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Il gozzo: quali sono le cause e la cura?

Che cos’è il gozzo?

Quando parliamo di gozzo (gozzo tiroideo) ci riferiamo in maniera molto generica ad un incremento del volume della tiroide, senza indicare una patologia specifica, in quanto si può verificare sia nei casi affetti da ipertiroidismo che in quelli di ipotiroidismo, anche perché è possibile che si verifichi anche in condizioni fisiologiche, per esempio quando la ghiandola è sottoposta ad uno sforzo maggiore, così come accade per esempio durante la gravidanza.

Il gozzo si può evidenziare durante l’adolescenza in quanto un lieve ingrandimento della tiroide può essere dovuto alla variazione del metabolismo ormonale tipico di questo periodo.
 Successivamente il fenomeno regredisce ma in alcuni casi (soprattutto nelle donne) può persistere o divenire nuovamente evidente nella gravidanza o in altri periodi della vita.

Tipologie di gozzo

  • Gozzo semplice: l’aumento di volume e di peso della tiroide si può verificare come fenomeno di compensazione, quando essa non è in grado di produrre adeguate quantità di ormoni tiroidei (carenza iodica) e in questo caso si parla perciò di gozzo endemico, che può verificarsi anche come conseguenza di una dieta povera di iodio o ricca di alimenti che impediscono l’assimilazione dello iodio.
  • Gozzo multinodulare: è l’evoluzione naturale del cosiddetto gozzo endemico, infatti la  stimolazione cronica della tiroide a crescere causata dalla carenza di iodio ha come conseguenza la selezione di gruppi di cellule all’interno della tiroide i quali si sviluppano in modo accelerato portando alla formazione dei noduli tiroidei.
  • Gozzo uninodulare tossico (morbo di Plummer): si tratta di una casistica ababstanza rara, ed è causata dalla presenza di un tumore benigno all’interno della tiroide che cresce e produce ormoni tiroidei in modo autonomo.
  • Gozzo multinodulare tossico: in questa fattispecie siamo in presenza di un gozzo multinodulare il quale al suo interno presenta uno o più noduli in grado di crescere e produrre ormoni tiroidei in modo autonomo e che nel tempo può causare ipertiroidismo, essendo una delle cause più frequenti di ipertiroidismo nelle aree iodio-carenti.
  • Gozzo diffuso tossico (morbo di Basedow): si tratta di una malattia autoimmune che colpisce di solito le donne e che porta in maniera molto frequente all’ipertiroidismo nelle aree iodio-sufficienti.

gozzo tiroideo

Le cause del gozzo

Come abbiamo già accennato più volte in precedenza la causa più frequente della formazione del gozzo è la carenza iodica.
In particolar modo si verificava molto spesso in passato in quanto le diete erano spesso carenti di iodio. L’attività primaria della ghiandola tiroidea è quella di concentrare iodio dal sangue e di trasformarlo in ormone tiroideo. La ghiandola non riesce a produrre abbastanza ormone tiroideo se non ha abbastanza iodio. Pertanto, con la carenza di iodio l’individuo diventa ipotiroideo. Conseguentemente, la ghiandola pituitaria (ipofosi) nel cervello avverte che il livello dell’ormone tiroideo è troppo basso e manda un segnale alla tiroide. Questo segnale è l’ ormone di stimolazione della tiroide (TSH).
Come spiega il nome stesso, questo ormone stimola la tiroide a produrre l’ormone tiroideo e ad aumentare in grandezza. Questa crescita abnorme delle dimensioni produce ciò che si definisce il gozzo.

In generale si può affermare che nei luoghi dove c’è carenza di iodio, sarà anche evidente la presenza del gozzo tiroideo.

La diagnosi del gozzo

La diagnosi di gozzo multinodulare è basata essenzialmente su:

  1. Esame obiettivo: consente di palpare la tiroide e di valutarne le dimensioni, la consistenza e l’eventuale presenza di noduli.
 Una tiroide di volume aumentato con più noduli ci indirizza verso la diagnosi di gozzo multinodulare.
  2. Esami di laboratorio: importante è la valutazione degli ormoni tiroidei in base ai quali è possibile distinguere il gozzo non tossico (FT3, FT4, TSH nella norma), il gozzo in ipertiroidismo subclinico (FT3 e FT4 nel range di normalità ma TSH leggermente soppresso in paziente asintomatico) e il gozzo tossico (alti valori di FT3 e FT4 e TSH soppresso in paziente spesso sintomatico): per maggiori informazioni su FT3, FT4 e TSH.
  3. Ecografia: questa metodica consente una descrizione anatomica più dettagliata dello struma tiroideo. 
Il sempre crescente utilizzo dell’ecografia nello studio della patologia tiroidea ha determinato un aumento del riscontro di patologia nodulare della tiroide.
  4.  Scintigrafia: consente una valutazione morfo-funzionale della tiroide.
 Si utilizzano dei radioisotopi che vengono captati dalla tiroide.
  5. Agoaspirato (FNAB): è una semplice procedura effettuata con ago sottile per prelevare del tessuto da sottoporre ad esame citologico.
 L’esperienza dell’operatore consente di ottenere un prelievo adeguato in una alta percentuale di casi.

