Goiter

Description

A goiter (GOI-tur) is an abnormal growth of the thyroid gland. The thyroid is a butterfly-shaped gland located at the base of the neck just under the Adam's apple.

A goiter can be an overall enlargement of the thyroid, or can be the result of irregular growth of the cell that forms one or more bumps (nodules) in the thyroid. A goitre can be associated with no change in the function of the thyroid or with an increase or a decrease in thyroid hormones.

The most common cause of goiters worldwide is a lack of iodine in the diet. In the united States, where the use of iodized salt is common, a goiter are caused by conditions that change the function of the thyroid or factors that affect the thyroid gland.

The treatment depends on the cause of the goiter, symptoms, and comcomplications resulting in goiter. Small goiters that are not noticeable and do not cause problems usually do not need treatment.

Symptoms

The majority of people with goiter have no signs or symptoms other than a swelling at the base of the neck. In many cases, the goiter is small enough that only discovered during a routine medical examination or an imaging test for another condition.

Other signs and symptoms depend on if the thyroid function changes, how quickly the goiter grows and if it obstructs breathing.

The underactive of the thyroid (hypothyroidism)

The signs and symptoms of hypothyroidism include:

  • Fatigue.
  • Increased sensitivity to cold.
  • Increased drowsiness.
  • Dry skin.
  • The constipation.
  • The muscle weakness.
  • Problems with memory or concentration.

The hyperactivity of the thyroid (hyperthyroidism)

The signs and symptoms of hyperthyroidism include:

  • The loss of weight.
  • Rapid heartbeat (tachycardia).
  • Increased sensitivity to heat.
  • The excess sweating.
  • The tremors.
  • The irritability and nervousness.
  • The muscle weakness.
  • Frequent bowel movements.
  • Changes in the menstrual pattern.
  • Difficulty sleeping.
  • The high blood pressure.
  • Increased appetite.

Children with hyperthyroidism may also have the following:

  • The rapid growth in height.
  • Changes in behavior.
  • The bone growth that exceeds the growth expected for the age of the child.

The obstructive goiter

The size or the position of a goiter can obstruct the airway and voice box. Signs and symptoms may include:

  • Difficulty swallowing.
  • Difficulty breathing with effort.
  • For cough.
  • The hoarseness.
  • Snoring.

Causes

How the thyroid gland works

Two hormones produced by the thyroid gland arand thyroxine (T-4) and triiodothyronine (T-3). When the thyroid releases T-4 and T-3 in the bloodstream, which play an important role in many functions in the body, including the regulation of:

  • The conversion of food into energy (metabolism).
  • The temperature of the body.
  • Heart rate.
  • Blood pressure.
  • Another hormone interactions.
  • Growth during infancy.

The thyroid gland also produces calcitonin, a hormone that helps regulate the amount of calcium in the blood.

How the thyroid is regulated

The pituitary gland and hypothalamus control the rate at which the T-4 and T-3 are produced and released.

The hypothalamus is a specialized region at the base of the brain. It acts as a thermostat to maintain balance in multiple systems of the body. The hypothalamus signals the pituitary gland to make a hormone known as thyroid-stimulating hormone (TSH).

The pituitary gland — located below the hypothalamus releases a certain amount of TSH, depending on how much T-4 and T-3 are found in the blood. The thyroid gland, in turn, regulates the production of hormones based on the amount of TSH it receives from the pituitary gland.

Causes of goiter

A number of factors that influence the function of the thyroid or growth may result in a goiter.

  • The deficiency of iodine. Iodine is essential for the production of thyroid hormones. If a person does not get enough iodine in the diet, the production of the hormone drops and the pituitary gland signals the thyroid to produce more. This increase of the signal results in the growth of the thyroid. In the united States, this case is unusual because of iodine added to table salt.
  • Hashimoto's disease. Hashimoto's disease is an autoimmune disorder, a disease caused by the immune system attacking healthy tissues. The damaged and the inflammation of the tissues of the thyroid gland is not producing enough hormones (hypothyroidism). When the pituitary gland senses the decrease and prompts the thyroid to create more hormones of the thyroid gland can become enlarged.
  • The Graves disease. Another autoimmune disorder called Graves ' disease occurs when the immune system produces a protein that mimics TSH. This rogue protein prompts the thyroid to produce hormones (hyperthyroidism) and can result in the growth of the thyroid.
  • Nodules in the thyroid. A nodule is an abnormal growth of thyroid cells that form a lump. A person may have a nodule or multiple nodules (multinodular goiter). The cause of nodules is not clear, but there may be a number of factors: genetics, diet, lifestyle and the environment. The majority of thyroid nodules are not cancerous (benign).
  • Cancer of the thyroid. Thyroid cancer is less common than other types of cancer and is usually treatable. Ab5% of people with thyroid nodules have cancer.
  • Pregnancy. A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause the thyroid gland to become overactive and expand slightly.
  • Inflammation. Thyroiditis is an inflammation of the thyroid gland caused by an autoimmune disorder, bacterial or viral infection, or medication. The inflammation can cause hyperthyroidism or hypothyroidism.

Risk factors

Any person can develop a goiter. It may be present at birth or develop at any time throughout life. Some common risk factors for goiter are:

  • A lack of iodine in the diet. Iodine is found primarily in seawater and in the soil in coastal areas. In the developing world, in particular, people who do not have enough iodine in your diet, or access to food, supplemented with iodine, are at greater risk. This is rare in the united States.
  • The fact of being a woman. Women are more likely to develop a goiter or other disorders of the thyroid gland.
  • Pregnancy and the menopause. Thyroid problems in women are more likely to occur during pregnancy and menopause.
  • Age. Goiters are more common after 40 years of age.
  • Medical history of the family. Family medical history of goiter or other thyroid disorders increases the risk of goiter. In addition, researchers have identified genetic factors that may be associated with a greater risk.
  • Drugs. Some medical treatments, including the heart drug amiodarone (Pacerone), and the psychiatric drug lithium (Lithobid), increase your risk.
  • The exposure to radiation. Your risk increases if you have had radiation treatments to his neck, or chest.

