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    Endocrine System ID

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    Vishakha Wahule

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    CHAPTER 17. MAL ENDOCRINE SYS SYMPTOMS AND 8 YNDR, EM DISEASE o Ms Op Ty . Main symptoms of endocrine system diseases uring the interview (collecting com the dee nd life) in adult patients with diseases of the endocting 8 following symptoms characteristic of diseases of the endoenn ¥sten a. identified, ake Polyuria, ; This increase in urine output more than 2.5 liters of urine Per day. Polyuria is observed with hyperglycemia syndrome, as well as With diabetes mellitus and primary aldosteronisin. Polydipsia (increased thirst). Associated with intense dehydration, Polydipsia is observed in many diseases of the internal Organs, and in patients with endocrine disorders, it occurs in hyperglycemia syndrome and disbets insipidus. Weight loss with increased appetite. Observed with hyperglycemia and hyperthyroidism syndromes, , [rritability, sweating, increased mental irritability, constant heartbeat, Sussiness, haste, quick speech and quick mood changes, ae by hyperthyroidism syndrome. a ohy so ased memory and me; ilitie 7 » drowsiness, weight gain red a cee ae es weakness, lethargy, Occur with hypothyroidism syndrome. ite menstrual cycle in women, low libido «and potency in men. ted in the syndrome of hypercortisolism, ‘ weatnss and oresive ing tt weakness, loss of appetite, weightloss, pat in hypocorticism, Sudden feting gg tn drome, Bits When taking insulin vee i TheY are specific signe plaints and clarifyin chills, severe weakness and diztne® ‘Lycemic drugs. ot hypoglycemia syndrome. Durin; the followings ee mination in adult Patients with ai idocrine org identi symptoms ae With diseases of the en be Nentitied, Sheractetstic of diseases of the endocrine stem 6 y ee emcee i. in Wide opening of the palpebral fissure, | kK sure, lust (exophthalmos), giving the face an expression of fight on hci eee eee Observed with hyperthyroidism syndrome, 1 "Masked" with frozen eyes, wide, impression of indifference and dullness. Observed with hypothyroidism syndrome. be wks aes of superciliary arches, the disproportionately large size of the nose, lips, ears and chin, excessive growth of divergence of the teeth (diastema). inne Heenan eee Characteristic for the syndrome of increased production of somatotropic hormone in adults (acromegaly). Large, wide "moon-shaped" face with pronounced redness of the cheeks. Characteristic for hypercorticoid syndrome. A small "doll" face, resembling a puppet, with a small nose and short lower round and wrinkless face, giving the jaw. Observed with reduced production of somatotropic hormone syndrome. Pathological symptoms when measuring height. Giant height (more than 195 cm). Observed with the syndrome of increased production of somatotropic hormone in children (gigantism). Dwarf growth (below 130 cm for men and below 120 cm for women) with preservation of children's body proportions. It is found in the syndrome of reduced production of somatotropic hormone, as well as in the syndrome of severe hypothyroidism. Pathological symptoms during inspection of the neck. Increased neck circumference. Observed with hyperthyroidism syndrome. Pathological symptoms during examin subcutaneous fat. Dark red color (“crimson ee ”) of the. face. i drome of hypercorticism. Beer os nubeos" of both cheeks of the face (due to the dilation of the blood vessels of the Bae rratacdree’ istic 0} ly Heaaeieiion of the skin (areas of brown or bronze apo of the he especially in open areas of the body, in areas of friction of clothing and near-c areas) and the oral mucosa (dark spots on the mucous membrane). Occurs in hypocorticism syndrome. ic i ‘the skin. % 3 . . jk in the syndrome of increased production of somatotropie hormone in adults (acromegaly). ation of the skin, hair and =311- EE _— ish-purple skin) on the chest, abdomen and thighs hish- y red Sirae (stretches re icison syndrome. of hairiness). ; by hy Characterize Oe i on the body (fem ‘ ne oN aby hypocorticisim syndrome. ae mi hair growth on the body in wana is car i isol syndrome. is stic of hypercortiso! s} : oo hy, idism syndrome. cterized by hypothyrot ; teeta uniform development of the subcutaneous, fat layer. Characteristic for syndromes of hypothyroidism and obesity. 