Dimensions and weight of a normal thyroid gland. What hormones does the thyroid gland produce? The structure of the thyroid gland

American scientists have determined that, in middle age, a decrease in the activity of the human thyroid gland contributes to the accumulation. Moreover, the observed decrease did not always go beyond the norm. The mass of a person and the level of the hormone in the blood, which is responsible for the functioning of the thyroid gland, were compared. (A high level of this hormone in the blood corresponds to a low activity of the thyroid gland).

As a result, it was determined that people with a relatively high level thyroid-stimulating hormone, not exceeding the normal range, had a higher body weight than people with lower levels of the hormone.

At the same time, the mutual influence of body weight on the level of thyroid-stimulating hormone was revealed. Body weight can similarly affect thyroid function. That is thyroid gland and human weight are interconnected.

Dependence of human weight and thyroid gland

The more hormones a person has, the higher the rate metabolic processes in organism.

For example, the norm for 10 to 26 pmol / l. So, in an obese person, the amount of thyroxine will be about ten, and in a lean person - 26 pmol / l, and both of these values \u200b\u200bare not beyond the permissible range.

Therefore, despite the difference in builds, the metabolic processes of both citizens are considered normal with such different indicators.

Here the extreme limits of the norm were considered. It is clear that, in terms of completeness, they will not become the same, but what if the difference is small, and one thyroid gland produces, for example, 12 pmol / l, and the other - 15 pmol / l thyroxine. Will they both have the same slim figures at normal operation all organs and systems of their organisms? Probably so, but the one with the indicator = 12 needs to “plow”, since his tendency to be overweight is higher than that of the other, whose hormonal indicator corresponds to the number 15 pmol / l.

Now you know what you already knew before: but those who want to have a more frail figure must restrain themselves in food, since human weight dependence and the thyroid gland are interconnected.

Although, in fact, the dependence there is much more complicated. For example, many people know that hypo thyroidism (lack of hormones) can lead to weight gain. However, and hyper thyroidism (an overabundance of hormones) at an early stage can lead to the same, as the feeling of hunger escalates, and the amount of food consumed increases. It will be so until toxicosis occurs, caused by an excess of hormones, as a result of which the weight begins to fall.

The thymus gland (thymus or thymus gland) is an organ of human immunity and hematopoiesis, responsible for the synthesis of certain types of white blood cells. The gland is located directly behind the sternum in the superior mediastinum. Rarely, an atypical location of thymus lobules in the thickness of the thyroid gland, in fatty tissue posterior mediastinum or between the muscles of the neck. This arrangement is called aberrant and occurs in a quarter of the world's population. A predisposing factor for aberrant thymus location is birth defects hearts.

The organ has a pinkish-gray color and a soft texture with a lobed structure. A healthy thymus consists of two large lobes and is shaped like a fork with two teeth, which gave rise to the second name of the organ. A damaged gland can change its shape. From above, the lobes are covered with a connective tissue capsule with bridges extending into the thickness of the gland. The bridges divide the lobes into smaller lobes. The mass of the gland in a newborn and infant is about 15-17 g, the size does not exceed 4-5 cm, and the thickness is 0.5 cm. The thymus reaches its maximum size by the onset of puberty - 8-16 cm in length, and the mass increases by two times. After that, in adults, iron is gradually exposed to reverse development- involution - and practically merges with the fatty tissue surrounding it. Involution can be physiological (age-related) and accidental - under stressful effects on the body.

The thymus is supplied by branches of the internal thoracic artery, aorta, and thyroid arteries. The outflow of blood goes through the internal thoracic and brachiocephalic veins. It is innervated by branches of the vagus nerves and the sympathetic trunk.

Histology of the thymus

The thymus develops from the ectoderm and contains cells of epithelial and hematopoietic origin. Conventionally, the entire substance of the thymus gland is divided into cortical and cerebral. The cortex contains:

cells that form the hemato-thymic barrier - supporting cells;
stellate cells that secrete hormones;
“nanny” cells, between the processes of which T-lymphocytes develop and mature;
T-lymphocytes - white blood cells;
thymic macrophages.

The medulla contains a large number of maturing T-lymphocytes. When these cells go through all the stages of their development, they are sent into the bloodstream through venules and veins, ready to carry out immune function.

Thus, the T-lymphocyte appears and begins to mature in the cortical substance, and then, as it matures, it passes into the medulla. This process lasts about 20-22 days.

As they move from the cortex to the medulla and from the medulla to the general circulation, T-lymphocytes undergo selection - positive and negative selection. In the course of it, the cells "learn" to recognize the alien and distinguish their own from the alien. According to scientists, only 3-5% of T cells pass both stages of selection and go into systemic circulation. Selection allows you to determine which of the cells fully perform their function, and which do not need to be released into the bloodstream.

What processes are regulated by the thymus?

The main role of the thymus is in the differentiation and maturation of T-cell immunity cells - T-lymphocytes. Proper Development and the selection of these cells leads to the formation of many receptors for foreign substances and, as a result, to an immune response upon contact with them.

The second function of the thymus gland is the synthesis of hormones, such as:

thymosin;
thymulin;
thymopoietin;
insulin-like growth factor-1;
thymic humoral factor.

Thymus hormones affect the function of T-lymphocytes and the degree of their activity. A number of studies have shown an activating effect of thymic hormones on the central nervous system.

thymosin

This hormone is a polypeptide protein synthesized in the epithelial cells of the organ stroma and performs the following functions:

regulation of development musculoskeletal system by controlling calcium metabolism;
regulation of carbohydrate metabolism;
increased synthesis of pituitary hormones - gonadotropins;
an increase in the synthesis of T-lymphocytes before puberty;
regulation of antitumor defense.

With insufficient activity or secretion in the human body, T-cell failure develops - up to absolute absence cells. Clinically, this is manifested by a sharp decrease in protection against infections, the dominance of severe and atypical forms of infectious diseases.

thymopoietin

Thymopoietin is a 49 amino acid peptide hormone. It is involved in the differentiation and maturation of T cells in the cortex and medulla and determines in which of several types of T lymphocytes a particular cell matures.

Another function of the hormone is to block neuromuscular transmission. It also has the property of immunomodulation - this is the ability of the hormone, if necessary, to suppress or enhance the synthesis and activity of T-cells.

Timulin

The protein hormone thymulin influences the final stages of T-cell differentiation. It stimulates cell maturation and recognition of foreign agents.

Of the general effects on the body, there is an increase in antiviral and antibacterial protection by increasing the production of interferons and enhancing phagocytosis. Thymulin also accelerates tissue regeneration. The determination of thymulin is decisive in evaluating the effectiveness of the treatment of thymus diseases.

