Pediatric sporadic goiter
Introduction
Introduction to sporadic goiter in children Sporadic goiter refers to a child with a non-localized hyperthyroidism, non-tumor or inflammation, and a normal thyroid function. Most of the goiters are symmetrical diffuse, and there are also asymmetry or nodular enlargement. basic knowledge Sickness ratio: 0.05% Susceptible people: children Mode of infection: non-infectious Complications: difficulty swallowing
Cause
Causes of sporadic goiter in children
(1) Causes of the disease
Common causes of sporadic goiter:
1. Increase the physiological requirements of thyroxine such as prepuberty, pregnancy or some kind of stress, such as infection, trauma and so on.
2. Drugs that affect the synthesis of thyroxine such as potassium thiocyanate, thiourea; sulfonamides.
3. Congenital defects of thyroxine synthesis Defects of a special enzyme in various steps of thyroid biosynthesis, thyroxine synthesis disorder, increased secretion of TSH, goiter, enzymatic defects may have complete defects and 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, iodine tyrosine coupling 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
The thyroid gland is diffusely enlarged, the surface is smooth, and the cut surface is brownish yellow due to the more gelatinous substance. The follicular epithelial cells under the microscope have different degrees of proliferation.
Prevention
Pediatric sporadic goiter prevention
The best treatment is prevention, and the following methods are often used:
1. Iodized salt: convenient and effective, adding sodium iodide or potassium iodide to the salt, the concentration is 1:10000 or 1:20000 occasional 1:50000.
2. Iodized drinking water: 1 g of potassium iodide per 100,000 liters (about 2,500 liters) of drinking water, 10 g of potassium iodide per liter of water.
3. Iodine oil intramuscular injection or consumption: can be applied when the physiological needs increase, also has a good preventive effect, the injection of iodized oil is less than 1 year old 125mg; 1 to 5 years old 250mg; 6 to 10 years old 750mg; 10 years old and above with the adult, Each time the injection of 1000mg, the goiter almost disappeared.
4. Eat more iodine-rich diets: such as seaweed, kelp, sputum, etc.
5. Use drugs with caution: drugs that affect the synthesis of thyroxine.
Complication
Pediatric sporadic goiter complications Complications, difficulty swallowing
Patients with larger glands may have hernia or difficulty swallowing. If caused by thyroid synthase deficiency, it may be accompanied by slow growth, decreased academic performance, poor intelligence, facial carbuncle and other low performance.
Most of the thyroid is moderately enlarged, and the thyroid function is normal or diminished. There may be different degrees of growth retardation. Individuals may be accompanied by hoarseness, congenital hypothyroidism and bone age.
Symptom
Symptoms of sporadic goiter in children Common symptoms Goiter, slow growth, nodules, difficulty in swallowing, increased heart rate, low thyroid function
There is no uniform standard for the judgment of the degree of goiter, and some people have divided the goiter into 5 degrees:
1.I degree: refers to the thyroid enlargement is not obvious, only can be affected.
2. II degree: refers to the slightly raised head visible to the thyroid or swallowing more obvious, the thyroid diameter is 3 ~ 5cm.
3.III degree: The thyroid gland can also be seen when not swallowed, and the diameter is 5-7 cm.
4. IV degree: The enlarged thyroid gland has gone beyond the outer edge of the sternocleidomastoid of the neck, and the shape of the neck has also changed.
5.V degree: thyroid enlargement diameter of 8 ~ 9cm or more, there are obvious compression symptoms, often nodular goiter.
It has also been suggested that no matter how it is indexed, as long as the thyroid gland can easily be swollen, it is swollen. If measured by weight, when the weight of the thyroid gland is 2 times (or more) than normal, it is called goiter.
Appearance, the goiter is mostly symmetrical diffuse, there are also asymmetry or nodular enlargement, different causes of goiter caused by different clinical symptoms, and the correct understanding and identification of different types of goiter to guide Treatment is crucial.
Light can be asymptomatic, most of the thyroid is slightly diffuse, soft, no noise, no tenderness, about 1/3 have mild nodules or uneven surface, without clinical manifestations of hyperthyroidism or hypothyroidism, A small number of children have a slightly faster heart rate. Those with larger glandular enlargement may have difficulty in hernia or dysphagia. If they are caused by defects in thyroid synthase, they may be accompanied by slow growth, decreased academic performance, poor intelligence, and facial edema.
Most of the thyroid is moderately enlarged, and the thyroid function is normal or diminished. There may be different degrees of growth retardation. Individuals may be accompanied by hoarseness, congenital hypothyroidism and bone age.
Examine
Examination of sporadic goiter in children
Serum T3 and T4 were normal and TSH was normal. Thyroid antibodies TPOAb and TGAb were negative. The 131I rate of thyroid uptake is normal or high, and there is no peak advancement, which can be inhibited by T3 inhibition test.