2 Dysplastic (not uniform) obesity with predominant deposition of the subcutaneous fat layer in the face, neck, upper torso and abdomen in disproportionately thin limbs. It is one of the signs of hypercortisol syndrome. Weight loss up to cachexia ; May occur in hyperglycemia and hyperthyroidism syndromes. Pathological symptoms during examination of the muscular and skeletal systems. Excessive development of muscles with the proliferation of soft tissues. Observed with the syndrome of increased production of somatotropic hormone in adults (acromegaly). Seizures attacks in the flexor muscles of the upper and lower extremities and facial muscles. May be observed in hypoparathyroidism (reduced synthesis of parathyroid hormone or parathyroid hormone). Pain in the bones when walking and changing gait. Characterized by hyperparathyroidism (increased production of the parathyroid hormone or parathyroid hormone). . ee vertebral compression fractures (due to osteoporosis). em cine hypercotic syndrome, as well as in the elderly. vckening of the cranial vault, especially in the region of the occipital and frontal tubercles, thickenj i ofteateleton thickening of the bones and disproportionately developed part Detected in the el (ecomezaly), ‘eelins hot, a! i 'g hot, hyperemic skin and fine tremor of the fingers of outstretched Observed with 1 Increased tongue, slow sp, idism syndrome, Ofer with pots syne Mand ad fet (male type of hairiness) syndrome of increased Production of somatotropic hormone in puring palpation in adult patients ymptoms characteristic of qj With dise, CASES Of the ¢ SCS Of the ete Moctine organs, the s owing . foe Ne endocrine 4 stem can te ified. is jen ing the size of the thyroi ncreasing roid gland observed with hyperthyroidism eiodn era ant ek . a es getes a background of. | 0 een nodes in it, i This is observed in hyperthyroidism sy; form of diffuse toxic or endemic goiter. An increase in the size of the thyroid gland with its Soreness and den: s ss and dense texture. i Oceurs with hyperthyroidism syndrome on the background of autoimm june ahyroidits 7 Increasing the size of the thyroid gland with its soreness and rocky density. Characteristic of hyperthyroidism syndrome in the background of thyroid cancer. The impossibility of removing testicles from the inguinal canal Evidence of cryptorchidism (undescenly of the testicles into the scrotum). diffuse toni ¢ size of the thyroid gland and the Presence of one or s, Several ndrome on the backgr nodular me on the background of a nodul During percussion in adult patients with diseases of the endocrine organs there are no symptoms characteristic of diseases of the endocrine system, since percussion is not of practical importance as a method for studying patients with endocrine system pathology. eee : aa 2 st diecasee of te ceOGtion rams, During auscultation in adult patients with diseases of ocrine the following symptoms characteristic of diseases of the endocrine system cam be identified. ’ h Tachycardia at rest (even during sleep), increased I tone, increased systolic and pulse blood pressure. Characteristic of roidism syndrome. ; Br. ee areas ee beats per minute or less) and hypotension. Observed with hypothyroidism syndrome. Severe arterial hypotension until collapse. Oceurs in hypocorticism syndrome. Arterial hypertension. Occurs in hypercorticism syndrome. gua edoctine sual : ith diseases O° can During laboratory studies in adult paiens fe enioeie 86 j istic nal : -313- jucose level above 5.5 mimol /1 in whole capillary biog, Hyperglycemia. ing ei ayia ‘an empty stomach plasma of venous blood. or beige 6.1 f the hyperglycemia syndrome of the same name Itis a specific symptom of irene " » glucose level is higher than 6.1 mmol in whole capillary bloog If the glucose leve! i Mie then diabetes mellitus is diagnoses)” se 20 mmol /Linan empty stomach plasma, oo erat is within 78-111 mmol /Lin whole capillary blood ang If the glucose leve } venous blood plasma after determining postprandial glycemia and conducting iucose tolerance test (G77), then impaired glucose tolerance (IGT) is diagnosed If the glucose level is higher than 11.1 mmol /1 in whole capillary blood and venous blood plasma after determining postprandial glycemia and conducting a glucose tolerance test, diabetes mellitus is diagnosed. Table 17.1. Glycemia levels in health and disease Type of definition of | Glucose concentration, mmol /] | glycemia Whole capillary blood Venous blood plasma [Norm Fastin 33-55 [Postprandial a8 oe Sl [ghvcemia