Enlarged thymus gland in adults symptoms. Hyperplastic processes - histopathology of the thymus gland. What are the dangers of an enlarged thymus gland?

05/11/2011 The thymus gland or thymus is an important organ of the immune system, which in childhood responsible for the formation of primary immunity. It is located just behind the sternum in anterior section mediastinum (mediastinum - space in chest cavity, limited to the lungs on both sides) and partially extends to the neck. In adults aged 20-25 years, functioning thymus gland stops and it gradually turns into fatty tissue.

Tumors, cysts, metastases of cancer of other organs, and lymphomas may appear in the thymus. Thymomas are the most common tumors of the thymus gland. They may or may not grow into surrounding tissue. Based on their histological structure, thymomas are classified as tumors with uncertain behavior.

Often patients do not present any complaints, and thymomas turn out to be an incidental finding on CT examination chest. Some patients experience a number of symptoms (see).

However, a special property of diseases of the thymus gland, which distinguishes them from other neoplasms, are the so-called “parathymic syndromes”. These include hypogammaglobulinemia, hypoplasia of the red bone marrow, dermatomyositis, systemic lupus erythematosus, aplastic anemia, rheumatoid arthritis and other autoimmune diseases. However, the most common of them is a neurological disease - autoimmune myasthenia, which occurs in more than 40% of patients with thymomas.

Myasthenia gravis is a disease characterized by autoimmune damage to the neuromuscular junction, leading to difficulty or complete blockade of signal transmission from the nerve to muscle fiber. It manifests itself as weakness and pathological fatigue various groups skeletal muscles. The thymus gland in a patient with myasthenia gravis produces autoantibodies that block acetylcholine receptors and, thereby, transmitting a signal about movement from the nerve to the muscle.

Most often, the disease begins with double vision in the evening, the inability to raise the eyelids and changes in voice (nasality) in the evenings or after prolonged speech stress, pathological fatigue of the muscles of the neck and limbs, difficulty speaking, swallowing and chewing movements. Sick people note that they feel good in the morning, but after the morning toilet they experience severe fatigue. In cold weather, health improves, in warm weather it worsens. After rest, strength is restored as quickly as it was lost. Feature movement disorders with myasthenia gravis is the spread of muscle weakness from some exhausted physical activity muscles to others that were not involved in this movement. For example, an increase in ptosis (drooping of the eyelids) is possible with forced loads on the muscles of the limbs. The disease may remain unrecognized for years, but it progresses and sooner or later makes itself felt.

Myasthenic crisis (develops in 10-15% of patients) - extreme degree myasthenia gravis, characterized by rapid worsening of movement disorders leading to breathing and swallowing problems. If emergency assistance is not provided to the patient at this time, there is a real threat to life.

Some medications may provoke exacerbation of myasthenia gravis. These include some antibiotics, β-blockers, botulinum toxin, calcium antagonists, curare-like muscle relaxants, magnesium salts, lidocaine, procainamide, quinine, quinidine, radiocontrast agents, D-penicillamine, diphenine, hormones thyroid gland, as well as glucocorticoids.

If myasthenia gravis is suspected, consultation with a neurologist and hospitalization in a specialized clinic that has a full range of diagnostic (including CT and MRI) and treatment capabilities, including surgical treatment - removal of the thymus gland (thymectomy) is necessary.

Used to treat thymomas surgical method. Often the operation can be performed thoracoscopically, but large sizes neoplasms (more than 8 cm) use sternotomy. If the tumor grows into neighboring tissues and organs, treatment should be continued with radiation therapy.

People don't know everything about their body. Many people know where the heart, stomach, brain and liver are located, but few people know the location of the pituitary gland, hypothalamus or thymus. However, the thymus or thymus gland is the central organ and is located in the very center of the sternum.

Thymus gland - what is it?

The iron got its name due to its shape resembling a two-pronged fork. However, this is what a healthy thymus looks like, while a sick one takes on the appearance of a sail or butterfly. Because of its proximity to the thyroid gland, doctors used to call it the thymus gland.What is the thymus?This is the main organ of vertebrate immunity, in which the production, development and training of T-cells of the immune system occurs. The gland begins to grow in a newborn baby before the age of 10, and after the 18th birthday it gradually decreases. The thymus is one of the main organs for the formation and activity of the immune system.

Where is the thymus gland located?

You can detect the thymus gland by placing two folded fingers on the upper part of the sternum below the clavicular notch.Location of the thymusthe same in children and adults, but the anatomy of the organ has age characteristics. At birth, the weight of the thymus organ of the immune system is 12 grams, and by puberty it reaches 35-40 g. Atrophy begins at approximately 15-16 years. By the age of 25, the thymus weighs about 25 grams, and by 60 it weighs less than 15 grams.

By the age of 80, the weight of the thymus gland is only 6 grams. By this time, the thymus becomes elongated, the lower and lateral sections of the organ atrophy, which are replaced by adipose tissue. This phenomenon official science does not explain. This is the biggest mystery in biology today. It is believed that lifting this veil will allow people to defy the aging process.

