main thyroid function is energetic exchange regulation (in different cells and organs), also called as calorie-gene one (this is such part of metabolism, which refers to kilocalories sphere), received by organism from food substances and own resources, and used by organs cells for its own needs), there is an increasing need in Th-d hormones at the viscera diseases and conditions with energetic insufficiency. Originally, an increased load on hormonal production is compensated, and is not revealed in iron changes or in any other signs. Later, to fulfil hormonal production tasks, its tissue is transformed in iron, general or local follicles increase is developing, in that way forming diffuse or nodular goiter. As a rule, euthyroid condition is revealed among patients with these changes, i.e. normal hormonal quantity. Changes in the thyroid hormonal level (reduction) in combination with the additional signs may be evidence of transition into sub-compensation condition (i.e. greater deficiency of functional TG opportunities). Thus, changes (increase) of hypophysis hormone quantity (thyrotropic hormone - TSH) are natural, as it controls Th-d activity. The TSH level becomes normal at the thyroid activitys renewal.

Thus, the base of the concerned Th-d is intension of its function in return to organisms needs.

This is promoted:

  • by viscera diseases,
  • by hereditary and acquired energetic (calorie-gene) insufficiency,
  • by goitrogenic environmental factors (some foodstuff substances and some environmental substances).
Important observation

It was revealed a considerable number of patients with thyroid changes at the investigation conducting among patients with the irritable bowel syndrome.
It is rather natural, that preferably women suffer from this syndrome, as well as from nodular Th-d changes (ratio of women and men equal to 4:1). It confirms the endocrine theory of gastroenterological pathologys development.
Scientific analysis of such situation showed, that Th-d activity is closely connected to digestive tract condition. Moreover, thyroid gland during the embryonic organism development appears from the main part digestive tracts sides. In other words, TG is a derivative organ from the digestive system, which also consists of majority of secretory formations (digestive and small endocrine glands, related to EPUD-system).
Later, practice revealed, that treatment among patients with the irritable bowel syndrome was much more successful at the joint thyroid gland recovery only.

On the other hand, recovery of TG itself without internal environment is also difficult and requires renewal treatment of the organs, interrelated with thyroid gland.

Thyroid disease diagnostics

During this disease history of its development (anamnesis) is being estimated, palpation Th-d investigation is being executed, Th-d hormonal, TSH and blood level is being studied (rarely some antibodies, calcitonin etc.). Visual assessment of th-d changes is important compound part of modern diagnostics.


Th-d thermography
In detail

Radio-nuclide scanning (it determines saturation level by radio-active iodine of Th-d tissue), ultrasonic scanning (US), computer tomography (CT) and magnetic-reverberatory tomography (MRT) are applied to reach this aim. Usually clinicians more often apply US as an initial diagnostics method. This method allows defining of TG and nodes sizes and volume, assessment their condition, including malignancy probability. Radio-nuclide scanning defines activity of its elements, but not often (as it was supposed before) allows confirming for sure malignancy availability. CT and MRT are used at the conditions, accompanying by upper airways compression symptoms. US is considered as the much cheaper among the above-mentioned visualization methods, and that is why it is popular and is applied at the control investigations.

Thin needle aspiration biopsy (TNAB), also called as paracentetic biopsy, is the directed impressment of Th-d tissue elements by means of the special syringe for the following assessment of the received material (under microscope). This is much more objective assessment of Th-d condition. That is why some specialists consider, that in most cases TNAB should be first of all carried out. In our country (judging by practice), TNAB is prescribed and carried out only at the suspicion on cancer probability. Disadvantages of this method are not absolute accuracy of getting the node and low probability of corresponding cellular impressment. That is why sensitivity and specificity of TNAB concerning Th-d cancer makes up 83 and 92 per cent correspondingly.

Malignancy

According to different statistic researches, probability of malignancy of single palpation Th-d nodes approaches to 5%. In this connection, surgeons offer ablation of all thyroid gland nodes, and physicians-endocrinologists prefer conservative treatment way, with a choice of operation as the extreme measure. The recent appearance and rapid growth may be evidence of the nodular malignancy (but it is not absolutely exact fact). Head and neck irradiations, occurred earlier, as well as presence of cancer cases (more often of medullary one) among family members are evidence of possible probable malignancy. Nodes among children and the persons elder 60 years (especially men) are more often malignant.

Voice hoarseness at the nodal process in the TG is not always should be estimated as cancer, and sudden pains in the neck are more often not a cancer sign.

Thyroid treatment

Treatment at the Th-d nodular and diffuse goiter should be directed on functional loads reduction on this organ. This will allow the gland, functioning in the usual mode, not to use its additional opportunities at the expense of functioning elements increase and to exclude critical situations, revealing locally.

To reach this aim, we offer two ways:

  • introduction in the organism of Th-d hormones, to fill up increased needs in them,
  • limination of reasons, conditions and factors, leading to a high functional load on thyroid gland.

The first variant is much more popular. As a rule, endocrinologists prescribe hormonal medications as substitutive therapy. Sometimes, such medications prescription is proved by a feedback with the hypophysis, hormone of which (TSH) stimulates Th-d activity at its function reduction. Some specialists consider, that the Th-d tissue is just due to this fact is transformed (nodal increase and formation appear), and they by mistake accent their attention just on ablation of TSH formation during the treatment.