or GTT . jpmbaited glucose tolerance asting 56-61 | Postprandial 78: < =} 81-20 | ; i 27,8; <11,1 27,8; <11L,1 ; S61 u SILT aud cemia or GIT ‘i F 1d Hypo, i er. Most often, develops ‘on the i” ; in or oral glucose. i ante or lowering drugs, / ae fe «eect of glucose in the urin Aree an of hyperglycemia eyndro ” &Ycosuria appears oo eRe Stomach above 9/9 mmol ape ep menhey abetes, Hy anied by ‘Land indicates glucose level rises on an ; VT NMEA inthe urine specific grave ets) lypertensuria). : 314. Itis a characteristic sign of hyper, The increase in glycated hemo total amount of hemoglobin. Jt is a specific symptom of hyperglyce; Increased levels of T4 and T3 above, ihe Characteristic of hyperthyroidism syndrome,” Reduced levels of T4 and 13 below normal Observed with hypothyroidism syndrome Decreased insulin and C-peptide levels Characteristic for diabetes mellitus type te” armel Increased levels of cortisol and 11-ACS i blood and urine above normal. inthe blood, as well as 17-ACS in the Characteristic for hypercorticoidism syndrome. Reduced levels of cortisol and 11-ACS in th . ~ e blo, se is blood and urine are below normal. eaeraernety cee Observed with hypocorticism syndrome. Increased levels of somatropic hormone above normal. Occurs with the syndrome of increased production of somatotropic hormone (gigantism and acromegaly). Reducing somatropic hormone levels below normal. Observed with reduced production of somatotropic hormone syndrome. glycemia syndrome globin in the blood (HAIG) j 8 me of the pre than 6.5% During instrumental studies in adult patients with diseases of the endocrine organs, the following symptoms characteristic of diseases of the endocrine system can be identified. Increase the level of basal metabolism by 30% or more. Characteristic of hyperthyroidism syndrome. Reduction in the level of basal metabolism by 20% or more. Observed with hypothyroidism syndrome. Increased size of the thyroid gland during ultrasound and computed tomogr ie id. ei . ee fe ‘and endemic goiter, as well as thyroiditis and thyroid cancer, _ Pathological symptoms during X-ray examination. Thickening of the bones. . Occurs ith the syndrome of increased production of adults (acromegaly). Osteoporosis of the vertebrae. Observed with hypercorticism syucron ppa Pathological changes back of the Turkish saddle. Characteristic of pituitary tumors. -315- somatotropic hormone in with radioisotope research methods, » mr padioactive iodine by the thyroid gland, ical sy’ ee rion O reased absorPtien igism syndrome, of radioactive iodine by the thyroid gland. dism syndrome Inc Observed with vi Reduced absorption Occurs in hypothyr 17.2. Main syndroms of endocrine system diseases 17.2.1. hy pergiycemia syndrome syndrome is a metabolic syndrome characterized by an ing, # Tease Hyperglycemia 3} Sete ce (both on an empty stomach and after a meal) due to Various eng io Fxowenous causes and leading to disruption of all types of metabolism iy Hyperglycemia syndrome develops due to absolute insulin defig; decree insulin production by freells of the pancreas) or relative insu serpaieney (decreased sensitivity of peripheral tissues to insulin) = syndrome of hyperglycemia is manifested by the following symptoms: 1) thirst, dry mouth; 2) frequent and abundant urination; 3) increased appetite; 4) dry skin and itchy skin; » reddening or "rubeoz" of both cheeks of the face; 8) weight loss; : 7) hyperglycemia; ya HbAIC more than 6.5%: Beane be Synarome is a specific symptom of diabetes mellitus type I and In addition, hyperglycemia i glucose toleranoe (aoe leo is syndrome is observed in sich a state as impaired But we must rem tw ember that hyperglycemia syndrome can be observed with 17.2.2, Hypogiycemia syndrome Hypoglycemia Poel rome is a Pathological condition of the body due to a 7 fo system due to ite ae oo, 04 char i 10 its carbohydrate and oxygen stray ation of the central nervous leads to var , the concennes , peas Pathological centration of glucose in the aa aid bsPoRlycemia syndrome ty t© decreases and this ‘Yeemia syndrome Le! ly to a malfunction of the brain, 2) suddenly there is a feeling of hunger bee Sy aweating or sharp cold sweat; mt “hill ) severe weakness and dizziness, 5) excitement, restlessness: 6) in severe cases, convulsions and hypo, yes Fispoglvcemia syndrome is most oR and (ess commonly) oral Ixpogiycemic agents in diabetic nav In addition, hypoglycemia syndrome can jnadequate food intake in diabetics