Structure of the thymus

We have already found out where the thymus is located.Structure of the thymus glandLet's look at it separately. This small-sized organ has a pinkish-gray color, soft consistency, and lobular structure. The two lobes of the thymus are completely fused or tightly adjacent to each other. Top part the organ is wide, and the lower one is narrower. The entire thymus gland is covered with a capsule of connective tissue, under which there are dividing T-lymphoblasts. The bridges that extend from it divide the thymus into lobules.

The blood supply to the lobular surface of the gland comes from the internal mammary artery, thymic branches of the aorta, branches of the thyroid arteries and the brachiocephalic trunk. Venous outflow of blood occurs through internal thoracic arteries and branches of the brachiocephalic veins. The growth of various blood cells occurs in the tissues of the thymus. The lobulated structure of the organ contains the cortex and medulla. The first appears as a dark substance and is located on the periphery. Also, the cortex of the thymus gland contains:

• hematopoietic cells of the lymphoid series, where T-lymphocytes mature;
• hematopoietic macrophages, which contain dendritic cells, interdigitating cells, typical macrophages;
• epithelial cells;
• supporting cells that form the blood-thymus barrier, which form the tissue framework;
• stellate cells – secrete hormones that regulate the development of T cells;
• “nanny” cells in which lymphocytes develop.

In addition, the thymus secretes the following substances into the bloodstream:

• thymic humoral factor;
• insulin-like growth factor-1 (IGF-1);
• thymopoietin;
• thymosin;
• Thymalin.

What is he responsible for?

Thymus forms all body systems in a child, and maintains good immunity in an adult.What is the thymus responsible for?in the human body? The thymus gland performs three important functions: lymphopoietic, endocrine, immunoregulatory. It produces T-lymphocytes, which are the main regulators of the immune system, that is, the thymus kills aggressive cells. In addition to this function, it filters the blood and monitors the outflow of lymph. If any malfunction occurs in the functioning of the organ, this leads to the formation of oncological and autoimmune pathologies.

In children

In a child, the formation of the thymus begins in the sixth week of pregnancy.Thymus gland in childrenup to a year is responsible for the production of T-lymphocytes by the bone marrow, which protect children's body from bacteria, infections, viruses. An enlarged thymus gland (hyperfunction) in a child is not the best way affects health because it leads to decreased immunity. Children with this diagnosis are susceptible to various allergic manifestations, viral and infectious diseases.

In adults

The thymus gland begins to involute as a person ages, so it is important to maintain its functions in a timely manner. Rejuvenation of the thymus is possible with a low-calorie diet, taking the drug Ghrelin and using other methods.Thymus gland in adultstakes part in modeling two types of immunity: cellular type response and humoral response. The first forms the rejection of foreign elements, and the second manifests itself in the production of antibodies.

Hormones and functions

The main polypeptides produced by the thymus gland are thymalin, thymopoietin, and thymosin. They are proteins by nature. When lymphoid tissue develops, lymphocytes are able to take part in immunological processes.Thymus hormones and their functionshave a regulatory effect on everything physiological processes, passing through the human body:

• reduce cardiac output and heart rate;
• slow down the functioning of the central nervous system;
• replenish energy reserves;
• accelerate the breakdown of glucose;
• increase the growth of cells and skeletal tissue due to enhanced protein synthesis;
• improve the functioning of the pituitary gland and thyroid gland;
• exchange vitamins, fats, carbohydrates, proteins, and minerals.

Hormones

Under the influence of thymosin, lymphocytes are formed in the thymus, then with the help of the influence of thymopoietin blood cells partially change the structure to ensure maximum protection body. Timulin activates T-helper and T-killer cells, increases the intensity of phagocytosis, and accelerates regeneration processes.Thymus hormonesparticipate in the work of the adrenal glands and genital organs. Estrogens activate the production of polypeptides, while progesterone and androgens inhibit the process. A glucocorticoid produced by the adrenal cortex has a similar effect.

Functions

In the tissues of the thymus gland, blood cells proliferate, which enhances the body’s immune response. The resulting T-lymphocytes enter the lymph, then colonize the spleen and lymph nodes. Under stressors (hypothermia, starvation, severe injury, etc.)thymus functionsweaken due to massive death of T-lymphocytes. After this, they undergo positive selection, then negative selection of lymphocytes, then regenerate. The functions of the thymus begin to decline by the age of 18, and fade almost completely by the age of 30.

Diseases of the thymus gland

As practice shows,thymus diseasesare rare, but are always accompanied characteristic symptoms. The main manifestations include severe weakness, enlarged lymph nodes, decreased protective functions body. Under the influence of developing diseases of the thymus, lymphoid tissue grows, tumors form, which cause swelling of the extremities, compression of the trachea, borderline sympathetic trunk or vagus nerve. Malfunctions of the organ appear when the function decreases (hypofunction) or when the thymus functions increase (hyperfunction).

Magnification

If the ultrasound photo showed that the central organ of lymphopoiesis is enlarged, then the patient has thymic hyperfunction. Pathology leads to the formation of autoimmune diseases (lupus erythematosus, rheumatoid arthritis, scleroderma, myasthenia gravis).Thymic hyperplasiaIn infants it manifests itself in the following symptoms:

• decreased muscle tone;
• frequent regurgitation;
• weight problems;
• failures heart rate;
• pale skin;
• profuse sweating;
• enlarged adenoids, lymph nodes, tonsils.

