Explore the world of goiter with Meri Sehat. Learn about its causes, symptoms, and effective solutions for a healthy thyroid.

Goiter

Overview

Goiter is an abnormal enlargement of the thyroid gland. 
&nbsp;

Goiters are fairly common. One of the major causes of goiter is iodine deficiency. Nearly 2.2 billion people globally have iodine deficiency.<a href="#accordion">[12]</a>

According to a study, despite efforts to combat iodine deficiency through iodization programs, the prevalence of goiter remains significant in many regions of India.<a href="#accordion">[6]</a>&nbsp;In Pakistan, too, several studies reported a high prevalence of goiter and iodine deficiency, with some studies reporting prevalence rates of 50% or higher.<a href="#accordion">[8]</a>

In Ethiopia, the prevalence of goiter varies across regions, with the results showing that at least 2 in 5 school-going children had the condition<a href="#accordion">[8]</a>. Evidently, goiter is more common among females than males.<a href="#accordion">[9]</a> 
&nbsp;

The thyroid is a small, butterfly-shaped gland located in the neck. It is responsible for the production of T3 and T4 hormones used in metabolism, mood and excitability, and body temperature and heart rate. 
&nbsp;

Goiter is categorized into the following types depending on how it grows:<a href="#accordion">[12]</a>

<ul>
	<li>Diffuse Or Simple Goiter &ndash; The entire thyroid gland swells up; smooth to touch</li>
	<li>Nodular Goiter &ndash; A fluid-filled or solid lump (called nodule) develops in the thyroid; lumpy to touch</li>
	<li>Multinodular Goiter &ndash; Multiple lumps or nodules within the thyroid; visible only through physical examination or scans</li>
	<li>Retrosternal Goiter-&nbsp;&nbsp;Goiter grows behind the breastbone 
	&nbsp;</li>
</ul>

The classification is also based on whether the patient&rsquo;s thyroid hormone levels are normal or not:<a href="#accordion">[12]</a>

<ul>
	<li>Toxic Goiter &ndash; The thyroid is enlarged and produces too much thyroid</li>
	<li>Nontoxic Goiter &ndash; The thyroid is enlarged but hormone levels are normal 
	&nbsp;</li>
</ul>

Other categories may include:

<ul>
	<li>Endemic Or Colloid Goiter &ndash; People who live in areas where iodine is scarce 
	&nbsp;</li>
</ul>

Sign and Symptoms

The signs and symptoms of goiter can vary depending on the size and underlying cause of the enlargement.

<ul>
	<li>Visible Swelling In The Neck: The most noticeable sign of goiter is a visible swelling or lump in the front of the neck, just under the Adam&rsquo;s apple.</li>
	<li>Hoarseness: Pressure on the vocal cords may produce a scratchy voice.</li>
	<li>Neck Pain Or Discomfort: The majority of goiters are painless, but the individual can experience a feeling of tightness in the throat and swelling of the neck vein. 
	&nbsp;</li>
</ul>

Other symptoms may include coughing, <a href="https://merisehat.pk/disease/dizziness">dizziness </a>when raising arms above the head, difficulty swallowing, shortness of breath, and snoring. 
&nbsp;

Causes

These include: 
&nbsp;

<ul>
	<li>
	<h5>Iodine Deficiency</h5>
	</li>
</ul>

Iodine is an essential nutrient that is required for the production of thyroid hormones. When the body lacks sufficient iodine, the thyroid gland enlarges in an attempt to produce more hormones.

<ul>
	<li>
	<h5>Autoimmune Diseases</h5>
	</li>
</ul>

Autoimmune diseases, such as Hashimoto&#39;s thyroiditis and Graves&#39; disease, are the most common causes of non endemic goiter.

In Hashimoto&#39;s thyroiditis, the immune system mistakenly attacks the thyroid gland, leading to inflammation and enlargement. Whereas, in Graves&#39; disease, the immune system produces antibodies that stimulate the thyroid gland to produce excessive amounts of hormones, resulting in goiter.<a href="#accordion">[1]</a> 
&nbsp;

<ul>
	<li>
	<h5>Thyroid Nodules</h5>
	</li>
</ul>

Thyroid nodules, which are abnormal growths within the thyroid gland, can also cause goiter. These nodules can be either benign or malignant. Benign nodules are more common and usually do not cause any symptoms. However, nearly 5% of people with thyroid nodules have cancer, which is usually treatable.<a href="#accordion">[13]</a>

<ul>
	<li>
	<h5>Inflammation</h5>
	</li>
</ul>

Inflammation of the thyroid gland, known as thyroiditis, can lead to swelling and enlargement of the thyroid gland. 
&nbsp;

Diagnosis

Screening and diagnosis for goiter typically involve the assessment of the size and function of the thyroid gland to determine the underlying cause and assess the extent of the enlargement.

