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Goiter

GOITER:

A goitre (BrE), or goiter (AmE) (Latin gutteria, struma), also called a bronchocele, is a swelling in the thyroid gland,[1] which can lead to a swelling of the neck or larynx (voice box). Goitre usually occurs when the thyroid gland is not functioning properly.

Classification

They are classified in different ways:

  • A “diffuse goiter” is a goiter that has spread through all of the thyroid (and can be a “simple goitre”, or a “multinodular goitre”).
  • “Toxic goiter” refers to goiter with hyperthyroidism. These most commonly due to Graves’ disease, but can be caused by inflammation or a multinodular goiter.
  • “Nontoxic goiter” (associated with normal or low thyroid levels) refers to all other types (such as that caused by lithium or certain otherautoimmune diseases).

Other type of classification:

  • I – palpation struma – in normal posture of head it cannot be seen. Only found when palpating.
  • II – struma is palpative and can be easily seen.
  • III – struma is very big and is retrosternal. Pressure and compression marks.

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Causes

Worldwide, the most common cause for goiter is iodine deficiency. In countries that use iodized salt, Hashimoto’s thyroiditis becomes the most common cause.

Other causes are:

Hypothyroid

Hyperthyroid

Symptoms

In general, goiter unassociated with any hormonal abnormalities will not cause any symptoms aside from the presence of anterior neck mass. However, for particularly large masses, compression of the local structures may result in difficulty in breathing or swallowing. In those presenting with these symptoms, malignancy must be considered.

Meanwhile, toxic goiters will present with symptoms of thyrotoxicosis such as palpitations, hyperactivity, weight loss despite increased appetite, and heat intolerance.

Treatment

Treatment may not be necessary if the goiter is small. Goiter may be related to hyper– and hypothyroidism (especially Graves’ disease) and may be reversed by treatment. Graves’ disease can be corrected with antithyroid drugs (such as propylthiouracil and methimazole), thyroidectomy (surgical removal of the thyroid gland), and iodine-131 (131I – a radioactive isotope of iodine that is absorbed by the thyroid gland and destroys it). Hypothyroidism may raise the risk of goitre because it usually increases the production of TRH and TSH. Levothyroxine, used to treat hypothyroidism, can also be used in euthyroid patients for the treatment of goitre. Levothyroxine suppressive therapy decreases the production of TRH and TSH and may reduce goitre, thyroid nodules, and thyroid cancer. Blood tests are needed to ensure that TSH is still in range and the patient has not become subclinically hyperthyroid. If TSH levels are not carefully monitored, it is alleged that levothyroxine may increase the risk of osteoporosis but no peer reviewed studies on levothyroxine replacement of Hypothyroid patients causing this effect have actually been produced.

Thyroidectomy with 131I may be necessary in euthyroid goitrous patients who do not respond to levothyroxine treatment, especially if the patients have difficulty breathing or swallowing. 131I, with or without the pre-injection of synthetic TSH, can relieve obstruction and reduce the size of the goitre by thirty to sixty-five percent. Depending on how large the goiter is and how much of the thyroid gland must be removed or destroyed, thyroidectomy or 131 may produce hypothyroidism requiring life-long treatment and may eventually lead to death.

See also

Search Wikimedia Commons Wikimedia Commons has media related to: Goiters

References

  1. ^ goiter at Dorland’s Medical Dictionary
  2. ^ “Mortality and Burden of Disease Estimates for WHO Member States in 2002” (xls). World Health Organization. 2002.
  3. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Pages 133–134.
  4. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Page 134.
  5. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Pages 134–135
  6. ^ Basedow’s syndrome or disease at Who Named It? – the history and naming of the disease
  7. ^ Ljunggren JG (August 1983). “[Who was the man behind the syndrome: Ismail al-Jurjani, Testa, Flagani, Parry, Graves or Basedow? Use the term hyperthyreosis instead]”. Lakartidningen 80 (32-33): 2902. PMID 6355710.
  8. ^ Nabipour, I. (2003), “Clinical Endocrinology in the Islamic Civilization in Iran”, International Journal of Endocrinology and Metabolism 1: 43–45 [45]
  9. ^ Robert James Graves at Who Named It?

January 27, 2010 - Posted by | Blood, Cells, Thyroid

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