I ask advice or council. The student.

[Vyacheslav123]

Hello, dear doctors. The student 4 courses of pediatric faculty Stavropol state medakademii, Vyacheslav Obozin disturbs you. Recently has found in a network your forum and here has wanted to consult. It will be a question of my relative.

The woman 51 year.

Complaints to a sleepiness, delicacy, increase in weight for last 2 years about 26 kg for no apparent reason, periodically moderate dyscomfort on a neck, a unstable BP.

The anamnesis of disease:

In 2001 have revealed a pathology of a thyroid gland. Since then on a regular basis accepts Thyreocombum on 1. In day. On US shch with 2002 on 2004 volume within the limits of 22 see a cube., in the left share gipoehogennoe education which increased gradually or was gradually enlarged for 2 years for 2 mm. In the bottom pole of the right share cystic education in diameter of 6 mm. Last blood analysises in 2002 of an antibody: 4, TTG in norm or rate, antibodies were not defined or determined. On the cytogram in 2002 - a colloid, macrophages.

Objectively: Weight - 83 kg. Body height - 161 see IMT - 33. Integuments pure or clean, usual humidity. The CARDIAC CONTRACTIONS RATE 80, a BP 140/90 mm Hg

The thyroid gland is difficultly palpated, non-uniform, weak density, is painless. Non-uniform inspissation in the left supraclavicular area is marked or celebrated.

Menopause since 42 years (the first years proceeded with the expressed vegetative displays).

Researches:

US

The sizes of the right share: The Sizes of the left share:

Height - 5,8 see Height - 5,6 see Width - 2,3 sm Width - 2,3 see

Thickness - 1,9 see Thickness - 1,8 see

Volume - 12,14 cube. Sm Volume - 11,10 cube. See

Thickness of an isthmus - 0,3 see

Total amount shch - 23,24 cube. See

shch it is located usually. Contours equal. Ehostruktura non-uniform: in the bottom third of right share, is closer to a back surface, it is visualized anehogennoe education of the oval form, with precise equal contours, with pristenochnymi the hyperechoic includings or incorporations, the raised or increased sound transmission, the sizes 0,8 h 0,7 h 0,3 sm; similar educations - in the top third of right share 0,4 h 0,5 h 0,4 sm, and also in the bottom third of left share - 0,9 h 0,9 h 0,7 sm and in an average third of left share - 0,8 h 0,9 h 0,9 sm, 0,4 h 0,4 h 0,3 see as a whole a parenchyma diffusively non-uniform, moderately lowered ehogennosti, with fine anehogennymi includings or incorporations in diameter up to 0,2 see

Are visualized juguljarnye lymph nodes, the sizes: on the right 1,8 h 0,6 sm, at the left - 1,2 h 0,6 see

The conclusion. Plural focal educations of solid and cystic character on a background of diffusive or diffuse changes of a parenchyma shch.

Blood analysis:

1. Definition THAT to a thyreoglobulin

AT - TG *lt; 20.0

TTG 0.047

Antibodies to MS fractions *lt; 10.0

Free 4 1.42

2. Definition in Serum bloods FSG (automatic device)

Thyreoglobulin 32,7

-stimulating hormone 120

Ljuteinezirujushchy a hormone 39,7

3. The leukocytic formula in norm or rate

It is recommended:

1. Scanning shch.

2. Kons. The gynecologist for the decision of a question about ZGT.

3. The Puncture biopsy.

Well in general what questions now excite. First, whether it is possible on resulted or brought given to judge about an oncology, secondly, with what the augmentation juguljarnyh lymphonoduses can be connected (confuse most of all), thirdly, whether operation in occasion of a polynodose struma is necessary.

Thankful in advance.

[Melnichenko]

Vyacheslav, complaints of the aunt (if they are now) though are a repetition from complaints gipotiroza in the textbook, cannot be connected with gipotirozom - last if and is it is compensated.

We it is not known, what was ttg BEFORE purpose or appointment tirokomba. Whatever was with a thyroid gland of the aunt, it has no the slightest value or meaning;importance for decision-making on presence ZGT by estrogens \ gestagenami - and here a mammography, koagulogrammma, vaginalnoe the US and pajpel the-test are important.

