CRAW SPORADIC (grech, sporadikos scattered, separate; synonym: sporadic goitrous disease, nontoxic craw) — the disease, a cut is characterized by an enlargement of the thyroid gland, as a rule, without the expressed dysfunctions of body; develops at persons, areas, living out of endemic on a craw.
Prevalence 3. to page accurately it is not established; at women it is observed by 6 — 8 times more often than at men.
Reason of development 3. the page can serve the relative iodic insufficiency caused: 1) receipt in an organism of goitrogenic substances — the thiocyanates and tiooksizolidon (contain in some grades of cabbage, turnip, a swede, a turnip) blocking utilization of iodine a thyroid gland; 2) damage of a liver also went. - kish. a path, breaking processes of absorption and metabolism of iodine; 3) receipt in an organism of iodine in the form unavailable to absorption (at high content in water and the soil of humin substances). etiol, a factor also disturbances of intratireoidny exchange of iodine and biosynthesis of hormones can be the leader: the inborn lowered ability of tirotsit to absorb and deposit iodine, insufficiency of fermental systems at oxidation of iodide with atomic iodine, disturbance of coupling of iodtyrosines in yodtironina. Deficiency of an intratireoidny hormonogenesis sometimes has hereditary character.
Etiol, factors lead to weakening of a gormonoobrazovaniye and deficit of thyroid hormones in an organism. Adaptatsionnokompensatorny reaction of an organism consists in strengthening of products a hypophysis of thyritropic hormone and intensive proliferation and a hypertrophy of tirotsit that provides the level of the hormones necessary for maintenance euthyroidism (see); sharply products increase triiodothyronine (see). Pathogenetic feature 3. page — continuation of a hyperplasia of a ferruterous parenchyma after compensation of the damaging action of causative factors. Presumable mechanisms of this phenomenon: relative denervation of aktivnoproliferiruyushchy zones of a parenchyma, distortion of the afferent impulses going from them to c. N of page, and emergence of the congestive dominant centers in talamo-hypothalamic area. Focal disturbances of an innervation can serve etiol, a factor in development of a nodal craw. According to Sh. Milka (1960), autoimmune processes participate in goitrous transformation. A. M. Raskin (1973) provides data on detection of anti-thyroid autoantibodies at patients with a nontoxic nodal craw. Believe that transition euthyroid 3. the page in hyper thyroid can be provoked by additional influence of the factors capable to cause development thyrotoxicosis (see).
At 3. page it is possible the diffusion, nodal and mixed forms of goitrous transformation. On gistol, structure distinguish parenchymatous and colloid, proliferating and not proliferating forms.
Diffusion parenchymatous 3. the page can have a tubular, trabecular and microfollicular structure (fig. 1 — 3). In an interfollikulyarny epithelium the cells of Askanazi (a cell In) producing biogenic amines come to light (I. G. Mikhaylov, 1972); cells In 1,5 — 2 times more largely cells And also differ in abundance of mitochondrions and high activity of oxidation-reduction enzymes.
Diffusion colloid 3. the page can have macro - and a microfollicular structure (fig. 4 — 6). Follicles are covered by cubic, is more rare — a prismatic epithelium. Their cavities are filled with a dense colloid with the low content of RNA, SH-group of proteins giving homogeneous CHIC reaction. Proliferating forms of a colloid craw are characterized active intra-and an interfollikulyarny hyperplasia of tirotsit, leads edges to emergence in a wall of follicles of a significant amount of thickenings (sandersonovy pillows), nipples and branched papillomatous outgrowths. Similar reorganization is often observed upon transition of an euthyroid craw to hyper thyroid.
Uzlovaya 3. the page also has a parenchymatous or colloid structure, but with that difference that goitrous transformation of a thyroid parenchyma has focal character. Nodes are isolated from a surrounding parenchyma by the thin connective tissue capsule. Nodes can be single and multiple; their sizes, a form and density considerably vary. The prelum large nodes of the parenchyma surrounding them can cause in it development of the atrophic phenomena. At the complicated forms 3. pages in nodes decide destructive changes of a parenchyma on a hyperplasia of connecting fabric, furnacing of walls of vessels and connective tissue layers; perhaps cystous and malignant regeneration of a craw.
Pathoanatomical features 3. pages not always correspond a wedge, to displays of a disease.