Other hormones

In its own way chemical structure insulin-like growth factor-1 is similar to insulin. Regulates the mechanisms of differentiation, development and growth of cells, participates in glucose metabolism. In muscle cells, the hormone has growth-stimulating activity, is able to shift metabolism and promote increased fat burning.

Thymus humoral factor is responsible in the body for stimulating the reproduction of lymphocytes.

Thymus gland diseases

Diseases of the thymus practically do not occur in adults, most often the pathology is recorded in children under the age of one year. The most common and most studied diseases of the thymus are:

MEDAC syndrome;
DiGeorge syndrome;
myasthenia gravis;
various tumors.

Inflammation of the thymic stroma is rare.

Tumors of the thymus gland include the following:

thymomas and hyperplasia - benign neoplasms in which the gland is enlarged in size;
hypoplasia, or underdevelopment of the organ;
T-cell lymphoma;
pre-T-lymphoblastic tumors with transformation into leukemia or cancer;
neuroendocrine tumors.

Thymus diseases have a variety of clinical manifestations, but some symptoms are common to all:

respiratory failure;
heaviness of the eyelids;
chronic fatigue;
muscle weakness and rarely muscle pain;
decreased resistance to infections.

Most of the diseases of the thymus are dangerous for the life of the child, therefore, if a pathology of the thymus is suspected, urgent consultations of an immunologist and a hematologist are necessary.

The doctor's examination plan includes:

general and biochemical blood tests;
determination of the activity of thymus hormones;
immunogram;
Ultrasound of the gland.

What is a colloidal thyroid nodule?

Colloidal nodule of the thyroid gland, what is it? This is a pathology characterized by the appearance benign neoplasms. Their presence is not dangerous to human life, but plays important role in the diagnosis of diseases endocrine system. Colloidal nodes in the thyroid gland are found in most patients of endocrinologists, but most often they are benign. A colloid is a viscous mass that fills the follicle of the gland, so it is not considered atypical for this body. Such a substance is formed in the tissues responsible for the production of thyroid hormones. Microscopic analysis reveals that the node consists of glandular cells, blood and colloid. It does not contain foreign inclusions, which means it is safe for health.

Reasons for the development of the disease

The role of the thyroid gland in human body cannot be overestimated. The organ, which is relatively small, must produce many hormones that are distributed throughout the body. Chronic and infectious diseases, stress, unfavorable environmental conditions make the gland work at an accelerated pace, which leads to organic and functional disorders. Some parts of the body begin to produce hormones unevenly, which is accompanied by vasodilation and an increase in tissue density. This is how colloidal nodes of the thyroid gland are formed.

The main reasons for the appearance of colloid nodes in the thyroid gland are: unfavorable environmental conditions, stress, high physical exercise, chronic diseases, iodine deficiency in the body, malnutrition, puberty, pregnancy. Iodine deficiency is the most common cause of nodular changes. All residents of our country are deficient in this element, with the exception of people living in the Crimea and the Far East. Iodine is considered essential substance, without which the thyroid gland cannot produce hormones.

Clinical picture

In the early stages of node development, no symptoms appear. More often the reason for going to the doctor is a significant increase in the size of the gland. In this case, symptoms of the mechanical impact of the node on the surrounding tissues appear: pressure in the area of the organ, difficulty in swallowing and breathing, sore throat, cough. On late stages the disease changes the timbre and volume of the voice. Constant pressure large vessels and nerve endings can affect the central nervous system: headaches, dizziness, tinnitus appear. Pain in the neck occurs with a rapid increase in the size of the node, the addition of hemorrhages or inflammatory processes.

Depending on the prevalence pathological process the thyroid gland can be enlarged on one or both sides. If the size of the node exceeds 1 cm, a person can detect it on their own. Depending on the degree of dysfunction of the thyroid gland, the clinical picture of the disease may vary. Symptoms of hypothyroidism appear when the colloidal mass begins to replace healthy cells glands. Appears general weakness, decrease intellectual ability loss of appetite. The patient's body swells, metabolic processes in the body slow down, weight begins to grow, the skin becomes dry.

When the thyroid gland begins to produce an increased amount of hormones, a person experiences symptoms of hyperthyroidism. This condition manifests itself in the form of irritability, fatigue, aggression. Appetite increases, but the person loses weight, digestive processes are disturbed, which manifests itself in the form of diarrhea. Body temperature may rise and tachycardia develop. If the process of hormone production is not disturbed, the only sign of the disease will be the compaction of the thyroid gland and its increase in size. Growing nodes compress large vessels and nerve endings, which leads to a feeling of a lump in the throat, problems with breathing and swallowing.

Diagnosis and treatment of the disease

It is possible to determine the nature of the nodes in the thyroid gland only after complete examination. It begins with palpation of the cervical region, in which pathological changes are detected. Additional diagnostic methods include: biopsy, ultrasound of the thyroid gland, CT or MRI, blood test for hormones, radioisotope scanning. Based on results diagnostic procedures the endocrinologist reveals the presence of organic and functional changes in the thyroid gland. A biopsy is prescribed in the presence of large colloid nodes. Despite the fact that in most cases nodal changes are benign, it is necessary to study the structure of the largest of them.

With an asymptomatic course of the pathological process, treatment may not begin immediately. Neoplasm is recommended to be observed for several years. The doctor may prescribe iodine preparations to restore thyroid function. The patient may wish to dispose of the colloidal nodule surgically However, doctors do not recommend such operations. After resection, the thyroid tissue begins to grow faster.

Surgical intervention should be performed in the presence of absolute indications: squeezing by a knot of large vessels and nerve endings, the production of an increased amount of hormones. Radical operations are also used in the malignant nature of the course of the pathological process. Depending on the size of the tumor and the presence of metastases, the thyroid gland can be partially or completely removed.

In other cases, the treatment of colloid nodes begins with the elimination of the cause of their occurrence. For example, if the accumulation of colloidal mass was facilitated by toxic goiter, it is necessary to regulate the production of thyroid hormones and restore the functions of all organs and systems. If the cause of nodular changes has not been clarified, symptomatic therapy is carried out, aimed at eliminating the unpleasant sensations associated with the mechanical effect of the colloidal node on the surrounding tissues.

There are several ways conservative treatment: drug therapy aimed at eliminating dysfunction of the thyroid gland; minimally invasive surgical interventions — laser treatment or sclerosis of colloid nodes. Before prescribing a particular drug, a blood test for hormones should be performed to assess functionality organ. It is necessary to interview the patient about the presence of allergic reactions to drugs. In most cases, derivatives of thyroxine and thyroidin are prescribed.