Hypoplasia

The central organ of human lymphopoiesis may have congenital or primary aplasia (hypofunction), which is characterized by the absence or weak development of thymic parenchyma. Combined immunological deficiency is diagnosed as congenital disease Di George, in which children have heart defects, seizures, and abnormalities of the facial skeleton. Hypofunction orthymic hypoplasiamay develop against the background diabetes mellitus, viral diseases or drinking alcohol by a woman during pregnancy.

Tumor

Thymomas (tumors of the thymus) occur at any age, but most often such pathologies affect people from 40 to 60 years of age. The cause of the disease has not been established, but it is believed thatmalignant tumor of the thymusarises from epithelial cells. It has been noticed that this phenomenon occurs if a person suffered chronic inflammation or viral infections or has been exposed to ionizing radiation. Depending on which cells are involved in the pathological process, the following types of thymus gland tumors are distinguished:

• spindle cell;
• granulomatous;
• epidermoid;
• lymphoepithelial.

Symptoms of thymus disease

When the functioning of the thymus changes, an adult feels breathing problems, heaviness in the eyelids, and muscle fatigue. Firstsigns of thymus disease- This long recovery after the simplest infectious diseases. In case of violation cellular immunity symptoms begin to appear developing disease, For example, multiple sclerosis, Basedow's disease. If there is any decrease in immunity and corresponding symptoms, you should immediately contact a doctor.

Thymus gland - how to check

If a child has frequent colds, turning into severe pathologies, there is a high predisposition to allergic processes or enlarged lymph nodes, then you needdiagnosis of the thymus gland. For this purpose, a sensitive ultrasound machine with high resolution is required, since the thymus is located near the pulmonary trunk and atrium, and is covered by the sternum.

If hyperplasia or aplasia is suspected after histological examination the doctor can refer you to computed tomography and examination by an endocrinologist. A tomograph will help identify the following pathologies of the thymus gland:

• MEDAC syndrome;
• DiGeorge syndrome;
• myasthenia gravis;
• thymoma;
• T-cell lymphoma;
• pre-T-lymphoblastic tumor;
• neuroendocrine tumor.

Norms

In a newborn baby, the size of the thymus gland is on average 3 cm wide, 4 cm long and 2 cm thick. Averagenormal thymus sizepresented in the table:

Pathology of the thymus

When immunogenesis is disrupted, changes in the gland are observed, which are represented by diseases such as dysplasia, aplasia, accidental involution, atrophy, hyperplasia with lymphoid follicles, thymomegaly. Oftenthymus pathologyassociated either with an endocrine disorder or with the presence of an autoimmune or cancer. Most common cause The decline in cellular immunity is age-related involution, in which there is a deficiency of melatonin in the pineal gland.

How to treat the thymus gland

As a rule, thymus pathologies are observed up to 6 years of age. Then they disappear or develop into more serious diseases. If a child has an enlarged thymus gland, then he should be observed by a phthisiatrician, immunologist, pediatrician, endocrinologist and otolaryngologist. Parents should take precautions respiratory diseases. If symptoms such as bradycardia, weakness and/or apathy are present, urgent medical attention is required.Treatment of the thymus glandin children and adults it is carried out medically or surgically.

Drug treatment

When the immune system is weakened, it requires biological administration to maintain the body. active substances. These are the so-called immunomodulators that are offered bythymus therapy. Treatment of the thymus gland in most cases is carried out on an outpatient basis and consists of 15-20 injections, which are administered into the gluteal muscle. The treatment regimen for thymus pathologies may vary, depending on clinical picture. In the presence of chronic diseases Therapy can be carried out for 2-3 months, 2 injections per week.

5 ml of thymus extract isolated from animal thymus gland peptides is injected intramuscularly or subcutaneously. This is a natural biological raw material without preservatives or additives. Improvements are noticeable after just 2 weeks general condition patient, since during the treatment the protective blood cells are activated. Thymus therapy has a long-term effect on the body after therapy. A repeat course can be carried out after 4-6 months.

Operation

Thymectomy or thymus removalprescribed if the gland has a tumor (thymoma). The operation is performed under general anesthesia, which keeps the patient in a state of sleep throughout the entire surgical procedure. There are three methods of thymectomy:

1. Transsternal. An incision is made in the skin, after which the sternum bone is separated. The thymus is separated from the tissues and removed. The incision is closed with staples or stitches.
2. Transcervical. An incision is made along the lower part of the neck, after which the gland is removed.
3. Video-assisted surgery. Several small incisions are made in the superior mediastinum. A camera is inserted through one of them, displaying an image on a monitor in the operating room. During the operation, robotic manipulators are used that are inserted into the incisions.

Diet therapy

Diet therapy plays an important role in the treatment of thymus pathologies. You should include foods rich in vitamin D in your diet: egg yolk, brewer's yeast, dairy products, fish oil. It is recommended to eat walnuts, beef, and liver. When developing a diet, doctors advise including in the diet:

• parsley;
• broccoli, cauliflower;
• oranges, lemons;
• sea ​​buckthorn;
• rosehip syrup or decoction.