receiving hypoglye inrensve exercise and alcohol intake, as well ay in prey ne ery. insulinoma (benign pancreatic fi-cell tumor), hypothyroid Mie So dumping syndrome (illness of the operated stomach), isease. failure and Emergency care for hypoglycemia syndrome: ux} an “ urgently give sweet tea, sugar. chocolate, and in the absence of effect - the immediate section of 40% a ml intravenously. glucose 10-20 h overdose of ins se of insuli tic patients, ee be observed with untimely or 17.2.3. Hypertyreidism syndrome Hyperthyroidism syndrome is a clinical and laboratory syndrome caused by a persistent pathological increase in the secretion of thyroid hormones (thyroxine and triiodothyronine) and the development of toxic damage to many organs and systems, primarily nervous and cardiovascular. Syndrome of hyperthyroidism is manifested by the following symptoms: 1) imitability; 2) constant sweating; 3) weight loss with increased appetite: 4) feeling of heat, hyperemic skin; 5) fine tremor of the fingers of outstretched hands; 6) exophthalmos; 7) constant tachycardia at rest (even during sleep): 8) [ tone accent; 9) increase in systolic and pulse blood pressure; 10) increase in blood levels of T4 and T3; 11) lowering cholesterol levels; 12) increase in basal metabolism by 30% and more; eae 13) increased absorption of radioactive iodine by the thyroid glan aH Hyperthyroidism syndrome occurs with diffuse toxic goiter (thyrotoxicos!s)- ae nbiaeest ei aa a drome yrheosis sy" " ndrome characterized by a q, 7.2.4, Hypothy a7 2 VE } and laboratory Sy! ry a clinical “, a ve as, UeCrea This is fy of thyroid hormones (thyroxine and triiodothyronine) asset, absence in the 0°” arious organs and systems tated @ s damage gat wah is cms of hypothyroidism syndrome are weakness, lethargy, drowsiness; J smorease in weight and decrease in body temperature; loss, voice coarsening; 4)hair eyebrows and eyelashes loss; 5)a swollen, masklike face without wrinkles, with frozen eyes; 6) excessive development of subcutaneous fat; 7) tongue enlargement slow speech; 8) the pasty face, hands and feet; 3) memory 9) bradycardia (heart rate 50-60 beats per minute or less); 10) hypotension (blood pressure below 100 / 60mm He.): 4 11) lower levels of T4 and T3; 12) reduction in basal metabolism by 20% and more: f 13) a decrease inthe absorption of radioactive iodine by the thyroid gland Hypothyroidism syndrome occurs in primary hypothyroidism, endemic autoimmune thyroiditis, thyroid cancer and strumectomy. : vie, 17.2.5. Hypercorticism syndrome a nen mune eel Se is E clinical, laboratory and instrumental increased secretion of adrenal corte: x hormones a hyy 7a ) aie levels of 17-ACg in the blood and uring e, ci “ ; i a ortisol and 1]-ACS in ‘tolation roe inn of the menstrual) cycle in women, loweri f the Li d lypercortisoli eke disease) and vei aera € occurs in gk i Prolonged intake of pees {isenko-Cushing Snae Pituitary (Iasenko-Cushing es of ‘slucocorticosteroid pt eo ar fe ah - ‘ | 17.2.6. Hy pocorticism syndrome This syndrome is caused by insutficient goons cretion of 4 scorticosteroids), idrenal hy (gluco Seen # Ve lormones, Hypocorticism syndrome is accompanied by the fo 1) progres severe general Weakness, ‘OWINg symptoms: 2) loss of appetite, weight loss; 3) pain and weakness in muscles, muscle wastin, 4) hyperpigmentation of the skin and oral tmiceca (pat coloring of the skin, especially in open areas of ihe tha, rr Shing and around the wrinkles, dark spots on the eg): 1 5) severe arterial hypotension until collapse; 6) hypoglycemia; 7) decrease in the level of 17-ACS i - 0. dere f'17-ACS in the blood and urine, cortisol and 11-ACS Hypocorticism syndrome is observed in chy i (Addison's disease), congenital adrenal hypoplasia, st pes ee ed withdrawal of corticosteroids, r ere 8 of brown or bronze y Places of f al mucosa), of friction of 17.2.7, Syndreme of the increased development of somatotropic hormone (giantism and acromegalia) This syndrome is due to increased secretion of growth hormone (somatropic hormone) and hence the physiological and pathological changes. There are 2 (two) types of this syndrome: 1) syndrome of increased somatropie hormone production in children and adolescents or gigantism syndrome: 2) syndrome of increased somatropic hormone production in adults or acromegaly syndrome. Gigantism syndrome i The syndrome of gigantism is manifested by the following symptoms: 1) increased growth in childhood and