What is Goiter?

The term goiter, which comes from the Latin word guttur meaning throat, is used to refer to a variety of conditions. In fact, goiter simply refers to an enlargement of the thyroid gland. This enlargement can be a small, localized swelling, or a more generalized swelling of both lobes.

 

The enlarged thyroid gland may secrete hormones in normal, subnormal, or excessive amounts. In rare cases, the growth can wrap around the trachea, causing it to narrow. This growth can make swallowing difficult. Surprisingly, goiters usually do not cause much discomfort. In most cases, the discomfort is due to emotional tension, where a person feels a sense of pressure or swelling in the throat.

 

In the past, the most common cause of goiter was dietary iodine deficiency in areas where the soil was deficient in iodine. Since the introduction of iodized salt, goiter has become much less common, and our diet is now such that even if a person does not use iodized salt, they are unlikely to be deficient in iodine. Although deficiencies are not uncommon elsewhere in the world, in the United States, iodine supplementation is unnecessary and therefore undesirable.

 

Simple Goiter

 

The characteristic of simple goiter is a soft and widespread enlargement of the thyroid gland. The most common periods are pregnancy and puberty. If the simple goiter is large enough to cause an aesthetic problem, thyroid hormone can be given to reduce it.

 

Graves' Disease

 

Graves' disease usually causes mild but generalized swelling of the thyroid gland. This is the result of overstimulation of the thyroid gland. Sometimes the gland itself may become enlarged.

 

Adenoma Goiter

 

Adenomas are more or less normal growths of thyroid tissue that separate themselves from the rest of the gland like a wall. In rare cases, one or more adenomas produce excessive amounts of thyroid hormone, resulting in hyperthyroidism. In rare cases, an adenoma may partially block the trachea, causing difficulty breathing that superficially resembles asthma.

 

Thyroid Cancer

 

Most thyroid cancers are slow-growing. They tend to be somewhat more common in people who have had radiation therapy to the neck. The most common types are papillary and follicular. The papillary type tends to spread (spread) to the lymph nodes in the neck. The follicular type can spread to the lungs and more distant parts of the body.

 

When thyroid cancer develops, it initially appears as a small swelling in the thyroid gland and may not be easily distinguishable from an adenoma.

 

Tissue is taken from a lump suspected of being cancerous with a needle and examined under a microscope. This test does not always provide a definitive answer as to whether the lump is cancerous or not, but the result is sufficient to guide surgical removal of the lump.

 

If the swelling is found to be malignant during surgery (the pathologist can tell the surgeon within minutes whether the removed swelling is malignant), the surgeon will remove most of the thyroid gland. Under certain circumstances, radioactive iodine may be given after surgery to support surgical treatment. It is also thought that giving thyroid hormone as a drug may delay the growth of remaining cancer cells.

 

Medullary Carcinoma of the Thyroid Gland

 

This is a rare form of thyroid cancer. The cells of this cancer secrete a hormone called Calcitonin, and the progression of the cancer can be monitored by measuring the concentration of Calcitonin in the blood. Medullary carcinoma often occurs in members of the same family, and the person affected may also have pheochroma cytoma.

 

Lymphocytic Thyroiditis

 

This type of goiter is sometimes called Hashimoto's disease, named after the Japanese pathologist who described the disease. In this condition, an abnormal antibody causes the thyroid to lose its normal function. This effect leads to hypothyroidism. The gland is usually moderately enlarged and has a very elastic rubbery texture.

 

Thyroid hormone treatment usually causes the gland to shrink so much that surgery is not necessary. This is the most common of all thyroid disorders. A blood test to detect antibodies will help diagnose it, and a thyroid needle biopsy will usually confirm it.

 

Subacute Thyroiditis

 

This is a rare condition that causes thyroid pain that worsens with swallowing. The thyroid gland is slightly enlarged and very sensitive. A special test called a sedimentation rate test may be done. In subacute thyroiditis, the sedimentation rate may be very high and thyroid hormone levels may be low or high.

 

The thyroid usually returns to normal within a few months. Aspirin often improves symptoms, but your doctor may prescribe corticothyroid medications if symptoms become more severe.