Goitre

Overview

A goitre is an abnormal enlargement of the thyroid gland, a butterfly-shaped organ located at the base of the neck, just below the Adam’s apple. This condition can manifest as a uniform swelling of the entire gland or the growth of one or more nodules (lumps) within the thyroid.

Depending on the underlying cause, a goitre may occur without affecting thyroid function or may be associated with either an overproduction (hyperthyroidism) or underproduction (hypothyroidism) of thyroid hormones.

What is Goitre?

Goitre refers to the abnormal enlargement of the thyroid gland, a small butterfly-shaped endocrine gland in your neck, just below the Adam’s apple. This enlargement may affect the entire gland or develop one or more small lumps, known as thyroid nodules.

The thyroid gland is crucial in regulating key bodily functions by producing two essential hormones: thyroxine (T4) and triiodothyronine (T3). These hormones influence one’s digestion, body temperature, metabolism, mood and emotional stability, pulse and heart rate.

Goitre may occur alongside irregular thyroid hormone levels, leading to either hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid). However, it can also develop with normal hormone levels, a condition known as euthyroid.

There are several potential causes of goitre, ranging from iodine deficiency to autoimmune conditions and thyroid disorders. Depending on the underlying cause and severity, treatment may or may not be necessary.

Types of Goitre

Goitres can be classified depending on the process of their development and their association with thyroid hormone level changes. Such are all types:

Classifications according to patterns of growth include:

Nodular Goitre: Nodular goitre occurs when one nodule forms within the thyroid gland resulting in a rough surface of the gland.

Simple Goitre Or Non-Toxic/Diffuse Goitre: This type refers to a condition in which the thyroid gland as a whole becomes enlarged and smooth.

Multinodular Goitre: Multinodular is a big name that refers to multiple nodules within the same thyroid. These nodules can be seen with the naked eye, through physical examination, or imaging.

Classifications based on the thyroid hormone levels:

Nontoxic Goitre: An enlargement of the thyroid with euthyroid level. This type is normally referred to as a euthyroid goitre which does not give rise to hyper or hypothyroid conditions.

Toxic Goitre: Enlargement type goitre where there is excessive secretion of the thyroid hormone resulting in conditions of hyperthyroidism (overactivity of the thyroid gland).

Healthcare providers often combine these classifications for diagnosis. For example: a toxic multinodular goitre refers to a thyroid with multiple nodules that overproduce thyroid hormone.
Whereas, a nontoxic diffuse goitre describes a uniformly enlarged thyroid with normal hormone levels.

Understanding these classifications helps in diagnosing the specific type of goitre and determining the most appropriate treatment.

Warning Signs and Symptoms of Goitre

In most cases, the most conspicuous feature of goitre is usually a lump located at the base of the neck. In many instances, it is small and goes unnoticed until it is found during a physical examination or an imaging modality unrelated to the neck.

The extent and severity of such symptoms depend on factors such as alteration in the thyroid hormones, the rate of increase of the goitre size, and whether it exerts pressure on surrounding anatomical parts such as the airways.

If the goitre is associated with an underactive thyroid (hypothyroidism), common symptoms may include, dry skin, sensitivity to cold, advanced sleepiness, constipation, fatigue, memory or concentration problems, weakness in muscle.

Causes of Goitre

Goitre can develop due to various factors that either impair thyroid function or stimulate the growth of the thyroid gland. One common cause is Hashimoto’s Disease, an autoimmune disorder where the immune system attacks the thyroid, leading underproduction of the hormone (hypothyroidism) followed by enlargement of the gland due to compensatory hypertrophy. The gland enlarges as a compensatory response.

Another cause is thyroid nodules, which are abnormal overgrowth of tissue in the gland. These nodules, often benign and caused by genetic or environmental factors, can lead to gland enlargement. Iodine deficiency is another contributor, as inadequate iodine levels reduce thyroid hormone production, causing the gland to expand.