Properly chosen treatment regimen helps to avoid the development dangerous complications. Colloidal nodes are a fairly common phenomenon; there are no specific preventive measures. A person should carefully monitor their health, regularly visit an endocrinologist, eat right and take iodine preparations. It is necessary to avoid exposure to radiation and visiting places with unfavorable environmental conditions. This will help maintain the health of the thyroid gland, normalize the structure of its tissues, improve general state organism.

Hormonal functions of the thyroid gland and their disorders

Location

Associating deviations from the norm in their condition with the pathology of the thyroid gland, patients are wondering where the thyroid gland is located, since the diagnosis begins with this - with palpation.

The gland is located under the larynx, at the level of the fifth or sixth cervical vertebra. It covers the top of the trachea with its lobes, and the isthmus of the gland falls directly into the middle of the trachea.

The shape of the gland resembles a butterfly with wings tapering upwards. The location does not depend on gender, in a third of cases there may be an insignificant additional part of the gland in the form of a pyramid, which does not affect its functioning, if present from birth.

In terms of mass, the thyroid gland reaches 25 grams, and in length no more than 4 cm. The average width is 1.5 cm, the same thickness. The volume is measured in milliliters and is up to 25 ml for men and up to 18 ml for women.

Functions

The thyroid gland is an endocrine organ responsible for the production of hormones. The functions of the thyroid gland are hormonal regulation through the production of certain types of hormones. Thyroid hormones include iodine in their composition, since another function of the gland is the storage and biosynthesis of iodine into a more active organic function.

Gland hormones

Patients who are referred for laboratory diagnosis of thyroid diseases mistakenly believe that they are examining thyroid hormones TSH, AT-TPO, T3, T4, calcitonin. It is important to distinguish which hormones are produced by the thyroid gland, and which are other organs of internal secretion, without which the thyroid gland simply will not work.

TSH is a thyroid-stimulating hormone that is produced by the pituitary gland, not the thyroid gland. But it regulates the work of the thyroid gland, activates the capture of iodine from the blood plasma by the thyroid gland.
Ab-TPO is an antibody to thyroperoxidase, a non-hormonal substance produced by immune system as a result of pathological processes and autoimmune diseases.

Directly thyroid hormones and their functions:

Thyroxine - T4 or tetraiodothyronine. Represents thyroid hormones, is responsible for lipid metabolism, lowering the concentration of triglycerides and cholesterol in the blood, supports bone tissue metabolism.
Triiodothyronine - T3, the main thyroid hormone, since thyroxine also tends to be converted to triiodothyronine by attaching another iodine molecule. Responsible for the synthesis of vitamin A, lowering the concentration of cholesterol, activating metabolism, accelerating peptide metabolism, normalizing cardiac activity.
Thyrocalcitonin is not specific hormones, since it can also be produced by the thymus and parathyroid glands. Responsible for the accumulation and distribution of calcium in bone tissue essentially reinforcing it.

Based on this, the only thing the thyroid gland is responsible for is the synthesis and secretion of thyroid hormones. But the hormones produced by it perform a number of functions.

secretion process

The work of the thyroid gland does not even begin in the gland itself. The process of production and secretion, first of all, begins with the "commands" of the brain about the lack of thyroid hormones, and the thyroid gland implements them. The secretion algorithm can be described in the following steps:

First, the pituitary and hypothalamus receive a signal from the receptors that the blood levels of thyroxine and triiodothyronine are low.
The pituitary gland produces TSH, which activates the uptake of iodine by thyroid cells.
Iron, capturing the inorganic form of iodine obtained from food, begins its biosynthesis into a more active, organic form.
Synthesis occurs in the follicles that make up the body of the thyroid gland, and which are filled with a colloidal fluid containing thyroglobulin and peroxidase for synthesis.
Received organic form iodine binds to thyroglobulin and is released into the blood. Depending on the number of attached iodine molecules, thyroxin is formed - four iodine molecules, or triiodothyronine - three molecules.
In the blood, T4 or T3 is released separately from globulin, and it is again captured by gland cells for use in further synthesis.
Pituitary gland receptors receive a signal about enough hormones, the production of TSH becomes less active.

Accordingly, having detected signs of thyroid disease, the doctor prescribes a study not only of the concentration of thyroid hormones, but also of the hormones that regulate it, as well as antibodies to an important component of the colloid - peroxidase.

gland activity

At the moment, medicine divides all pathologies of the thyroid gland into three conditions:

Hyperthyroidism is a dysfunction of the thyroid gland, in which secretion activity increases and an excess amount of thyroid hormones enters the blood, metabolic processes in the body increase. Thyrotoxicosis is also included in the disease.
Hypothyroidism is a dysfunction of the thyroid gland, in which an insufficient amount of hormones is produced, as a result of which metabolic processes slow down due to lack of energy.
Euthyroidism - diseases of the gland, as an organ, which do not have any hormonal manifestations, but are accompanied by pathology of the organ itself. Among the diseases, this includes hyperplasia, goiter, nodular formations.

Diseases of the thyroid gland in women and men are diagnosed through the TSH index, a decrease or increase in which indicates the reactivity or hypoactivity of the gland.

Diseases

Women are more likely to experience symptoms of thyroid disease because hormonal fluctuations are reflected in the menstrual cycle, which makes the patient seek help from a doctor. Men cheat more often typical symptoms thyroid glands for fatigue and overexertion.

The main and most common diseases:

Hypothyroidism;
Nodular, diffuse or mixed goiter;
Malignant tumors of the gland.

Each of these diseases is characterized by a particular clinical picture and stages of development.

Hypothyroidism

This is a syndrome of chronic decrease in the secretion of T3 and T4, which helps to slow down the body's metabolic processes. At the same time, the symptoms of thyroid disease may not make themselves felt for a long time, progress slowly, and disguise themselves as other diseases.

Hypothyroidism can be:

Primary - with pathological changes in the thyroid gland;
Secondary - with changes in the pituitary gland;
Tertiary - with changes in the hypothalamus.

The causes of the disease are:

Thyroiditis, which occurs after inflammation of the thyroid gland;
iodine deficiency syndrome;
Rehabilitation after radiation therapy;
Postoperative period of removal of tumors, goiters.

Hypofunctional thyroid disease symptoms are as follows:

Slow heart rate, heart rate;
dizziness;
pale skin;
Chills, trembling;
Hair loss, including eyebrows;
Swelling of the face, legs, hands;
Voice changes, its roughness;
constipation;
An increase in the size of the liver;
Weight gain despite decreased appetite;
Loss of strength, emotional inertia.

