Goiter

Introduction

Abnormal enlargement of the thyroid gland is known as a goiter. The thyroid may enlarge completely or it may produce one or more thyroid nodules, which are tiny lumps. At the base of the neck, the thyroid gland can be located and it is a butterfly-shaped endocrine gland. It lies exactly below the larynx, in the front and sides of the trachea. It secretes thyroid hormones, which are crucial for regulating many elements of metabolism throughout a person's life as well as for normal growth and development of the brain in children, besides playing a crucial part in the metabolic activities of calcium. Goiters can be generally categorised as diffuse, multinodular, or uni-nodular. Each additionally includes a diverse range of goiters. A Goiter can arise in a gland that is generating an excessive amount of hormone (hyperthyroidism), an inadequate amount of hormone (hypothyroidism), or the precise quantity of hormone (euthyroidism).

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Types of Goiter

According to how Goiter expands, it is categorised as follows −

• Simple (diffuse) goiter − When the entire thyroid gland swells and appears smooth to touch.

• Nodular goiter − This sort of goiter occurs when a nodule, a solid or fluid-filled lump, forms within the thyroid, giving it a lumpy appearance.

• Multinodular goiter − It arises when the thyroid has numerous lumps (nodules). The nodules could be obvious or only be found through testing or imaging.

Classification is based on the thyroid (origin) and hormone levels.

• Toxic Goiter − It's a condition when the thyroid is swollen and generates an excessive amount of thyroid hormone.

• Nontoxic goiter − This type of goiter occurs when the thyroid is enlarged but the thyroid hormone levels are normal (euthyroid). It might be brought on by taking lithium as part of a prescription regimen for mood disorders.

• Colloid goiter − Endemic condition brought on by iodine deficiency. Iodine is a mineral that is necessary for thyroid hormones to be produced.

Causes of Goiter

• Iodine deficiency − The primary causes of goiter formation in the world. The thyroid gland's main function is to concentrate iodine from the blood to produce thyroid hormone. Iodine deficiency reduces the synthesis of thyroid hormones.Consequently, a Thyroid stimulating hormone (TSH) signal is sent to the thyroid gland by the pituitary gland in the brain. The goiter develops when this hormone causes the thyroid to generate more thyroid hormone and to expand in size.

• Hashimoto’s Thyroiditis − An autoimmune condition resulting in thyroid gland inflammation. The thyroid gland cannot release enough thyroid hormones as a result, which is countered by an increase in TSH hormone, which stimulates the thyroid gland. Goiter is the outcome, which causes the thyroid gland to expand.

• Grave’s disease − Hyperthyroidism is the cause of this illness. The thyroid gland enlarges as a result of excessive hormone production.

• Multinodular Goiter − Another cause of goiter, is in which the thyroid gland develops many nodules or masses, resulting in enlargement of the thyroid (goiter).

There are several other less common causes of goiter. Some of these are brought on by genetic flaws, during pregnancy, while others are brought on by thyroid trauma or diseases, and yet others are brought on by tumours (both cancerous and benign tumours).

Symptoms of Goiter

Goiter symptoms might vary from person to person since some people experience symptoms associated with thyroid gland enlargement while others experience none at all.

Common symptoms include −

• Constrictive or heavy feeling in the throat

• Voice alterations such as high-pitched voice or occasionally hoarseness of voice

• Cough

• Pressure over the windpipe cause shortness of breath

• Pressure over the food pipe can make swallowing uncomfortable or difficult.

• Goiter is accompanied by hypothyroidism: Fatigue, dry skin, constipation, irregular menstruation, and excess weight gain are some of the symptoms.

• Goiter accompanied by hyperthyroidism: Symptoms include quick heartbeat (tachycardia), unspecified loss of body weight, diarrhoea, perspiration without physical activity or a rise in ambient temperature, shaking and agitation.

Diagnosis of Goiter

The clinical examination and medical history of a person aid in evaluating possible conditions related to Goiter. An accurate evaluation may be required if there is significant or palpable swelling in the front neck area. To determine whether goiter might be present, a minimally enlarged thyroid gland must be thoroughly checked. Blood tests or thyroid function tests to measure thyroid hormone levels are frequently used in the diagnosis of goiter. Commonly ordered tests include those to measure T3, T4, and TSH levels. The outcomes of the thyroid function tests will determine the need for any additional testing. The doctor will order tests to assist diagnose Grave’s Disease if the thyroid is diffusely enlarged and if the patient has hyperthyroidism. If the patient has hypothyroidism, additional blood tests may be ordered to confirm the diagnosis of Hashimoto's thyroiditis. A thyroid ultrasound, a small needle aspiration biopsy, or a radioactive iodine scan, may also be done to assist in identifying the source of the goiter.

Treatment options

Treatment for goiters is based on the Goiter's size, its symptoms, and its underlying source. The doctor may advise a wait-and-see strategy with routine checks if the goiter is minimal and the thyroid function is normal.

Medications

The drugs used to treat hypothyroidism or hyperthyroidism may be sufficient to reduce a goiter. If you have thyroiditis, medications (corticosteroids) to lessen your inflammation may be administered.

Surgeries

If the thyroid becomes too large or doesn't respond to drug therapy, surgery to remove it, known as a thyroidectomy, is a possibility. Lifetime thyroid hormone replacement treatment following surgery is a must, depending on how much of the thyroid gland was removed.

Iodine-131 radioactive

It may be required to administer radioactive iodine (RAI) to patients with toxic multinodular goiters. Orally consumed RAI enters the bloodstream and then travels to the thyroid, where it kills the tissue of the hyperactive thyroid. Probably there is a need to use thyroid hormone replacement therapy for the rest of life after radioactive iodine therapy.

Conclusion

The condition goiter results in an enlargement of the thyroid gland in the front and side regions of the neck. Iodine deficiency is the root cause of more than 90% of goiter cases worldwide. It could be brought on by excessive or insufficient thyroid hormone production, nodules in the thyroid gland, or any of these factors. Goiter can be detected through visual inspection, palpation, or imaging research. The size, cause, and symptoms of the goiter all affect how it should be treated. Goiters that are minor or do not create any issues do not require treatment.

FAQs

Q1. What major hormones does the thyroid gland produce?

Ans. Two hormones are produced by the thyroid gland: Thyroxine (T3) and Triiodothyronine (T4).

Q2. How are pregnancy and Goiter associated?

Ans. Human chorionic gonadotropin (HCG) is a hormone produced during pregnancy that can occasionally induce goiter by minor swelling of the thyroid gland.

Q3. What is called thyroiditis?

Ans. Overproduction or underproduction of thyroid hormone results from the swelling or inflammation of the thyroid gland.