Edit concept Question Editor Create issue ticket

Goiter

Goiters

Goiter is a condition characterized by abnormal enlargement of the thyroid gland. Majority of the cases is caused due to iodine deficiency.


Presentation

An enlarged thyroid gland is the classical symptom of goiter. The size of the enlarged gland may either appear as a single nodule, or large lump. In rare cases, goiter may produce the following signs and symptoms [5]:

Fatigue
  • Phonatory symptoms included hoarseness, vocal fatigue, vocal straining, lump sensation, and aphonia. The Voice Handicap Index 10 was used to assess the impact of phonatory symptoms on quality of life.[ncbi.nlm.nih.gov]
  • A 51-year-old Japanese woman presented to our hospital with systemic edema and general fatigue. Her serum albumin level was very low (1.5 g/dL).[ncbi.nlm.nih.gov]
  • In these cases patients may have symptoms such as sleeping problems, increased irritability, fatigue and unintentional weight loss or weight gain, which can cause further problems for some patients.[ic.steadyhealth.com]
  • Calling your health care provider: Call your health care provider if signs of thyrotoxicosis develop: Fever Increased pulse rate Palpitations Diarrhea or constipation Nausea Fatigue Dry Skin Sweating Tremors Anxiety Shortness of breath Prevention: Use[uclahealth.org]
  • Symptoms of hypothyroidism can include: Fatigue (feeling tired) Constipation Dry skin Weight gain Menstrual irregularities Cleveland Clinic News & More Cleveland Clinic News & More[my.clevelandclinic.org]
Weight Gain
  • In these cases patients may have symptoms such as sleeping problems, increased irritability, fatigue and unintentional weight loss or weight gain, which can cause further problems for some patients.[ic.steadyhealth.com]
  • Warning Iodine deficiency is a serious condition that may lead to birth defects, miscarriage, mental retardation, learning disorders and weight gain. Follow your doctor's treatment plan carefully.[livestrong.com]
  • Hypothyroid individuals may have weight gain despite poor appetite, cold intolerance, constipation and lethargy. However, these symptoms are often non-specific and make diagnosis difficult.[en.wikipedia.org]
  • Symptoms of hypothyroidism can include: Fatigue (feeling tired) Constipation Dry skin Weight gain Menstrual irregularities Cleveland Clinic News & More Cleveland Clinic News & More[my.clevelandclinic.org]
Hemoptysis
  • CASE REPORT: We describe a case, not previously reported in literature, of mediastinal goiter with hemoptysis as first clinical manifestation.[ncbi.nlm.nih.gov]
Long Arm
  • Based on similar changes in other tumors, it seems reasonable to also analyze a large number of adenomatous goiters for submicroscopic deletions of the long arm of chromosome 13.[ncbi.nlm.nih.gov]
Neck Swelling
  • A visible neck swelling is rarely present. However, the enlargement may be felt during a physical examination. In most cases, lithium-induced goiter does not present with any significant increase or decrease in thyroid hormone levels.[healthhype.com]
  • Should patients develop neck swelling or difficulty breathing, they should go immediately to the nearest emergency room. Complications Bleeding Infection .[woundcaresociety.org]
Kidney Failure
  • A 66-year-old female patient presented with dysphagia and hoarseness; the patient suffered from rheumatoid arthritis but did not have kidney failure or altered thyroid function.[ncbi.nlm.nih.gov]

Workup

Several tests are employed for diagnosing goiter. These include:

  • Physical examination: A preliminary examination of the neck of the individual is done. The individual would be asked to swallow, and swelling can be determined in the neck region. 
  • Blood tests: Blood tests will be done to detect the levels of T3 and T4. The levels of thyroid hormones, and TSH would indicate the underlying cause of goiter. In addition, antibody test would also be required.
  • Thyroid scan: This would furnish information about the size and nature of the thyroid.
  • Ultrasonography: This test provides information about the size of the thyroid gland and presence of nodules, if they had been missed out during physical examination [6].
  • Biopsy: This is achieved using fine needle aspiration technique, wherein a sample is obtained for analysis of the nature of the thyroid [7].
Mediastinal Mass
  • Ectopic thyroid goiter accounts approximately for 1% of all substernal goiters and for 10-15% of all mediastinal masses.[ncbi.nlm.nih.gov]
  • She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy.[ncbi.nlm.nih.gov]
  • Additionally, CT-guided biopsy is an effective tool in preoperative diagnosis of anterior mediastinal masses. Copyright 2011 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
  • Abstract Retrosternal goiter is one of the common causes of anterior mediastinal masses.[ncbi.nlm.nih.gov]
  • The patient with newly diagnosed breast carcinoma was also known to have a distinct large anterior mediastinal mass.[ncbi.nlm.nih.gov]
Ischemic Changes
  • Moreover, ischemic changes of the thyroid tissue were observed closer to the capsule. We report a case of Aspergillosis of the thyroid of a patient who underwent surgery for a multinodular goiter.[ncbi.nlm.nih.gov]

Treatment

Treatment of goiter would depend on the nature and size of the enlarged gland, underlying disease conditions if any, and symptoms experienced by the individual. The following types of methods are employed for treating the condition:

  • Medications: Hormone replacement medications are required if goiter is caused due to underactive thyroid. In addition, if inflammation is the cause, then medications to reduce the same will be administered. If hyperthyroidism is the underlying cause, then medications to normalize the levels of hormones is given.
  • Surgery: Surgery is the method of choice if goiter causes uncomfortable signs and symptoms. It is also considered in patients with nodular goiter [8].
  • Radioactive iodine is considered in cases, when overactive thyroid has caused goiter. The radioactive material destroys the thyroid cells, thereby reducing the size of the gland [9].

