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Local craw


Local craw - an enlargement of the thyroid gland" developing owing to iodic insufficiency at the persons living in certain geographical areas with insufficiency of iodine in the environment (i.e. in the area, endemic on a craw).

Normal growth and development of the person depends on the correct functioning of endocrine system, in particular on activity of a thyroid gland. Chronic deficit of iod leads to growth of fabrics of gland and change of its functionality.

Symptoms of the Local craw:

1. Degree of an enlargement of the thyroid gland.
0 - There is no craw
l - The sizes of shares there is more distal phalanx of a thumb. The craw is palpated, but is not visible
II - The craw is palpated and is visible approximately.

According to WHO recommendations "the thyroid gland is considered increased if the sizes of each of shares at a palpation there is more distal phalanx of a thumb of the inspected patient".
2. Form of a local craw (morphological).
2.1. Diffusion.
2.2. Uzlovaya.
2.3. Mixed (diffusion and nodal).

3. Functional condition of a thyroid gland.
3.1. Euthyroid craw.
4. Localization of a craw:
4.1. Usually located.
4.2. Partially retrosternal.
4.3. Ring.
4.4. Дистопировашшй a craw from embryonal bookmarks (a craw of a root of language, an additional share of a thyroid gland).

Symptoms of a local craw are defined by a form, craw size, a functional condition of a thyroid gland. Even at an euthyroid state patients can complain of the general weakness, fatigue, a headache, unpleasant feelings in heart. Usually these complaints appear at big extents of increase in gland and reflect functional frustration of nervous and cardiovascular systems.

In process of increase in a craw and a prelum of adjacent bodies there are complaints to the pressure sense in a neck more expressed in a prone position to the complicated breath, sometimes swallowing, at a prelum of a trachea suffocation attacks, dry cough can be observed. The increased thyroid gland is moderately dense.
Distinguish the diffusion, nodal and mixed craw forms.

The diffusion craw is characterized by a uniform enlargement of the thyroid gland at absence in it local consolidations. Tumorous growth of tissue of thyroid gland in the form of a node is characteristic of a nodal craw, other departments of gland are usually not increased and are not probed. At the mixed craw the combination of a diffusion hyperplasia and a node takes place.

Except a usual arrangement of a craw on the front surface of a neck its atypical localization meets: retrosternal, ring (around a trachea), hypoglossal, lingual, zatrakhealny, from accidental elements of a thyroid gland.
Depending on a functional condition of a thyroid gland distinguish an euthyroid and hypothyroid craw. 70-80% of patients have an euthyroid state.

One of the heaviest manifestations of a hypothyroidism at a local craw is cretinism which clinical symptoms begin with the childhood. Characteristic signs of cretinism - sharply expressed hypothyroidism, the expressed lag in physical, mental, intellectual, intellectual development, the small growth, tongue-tie, sometimes a surdomutism, the slowed-down maturing of bones.

Complications of a local craw, as a rule, develop at big degrees of an enlargement of the thyroid gland:
- prelum of a gullet, trachea, adjacent nerves and vessels;
- development of "goitrous heart" - i.e. hyperfunction and expansion of the right departments of heart owing to mechanical difficulty of blood circulation because of a prelum of adjacent vessels;
- hemorrhage in a parenchyma of a thyroid gland with the subsequent its calcification;
- a strumitis (an inflammation zobno the changed thyroid gland, clinically similar to a subacute thyroiditis);
- malignant regeneration zobno the changed thyroid gland (usually nodal forms).

Внешний вид больных с эндемическим зобом

Outward of patients with a local craw

Reasons of the Local craw:

The main reason for development of a local craw - insufficient intake of iodine in an organism.

Iodine - the microelement necessary for biosynthesis of thyroid hormones - thyroxine and triiodothyronine. Iodine comes to a human body with food, water, air. 90% of daily need for iodine are provided at the expense of food stuffs, 4-5% - waters, about 4-5% - arrive with air. Iodine contains in fish, meat, a laminaria, shrimps and other products of the sea, milk and dairy products, water, including the mineral, iodated table salt, buckwheat and oat grain, haricot, salad, beet, grapes, milk chocolate, eggs, potatoes.

At receipt in an iodine organism in smaller quantities, than necessary daily requirement, develops a compensatory enlargement of the thyroid gland, i.e. a craw.

Distinguish absolute iodic insufficiency (i.e. deficit of intake of iodine with food and water) and the relative iodic insufficiency caused not by an iodine deficiency in external environment and food stuffs, and diseases of a digestive tract and disturbance of absorption of iodine in intestines, iodine capture blockade of a thyroid gland of some medicines (kordarony, potassium perchlorate, nitrates, a lity a carbonate, streptocides, some antibiotics), inborn defect of biosynthesis of thyroid hormones in a thyroid gland.

The factors contributing to development of a local craw:
- the heredity burdened on a craw;
- genetic defects of biosynthesis of thyroid hormones;
- impurity of water an urochrome, nitrates, the high content in it of calcium, humic substances that complicates iodine absorption;
- deficit in the environment and food stuffs of microelements of zinc, manganese, selenium, molybdenum, cobalt, copper and excess of calcium. Deficit of copper reduces activity of the yodinaza participating in accession of iodine to the tirozilny radical and also reduces activity of cytochrome oxydase, ceruloplasmin. Deficit of cobalt reduces activity of iodperoxidase of a thyroid gland. The imbalance of microelements promotes disturbance of biosynthesis of thyroid hormones;
- use of the medicines blocking iodide transport in cells of a thyroid gland (periodate, potassium perchlorate);
- use of the drugs breaking an iodine organifikation in a thyroid gland (derivative thioureas, thiouracil, some streptocides, paraaminobenzoic acid, aminosalicylic acid);
- existence of goitrogenic factors in products. Natural goitrogens can be divided into two groups. One group is the thiocyanates and isocyanates which are contained преимуществен but in Crucifera family plants (cabbage white, color, broccoli, Bruxelles, a turnip, turnip, horse-radish, salad, colza). Tiotsionata and isocyanates block capture of iodides a thyroid gland and accelerate release it from gland. Other group of goitrogens are the cyanogenetic glycosides which are contained in a cassava, corn, sweet potatoes, the Lima haricot;
- impact of infectious and inflammatory processes, especially chronic, helminthic invasions, unsatisfactory sanitary and hygienic and social conditions. In these situations compensatory opportunities of a thyroid gland to support optimum level of thyroid hormones in blood sharply decrease.

Treatment of the Local craw:

Tactics of treatment of a local craw in many respects depends on degree of an enlargement of the thyroid gland and a condition of function of gland. At small increase in the sizes of gland (a craw of the first degree) are usually limited to purpose of potassium iodide, obligatory a discontinuous course, products rich with iodine.

In the presence of depression of function of a thyroid gland synthetic analogs of tiroidny hormones or the combined drugs (tireoty, left thyroxine), under control of content of hormones of a thyroid gland in blood are appointed. If the craw form nodal, nodes big or fast-growing, leading to a prelum of surrounding bodies, is carried out surgical treatment of a craw. After operation hormones of a thyroid gland, for the prevention of repeated development of a craw are appointed.

Drugs, drugs, tablets for treatment of the Local craw:

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