&nbsp;

<ul>
	<li>Medical History And Physical Examination: A healthcare provider will take a detailed medical history and may examine the neck to assess for the presence of a goiter. 
	They will ask about any family history of thyroid disorders, exposure to radiation, and use of medications that can cause goiter. They will also palpate the thyroid gland to feel for any enlargement or nodules. Further, they may ask the individual to swallow to observe any visible swelling or movement of the thyroid gland.<a href="#accordion">[5]</a> 
	&nbsp;</li>
	<li>Thyroid Function Tests: Thyroid function tests measure the levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH) in the blood. Abnormal levels of these hormones can indicate an underlying thyroid disorder, including goiter. 
	&nbsp;</li>
	<li>Antibody Test: Depending on the results of the thyroid function test, the healthcare provider may order a blood test to detect an antibody linked to an autoimmune disorder. 
	&nbsp;</li>
	<li>Imaging Tests: An ultrasound can provide detailed images of the thyroid gland. It can help determine the size and structure of the gland, as well as identify any nodules or abnormalities. 
	Other imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), may be used in certain cases to further evaluate the goiter. 
	In rare instances, doctors may order a thyroid uptake and scan test, which requires a small amount of radioactive material to be injected into the patient&rsquo;s vein. 
	&nbsp;</li>
	<li>Fine-Needle Aspiration Biopsy: If large nodules are detected within the goiter, a fine-needle aspiration biopsy may be performed. During this procedure, a thin needle is inserted into the nodule to collect a sample of cells, which are then examined under a microscope to determine whether they are benign or malignant. 
	&nbsp;</li>
</ul>

Treatment

The treatment of goiter depends on the underlying cause, the size of the goiter, and the presence of any symptoms.

<ul>
	<li>Watchful Waiting: In cases where the goiter is small and not causing any symptoms, a healthcare provider may advise regular monitoring without any specific treatment. 
	&nbsp;</li>
	<li>Medications: In cases of an overactive thyroid (hyperthyroidism), medications such as propylthiouracil and methimazole may be prescribed to regulate thyroid hormone production. 
	Alternatively, in the case of hypothyroidism, thyroid hormone replacement therapy like levothyroxine may be prescribed, while corticosteroids or aspirins are the preferred option to treat goiter caused by inflammation.<a href="#accordion">[12]</a> 
	&nbsp;</li>
	<li>Radioactive Iodine Therapy: This involves the oral administration of radioactive iodine, which destroys the overactive thyroid cells. One aspect of this treatment is that the patient will probably be required to take thyroid hormone replacement therapy for life. 
	&nbsp;</li>
	<li>Surgery: Surgical removal of all or parts of the thyroid gland, called total or partial thyroidectomy, may be recommended in certain cases. Surgery is typically considered when the goiter is large, malignant, causing significant symptoms, and when other forms of treatment are ineffective or not practical. The extent of the surgery will depend on the size and characteristics of the goiter.<a href="#accordion">[5]</a> 
	&nbsp;</li>
</ul>

Goiter can lead to several complications, which can be life-threatening and require immediate medical treatment.

<ul>
	<li>Difficulty Breathing: A large goiter can cause compression of the trachea, leading to tracheomalacia and asphyxiation. 
	&nbsp;</li>
	<li>Intra-Nodular Hemorrhage: It can also cause damage to and rupture blood vessels in the thyroid nodules. Consequently, blood may accumulate inside the thyroid. 
	&nbsp;</li>
	<li>Thyroid Dysfunction: Goiter is associated with both<a href="https://merisehat.pk/disease/hyperthyroidism"> hyperthyroidism</a> (overactive thyroid) and hypothyroidism (underactive thyroid). These conditions can cause a range of symptoms, including unexplained weight changes, fatigue, and abnormal menstruation, and require ongoing management. 
	&nbsp;</li>
	<li>Cancer: While most goiters are benign, a patient with autoimmune goiters may develop lymphoma, whereas multinodular goiter may become malignant. 
	&nbsp;</li>
	<li>Psychological Impact: Living with a visible goiter or managing the symptoms of thyroid dysfunction can have a psychological impact on individuals, leading to feelings of self-consciousness, anxiety, or<a href="https://merisehat.pk/disease/depression"> depression</a>. 
	&nbsp;</li>
</ul>

Several risk factors can increase the likelihood of developing goiter:<a href="#accordion">[13]</a> 
&nbsp;

<ul>
	<li>Lifestyle: Inadequate intake of iodine through diet and cigarette smoking are significant risk factors for goiter.</li>
	<li>Age: Goiter can occur at any age, but it is more common in individuals aged 40 or above.</li>
	<li>Gender: Women are more likely to develop goiter, particularly during pregnancy or menopause.</li>
	<li>Family History: Having a family history of thyroid disorders, including goiter, can increase the risk of developing the condition.</li>
	<li>Personal History: A person who is obese or has metabolic syndrome or insulin resistance may be more likely to develop goiter.</li>
	<li>Radiation Exposure: Exposure to high levels of radiation, either through medical treatments or environmental factors, can increase the risk of goiter. This is particularly relevant in individuals who have undergone radiation therapy to the neck or chest.</li>
	<li>Medications: Certain drugs, such as lithium and amiodarone, can increase the risk of goiter. 
	&nbsp;</li>
</ul>

Avoid goitrogenic foods, such as cabbage, broccoli, and soy, which can interfere with thyroid function. It is also important to ensure an adequate intake of iodine through diet, which is why dairy, fish, and a healthy amount of iodized table salt are recommended to prevent goiter.