Hypothyroidism is usually treated hormonal drugs replenishing the lack of thyroid hormones in the body. But it should be understood that such treatment is advisable in a chronic case, which is diagnosed most often. If the disease is detected in the early stages, there is a chance to stimulate the work of the body by eliminating the root causes and temporarily taking another class of hormones.

This disease is called the lady's disease, since there are nine women for ten patients diagnosed with hyperthyroidism. Excessive production of hormones leads to an acceleration of metabolic processes, excitation of cardiac activity, disturbances in the work of the central nervous system and ANS. Pronounced signs of the disease and the advanced form is called thyrotoxicosis.

Reasons for the development of pathology:

Graves', Plummer's syndrome - goiters of an autoimmune or viral nature;
Malignant tumors in the thyroid gland or pituitary gland;
Possible development due to long-term treatment arrhythmic drugs.

Often, the disease overtakes women after the onset of menopause due to hormonal imbalance, not being a consequence of tumors or goiters.

In this case, the main signs of thyroid gland in women:

accelerated heartbeat;
Atrial fibrillation;
Humidity, hotness of the skin;
Trembling of the fingers;
Tremor can reach amplitudes, as in Parkinson's disease;
Increased body temperature, fever;
increased sweating;
Diarrhea with increased appetite;
Decrease in body weight;
An increase in the size of the liver;
Irritability, irascibility, insomnia, anxiety.

Treatment involves taking thyreostatics - drugs that reduce the activity of the secretion of thyroid hormones. Thyreostatics include drugs Thiamazole, Diiodothyrosine, as well as drugs that prevent the absorption of iodine.

In addition, assigned special diet, which excludes alcohol, coffee, chocolate, hot spices and spices that can excite the central nervous system. Additionally, adrenergic blockers are prescribed to protect the heart muscle from harmful effects.

The disease has vivid symptoms - already from the second stage of goiter, the gland increases, which means that the entire neck area above the collarbone, where the thyroid gland is located, acquires distorted outlines.

Goiter can be nodular, diffuse and diffuse-nodular. The causes of the disease are sufficiently differentiated - it may be a lack of iodine, on its own developing syndrome and excess hormones.

Symptoms depend on the degree of goiter, of which there are five in medicine:

In the first degree, the isthmus of the gland increases, which can be felt when swallowing;
The second degree is characterized by an increase in both the isthmus and the lateral lobes of the gland, which are visible when swallowing and are well felt on palpation;
At the third stage, the gland covers the entire wall of the neck, distorting its outlines, visible to the naked eye;
The fourth degree is characterized by a clearly visible goiter, even visually, by a change in the shape of the neck;
The fifth degree is indicated by a huge goiter, which compresses the trachea, blood vessels and nerve endings of the neck, causes coughing, difficulty breathing, swallowing, tinnitus, memory and sleep disorders.

A characteristic, but non-specific symptom of this thyroid disease in women is severe protrusion of the eyes, amenorrhea up to six months or more, which is often confused with early menopause.

Treatment consists of hormonal therapy in the early stages, in the later stages surgery is proposed to remove part of the organ.

In addition, treatment depends on the type of goiter, as Graves' syndrome, euthyroid goiter, Plummer's syndrome and Hashimoto's syndrome are subdivided. Precise definition possible only with complex diagnostics.

Malignant formations

Develop against the background chronic diseases thyroid glands that did not respond to treatment. The growth of cells in the gland can be provoked and unauthorized.

The prognosis is positive, as in most cases it is diagnosed at an early stage and can be treated. Vigilance requires only possible relapses.

Symptoms:

Pain in the neck;
Seals, the growth dynamics of which is noticeable even within two weeks;
Hoarse voice;
breathing difficulties;
bad swallowing;
Sweating, weight loss, weakness, poor appetite;
Cough of non-infectious nature.

At timely diagnosis sufficient drug therapy. In later stages, surgical removal is indicated.

Diagnostics

Diagnosis of any disease of the thyroid gland begins with the collection of anamnesis. Then an ultrasound is prescribed for:

Timely detection of nodes, cysts, tumors of the thyroid gland;
Determining the size of an organ;
Diagnosis of deviations from the norm in size and volume.

Laboratory diagnostics involves the analysis of:

AT-TPO;
T3 - general and free;
T4 - general and free;
Tumor markers for suspected tumor;
General analysis of blood and urine.

In some cases, a biopsy of the tissues of the organ may be prescribed to clarify the diagnosis, if laboratory diagnostics was not enough. It is not recommended to independently interpret the results of tests and make a diagnosis, since the norm of thyroid hormones is different for each gender, age, disease, and the impact of chronic diseases. Self-treatment autoimmune and especially oncological diseases may result in a threat to health and life.

How safe is thyroid cancer surgery?

Treatment of thyroid hyperplasia

What does the appearance of a cough with a thyroid gland mean?

Flow features autoimmune thyroiditis

How to recognize and treat thyroid cysts

Reasons for the development of adenoma in the thyroid gland

The thyroid gland is an endocrine gland located on the front of the neck. It consists of two parts. As a rule, the right lobe is slightly larger than the left. Both parts are united by an isthmus lying on the trachea.

A normal thyroid gland is shaped like a butterfly. The average weight of an organ in an adult is 15–30 g, but in some cases it can reach 50 g. From the moment of birth, the mass of the gland in a person increases 20 times, the maximum growth peak is observed in adolescence. With age, there is a decrease in size and weight. endocrine organ. In women, the norm of the volume of the thyroid gland is usually larger than in men.

Volume indicators are important diagnostic value. According to the results, the norm for women is 15-18, and for men - 25-28 cm³. The parameters depend on the age of the patient and total weight body. The lobes of the thyroid gland contain many follicles, each of which has a diameter of 0.3 to 1–2 mm. The dimensions of the shares in a healthy person are: length - 4, width - 2, thickness - 2 cm. The permissible parameter for the thickness of the isthmus is 4-5 cm.

Types of gland cells:

A are thyrocytes that synthesize thyroid hormones.
B - oxyphilic cells, which should not be present in healthy tissues. They appear in some diseases.
C cells produce calcitonin.

Normal size of the thyroid gland in adults:

Patient's weight, kg	Normal volume, cm³
Patient's weight, kg	Among women	In men
50	15	18
60	18	20
70	21	23
80	25	28
90	28	30
Over 100	32	34

In pregnant women and adolescents, the volume of the gland increases significantly and may differ slightly from the data in the table; this is not considered a pathology. A deviation of 1 cm³ is allowed.