Thyroid cancer can also cause goitre, though it is a rare occurrence. This malignant condition is typically treatable. Graves’ Disease, an autoimmune condition, stimulates excessive hormone production (hyperthyroidism) which can also lead to gland swelling. Lastly, pregnancy can temporarily cause thyroid growth due to the hormone HCG released during this period.

Diagnosing of Goitre

Diagnosis and tests required for goitre are done by healthcare providers, where they palpate the neck to detect an enlarged thyroid gland. Goitre assessment is only the beginning, and doctors recommend other tests to determine the cause of the condition. They may use the following diagnostic tools:

Thyroid Blood Tests: These Tests screened T3, T4 and TSH hormone levels to evaluate if the thyroid gland works appropriately.

Physical Examination: For the examination, the health professional will manually examine the neck for thyroid enlargement, nodules, or tenderness to palpation.

Biopsy: If there is the presence of large nodules, doctors then take some cells from the tissue to conduct laboratory tests for conditions like thyroid cancer and to ascertain another diagnosis.

Antibody Tests: Patients with autoimmune illnesses such as Hashimoto’s or Graves’ disease may use this blood test to screen for certain antibodies which are often associated with such disease conditions. There are substances called antibodies, which are made by your immune system to eliminate infections and foreign invaders.

Thyroid Ultrasound: Ultrasound examination sends sound waves into the body and records the return patterns to create an image of the thyroid. The examination effectively assesses the volume and the morphology of the gland, as well as the existence of nodular lesions.

CT Scan or MRI: For very large goitres or those extending into the chest, advanced imaging like CT scans or MRIs provides detailed information about the size and spread of the goitre.

Treatment of Goitre

Treatment for goitre varies based on its underlying cause. Common approaches include:

Iodine Deficiency: Increasing dietary iodine can help, often through iodine-rich foods like seafood, dairy products, or iodised salt.

Benign Thyroid Nodules: Treatment depends on the type and severity: goitre medications to shrink nodules. Radioactive iodine therapy to destroy abnormal thyroid cells. Surgery to remove large or problematic nodules.

Hypothyroidism: Treated with lifelong hormone replacement therapy to restore normal thyroid hormone levels.

Thyroid Cancer: Typically managed with surgical removal of the thyroid gland, often followed by radioactive iodine therapy to eliminate remaining cancerous cells.

Hyperthyroidism: Managed with medications that reduce thyroid hormone production. If medications are ineffective, options include surgical removal and radioactive iodine therapy.

Preventive Measures of Goitre

Simple goitre, the most common type of goitre, happens due to iodine deficiency, and it is largely preventable. To reduce the risk of developing a goitre, ensure your diet includes sufficient iodine-rich foods such as fish and dairy products. Additionally, using iodized table salt in your cooking can help maintain adequate iodine levels in your body.

While iodine supplements may seem like a quick fix, doctors generally do not recommend them, since this could potentially lead to adverse effects. Focusing on a balanced diet is the best approach to prevent goitre effectively.

Myths and Facts Related to Goitre

Here are all the most interesting myths and facts related to goitre:

Myth 1: Thyroid disease means that you need iodine supplements
Fact: A few of the facts I learned: Not every thyroid disease is due to iodine deficiency. Some conditions, like hyperthyroidism, can worsen with excess iodine, so never take iodine supplements without first checking with your doctor. It is always a good idea to ask for medical advice before taking supplements.

Myth 2: If you have a thyroid nodule, you have cancer
Fact: The majority of thyroid nodules will not turn out to be cancer. Less than 5 percent of thyroid nodules turn out to be cancerous, so having a nodule does not automatically mean there’s cancer.

Myth 3: It is possible to cure goitre by eating seafood
Fact: Seafood is a great source of iodine, but goitre is not something you can just eat away. Dietary modification often requires medical treatment for goitre due to iodine deficiency.