Often there is no suspicion that the neck is a dangerous knot: every year there are more and more people who can lead to insidious cancer.

The thyroid gland is a vital butterfly in shape and size, weighing only 15 to 30 grams, made up of two interconnected lobes. It is located in the front of the neck, below the larynx (Adam’s apple).

An enlarged thyroid gland is called a goiter or otherwise goiter. As long as there are no complications, the person does not feel anything and often does not even know that they have a goiter.

According to Birutė Žilaitienė, a professor at Northway Medical Center and a professor at the Lithuanian Health Sciences University (LSMU), for most people this increase is not related to thyroid dysfunction, so they notice an enlarged thyroid by accident or during a medical examination.

One of the causes of goiter is iodine deficiency.

“Because iodine is used to produce thyroid hormones, which are very deficient in the world, the so-called endemic goiter is observed in those areas; a large part of the population is diagnosed with an enlarged thyroid gland. Lithuania is a region with a mild iodine deficiency.

In 2005, universal salt iodization was introduced in Lithuania, since then there have been no epidemiological studies and today we cannot answer whether we get enough iodine. The epidemiological study that we started at the Lithuanian University of Health Sciences was stopped by the COVID-19 pandemic, and we hope that we can update it and be responsible for the thyroid condition of the residents of Kaunas city, ”said B Žilaitienė.

“Another physiological cause of goiter is an increased need for thyroid hormones, especially in women: puberty, menopause, pregnancy.

In Lithuania, this trace element is sufficient for people unless they live by the sea. Various thyroid diseases are also often associated with changes in the volume of the thyroid gland, which is why it is often referred to in society with a single term – goiter, which is not the goal. The thyroid gland may begin to produce too many hormones or its activity may begin to deteriorate and a person begins to lack thyroid hormones.

There may be nodules in the thyroid tissue that sometimes press on the organs in the neck, and the nodes should also be evaluated for possible malignancy. It should be noted that excessive iodine intake also has a negative effect on thyroid tissue and may be related to its dysfunction, “noted the doctor.

B. Žilaitienė, an endocrinologist at Northway Medical Center, shared her thoughts on diagnosing and treating goiter, reducing the risk of thyroid cancer, and who is in the risk area.

– Is it true that as long as there are no complications, the patient does not feel anything and many times the person does not even know that they have a goiter?

– This is typical of a mild thyroid dysfunction, a ganglionic thyroid gland with normal thyroid function. Long-term imbalance of thyroid hormones causes comorbidities, well, and the nodules can be malignant, so with a timely diagnosis of thyroid cancer, most forms are completely curable.

– How is goiter diagnosed, who and when should goiter tests be suspected?

– Goiter is diagnosed by medical examination, palpation, ultrasound, thyroid hormone, and some additional tests. Anyone with complaints possibly related to thyroid dysfunction should be investigated.

In the event of an excess of thyroid hormones, the cardiovascular system reacts first: it tires of frequent heartbeats, palpitations and sometimes altered heart rhythm. The patient becomes nervous, sleeps poorly.

If there is a lack of thyroid hormones, a person complains of fatigue, drowsiness, memory impairment, decreased ability to work, symptoms of depression, fear of cold, hair loss.

The American Thyroid Society recommends that all people over the age of 35 have thyroid hormone activity tested at least once every five years. Other groups to be studied are women over 60 years of age, with a family history of thyroid disease, autoimmune diseases (eg, type 1 diabetes), pregnancy, and cardiovascular disease.

– What is the treatment of goiter and kWhat are the possible complications?

– Depending on the thyroid disease, medication, surgery, radiation can be prescribed, but in some cases it is enough to consume more iodine or simply monitor physiological changes.

The most common complication of thyroid dysfunction is cardiovascular disease. In addition, the complications of thyroid cancer, which are rare in well-differentiated cancers, in rare cases, are the spread of the oncological process to the surrounding tissues and distant metastases that cause damage to the relevant tissues and organs.

– Is there an effective prophylaxis to protect against thyroid dysfunction?