Diagnosis of thyroid nodules

At healthy people the structure of the thyroid nodules is homogeneous, medium, does not exceed 2 mm in diameter. Such elements are referred to as follicles. If the formation is more than 1 cm, this is a knot.

Depending on the echogenicity, the nodes are:

Isoechoic - have a clear contour, formed as a result of increased circulation in the affected area of the gland. The structure of tissues is little changed, they can find cystic formations. Such nodes do not disrupt the functioning of the organ, the size of the thyroid gland is normal.
Hyperechoic formations are characterized by a change in the structure of tissues, they appear against the background of a violation of the salt balance in the body. Most often, such nodes occur with malignant tumors that disrupt the normal functioning of the organ.
Hypoechoic nodes form when the follicles die off, observed.
Anechogenic thyroid nodules larger than 1 cm have a cystic membrane and are filled with fluid inside. On ultrasound, they look like dark spots.

Nodes can be single and multiple, differ in size and structure. The most characteristic signs of the formation of seals of the gland are a change in the shape of the neck, hoarseness, discomfort during swallowing of food. Pathology leads to a violation of the secretion of hormones, as a result, exophthalmos develops, metabolism is disturbed, body temperature rises, blood pressure rises, patients complain of shortness of breath, heart palpitations.

Node types

There are the following types of nodular formations:

- This is a rounded node with clear contours, having a connecting capsule and filled with liquid. Pathology is typical for women over 40 years of age, marked by slow growth.
are follicles containing colloidal fluid. Such formations grow slowly, do not cause pain, long time present asymptomatically. In most cases, treatment is not required, since the functioning of the organ is not impaired.
- characterized by swelling of the tissues surrounding the benign node, inside contains a small amount blood vessels. Adenoma has a fibrous capsule, does not grow into neighboring organs. Her cells produce hormones, but can be observed.
Malignant node has an indistinct shape, grows into the surrounding tissues. The structure is heterogeneous, there are areas of necrosis or fluid accumulation. The tumor is dense to the touch, grows rapidly, painless. Increase cervical lymph nodes occurs during metastasis. : papillary, anaplastic, .

To detect cancer cells in a patient, a sample of pathological tissue is taken for cytological examination. The material may contain colloidal fluid, atypical, epithelial cells, purulent masses. According to the results of the analysis, treatment is prescribed.

Treatment Methods

Hormone therapy is prescribed for patients with colloid toxic goiter. Patients take L-thyroxine, as a result, the production of thyroid-stimulating hormone by the pituitary gland decreases and the growth of the pathological node slows down.

Thyrotoxic drugs are indicated for the treatment of nodular toxic goiter and thyroid adenoma. Therapy with Thiamozole inhibits the production of thyroxin, relieves symptoms, but does not affect the growth of the node.

(Iodide) is prescribed to patients with euthyroid goiter against the background of severe iodine deficiency. Such treatment ensures the entry of I into the cells of the thyroid gland, which slows down the pathological growth of nodes.

Surgery is indicated if:

the volume of the gland determined during the diagnosis exceeds the norm;
node diameter greater than 3 cm;
there is a rapid growth in education;
during the study revealed cancer cells;
"cold" compaction does not synthesize hormones.

Large formations are excised together with one lobe. In case of malignant tumors, the gland is completely removed and partially the surrounding tissues into which the cancer cells have grown. Sometimes regional lymph nodes are also removed. After that, chemotherapy is prescribed, taking hormonal drugs.

Thyroid nodules are detected during examination and palpation of the neck, ultrasound. You can calculate the volume using a special formula, knowing the main parameters of the left and right lobe. Laboratory research necessary to assess the secretory function of the endocrine organ. Based on the data obtained, the necessary treatment is prescribed.

Bibliography

Uzhegov, G.N. Diseases of the thyroid gland: Varieties of diseases; Medication treatment traditional medicine; Medical / G.N. Uzhegov. - Moscow: RGGU, 2014. - 144 p.

I talked about why it is useful to conduct a regular examination of the thyroid gland using ultrasound. After that, a lot of letters came to the mail with questions about what the norms of the thyroid gland should be.

Therefore, I decided to write a separate article so that everyone can get acquainted with the information.

The thyroid gland is an organ located in the neck, in front, under the larynx. It has the shape of a butterfly and consists of two symmetrical lobes and an isthmus. Since the gland is located directly under the skin, deviations in its structure or structure can be detected even during the initial examination by an endocrinologist by palpation.

The thyroid gland of normal size in most cases is not palpable, except in cases where excessive thinness or anatomical structure the patient's neck allows this.

However, with a noticeable increase in the size of the gland during palpation, it is easy to determine:

the shape of the organ, the size and symmetry of its lobes, the total volume;
mobility and localization of the gland;
density and consistency of gland tissue;
the presence of nodes and volumetric formations.

Unfortunately, the manipulation does not allow to detect formations while maintaining or reducing the normal size of the organ, therefore, the main method for reliable diagnosis of the state of the thyroid gland is ultrasound.

On ultrasound, the thyroid gland is defined as a rounded organ, vaguely resembling a butterfly in shape, with symmetrical lobes and a homogeneous structure.

The volume of the gland: in women - from 15 to 20 cm3, in men - from 18 to 25 cm3.
Dimensions of the lobes of the gland: length - 2.5-6 cm, width - 1.0-1.8 cm, thickness - 1.5-2.0 cm.
Isthmus thickness: 4 to 8 mm.
Parathyroid glands with a diameter of 2–8 mm, from 2 to 8 units.

In different medical sources of the border normal indicators the size of the lobes and the volume of the organ differ. Studies among the population have shown that the average values of the norm are relative - for example, the population of regions with a constant iodine deficiency is characterized by a general change in the size of the thyroid gland upwards, and this is not a pathology.

The asymmetry of the organ is often noted - the right lobe is usually larger than the left, but it also happens vice versa - as an individual feature of the organism. There were cases when in healthy people one of the lobes was underdeveloped or completely absent.

The difference in the volume of the thyroid gland in men and women is not associated with gender, but with the difference in the physical and physiological parameters of the body.

Normal thyroid size

Although during the menstrual cycle in women there are some fluctuations in the data of ultrasound of the thyroid gland, nevertheless, specialists during the examination take into account, first of all, the age and weight of the patient. In adults, the normal size of the thyroid gland can vary within:

weight up to 40 kg - up to 12.3 cm3;
41–50 kg - up to 15.5 cm3;
51–60 kg - up to 18.7 cm3;
61–70 kg - up to 22 cm3;
71–80 kg - up to 25 cm3;
81–90 kg - up to 28.4 cm3;
91–100 kg - up to 32 cm3;
101–110 kg - up to 35 cm3.

