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Goiter

Definition


Disease: Goiter Goiter
Category: Endocrine and metabolic diseases
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Disease Definition:

Located at the base of the neck just below Adam's apple, the thyroid is a butterfly-shaped gland. When the thyroid gland grows larger than normal, it means that a person has a condition called goiter. Although painless, a large goiter could cause a cough and make it difficult to swallow or breathe.

 

A lack of iodine in the diet is the most common cause of goiter worldwide. This condition could also be due to nodules that develop in the gland itself, or to the over- or underproduction of thyroid hormones.

 

The size of the goiter, the symptoms and the underlying cause is what treatment for goiter depends on. Usually, small goiters don't need treatment because they aren't noticeable and don't cause any problems.
 

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Not all goiters cause signs and symptoms, but when signs and symptoms do occur they may be:

 

  • Coughing
  • Difficulty breathing
  • Difficulty swallowing
  • Hoarseness
  • A tight feeling in the throat
  • A visible swelling at the base of the neck, which could be partially obvious when someone puts on makeup or shaves.
     

Causes:

Two main hormones are produced by the tyroid gland, triiodothyronin (T-3) and thyroxine, which circulate in the bloodstream and help regulate metabolism. These hormones maintain the rate at which a person’s body uses fats and carbohydrate, help control the body temperature, influence the heart rate, in addition to helping regulate the production of proteins. Calcitonin, which is a hormone that regulates the amount of calcium in the blood, is also produced by the thyroid gland.

 

The rate at which these hormones are produced and released are controlled by the pituitary gland and hypothalamus. When the hypothalamus, which is an area at the base of the brain that acts as a thermostat for a person’s whole system, signals the pituitary gland to make a hormone called thyroid-stimulating hormone (TSH), the process begins. Also located at the base of the brain, the pituitary gland releases a certain amount of TSH. This amount will depend on how much thyroxine and T-3 are in the person’s blood. Based on the amount of TSH the thyroid gland receives from the pituitary gland, it regulates its production of hormones.

 

If someone has a goiter, it doesn't necessarily mean that their thyroid gland isn't working normally. The thyroid may produce normal amounts of hormones, even when it's enlarged. However, it could also produce too much or too little T-3 and thyroxine.

 

Some of the most common factors that could cause the thyroid gland to enlarge include:

 

Iodine deficiency:

Primarily found in seawater and in the soil in coastal areas, iodine is essential for the production of thyroid hormones. People who live inland or at high elevations in the developing world are usually iodine-deficient and develop goiter when the thyroid enlarges in an effort to obtain more iodine. A diet that is high in hormone-inhibiting foods, including cauliflower, broccoli and cabbage, could make the initial iodine deficiency worse. Despite the fact that in many parts of the world a lack of dietary iodine is the main cause of goiter, however, in First-World countries, this is not the case because iodine is routinely added to foods and table salt.

 

Graves' disease:

When the thyroid gland produces too much thyroid hormone (hyperthyroidism), goiter can sometimes occur. In this disease, excess thyroxine is produced because the antibodies that are produced by the immune system that usually help protect against bacteria and viruses, mistakenly attack the thyroid gland. The thyroid swells because of this overstimulation.

 

Hashimoto's disease:

An underactive thyroid (hypothyroidism) could also cause goiter. Hashimoto's disease is an autoimmune disorder just like Graves' disease. But Hashimoto's disease damages the thyroid so that it produces too little hormone instead of causing it to produce too much. Consequently, the thyroid gland enlarges because when the pituitary gland senses a low hormone level, it produces more TSH to stimulate the thyroid.

 

Solitary thyroid nodules:

In this condition, a single nodule, which is a solid or fluid-filled lump, develops in one part of the thyroid gland. Most nodules are benign and don't lead to cancer.

 

Multinodular goiter:

In this case, the gland is enlarged due to the development of nodules in both sides of the thyroid.

 

Inflammation:

Pain and swelling in the thyroid could be caused by thyroiditis, which is an inflammatory condition.

 

Pregnancy:

The thyroid gland could enlarge slightly due to HCG (human chorionic gonadotropin), which is a hormone that is produced during pregnancy.

 

Thyroid cancer:

Cancer of the thyroid usually appears as an enlargement on one side of the thyroid. Thyroid cancer is far less common than benign thyroid nodules.
 

Complications

Complications:

Physical or cosmetic problems aren't caused by small goiters. However, large goiters could cause a cough or hoarseness and make it difficult to swallow and breathe. When hyperthyroidism or hypothyroidism is the cause of goiters, they could be associated with a number of symptoms ranging from weight gain and fatigue to trouble sleeping, irritability and unintended weight loss.
 

Treatments:

Treatment for goiter will depend on:

 

  • The size of the goiter
  • Signs and symptoms
  • The underlying cause

 

The patient may be recommended:

 

Observation:

A person may be suggested a wait-and-see approach in case their goiter is small and doesn't cause problems, and the thyroid is functioning normally.

 

Medications:

In case someone has hypothyroidism, thyroid hormone replacement with levothyroxine usually resolves the symptoms of hypothyroidism and slows the release of thyroid-stimulating hormone from the pituitary gland, which usually decreases the size of the goiter. In the case of inflammation of the thyroid gland, the patient may be suggested aspirin or a corticosteroid medication. Someone may need medications to normalize hormone levels in case their goiter is associated with hyperthyroidism.

 

Surgery:

If someone has a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or if someone has nodular goiter causing hyperthyroidism, removing all or part of the thyroid gland (total or partial thyroidectomy) could be an option. The treatment of thyroid cancer is also surgery. Depending on the amount of thyroid removed, the patient may need to take levothyroxine after the surgery.

 

Radioactive iodine:

Some cases of overactive thyroid gland are treated with radioactive iodine. Taken orally, the iodine reaches the thyroid gland through the bloodstream and destroys the thyroid cells, which results in the diminishing size of the goiter. However, this treatment could also eventually cause an underactive thyroid gland. Hormone replacement with the synthetic thyroid hormone levothyroxine becomes necessary, usually for life.
 

Prognosis:

Not available

Expert's opinion

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