Goitre

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Goitre
Synonyms	Struma, thyromegaly
Pronounce	N/A
Specialty	N/A
Symptoms	Neck swelling, cough, difficulty swallowing, difficulty breathing
Complications	Hypothyroidism, hyperthyroidism, thyroid cancer
Onset	Any age
Duration	Variable
Types	N/A
Causes	Iodine deficiency, Graves' disease, Hashimoto's thyroiditis, thyroid nodules
Risks	Female, age, family history, radiation exposure
Diagnosis	Physical examination, ultrasound, thyroid function tests, fine needle aspiration biopsy
Differential diagnosis	Thyroiditis, thyroid cancer, thyroid cyst
Prevention	Adequate iodine intake
Treatment	Iodine supplementation, thyroid hormone replacement, radioactive iodine, surgery
Medication	N/A
Prognosis	Generally good with treatment
Frequency	Common in areas with iodine deficiency
Deaths	N/A

A goitre is a medical condition that presents as an abnormal enlargement of the thyroid gland, which is located in the neck. This swelling is commonly caused by an iodine deficiency, although other factors can contribute to its development.

Thyroid adenoma

Histopathology of colloid goiter

Causes

Iodine Deficiency

The primary cause of goitre worldwide is iodine deficiency. Iodine is a critical element needed by the thyroid gland to produce thyroid hormones (thyroxine (T4) and triiodothyronine (T3)) which regulate the body's metabolic rate. When the intake of iodine is inadequate, the thyroid gland enlarges in an attempt to compensate for the shortage and maintain production of these hormones.

Other Causes

Although iodine deficiency is the most common cause, there are numerous other potential causes of goitre, such as:

• Hashimoto's thyroiditis
• Graves' disease
• Thyroid cancer
• Thyroiditis
• Pregnancy

Certain medications like lithium and amiodarone

Symptoms and Complications

In many cases, a goitre may not cause noticeable symptoms. However, when symptoms do occur, they can include:

• Visible swelling at the base of your neck
• Tightness in the throat
• Hoarseness
• Difficulty swallowing
• Difficulty breathing
• In severe cases, goitres can interfere with breathing and swallowing. If left untreated, iodine-deficiency goitres can lead to cretinism in children and myxedema in adults.

Diagnosis

Goitres are often detected during a physical examination. Diagnostic tests can help confirm the presence of a goitre and determine its cause. These tests may include:

• Thyroid function test
• Antibody test
• Ultrasound of the thyroid
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Thyroid scan
• Fine-needle aspiration biopsy

Treatment

The treatment of goitre largely depends on the underlying cause, size of the goitre, and presence of symptoms. Treatment may involve: Monitoring: For small goitres that aren't causing physical or cosmetic problems, doctors may suggest a wait-and-see approach. Medication: Levothyroxine, a hormone replacement therapy, may be given to shrink the goitre. Surgery: Large goitres or those causing symptoms may require surgical removal (thyroidectomy). Radioactive iodine: This treatment, often used in Graves' disease, shrinks the thyroid gland.

Prevention

Iodine deficiency, the primary cause of goitre, can be prevented through the use of iodized salt or dietary supplements. In regions where iodine deficiency is prevalent, public health measures may be taken to add iodine to the water or food supply.

References

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See Also

• Thyroid
• Hypothyroidism
• Hyperthyroidism
• Thyroid nodules

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