Goitre

What is Goitre?

Goitre is a problem associated with the thyroid gland that causes abnormal swelling of the same. The thyroid is a small gland located in front of the windpipe and below Adam’s apple and is an important part of the endocrine system. It produces some hormones that are vital for regulating the process of metabolism and other chemical activities in the body. It also helps in the functioning of the brain, heart, digestive system, and muscles. The two main hormones secreted by the gland are thyroxine (T4) and tri-iodothyronine (T3). The thyroid is controlled by the pituitary gland which is located in the brain and produces the thyroid-stimulating hormone (TSH). A lack of iodine in the dirt prevents the thyroid from manufacturing the hormones even though the signals from the pituitary keep coming. This causes an enlargement of the gland as it tries to produce more quantity of hormones.

Goitre does not necessarily indicate that the thyroid gland is not working properly. The gland may very well produce the necessary quantity of hormones or too much or too little of them. The disease has various symptoms which include persistent cough, hoarseness, and tightness or swelling in the throat. In severe cases, there can be difficulty in swallowing and breathing. For some people, there are no external symbols and the disease can only be found out through a physical examination by a doctor. In most of the developed countries, the major cause of goitre is the lack of iodine in the diet. So the consumption of salt supplemented with iodine is considered as a step to relieve the symptoms of the disease. Autoimmune diseases are also a major cause behind goitre in developed countries. Goitre is not treated with medication in general unless there are specific symptoms that deserve treatment.

The main causes behind goitre

As stated earlier, one of the major causes behind goitre is iodine deficiency but this has been significantly resolved by various methods in the past few decades. To make the hormones, the gland needs to gather sufficient iodine from the blood. If the quantity available is not adequate, the gland grows in size to compensate for the thyroid production rate. Hashimoto’s thyroiditis is an autoimmune condition that makes the gland produce too little hormone. This is caused because the immune system attacks the gland and destroys the cells. In such a case, the pituitary gland senses a low thyroid hormone level in the blood, which is also called hypothyroidism and secretes more TSH to stimulate the thyroid. This stimulation causes the thyroid to grow in size. Graves’ disease is another autoimmune disease that causes one’s immune system to produce a protein, called thyroid-stimulating immunoglobulin (TSI). The TSI makes the gland enlarged and results in the over-production of the hormone, causing hyperthyroidism.

Some individuals have multiple nodes in the thyroid that causes multinodular goitres. These fluid-filled lumps enlarge the thyroid and the reason behind their generation is still not understood. In some cases, a single nodule can develop in the gland which may lead to thyroid cancer. In some cases, hormonal changes during pregnancy, puberty, and menopause can also lead to disorders of the thyroid. Smokers can suffer from goitre due to the presence of Thiocyanate in tobacco smoke which interferes with the iodine absorption in the body. Pain or swelling in the gland can also be caused by an inflammatory condition called Thyroiditis. Medications containing lithium used to treat certain mental health conditions can also cause an imbalance in the gland. When radiation therapy is done in the neck area, it can impact the overall performance of the thyroid gland.

The symptoms of goitre

The three conditions of a thyroid gland are hormone overproduction (hyperthyroidism), too little hormone production (hypothyroidism), and the correct amount of hormone production (euthyroidism). Goitre can occur in various forms and not all of them come with symptoms. Some of the most common symptoms that are observed in the disease are listed below.

• Swelling at the base of the neck can range from being a small lump to a large mass.
• A tight feeling or constriction in the throat
• Coughing
• Hoarseness
• Difficulty in swallowing when the goitre presses on the oesophagus.
• Difficulty in breathing when the goitre presses on the windpipe

The types of goitre

The disease can be classified by its effect on the population in two ways. When it affects an entire community due to iodine deficiency, it is called endemic goitre. This can be in regions where the soil is depleted of iodine. Sporadic goitre is the case when only an individual is affected. On the basis of the nature of the disease, goitre can again be divided into two types. In general, endemic goitres are sub-classified into four different categories mentioned below.

Grade 0:

In this case the thyroid is discernible but it is not larger than normal.

Grade 1 a:

Here the thyroid is larger than normal and distinctly noticeable but usually not visible with the head in a raised position.

Grade 1 b:

The thyroid is easily visible with the head in a raised position. This grade also includes patients with a palpable nodule.

Grade 2:

The enlarged thyroid is easily visible even with the head in a normal position.

Grade 3:

The goitre visible from a distance.