Traditional treatment

To improve immunity, children's doctor Komarovsky advises warming up the thymus gland with the help of a special massage. If an adult has an unreduced gland, then he should maintain immunity for prevention by taking herbal teas with rose hips, black currants, raspberries, lingonberries.Thymus treatment folk remedies It is not recommended to carry out this procedure, since the pathology requires strict medical supervision.

Video

There is an organ in our body that is talked about very little, but which can rightfully be called the “spot of happiness.” This is the thymus gland.

There is an organ in our body that is talked about very little, but which can rightfully be called the “point of happiness.” And you don’t have to look for it for long. This is the thymus gland. Located in the upper part of the chest, right at the base of the sternum. It is very easy to detect: to do this, you need to place two fingers folded together below the clavicular notch. This will be the approximate location of the thymus gland.

The thymus gland got its name thanks to characteristic form, resembling a three-pronged fork. However, only a healthy gland looks like this - a damaged one most often takes on the shape of a butterfly or sail. The thymus gland has another name - thymus, which translated from Greek means “vital force”. In the 60s of the last century, scientists realized that the thymus gland belongs to the organs of the immune system! And not to the secondary ones, like lymph nodes, tonsils or adenoids, but to the most central ones.

Functions of the thymus gland.

Long-term observations have shown that this pink gland largely determines human life, especially the lives of children who are not yet five years old. The fact is that the thymus is a “school” of accelerated training of immune system cells (lymphocytes), formed from bone marrow stem cells. Once in the thymus gland, newborn “soldiers” of the immune system are transformed into T-lymphocytes, capable of fighting viruses, infections and autoimmune diseases. After this, in full combat readiness, they enter the bloodstream. Moreover, the most intensive training takes place in the first 2-3 years of life, and closer to five years, when a quite decent army of defenders is recruited, the function of the thymus gland begins to fade. By the age of 30, it fades out almost completely, and closer to forty, as a rule, not a trace remains of the thymus gland.

Antiage organ.

Doctors call the extinction of the thymus gland involution, or reverse development, although in some people the thymus gland does not disappear completely - a faint trace remains in the form of a small accumulation of lymphoid and adipose tissue. Why the thymus in some people ages and dissolves earlier, and in others later, is difficult to say. Maybe it's all about genetic predisposition, maybe in the lifestyle... But doctors are sure: the later this happens, the better. And all because the thymus gland is capable of slowing down biological clock the body, in other words, slow down aging.

So, during one of the experiments, two dogs (old and young) underwent thymus gland transplantation. A young gland was implanted into an old animal, and an old one into a young dog. As a result, the first animal recovered very quickly, began to eat more, behave more actively and generally look a couple of years younger. And the second quickly grew old, became decrepit, until it died of old age.

Why is this happening? Yes, because the thymus gland not only collects an army of T-lymphocytes, but also produces thymic hormones that activate the immune system, improve skin regeneration, and promote rapid cell restoration. In a word, the thymus (thymus gland) works to seriously rejuvenate the entire body.

A shot of youth.

Immunologists have found a way to renew the aging gland - for this, a little is needed: a suspension of embryonic stem cells, a syringe and the skillful hands of a doctor who will inject them directly into the thymus. According to the plan, this simple manipulation will force the fading organ to fully recover, returning lost youth to its owner. According to supporters of the method, such an injection is much more effective than injecting stem cells into the blood, where they are quickly destroyed, giving only a short-term surge of strength, energy and youth.

Life after death.

And yet there is no need to be afraid of the natural decline of the thymus gland. This natural process does not pose any threat to human life. The fact is that in the first five years active work The thymus manages to provide the human body with such a supply of T-lymphocytes, which is quite enough for the rest of his life. In addition, the function of the retired gland is partially taken over by certain skin cells that are capable of synthesizing thymic hormones.

What she loves.

Like all organs of the immune system, the thymus gland loves protein, which, on the one hand, is a building material for antibodies, and on the other, enhances the activity of its own cells. Moreover, preference should be given to proteins of animal origin (they can be found in fish, meat, cheese , dairy products) as well as vegetable protein (spirulina, buckwheat and beans).

In addition to the protein diet, the thymus also loves thermal procedures. He will definitely enjoy a sauna, a warming compress, and rubbing with ointments based on... essential oils or a physical therapy session. True, immunologists do not recommend getting carried away with stimulating the thymus gland, because prolonged activity will inevitably lead to depletion of the organ, and this can cause the opposite effect. So the thymus should be warmed up for no longer than 5-10 days, preferably shortly before the period of colds.

As for the disease itself, which occurs with fever, at this moment stimulation of the thymus can lead to damage in the tissues of the organ and a more rapid progression of the disease (it it will go faster, but it will be more difficult to bear). So, it is best to apply compresses to the thymus gland when the disease is just beginning and the person feels weak, lethargic, has a runny nose, but the temperature does not rise.

What she can't stand.

The thymus gland does not tolerate stress at all (noise, temperature changes, anesthesia). During stress, the gland contracts, which leads to a decrease in vital energy. Stress requires the mobilization of all T-lymphocytes, as a result of which the thymus gland has to quickly prepare new defenders. Therefore, in a person who often takes risks and is nervous, the thymus gland wears out and ages faster.

