A goiter is an enlarged thyroid gland. This occurs when it is not able to produce enough thyroid hormone to meet the body’s needs. Goiter may either be endemic meaning it affects a group of people living in the same area or it may be sporadic. This may sometimes be caused by certain medications such as lithium. In the endemic goiter, the reason for the development of the condition is the lack of iodine in the diet. About 200 to 800 million people who are iodine deficit are affected with goiter. Most goiters though are only benign and can only cause cosmetic disfigurement. Cases of death happens when thyroid cancer, hyperthyroidism and hypothyroidism occurs.
The most common cause of goiter is iodine deficiency. The excess of iodine can also lead to the condition. This is also known as lithium ingestion and this decreases the release of thyroid hormones in the thyroid gland. Congenital errors of thyroid hormone synthesis can also lead to the development of the condition. Other causes are exposure to radiation, deposition diseases, granulomatous diseases and infectious agents that may either be bacterial, fungal or parasitic.
The thyroid enlargement may vary from a single nodule to a massive enlargement such as a neck lump. This is the common sign of goiter. This accounts for three percent of men who are 60 years old and older and 36% of women who are between 49 to 58 years of age. Having difficulty breathing may be experienced due to compression of the windpipe which may also cause cough or wheezing. Swallowing difficulties may also happen due to compression of the esophagus. Neck vein distention and dizziness may be experienced by the individual when arms are raised above the head. Pain due to hemorrhage, inflammation, necrosis or malignant transformation can also occur. This may lead to hyperthyroidism or hypothyroidism. Thyroid cancer with or without metastases can also occur. When this happens, there is now a risk of mortality.
One way of examining goiter is to let the patient sit or stand upright and take a sip of water to facilitate inspection. The thyroid gland should move upon swallowing water. Measurement of TSH or thyroid stimulating hormone and T4 of free thyroxine in the blood will also help diagnose goiter. A thyroid scan or an ultrasound of thyroid would also be forms of goiter diagnosis. In the ultrasound, if nodules are present a further diagnosis in the form of a biopsy should be done. Palpation is another procedure that needs to be done to rule out the possibility of pseudogoiter. This is a prominent goiter present in individuals who are thin. The thyroid gland’s lobes are palpated for size, consistency, nodules and tenderness.
Small benign goiters do not usually require treatment. The ones that require medical and surgical treatments are large and complicated goiters, especially the malignant goiters. If the individual still decides to treat his benign goiter, a leyothyroxine suppressive therapy may help reduce the goiter. In this process, the patient is monitored to keep serum TSH low but in a detectable range to prevent the development of hyperthyroidism and other disease such as cardiac arrhythmias and osteoporosis. For large goiters and malignant goiters, a surgical treatment may be done when other forms of treatment does not work. A thyroid hormone replacement is then done after the surgery.
