Goitre

A goitre or goiter (Latin gutteria, struma), is a swelling of the thyroid gland,[1] which can lead to a swelling of the neck or larynx (voice box). Goitre is a term that refers to an enlargement of the thyroid (thyromegaly) and can be associated with a thyroid gland that is functioning properly or not. Worldwide, over 90.54% cases of goitre are caused by iodine deficiency.[2]

Signs and symptoms

Goitre associated with hypothyroidism or hyperthyroidism may be present with symptoms of the underlying disorder. For hyperthyroidism, the most common symptoms are weight loss despite increased appetite, and heat intolerance. However, these symptoms are often nonspecific and hard to diagnose.

Morphology
Regarding morphology, goitres may be classified either as the growth pattern or as the size of the growth: Growth pattern

Size

Uninodular (struma uninodosa): can be either inactive or a toxic nodule Multinodular (struma nodosa): can likewise be inactive or toxic, the latter called toxic multinodular goitre Diffuse (struma diffuse): the whole thyroid appearing to be enlarged.

Class I (palpation struma): in normal posture of the head, it cannot be seen; it is only found by palpation. Class II: the struma is palpative and can be easily seen. Class III: the struma is very large and is retrosternal; pressure results in compression marks.

Struma nodosa (Class II)

Causes Worldwide, the most common cause for goitre is iodine deficiency, usually seen in countries that do not use iodized salt. Seleniumdeficiency is also considered a contributing factor. In countries that use iodized salt, Hashimoto's thyroiditis is the most common cause.[3]
Incidenc e and prevalen ce

Cause

Pathophysiolog y

Resultant thyroid activity

Growth pattern

Treatment

Progno sis Increased size of thyroid may be permanent if untreated for around five years

Iodine deficiency

Hyperplasia of thyroid to compensate for decreased efficacy

Can cause hypothyroidism

Diffuse

Iodine

Constitutes over 90% cases of goitre worldwide[2]

Inborn errors of Congenital thyroid hormone hypothyroidism synthesis Goitrogeningest ion Adverse drug reactions

Hypothyroidism

Hashimoto's thyroiditis

Autoimmune disease in which the thyroid gland is Hypothyroidism gradually destroyed. Infiltration of lymphocytes.

Diffuse Thyroid andlobulated hormone [4] replacement

Prevalence: Remission 1 to 1.5 in a with 1000 treatment

Hypersecretion of thyroid stimulating Pituitary disease hormone, almost always by a pituitary adenoma[5]

Diffuse

Pituitary surgery

Very rare[5]

Graves' diseasealso called Basedow syndrome

Autoantibodies (TS HR-Ab) that Hyperthyroidism activate theTSHreceptor (TSHR)

Diffuse

1 to 2 cases Antithyroid per 1,000 agents,radioiodi population ne, surgery per year

Remission with treatment, but still lower quality of life for 14 to 21 years after

Cause

Pathophysiolog y

Resultant thyroid activity

Growth pattern

Treatment

Incidenc e and prevalen ce

Progno sis treatment, with lower mood and lower vitality, regardless of the choice of treatment[6]

Thyroiditis

Can be Acute or hyperthyroidisminiti chronicinflammatio ally, but progress to n hypothyroidism Overall relative 5year survival rate of 85% for females and 74% for males[7] Mostly harmless

Thyroid cancer

Usually uninodular

Benign thyroid neoplasms Thyroid hormone insensitivity

Usually hyperthyroidism Secretional hyperthyroidism, Symptomatical hypothyroidism

Usually uninodular

Diffuse

Sarcoidosis amyloidosis hydatidiform mole cysts acromegaly

Epidemiology

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
Goitre is treated according to the cause. If the thyroid gland is producing too much T3 and T4, radioactive iodine is given to the patient to shrink the gland. If goitre is caused by iodinedeficiency, small doses of iodide in the form of Lugol's Iodine or KI solution are given. If the goitre is associated with an underactive thyroid, thyroid supplements are used as treatment. In extreme cases, a partial or complete thyroidectomy is required.[9]