The recommended daily intake (RDI) of iodine is:<a href="#accordion">[14]</a>

<ul>
	<li>Children (2-5 years) &ndash; 90 &micro;g/day</li>
	<li>Children (6-9 years) &ndash; 120 &micro;g/day</li>
	<li>Adolescents And Adults &ndash; 150 &micro;g/day</li>
	<li>Pregnant Women &ndash; 250 &micro;g/day</li>
	<li>Lactating Women &ndash; 290-300 &micro;g/day 
	&nbsp;</li>
</ul>

Moreover, regular medical check-ups can help detect goiter at an early stage and monitor its progression. Individuals with a family history of thyroid disorders or other risk factors may benefit from more frequent screenings.

Similarly, treating underlying thyroid disorders, such as Hashimoto&#39;s thyroiditis or Graves&#39; disease, can help prevent the development or progression of goiter. 
&nbsp;

Key Points

<ul>
	<li>Goiter is an abnormal enlargement of the thyroid gland.</li>
	<li>It can be classified as diffuse or nodular and toxic or nontoxic, depending on the pattern of enlargement and thyroid hormone levels.</li>
	<li>Common signs and symptoms include visible swelling in the neck, difficulty swallowing or breathing, hoarseness, and neck pain.</li>
	<li>The most common causes of goiter are iodine deficiency and autoimmune diseases.</li>
	<li>Screening and diagnosis for goiter involve physical examination, thyroid function tests, and imaging tests.</li>
	<li>Treatment options include watchful waiting, medications, radioactive iodine therapy, and surgery.</li>
	<li>Complications of goiter can include difficulty breathing, intra-nodular hemorrhage, and psychological impact.</li>
	<li>Risk factors for goiter include age and gender, family history, radiation exposure, and certain medications.</li>
	<li>Preventive measures include adequate intake of iodine, avoidance of goitrogenic foods, regular medical check-ups, and prompt treatment of underlying thyroid disorders.</li>
</ul>

[1] Iddah, M. and Macharia, B. (2013). Autoimmune thyroid disorders. Isrn Endocrinology

[2] Ferrari, S., Ragusa, F., Elia, G., Paparo, S., Mazzi, V., Baldini, E., … & Fallahi, P. (2021). Precision medicine in autoimmune thyroiditis and hypothyroidism. Frontiers in Pharmacology,

[3] Abera, B., Abera, M., Berhe, G., Abreha, G., Gebru, H., Abraha, H., … & Ebrahim, M. (2021). Thyrotoxicosis and dilated cardiomyopathy in developing countries. BMC Endocrine Disorders,

[4] Aghajanzadeh, M., Asgary, M., Mohammadi, F., Darvishi, H., & Safarpour, Y. (2018). An investigation into symptoms, diagnosis, treatment, and treatment complications in patients with retrosternal goiter. Journal of Family Medicine and Primary Care, 7(1), 224.

[5] Altaf, S., Mehmood, Z., Baloch, M., & Javed, A. (2019). Experience of thyroid surgery at a tertiary care hospital in karachi, pakistan. Open Journal of Thyroid Research, 2(1), 005-008.

[6] Unnikrishnan, A. and Menon, U. (2011). Thyroid disorders in india: an epidemiological perspective. Indian Journal of Endocrinology and Metabolism, 15(6), 78.

[7] Khattak, R., Khattak, M., Ittermann, T., & Völzke, H. (2017). Factors affecting sustainable iodine deficiency elimination in pakistan: a global perspective. Journal of Epidemiology, 27(6), 249-257.

[8] Tekalegn, Y., Bekele, K., Sahiledengle, B., & Woldeyohannes, D. (2021). Prevalence of goiter among school-aged children in ethiopia: update of systematic review and meta-analysis. Global Advances in Health and Medicine, 10, 216495612098866.

[9] Dessie, G., Amare, D., Dagnew, A., Mulugeta, H., Kassa, D., Negesse, A., … & Burrowes, S. (2019). Prevalence of goiter among children in ethiopia and associated factors: a systematic review and meta-analysis. BMC Public Health, 19(1).

[10] Gupta, P., Srivastava, J., Zaidi, Z. H., & Srivastava, M. R. (2015). A study to assess the iodine deficiency disorder and salt consumption pattern in lucknow. International Journal of Community Medicine and Public Health, 2(1), 29.

[11] Gupta, P., Raizada, N., Giri, S. K., Sharma, A., Goyal, S., Jain, N., … & Madhu, S. V. (2020). Goiter prevalence and thyroid autoimmunity in school children of delhi. Indian Journal of Endocrinology and Metabolism, 24(2), 202.