adolescence; on 2) gigantic growth (more than 195 om) for both boys and girls: : 3) the level of somatropic hormone in the blood is higher than nommal in childhood and adolescence. GAETEAE pets ah The syndrome of gigantism is observed in the same state - gigantism, which is a normal (physiological) state. . A , Som ems is characterized by the following symptoms: 1) the rapid development of brow arches, hin; the OG pecan large size of the nose, lips, a am fect (diastema); 3) excessive growth of the lower jaw and discrepancy © -319- phy of the papillary layer. sociated with hypertrophy of oss useles with the proliferation of soft tissues, 4) thickening of the skin 41 vault, especially in the area of the ceipity eve t of m 5) excessive development of mus? @) uneven thickening of the crania .d frontal tubercles; i * D thickening of the bones of none in the blood above the norm in adulthoog in the pathology of the same name, acromegaby, disproportionately developed parts of the skeleton; f 8) the level of somatropic horm Acromegaly syndrome occurs i duction of sematotrepic hormone 17.2.8, Syndrome of a decreased pro This syndrome is caused by a decrease in the secretion of growth hormone (somatropic hormone) in children and adolescents. The syndrome of reduced somatropic hormone production is characterized by the following symptoms 1) growth retardation in childhood and adolescence; 2) a puppet-like face with a small nose and a short lower jaw; 3) dwarf growth (below 130 cm for men and below 120 cm for women); 4) the level of somatropic hormone in the blood is higher than normal in childhood and adolescence. Syndrome of reduced production of somatropic hormone in children and adolescents is found in pituitary nanism. 17.2.18. Obesity syndrome Obesity syndrome is a clinical syndrome characterized b it ¢ y syndrome ¢ y excessive depositior ie the subcutaneous tissue and physiological deposits due to imy Bhat sa types of metabolism. i . Obesity syndrome is characterized by ex iti Sie maa ed by excessive deposition of fat in the neck. feos eee ary glands and buttocks (the distribution of fat depends on At the same tii bee ee shee are three types of segmental fat deposits: "upper, int et and apps ah pper type” of obesity, fat is mainly localized on the face. pelvis, butocks, ae in aioe “middle” type of obesity - in the abdomen, (thighs and legs) er” obesity - in the pelvis and lower extremities In addition, the followi 7 : “Owing symptoms may bi ved i i _ jn ted aps, manana a, } e observed in obesity syndrome: tenden nstipation, weakness, drowsi ‘ } shortness of breath with litle exertion: anne ean: ) pain in the heart lon, and then at rest; Processes (furunculosis, py headaches, weaken : culos, py , ing of memory, tendency to pustular derma, phlegmon, fungal lesi fein gal lesions), trophic skin changes . - tay the s, brittle nails), thin skin (stretch sir 155 Pe auinal, femoral), lvmphostase nryjtn’ SPPCAANCE of hey (unbilea nas of the lower extremities, ir 2 exteteg into oa eatin of obesity By BMI (WHO, 1997) - Trusceeotaah CO Sees cf esi [Mika — Noth 185245 OsEeEHt 25,0-29.9 [ist degree obesity 30,0-34,9 2st degree obesity 35,0-39.9 3st degree obesity >40 The causes of obesity syndrome are the alimentary factor (excessive consumption of food, especially rich in carbohydrates and fats), hypodynamia, heredity, dyshormonal conditions (pregnancy, childbirth and iactation), endocrine diseases, traumatic brain injuries, neuroinfection and brain tumors. Obesity syndrome is clinically manifested by a different distribution of subcutaneous fat depending on the causative diseases: 1) a uniform distribution of the subcutaneous fat layer is characteristic of thyroid (hypothyroidism) and alimentary obesity, 2) excessive deposition of fat in the lower parts (in the thighs, abdomen), the presence of a distinitive contrast between the deposition of adipose tissue in the upper and lower half of the body ee the development of the so-called "wasp waist" is ved in Barraker-Symonds disease: oy Se Gf with a predominant deposition of fat in the chest, gene thighs with a significant lag in the development of the sexual apparatus 1s 0! adiposogenital dystrophy; B33 i eee aia TD plane obesiy « “blo op wih pro er subcutaneous fat layer in the face and neck ( “fat hump”), Ee Misproportinately thin (climacteric hump), upper half of the bodv and eo limbs is one of the signs of hypercorticism syndrome; the face, neck, chest, anterior Site combination gigas Jat cpr i ‘bances, sympathoadrenal crises abdominal wall, with increased appetite, sleep diswurt ae "sity and impaired thermoregulation is characteristic of hypo! 17.3. Main diseases of the endocrine system? 