Although problems with the thymus can also be caused by a deficiency of cortisol, a hormone produced by the adrenal glands. As a result, the thymus gland has to work for two, which can lead to the development of thymomegaly (enlargement of the gland) or thymoma (tumor of the thymus gland). Both of these diseases can be suspected in sluggish people who often suffer from colds, herpes and flu. Accurate diagnosis can be diagnosed based on an x-ray, ultrasound or immunogram results (a reduced number of T-lymphocytes indicates possible problems with the thymus gland).

How to stimulate the thymus gland?

A weakened thymus can be strengthened using the simplest method literally in a matter of seconds.

The method is to lightly tap the location of the gland with your hand 10-20 times. This tapping can be done with your fingertips or lightly clenched fist, choosing a pleasant rhythm. In this way, you can stabilize the body in a few seconds and fill it with life-giving energy.

But rubbing this place, on the contrary, has a weakening effect. Of course, you can also simply place your hand on the thymus and allow the energy to flow. This is another effective way to use vital energy.

If you regularly activate your thymus every morning and repeat this procedure several times during the day, then after a short period of time you will feel much stronger.

You can add affirmations, for example: “I am young, healthy, beautiful,” or come up with your own, but be sure to be positive.

When your thymus gland is activated, you may experience “goosebumps” and experience feelings of joy and happiness. It may take some time before you feel anything. Do this exercise every day and you will definitely feel its effect.

If you have frequent attacks anxiety, panic, stress - do this several times a day and you can regain your life balance. published

The thymus in children is one of the main organs of the immune system. It is located behind the sternum between the lungs, above the heart.

Synonymous names - thymus gland, thymus gland, gland of “childhood”. Thymus - because it is similar in shape to the Latin letter V. Goiter - presumably because it is located near the thyroid gland.

The main task of the thymus in the body is to ensure the maturation, differentiation and immunological “training” of T-lymphocytes.

T-lymphocytes are blood cells responsible for the body's immune response to the introduction of antigens. Antigens are organisms (bacteria, protozoa, viruses, etc.), bodies or substances foreign to the body, which can cause harm to the body and which need to be neutralized.

Enlargement of the thymus gland or thymomegaly is a pathology in which the size and weight exceed normal indicators, characteristic of a certain age of the child.

Before we talk about enlargement of the thymus, we will find out what size of this gland is considered normal. By the way, it changes in size and weight in a person with age.

When a child is just born, the weight of the thymus gland is on average about 12 g. Then the child grows, and the thymus gradually increases. By the age of puberty (approximately 15 years), his normal weight is about 30 g.

Since the main task of the thymus is to educate and train immunological cells, it is in childhood that it is most needed, when children first encounter bacteria and viruses.

As soon as puberty ends, the thymus gland begins to involute (atrophy). Already by the age of 25 years, the weight of the thymus is on average 25 g. By the age of 60, it weighs approximately the same as that of a new born child- 12-15 g. And for a 70-year-old person it weighs only about 6-7 g.

Now let's return to the enlargement of the thymus gland in young children.

This problem occurs mainly in children under one year of age. Cases of thymomegaly are reported more often in boys than in girls.

What provokes the development of thymomegaly?

Can cause enlargement of the thymus gland various factors. These may be exogenous ( external factors environment) and/or endogenous (internal factors of the body) factors.

Such factors may be:

• A burdened obstetric and gynecological history of the pregnant woman ( recurrent miscarriage, abortions)
• Diseases of the mother during pregnancy - gestosis, infectious diseases, Rhesus conflict between mother and baby, late pregnancy and others.
• The birth of a baby ahead of schedule.
• Negative effects on the unborn child (alcoholism and nicotine addiction mothers, x-ray irradiation, taking unauthorized medications during pregnancy).
• Pathologies of the newborn - birth injuries, sepsis, asphyxia, jaundice and others.

In a slightly simplified way, the fact that the thymus gland is enlarged can be explained by the fact that it has to actively perform the function of immune defense even before birth or immediately after birth.

The load on the gland exceeds its capabilities. Therefore, it increases in size to cope with the task. But, as a rule, even the enlarged gland fails to cope with the task, and its lymphoid tissue degenerates...

Since, in fact, an enlargement of the thymus gland is not the cause of the pathology, but a consequence, it is clear that, in addition to the enlargement of the thymus, there may be many other problems in the body of such a child.

What external manifestations can you notice in a baby with thymomegaly?

Babies with an enlarged thymus gland are characterized by high birth weight, increased appetite and speed dial weight in the future. At the same time, their muscle tone is reduced and the muscles themselves are poorly developed. Such children usually have large facial features, a curvy body and broad shoulders.

Patients with thymomegaly have weak pigmentation, so they have pale skin, Very light eyes and hair. When screaming or crying, infants experience blueness of the lips or nasolabial triangle. Doctors call this skin cyanosis.

A bright vascular pattern can be seen on the skin. In other words, visible venous network on the chest, stomach, back, which gives the skin a so-called marble pattern.

These children are different excessive sweating, so their feet and palms are often wet and cold.

