simple goiter in children
Introduction
Introduction to simple goiter in children Simple goiter is a general term for thyroid enlargement diseases other than secondary goiter and hyperthyroidism. It is caused by iodine deficiency or thyroid-induced substances. Generally, there is no thyroid dysfunction. Simple goiter can be divided into local and sporadic. basic knowledge The proportion of sickness: 0.002%-0.003% Susceptible people: children Mode of infection: non-infectious Complications: hyperthyroidism
Cause
Causes of simple goiter in children
(1) Causes of the disease
1. Endemic goiter The main cause of endemic goiter is iodine deficiency. Soils in popular areas, water and food contain very little iodine. The incidence rate is proportional to the amount of iodine. It is also reported that calcium, magnesium and fluoride are contained in water. Excessive too much can cause goiter, and some monovalent anions similar to I- are too high in the blood, such as SCN-, Br-, etc. compete with iodine, so that the thyroid iodine ability is reduced, the synthesis of thyroxine is reduced, and the pituitary Secrete more TSH to stimulate goiter.
2. The common cause of sporadic goiter in sporadic goiter:
(1) Increase in physiological requirements: increase the physiological requirements of thyroxine, such as prepuberty, pregnancy or some kind of stress, such as infection and trauma.
(2) drugs: drugs that affect the synthesis of thyroxine, such as potassium thiocyanate, thiourea; sulfonamides.
(3) Congenital defects: congenital defects in thyroxine synthesis, defects in a special enzyme in various steps of thyroid biosynthesis, thyroxine synthesis disorder, increased secretion of TSH, goiter, and complete defects in enzyme defects Partial defects, partial enzyme defects swollen thyroid tissue, so that thyroid function can be compensated, clinical goiter, thyroid function is normal; if decompensation, clinical symptoms of hypothyroidism, known as peroxidase deficiency, iodized tyrosine Acid-coupled enzyme deficiency, deiodinase deficiency, etc., recently found that the thyroid target gland does not respond to TSH, and the surrounding tissue does not respond to thyroxine.
(two) pathogenesis
Early thyroid gland is uniform, diffuse gonadal cell hypertrophy and hyperplasia, blood vessels are significantly increased, acinar cell hypertrophy is columnar, epithelial cells proliferate, acinar cavity is reduced in glial, late stage due to irregular proliferation of glandular tissue, gradually appearing nodules, part Acinar necrosis, hemorrhage, cystic changes, fibrosis.
Prevention
Pediatric simple goiter prevention
The best way is prevention. The following methods are often used:
1. The iodized salt is convenient and effective, and sodium or potassium iodide is added to the salt, and the concentration is 1:10000 or 1:20000 occasional 1:50000.
2. Iodized drinking water is added with 1 g of potassium iodide per 100,000 liters (about 2,500 liters) of drinking water, and 10 g of potassium iodide per liter of water.
3. Iodine oil intramuscular injection or consumption also has a good preventive effect, the injection of iodized oil is less than 1 year old 125mg; 1 ~ 5 years old 250mg; 6 ~ 10 years old 750mg; 10 years old or older with the same adult, each injection 1000mg, goiter Almost all disappeared.
4. Eat more iodine-rich diets such as seaweed, kelp, sputum, etc.
Complication
Pediatric simple goiter complications Complications
There may be symptoms of compression, such as difficulty breathing, hoarseness, causing superior vena cava compression syndrome; hypothyroidism occurs; when iodine is supplemented, thyroxine is synthesized too much to form iodothyronidine.
Symptom
Symptoms of simple goiter in children Common symptoms Nodular goiter hoarse heart rate increases
There are no obvious clinical symptoms in the early stage. A few may have excessive sweating, increased appetite, easy impulsivity, and a slightly faster heart rate. Adolescent patients have irregular menstruation, mild diffuse thyroid enlargement, soft texture, and few are nodular, obviously swollen. The thyroid gland may have symptoms of compression, such as difficulty breathing, irritating cough, hoarseness, etc. If the giant goiter is located behind the sternum or in the chest, it may cause superior vena cava compression syndrome, and 5% of the patients have thyroid compensatory function. Insufficient, hypothyroidism, it can also be seen that patients with endemic goiter due to long-term serum TSH levels increased, when iodine supplementation, thyroxine synthesis is too much, can form iodothyroid.