Complications

A goiter itself usually does not cause complications. The appearance can be annoying or uncomfortable for some people. A large goiter can obstruct the airway and voice box.

The changes in the production of thyroid hormones thcan be associated with a goiter have the potential to cause complications in multiple systems of the body.

Goiter

Diagnosis

A goiter, is often discovered during a routine physical examination. Touching your neck, your doctor can detect an enlargement of the thyroid, an individual nodule or nodules multiple.. sometimes a goiter is when they are subjected to a diagnostic test for another condition.

Additional testing is then ordered to do the following:

  • Measure the size of the thyroid gland.
  • Detect any nodules.
  • To evaluate if the thyroid can be overactive or underactive.
  • Determine the cause of the goiter.

Tests may include:

  • Thyroid function tests. A blood sample can be used to measure the amount of Thyroid-stimulating Hormone (TSH) produced by the pituitary gland and how much Thyroxine (T-4) and Triiodothyronine (T-3) is produced by the thyroid gland. These tests can show if the goitre is associated with an increase or decrease in thyroid function.
  • The antibody test. Depending on the results of the thyroid function test, your doctor can order a blood test to detect an antibody linked to an autoimmune disorder such as Hashimoto's disease or Graves disease.
  • Ultrasound. The ultrasound uses sound waves to create a computerized image of the tissues in the neck. The technician uses a wand-like device (transducer) over your neck, to make the test. This imaging technique can reveal the size of the thyroid gland and detect nodules.
  • Radioactive iodine uptake. If your health care provider orders this test, you are given a small amount of radioactive iodine. Through a scanning device, a technician can measure the amount and the speed at which your thyroid takes in. This test can be combined with radioactive iodine scan to display a visual image of the uptake pattern. The results can help to determine the function and the cause of the goiter.
  • The biopsy. During a fine needle aspiration biopsy, ultrasound is used to guide a very small needle in your thyroid to obtain a sample of tissue or fluid of nodules. The samples are analyzed for the presence of cancerous cells.

Treatment

Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. If the goiter is small and the function of the thyroid is healthy, your doctor may suggest a " wait and see what happens with regular check-ups.

Drugs

Medicines for goiter you can include one of the following:

  • To increase the production of the hormone. A low activity of the thyroid gland is tis reated with a thyroid hormone replacement. The medication levothyroxine (Levoxyl, Thyquidity, other) replaces the thyroxine (T-4) and the results in the pituitary gland, releasing less thyroid-stimulating hormone (TSH). The drug liothyronine (Cytomel) can be prescribed as a triiodothyronine (T-3) replacement. These treatments can reduce the size of the goiter.
  • For the reduction of the production of the hormone. An overactive thyroid can be treated with an anti-thyroid drug that alters the production of the hormone. The most commonly used drug, Ithimazole (Tapazole), can also reduce the size of the goiter.
  • For blocking the hormone of activities. Your health care provider may prescribe a medicine called a beta-blocker for the management of the symptoms of hyperthyroidism. These drugs — including atenolol (Tenormin), metoprolol (Lopressor) and others — can disrupt the excess of thyroid hormones and reduce symptoms.
  • For the management of pain. If the inflammation of the thyroid results in pain, it is usually treated with aspirin, naproxen sodium (Aleve), ibuprofen (Advil, Motrin IB, others) orr-related pain relievers. The severe pain can be treated with steroids.

Surgery

You may need surgery to remove all or part of the thyroid gland (total or partial thyroidectomy) can be used to treat goiter with the following complications:

  • Difficulty breathingg or swallowing.
  • Nodules in the thyroid that causes hyperthyroidism.
  • Cancer of the thyroid.

You may need to take thyroid hormone replacement, depending on the amount of thyroid removed.

Treatment with radioactive iodine

The radioactive iodine is a treatment for hyperactivity of the thyroid of the gland. The dose of radioactive iodine is taken by mouth. The thyroid takes up the radioactive iodine, which destroys the cells in the thyroid gland. The treatment reduces or eliminates the production of hormones, and may decrease the size of the goiter.

As with the surgery, you may need to take thyroid hormone replacement to maintain adequate levels of hormones.

Self-care

Your body is iodine of the food. The recommended daily dose is 150 micrograms. One teaspoon of iodized salt has about 250 micrograms of iodine.

Foods that contain iodine include:

  • Salt-water fish and seafood.
  • The marine algae.
  • Dairy products.
  • Soy products.

Most of the people in the united States to obtain a sufficient amount of iodine in a healthy diet. Also the amount of iodine in the diet, however, can cause thyroid dysfunction.

Preparing for your appointment

If you have been diagnosed with a goiter, it is likely that you will have additional tests to determine the cause. You may find it helpful to make a list of questions to ask your health care provider, such as:

  • What caused this goiter develop?
  • Is serious?
  • What can you do to treat the underlying cause?
  • I have other health conditions. How can I best manage them together?
  • What are the alternatives to the main treatment you propose?
  • What would happen if I decide not to do anything?
  • Is the goiter continue to grow?
  • How often should I have follow-up appointments?
  • It will be the treatment you are suggesting to improve the appearance of the goiter?
  • I'm going to have to take medication? For how long?
Symptoms and treatment of Goiter