17.3.1, Diabetes -321- ute or relative insufficiency of insulin, pohydrates (primarily caused by absol a f proteins, fats, car ‘This disease ! Lo ystems. etabolistr ‘ed by impaired metal secotydiate) rand gradual damage to all organ’ and 8 Hal carbohydrates) anlar Teens: diabetes mellitus type I (he old name i satin dependent t¥P2) and type II (the ‘old name is insulin in dependent type). insulin-de Etiology I diabetes: viral infections, immunogenetic predisposition, The etiology of type toimmune disorders and pancronecrosis ; ™ The etiology of type II diabetes: overeating, carbohydrate abuse, obesity. Symptomatology. * the above symptoms of hyperglycemia syndrome; + HbAle content up to 10% and higher of the amount of total hemoglobin; Ja decrease in the level of insulin and C-peptide (in diabetes mellitus type 1); + muscle weakness, pain in the limbs and muscle atrophy; + in the late stages - complications from many organs and systems, primarily from the cardiovascular system. Tt should be noted that diabetes mellitus type I manifests itself at a young age, has a rapidly progressive course, is characterized by early complications, low treatment efficacy and poor prognosis. “ gh same time, diabetes mellitus type II manifests itself in middle and old age, has a slow progressive course, is characterized by late complications. treatment efficacy and a relatively favorable prognosis. Sonate General principles of treatment. de Foren of physical activity. et ‘tab i therapy (table number 10), the use of sugar substitutes (sorbitol, xylitol, etc.), = rejection of alcohol. . Replacement therapy with insulin preparations (in case of diabetes mellitus typeI). 4. Oral hypoglycemic agents (1 . type II dial 5. Treatment of complications, pe II diabetes). 17.3.2. Diffusive toxi — ie goiter This is a disease of an auto ‘terized . 0 unmune nature, character thyroid an tas — toma ba gland cand the development of ieee y ath dama 4 Eiology ‘stems, primarily the nervous and cardiovascular systems. —¥ Immunogenetic predispositi Ssmptomatolog Pion, long-term emotional stress, viral infections *theisbovesy Symptoms of hyperthy ete 7” le + palpation of nodular lesions; + eye symptoms (Deltymple - wide ope Mobius - impaired convergence of the epebala oe from the iris during the movement of the | eyel Boca yeball dow + in the long run, complications arise systems, as well as from the eyes, General principles of treatment. 1, Treatment with thyrostatic drugs. 2. Treatment with corticosteroids, 3. Treatment with B-blockers, 4. Treatment with radioactive iodine, 5. Surgical treatment (subtotal resectio 1 S n of the thys ineffectiveness of drug treatment. rire SE em te 6. Symptomatic treatment (sedatives, tranquilizers, cardiac glycosides, antihypertensives). : 7. Treatment of ophthalmopathy a diffuse rae Ty ‘enlarged, painless thyroid gland, sometimes with he eyes, Stelvag - rare blinking, fe - lagging of the upper eyelid nwards when looking at moving from the cardiovascular and nervous 17.3.3. Endemic goiter Definition. This disease is accompanied by a progressive enlargement of the thyroid gland with a subsequent decrease in its function. Endemic goiter is observed in people living in regions with iodine deficiency in the extemal environment, primarily in soil and water. Etiology. Lack of iodine in food due to its lack in soil and water (iodine deficiency leads to insufficient synthesis of thyroid hormones, which causes hypersecretion of thyroid stimulating hormone and an increase in the thyroid gland). Symptomatology. E « diffuse or nodular enlargement of the thyroid gland; ; + distinguish the following degrees of enlargement of the thyroid gland: Y Ost -no goiter (visually and by palpation): e Y 1st - determined by palpation, but goiter is not visible; v - is determined visually; . . eas ae in suplenng ie ae the head, in the subsequent development of the hypofunction of the thyroid glans 4 * the above symptoms of TE ey oli + feeli i in swallowin; > tata Fi pele a decline (intelligence), and if it developed in childhood bow in mental development up to oligophrenia and idiocy (myxedema); -323- he plications from many organs and systems, primarijy

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