Thyroid bronchus, thyroid gland is mild to moderate swelling, generally no nodules. The thyroid scan was diffusely evenly distributed.
The palpation of the thyroid gland is diffuse and the surface is smooth, and the cut surface is brownish yellow due to the more gelatinous substance. The follicular epithelial cells under the microscope showed different degrees of proliferation.
Diagnosis
Diagnosis and diagnosis of sporadic goiter in children
diagnosis
Seriously ask about the medical history, combined with clinical symptoms is not difficult to make a diagnosis, should be differentiated from chronic lymphatic thyroiditis, laboratory examination of thyroid absorption 131I increased; thyroid inhibition test can be differentiated from hyperthyroidism; perchlorate release test can be diagnosed Peroxidase deficiency.
Differential diagnosis
1. simple goit (simple goitre): In fact, simple goiter is a general term for thyroid disease except for secondary goiter and hyperthyroidism. Sporadic goiter is included in simple goiter. In the context, patients are from non-thyroid-prone areas and are differentiated from hypothyroidism and endemic goiter.
2. Congenital goitre: Congenital goiter (congenital goiter) is a congenital thyroid morphological and dysfunctional disease caused by the synthesis of thyroxine deficiency, the synthesis of thyroid hormone is reduced, through the feedback mechanism to promote TSH Increased secretion, TSH stimulates thyroid epithelial cells, causing them to enlarge and cause goiter.
(1) Clinical manifestations: Congenital goiter caused by different causes has different clinical manifestations. In addition to goiter, Pendred syndrome has different degrees of hearing impairment, further hindering language development due to hearing impairment, and difficulty in pronunciation. Became hoarse; familial enzyme-deficient kedin disease, in addition to thyroid enlargement, there is mental retardation, ugly face, growth and development; maternal gestational antithyroid drugs caused by neonatal goiter often combined with hypothyroidism, In the neonatal period, symptoms such as prolonged jaundice, low response, constipation, and bloating will disappear in the short term.
(2) Diagnosis and differential diagnosis: detailed history of medical history, maternal pregnancy history can provide pregnant mothers with antithyroid drugs caused by neonatal and infant goiter, family history can help to find karsts caused by familial enzyme deficiency, Pecdred synthesis Sign, combined with clinical special appearance, physical signs to make a diagnosis.
3. Adolescence goitre: During puberty, there is often a goiter in women, and adolescent goiter often occurs in healthy people, not all diseases.
4. Nodular goitre: A nodular goiter that refers to a swollen thyroid tissue with single or multiple nodules (more than 2 nodules).
Nodular goiter often occurs in areas where endemic goiter is endemic. The formation of thyroid nodules is caused by iodine deficiency in the area, thyroxine synthesis is decreased, TSH secretion is increased by feedback, and TSH stimulates thyroid tissue to repeatedly proliferate and degenerate. result.
Most of the structures in the thyroid nodules are gelatinous follicles, and the epithelial cells of the follicles are cuboidal (partially flat). The cytological examination of the fine needles of the thyroid gland is characterized by a large amount of gel after the special staining. Less or moderate amount of cubic epithelial cells dispersed in the cytoplasm, the cell volume is larger than normal thyroid epithelial cells, and the staining is uniform, a few multiple nodules or scattered single nodules, most of which are adenomas, and have a complete package Membrane, divided into 3 types: follicular adenoma, which consists of follicles with different sizes and different gum masses. Follicular epithelium has different degrees of hyperplasia, usually with a hard texture and intact capsule. Papillary adenoma, follicular epithelium increased pedicle-like papillary shape, connective tissue in the pedicle, sometimes soft part of the nodule is cystic, viscous fluid or stale bloody Liquid; mixed adenoma, the structure of the above two nodules is present in this tumor, that is, both follicular epithelial cells and papillary epithelial cells are visible.
5. Thyroid cancer (thyroid cancer): Children with thyroid cancer are rare, and there are reports in the literature about 3.7/100,000. Children with thyroid cancer are characterized by relatively slow development, and the onset is more insidious. The clinical manifestation is early local thyroid swelling. Large, palpable nodules, nodules are asymmetrical. In the initial stage, when the mass does not adhere to the surrounding tissue, it can move up and down with swallowing. As the disease progresses, the tumor tissue adheres to the surrounding tissue, and the nodules become fixed. The texture is hard or hard, and the lymph nodes are gradually enlarged.
Early diagnosis of thyroid cancer is difficult. Once a nodule is found on the thyroid gland, there is a long-term metastasis of the cancer tissue. Therefore, when there is suspected thyroid cancer (or adenoma), it is the thyroid B-ultrasound and radionuclide. 131I thyroid imaging, in order to diagnose early, radionuclide 131I or 99mTc whole body imaging is more important for the discovery of metastatic lesions.