Scanning will not answer a question is or not a cancer in any of these sites (statistical probability about 6 %), and, that it is more important, whether on a question has this cancer clinical value or meaning;importance (is such termin-a laboratory cancer). Supressivnye tests with a thyroxine and trijodtironinom (components tirokomba) are used dli acknowledgement or confirmations of a functional autonomy - but with an iodide of a potassium (and in tirokombe it or him of 150 mkg) - hardly.

In a word, it is necessary to answer a question, why to the aunt it is bad - not from a hypothetical tumour and not from problematic, but compensated gipotiroza, punktirovat the most suspicious sites - it is important to abstract from a thyroid gland and to think of other organs.

[Vyacheslav123]

Galina Afanasevna, thanks for advice or council. Certainly, most of all we are afraid a cancer, and here juguljarnye lymphonoduses add troubles. So means, what - to prepare for the aunt morally for operation?

[Melnichenko]

1\ complaints of the aunt have no attitude or relation to shitovidnoj to iron or gland

2\ vysokodifferentsirovannye cancers of a thyroid gland are asymptomatic (if there is no prelum)

3\ a multinodal struma - the most frequent change of a thyroid gland at women of the senior age group

4 \ lymphonoduses can be increased for the most different reasons.

We prepare for the aunt for what operation?

[Vyacheslav123]

Recently at us in medakademii has passed or has taken place a cycle of Surgical Illnesses or Diseases. Our teacher the professor has told or said, that in general any nodal forms of a struma need to be deleted, t. To. Sites will not disappear in any way and here razrastis or malignizirovatsja can.

[Melnichenko]

Alas, the international consensuses a little bit differing concepts of yours profesora, already were many times published on pages Tironet for doctors, we hope, that after 3 Vsserossijskogo the congress on which we shall discuss this problem, even some doctors will think of a following problem - palpated sites are at 15 % of all population of the Earth

2 \not palpated more than 1 sm-at half of faces

3\ neplpiruemye less than 1 sm - practically at all in the age of is more senior than 60 years

4\ the cancer of a thyroid gland meets in 6-10 % of cases of all sites .. but all these sites are not even 50-th on frequency the reason of mors of adult population... On not selective sectional material of Moscow (our data) among died of the different problems not connected with a thyroid gland - infarcts. minsulty. Alcoholic illness or disease - sites in iron or gland had not less than 20 % of people ... but they have died not of these sites. Slovom-why to badly aunt, that for sites at it or her... That else at the aunt.

In a word, if the aunt all the same it would be necessary to operate (sites are). That what for was a kitchen garden to fence with inspection _?

Whether and to try to esteem that. That is already known to other world, tov. The student..

[Vyacheslav123]

Many thanks, I believe YOU.

[Melnichenko]

Vyacheslav, a problem not in belief. A problem here in chem-found nodal obrazovnaija cannot cause disturbances of state of health, and in the story it is too much discrepancies (I already spoke about them). The concept - cut sites, yet became a cancer has become outdated to the beginning of 80th years of the past veka-you can about it or this prohonour - and in general to read it is necessary much, and not only textbooks in Russian.

The problem or task of doctors - to find out the real reason tetinogo malaises, to find out morphology of sites. To solve. Than to treat that zabolenvaie. Which predstaljaet problems. To solve. It is necessary or is not necessary (such quite probably) to do or make that-or with sites. Strange detal-regular reception tirokomba should reduce volume of a struma as those..

[Vyacheslav123]

Yes, by the way about Thyreocombum. To instructions to a preparation it is written, that its or his application is counter-indicative at a nodal struma. The aunt snachalo had 2 sites before reception of Thyreocombum (she so speaks it). That is, she connects or binds occurrence of new sites with reception of Thyreocombum.

[Melnichenko]

No, it not so. An iodine containing in Thyreocombum is not necessary, if the functional autonomy (esteem, on Tironete it is a lot of) is already formed and is dangerous because of potential risk of its or her decompensation, but new sites will not create. New sites - natural evolution of a nodal struma.

Let's find out. Whether is not present at the aunt rasprostranenyh at its or her age of problems - an. Bloods obshch (an anemia!)., biochemistry (Saccharum! A cholesterin), an electrocardiogram, a mammary gland, the gynecologist psihatr (here depressions in it or this perode..), a colonoscopy (an occult blood ka a minimum) we Shall solve, that for sites - the most suspicious and large. We shall discuss a situation with lymphonoduses (after a blood and a mammary gland)