Grade 4:

A very large goitre:

When the entire thyroid gland swells up, the condition is called diffuse goitre. In other cases, solid or fluid-filled lumps called nodules develop within the gland. There can be single or multiple nodules and this is termed as nodular goitre.

Diagnosis of goitre

In most cases, the doctor may detect a goitre through a visual inspection or manually during a clinical examination. In addition, the following steps can be taken for a more accurate diagnosis.

Blood tests:

An interrelationship between the TSH, T3, and T4 hormones and their levels help in the determination of overall thyroid health. In case the thyroid is underactive, the level of thyroid hormone will be low, but the TSH level will be elevated. The levels of Thyroglobulin (Tg), which is a protein generated by the thyroid are also measured. For checking autoimmune thyroid disease, the level of three major antibodies is tested.

Imaging tests:

Computed tomography (CT) scans, magnetic resonance imaging (MRIs), and ultrasounds are used to check detailed images of the gland. This also helps the doctors to determine whether there are any nodules in the gland.

A thyroid scan:

During this scan, a radioactive isotope is injected into the vein in the arm and the patient is asked to lie down on the back. Then a special camera is used to generate detailed images of the thyroid on a computer screen. While this process delivers a more detailed image, these scans are time-consuming and more expensive.

A biopsy:

In case thyroid cancer is suspected a biopsy of the gland can be required. A needle is directed into the thyroid gland by taking the help of ultrasound guidance and a tissue or fluid sample is collected for investigation in the laboratory.

Goitre treatment

In case the goitre is small in size and is not causing any problems, the doctors do not prescribe any treatment and adopt a wait-and-watch policy. These conditions are monitored as they can result in hypothyroid or hyperthyroid in the future. In more severe cases the following modes of treatment are followed.

Medications:

In the case of hypothyroidism, thyroid hormone replacement drugs are used that can slow the secretions of the pituitary gland as well. It can also slow down the overall growth of the thyroid. Drugs are also used in case of hyperthyroidism that reduces the production of the T3 and T4 hormones and stops the growth of the gland. When it comes to inflammations, medicines like aspirin or a corticosteroid can be used to treat the symptoms.

Radioactive iodine:

In some cases, radioactive iodine is used to treat the condition and reduce the size of the gland. These drugs are consumed orally and once they reach the thyroid they destroy the cells of the gland. The treatment often results in an underactive thyroid gland.

Surgery:

Removing all or a part of the thyroid gland is an option if you have a large goitre that is extremely uncomfortable, or in some cases when there is a nodular goiter causing hyperthyroidism. Removing the thyroid gland or some parts of it through surgery is called thyroidectomy. This is done when the gland continues to grow in spite of medication and results in difficulty breathing or swallowing. In many cases, surgery is also done because of cosmetic reasons. Surgery is also the primary treatment for thyroid cancer. But most goitres are non-cancerous and only around one in twenty can have cancerous cells.

Prevention of goitre

In some patients, the base cause of goitre is unknown and hence there is not a specific way to prevent the disease. For others, the simple practice of consuming the daily recommended quantity of iodine is sufficient reason to prevent the occurrence of the disease. There are medications that can also help in maintaining the level of iodine in the blood that is necessary for the production of thyroid hormones. The use of iodized table salt has been beneficial in supplying the necessary amount of iodine to a large segment of the population. In some areas where such salt is not available, the injection of iodinated oil has produced good results. Some other foods that contain iodine are strawberries and cranberries, raw organic cheese, organic yogurt, seafood, and organic potatoes. For those who do not have such foods readily available, supplementation of iodine through commercially available forms is a solution.

A few dos and don’ts for goitre

When a patient is suffering from the disease of goitre, the negative effects fall on the entire body. The patient can suffer from various side effects like depression, weight gain, fatigue, low body temperature, hair fall, and lack of stamina. There are a few important dos and don’ts that can be kept in mind to make the treatment more effective.

Conclusion

Goitre is a disease that can be cured completely with the right treatment. While proper and timely treatment can help control the thyroid hormone levels it is best to be aware of what can cause goitre and how to take the necessary precautions. No matter what kind of treatment a person undergoes, the daily lifestyle choices are the key that decides the overall health. So to maintain the thyroid gland in the best condition, make sure that you keep your lifestyle choices healthy. The factors like a healthy diet, sufficient rest, proper exercise, and stress-free life can go a long way in keeping one free from any thyroid-related problems.

References