Goitre

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

A goitre (BrE), or goiter (AmE) (Latin struma), also called a bronchocele, is a swelling in the neck (just below Adam’s apple or larynx) due to an enlarged thyroid gland. The most common cause is a lack of iodine in the diet. It also can be caused by many other diseases such as Graves’ disease, Hashimoto’s disease and thyroid cancer. Usual signs and symptoms include a visible swelling at the base of your neck, a tight feeling in your throat, cough, hoarseness and shortness of breath. Blood tests of thyroid gland hormone level, ultrasonography and thyroid gland scans may be helpful for the diagnosis. Treatment of goitre depends on the cause and the size of the lump. The cause of goitre determines the outcome.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Paracelsus (born Philippus Aureolus Theophrastus Bombastus von Hohenheim) (1493–1541) was the first to describe the connection between goitre and the consumption of minerals, specifically lead in drinking water.^[1].

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

They are classified in different ways:

• A “diffuse goitre” is a goitre that has spread through all of the thyroid (and can be a “simple goitre”, or a “multinodular goitre”).
• “Toxic goitre” refers to goitre with hyperthyroidism. These most commonly due to Graves disease, but can be caused by inflammation or a multinodular goitre.
• “Nontoxic goitre” (associated with normal or low thyroid levels) refers to all other types (such as that caused by lithium or certain other autoimmune diseases).

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes include:

• Hashimoto’s thyroiditis (E06.3)
• Graves-Basedow disease (E05.0)
• Inborn errors of thyroid hormone synthesis, causing congenital hypothyroidism (E03.0)
• Thyroiditis (acute, chronic) (E06)
• Side-effects of pharmacological therapy (E03.2); Potassium iodide
• Thyroid cancer
• Iodine deficiency.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Goitre was previously common in many areas that were deficient in iodine in the soil. For example, in the English Midlands, the condition was known as Derbyshire Neck. In the United States, goitre was found in the Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in India,^[1] Central Asia and Central Africa.

Some health workers fear that a resurgence of goitre might occur because of the trend to use rock salt and/or sea salt, which has not been fortified with iodine.

New research indicates that there may in fact be a tendency to inherit an increased vulnerability to goitre.

Iodine is necessary for the synthesis of the thyroid hormones triiodothyronine and thyroxine (T3 and T4). In conditions producing endemic goitre, when iodine is not available, these hormones cannot be made. In response to low thyroid hormones, the pituitary gland releases thyroid stimulating hormone (TSH). Thyroid stimulating hormone acts to increase synthesis of T3 and T4, but it also causes the thyroid gland to grow in size by increasing cell division.

Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Goiters can affect anyone. Some common risk factors for goiter include:

• A lack of dietary iodine: Epidemical data show that people living in areas lack of iodine and not getting enough iodine in the diet are at high risk of goiter.
• Female gender: Studies demonstrate that women are more likely to thyroid disorders than men.
• Age over 50 years
• Personnal or family history: A personal or family history of autoimmune disease increases your risk.
• Certain medications: Some drugs, such as immunosuppressants, antiretrovirals, amiodarone for arrhythmia and lithium for psychiatric disorders, may increase the risk of developing goitre.
• Radiation: Clinical surveys demonstrate the risk increases when patients have been treated with radiation to the neck or chest area, even when they have been exposed to radiation in a nuclear facility, test or accident.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Prognosis of goitre depends on the causes of the disease. The outcome of goitre caused by the thyroid cancer is worse than prognosis caused by other diseases, such as Graves’ disease, Hashimoto’s disease and iodine deficiency.

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