As the data of the list show, the concept of the norm in a healthy person is very relative and often goes beyond the average indicators. In addition, it is allowed to exceed these norms by 1 cm3 or more, provided that the function of the thyroid gland is not impaired.

There are cases of individual underdevelopment (hypoplasia) of the organ with the preservation of its full functionality.

In about 1/6 of the population, the thyroid gland has a pyramidal lobe - an additional structural unit with a base in the middle of the isthmus - which is also one of the options for an individual norm. Specialists of diagnostic rooms periodically observe the absence of an isthmus between the lobes of the organ in some patients.

To detect pathological changes, complex analysis thyroid ultrasound data:

The contours of the gland - a healthy organ has clear, even contours, the change of which indicates the development inflammatory process.
Structure - homogeneous glandular tissue is an indicator of the norm and has a characteristic granularity. With the development of immune inflammatory diseases - autoimmune thyroiditis, diffuse toxic goiter - the structure becomes heterogeneous. Sometimes heterogeneous structure glandular tissue also occurs in healthy people of older age groups with increased production of antibodies to certain enzymes of thyroid cells.
Echogenicity is a certain value of the general acoustic response characteristic of the tissue under study. Echogenicity should be normal, i.e. meet the standards for that body. If echogenicity is reduced, the doctor may suspect the development of an inflammatory process. An increase in echogenicity may indicate acute inflammation or the development of pathological changes.
Foci of changes are areas characterized by a decrease (hypoechogenicity), absence (anechoicity) or an increase (hyperechogenicity) of the acoustic response of ultrasound. Such formations should not normally be, although the presence of small, up to 4 mm, anechoic areas is allowed - single enlarged follicles of the glandular tissue. Pathological foci, identified in the structure of the tissue, are nodes of the thyroid gland. Nodes can be single or multiple. Solitary small nodules (1-3 mm) are usually not treatable and often disappear on their own over time. Formations larger than 3 mm, as a rule, require clarification of the diagnosis.
The state of the lymph nodes - the latter should have clear, even contours, the absence of cysts and normal size(not enlarged).

What does a thyroid ultrasound show?

colloid nodes- formations, which are overgrown follicles. These are benign lesions that almost never degenerate into malignant tumors.

Adenoma- a benign tumor surgical removal. The presence of a fibrous capsule allows it to be differentiated from other pathologies. It develops with age, mainly in women.

Cyst- fluid-filled formation. Usually observable.

thyroid cancer- a dangerous single node that does not have clear boundaries and a shell. Is different rapid growth, is subject to immediate removal along with the lymph nodes.

When a neoplasm is detected, the patient undergoes additional research- Dopplerography or elastography, to assess changes in the intensity of blood flow in the vessels of an organ, and the cellular and tissue structure of existing formations. If necessary, a needle biopsy is performed to histological analysis under ultrasound supervision.

Diffuse toxic goiter- a disease manifested by an increase in the volume of the gland and the heterogeneity of its structure due to the formation of multiple nodes.

Inflammatory diseases (thyroiditis)- Distinguish between acute and subacute thyroiditis infectious and viral origin, arising as complications after tonsillitis, bronchitis, pneumonia, SARS; fibrous thyroiditis - inflammation of the tissue as a result of the abundant growth of its fibrous component; autoimmune chronic thyroiditis- a feature of the body to perceive thyroid cells as foreign, as a result of which an inflammatory process occurs.

Goiter of the thyroid gland- an increase in volume due to tissue growth. Euthyroid goiter does not affect the function of the organ, hypo- and hyperthyroid goiters are associated with corresponding dysfunctions. Perhaps the development of endemic goiter among the population of areas with reduced content iodine in the environment, as well as some hypertrophy of the thyroid gland during pregnancy.

Hypoplasia of the thyroid gland- congenital underdevelopment of the organ due to endocrine disorders during pregnancy of the mother or insufficient intake of iodine in the body.

Thyroid atrophy- a decrease in its size as a result of the gradual replacement of the glandular tissue with connective tissue, combined with the development of hypothyroidism, requiring constant replacement therapy.

Thus, when setting accurate diagnosis endocrinologist the results of ultrasound examination (ultrasound) are analyzed in combination with other indicators of the patient's health. The totality of complaints, individual symptoms, general well-being, blood tests and data functional diagnostics allows the doctor to determine the individual boundaries of the norm and pathology and choose the best means of treating the patient.

Dear readers, if you have any questions, then ask them in the comments, I will try to answer them in detail.

Thyroid(glandula thyroidea) is an endocrine gland that synthesizes a number of hormones necessary to maintain homeostasis.

The thyroid gland consists of two lobes and an isthmus. The lobes are adjacent to the left and right to the trachea, the isthmus is located on the anterior surface of the trachea. Sometimes an additional pyramidal lobe extends from the isthmus or more often the left (rarely the right) lobe of the gland. Normally, the mass of the thyroid gland is from 20 to 60 g, the size of the lobes varies within 5-8´2-4´1-3 cm.

During puberty, the mass of the thyroid gland increases, and in old age decreases. Women have a larger thyroid gland than men; during pregnancy, its physiological increase occurs, which disappears on its own within 6-12 months.
after childbirth.

The thyroid gland has an external and internal connective tissue capsule. Due to the external capsule, a ligamentous apparatus is formed that fixes the gland to the trachea and larynx (Fig.). upper bound gland (lateral lobes) is the thyroid cartilage, the bottom - 5-6 tracheal rings. The isthmus is located at the level of I-III or II-IV cartilages of the trachea.

The thyroid gland is one of the most vascularized organs with developed arterial and more powerful venous systems. Blood enters the gland through two superior thyroid arteries (branches of the external carotid artery) and two inferior thyroid arteries, which form anastomoses between themselves. The venous and lymphatic systems carry out the outflow from the thyroid gland of blood and lymph containing thyroid hormones, thyroglobulin, and in pathological conditions, antithyroid antibodies, thyroid-stimulating and thyroblocking immunoglobulins.

The thyroid gland is innervated by branches like vagus nerve(parasympathetic), and branches of the cervical ganglia (sympathetic).

The main structural and functional unit thyroid gland are follicles - vesicles of various shapes, often rounded, with a diameter of 25-500 microns, separated from each other by thin layers of loose connective tissue With big amount blood and lymph capillaries.