Examine
Examination of simple goiter in children
Thyroid 131I uptake test, the rate of 131I increased, up to 90% to 98%, showing iodine starvation, but can be inhibited by thyroid inhibition test, blood T4 is normal or reduced, thyroid hormone inhibition of pituitary is reduced, TSH is increased, blood T3 is increased, because it not only saves the raw materials of iodine, but also has strong biological activity, which can meet the physiological needs. The urinary iodine reduction is often <50g/d (normal value 50-100g/d), and the severe urinary iodine is 0.
Thyroid ultrasonography and scanning can reveal diffuse enlargement of the thyroid gland.
Diagnosis
Diagnosis and diagnosis of simple goiter in children
diagnosis
Diagnose based on
Goiter, but function (T3, T4, TSH) is basically normal, thyroid antibody TG-Ab and TM-Ah are negative in the blood; thyroid B-ultrasound only sees enlarged thyroid volume and uniform echo, normal diagnosis of thyroid scan, patient from non- Goiter is a prevalent area and is distinguished from hypothyroidism and endemic goiter.
1. Diagnosis of endemic goiter
(1) The patient is from a prevalent area of goiter.
(2) The thyroid gland is swollen to varying degrees.
(3) The rate of 131I increased, mainly due to iodine starvation, generally no peak shift, can be inhibited by thyroxine.
(4) Urinary iodine <50 g / d (normal value 50 ~ 100 g / d).
(5) Serum T4 is reduced.
(6) The concentration of TSH in the blood is increased.
2. Diagnosis of sporadic goiter
No regional epidemic, more common in growth and development, pre-puberty or adolescent children, or have taken thyroid-causing substances, 24h urine iodine does not decrease, the rate of 131I is more than iodine-free hunger curve.
(1) Careful inquiry of medical history, combined with clinical symptoms is not difficult to make a diagnosis, should be differentiated from chronic lymphatic thyroiditis.
(2) thyroid absorption 131 iodine increased.
(3) Thyroid inhibition test can be differentiated from hyperthyroidism.
(4) Perchlorate release test can diagnose peroxidase deficiency.
Differential diagnosis
Need to be differentiated from chronic lymphocytic thyroiditis, nodular goiter, familial enzyme-deficient cretinism.
Thyrotoxicosis
Hyperthyroidism caused by various reasons, children with clinical manifestations of hyperthyroidism, such as polyphagia, weight loss, sweating, diarrhea, heart rate, blood T4, T3 can increase, the rate of 131I increased and not for thyroid suppression test Inhibited, the thyroid scan has more hot nodules.
2. Deafness -
Goiter syndrome (Pendred syndrome) is an autosomal recessive disorder, with deafness and dumb after birth. Goiter can occur in childhood, thyroid function is basically normal or low, and perchlorate excretion test is often positive (often More than 30%), the disease is a defect in the organicization of congenital iodine, increased iodine tyrosine in the blood, increased MIT/DIT and iodine tyrosine/iodolinine ratio, and no reduction in urinary iodine.
3. Familial enzyme deficiency cretinism
Due to enzyme defects caused by thyroid hormone synthesis disorders, there may be a family history, clinical manifestations in addition to goiter, accompanied by hypothyroidism, such as poor appetite, constipation, mental retardation, growth and development, if there is a typical face More easy to diagnose, low basal metabolic rate, low blood T4, high TSH, and no reduction in urinary iodine.
4. Chronic lymphocytic thyroiditis
Painless goiter in childhood, tough texture, most of the normal function, hypothyroidism after a few years, very few transient hyperthyroidism; anti-thyroglobulin antibody (TGAb) or anti-peroxide in the blood Enzyme antibody (TPOAb); multiple needle aspiration thyroid tissue biopsy can be found in the acinar filled with lymphocytes and plasma cells, urine iodine is not reduced.