Using hormonal medications, the TG load is being reduced, and the changes (thyroid nodes and diffuse Th-d volume increase) undergo to some back development. This is a remarkable indication on reversibility of pathologic (more exactly accommodated processes) in the thyroid gland! But the given reversibility is not valuable. First, because everything, due to that the TG appeared in such condition, continues to be valid and to require the greater hormonal quantity. Patients are forced to increase medications dose. Second, because as the hormonal need increases, and as their dozes increase (with medications), as gradual reduction of the Th-d activity occurs, with a possibility of a full organs atrophy. Third, because after abolition of hormonal medications using there is a reversible nodular development.

Hormonal medications application may be proved either as temporary measure (for assessment of the thyroid condition, its maintenance in the conditions of impossibility of the alternative treatment conducting, with the diagnostic aim), or due to the surgically ablated thyroid gland (because of nodular malignancy, for instance). In the latter case, using of hormonal medications becomes obligatory during all the period of life.

Thus, it is important to remember, that reception of the medications, containing Th-d hormones, accelerates osteoporosis and may lead to changes in the hearts cells, increasing a risk of atrial fibrillation (condition, close to the hearts stop) to the middle age.

Nodular ablation (more often of the whole TG lobe) does not exclude functional load on the thyroid, i.e. it doesnt exclude the reason of such condition of the thyroid gland. That is why nodular formation is going on. And if one lobe is ablated, the thyroid gland nodes are being developed in the other lobe. Later surgeons may offer next operation. It shouldnt to forget about small, but very important parathyroid glands, usually located close to the Th-d. Cases of their ablation together with the Th-d lobes are not in the least rare. It may also lead to some disorders.

But in some cases (for instance, process malignancy) operational method is forcedly prescribed. In this case the smaller harm is preferred (chronic medication reception).

The second way of treatment should be related to the renewable, as elimination of the reasons, conditions and factors, provocative the functional thyroid intension (revealing in nodular formation and volume increase), leads to the stable renewable transformation of the Th-d tissue. Developed and practically approved treatment method of the thyroid nodular and diffuse goiter (A.V. Ushakov, 2002) includes correction of energetic (calorie-gene) condition, renewal of hormonal balance in interrelations between internal organs, elimination and reduction of the harmful factors influence, and functional maintenance of the TGitself. These measures are realized by means of acupunctural influence, assessment of mode of living and recommendations on the not difficult (but necessary) food correction, some habits, and the other factors, having an influence on pathology.

Example of recovery

Patient, a woman, S., 29 years old, applied to the doctor in connection with the diffuse nodular goiter revealed by US. During the examination the changes in activity of some internal structures were revealed. These are disturbances in sleep, of the general state of health, periodical headaches, discomfort in the neck part of spine and signs of digestive apparatus activity disturbance. Assessment of the hormonal Th-d level in blood revealed euthyroid condition (hormonal quantity is in the limits of norm). This is indicated on the conditions compensation.

Before treatment

In 1.5 months after
the first treatment course
In 2 months after
the second treatment course
General volume of the
thyroid gland
43,6
ml
General volume of the
thyroid gland
32,2
ml
General volume of the
thyroid gland
26,7
ml
TG node node in the right lobe sizes
2.12.94.7cm
TG node node in the right lobe sizes
1,61,83,1.
TG node node in the right lobe sizes
1,21,32,3.
Thyroid gland node in the left lobe sizes
1,81,92,5 1,81,32,1.
Thyroid gland node in the left lobe sizes
1,61,21,9 1,40,91,6.
Thyroid gland node in the left lobe sizes
0,60,81,2 1,10,51,2.

After the third and fourth treatment courses the TG volume was renewed up to the normal condition, the residual node was preserved in the right lobe, but it was of a smaller size. Further two courses with three months-intervals allowed fully to eliminate changes in the thyroid gland.

Advice

To get advice, you should present information, as follows:

  • about state of health (to describe in any words disease manifestations) for the recent period of time (a week, month, half-year, year),
  • US results of the TG (the recent ones, and the earlier according to the date),
  • blood tests results (general analysis, thyroid glands hormonal analysis, TH, etc.),
  • results of the operations, being made, their volume (epicrisis),
  • treatment having been applied and applying at the moment,
  • internal organs examination results (if any exist).

The additional data will assist:

  • age, weight, growth,
  • temperature preferences (if you like cooler or warmer temperatures); i.e. if you have or not chill of footsteps etc.),
  • place of birth or residence (for orientation according to the middle-seasonal temperatures, iodine saturation of the region),
  • taste preferences (if you like salted, pungent, bitter, sweet, sour food),
  • arterial pressure adherent for you (what it was before, and what you have at the moment),
  • if you often have catarrhal diseases during a year (including slight cold and if you dont lay in the bed),
  • what was your diseases (special attention to lungs, digestive tract, cardiovascular system condition),
  • for women: menstrual cycle (rhythm, duration, abundancy, morbidity) and gynaecological sphere,
  • for men: potency level.


Apply to Doctor A.V. Ushakov
tel.+7 (495) 346-2038
Initial advice. Answers to questions.



Dr. Ushakov Copyright Dr. Ushakov 1999-2009


Rambler's Top100
 ,  ,   !