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GOITER

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Goiter is an enlargement of the thyroid gland that causes the neck to swell resulting in its increase in size.

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Paul Bass
5th year medical student
University of the Gambia

UTG Medical Students’ Association

It is one of the commonest thyroid disorders. It does not always mean that the thyroid is functioning abnormally. In some cases, however, it can be the sign of an underlying thyroid disease that requires treatment.

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Goiters are often harmless and may go away after a short time without treatment. People usually do not need treatment unless it is large and causes troubling symptoms.

Doctors can tell whether you have goiter through a physical examination. They may also request blood test or scans to find out the cause of the goiter.

In this article, we will have an overview on goiters, including their symptoms, causes, treatments, and types.

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What are goiters

A goiter is an enlarged thyroid gland.

The thyroid is a butterfly shaped gland located in front of the trachea or windpipe. It is responsible for producing and secreting hormones that control growth and metabolism.

Most cases of a goiter are classified as “simple” goiters. These do not involve inflammation or any compromise to thyroid function, produce no symptoms, and often have no known cause.

Some people experience a small increase in the size of the thyroid gland. Others can have considerable swelling that constricts the trachea and causes breathing problems.

An enlarged thyroid does not necessarily mean that the thyroid gland is working incorrectly. A person with a goiter may have a thyroid gland that is:

o          creating too much hormone, known as hyperthyroidism

o          creating too little hormone, known as hypothyroidism

o          creating the normal amount of hormone, known as euthyroidism

Goiters are more common in females than males, especially after menopause. Goiters and thyroid disease are normally more common after the age of 40.

Symptoms

In most cases, the only symptom of a goiter is a swelling in the neck. It may be large enough to touch and feel with the hand.

The level of swelling and the gravity of symptoms produced by the goiter largely depend on the individual.

If other symptoms are present, these are usually the most common:

o          throat tightness, cough, and hoarseness

o          difficulty swallowing

o          in severe cases, trouble breathing

Other symptoms may be noticed because of the underlying cause of the goiter.

Hyperthyroidism, a thyroid that is producing and secreting more hormone than normal, can cause symptoms such as:

o          palpitations

o          nervousness

o          hyperactivity

o          weight loss

o          heat hypersensitivity

o          hair loss

o          increased appetite

o          fatigue

o          increased sweating

Hypothyroidism, a thyroid that is producing and secreting less hormone than the required amount, can cause symptoms such as:

o          an intolerance to the cold

o          hair loss

o          personality changes

o          constipation

o          hair loss

o          forgetfulness

Causes

There are a several causes of a goiter, and they include the following:

1.         Iodine Deficiency

The most common cause of goiters in many parts of the developing world is a lack of iodine in the diet. The thyroid needs iodine to create thyroid hormones, which regulate metabolism. A lack of iodine is uncommon in certain countries because producers add iodine to salt and other foods.

Because iodine is less in plants, vegetarian diets may lack enough iodine. This is however not a big  problem for vegans in countries where food industries add iodine to salt and foods.

Foods that contain iodine includes:

o          cow’s milk

o          plant foods grown in iodine-rich soil

o          seafoods

In some parts of the world, the incidence of goiters can be very high. This includes but not limited to remote mountainous areas of Southeast Asia, Latin America, and central Africa.

2.         Hypothyroidism

Hypothyroidism is the result of an underactive (a thyroid that is producing less than the normal amount of hormone required by the body) thyroid gland. When the gland produces too little thyroid hormone, it is stimulated to produce more, which leads to swelling.

This usually results from a condition in which the body’s immune system attacks its own tissue and causes inflammation of the thyroid gland.

3.         Hyperthyroidism

Hyperthyroidism, or a thyroid gland that is over active, is another cause of goiters. In people with this condition, the thyroid produces too much thyroid hormone.

This usually happens as a result of graves’s disease, an autoimmune abnormality where the body’s own immunity turns on itself and attacks the thyroid gland, causing the swelling.

Other causes

Less common causes of goiters include the following:

o          Smoking: certain substances in tobacco smoke interferes with iodine absorption and can cause enlargement of the thyroid gland.

o          Hormonal changes: pregnancy, puberty, and menopause can interfere with thyroid function.

o          Thyroiditis: inflammation caused by infection, for example, can lead to goiter.

o          Lithium: this drug that is use in the treatment of psychiatric conditions can interfere with thyroid function.

o          Too much iodine: this can trigger a swollen thyroid.

o          Radiotherapy: this also can trigger a swollen thyroid, particularly when administered to the neck.

o          Thyroid cancer: This is mostly common in females.

People above the age of 40 have an increased risk of developing goiters, just like people with a family history of the condition.

Do goiters go away on their own?

A simple goiter may happen for only a short time and may regress on its own without any form of treatment.

Also, many goiters, such as multinodular goiter, are associated with normal levels of thyroid hormone.

These goiters usually don’t require any special treatment after your healthcare provider has diagnosed it; but you may be at risk of developing hypothyroidism or hyperthyroidism in the future.

Once you noticed that your thyroid gland has increased in size, it is very important to see your healthcare provider since goiters have many possible causes — most of which require treatment.

Prevention of goiters

A goiter resulting from iodine deficiency (simple goiter) is actually the only type of goiter that is preventable.

Consuming a diet that includes seafoods, dairy and a healthy amount of salt that contain iodine prevents these types of goiters.

Iodine supplements and other supplements are usually not required

and may do more harm than good.

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