), or goiter
) (Latin struma
), also called a bronchocele
, is a swelling in the neck (just below the Adam's apple
) due to an enlarged thyroid gland
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 goitre" refers to goitre with hyperthyroidism. These most commonly due to Graves' disease, but can be caused by inflammation or a multinodular goitre.
- "Nontoxic goitre" (associated with normal or low thyroid levels) refers to all other types (such as that caused by lithium or certain other autoimmune 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.
The most common cause for goitre is iodine deficiency
. Other causes are:
Iodine is necessary for the synthesis of the thyroid hormones thyroxine
) and triiodothyronine
). In endemic goitre, iodine deficiency leaves the thyroid gland unable to produce its hormones because the hormones are made out of iodine. When levels of thyroid hormones fall, thyrotropin-releasing hormone (TRH
) is produced by the hypothalamus. TRH then prompts the pituitary gland to make thyrotropin or thyroid stimulating hormone (TSH
), which stimulates the thyroid gland’s production of T4
. It also causes the thyroid gland to grow in size by increasing cell division.
Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.
Treatment may not be necessary if the goitre is small. Goitre may be related to hyper
- and hypothyroidism
(especially Graves' disease) and may be reversed by treatment of hyper- and hypothyroidism. Grave's disease can be corrected with antithyroid drugs (such as propylthiouracil
(surgical removal of the thyroid gland), and iodine-131
I - 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, levothyroxine may increase the risk of osteoporosis.
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 goitre is and how much of the thyroid gland must be removed or destroyed, thyroidectomy or 131 may produce hypothyroidism requiring life-long treatment.
The symptoms of goiter/goitre are mainly the swelling of the front part of the neck and protruding eyes.
History and future
physicians of the Tang Dynasty
(618–907) were the first to successfully treat patients with goiter by using the iodine-rich thyroid gland of animals such as sheep and pigs—in raw, pill, or powdered-mixture-in-wine form. This was outlined in Zhen Quan's (died 643 AD) book, as well as several others. One Chinese book (i.e. The Pharmacopoeia of the Heavenly Husbandman
) asserted that iodine-rich sargassum
was used to treat goiter patients by the 1st century BC, but this book was written much later.
In the 12th century, al-Jurjani, a Persian physician, provided the first description of Graves' disease after noting the association of goitre and exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical dictionary of its time. Al-Jurjani also established an association between goitre and palpitation. The disease was later named after Irish doctor Robert James Graves, who described a case of goiter with exophthalmos in 1835. The German Karl Adolph von Basedow also independently reported the same constellation of symptoms in 1840, while earlier reports of the disease were also published by the Italians Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively, and by the English physician Caleb Hillier Parry (a friend of Edward Jenner) in the late 18th century.
Paracelsus (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water. Iodine was later discovered by Bernard Courtois in 1811 from seaweed ash.
Goitre was previously common in many areas that were deficient in iodine in the soil. For example, in the English Midlands, the condition was known as Derbyshire Neck. In the United States, goitre was found in the Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in India, Central Asia and Central Africa.
Some health workers fear that a resurgence of goitre might occur because of the trend to use rock salt and/or sea salt, which has not been fortified with iodine. New research indicates that there may in fact be a tendency to inherit an increased vulnerability to goitre.
Famous goitre sufferers