If the thymus is significantly enlarged, it puts pressure on neighboring organs. Therefore, newborn babies with thymomegaly often regurgitate. They also cough without symptoms of a cold, since the thymus puts pressure on the trachea.

Children with an enlarged thymus gland also experience hypertrophy of other types. lymphoid tissue involved in providing immunity: tonsils, adenoids, lymph nodes.

Often, girls with thymomegaly experience hypoplasia or underdevelopment of the genital organs, and in boys, the testicles do not descend into the scrotum at the time of birth.

How to determine an enlarged thymus?

First of all, the pediatrician or specialists study the mother’s medical history and how the pregnancy proceeded. The characteristics of the baby’s newborn period and its anthropometric data (weight, height, monthly weight gain and height) are also analyzed.

The doctor will be able to verify the diagnosis only after conducting an examination. They will help him with this following methods diagnostics

1. Chest X-ray

It allows you to determine the size of the thymus gland and the degree of its enlargement. The doctor can do this by calculating the cardiothymycothoracic index (CTTI) on the image.

So, with 1st degree thymomegaly, the CCTI is 0.33 – 0.37. The second degree of increase is indicated by CCTI from 0.37 to 0.42. The range of CCTI for the third degree of thymomegaly is 0.42 – 3.

2. Ultrasound examination

This method allows you to determine the mass, volume and location (using a 3D sensor) of the thymus gland. During an ultrasound, not only the thymus gland is examined, but also organs abdominal cavity and adrenal glands.

3. Immunogram

With thymomegaly, there is a reduced number of mature T-lymphocytes and a weakening of their functional activity, a decrease in immunoglobulins of class G and A.

Children with suspected thymomegaly should be examined by a pediatrician together with an immunologist or endocrinologist.

What danger does an enlarged thymus gland pose?

Significant enlargement of the thymus gland can provoke the development of autoimmune, allergic diseases. Also this pathology can be an impetus for development endocrine disorders in the child’s body, which can manifest itself as obesity and diabetes.

It has also been proven that children with an enlarged thymus gland have a much higher risk of sudden infant death syndrome.

Due to hypertrophy of lymphoid tissue with thymomegaly, infectious diseases can be complicated by otitis media or abdominal pain (enlarged intra-abdominal lymph nodes). Children are often diagnosed with heart rhythm disturbances.

Due to reduced immunity, such children are more likely to experience colds and various infectious diseases.

Treatment of thymomegaly

Slight enlargement of the thymus gland specific treatment does not require. With the first and second degrees of thymomegaly, parents and doctors need to provide dynamic monitoring of the child and simply be vigilant regarding the baby’s health.

Parents are advised to adhere to all the rules of a healthy lifestyle: breast-feeding at least in the first year of the baby’s life, sufficient physical activity of the child, limiting contact with infectious patients.

Drug treatment of thymomegaly in children is prescribed when there is a significant enlargement of the gland, when complications are observed of this disease. At severe course diseases individually decide on the issue of surgical intervention.

In preparation for surgery and in case of serious health problems associated with thymomegaly, a course of glucocorticosteroids is prescribed.

For children with thymomegaly, it is recommended to correct immunity individual course adaptogens and natural immune stimulants (eleutherococcus or ginseng).

Children with an enlarged thymus gland are monitored by a pediatrician, endocrinologist and immunologist. And only specialists based individual approach solve the issue of therapeutic tactics in relation to a specific patient. Do not self-medicate.

Most often, with proper treatment and good care for the child, the problem is solved and recovery occurs.

Thymomegaly and vaccination

With thymomegaly, the child’s immune system is greatly weakened. Therefore, parents are concerned about the issue of vaccination of such children.

On the one hand, they cannot be left without protection from common infections. On the other hand, vaccination is a temporary additional burden on the child’s immune system.

That is, after the vaccine is administered, some minimal manifestations of the disease for which the vaccine was vaccinated appear in the body. Healthy baby will easily cope with these minimal manifestations, gain immunity and will not suffer from this disease in the future.

Is there a guarantee that the introduction of the vaccine will not provoke a deterioration in the health of an already weakened baby, that his body will cope with the load?

In all other cases, vaccination is acceptable. But the question of the possibility of vaccination in a particular patient should always be decided by the attending physician.

Parents cannot and should not decide this issue on their own. And even the most experienced doctor cannot give recommendations on this matter in absentia, without a comprehensive examination of the child.

Summary: enlargement of the thymus gland is serious pathology, which has favorable prognosis with timely detection and appropriate treatment.

As a rule, by the age of six years of a child’s life, all signs of pathology disappear without a trace. But these 6 years are a serious test for a child with thymomegaly and his parents. And all these years, attention, common sense and patience are required from the parents and the pediatrician observing the child.

A practicing pediatrician and twice-mother, Elena Borisova-Tsarenok, told you about thymomegaly in children.

