Goiter:

A noncancerous enlargement of the thyroid gland. With a goiter, the levels of thyroid hormones may be normal (euthyroid), elevated (hyperthyroidism), or decreased (hypothyroidism).

Goiter is an enlargement of the thyroid gland, which is situated across the front of the neck just below the Adam’s apple {larynx}. The swelling of the gland may be so great as almost to double the width of the neck.

It is commoner in women than in men. The result is a bulge or a painless swelling or disfigurement of the neck, sometimes so large that it can easily be seen as a mass in the neck. There are two main types of goiters; Diffuse Goiters and multinodular goiters. Diffuse goiters are divided into simple and smooth goiters.

A simple goiter is classified as either an endemic (colloid) or sporadic (non toxic) goiter. This type usually occurs when thyroid gland is under active (hypothyroidism) and cannot produce enough thyroid hormone (thyroxin) to meet the body’s requirements.

The thyroid gland enlarges to compensate and produce the necessary hormones. The main cause of this goiter is iodine deficiency. The thyroid gland manufactures protein hormones, for which it needs iodine. If the diet doesn’t contain enough iodine, the gland goes on trying to produce the hormones and increases its activity.

The result is an enlargement of the thyroid, which is not associated with overproduction of thyroid hormone or malignancy.

Dyshormonogenesis, a genetic enzyme deficiency that interferes with normal thyroid hormone synthesis can lead to simple goiters. It is common that a simple goiter progresses to nodularity. An overproduction of thyroid stimulating hormone in the pituitary gland in response to a defect in normal hormone synthesis within the thyroid gland can also result to a goiter.

It occurs in an autoimmune condition called (smooth toxic goiter) Grave’s disease, in which there is plenty of iodine but the ground is overactive. In this case the enlargement is accompanied by excessive production of thyroid hormones.

Other causes of smooth goiters are Hashimoto’s thyroiditis, caused by antibodies to thyroid hormones, Sub-acute thyroiditis, which is probably a virus infection, Lymphoma and thyroid amyloidosis

Another form of goiter, called toxic nodular goiter, appears when one or more nodules in the thyroid get out of control and produce too much thyroid hormone.

Other conditions causing goiter are Benign or malignant tumors of the thyroid gland (rare); certain medications in high doses, such as lithium or aminoglutethimide; a family history of congenital goiter. In most cases of sporadic goiter the cause is unknown.

The main symptom of goiter is a swelling at the base of the neck. The swelling can range in size from a small lump to a noticeable enlargement. If hyperthyroidism is the cause of the goiter, weight loss, increased appetite, elevated blood pressure, increased heart rate, diarrhea, anxiety, hand tremors and muscle weakness can also result.

If hypothyroidism is the cause, fatigue, depression, decreased heart rate, constipation, intolerance to cold, weight gain, and numbness in the hands can occur. Both under and overactive thyroid, if left untreated, can lead to life threatening complications.

The mass can sometimes compress the trachea (windpipe) and esophagus (swallowing tube), causing difficulty in breathing and swallowing. Psychological problems can also develop, including fear of social situations, anxiety, loss of self-confidence, even fear of the growth itself.

Goiters are easily diagnosed using physical examination and thyroid function tests.

FYI: Diffuse euthyroid goiters= physiological goiter or autoimmune thyroiditis.

Diffuse hyperthyroid goiter= primary hyperthyroidism.

Multionodular euthyroid goiter= of a multinodular goiter.

Solitary euthyroid nodule= thyroid cyst or tumour.

Solitary hyperthyroid nodule= functioning adenoma.

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