– Unfortunately, it is not yet known how to prevent most thyroid diseases. It is true that it is possible to point out the circumstances that provoke thyroid dysfunction: high stress, hormonal changes during pregnancy, lactation, iodine deficiency or excess, environmental pollution.

We can only identify groups of people who are at increased risk of thyroid disease and identify them at an early stage, thus avoiding significant damage to health. We highly value the vigilance of family physicians in conducting initial examinations and referring patients to an endocrinologist in a timely manner.

And it is the duty of the patients themselves to first inform their family doctor about the symptoms observed, about the relapse of thyroid diseases or about thyroid diseases in the family.

– Who is most at risk of thyroid cancer and who is first?

– The nodular thyroid gland should be carefully evaluated by ultrasound, if necessary by aspiration puncture and cytological examination. Women, especially those in their 40s to 50s, as well as obese people are at risk. Some forms of thyroid cancer are inherited.

Thyroid cancer can be caused by radiation treatment of other head and neck cancers, especially in childhood.

Too much or too little iodine in food is also associated with some forms of thyroid cancer.

– Goiter is said to be the most common endocrine disease, what is the situation in Lithuania?

– Goiter (goiter) is diagnosed in about 15% of cases. people. In our 2012 study, the frequency in the ranks of Kaunas city residents aged 49 to 50 years was similar. But the nodes in this group are at 30 percent.

The incidence of hyperthyroidism (excessive production of thyroid hormones) in the population is about 0.5 percent. Hyperthyroidism is diagnosed more often in the elderly and in women five times more often than in men. Hypothyroidism (thyroid hormone deficiency) is detected in 3-5 percent. Adults.
According to the National Cancer Institute, about 300 new cases of thyroid cancer are diagnosed in Lithuania each year.

– Is there an increase in goiter patients in Lithuania, as well as working endocrinologists?

– The number of patients is increasing due to longer life expectancy: older people have more thyroid changes, due to better diagnoses, opportunities for family physicians to test thyroid hormones, and due to the education of physicians and the public.

For example, there is increasing data on the role of thyroid function in the course of pregnancy, fetal development, which is why more and more pregnant women are being studied.

The thyroid gland is also affected by the side effects of the drug.

Cardiologists can often suspect thyroid dysfunction after analyzing a patient’s symptoms. According to Milda Kovaitė, a cardiologist at Northway Medical Center, suspicions that a person may have problems with the thyroid gland may be due to recorded heart palpitations or heart rhythm disorders.

“Cardiology and thyroid problems are related. Basically, whenever we have different types of arrhythmias, we try to rule out thyroid problems as a possible cause of arrhythmias.

Goiter can be suspected when frequent pulse episodes or various rhyming disorders occur and the person is accompanied by unreasonable anxiety.

In the case of pathological arrhythmias, such as atrial fibrillation, we encourage both the young and the elderly to have thyroid hormone tests.

In the case of thyrotoxicosis (greatly increased activity of the thyroid gland), the thyroid gland releases too much thyroxine hormone, which stimulates metabolism. Excess thyroxine irritates the heart tissue, causing the heart to beat faster, causing pathological arrhythmias (heartbeat, atrial fibrillation). Due to the intensified metabolism, the body temperature may increase or the sensation of the heartbeat may appear, the nervousness and sensitivity of the person may increase, ”said M. Kovaitė, cardiologist at Northway Medical Center.

According to her, thyroid dysfunction can be caused by cardiologists, who are rarely prescribed drugs (amiodarone) to treat arrhythmias.

“Once prescribed, we must always warn the patient that periodic thyroid hormone testing is necessary. These drugs can cause thyrotoxicosis (increased thyroid function) and, in rare cases, hypothyroidism due to the amount of iodine they contain.

So the drugs no longer serve their purpose, they no longer cause serious disorders, because there is another reason for the arrhythmia, that is, thyroid dysfunction.

It seems that we have controlled arrhythmias with drugs and the same drug no longer helps, in which case we have to look for side effects, ”said a cardiologist at Northway Medical Center.