Their lumen is filled with a colloid - a structureless mass containing thyroglobulin, which is synthesized by follicular, or the so-called A-cells that form the wall of the follicle. These are epithelial cells of a cubic or cylindrical (with an increase in functional activity) shape. With a decrease in thyroid function, they flatten. Along with the follicles in the thyroid gland, there are interfollicular islands of epithelial cells (B cells, Ascanazi cells), which are the source of the formation of new follicles.

Ascanazi cells are larger than A-cells, have a zosinophilic cytoplasm and a rounded centrally located nucleus: biogenic amines, incl. serotonin. In addition to A- and B-cells, the thyroid gland also contains parafollicular cells (C-cells). They are located on outer surface follicles, are neuroendocrine cells, do not absorb iodine and belong to the APUD system.

The thyroid gland secretes two iodine-containing hormones, thyroxine (T4) and triiodothyronine (T3), and one peptide hormone, calcitonin.
Thyroxine and triiodothyronine are synthesized in the apical part of the thyroid epithelium and partly in the intrafollicular space, where they accumulate and become part of thyroglobulin. Calcitonin (thyrocalcitonin) is produced by C-cells of the thyroid gland, as well as parathyroid glands and thymus gland.

Follicular cells of the thyroid gland have a unique ability to capture iodine from the bloodstream, which, with the participation of the peroxidase farmer, binds to colloid thyroglobulin. Thyroglobulin plays the role of an intrafollicular reserve of thyroid hormones. If necessary, by pinocytosis, a certain amount of it enters the follicular cell, where, as a result of proteolysis, T3 and T4 are released from thyroglobulin and separated from other hormonally inactive iodinated peptides.

Free hormones enter the blood, and iodine proteins undergo deiodization; The released iodine is used for the synthesis of new thyroid hormones. The rate of breakdown of thyroglobulin, the synthesis of thyroid hormones depends both on the central regulation and on the level of iodine and blood and the presence in it of substances that affect iodine metabolism (immunostimulating globulins, thiocyanates, bromides, etc.). Thus, their synthesis and secretion are carried out at such a rate and in such quantity that the body needs to maintain the concentration of hormones in the tissues that provide homeostasis. The latter is achieved by a complex system of central and peripheral regulation.

Central regulation is carried out by the production of thyroliberin (a releasing factor of thyroid-stimulating hormone) and, possibly, thyreostatin (a factor that inhibits the synthesis of thyroid-stimulating hormone). Thyroid stimulating hormone (TSH) is synthesized by thyrotrophs of the anterior pituitary gland, it stimulates the growth and functional activity of the thyroid epithelium.

The entry of TSH into the blood is regulated by the level of concentration of thyroid hormones in the blood and thyreoliberin, however, the main regulatory factor is the concentration of thyroid hormones in the blood; extremely high level the latter makes thyreotrophs resistant to thyreoliberin.

Peripheral regulation of thyroid metabolism depends on the number of specific receptors for thyroid hormones in the cell; under conditions of a high content of thyroid hormones, their number is reduced, with a low content - increases. In addition, most of thyroxin can be metabolized into an inactive form and thus carry out one of the types of peripheral regulation of the functional state of the body.

The physiological content of thyroid hormones is necessary for the normal synthesis of proteins in various bodies and tissues (from central nervous system to bone tissue); their excess leads to uncoupling of tissue respiration and oxidative phosphorylation in cell mitochondria, followed by a sharp decrease in the body's energy reserve.

In addition, by increasing the sensitivity of receptors to catecholamines, thyroid hormones cause increased excitability of the autonomic nervous system, manifested by tachycardia, arrhythmia, increased systolic blood pressure, and increased motility. gastrointestinal tract and secretion of digestive juices: they also increase the breakdown of glycogen, inhibit its synthesis in the liver, and affect lipid metabolism. Deficiency of thyroid hormones causes a sharp decline speed of all oxidative processes in the body and the accumulation of glycosaminoglycans. The cells of the c.n.s. are most sensitive to these changes. myocardium, endocrine glands.

RESEARCH METHODS
Examination of patients with pathology of the thyroid gland includes clinical, laboratory methods for assessing its functional activity, as well as methods for intravital (preoperative) study of the structure of the gland. Palpation of the thyroid gland determines its size, consistency and the presence or absence of nodular formations. Most informative laboratory methods determination of thyroid hormones in the blood are radioimmune methods carried out using standard test kits.

The functional state of the thyroid gland is determined by the absorption of 131I or 99mTc pertechnetate. Methods for in vivo assessment of the structure of the thyroid gland include computed tomography, ultrasound diagnostics, radionuclide scanning and scintigraphy, providing information about the topography, size and nature of the accumulation of the radiopharmaceutical various sites glands, as well as puncture (aspiration) biopsy followed by punctate microscopy.

PATHOLOGY
Clinical manifestations of thyroid diseases are caused either by excessive or insufficient production of thyroid hormones, or by excessive production of calcitonin and prostaglandins (for example, in medullary carcinoma - a calcitonin-producing tumor), as well as symptoms of compression of the tissues and organs of the neck of an enlarged thyroid gland without impaired hormone production (euthyroidism).

There are five degrees of enlargement of the thyroid gland: O degree - the gland is not visible during examination and is not determined by palpation; I degree - when swallowing, the isthmus is visible, which is determined by palpation, or one of the lobes of the thyroid gland and the isthmus are palpated; II degree - both lobes are palpated, but during examination, the contours of the neck are not changed; III degree- the thyroid gland is enlarged due to both lobes and the isthmus, visible when viewed as a thickening on the anterior surface of the neck (thick neck); Grade IV - large goiter, not sharply asymmetric, with signs of compression of nearby tissues and organs of the neck; V degree - a goiter of extremely large sizes.

Developmental defects. Aplasia (absence) of the thyroid gland is rare, due to a violation of the differentiation of the embryonic rudiment of the thyroid tissue: it is found in the early childhood based on the clinical picture of severe congenital hypothyroidism.

congenital hypoplasia thyroid gland develops due to a lack of iodine in the mother's body, clinically manifested by cretinism and a delay physical development child. The main type of treatment for both pathological conditions is lifelong hormone replacement therapy.

With the preservation of the thyroid-lingual duct, median cysts and fistulas of the neck are often formed, as well as goiter of the root of the tongue, which must be removed. The displacement of the rudiment of the thyroid gland into the mediastinum leads to the development of a retrosternal goiter or tumor. The source of their formation can also be foci of thyroid tissue dystopian in the wall of the trachea, pharynx, myocardium, pericardium.

Injuries to the thyroid gland are extremely rare, they are usually combined with injuries to other organs of the neck. As a rule, open lesions are accompanied by profuse bleeding, require urgent surgical care. Closed damage observed with compression of the neck (for example, a loop during a suicide attempt), are manifested by the formation of a hematoma.