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Hyperplastic processes in the thymus gland are characterized by an increase in the amount of its parenchyma, which is usually manifested by an increase in its size and weight. However, the latter, depending on age, can be expressed in varying degrees. In this regard, Schminke (1926) proposed to distinguish between thymic hyperplasia in children and adults, noting that hyperplasia in children is always accompanied by an increase in the size and weight of the thymus gland, while in adults its increase is often only relative and it is in the majority cases does not exceed the size and weight of the thymus gland in children. Similar changes in the thymus gland in adults are often described as persistence (preservation) or subinvolution (Hammar, 1926; Tesseraux, 1956).
As already indicated, the thymus gland is very sensitive to various hormonal influences. At the same time, glucocorticoids and sex hormones are its antagonists, while thyroxine has a stimulating effect on it. In accordance with this, an increase in the production of thyroxine in Graves' disease, as well as a decrease or cessation of the production of glucocorticoids or sex hormones, which is observed in Addison's disease, atrophy of the adrenal cortex and during castration, naturally lead to hyperplasia of the thymus gland. Tesseraux (1956, 1959) noted hyperplasia of the thymus gland also in acromegaly. However, it remains unclear with which specific ones hormonal disorders this may be related.
Histologically, hyperplastic processes in the thymus gland do not always manifest themselves in the same way. In children and young people, the thymus gland with hyperplasia most often retains its normal structure. In slightly enlarged lobules there is a clear division into the cortical and medulla layers. In the latter, typical Hassall bodies are found, the number of which is sometimes increased. However, the ratio between the cortical and medulla layers in hyperplasia can vary significantly, and in some cases the cortical layer is predominant, in others - the medulla. In accordance with this, Schridde (1911) proposed to distinguish between hyperplasia of the cortical and medulla thymus gland. It should, however, be taken into account that the narrowing of the cortical layer and the presence of degenerative forms of Hassall's bodies, often noted when examining the thymus gland in the deceased, may be a consequence of processes that arise in connection with the disease that was the cause of death and during agony.
A manifestation of thymic hyperplasia should also be considered the formation of lymphatic follicles in its lobules, often with typical reproduction centers (Fig. 11), as is often observed in lymphoid tissue. In children and young people, this is usually combined with general hyperplasia of the thymus gland in the form of an increase in the size of its lobules and the presence of a well-defined cortical layer in them, while in older people the formation of lymphatic follicles in the thymus gland is often the only manifestation of its hyperplasia. Mackay calls such changes in the thymus gland dysplastic.

Finally, hyperplastic processes should also include the appearance of peculiar glandular formations, often found against the background of involutive changes in the thymus gland. They were first described by Sultan (1896). They were later observed by Lochte (1899) and Weise (1940), who dedicated to them special studies. They are usually not numerous and are found along the periphery of individual lobules in the form of single glandular cells (Fig. 12), entirely filled with cells or containing small gaps. Along the periphery of the cells there are larger cells, often forming a palisade-shaped basal layer. The cells have a pronounced basement membrane, which is best seen when sections are processed using the PHIK reaction or impregnated with silver according to Foote.
We found similar glandular cells in the thymus gland in 68 of the 145 examined dead. In men and women they were observed with approximately the same frequency, which increased as the age of the deceased increased. At the same time, the youngest deceased in whom such glandular cells were found was a 21-year-old man who died from acute leukemia. These data completely coincide with the data of other researchers (Sultan, 1896; Lochte, 1899; Weise, 1940; Tesseraux, 1959). IN Lately similar glandular cells were also found in children with alymphoplasia of the thymus (Blackburn, Gordon, 1967).
Rice. 11. Lymphatic follicles with reproduction centers in the lobules of the thymus gland in progressive myasthenia. a-uv, 40X; 6-120X.
Rice. 12. Glandular cells in the lobules of the thymus.
ah-dead from alcoholic delirium complicated by pneumonia. Hematoxylin-eosin staining. Uv. 200X; used by a person who died from rheumatic heart disease. Treatment using the CHIC reaction. Uv. 1&OXI for the same reason. Impregnation with silver according to Ft. Uv. 240X.
Weise (1940), who specifically studied these glandular formations in the thymus gland of people, called them primitive bodies, believing that Hassall's corpuscles are formed from them. However, this assumption is contradicted by their different localization, as well as the fact that these glandular cells are found in the thymus not in early childhood, when intensive formation of Hassall's bodies occurs in it, but in a later period, when further formation of Hassall's bodies stops or It's already completely over. In addition, these glandular cells differ from Hassall's bodies in the presence of basement membranes and the absence of accumulation of glycolipids in their cells and lumens, so characteristic of Hassall's bodies.
At the same time, the undoubted epithelial nature of these cells and their great similarity with the tubular formations of the epithelial primordium of the thymus gland in the early phases of its development (see Fig. 6) allow, it seems to us, to consider them as the result of proliferation of epithelial elements of the thymus gland, which has a reactive nature . In the light of the currently developed idea about the participation of epithelial elements of the thymus in the production of humoral factors (E. Z. Yusfina, 1958; E. Z. Yusfina and I. N. Kamenskaya, 1959; Metcalf, 1966), these formations are of undoubted interest. The appearance of similar glandular cells in the thymus gland of rats after administration of Freund's adjuvant, noted by G. Ya. Svet-Moldavsky and L. I. Rafkina (1963), allows us to think about their relationship to immunological reactions. This assumption is well-known confirmed in the results of our research. Analysis of the possible dependence of the formation of glandular cells in the thymus gland in the examined deceased on the presence of infectious diseases inflammatory processes showed that glandular cells were observed in 45 out of 65 deaths with infectious inflammatory processes, while out of 80 deaths without infectious inflammatory processes they were found only in 23. The noted differences in the frequency of detection of glandular cells in the thymus gland in these two groups of deaths are statistically significant ( y == == 6.82; p< 0,01).
Thymic hyperplasia may be accompanied by various clinical manifestations and be a consequence of others pathological processes. At the same time, the nature of its changes in various cases may have some features that should be examined specifically.
Tumor-like hyperplasia
In some cases, the only manifestation of thymic hyperplasia is an increase in its size. This is often discovered by chance when X-ray examination organs of the chest, undertaken for a completely different reason. In other cases, the thymus gland, due to a significant increase in size, begins to put pressure on neighboring organs and nerves, causing a feeling of pressure behind the sternum, coughing, difficulty breathing, and sometimes swelling of the face and neck, which forces the patient to see a doctor. The cause of these disorders is determined after an X-ray examination reveals an enlargement of the thymus gland.
The clinical and radiological manifestations of such hyperplasia are very similar to tumors of the thymus and their difficulties differential diagnosis allow us to call it tumor-like hyperplasia. It should be emphasized that with tumor-like hyperplasia, no matter how severe it is, unlike tumors, the shape of the thymus gland is always preserved. This can sometimes be detected already by X-ray examination and is clearly visible during surgery (O. A. Lenzner, 1968) or during autopsies of the dead.
Histologically, the thymus gland with tumor-like hyperplasia, regardless of the patient’s age, retains its structure. In its lobules a distinct medulla, rich in lymphocytes and containing Hassal's bodies, is found.
After successful removal of the hyperplastic thymus gland in patients, no clinically pronounced disorders are observed, and, as long-term results monitored by O. A. Lenzner (1968) show, in in some cases up to 10 years or more they remain practically healthy people.

