Goiter

Overview

Goiter is the abnormal enlargement of the thyroid gland. The thyroid gland is a small, butterfly-shaped endocrine gland that sits below the Adam’s apple, in the front of the neck. It generates the hormones thyroxine (T4) and triiodothyronine (T3), collectively known as thyroid hormones.

A goiter can be characterized by an overall enlargement of the thyroid or by uneven cell growth that causes one or more lumps (nodules) in the thyroid. If you have hyperthyroidism or hypothyroidism, or if your thyroid hormone levels are normal, goiter may be related to either of these conditions.

Goiter can be characterized in various ways, including how it grows, and whether the thyroid hormone levels are abnormal. Goiters that enlarge are often classified as simple (diffuse) goiter, nodular goiter, and multinodular goiter.

Goiters are also fluctuations in thyroid hormone levels are categorized as toxic goiter and nontoxic goiter. It’s a nontoxic goiter if your thyroid is enlarged but your thyroid hormone levels are normal (euthyroid). You do not, therefore, have either hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

Goiter is a common condition. Iodine deficiency is the most frequent cause of goiters, affecting an estimated 2.2 billion individuals. This is prevalent in countries where iodized salt is widely utilized.

A simple goiter may occur for a brief period and may heal on its own without any medical intervention. Common treatment for goiters includes medication and surgery. The doctor will need to identify the cause of the goiter and the potential risks before deciding the appropriate treatment.

Symptoms

Small goiters are often painless. People who have them barely know they have one, until they notice a bulge at the base of the neck. Goiters can grow very large. It can be painful if the thyroid gland becomes inflamed (thyroiditis). Signs and symptoms may vary based on the changes in the thyroid function, the rate at which the goiter grows, and whether it obstructs breathing.

Symptoms of goiter commonly include:

• Lump directly below the Adam’s apple in the front of the neck
• Sensation of pressure in the throat
• Hoarseness of voice
• Neck vein enlargement
• Dizziness when arms are raised above the head

Obstructive goiter

If the goiter grows large enough or is placed where it might block the larynx and the passageway for air, the person might experience:

• Trouble swallowing
• Problems breathing normally
• Snoring
• Coughing
• Hoarseness

Hypothyroidism

Common signs and symptoms of an underactive thyroid include:

• Tiredness
• Extra sensitive to cold
• Frequent sleepiness
• Dry skin
• Constipation
• Muscle weakness
• Memory or concentration issues
• Unexplained weight gain
• Irregular periods
• Hyperthyroidism
  Common signs and symptoms of an overactive thyroid include:
  • Unexplained weight loss
  • Fast heartbeat (tachycardia)
  • Excessive sweating
  • Extra sensitivity to heat
  • Shaking
  • Anxiety and irritability
  • Muscle weakness
  • Frequent bowel movements
  • Changes in menstrual patterns
  • Sleep problems
  • Hypertension (high blood pressure)
  • Increased hunger
  • Children with hyperthyroidism may experience these symptoms:
  • Rapid growth in height
  • Bone growth that exceeds the normal growth rate within the age group
  • Behavioral changes

Causes

The abnormal enlargement of the thyroid gland is caused by many factors, commonly:

• Iodine deficiency: This is the most common cause of goiter. Iodine is often consumed through seafood, dairy products and iodized salt in food. Iodine is important for thyroid gland to make thyroid hormones. If iodine is deficient, hormone production decreases and the pituitary gland instruct the thyroid to produce more. The thyroid produces more cells, making it grow abnormally to produce more thyroid hormone.
• Hashimoto’s disease: This is an autoimmune condition that leads to thyroid gland inflammation. The thyroid’s impaired and swollen tissues do not generate sufficient hormones (hypothyroidism). When the pituitary gland perceives a decrease and signals the thyroid to produce additional hormones, the thyroid expands. This kind of goiter normally improves on its own with time. Thyroid hormone treatment is required in some cases of Hashimoto’s disease.
• Graves’ disease: Graves’ disease is an autoimmune condition that causes the immune system to target the thyroid. The immune system creates a protein that mimics thyroid-stimulating hormones (TSH) which causes the thyroid to make too much thyroid hormone, resulting in thyroid enlargement.
• Thyroid nodules: Individuals may have one or more nodules (multinodular goiters). A nodule is a lump formed by the uneven development of thyroid cells. The majority of thyroid nodules are not malignant (benign). The cause of nodules is unknown, however genetics, diet, lifestyle, and environment may all have a role.
• Thyroid cancer: Thyroid cancer, an endocrine cancer, is considered generally curable. However, early detection and treatment is important to minimize the chance that it spread to other regions of the body, including the liver, lungs, and bones. Cancer is found in about 5% of patients with thyroid nodules.
• Pregnancy: The thyroid gland can become hyperactive and expand due to the human chorionic gonadotropin (HCG) produced during pregnancy.
• Thyroiditis: A condition known as thyroiditis caused by an autoimmune illness, bacterial or viral infection, or medication can induce thyroid inflammation. Thyroiditis can cause excessive (hyperthyroidism) or insufficient (hypothyroidism) thyroid hormone production.

Risk factors

Goiter can occur to anyone at any age. However, several factors may contribute to a higher chance of obtaining it, including:

• Lack of iodine: Iodine deficiency can cause of goiter. People who have limited or no access to iodine-fortified foods are at greater risk. It is usually found in seawater and coastal soil. Seafood, dairy products, and iodized salt are some of the products that are rich in iodine.
• Gender: Goiters are more common in female. Women are also more susceptible to thyroid disorders during menopause and pregnancy.
• Age: The risk of having a goiter increases as the person grows older. It is more common after age 40.
• Family medical history: Researchers have discovered genetic markers that may be linked to an increased risk for thyroid diseases. This means that goiters can occur in people with a family history of thyroid diseases.
• Medications: The likelihood of getting a goiter increases in people taking heart medication amiodarone and the psychiatric medication lithium.
• Radiation exposure: Medical treatments that required radiation exposure, especially in the head, neck, or chest area, puts a person to a greater risk of developing goiter.