DISEASES
Among thyroid diseases, the most common goiter is diffuse toxic and autoimmune thyroiditis, which are considered as typical autoimmune diseases with a similar pathogenesis, but a different clinical picture, often found in blood relatives. The group of infectious inflammatory diseases of the thyroid gland includes various clinical manifestations pathological conditions characterized common symptoms associated with compression of the tissues and organs surrounding the thyroid gland.

Tumors. Characteristic benign epithelial tumors of the thyroid gland are adenomas of various histological structure. Clinical detection of adenomas is based on palpation of a tumor in the thyroid gland with clear contours and a smooth surface that slowly increases in size over time.

The cervical lymph nodes are intact, the function of the gland is most often not changed. In an outpatient setting in the recognition benign tumors in addition to palpation, an important role is played by scanning of the thyroid gland, ultrasound examination, followed by a cytological examination of the punctate. The basic principle of liver surgery is to remove the lobe of the gland in which the tumor is located (hemithyroidectomy). The prognosis after surgical treatment of adenomas is favorable.

Malignant tumors of the thyroid gland are the most common various forms cancer and make up 0.5-2.2% of all malignant neoplasms. Other types of thyroid cancer are less common. Precancerous diseases include nodular and mixed goiter, as well as thyroid adenomas.

The development of thyroid cancer is promoted by a high level of secretion of thyroid-stimulating hormone from the pituitary gland (observed more often in people living in goitre-endemic areas) and x-ray or other irradiation of the head and neck area, upper mediastinum conducted with diagnostic and (or) therapeutic purpose in childhood and adolescence. Special meaning in the development of thyroid cancer has a combination of external irradiation of these areas with internal irradiation with incorporated radionuclides of iodine when contaminated environment radioactive substances.

Clinically, thyroid cancer usually manifests itself in two ways. More often, a tumor in the thyroid gland and the presence (or absence) of regional (lymph nodes of the anterolateral parts of the neck, supra- and subclavian areas, as well as the anterior superior mediastinum) and distant (lungs, bones, etc.) metastases. On palpation in the gland, a dense, bumpy, often poorly displaced tumor is noted, which over time leads to a change in voice, impaired breathing or swallowing.

In the second clinical variant, the tumor, due to its small size, is not detected by palpation, as well as by radionuclide and ultrasound methods (“hidden cancer” of the thyroid gland); metastases in regional lymph nodes and (or) in distant organs come to the fore. The so-called highly differentiated follicular cancer (malignant adenoma, metastasizing struma Langhans, angioinvasive adenoma) is especially distinguished, which, with a relatively mature structure, has invasive growth and the ability to metastasize.

The diagnosis of thyroid cancer is very difficult in the presence of a long-term goiter or adenoma, the leading signs of malignancy of which are their rapid increase, compaction, the appearance of tuberosity, and then the limitation of the displacement of the gland. The final diagnosis is established only by cytological or histological examination.

With "hidden cancer", along with the determination of the level of calcitonin (medullary cancer), the final stage of diagnosis is often a wide exposure and revision of the thyroid gland. Differential Diagnosis thyroid tumors is based on clinical and radiological data, the results of a thyroid scan, ultrasound and computed tomography, targeted puncture of the tumor and subsequent cytological examination punctate.

Surgical treatment includes hemithyroidectomy, subtotal resection of the thyroid gland and thyroidectomy. In the presence of regional metastases on the neck, a fascial-sheath excision of the tissue of the neck is performed. In the presence of distant metastases locally operable cancer, thyroidectomy followed by radioactive iodine treatment is indicated.

The prognosis is favorable for differentiated forms of cancer (follicular and papillary) and unfavorable for other forms. Prevention of thyroid cancer is aimed primarily at the treatment of goiter and benign tumors, the exclusion of X-ray exposure and radiation therapy of the thyroid gland in children and adolescents, and the prevention of iodine radionuclides from entering the body with food and water.

IN early detection thyroid cancer, a large role is given to the clinical examination of patients with various forms of goiter and their surgical treatment, as well as to the examination of blood relatives of patients suffering from medullary thyroid cancer, especially in cases of Sipple's syndrome and mucosal neurinoma syndrome in combination with adenomatosis of the endocrine glands.

Operations on the thyroid gland are performed both under local anesthesia and under intubation anesthesia. Patients with thyrotoxicosis before surgery require special preoperative preparation. The most convenient access to the thyroid gland is a transverse arcuate incision along the anterior surface of the neck 1-1.5 cm above the jugular notch. Retrosternal forms of goiter in most cases can also be removed through this access, although sometimes it is necessary to resort, as in patients with intrathoracic goiter, to thoracotomy.

The main characteristics of each operation on the thyroid gland are the scope of intervention and the method (method) of removal of thyroid tissue. There are intracapsular, intrafascial and extrafascial methods. The intracapsular method is usually used for enucleation of thyroid nodules in order to maximize the preservation of unchanged gland tissue.

Intrafascial secretion of the thyroid gland is used for all forms of goiter, while there is no possible traumatization of the branches of the recurrent laryngeal nerves and the parathyroid glands are preserved, located outside (rarely inside) the visceral sheet of the 4th fascia of the neck, within which the operation is performed. Sometimes this method is supplemented with ligation of the arteries throughout. The extrafascial method is carried out exclusively in oncological practice and, as a rule, involves ligation of the main arteries of the thyroid gland.

Volume surgical intervention depends on the nature and localization of the pathological process, the size of the pathological focus and the amount of tissue left. The most commonly used partial, subtotal resection and extirpation ( complete removal) of one or both lobes of the thyroid gland. Partial resection is used for small nodular benign goiters, while approximately half of the resected lobe(s) is preserved.

Subtotal resection involves leaving 4 to 8 g of gland tissue in each lobe (usually on the lateral surface of the trachea in the region of the recurrent laryngeal nerves and parathyroid glands). Such an intervention is performed for all forms of goiter in patients with thyrotoxicosis, as well as for nodular and multinodular euthyroid goiters, which occupy almost the entire lobe (lobes) of the thyroid gland.

Extirpation is usually used for malignant neoplasms thyroid gland, this operation can be supplemented, depending on the stage and localization of the process, by removing the muscles adjacent to the gland, the external and internal jugular veins with tissue containing lymph nodes.

Among the possible complications that develop after thyroid surgery, paresis of the recurrent laryngeal nerves and hypoparathyroidism, as well as secondary bleeding in the early postoperative period, should be noted.