Thymic-lymphatic condition (Status thymico-lymphaticus)

It has long been noted that in some cases of sudden death of people, the only change detected during their pathological examination is an enlargement of the thymus gland, often combined with hyperplasia of the entire lymphatic system. For a long time, they tried to explain death in such cases by mechanical compression of the trachea or passing nearby by the enlarged thymus gland. nerve trunks. However, in 1889, Paltauff put forward the idea that these changes were a manifestation of a special constitutional condition, which he called Status thymico-lymphaticus, and that the death of people in this case occurs as a result of the toxic influence of a malfunctioning enlarged thymus gland. Subsequently, these ideas were again subject to revision and the very existence of the thymic-lnmphatic state began to be questioned.
The basis for this, apparently, was data on better preservation of the thymus gland in those who died a violent death compared to those who died from diseases, which was erroneously interpreted as its hyperplasia and created a false impression of the high frequency of thymic hyperplasia in healthy people. The references given to German authors should be considered unfounded, since Aschoff, Beitzke and Schmorl, who spoke at a conference on military pathology held in Berlin in 1916, emphasized the rarity of hyperplastic changes in the thymus gland in those killed in the war, and Beneke, who discovered its hyperplasia in a number of deceased wounded people was associated with atrophy of the adrenal glands.
The doubts expressed regarding the existence of a thymic-lymphatic condition, according to Sugg (1945), are based not so much on observations as on prejudice. With an impartial attitude, it is impossible to deny cases of sudden death in young people, in whom, if not the only, then the most outwardly expressed morphological changes detected at autopsy is an enlargement of the thymus gland and lymph nodes. We have to deal with this from time to time. For example, we had to participate in the analysis of the cause of death of a 19-year-old man, which occurred suddenly a few hours after tonsillectomy, in the absence of bleeding and any other complications. During its autopsy (prosector M.F. Gusenkova), apart from signs of acute venous congestion and a significant enlargement of the thymus gland, no other changes were found. Sugg (1945), who analyzed the results of an examination of 500 children who suddenly died, could not find any other changes in 49 of them that would explain the onset of death, except for an enlargement of the thymus gland.
At the same time, it is now hardly possible to associate the onset of sudden death in thymic hyperplasia with the hypothetical toxic influences emanating from it. The causes of death in this case should, apparently, be sought in the insufficiency of the adrenal glands, in which, with hyperplasia of the thymus gland, as shown by the studies of Wiesel (1912), Beneke (1916) and what was noted in the above-mentioned own observation, pronounced atrophic changes are often found.
Obviously, thymic hyperplasia itself, observed in sudden death, is one of the manifestations of adrenal insufficiency (Selye, 1937). From these positions, the onset of sudden death of young people after seemingly mild injuries becomes more understandable. surgical interventions, such as tonsillectomy, appendectomy, or simply during bathing, mental trauma, etc., which is also confirmed in modern ideas about the general adaptation syndrome (Selye, 1930). In this regard, it is interesting to note that with thymic hyperplasia in castrates sudden death not observed (Hammar, 1926).
Histological changes in the thymus gland in the thymic-lymphatic state do not have characteristic features. In its lobules there is a well-defined cortical layer and a medulla containing Hassal's bodies.