Quali sono i sintomi del gozzo?

I principali sintomi del gozzo possono essere brevemente elencati:

  • difficoltà respiratoria
  • gonfiore di dimensioni variabili, da un piccolo nodulo a un grumo enorme nella parte anteriore del collo appena sotto il pomo d’Adamo
  • sensazione di tensione alla gola
  • raucedine
  • problemi nella deglutizione
  • vertigini quando si alzano le braccia sopra la testa
  • disturbi del ciclo mestruale
  • battito del cuore accelerato
  • sudorazione eccessiva
  • tremore
  • diarrea e nausea
  • aumento di peso

gozzo

Le informazioni qui fornite hanno lo scopo di informare, ma non possono in alcuna maniera sostituire la valutazione medica. Rivolgetevi sempre al vostro endocrinologo di fiducia.

74 Comments

  1. L’ipertiroidismo si cura con farmaci che bloccano la produzione ormonale e, nei casi in cui ГЁ richiesto il trattamento definitivo, mediante terapia radiometabolica con radioiodio o intervento chirurgico di tiroidectomia. Il gozzo nodulare ГЁ quasi sempre benigno e necessita solo di regolari controlli nel tempo. Nella patologia nodulare si puГІ ricorrere alla chirurgia che oggi si ГЁ molto evoluta sia nelle indicazioni (non operare se non si ГЁ sicuri del beneficio) sia nella tecnica (introduzione della chirurgia mini-invasiva e robotica). I noduli maligni della tiroide possono essere curati con successo nella maggior parte dei casi mediante tiroidectomia associata in casi selezionati alla terapia radiometabolica con radioiodio. Al fine di poter visuarizzare correttamente i centri partecipanti all’iniziativa, inviatiamo l’utente (nel momento in cui visualizza la mappa dell’ Italia-dopo aver cliccato su “iniziative nella tua cittГ “) di ingrandire l’immagine del punto di interesse per poter vedere singolarmente le farfalle rosa che sono i centri aderenti.

    Reply
  2. Ho gozzo miltinodulare che tengo sotto controllo con ecocolodoppler tiroideo annuale e visita endocrinologica .
    Assumo Eutirox 25 .
    Tutti i valori dei tsh sono sempre stati nella norma .

    Non capisco se la mia patologia rientra nell ipertiroidismo o ipotiroidismo .
    Non capisco inoltre se devo assumere poco o più sale e di che tipo .

    Assumo anche integratore fortilasa a base di bromelina dato dall’ endocrinologa.

    Ultimamente ho edema palpebrale fastidioso e leggermente rosso a tratti durante la giornata che mi porta la sensazione di avere un corpo estraneo nell’ occhio .

    Non ho altro sintomi

    Reply
  3. Buongiorno,
    ho 45 anni ed ho un gozzo di 4 cm ( colloidocistico e ipocaptante) con valori del sangue nella norma, è possibile farlo regredire ? con quali terapie
    non assumo terapie sostitutive. Molte grazie dell aiuto

    Reply
  4. : Buongiorno..mia figlia (14anni)da qualche giorno evidenzia un gonfiore alla tiroide..martedì ritiriamo esito esami del sangue.oggi ha fatto ecografiacon esito :tiroide in sede di dimensioni nettamente aumentate con spessori di entrambi i lobi di oltre 20 mm.il parenchima è francamente disomogeneo caratterizzato dalla presenza di aree ipo e iperecogenei in presenza di plurime nodularita’ infiammatoria.i margini sono bozzuti e irregolari. La vascolarizzazione al color doppler nettamente incrementata rispetto alla norma.non si apprezzano linfoadenopatie significative della regione laterò-cervicali.dottore sono molto preoccupata.

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  18. Come già accennato in precedenza, la carenza di iodio è la causa più comune della formazione del gozzo. È importante prestare attenzione alla propria dieta e assumere cibi ricchi di iodio per prevenire la formazione di questa patologia della tiroide.

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