Goiter : types and risk factors

A goiter is an abnormal enlargement of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck just below your Adam’s apple. Although goiters are usually painless, a large goiter can cause a cough and make it difficult for you to swallow or breathe.

 

Goiters have many causes. As a result, there are different types. These include:

  • Simple Goiter : Simple goiters develop when the thyroid gland does not make enough hormones to meet the body’s needs. The thyroid gland tries to make up for this shortage by growing larger.
  • Colloid Goiter (Endemic): A colloid goiter develops from the lack of iodine, a mineral essential to the production of thyroid hormones. People who get this type of goiter usually live in areas where iodine is scarce.
  • Nontoxic (Sporadic): The cause of a nontoxic goiter is usually unknown, though it may be caused by medications like lithium. Lithium is used to treat mood disorders such as a bipolar disorder. Nontoxic goiters don’t affect the production of thyroid hormone, and thyroid function is healthy. They are also benign
  • Nodular or Multi-nodular Goiter: This type of goiter forms one or more small nodules as it enlarges. The nodules produce their own thyroid hormone, causing hyperthyroidism. It generally forms as an extension of a simple goiter.

Causes and Risk Factors 

Goiters have different causes, depending on the particular  type. Goiters can affect anyone. They may be present at birth and occur at any time throughout life. Some common risk factors for goiters include:

  • A lack of dietary iodine. People living in areas where iodine is in short supply and who don’t have access to iodine supplements are at high risk of goiters.
  • Being female.  Women are more prone to thyroid disorders, they’re also more likely to develop goiters.
  • Your age. Goiters are more common after age 40.
  • Medical history. A personal or family history of autoimmune disease increases your risk.
  • Certain medications. Some medical treatments, including the heart drug amiodarone (Cordarone, Pacerone, others) and the psychiatric drug lithium (Lithobid, others), increase your risk.
  • Pregnancy and menopause. For reasons that aren’t entirely clear, thyroid problems are more likely to occur during pregnancy and menopause.

Other diseases and conditions can also cause a goiter. These include:

  • Graves’ disease : This is an autoimmune disease (your body’s immune system mistakenly attacks your healthy body). In this case, the immune system attacks the thyroid gland and the thyroid grows larger.
  • Hashimoto’s disease : This is another autoimmune disease. In this case, the disease causes inflammation (swelling) of the thyroid gland. This causes it to produce fewer thyroid hormones, resulting in a goiter. This type of goiter usually gets better on its own over time.
  • Nodular goiter : In this condition, growths called nodules occur on one or both sides of the thyroid gland, causing it to grow larger.
  • Thyroid cancer : Cancer of the thyroid gland often enlarges the thyroid.
  • Human chorionic gonadotropin : This is a hormone that a woman produces during pregnancy. It can cause the thyroid to grow.
  • Inflammation of the thyroid gland itself can cause the thyroid gland to grow. This can happen after the person has an illness caused by a virus, or after a woman gives birth.
  • Exposure to radiation : A person who has had medical radiation treatments to the head and neck (but not diagnostic procedures, such as a CT scan) has a greater risk of developing goiter.

Symptoms

A goiter is most often spotted because it’s in the very front of the neck and moves up and down when a person swallows. People with a goiter might have the sensation that food is stuck in the throat, especially when they lie down or sleep on their backs.

But goiters often grow very slowly over months and years before being noticed. It can be hard even for parents who pay close attention to notice the change early.

In more severe cases, symptoms may include:

  • Coughing.
  • A tight feeling in your throat.
  • Changes to your voice, such as hoarseness.
  • Difficulty swallowing (dysphagia).
  • Difficulty breathing – there may be a high-pitched sound when you breathe.

Diagnosis

Several tests can be used to diagnose and evaluate goiter, including the following:

  • Physical exam : Your doctor may be able to tell if the thyroid gland has grown by feeling the neck area for nodules and signs of tenderness.
  • Hormone test : Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is under active, the level of thyroid hormone will be low. At the same time, the level of thyroid-stimulating hormone (TSH) will be elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone.
  • Antibody test : This blood test looks for certain antibodies that are produced in some forms of goiter. An antibody is a protein made by white blood cells. Antibodies help defend against invaders (for example, viruses) that cause disease or infection in the body.
  • Ultrasound of the thyroid : Ultrasound is a procedure that sends high-frequency sound waves through body tissues. The echoes are recorded and transformed into video or photos. Ultrasound of the thyroid reveals the gland’s size and finds nodules.
  • Thyroid scan : This imaging test provides information on the size and function of the gland. In this test, a small amount of radioactive material is injected into a vein to produce an image of the thyroid on a computer screen. This test is not ordered very often, since it is only useful in certain circumstances.
  • A biopsy : During a fine-needle aspiration biopsy, ultrasound is used to guide a needle into your thyroid to obtain a tissue or fluid sample for testing.
  • CT scan or MRI (magnetic resonance imaging) of the thyroid : If the goiter is very large or spreads into the chest, a CT scan or MRI is used to measure the size and spread of the goiter.

Treatment

Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. Your doctor may recommend the following after diagnosing goiter.

  • If your goiter is small and doesn’t cause problems, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.
  • If you have hypothyroidism, thyroid hormone replacement with levothyroxine (Levoxyl, Synthroid, Tirosint) will resolve the symptoms of hypothyroidism as well as slow the release of thyroid-stimulating hormone from your pituitary gland, often decreasing the size of the goiter. For inflammation of your thyroid gland, your doctor may suggest aspirin or a corticosteroid medication to treat the inflammation. For goiters associated with hyperthyroidism, you may need medications to normalize hormone levels.
  • Radioactive iodine treatment. This treatment, used in cases of an overactive thyroid gland, involves taking radioactive iodine orally. The iodine goes to the thyroid gland and kills thyroid cells, which shrinks the gland. After radioactive iodine treatment, the patient usually has to take thyroid hormone replacement therapy for the rest of his or her life.
  • A biopsy is the removal of a sample of tissue or cells to be studied in a laboratory. A biopsy may be needed if there are large nodules in the thyroid gland. A biopsy is taken to rule out cancer.
  • Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have a nodular goiter causing hyperthyroidism. Surgery is also the treatment for thyroid cancer.

 

 

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