Prognosis

In certain cases, simple forms of goiter can resolve on its own, without treatment. In some other cases, the gland can eventually enlarge, as a result of which, thyroid gland can stop producing enough thyroid hormone, leading to hypothyroidism.

In yet some other cases, goiter can turn toxic, and begin producing thyroid hormones on its own, causing over production of hormones, leading hyperthyroidism.

Etiology

Iodine deficiency is the most common cause of goiter in countries that do not use iodized salt. However, goiter is also a common occurrence in those parts of the world that routinely use iodized salt. In such conditions, following are the factors that lead to goiter:

  • Disease conditions: Underlying disease conditions, such as Graves disease, or Hashimoto thyroiditis, which are autoimmune disorders, cause the development of goiter.
  • Development of nodules: Development of fluid filled sacs at both sides of the thyroid glands causes it to enlarge, giving rise development of multinodular goiter.
  • Solitary thyroid nodules: In this, a single nodule takes shape in one part of the gland causing goiter.
  • Pregnancy: In such conditions, the thyroid gland can enlarge due to hormone HCG that is produced during pregnancy.
  • Thyroiditis: This condition can cause the thyroid gland to swell and enlarge [2].

Epidemiology

Iodine deficiency is the most common cause of goiter worldwide. It has been estimated that about 200 to 800 million individuals with iodine deficiency develop goiter. In the US, majority of the cases of goiter occur due to underlying autoimmune disease, such as Hashimoto thyroiditis [3]. Females are more prone to develop goiter, as compared to males, with female to male ratio been 4:1.

Sex distribution
Age distribution

Pathophysiology

The functioning of the thyroid gland is regulated by the hormone TSH, which is produced by the pituitary gland. The thyroid gland produces 2 hormones, namely T3 and T4. These hormones are responsible for regulating the metabolism. Along with T3 and T4, the gland also produces the hormone known as calcitonin which regulates the calcium levels in blood. The pituitary gland along with hypothalamus, also controls and regulates the hormones that are produced.

Any form of deficiency occurring in synthesis of thyroid hormone, causes increased production of TSH. Increase in the levels of TSH causes the thyroid gland to enlarge, causing in order to normalize the levels of thyroid hormones. When such a phenomenon continues for prolonged duration, goiter develops [4].

Prevention

Taking iodized salt can prevent the development of most forms of simple goiter [10]. Other forms of goiter can seldom be prevented.

Summary

Improper functioning of the thyroid gland causes it to enlarge, which eventually paves way for development of compressive syndromes. The thyroid gland is anatomically linked to the trachea, larynx, esophagus and laryngeal nerves. As a result of this, the enlargement of the gland, also gravely affects the functioning of the neighboring regions. Goiter is a painless condition; however in some it can pose difficulty in swallowing food [1].

Patient Information

Definition

Goiter is a condition characterized by enlarged thyroid gland. Enlargement of the gland is in many cases non cancerous in nature. Such a type of condition strikes more women than men.

Cause

Iodine deficiency is the most common cause of goiter worldwide. However, in countries where iodized salt is regularly used, certain underlying disease conditions, and autoimmune diseases cause goiter.

Symptoms

In majority of the cases, goiter does not cause any symptoms. In cases when the gland enlarges to a great extent, individuals experience difficulty in breathing and swallowing. Affected individuals also experience hoarseness in voice.

Diagnosis

A preliminary physical examination is done, followed by blood tests to determine the levels of thyroid hormones. In addition, thyroid scans, ultrasonography and biopsy, are also indicated to analyze the fundamental cause of goiter.

Treatment

Simple forms of goiter do not require treatment. In many cases, a wait and watch approach is considered. When symptoms are experienced, the mode of treatment is designed, depending on nature and size of thyroid gland. Medications, surgery and radioactive iodine, are administered for treating goiter. 

References

Article

  1. Bardin CW. Endemic goiter. In: Current Therapy in Endocrinology and Metabolism. 6th ed. Mosby-Year Book; 1997:101-112.
  2. Knudsen N, Perrild H, Christiansen E, et al. Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency. Eur J Endocrinol 2000; 142:224.
  3. Sawin CT, Geller A, Hershman JM, Castelli W, Bacharach P. The aging thyroid. The use of thyroid hormone in older persons. JAMA. May 12 1989;261(18):2653-5.
  4. Elte JW, Bussemaker JK, Haak A. The natural history of euthyroid multinodular goitre. Postgrad Med J 1990; 66:186.
  5. Braverman LE, Utiger RD. Thyroid diseases: nontoxic diffuse and multinodular goiter. In: Werner and Ingbar, eds. The Thyroid: A Fundamental and Clinical Text. 7th ed. Lippincott-Raven; 1996:889-900.
  6. Hegedüs L. Thyroid ultrasound. Endocrinol Metab Clin North Am 2001; 30:339.
  7. Arda IS, Yildirim S, Demirhan B, Firat S. Fine needle aspiration biopsy of thyroid nodules. Arch Dis Chil. 2001;85(4):313-7.
  8. Romanchishen AF, Iakovlev PN. [Special surgical treatment of patients with nodular tumors of the thyroid gland against the background of diffuse toxic goiter]. Vestn Khir Im I I Grek. 2005;164(1):21-4.
  9. Fast S, Nielsen VE, Grupe P, et al. Prestimulation with recombinant human thyrotropin (rhTSH) improves the long-term outcome of radioiodine therapy for multinodular nontoxic goiter. J Clin Endocrinol Metab 2012; 97:2653.
  10. Dohán O, De la Vieja A, Paroder V, et al. The sodium/iodide Symporter (NIS): characterization, regulation, and medical significance. Endocr Rev. Feb 2003;24(1):48-77

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 22:53