The clinical picture
the Disease usually develops gradually, its progressing can be promoted by a nerve strain, an injury, pregnancy, a lactation, intercurrent diseases. Distinguish 3. page in a form of goitrous transformation (diffusion, nodal, mixed), the size of a craw (the II—V degree) and on functional manifestations (euthyroid, hypothyroid and hyper thyroid). The hyperthyroidism often is considered as a complication 3. page. The symptomatology considerably is defined by the sizes and topography of a craw. The euthyroid craw of the small sizes can not give the expressed symptomatology. However at careful inspection at most of patients with 3. pages come to light functional disturbances from nervous, cardiovascular, sexual systems. At a craw of the big sizes or its retrosternal arrangement the prelum of adjacent bodies is possible (tracheas, a gullet, vessels) that leads to difficulty of breath or swallowing, an osiplost of a voice, venous stagnation. Hypothyroid 3. the page is characterized a wedge, symptomatology hypothyroidism (see), hyper thyroid — signs of increase in function of gland (see. Thyrotoxicosis ).
3. the page can be complicated by a subacute or acute inflammation (see. Strumitis ), hemorrhage in nodes, malignant regeneration of nodes.
the Diagnosis is made to hl. obr. on the basis of increase in the sizes of a thyroid gland, change of its form and a consistence, existence of nodes. The functional condition of a thyroid gland is determined by data of a laboratory research (standard metabolism, the proteinaceous and connected and butanolekstragiruyemy iodine etc.) and scannings. To differentiate 3. the page follows with craw local (see), an autoimmune thyroiditis (see. Hashimoto disease ) and cancer thyroid gland (see). Hashimoto's disease is characterized by a high antiserum capacity to tissue of a thyroid gland whereas at patients 3. page the antiserum capacity in blood is low. With the diagnostic purpose sometimes apply a puncture biopsy: it is necessary to think of a malignancy in the presence in iron of dense slow-moving nodes with a pulled surface with the progressing growth of a craw and signs of a prelum of the next bodies. The probability of cancer of thyroid gland is confirmed by detection on skanogramma of «cold» nodes at increase regional limf, nodes.
in the absence of a hyperthyroidism the patient diffusion 3. Thyreoidinum (in the beginning on 0,05 — 0,1 g every other day or daily, then a dose gradually increase) or triiodothyronine in doses of 50 — 100 mkg a day under control of the test of absorption is shown to page 131 I thyroid gland; in the presence of symptoms of a hyperthyroidism the dose decreases. Treatment is carried out within a year.
At patients 3. the village at advanced age, in particular with coronary insufficiency, treatment by thyroid drugs demands control of an ECG and the ABP. At a hyper thyroid craw appoint thyreostatic drugs. In treatment of nodal forms thyroid hormones are less effective. At the big nodal or mixed craw, suspicion on a malignancy, and also at a craw of a root of language (in connection with tendency to a malignancy) the operational treatment obligatory is shown at nodal 3. page at children.
Timely effective treatment provides recovery; at a malignancy the forecast is doubtful.
Prevention consists in an exception of a diet of goitrogenic substances, improvement of quality of drinking water, the prevention of diseases of a liver and went. - kish. path.
Bibliography: Mikhaylov I. G. New aspects in studying of cells of Ashkinazi of a thyroid gland of the person, Arkh. patol., t. 34, No. 7, page 46, 1972, bibliogr.; P and with to and A. M N. Autoimmune processes in pathology of a thyroid gland, page 174, L., 1973, bibliogr.; The guide to clinical endocrinology, under the editorship of V. G. Baranov, L., 1977, bibliogr.; The guide to endocrinology, under the editorship of B. V. Alyoshin, etc., page 162, M *., 1973; Smirnovaye. And. iraykhlinn. T. Gistoen the zimologichesky characteristic of tumors of a thyroid gland from cells Ashkinazi (Gyurtlya), Arkh. patol., t. 31, No. 10, page 33, 1969, bibliogr.; A thyroid gland, Physiology and clinic, under the editorship of S. Verner, the lane with English, page 209, L., 1963; Local craw, the lane with English, M., WHO, 1963; P e and of s e A. G. The cytochemistry of the thyroid G cells and their relationship to calcitonin, Proc. roy. Soc. Med., v. 164, p. 478, 1966; Textbook of endocrinology, ed. by R. H. Williams, Philadelphia, 1974.
A. E. Yefimov; V. A. Odinokova (pat.an.).